Correlates of objectively measured overweight/obesity and physical activity in Kenyan school children: results from ISCOLE-Kenya

Associations of family socioeconomic indicators and physical activity of primary school-aged children: a systematic review

BACKGROUND

Family socioeconomic indicators (education, occupation, and household income) are key determinants influencing children's physical activity (PA). This study aims to systematically review the current research about the association between family socioeconomic indicators and PA among primary school-aged children and to quantify the distribution of reported associations by childs' and parents' sex and according to analysis and assessment methods.

METHODS

A systematic literature research in multiple scientific databases (MEDLINE via PubMed, Web of Science, ScienceDirect, SPORTDiscus and ERIC) was performed for literature published between 1st January 2010 and 31st March 2022. Only studies reporting statistical associations between an SES indicator of at least one parent (education, occupation, income, or an SES index) and different types and intensities of PA in primary school-aged children (6 to 12 years) were included in the analysis. The distributions of the reported associations were evaluated across and differentiated by sub-group analysis of assessment methods (objectively measured vs. self-reported PA) and analysis methods (univariate vs. multivariate models).

RESULTS

Overall, 93 studies reported in 77 publications were included in this review. Most of the studies were conducted in Europe and used self-reports (questionnaires) to assess PA. Most studies used only a single SES indicator (commonly maternal education), and only two studies calculated an SES index. The majority of the studies focused on moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and organized physical activity (OPA). Results showed predominantly positive associations between SES indicators and OPA. In contrast, results regarding different intensities of daily PA (TPA, LPA, MPA, MVPA, VPA, LTPA) were heterogeneous, with overwhelmingly no associations.

CONCLUSION

Overall, the results expand the knowledge about the association between family socioeconomic indicators and children's PA and disprove the hypothesis of a clear positive association. However, large multicenter studies are lacking using a real SES index as a predictor and analyzing gender-specific multivariate models.

Sustainable effects of a motor skill programme on physical activity levels in 7-8 years old children, in the Eastern Cape Province of South Africa

BACKGROUND

Deteriorating global physical activity (PA) levels among children warrants new and sustainable approaches to increase PA levels. This study aimed to determine the immediate and sustainable influences of a 9-week movement program on the PA levels in 7 to 8-year-old school children in the Raymond Mhlaba Municipality in the Eastern Cape Province of South Africa.

METHODS

A randomized control trial including two groups (control group (CG) and intervention group (IG)), pre-post-retest (after six months of no intervention) design was used. Seventy school children, mean age 7.12 years (± 0.71) (n = 35 IG; n = 35 CG) participated in the study. A 9-week movement program was followed twice a week for 30 min during school hours. PA was measured for 7 consecutive days using a hip-mounted wGT3X-BT Actigraph accelerometer. The Test of Gross Motor Development-Third Edition (TGMD-3) was used to assess motor skills. Hierarchical Linear Modelling (HLM) was applied to analyze the data with time, sex, and group as predictors. Effect sizes were computed using Cohen's d-cut points to assess the practical significance of changes over time. Estimated regression coefficients were also computed to determine the strength of the relationship between moderate-to-vigorous physical activity (MVPA) and fundamental movement skills (FMS).

RESULTS

Before the intervention, 60% of the IG met the 60 min of daily MVPA guideline, while light physical activity (LPA) per day was also higher than sedentary behavior (SB) in both groups. No immediate (p < 0.01) or sustainable (p < 0.01) increases in MVPA levels were found and no positive associations emerged between FMS and MVPA levels.

CONCLUSIONS

This intervention had little to no effect on children's MVPA. More understanding of the activity behavior and interests of children is needed to improve their PA behavior through the content of movement programs. Strategies are also needed to communicate clear messages at a personalized but also parental level, focusing on enhancing health through regular PA, especially to promote PA in young children.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Knowledge of non-communicable diseases among adolescents in Uasin Gishu County, Kenya

Introduction

Exposure to risk factors of non-communicable diseases (NCDs) begins early especially during adolescence while morbidity and mortality occurs mainly in adulthood.

Objective

To assess the level of knowledge of major NCDs (cardiovascular disease, cancer, and diabetes) and risk factors among adolescents in a semi-urban setting.

Methods

A descriptive cross-sectional survey was used to collect data. The study targeted students attending mixed secondary schools in Uasin Gishu County in Kenya. An adapted knowledge assessment questionnaire relating to chronic diseases of lifestyle was used for data collection. Data was analysed using SPSS version 25.

Results

A total of 1,281 students participated in the study. The results revealed that most of the participants (62.1%) had low levels of knowledge about NCD risk factors. Very few students in the present study recognized the role of family history and genetic predisposition as potential risk factors of hypertension (18%) and diabetes (24.7%) as well as the normal blood pressure (35.9%) and blood glucose levels (20.5%). Although most of the students identified alcohol and smoking as risk factors for cancer, half (51.6%) of them did not have the knowledge that regular physical activity reduces the risk of getting cancer.

Conclusion

Many of the adolescents in Uasin Gishu County, Kenya had low level of knowledge regarding NCDs and their risk factors. The findings of this study highlight the need for a school-based intervention programme to raise awareness of non-communicable disease risk factors among adolescents.

Socio-economic determinants of healthy behaviours among primary schoolchildren and adolescents in Lokossa district of southern Benin

BACKGROUND

There is little information regarding fruit and vegetable (FV) intake and physical activity (PA) among schoolchildren in Benin. In this study we evaluated the differences in breakfast eating, FV consumption and PA according to socio-economic (SE) determinants in primary schoolchildren.

METHODS

A cross-sectional study using a probabilistic sample of 612 students (8-17 y of age) from 26 primary schools was done between December 2018 and January 2019. The association was estimated by logistic regression analyses.

RESULTS

Of all students, 53% were physically inactive, 60% took breakfast <5 d/week, 84% irregularly ate fruits and 68% irregularly ate vegetables. Younger students (8-10 y) take breakfast regularly and older ones (>15 y) were physically more active. The probability of regular breakfast and fruit consumption were significantly higher in children of educated parents (p<0.01 and p<0.001, respectively) compared with children of non-educated parents. Medium SE status was associated with regular breakfast intake, whereas high SE status was associated with higher fruit intake and lower physical activity compared with low SE status (p<0.001). There was no association between breakfast eating, FV intake, PA and the body mass index.

CONCLUSIONS

Findings emphasize the need for interventions to promote healthy eating behaviours in primary schoolchildren and their family environments.

Prevalence of non-alcoholic fatty liver disease in overweight and obese children seeking ambulatory healthcare in Nairobi, Kenya

BACKGROUND

While linked to obesity and associated with an increased cardiovascular morbidity, non-alcoholic fatty liver disease (NAFLD) is an often-asymptomatic cause of chronic liver disease in children. Early detection provides opportunity for interventions to curb progression. Childhood obesity is on the rise in low/middle-income countries, but cause-specific mortality data associated with liver disease are scanty. Establishing the prevalence of NAFLD in overweight and obese Kenyan children would guide in public health policies aimed at early screening and intervention.

OBJECTIVES

To investigate prevalence of NAFLD in overweight and obese children aged 6-18 years using liver ultrasonography.

METHODOLOGY

This was a cross-sectional survey. After obtaining informed consent, a questionnaire was administered, and blood pressure (BP) measured. Liver ultrasonography was performed to assess fatty changes. Categorical variables were analysed using frequency and percentages. χ² test and multiple logistic regression model were used to determine relationship between exposure and outcome variables.

