ABSTRACT
This study
investigates the prevalence of overweight and obesity among pre-school and
school-aged children (2-12 years) in rural and urban areas of Ebonyi State,
Nigeria. Specific objectives include determining prevalence rates, analyzing
gender and age differences, assessing socio-economic and demographic
influences, and comparing prevalence between rural and urban settings.
A cross-sectional
and comparative study design was employed, targeting children aged 2-12 years
from rural and urban areas of Ebonyi State. A sample size of 360 children (180
from rural and 180 from urban areas) was selected using systematic random
sampling across 12 schools (6 rural, 6 urban). Data were collected using
validated questionnaires administered to parents or guardians, covering
socio-economic, demographic, and dietary factors. Anthropometric measurements
were taken to assess nutritional status. Descriptive statistics were used to
analyze anthropometric characteristics, with WHO Anthro and Anthro Plus
software utilized for classification. Chi-square and Pearson's correlation
tests were employed to assess socio-economic and demographic influences on
overweight and obesity. Statistical significance was set at p<0.05.
The study reveals
a significant prevalence of overweight and obesity among pre-school and
school-aged children in Ebonyi State, with higher rates observed in urban areas
compared to rural areas. Gender-specific prevalence rates indicate higher
overweight rates in females and higher obesity rates in males. Obesity
prevalence peaks among pre-school children and decreases with age, while
overweight peaks among 6-9 year-olds. Socio-economic factors such as father's
occupation and urban residence significantly influence overweight and obesity
prevalence.
To address these
findings, comprehensive school-based health and nutrition programs should be
established, including school feeding initiatives. Nutrition education
targeting parents, particularly mothers, is crucial to influencing children's
dietary habits. Regular assessment of weight, height, and BMI in children is
recommended to identify at-risk individuals. Increased provision of
recreational facilities in schools and towns can promote physical activity.
Health agencies should engage in media campaigns, involving religious leaders
and educational institutions, to raise awareness about predisposing factors for
overweight and obesity and promote healthy lifestyles.
TABLEOF
CONTENTS
CHAPTER 1
INTRODUCTION
1.0 Background of the Study
1.1
Statement of Problem.
1.2 Objectives of Study.
1.3
Significance of Study.
CHAPTER 2
LITERATURE REVIEW
2.1
Childhood Obesity and Overweight.
2.2 Obesity and Overweight in Children in
Different Countries of the World
2.2 Obesity in Nigeria
2.3 Obesity
in South East Nigeria
2.4 Interventions for
Prevention of Obesity in Children
2.5
Methods of Nutritional Assessment.
2.5.1 Anthropometric Measurement
2.5.2 Biochemical Assessment
2.5.3 Clinical Assessment
2.5.4 Dietary Assessment
2.5.5 Evaluation of
Nutritional Assessment
2.6 Predisposing
Factors to Obesity and Overweight
2.6.1 Genetics
2.6.2 Parental And Perinatal Influence
2.6.3 Postnatal Effects
2.6.4 Parent Restrictions
2.6.5 Sedentary Behaviours and Decreased Physical
Activity.
2.6.7 Increased Caloric Sweeteners
2.7 Roles of the Family and the Society
towards Handling Overweight and Obesity
2.8 Nutritional Management of Obesity
2.8.1 Energy Density
2.8.2 Portion Size
2.8.3 Structured Meals
2.9 Problems
Associated With Obesity and Overweight
2.9.1 Metabolic Syndrome
2.9.2 Type 2 Diabetes
2.9.3 Asthma
2.9.4 Sleep Apnea
2.9.5
Early Puberty Menstruation
2.9.6 Behaviour and Learning Problems
2.9.7 Depression
CHAPTER 3
MATERIALS AND METHOD
3.1 Study
Design
3.2 Study
Area
3.3
Study Population
3.4
Sample Size and Sample Size
Calculation.
3.5 Sampling
Technique
3.6
Preliminary Activities
3.7 Informed
Consent
3.8
Data Collection And Instrumentation
3.8.1
Questionnaire
3.8.2
Anthropometric measurement
3.8.3
Assessment of feeding pattern
3.8.3
Data Analysis
3.9 Statistical
Analysis
CHAPTER 4
RESULTS AND
DISCUSSION
4.1 Demographic
Characteristics of Respondents
4.2 Educational Qualification and Occupation of Parents
4.3
Income and Household
Characteristics of Children’s Families.
4.4 Feeding Pattern of Children.
4.5
Consumption of Snacks by the
Children
4.6 Feeding
Pattern of the Children Using Food Frequency.
4.7 Anthropometric
Assessment of the Children.
