Association between socioeconomic status indicators and obesity in adolescent students in Botswana, an African country in rapid nutrition transition

Objective: The purpose of this study was to examine two separate socioeconomic status (SES) indicators of obesity in Botswana, an African country that has experienced rapid economic development and where the prevalence of human immunodeficiency virus/acquired immune deficiency syndrome is high. Methods: We conducted a nationally representative, cross-sectional study of 707 adolescent secondary school students in Botswana. Measured height and weight were used to compute World Health Organization age- and sex-specific body mass index z-scores. SES was described by private vs. public school attendance and a survey of assets/facilities within the home. Results: Overall, private school students and those with more assets had a higher prevalence of overweight and obesity than public school students (private: 27.1%, 95% confidence interval [CI]: 20.4-34.5; public: 13.1%, 95% CI: 9.8-16.8) and those with fewer assets (more assets: 20.0%, 95% CI: 16.0-24.4; fewer assets: 11.2%, 95% CI: 6.6-16.9). Conclusions: Public health interventions in developing countries may need to be targeted differently to low or high SES individuals in order to treat already high obesity rates in higher SES groups and to prevent the development of obesity in lower SES communities undergoing economic transition.