RESULTS

Prevalence of NAFLD was 26.2% (27/103, 95% CI=18.0% to 35.8%). There was no association between sex and NAFLD (OR1.13, p=0.82; 95% CI=0.4 to 3.2). Obese children were four times more likely to have NAFLD compared with overweight children (OR=4.52, p=0.02; 95% CI=1.4 to 19.0). About 40.8% (n=41) had elevated BP, but there was no association with NAFLD (OR=2.06; p=0.27; 95% CI=0.6 to 7.6). Older children (13-18 years) were more likely to have NAFLD (OR 4.42; p=0.03; 95% CI=1.2 to 17.9).

CONCLUSION

Prevalence of NAFLD was high in overweight and obese school children in Nairobi. Further studies are needed to identify modifiable risk factors to arrest progression and prevent sequelae.

Factors associated with provision of physical activity in primary schools in Makindye Division in Kampala, Uganda: a cross-sectional study

BACKGROUND

Globally, school-going children spend most of their days at school, sitting in lessons and unable to achieve the daily WHO recommendations for Physical Activity (PA) of at least 60 minutes per day. Limited studies have assessed the opportunities schools provide for PA to help the children achieve their daily recommended PA. We determined the level of and the factors associated with PA offered in primary schools in Makindye Division in Kampala during the school term.

METHODS

This cross-sectional study was conducted in 36 selected government and private primary schools in Makindye Division, Kampala. PA was defined as the amount of time in minutes available for PA as per WHO recommendations - sufficient (60 minutes or more of PA) or insufficient (less than 60 minutes of PA) and assessed for any factors associated with provision of time for PA in schools. Data were collected by interview administered questionnaires and analysed descriptively. Factors associated with PA were assessed using a logistic regression model.

RESULTS

Of the 36 schools, 3 were government and 33 were private schools. The proportion of schools offering sufficient time for PA among Primary schools in the Makindye Division was (8/36) 22%. The average time for PA for all schools per week was 197 minutes (SD 70.7). Sufficient PA was associated with the provision of PE lessons after a break or after lunch (p-value 0.038). Sufficient PA was more likely in schools that offered volleyball (OR 8.69), had space in the school for PA (OR 13.27), provided athletics (OR 2.26) and whose fees were Ushs 700,000 (USD 187) or more (OR 1.30).

CONCLUSIONS

Only 22% of sampled schools offered sufficient time for PA among Primary schools in Kampala per WHO guidelines. Provision of sufficient time for PA was associated with PE scheduled either after break or lunch. Sufficient PA was more likely with schools that had space for PA, schools which offered volleyball and athletics, and whose fees were 700,000/= or more. Schools should consider scheduling PE lessons after break or after lunch to increase the likelihood of meeting the targeted time for PA. Primary schools need to be supported to establish facilities and to increase diversity in available activities to ensure children achieve their recommended PA.

Patterns and predictors of elevated blood pressure and hypertension among primary school children in urban Kenya

OBJECTIVE

We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status.

METHODS

Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity.

RESULTS

About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption.

CONCLUSION

These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early‐life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early‐life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross‐sectional sample of 6‐year‐olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early‐life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural‐urban differences in demographic, socioeconomic, early‐life, and anthropometric variables, then created linear mixed models to evaluate associations between early‐life variables and child anthropometric outcomes. Two‐way interactions were tested between early‐life variables and child sex, and between early‐life variables and rural‐urban residence. Results showed that rural children were shorter‐statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6‐year‐old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early‐life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.

Low leptin levels are associated with elevated physical activity among lean school children in rural Tanzania

BACKGROUND

In Sub-Saharan African countries, rapid urbanization and increasing socio-economic status are associated with a transition to decreased physical activity (PA). A more sedentary lifestyle is linked to increased body fat leading to increments in leptin levels. Since rodent and human studies in high-income countries have shown that starvation-induced hypoleptinemia triggers high PA, efforts are warranted to pursue the hypothesis that low leptin levels in lean children of low- and middle-income countries (LMIC) are also associated with high PA.

METHODS

In this cross-sectional study, we assessed seven-day PA with triaxial accelerometry (ActiGraph GT3X) among 223 primary school children (9 to 12 years of age) in rural Tanzania. Moderate-to-vigorous PA (MVPA) and total accelerometer counts per day were outcome variables. Leptin was determined using enzyme linked immunosorbent assay tests from dried blood spots. Anthropometric assessments were conducted and food insecurity and socio-demographic data were gathered using semi-structured interviews.

RESULTS

In this sample of school children in rural Tanzania, leptin concentrations (median: 0.91 ng/mL, P25: 0.55, P75: 1.69), body mass index z-scores (median: -1.35, P25: -1.93, P75: -0.82), and height-for-age-z-scores (median: -1.16, P25: -1.96, P75: -0.61) were low. In contrast, PA levels were high with a median MVPA time of 119 min/day. Linear regression confirmed that leptin levels were negatively associated with MVPA (beta: -18.1; 95%CI: -29.7; -6.5; p = 0.002) and total accelerometer counts (beta: -90,256; 95%CI: -154,146; -26,365; p = 0.006). Children residing in areas with better infrastructure had lower MVPA levels (p < 0.001) and tended to have higher leptin levels (p = 0.062) than children residing in areas only reachable via dirt roads.

CONCLUSION

Our cross-sectional field study is the first that supports the hypothesis of low leptin levels as a potential endocrine trigger of high PA in lean children of a LMIC. We observed early signs of a PA transition towards a less active lifestyle in a subgroup residing in areas with better infrastructure that concomitantly tended to have higher leptin concentrations. Considering that area-dependent PA differences were more pronounced among girls than boys, whereas differences in leptin levels were less pronounced, not only biological, but also external factors explain PA transition.

Weekday and Weekend Physical Activity of Preschool Children in Relation to Selected Socioeconomic Indicators

Physical activity (PA) is as vital for improving the health of young children as it is positively associated with a broad range of psychological, cognitive, and cardio-metabolic outcomes. The aims of this study were to: (1) to assess the level of PA and meeting the WHO recommendations: moderate-to-vigorous physical activity (MVPA) and the number of steps in Polish preschool boys and girls on weekdays and on weekends; (2) to investigate the relationship between selected socioeconomic indicators (self-reported by parents) and PA, including meeting the WHO recommendation for daily MVPA and the number of steps on weekdays and on weekends among Polish preschoolers. Data were collected in the 2017/2018 school year. The study included a total of 522 boys and girls both aged between 5 and 6 years. The ActiGraph GT3X-BT tri-axial accelerometer was used to measure PA. Selected socioeconomic indicators as well as parental body weight and body height were self-reported by parents/caregivers using a questionnaire. In most of the PA indicators analyzed for girls (moderate, vigorous, total MVPA, and steps/day), the averages were higher during the week than during the weekend. Moreover, significantly more boys met the criteria of MVPA, both on weekdays and over the weekend (32.3% boys and 19.2% girls on weekdays and 31.1% boys and 18.1% girls on weekends). Additionally, more boys met the step recommendations, but only on weekends (15.5% boys and 6.6% girls). It was found that if there were two people in a household, there was an almost a three-fold greater chance (adj. OR = 2.94, p = 0.032) of meeting the MVPA criterion with an even stronger association (over fivefold greater chance) in meeting the step recommendation (adj. OR = 5.56, p = 0.033). The differences in the day schedule may potentially contribute with the level of PA in girls. Among the analyzed selected socioeconomic indicators, only the number of people in a household had a significant association on PA.