4.8 Prevalence
of BMI- For- Age, Stunting, Underweight And Wasting In The Urban And Rural Area
4.9 Prevalence
of Overweight and Obesity in Pre-School and School Aged Children.
4.10 Prevalence
of Overweight and Obesity in Preschool and School Aged Children in the Rural and
Urban Area.
4.11 Prevalence
of Overweight and Obesity among Preschool and School Age Children by Gender.
4.12 Prevalence
of Overweight and Obesity in the Urban and Rural Area by Gender.
4.13 Influence
of Socio Economic/ Demographic Variables on the Prevalence of Overweight and
Obesity in the Children.
4.14 Influence
of Some Selected Foods (Bread, Rice, Okpa, Beans, Beef, Fish, Palm Oil, Garri,
Yam, Oranges and Banana) on the Nutritional Status Of The Children Studied.
CHAPTER 5
CONCLUSION AND
RECOMMENDATION
5.1 Conclusion
5.2 Recommendation
REFERENCES
LIST
OF TABLE
Table
4.1: Demographic characteristics of
Respondents
Table 4.2: Educational Qualification and Occupation of parents of the
Children
Table 4.3: Income and household characteristics of the children’s
families.
Table 4.4: Feeding Pattern of Children
Table 4.5: Consumption Pattern of Snacks by Children
Table 4.6.1: Consumption of Cereal, Legumes and
products, Meat and Meat product.
Table 4.6.2: Consumption of fat and oil, Root and Tuber, Fruit and Vegetable
Table
4.9: Prevalence of overweight and
obesity among preschool and school age
children.
Table 4.12 Prevalence of overweight and obesity in the rural and urban
area by gender
Table
4.13.1 Influence of fathers’ level of
education on the overweight/obese status of
the children
Table
4.13.2 Influence of mothers’ level of
education on the overweight/obese status of
the children
Table
4.13.3 Influence of fathers’ occupation
on the overweight/obese status of the
children
Table
4.13.4 Influence of mother’s occupation
on the overweight/obese status of the
children
Table
4.13.5 Influence of family monthly
income on the overweight/obese status of the
children
Table 4.14.1 Influence of selected foods on the underweight status of the
children in
urban and rural areas.
Table 4.14.2 Influence of selected foods on the stunting status of the children
in urban
and rural areas.
Table 4.14.3 Influence of selected foods on the overweight and obesity status
of the
children in urban and rural areas.
Table 4.14.4 Influence of selected foods on the wasting status of the children
in urban
and rural areas.
Table 4.14.5 Influence of breakfast consumption on the nutritional status of
the
children
Table 4.14.6 Influence of snack consumption on the nutritional status of the
children.
LIST
OF FIGURE
Figure
4.7 Anthropometric Status of the
children
Figure
4.8a Prevalence of overweight and
obesity in the urban and rural area.
Figure
4.8b Prevalence of stunting in the
rural and urban area.
Figure 4.8c Prevalence of underweight in the rural and
urban area.
Figure
4.8d Prevalence of wasting in the
rural and urban area.
Figure
4.9 Prevalence of overweight and
obesity in preschool and school aged children
by location.
Figure
4.10 Prevalence of overweight and
obesity in preschool and school aged children
by gender.
CHAPTER 1
INTRODUCTION
1.0 BACKGROUND OF THE STUDY
Childhood obesity is one of the most
challenging Public Health issues of the 21st century (WHO, 2014). As early as
1998, the World Health Organization (WHO, 1998), pronounced obesity in
childhood a prime public health epidemic, that demands urgent intervention.
Obesity among under-fives has maintained an increase at an alarming rate
(Childhood overweight and obesity, 2014), affecting about 43 million under five
aged children in 2010 representing a 60% rise since 1990 (de Onis et al., 2010). Furthermore, it has been
predicted that in 2020 the number of overweight and obese under-fives will
reach 60 million globally if interventions are not put in place to control the
current epidemic (de Onis et al.,
2010).
The
World Health Organization projected that by 2005, about 1.6 billion and 400
million people aged above 10 years were overweight and obese respectively. It
further predicted that by 2015, these statistics will rise to 2.3 billion for
overweight and 700 million for obesity, unless desperate measures were taken to
limit this burgeoning problem (WHO, 2006). In Africa, regardless of the high
prevalence of under nutrition, the prevalence of overweight is rising at an
disturbing rate. It is approximated that 25% to 60% of urban women are
overweight (World Health Organization, 2008). The prevalence of overweight and
obesity is also speedily rising in children, the International Obesity Task
Force estimates that about 155 million school children globally, are either
overweight or obese (Lobstein et al.,
2004).
