A cross-sectional research design using quantitative method was conducted to determine the knowledge and factors associated with overweight and obesity prevention among women in Kibagabaga Hospital. The study targeted all women aged 20 to 45 years old attending Kibagabaga Hospital. Participants who were not consent to participate were excluded from participating in this study. The study included women that attending outpatient department within above defined age bracket.

Systematic sampling technique was used to select participants for this study. In this study, a sampling frame was defined based on the list of all women attending the Kibagabaga Hospital between 20 - 45 ages. The sample size was calculated based on the following simplified formula provided by Kish Leslie (1965) formula.

Where n= required sample size, Z is value (1.96 for 95% confidence level) and p is the estimated proportion of respondents. Then Q is (1-p), and D is the accuracy (error allowed or error in the margin). Since no large pattern has been performed in the field, P is 0.5 can be used as an approximate small sample to provide the study with excess amount.

Using the above formula a sample size of 384 women was selected to participate in this study.

A structured questionnaire with close ended questions was developed by the researcher using information from the related previous studies. The Questionnaire was translated in Kinyarwanda by the professional linguists and was backing translated to ensure that it has maintained its original meaning. To ensure the validity and reliability of research tools, a pilot study was conducted at Masaka Hospital where 25 women attending Masaka Hospital were requested to respond to our questionnaire. After analysis of results from pilot test, the Cronbach s alpha coefficient was 7.3, we therefore concluded that our tools are reliable.

Permission to carry out this study was obtained from Mount Kenya University Rwanda (MKUR) and Kibagabaga District hospital before the Data collection. Participants voluntarily signed the consent form after a brief introduction and explanation of the aims of the revision. The researcher administered the questionnaire to each participant with a cover note which explained the purpose of study, clear and concise instructions for completing the questionnaire. The participant had about 10-15minutes to read the questionnaire and asked for any clarification when responding to questions, after which they have got another 20 minutes or more to fill the questionnaire.

After completing data collection, the data was coded and entered into Microsoft Excel computer program for analysis. Data have been analyzed using different quantitative statistical procedure and methods. In return they have be processed, analyzed and tested using SPSS. In the first instance descriptive statistical measures was be used to analyze, summarized and categorized in table, means, percentage and frequencies. In second instance, bivariate analysis using Chi-square test and multivariate analysis have been performed to test the association of knowledge and practices on overweight and obesity prevention among women from Kibagabaga District hospital.

After obtaining the permission from MKU Rwanda and from the Kibagabaga hospital coordinators and approval consent from participants, data collection was done by the researcher himself and this took three weeks. The first week was about the arrangement of the instrument. The second week was to pretest and to provide the explanation to the participants who involved in responding according to the aim of study, motivation, significance, introducing my consent and data collection then, the other weeks were for data collection and entry. In addition, the following guideline was followed in order to assure the confidentiality of participants for their information.

By means of an official document, the object of the study was provided to the respondents. Respondents were sure that the data they had given was strictly confidential. Each group was given with an explicit, written permission and clarified. Participate in the research was purely voluntary and the individual was free at any time to withdrawal from the research without penalty.

The distribution of social-demographic characteristics of 384 women who participated in the study was presented in Table 1.

A total of 384 mothers aged at least 20 years old in Kibagabaga Hospital were recruited. The majority of women 136(35.4%) were aged 30-34, very few 42(10.9%) were aged 35-39 years old. Among 384 mothers (23.7%) were from rural while 76.3% were from urban setting. Most of respondents attended primary school (36.5%) and majority 234(60.1%) women were married. Majority 137(35.6%) of the participants were working in private sector.

The women knowledge about overweight and obesity prevention is presented in Table 2.

This study shows the results of knowledge different components about overweight and obesity prevention. Among 384 mothers recruited more than 62.0% knows that Eating too much fat can cause obesity while more than half knew that doing insufficient physical activity (51.8%) can also lead to overweight and obesity. The respondent knew that having stress should increase the risk of overweight/obesity (41.7%). Having hormonal disorder is known to be a risk factor of overweight and obesity (58.9%). Most of respondents knew that being in high income category (63.3%) can contribute to increase of overweight/obesity among the women. At least a half 51.8% of women knew that being overweight and obesity is a risk of other health problems. Nearly half of respondents 175 (45.6%) knew that being overweight or obese increase social problems. More than sixty percent of women (65.6%) were aware that normal weight is important for health.

The level of knowledge among women about overweight and obesity prevention were estimated using individual answers presented in Table 2. Women were considered to have high level of knowledge if they had score of ≥70%, moderate level if they had score between 50 and >70% and low level if they had score <50%. Figure 1.

The current study reveals that only 22% of women had higher level of knowledge, 62% of women demonstrated moderate knowledge while 16% had lower knowledge about overweight and obesity prevention.

The participants were each asked to answer questions about her practices towards overweight and obesity prevention. Table 3 presented the women practices towards overweight/obesity prevention.

