Predisposing, facilitating and reinforcing factors of healthy and unhealthy food consumption in schoolchildren: a study in Ouagadougou, Burkina Faso

Objective:

African schoolchildren’s dietary habits are likely changing in the realm of the nutrition transition, particularly in urban areas, but data on their diet and on determinants are scanty. In order to design relevant interventions for this priority target group, the study aimed to assess food habits and their determinants in schoolchildren of Ouagadougou.

Methods:

In a cross-sectional survey, fifth-grade schoolchildren filled during school hours a questionnaire to assess consumption frequency of ‘healthy’ foods (fruits, vegetables, meat, fish, legumes) and ‘unhealthy’ (superfluous) items (cake, cookies, candies, ice, soda) and underlying factors, using Green’s PRECEDE model.

Results:

The study included 769 schoolchildren, mean age 11.7 ± 1.4 years, from eight public and four private schools. Consumption scores of unhealthy items were significantly higher than healthy foods ( p = 0.001). During the week prior to the survey, 25% of children had eaten no fruit, 20% no meat, 20% no legumes, 17% no fish and 17% no vegetables. While less than 4% ate fruits or vegetables every day, 18.3% ate ice pop every day. Children eating cookies, cakes and candy every day were up to seven-fold those eating fruits, vegetables or legumes. Compared to public-school pupils, those from private schools consumed both healthy and unhealthy items more frequently ( p = 0.002 and p = 0.007, respectively). Urban schoolchildren had significantly higher unhealthy food scores ( p = 0.027) compared to peri-urban schools. Children’s healthy and unhealthy food consumption was primarily explained by perceived decisional power and availability [facilitating factors] for both types of foods, and maternal reinforcement for healthy foods and peers’ reinforcement for consumption of unhealthy items. Overall, facilitating factors rated higher for unhealthy than healthy foods.

Conclusion:

The study showed that city schoolchildren’s eating behaviours are far from optimal. Nutrition interventions should be tailored to address the underlying factors in order to impact on behaviours, thereby preventing both dietary inadequacies and excess.

Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou (Burkina Faso)

BACKGROUND

Malnutrition is still highly prevalent in developing countries. Schoolchildren may also be at high nutritional risk, not only under-five children. However, their nutritional status is poorly documented, particularly in urban areas. The paucity of information hinders the development of relevant nutrition programs for schoolchildren. The aim of this study carried out in Ouagadougou was to assess the nutritional status of schoolchildren attending public and private schools.

METHODS

The study was carried out to provide baseline data for the implementation and evaluation of the Nutrition Friendly School Initiative of WHO. Six intervention schools and six matched control schools were selected and a sample of 649 schoolchildren (48% boys) aged 7-14 years old from 8 public and 4 private schools were studied. Anthropometric and haemoglobin measurements, along with thyroid palpation, were performed. Serum retinol was measured in a random sub-sample of children (N = 173). WHO criteria were used to assess nutritional status. Chi square and independent t-test were used for proportions and mean comparisons between groups.

RESULTS

Mean age of the children (48% boys) was 11.5 ± 1.2 years. Micronutrient malnutrition was highly prevalent, with 38.7% low serum retinol and 40.4% anaemia. The prevalence of stunting was 8.8% and that of thinness, 13.7%. The prevalence of anaemia (p = 0.001) and vitamin A deficiency (p < 0.001) was significantly higher in public than private schools. Goitre was not detected. Overweight/obesity was low (2.3%) and affected significantly more children in private schools (p = 0.009) and younger children (7-9 y) (p < 0.05). Thinness and stunting were significantly higher in peri-urban compared to urban schools (p < 0.05 and p = 0.004 respectively). Almost 15% of the children presented at least two nutritional deficiencies.

CONCLUSION

This study shows that malnutrition and micronutrient deficiencies are also widely prevalent in schoolchildren in cities, and it underlines the need for nutrition interventions to target them.