Maternal and Child Health Journal

, Volume 19, Issue 8, pp 1662–1671 | Cite as

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women’s Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys

  • Mariano J. KanamoriEmail author
  • Olivia D. Carter-Pokras
  • Sangeetha Madhavan
  • Sunmin Lee
  • Xin He
  • Robert H. Feldman


This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women’s overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006–2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women’s caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers’ overweight status in Namibia.


Caregivers Africa south of the Sahara Economic factors Overweight 



Absolute household wealth


Demographic Health Surveys


Orphan and vulnerable children



We acknowledge Dr. Michel Garenne as he has always been willing to answer questions and share his previous work related to the Absolute Wealth Index. We are grateful to Macro International Inc. for making available the DHS data for these analyses. This work was supported in part by Cooperative Agreement Number 1 U48 DP001929 from the Centers for Disease Control and Prevention, Prevention Research Centers Program and by a P20 Exploratory Center of Excellence grant (P20MD002288; Sub-Project ID: 6068), funded by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) and house within the Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA) at Florida International University and the Department of Epidemiology at the University of Maryland College Park.

Conflict of interest

The author(s) declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Mariano J. Kanamori
    • 1
    • 2
    Email author
  • Olivia D. Carter-Pokras
    • 2
  • Sangeetha Madhavan
    • 3
  • Sunmin Lee
    • 2
  • Xin He
    • 2
  • Robert H. Feldman
    • 4
  1. 1.Center for Research on U.S. Latinos HIV/AIDS and Drug UseFlorida International UniversityMiamiUSA
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthUniversity of Maryland College ParkCollege ParkUSA
  3. 3.Department of African-American Studies, Maryland Population Research CenterUniversity of Maryland College ParkCollege ParkUSA
  4. 4.Department of Behavioral and Community Health, School of Public HealthUniversity of Maryland College ParkCollege ParkUSA

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