Regional inequalities in concurrent anaemia and overweight/obesity among women in Ghana: a nationally representative analysis of the 2022 Ghana Demographic and Health Survey

Abstract Background Ghana is experiencing persistent anaemia alongside a high and rising burden of excess adiposity among women. These conditions may coexist within the same woman, yet contemporary evidence on how this intraindividual double burden is distributed across Ghana’s current 16 administrative regions is limited. We estimated the prevalence and regional distribution of concurrent anaemia and overweight/obesity and examined its socioeconomic and dietary patterning. Methods We analysed the 2022 Ghana Demographic and Health Survey. The analytical sample comprised 5,611 non-pregnant women aged 20–49 years with valid haemoglobin and body mass index measurements. Anaemia was defined using the DHS classification for non-pregnant women and overweight/obesity as BMI ≥ 25.0 kg/m². Survey-weighted national and regional prevalence estimates were calculated. Regional correspondence among anaemia, overweight/obesity and concurrent burden was assessed using Spearman rank correlations across 16 regions. Design-based modified Poisson regression estimated adjusted prevalence ratios (aPRs), and marginal standardisation estimated composition-adjusted regional prevalence. Results Anaemia affected 39.77% (95% CI 38.00–41.53) of women, overweight/obesity 50.22% (48.25–52.18), and concurrent anaemia and overweight/obesity 17.71% (16.24–19.19). Concurrent prevalence ranged from 6.10% (3.24–8.96) in North East to 26.88% (20.99–32.78) in Western Region. Regional concurrent burden correlated strongly with overweight/obesity prevalence (ρ = 0.921) but weakly with anaemia prevalence (ρ=−0.159). Compared with women aged 20–29 years, aPRs were 1.58 (1.29–1.93) at ages 30–39 and 2.08 (1.69–2.55) at ages 40–49. Compared with the poorest quintile, the richest quintile had an aPR of 2.84 (1.95–4.15). MDD-W, sweet beverages and sentinel unhealthy foods showed no clear independent associations. Regional heterogeneity persisted after standardisation. Conclusions Concurrent anaemia and overweight/obesity affects approximately one in six non-pregnant Ghanaian women aged 20–49 years and is geographically unequal. Its regional distribution follows the geography of excess adiposity more closely than that of anaemia. Integrated, geographically responsive double-duty nutrition strategies may be appropriate.