Has the double burden of malnutrition reached pupils in rural western Kenya?

BACKGROUND

Undernutrition and overnutrition have been considered separate challenges caused by the distinct factors in distinct settings. The double burden of malnutrition is defined as the coexistence of both undernutrition and overnutrition, which has now spread globally, especially in low- and middle-income countries. In Kenya, the double burden of malnutrition is present in the capital city but the situation in rural areas currently remains unknown. The aim of this study was therefore to analyze nutritional status in rural Kenya.

METHODS

Data from height and weight measurements conducted by teachers in the third term of school year 2013 were collected from primary schools. Teachers were trained by experts before starting the measurements. The Z-scores of height-for-age, weight-for-age, and body mass index-for-age were calculated using AnthroPlus, and nutritional status was defined according to the World Health Organization guidelines.

RESULTS

Data analyzed from 7,447 pupils (3,763 boys and 3,684 girls) showed that 12.4% were stunted and 7.8% were underweight among those ≤120 months old, and 11.7% were thin among those >120 months old. Boys were more likely to be stunted than girls. Boys were more likely to be underweight and girls were more likely to be overweight in the older age group.

CONCLUSION

The double burden of malnutrition was not found, and undernutrition was still common among schoolchildren in the study area. However, it is important to monitor nutritional status due to adverse effects of rapid urbanization. Height and weight measurements in schools may be useful for monitoring the nutritional status of schoolchildren.

Segmented physical activity and sedentary behavior patterns among children in Maasai village and Nairobi city

OBJECTIVES

Urban-rural comparisons between those who maintain traditional lifestyles such as pastoralist Maasai children, and those who live in cities such as Nairobi, provide implications on how urbanization is associated with children's physical activity (PA) and sedentary behavior (SB) patterns. This study compares PA and SB volumes and patterns across different segments of the week among children in Maasai village and Nairobi city in Kenya.

METHOD

A total of 261 children (11.4 ± 1.3 years) from Maasai (n = 118) and Nairobi (n = 143) participated in this cross-sectional study. Moderate- to vigorous-intensity PA (MVPA) and SB on weekdays (before, during, and after school) and weekends (morning, afternoon, and evening) were calculated using accelerometers (ActiGraph). Screen time and sleep duration were assessed using questionnaires.

RESULTS

Maasai children were more physically active than Nairobi children with MVPA (min/day) of 166.6 and 81.4 for Maasai and Nairobi boys and 116.4 and 77.4 for Maasai and Nairobi girls, respectively. Our week segments analyses suggested that Maasai children were more active both in and out of school than Nairobi children. Additionally, Nairobi children spent more time watching television and playing computer games than Maasai children. There was no significant difference in sleep duration between Maasai and Nairobi children.

CONCLUSION

Our findings suggest that urbanization is negatively associated with activity patterns both in and out of school in Kenyan children. This is concerning given that Kenya is currently undergoing rapid urbanization, which may lead to further reductions in PA among Kenyan children.

Association between Objectively Determined Physical Activity Levels and Body Composition in 6-8-Year-Old Children from a Black South African Population: BC-IT Study

Physical inactivity in children is a global pandemic in parallel with increasing obesity prevalence. However, studies assessing the association between physical activity (PA) and body composition (BC) report conflicting findings, possibly because of the different methodologies across studies, with objective methods promising reliable results. This study determines the association between objectively determined PA levels and BC in 6–8-year-old children from a black South African population. Ninety-three children aged 6–8 years, who formed part of a larger study on BC using the deuterium dilution method (DDM), were included. Height and weight were measured according to the standard procedures, and body mass index z-score was calculated. Fatness was determined by DDM. An accelerometer was used to measure PA levels. Regression models were performed to determine the relationship between PA and BC. Approximately 23% of the children did not meet the recommended PA guidelines and 27% were overfat. After adjustments were made, more time spent in vigorous PA was significantly associated with lower fat mass (β = −0.25, p = 0.01, 95%CI: −11.08; −1.20) and fat mass % (β = −0.20, p = 0.04, 95%CI: −12.63; −0.18). Participation in high PA, especially of high intensity, was associated with reduced adiposity in children. Behavioural changes such as increasing high intensity PA is strongly recommended for reducing adiposity.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions: This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports.

Overweight/Obesity and Associated Factors Among Second Cycle Primary School Children in Kirkos Sub-City, Addis Ababa, Ethiopia

Background

Although overweight/obesity is becoming a public health issue in low income countries, there is a paucity of evidence concerning overweight/obesity in Ethiopia. The aim of the study was to assess the magnitude of overweight/obesity and associated factors among second cycle primary school children in Kirkos Sub-City, Addis Ababa, Ethiopia.

Methods

A school based cross-sectional study was conducted among 482 children from May to June, 2019. Data were collected using a questionnaire and checklist. Data were entered using EpiData version 3.1 and exported into SPSS version 22.0. Bivariable and multivariable logistic regression analyses were done to identify factors associated with overweight/obesity. Level of statistical significance was declared at p ≤ 0.05.

Results

The overall magnitude of overweight/obesity was 21.2%. The magnitude of overweight was 13.7% while obesity was 7.5%. Vehicle availability, being from private school, not having friend(s), preferring sweet foods, eating breakfast irregularly, watching movies/Television while eating and physical inactivity were the factors significantly associated with overweight/obesity among second cycle primary school children.

Conclusions

The magnitude of overweight/obesity was high in the study area. Therefore, health and education sectors should promote healthy lifestyle to curb child overweight/obesity.

Food Environment in and around Primary School Children's Schools and Neighborhoods in Two Urban Settings in Kenya

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children's neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions: This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for use among primary school children in, Tanzania. In order to understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community based cross-sectional study was conducted from May to July, 2018. Four primary schools were conveniently selected in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania and from these 51 children aged 9 - 11 years were randomly selected. Self-reported questionnaire was used to collect physical activity related variables. In addition, children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The mean age of the study participants was 10 (SD=0.8) years and 32 (63%) were girls. A positive significant correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). Accelerometer had higher mean MVPA 408 (SD = 66) compared to self-reports 261 (SD = 179). Children who reported walking to school had higher MVPA for both accelerometer and self- reports compared to children who use other means of transport to school, e.g. school buses (p < 0.001). Conclusions: This study found a positive significant correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, and this interferes their validity. More research is needed to develop better self-reported measures with specific activities which can easily be recalled by children. Also, researchers have to be aware of self-reports validity limitation.

Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment

This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from <5% to >40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.

Risk factors and morbidities associated with childhood obesity in sub-Saharan Africa: a systematic scoping review

BACKGROUND

The rising burden of childhood obesity is a major public health concern, particularly in sub-Saharan Africa (SSA), where most health systems are weak and least prepared for complications that may arise. While the need for preventive action is increasingly recognized, policy implementation within the sub-region has often been inadequate, non-systematic, and ad hoc. This study described evidence on the risk factors and morbidities associated with childhood obesity in SSA.

METHODS

Guided by the Arksey and O'Malley framework incorporating the Levac et al. recommendations, and the Joanna Briggs Institute guidelines, we conducted a scoping study to address the research question. Thorough keywords systematic search was conducted for potentially eligible articles in PubMed, Google Scholar, Web of Science, and CINAHL published between 2009 and June 2019. Articles obtained were screened independently by two investigators at the abstract and full text phases using the eligibility criteria. All relevant data were extracted by two investigators in parallel and thematic analysis conducted.