The respondents among mothers attending Kibagabaga hospital described their lived experiences by freely giving their opinions about the overweight and obesity prevention practices. Eating moderate food 140(36.45%), eating less fatty 164(42.7%) and avoid eating between meals 221 (57.5%) were reported as measured used by women to prevent overweight and obesity. Eating more fruits and vegetables 224(58.3%), consumption of lower caloric drinks 251(65.3%) and lower consumption of energetic drinks 187(48.6%) are measures used by women towards obesity prevention. The majority of women 64.8% do physical exercises as overweight/obesity prevention measure, 58.3% avoided alcoholic beverage consumption as a measure to prevent overweight and obesity.

Individual questions presented in Table 3 were used to aggregate the total practice scores where respondents with 50% and more were considered as having adequate practices while those with less than 50% were considered as having poor/inadequate practices towards overweight/obesity prevention. Figure 2.

Present research find that 67% mothers had adequate practices compared to 33% who had inadequate practices towards overweight and obesity prevention.

The main purpose of this analysis is to know to what extent is the dependent variable (overweight and obesity prevention) is influenced by the independent variables. Variables were analyzed through multivariate logistic regression analysis to examine the independent variables associated with overweight and obesity prevention. The independent variables associated with overweight and obesity prevention are presented in Table 4 below.

From backward Wald binary logistic regression, variables that were retained in the model after considering variables associated with dependent variable and controlling potential confounders were age, occupation, total knowledge while others were found to be not independent predictors of overweight and obesity prevention. From the multivariate analysis the present study reveals that age has a strong statistical association with overweight and obesity prevention where advanced age group (35-39) were found to be 6.58 times compared to other age-group (AOR = 6.58 95% CI= 1.31-33.18, p-value<0.001). Unemployed workers were about 3.12 times more likely to prevent overweight and obesity as compared to public and private people (AOR = 3.12% CI= 1.61-6.05; p-value< 0.001).

Similarly, total score of knowledge has been also found to be a strong predictor of overweight and obesity prevention (p< 0.001). Mothers with high level of knowledge were 24.52 times more likely to prevent overweight and obesity than the ones who have low and moderate level (AOR=24.52,95% CI=8.16-73.64, p-value <0.001).

The main research objective of the study was to determine the factors that influence the overweight and obesity prevention among women attending Kibagabaga hospital. Overweight and obesity are important indicators of health status of women. The present study indicates that 22% of women possess higher of knowledge on overweight and obesity prevention. Similar results was reported in as study conducted in Kenya where less than half of study participants had an appropriate knowledge of obesity5. Another study conducted in Zimbabwe showed that only 0.8% of study participants has strong nutritional knowledge7. In contrast a study conducted in Nepal found that participants had good knowledge about obesity prevention12. The poor over all knowledge observed in this study may due to cultural aspects and preference of women appearance in Africa. In Africa being overweight specifically for women is still regarded as sign of good nutrition, happiness and improved socio-economic conditions.

The current study found that women attending Kibagabaga Hospital had adequate practices towards overweight and obesity prevention. A study conducted Brazil found that overweight is much frequent in female aged 20 to 60 years. The same study revealed that Low fitness levels and excessive proportion of high-energy foods have contributed to higher rates of obesity among females in Brazil 1. Generally, women are physical inactive than males this predispose them to the risk of overweight and obesity.

The present study findings show the association between independent and depend variables where age group with (p-value<0.001) found to have a strong statistical association. Again, factors of overweight and obesity prevention were found to be total score of knowledge (p-value<0.001) respectively. A study conducted among Spanish adults found that a lower incidence of overweight is found in those with regular exercise, with gender disparities (10.9% vs 21.6%). Obesity and overweight are correlated with male gender (OR = 3.35 2.75-4.07), heavy alcohol intake (OR = 1.38 1.03-1.86) and tv watching (OR = 1.52 1.11-2.07), and products like rice and dairy products (OR = 1.47 1.13-1.91)11. While the triggers of obesity and overweight are complicated, two potential main causes, called the "Big Two," have been found out by scientists. The "Big Two" consists of a calorie consumption that is too high, coupled with a substantial drop in regular exercise. True to the declines in regular exercise, too few carbohydrates are consumed relative to their consumption4.

As evidenced from RDHS(2014-15) The steps research study published in Rwanda in 2012/13 indicated that the frequency of major risk factors for obesity and associated health negative impacts were: unhealthy diets (only 0.3 percent of fruit intake each day, 0.9 percent of veggies consumed, and 99.1 percent of fruits and/or vegetables consumed less than 5 servings), lack of physical activity (21.4 percent of activity was low) (MoH, 2015). With family education and income, excess weight and overweight in women rises. Excess weight has risen from 12 percent to 21 percent in 2014-151 since 200510.

The prevention of overweight and obesity should involves two main objectives to adopt healthy behaviors focused on food and nutritional aspect and physical activities because has been shown the sedentary life the risk of gaining extra weight and overweight is increased.