Prevalence and factors associated with obesity in Rwanda: Evidence from the 2022 NCD STEPS Survey

Abstract

Obesity is an emerging public health concern in Rwanda, yet nationally representative data on its associated factors remain limited. This study analyzes recent survey data to assess the prevalence of obesity and explore associated demographic, behavioral, and metabolic characteristics. The study analyzed data from the 2022 Rwanda NCD STEPS Survey, a nationally representative cross-sectional study of 5,509 adults aged 18-69 years. Data collection followed the WHO STEPwise approach and included structured questionnaires, physical measurements, and biochemical tests. Obesity was defined as a body mass index (BMI) ≥30 kg/m2. Poisson regression with robust standard errors was used to estimate crude, age- and sex-adjusted, and fully adjusted prevalence ratios (PRs) with 95% confidence intervals (CI) to describe associations between obesity and selected characteristics. The prevalence of obesity in the study population was 4.3% (95% CI: 3.7-5.1%). Obesity was significantly more common among women (APR: 4.2, 95% CI: 2.1-8.5) and adults aged 60-69 years (APR: 2.7, 95% CI: 1.03-6.9) compared to younger adults. Rural residents had a substantially lower prevalence of obesity than urban residents (APR = 0.30, 95% CI: 0.20-0.50). Individuals with primary education (APR: 1.7, 95% CI: 1.02-3.0) were more likely to be obese, while individuals earning less than USD 33/month had lower obesity prevalence (APR: 0.5, 95% CI: 0.2-0.9). Past drinkers (APR: 0.5, 95% CI: 0.3-0.9) and non-heavy drinkers (APR: 0.5, 95% CI: 0.3-0.9) had lower obesity prevalence compared to non-drinkers. Hypertension remained significantly associated with obesity (APR: 1.7, 95% CI: 1.1-2.5). Obesity in Rwanda was significantly associated with sex, age, residence, education, income, alcohol use, and hypertension. Interventions should prioritize older women in urban areas and integrate education-sensitive strategies, alcohol-related risk reduction, and hypertension management into obesity prevention programs.