RESULTS

A total of 337,229 articles were obtained from the database search of which 68 satisfied the inclusion criteria and were included for data extraction. These 68 included studies were conducted in 19 countries with the majority, 27.9% (19/68) from South Africa followed by Nigeria with 20.6% (14/68). Six of the included studies were conducted in Ethiopia, 5 studies in Kenya, 4 studies each in Tanzania and Cameroon, and 2 studies each in Ghana, Uganda, and Sudan. Of the 68 included studies, one each was conducted in Botswana, Gambia, Lesotho, Mauritius, Mozambique, Seychelles, Togo, and Zimbabwe. Most (80.9%) of the included studies were cross-sectional, and only one was an intervention trial. Of the 68 included studies, 53 reported on risk factors, 12 reported on morbidities, and 3 reported both risk factors and morbidities. We found no evidence in almost 60% (28/47) of countries included in the World Health Organisation Africa region.

CONCLUSION

This review findings suggest a paucity of literature on the risk factors of childhood obesity and morbidities in most SSA countries. Hence, there is the need to intensify research efforts, especially experimental study designs using innovative strategies to promote healthy lifestyle choices that will prevent or minimize the risks and health consequences of childhood obesity in SSA.

Validation of self-reported physical activity by accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children.  Existing self-reports for physical activity have not been validated for use among primary school children in Kilimanjaro, Tanzania. In order to understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community based cross-sectional study was conducted from May to July, 2018 among four primary schools in Moshi municipal and Moshi rural districts, Kilimanjaro, Tanzania.  A total of 51 primary school children aged 9-11 years were enrolled using a simple random sampling technique. A self-reported questionnaire was used to collect physical activity related variables. In addition, children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The mean age of the study participants was 10 (SD=0.8) years. Majority of the study participants were female 32 (63%). A moderate, positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). Accelerometer had higher MVPA compared to self-reports. Children who reported walking to school had higher MVPA for both accelerometer and self- reports compared to children who use other means of transport to school, e.g. school buses (p < 0.001). Conclusions: This study found the moderate positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, and this interferes their validity.  More research is needed to develop better self-reported measures with specific activities which can easily be recalled by children. Also, researchers have to be aware of self-reports validity limitation.

Are neighborhood characteristics associated with sedentary behavior in adolescents? A systematic review

Sedentary behavior (SB) has emerged as a potential risk factor for chronic diseases. SB includes activities requiring low energy expenditure (≤1.5 metabolic equivalents) performed in a sitting or reclining posture. Our study aimed to gather evidence on the association between SB outcomes in adolescents (10-19 years) and neighborhood characteristics. This systematic review (PROSPERO registration number: CRD42018076877) examined studies indexed in PubMed Central®, LILACS, ScienceDirect, and SPORTDiscus databases. Sixteen articles were included. Insecurity during daytime hours, crime incidence, physical and social disorders, a higher neighborhood socioeconomic level, and time spent with peers were associated with higher levels of SB. Traffic, availability of a favorable environment for physical activity, and higher residential density were associated with lower levels of SB. Despite great variability in the SB cutoff points and methodology used for evaluating SB and neighborhood characteristics among studies, the evidence suggests that adolescent SB might be influenced by neighborhood characteristics.

Prevalence and socio-demographic correlates of accelerometer measured physical activity levels of school-going children in Kampala city, Uganda

Background

The current international physical activity guidelines for health recommend children to engage in at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. Yet, accurate prevalence estimates of physical activity levels of children are unavailable in many African countries due to the dearth of accelerometer-measured physical activity data. The aim of this study was to describe the prevalence and examine the socio-demographic correlates of accelerometer-measured physical activity among school-going children in Kampala city, Uganda.

Methods

A cross-sectional study design was used to recruit a sample of 10–12 years old school-going children (n = 256) from 7 primary schools (3 public schools and 4 private schools) in Kampala city, Uganda. Sedentary time, light-intensity physical activity (LPA), moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA) were measured by accelerometers (ActiGraph GT3X+ [Pensacola, Florida, USA]) over a seven-day period. Socio-demographic factors were assessed by a parent/guardian questionnaire. Weight status was generated from objectively measured height and weight and computed as body mass index (BMI). Multi-level logistic regressions identified socio-demographic factors that were associated with meeting physical activity guidelines.

Results

Children’s sedentary time was 9.8±2.1 hours/day and MVPA was 56±25.7 minutes/day. Only 36.3% of the children (38.9% boys, 34.3% girls) met the physical activity guidelines. Boys, thin/normal weight and public school children had significantly higher mean daily MVPA levels. Socio-demographic factors associated with odds of meeting physical activity guidelines were younger age (OR = 0.68; 95% CI = 0.55–0.84), thin/normal weight status (OR = 4.08; 95% CI = 1.42–11.76), and socioeconomic status (SES) indicators such as lower maternal level of education (OR = 2.43; 95% CI = 1.84–3.21) and no family car (OR = 0.31; 95% CI = 0.17–0.55).

Conclusion

Children spent a substantial amount of time sedentary and in LPA and less time in MVPA. Few children met the physical activity guidelines. Lower weight status, lower maternal education level and no family car were associated with meeting physical activity guidelines. Effective interventions and policies to increase physical activity among school-going children in Kampala, are urgently needed.

Physical Activity and Sedentary Behaviour Patterns among Kenyan and Japanese Children: A Comprehensive Cross-Country Comparison

Health benefits of physical activity are well known, yet available physical activity data is limited from children living in African and Asian countries. The purpose of the cross-sectional study was to evaluate and compare physical activity and sedentary behavior patterns, particularly hourly variations, among children in Kenya and Japan. Participants included 298 primary school students (122 Kenyan, 176 Japanese) aged 9-12 years. Physical activity and sedentary behavior were measured with accelerometers. Domain-specific physical activity, screen time, and proportion of children using active transport to school were measured by questionnaire. A two-way ANOVA (countries × time) was used to examine the differences in the activity patterns between Kenyan and Japanese children. The results from the present study demonstrated that Kenyan children spent more time in moderate-to-vigorous physical activity compared to Japanese children (p < 0.05) with the greatest differences found for weekday evenings (for boys and girls) and weekend afternoons (for girls). This suggests that these were 'critical periods' to differentiate the physical activity levels between Kenyan and Japanese children. However, a higher proportion of the children from Japan used active transport to school and spent less time in television viewing and computer gaming. The results suggest that both countries have successes and challenges that can aid in developing effective and country-specific intervention strategies for promoting physical activity.

Alcohol consumption, hypertension and obesity: Relationship patterns along different age groups in Uganda

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Hypertension prevalence ratios don’t rise with age groups among frequent drinkers.

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Alcohol consumption pattern partly modifies the age-hypertension relationship.

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Alcohol consumption pattern does not modify obesity-age relationship.

The prevalence of non-communicable diseases including hypertension and obesity is rising and alcohol consumption is a predisposing factor. This study explored the effect of alcohol consumption patterns on the hypertension-age group and obesity-age group relationships.

The data were extracted from the 2014 National NCD Survey of adults aged 18–69 years. Hypertension was defined as a condition of having systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg while obesity was defined as having a body mass index ≥30 kg/m². Frequent alcohol consumption was measured as alcohol use ≥3 times a week. Multivariable log binomial regression analysis was used to assess independent relationship between the outcomes and alcohol consumption.

