Applying the epidemiological triad to obesity in Uganda: is it relevant?

Abstract

Uganda is grappling with a rising double burden of malnutrition, where obesity coexists with undernutrition, particularly in urban areas. This dissertation examines the relevance of the epidemiological triad model—originally for infectious diseases—to obesity, conceptualizing calorie-dense foods as the "agent," individual characteristics as the "host," and socio-economic contexts as the "environment." The purpose is to provide an evidence-based framework for multi-level interventions by identifying key factors driving obesity among Ugandan adults aged 18 and above. Using a cross-sectional mixed-methods design, the study conducted secondary analysis of data from the 2014 Uganda Demographic and Health Survey (N=1,210 adults), supplemented by qualitative review of policy documents and literature. Descriptive statistics, bivariate chi-square tests, and multivariate logistic regression were employed to analyze associations, with diagnostic tests confirming model robustness (e.g., low multicollinearity, correct specification). Findings reveal an overall overweight/obesity prevalence of 25%, with significant host factors including female gender (Adj OR=4.3), middle age (35-54 years; Adj OR=3.1-4.1), and higher socioeconomic status (Adj OR=2.5-2.7). Peri-urban residence, as an environmental proxy, doubled the risk (Adj OR=2.6), inferring agent influences like increased access to processed foods (e.g., sugar-sweetened beverages, refined oils). The triad model proves relevant, highlighting systemic interactions beyond individual behaviors. In conclusion, obesity in Uganda stems from environmental facilitation of obesogenic agents interacting with vulnerable hosts. Recommendations include regulating food marketing, integrating NCD prevention into urban planning, and targeting high-risk groups through gender-specific programs to curb the epidemic effectively