The social epidemiology of maternal obesity in Egypt.

摘要

Obesity is emerging as one of the leading public health challenges in low and middle income countries. In particular, women of reproductive age are vulnerable to many compromised reproductive health outcomes associated with obesity. Egypt is an especially interesting country to study having experienced a rapid rise in obesity, with nearly half of women of reproductive age obese in 2005, exceeding levels of obesity seen in many high income countries. Despite the importance of obesity and its implications for health in developing countries, the subject has not received sufficient research interest; this dissertation contributes to addressing this deficiency. The dissertation is comprised of three empirical chapters all using Egyptian Demographic and Health Surveys from 1992 to 2005. The first uses factor and multilevel analysis to analyze the variables used to measure female empowerment. The findings highlight the difficulty in measuring female empowerment in a meaningful way, with questions around both the reliability and the validity of the data. In the second chapter, I conduct an analysis of the temporal changes in the relationship between maternal obesity and social determinants, using both recursive partitioning and logistic regression. The findings show that not only are Egyptian women becoming more obese but that the increase in obesity has disproportionately affected the most deprived: those with the least education, the poorest, the rural population, and those living in Upper Egypt. Finally, I look at the relationship between maternal obesity and maternal and child health outcomes, and at the mediating effect of socioeconomic status, using Cox proportional hazards and logistic regression models. The findings show that for some outcomes, there is a mediating effect of SES and that this relationship is also changing over time.