The prevalences of hypertension, frequent alcohol consumption and obesity increased across age groups but were divergent towards last age group. Hypertension prevalence ratios were higher with higher age groups among moderate and nondrinkers but not among frequent drinkers. Alcohol drinking pattern modified the age hypertension relationship in a model with ungrouped age. The drinking pattern did not modify obesity-age relationship.

Alcohol consumption pattern appeared to modify the hypertension-age group relationship. However, more research is needed to explain why prevalence ratios are higher with higher age groups among moderate drinkers and abstainers while they stagnate among the frequent drinkers. There was no evidence to show the effect of alcohol consumption on obesity-age group relationship.

Nutritional status, physical activity and associated nutrition knowledge of primary school learners

BACKGROUND

Nutrition education has the potential to improve eating habits, physical activity and nutritional status of schoolchildren.

AIM

This study aimed to determine the nutritional status, physical activity levels and the associated nutrition knowledge of primary school learners aged 9-14 years in Harare, Zimbabwe.

METHODS

A cross-sectional survey was conducted among learners (n = 368) from eight primary schools. A self-administered questionnaire was used to collect sociodemographic, nutrition knowledge and physical activity data. The weights and heights were measured using World Health Organization (WHO) standards. Pearson chi-square and Fisher's exact tests were used to assess association between categorical variables. Binary logistic regression was used to explore the determinants of wasting and overweight. The level of significance was set at p < 0.05.

RESULTS

Overweight, wasting and stunting affected 25.8%, 6.3% and 3% of the learners, respectively. Only 52.7% of the learners achieved the WHO recommended 60 minutes of physical activity. The mean±standard deviation nutrition knowledge score of the learners was 70.3±10.9%. Stunted children were more likely to be wasted (odds ratio (OR) = 4.38; 95% confidence interval (CI) 1.07-17.8; p = 0.039). Inadequate dietary diversity score (OR = 0.44; 95% CI 0.22-0.87; p = 0.018) and using non-active forms of transportation (OR = 2.69; 95% CI 1.52-4.76; p = 0.001) were a significant predictor of overweight among the learners.

CONCLUSIONS

Overweight was the leading form of malnutrition, coexisting with undernutrition, reflecting the presence of a 'double burden of malnutrition'. Therefore, comprehensive and multi-sectoral interventions to improve healthy eating and physical activity are warranted.

Prevalence and correlates of objectively measured weight status among urban and rural Mozambican primary schoolchildren: A cross-sectional study

BACKGROUND

The coexistence of undernutrition (thinness) and overnutrition (overweight/obesity) among children and adolescents is a public health concern in low-middle-income countries. Accurate prevalence estimates of thinness and overweight/obesity among children and adolescents are unavailable in many low-middle-income countries due to lack of data. Here we describe the prevalences and examine correlates of objectively measured weight status among urban and rural schoolchildren in Mozambique.

METHODS

A cross-sectional study design was applied to recruit 9-11-year-old schoolchildren (n = 683) from 17 urban and rural primary schools in Mozambique. Body mass index (BMI) was computed from objectively measured height and weight and participants' weight categories were determined using the World Health Organization cut-points. Actigraph GT3X + accelerometers were worn 24 hours per day for 7 days to assess movement behaviours. Multilevel multivariable modelling was conducted to estimate odds ratios and confidence intervals.

RESULTS

Combined prevalence of overweight/obesity (11.4%) was significantly higher among urban participants compared to rural participants (5.7%; χ2 = 7.1; p = 0.008). Conversely, thinness was more prevalent among rural (6.3%) compared to urban (4.2%) participants. Passive school commute, not meeting daily moderate- to vigorous-intensity physical activity (MVPA) guidelines, and maternal BMI >25 kg/m2 were associated with overweight/obesity while possessing one or more functional cars at home, maternal BMI >25 kg/m2 and being an older participant were associated with thinness in the present sample. The proportion of total variance in the prevalences of obesity and/or thinness occurring at the school level was 8.7% and 8.3%, respectively.

CONCLUSION

Prevalences of thinness, overweight/obesity and other key variables differ between urban and rural schoolchildren in Mozambique. MVPA, active transport and mother's BMI are important modifiable correlates of weight status among Mozambican schoolchildren. Results from this study demonstrate important differences between urban and rural schoolchildren that should not be ignored when designing interventions to manage malnutrition, formulating public health strategies, and interpreting findings.

How healthy are children at the beginning of primary school in Iran?

Background:

Childhood is the most important life stages where personality is built and formed. Since children are as a treasured capital for each society, assessment of their health status is so vital. This study assessed the health indices of children starting the primary school and considered parental factors influencing kid's health.

Methods:

An analytical descriptive cross-sectional study applied to measure the health status of children at the beginning primary school. The data extracted from 7768 primary school children with an average value of age 7 years and their parents, who were referred to Children Health Testing centers in the school year of 2016, in all provinces of Iran.

Results:

From 7768 kids, 52.3% were boys and 47.7% were girls. The mean of weight and height of children was 20.65 kg, and 115.84 cm, respectively. The mean body mass index (BMI, kg/m2) for age ratio of children in the country was 16.26. In addition, 4.9% of boys and 3.7% of girls were short stature, 0.5% of boys and 1.8% of girls were tall and 94.5% of kids had normal growth. About 5.3% of boys and 6.8% of girls were underweight, 9.2% of boys and 7.7% of girls were overweight, and 4.7% of boys and 3.4% of girls were obese.

Conclusions:

The overweight and severe short stature problems in children were more dominant than underweight and severe tall. Although underweight is more common in girls than boys, it is reversed in the case of overweight and obesity. In addition, the ratio of health problems among children in different provinces was dissimilar, thus considering the health status of children in each province to find a solution was crucial.

Prevalence of overweight and obesity among African primary school learners: a systematic review and meta-analysis

INTRODUCTION

The increasing trend in the global prevalence of childhood overweight and obesity presents a major public health challenge. This study reports the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to the different body mass index criteria and population level characteristics.

METHODS

A search of multiple databases was conducted to identify relevant research articles published between January 1980 and February 2017. Random effects models were used to pool prevalence data within and across population level characteristics after variance stabilization through arcsine transformation (PROSPERO registration number CRD42016035248).

RESULTS

Data from 45 studies across 15 African countries, and comprising 92,379 and 89,468 participants for overweight and obesity estimates were included. Estimated overweight and obesity prevalence differed significantly across criteria: 10.5% [95% confidence interval, CI: 7.1-14.3] and 6.1% [3.4-9.7] by World Health Organization; 9.5% [6.5-13.0] and 4.0% [2.5-5.9] by International Obesity Task Force; and 11.5% [9.6-13.4] and 6.9% [5.0-9.0] by Centre for Diseases Control, respectively (p = 0.0027 for overweight; p < 0.0001 for obesity). Estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year and sample size. Substantial heterogeneity in the estimates across and within criteria were not always explained by major study characteristics.

CONCLUSION

Overweight and obesity are prevalent among African primary school learners, particularly those attending urban, and private schools. The results from this meta-analysis could be helpful in making informed decisions on childhood obesity prevention efforts in African countries.

Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana

Background

There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.

Methods

Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.

Results

The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese.

Conclusions

A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

A Median Analysis of Factors Influencing Body Fatness in Urban School-Age Children in Cameroon

Background

Childhood overweight/obesity is a fast growing public health problem in developing countries. The adverse health consequences of obesity have been attributed to higher body fat levels and this has drawn overwhelming attention towards more accurate assessment of body fat. The goal of this study is to evaluate the relationships between selected behavioral factors and percentage body fat (%BF) estimated using bioelectrical impedance analysis in school-age children.

Methods

A cross-sectional analysis was carried out in randomly selected 6- to 11-year-old children (507 boys and 501 girls). Percentage body fat was assessed using bioelectrical impedance analysis. The behavioral factors were reported by parents using a structured questionnaire. Multiple quantile regression analysis was used to evaluate the relationship between the selected behavioral factors and %BF.

Results

With quantile regression, the daily consumption of fruits and vegetables, daily breakfast consumption, and high physical activity (>4–7 times/week) were significantly (p < 0.001) associated with a 4.95, 3.29, and 3.66 decrease in median %BF, respectively. Also, consumption of snacks (>3 times a day) (p < 0.001), high sedentary lifestyle (>3–6 hours/day) (p < 0.001), and motorization to school (p < 0.005) significantly increased the median %BF by 3.69, 3.01, and 1.39, respectively. The largest changes in median %BF were observed in girls.

Conclusions

Efforts are needed using longitudinal studies to clarify the effects of these behavioral factors on %BF in different regions and ethnic groups of Cameroon and also to assess whether any observed differences are of clinical relevance.

Prevalence and predictors of physical inactivity levels among Kenyan adults (18-69 years): an analysis of STEPS survey 2015

BACKGROUND

Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey.

METHODS

This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity.

RESULTS

A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9-41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30-49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL).

CONCLUSION

A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya.

Screen-based sedentary behaviour and adiposity among school children: Results from International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) - Kenya

BACKGROUND

High levels of sedentary behaviours have been independently associated with several negative health indicators, including obesity. Screen time (ST) is often used as a contributing measure of sedentary time. It is recommended that children spend no more than 2 hours on recreational sedentary screen-based activities daily. We describe screen-based sedentary time of urban school children and examine the associations between body mass index (BMI) and percent Body Fat (%BF) with ST levels.

METHODS

Data were collected from 563 children aged 9 to 11 years attending 29 non-boarding primary schools in Nairobi, Kenya, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Data were analysed to test for associations between ST and sex, type of school attended (public verses private), Socioeconomic status, adiposity, and access to electronic devices. We also assessed participants' ST on school and weekend days.

RESULTS

Of the participants recruited, 15.5% had high ST levels, 67.9% spent no more than 2 hours in recreational screen activities on school days while 74.2% did not meet the guidelines on weekend days. Participants sex was associated with daily ST (t = 3.5, p<0.001), ST on the weekend (t = 3.9, p <0.001) and total ST per week (t = 3.5, p<0.001) with males having higher ST than females. ST was associated with type of school for daily ST (t = 3.6, p <0.001), ST on the weekend (t = 4.5, p<0.001) and total ST per week (t = 3.6, p<0.001) where private schools pupils had higher ST. ST was not associated with BMI. ST was not associated with %BF except on weekend days (p = 0.038) where those classified as overfat/obese (fat) had higher ST.

CONCLUSIONS

A large proportion of children spend more time than recommended on screen activities particularly on weekend days. Strategies to improve healthy living should focus on the reduction of sedentary ST for school-aged children.

Perspectives on Underlying Factors for Unhealthy Diet and Sedentary Lifestyle of Adolescents at a Kenyan Coastal Setting

Unhealthy diet and physical inactivity are among the key modifiable risk factors for non-communicable diseases, such as diabetes and cardiovascular disease. Although such diseases often only appear in adulthood, these behaviors are typically initiated or reinforced already during adolescence. However, knowledge on underlying factors for adolescents' unhealthy dieting and physical inactivity in sub-Saharan Africa (SSA) is poor. We conducted in-depth interviews and focus group discussions to explore the perceptions of a diverse group of 78 young people of 10-19 years of age, which also included some adolescents living with HIV, as this is an emerging group in the HIV/AIDS epidemic in many parts of SSA. In addition, 10 stakeholders, such as teachers, clinicians, and staff from organizations at the Kenyan coast and seven young adult community representatives informed us on: (a) adolescents' unhealthy food choices and their forms of sedentary behavior; (b) predisposing factors; and (c) protective factors against unhealthy food choices and sedentary behavior of adolescents living in Kilifi County. The findings reveal that adolescents occasionally access nutritious foods, such as fruits, vegetables, and animal protein. However, there is a growing tendency to consume unbalanced diets with high intake of carbohydrates, oily foods, and consumption of sugar dense processed foods and drinks. Sports and domestic chores were found to be major sources of physical activity. Sedentary lifestyles characterized by a long-time sitting and chatting, watching sports games and movies were described. Adolescents living with HIV did not indicate any divergent perceptions from those of other adolescents relating to diet and physical activity, but mentioned health-related conditions, such as medication, asthma, and low body weight, as a risk factors for sedentary lifestyle. Using a Socio-Ecological model, our findings suggest that risk factors are numerous and interrelated, especially at intrapersonal, interpersonal, and community level. The negative influences at an intrapersonal level were as follows: body image concerns, attitudes and misconceptions, substance use behavior, and taste for unhealthy foods. In the interpersonal domain, household poverty and parenting practices that condone unhealthy habits were identified risk factors. Availability of affordable unhealthy foods, high prices for nutritious food, farming practices, gambling, and influx of transportation alternatives in the community were interrelated but also had relationships with intrapersonal and interpersonal risk factors. Modernization and poor implementation of policies were discussed as enabling factors especially by stakeholders from a societal perspective. Seasonality and farming practices, school attendance, community-based services, and regulations mitigating adolescents' engagement in gambling were identified as potential protective factors. Our findings provide a unique qualitative insight of the factors underlying adolescents' dietary and sedentary lifestyle and highlight the need for ecological intervention approaches to address these forms of health risk behavior in a rural African setting.

Overweight/obesity among school aged children in Bahir Dar City: cross sectional study

BACKGROUND

Developing countries, including Ethiopia are experiencing a double burden of malnutrition. There is limited information about prevalence of overweight/obesity among school aged children in Ethiopia particularly in Bahir Dar city. Hence this study aimed to assess the prevalence of overweight/obesity and associated factors among school children aged 6-12 years at Bahir Dar City, Northwest Ethiopia.

METHODS

A school based cross-sectional study was carried out. A total of 634 children were included in the study. Multi stage systematic random sampling technique was used. A multivariable logistic regression analysis was used to identify factors associated with overweight/obesity. The association between dependent and independent variables were assessed using odds ratio with 95% confidence interval and p-value ≤0.05 was considered statistically significant.

RESULTS

The overall prevalence of overweight and/or obesity was 11.9% (95% CI, 9.3, 14.4) (out of which 8.8% were overweight and 3.1% were obese). Higher wealth status[adjusted OR = 3.14, 95% CI:1.17, 8.46], being a private school student [AOR = 2.21, 95% CI:1.09, 4.49], use of transportation to and from school [AOR = 2.53, 95% CI: 1.26,5.06], fast food intake [AOR = 3.88, 95% CI: 1.42,10.55], lack of moderate physical activity [AOR = 2.87, 95% CI: 1.21,6.82], low intake of fruit and vegetable [AOR = 6.45, 95% CI:3.19,13.06] were significant factors associated with overweight and obesity.

CONCLUSION

This study revealed that prevalence of overweight/obesity among school aged children in Bahir Dar city is high. Thus, promoting healthy dietary habit, particularly improving fruit and vegetable intake is essential to reduce the burden of overweight and obesity. Furthermore, it is important to strengthen nutrition education about avoiding junk food consumption and encouraging regular physical activity.

Associations of out of school physical activity, sedentary lifestyle and socioeconomic status with weight status and adiposity of Cameroon children

BACKGROUND

Low physical activity and a sedentary lifestyle are contributing to overweight/obesity in children. This study aims to explore relationships between out of school physical activity, sedentary lifestyle and socioeconomic status indicators with children's weight status and adiposity.

METHODS

Five hundred twenty-two children of ages 5 to 12 years were randomly selected in a school-based cross sectional study in Bamenda, Cameroon. Weight and height were measured and BMI calculated. These variables were standardized for age and gender. Socioeconomic variables and proxy measures of physical activity and sedentary lifestyle of children were reported by parents using a structured questionnaire. Bivariate and multivariable logistic regression was used to calculate odds ratios.Quantile regression was used to compare median values of triceps skinfold thickness across the different factors.

RESULTS

In bivariate analysis, physical activity > 4 - 7 times/week was significantly (p = 0.010) associated with a lower prevalence (5.9%) of overweight/obesity. In multivariable analysis, physical activity > twice a week (OR 0.1, 95% CI 0.05 - 0.3), sedentary lifestyle > 3 h/day (OR 2.4, 95% CI 1.2 - 4.3) and being in the high occupation class (OR 4.3, 95% CI 2.2 - 8.1) independently predicted overweight/obesity. With quantile regression, physical activity > 4 - 7 times/week was significantly (p = 0.023) associated with a 1.36 mm decrease in median triceps skinfold thickness, while sedentary lifestyle (> 3 h/day) (p = 0.026) and being in the high occupation class (p = 0.007) were significantly associated with a 1.37 mm and 1.86 mm increase in median triceps skinfold thickness respectively.

CONCLUSION

Physical activity is inversely related to BMI-defined overweight/obesity and triceps skinfold thickness. Also, a high sedentary lifestyle and a high occupation class were associated with overweight/obesity and had the largest significant relationship with triceps skinfold thickness. There is need to objectively assess physical activity and sedentary lifestyle in our setting, in and out of school. Also longitudinal studies are warranted to understand the influence of cultural and behavioral drivers of physical activity and sedentary lifestyle.

Physical Activity, Sleep, and BMI Percentile in Rural and Urban Ugandan Youth

BACKGROUND

Uganda is experiencing a dual burden of over- and undernutrition, with overweight prevalence increasing while underweight remains common. Potential weight-related factors, particularly physical activity, sleep, and rural/urban status, are not currently well understood or commonly assessed in Ugandan youth.

OBJECTIVE

The purpose of this study was to pilot test a survey measuring weight-related factors in rural and urban Ugandan schoolchildren.

METHODS

A cross-sectional survey measured sociodemographics, physical activity, sleep patterns, and dietary factors in 148 rural and urban schoolchildren aged 11-16 in central Uganda. Height and weight were objectively measured. Rural and urban youth were compared on these factors using χ² and t tests. Regression was used to identify correlates of higher body mass index (BMI) percentile in the full sample and nonstunted youth.

FINDINGS

Youth were on average 12.1 ± 1.1 years old; underweight (10%) was more common than overweight (1.4%). Self-reported sleep duration and subjective sleep quality did not differ by rural/urban residence. Rural children overall had higher BMI percentile and marginally higher stunting prevalence. In adjusted analyses in both the full and nonstunted samples, higher BMI percentile was related to living in a rural area, higher frequency of physical activity, and higher subjective sleep quality; it was negatively related to being active on weekends. In the full sample, higher BMI percentile was also related to female gender, whereas in nonstunted youth, higher BMI was related to age. BMI percentile was unrelated to sedentary time, performance of active chores and sports, and dietary factors.

CONCLUSIONS

This study is one of the first to pilot test a survey assessing weight-related factors, particularly physical activity and sleep, in Ugandan schoolchildren. BMI percentile was related to several sociodemographic, sleep, and physical activity factors among primarily normal-weight school children in Uganda, providing a basis for understanding weight status in the context of the nutrition transition.

Aerobic capacity and future cardiovascular risk in Indian community from a low-income area in Cauca, Colombia

Background

Several studies indicates that children’s aerobic capacity levels are predictors of the future risk of non-communicable diseases. Therefore, the aim of this study was to establish the proportion of subjects whose aerobic capacity is indicative of future cardiovascular risk in Indian-Nasa community from a low-income area in Cauca, Colombia.

Methods

We performed a cross-sectional analysis of morphological component (height, weight, body mass index (BMI), waist circumference, triceps skinfold, subscapular skinfold, and body fat percent [BF%]), and the cardiorespiratory component (course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption by indirect VO₂max) from 576 participants (319 boys and 257 girls) aged 10 to 17.9 years, using the standardized FUPRECOL test battery.

Results

We showed that the boys performed better than the girls in cardiorespiratory fitness. The proportion of subjects with an aerobic capacity indicative of future cardiovascular risk was 7.3%. By sex, 3.8% of boys and 11.7% of girls (X²p = 0.001) displayed an unhealthy aerobic capacity in this study.

Conclusion

The findings of this study that provide the first data on aerobic capacity health for Colombian Nasa Indian children and adolescents aged 10–17.9 years. Although the known loss of aerobic capacity is a serious consequence of the future risk of non-communicable diseases, the deterioration of physical fitness deserves increased attention among indigenous population.

Active transport and obesity prevention - A transportation sector obesity impact scoping review and assessment for Melbourne, Australia

Given the alarming prevalence of obesity worldwide and the need for interventions to halt the growing epidemic, more evidence on the role and impact of transport interventions for obesity prevention is required. This study conducts a scoping review of the current evidence of association between modes of transport (motor vehicle, walking, cycling and public transport) and obesity-related outcomes. Eleven reviews and thirty-three primary studies exploring associations between transport behaviours and obesity were identified. Cohort simulation Markov modelling was used to estimate the effects of body mass index (BMI) change on health outcomes and health care costs of diseases causally related to obesity in the Melbourne, Australia population. Results suggest that evidence for an obesity effect of transport behaviours is inconclusive (29% of published studies reported expected associations, 33% mixed associations), and any potential BMI effect is likely to be relatively small. Hypothetical scenario analyses suggest that active transport interventions may contribute small but significant obesity-related health benefits across populations (approximately 65 health adjusted life years gained per year). Therefore active transport interventions that are low cost and targeted to those most amenable to modal switch are the most likely to be effective and cost-effective from an obesity prevention perspective. The uncertain but potentially significant opportunity for health benefits warrants the collection of more and better quality evidence to fully understand the potential relationships between transport behaviours and obesity. Such evidence would contribute to the obesity prevention dialogue and inform policy across the transportation, health and environmental sectors.

Physical fitness and anthropometric normative values among Colombian-Indian schoolchildren

Background

Substantial evidence indicates that children’s physical fitness levels are markers of their lifestyles and their cardio-metabolic health profile and are predictors of the future risk of chronic diseases such as obesity, cardiometabolic disease, skeletal health and mental health. However, fitness reference values for ethnic children and adolescents have not been published in a Latin-American population. Therefore, the aim of the study was to provide sex- and age-specific physical fitness and anthropometric reference standards among Colombian-Indian schoolchildren.

Methods

A sample of 576 participants (319 boys and 257 girls) aged 10 to 17 years old was assessed using the FUPRECOL test battery. Four components of physical fitness were measured: 1) morphological component: height, weight, body mass index (BMI), waist circumference (WC), triceps skinfold, subscapular skinfold, and body fat (%); 2) musculoskeletal component: handgrip and standing long jump test; 3) motor component: speed/agility test (4 × 10 m shuttle run); and 4) cardiorespiratory component: course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption by VO₂max indirect. Centile smoothed curves for the 3^rd, 10^th, 25^th, 50^th, 75^th, 90^th and 97^th percentiles were calculated using Cole’s LMS method.

Results

Our results show that weight, height and BMI in each age group were higher in boys than in girls. In each groups, age showed a significant effect for BMI and WC. Boys showed better than girls in cardiorespiratory fitness, lower- and upper-limb strength and speed/agility and girls performed better in low back flexibility.

Conclusion

Our results provide for the first time sex- and age-specific physical fitness and anthropometric reference values for Colombian Nasa Indian children and adolescents aged 10–17.9 years.

Correlates of Insufficient Physical Activity among Junior High School Students: A Cross-Sectional Study in Xi'an, China

Background: Physical activity plays an important role in individual health at all stages of life. However, evidence is lacking regarding the level of moderate to vigorous physical activity (MVPA) and the related factors to insufficient physical activity (IPA). Methods: A sample of 1060 students aged 12–15 years from nine public junior high schools in China were invited to participate in this study. Physical activity was assessed by a modified version of the International Physical Activity Questionnaire. Logistic regression was used to assess the factors associated with IPA. Results: 30.1% boys and 43.0% girls in our sample did not engage in sufficient physical activity. Obesity (OR = 2.2, 95% CI: 1.5–2.9) and high socioeconomic status (SES) (OR = 2.4, 95% CI: 1.3–4.8) were positively associated with IPA, whereas male sex (OR = 0.7, 95% CI: 0.5–0.9), underweight status (OR = 0.5, 95% CI: 0.3–0.7), and high family support level for physical activity (OR = 0.7, 95% CI: 0.6–0.9) showed inverse associations. Age was not associated with IPA. Conclusions: IPA appears to be a considerable problem in this sample of Chinese youth. Effective interventions to increase physical activity are needed and may include improving family support level for physical activity, especially for girls, the obese and those with high SES.

Patterns and Associated Factors of Physical Activity among Adolescents in Nigeria

INTRODUCTION

Understanding the context where adolescents' physical activity (PA) takes place could impact a more targeted approach to implement PA promotion and interventions in Africa. However, standardized data on adolescents' PA behaviour is lacking in Nigeria. We described PA patterns in the various domains (home, school, transport, leisure-time) and intensity categories (light-intensity PA, moderate- to vigorous- intensity physical activity [MVPA] and total PA), and their associations with sociodemographic factors and socioeconomic status (SES) among secondary school adolescents in Nigeria.

METHODS

A cross-sectional survey was conducted in a representative sample of 1006 secondary school adolescents (12-18 years, 50.4% girls) in Maiduguri, Nigeria. Self-reported PA was assessed with an adapted version of the Activity Questionnaire for Adolescents and Young Adults. Outcomes were weekly minutes (min/wk) of PA spent in the various domains and intensity categories. Multivariate ANOVA was used to examine associations of PA scores (domains and intensity levels) with adolescents' sociodemographic characteristics and SES, and track differences in PA scores between subgroups.

RESULTS

The total sample reported most PA at school (1525 min/wk), the least during active transportation (210 min/wk), and only 37% engaged in 60 min of MVPA daily. Boys reported significantly more leisure-time PA (P<0.001), active transportation (P<0.001), MVPA (P = 0.023) and total PA (P = 0.003) than girls, while girls reported more school-based PA (P = 0.009), home-based PA (P<0.001) and light-intensity PA (P<0.001) than boys. Moderate-intensity PA (P = 0.024) and total PA (P = 0.049) were significantly higher in younger age group than in older group. Household car ownership was associated with less active transportation (P = 0.009), less moderate-intensity PA (P = 0.048) and with more leisure-time PA (P = 0.013). High parental SES was associated with more leisure-time PA (P = 0.002), more MVPA (P = 0.047) and less active transportation (P<0.001). Adolescents of various weight status differed significantly in their leisure-time PA (P<0.001), moderate-intensity PA (P = 0.011) and total PA (P = 0.033).

CONCLUSIONS

The patterns and levels of physical activity among adolescents in Nigeria vary according to the adolescents' age, gender, weight status and SES. These findings have important public health implications for identifying subgroups of Nigerian adolescents that should be targeted for effective physical activity promoting interventions.

Risk Factors of Overweight and Obesity among High School Students in Bahir Dar City, North West Ethiopia: School Based Cross-Sectional Study

Background. Overweight and obesity are risk factors for diet-related noncommunicable diseases. These diseases are the fifth leading risks for global deaths. Virtually, all age groups are affected from consequences of overweight and obesity. Methods. Cross-sectional study was conducted among 431 school adolescents. Data were collected using self-administered questionnaire and physical measurements. The sex and age specific BMI was computed using WHO Anthroplus software and the data were analyzed using bivariate and multivariable logistic regression analysis. Results. The magnitudes of overweight and obesity were 12.3% and 4.4%, respectively, and the combined prevalence of overweight and obesity together was 16.7%. Three-fourths of the respondents (74.7%) had healthy body mass index; however, 8.6% were underweight. Sex, frequency of eating food out of home, school type, family monthly income, family having vehicle, vigorous physical activity, and frequency of vigorous physical activity were statistically significant predictors of overweight and obesity. Conclusion. The problems of overweight and obesity are taking place while students are still under the risk of underweight. Several factors were correlated with overweight and obesity. Therefore, interventions targeting gender, frequency of eating food out of home, vigorous activities, and frequency of doing vigorous physical activity are recommended.

Quantitative physical activity assessment of children and adolescents in a rural population from Eastern Nepal

OBJECTIVES

We report cross-sectional, objectively measured physical activity data for 399 children and adolescents aged 6 to 18 years. We evaluated physical activity of children and adolescents, considered time spent in each activity intensity category, and explored the impact of growth disruption (stunting and wasting) on physical activity patterns.

METHODS

Participants wore an Actical (Mini-Mitter, Bend, OR) omnidirectional accelerometer for one week as part of their annual visit to the Jiri Growth Study. The percentage of time spent in standard activity intensities were computed using standard metabolic equivalents (METS) cutpoints and compared by chronological age, sex, and school versus non-school days.

RESULTS

Primary findings include (1) children are more active on non-school days and adolescents are more active during the school week; (2) Jirel children do not exhibit the reduction in physical activity that most Western populations experience during the transition from childhood to adolescence; and (3) Jirel children and adolescents routinely meet the suggested one hour/day MVPA threshold; (4) Stunting is prevalent and factors leading to this growth disruption may contribute to the amount of time in sedentary or light physical activity.

CONCLUSIONS

We report child and adolescent physical activity patterns from the Jirel population of eastern Nepal. In this rural context, children and adolescents are more active than populations reported from Western contexts. This key finding has important biomedical implications for the maintenance of healthy body composition, skeletal health, and other health traits.

Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi, Kenya

Background

Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya.

Methods

Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.

Results

Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.

Conclusion

The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.