Also, in 2013,
42 million children below 5 years were overweight or obese. Once believed to be
a high-income country problem, overweight and obesity are now increasing in
low- and middle-income countries, especially in urban settings. In developing
countries with emerging economies (categorized by the World Bank as lower- and
middle-income countries) the pace at which childhood overweight and obesity is
rising has been more than 30% higher than that of developed countries. Overweight
and obesity are connected to more deaths worldwide than underweight. Most of
the world's inhabitants reside in countries where overweight and obesity cause
more deaths than underweight (this includes all high-income and most
middle-income countries) (WHO, 2015).
Overweight and
obesity to a layman can be defined as abnormal or accumulated fat that may
impair health. Body mass index (BMI) is a straight forward index of
weight-for-height that is commonly used to classify overweight and obesity in
adults. It is defined as a person's weight in kilograms divided by the square
of his height in meters (kg/m2).
Body
mass index (BMI) is provides a parameter used to determine childhood overweight
and obesity. Overweight is defined as a BMI at or above the 85th
percentile and below the 95th percentile for children and teens of
the same age and sex and Obesity is defined as a BMI at or above the 95th
percentile for children and teens of the same age and sex. Children’s growths are different at different times, so it is
not usually easy to decide if a child is overweight. BMI charts for children
compare their height and weight to other children of the same sex and age.
BMI is derived by dividing a person's weight in kilograms by the square of
height in meters. For children and teens, BMI is age and sex specific and
is usually referred to as BMI-for-age. A child's weight status is can be determined
using an age- and sex-specific percentile for BMI rather than the BMI
classifications used for adults. This is because children's body
composition differs as they grow and also differs between the boy and girl
child. Therefore, BMI levels among children and teens needs to be expressed
relative to other children of similar age and sex. For example, a
10-year-old boy of average height (56 inches) who weighs 102 1b would have a
BMI of 22.9 kg/m2. This would place the boy in the 95th
percentile for BMI, and he would be classified as obese. This means that
the child’s BMI is greater than the BMI of 95% of 10-year-old boys from the
population used as reference.
Nevertheless,
obesity and overweight in children and young adults is not a benign problem. It
is usually linked with the presence of metabolic syndrome and asymptomatic
cardiovascular disease (Vercoza et al., 2009). Disturbinly,
children and young adults who are obese, are more likely to have clustering of
cardiovascular disease risk factors such as; dyslipidemia, hypertension,
increase in left ventricular mass, type 2 diabetes mellitus and increased
fasting and post-load insulin levels (Demerath et al., 2003; Dai et al.,
2009). In addition, according to the Path Biological Determinants of Atherosclerosis
in the Young study (PDAY), obese young adults who had high glycosylated
hemoglobin of > 8% had higher chances of having atheromata in the aorta and
coronary arteries (Mcgill et al.,
1995).
Also,
childhood obesity and overweight increases the risk for obesity and metabolic
syndrome in later adulthood (Morrison et al., 2007; Freedman et al., 1999). Therefore, if not
checked, obesity in childhood and young adulthood represents will continue to
be a risk factor for the development of cardiovascular disease, which will be
higher in developing countries with poor secondary prevention. The rise in
obesity requires more programs that center on primary prevention in developing
countries, a practice that needs local data on the magnitude of the problem and
associated risk factors.
The
rate of overweight and obesity varry from country to country, Gaeini et al (2011) recorded overweight of
9.81% and 10.31% and obesity of 4.77% and 4.49% among Iran preschool male and
female children respectively. Also in Iran, (Fatemeh et al., 2012), observed prevalence rates of overweight of 10.6% and
obesity of 7.6% amongst 2-5-year-old kindergarten children in Birjand. Overweight and obesity prevalence rate of
16.6% and 8.0%, respectively among 2-6-year old Italian children was reported
by (Maffeis et al., 2006). In the
United States of America, prevalence of obesity amid preschool children aged
2-5 years was 8.4% and 14.94% among US low income preschool aged children (CDC,
2012). In Africa, the prevalence of childhood overweight and obesity of 8.5%
was recorded in 2010 and it is forecasted to hit 12.7% in 2020 (de Onis et al., 2010).
There
is scarcity of data on overweight and obesity among preschool children in
Nigeria. Many of the studies (Ben-Bassey et
al., 2007; Akesode and Ajibode, 1983), conducted was centered on school
aged children and adolescents. However, the rate of obesity among preschool
children in Enugu Metropolis was 0.5% (Odetunde et al., 2014) while (Senbanjo and Adejuyigbe ,2007)
recorded prevalence rates of overweight and obesity of 13.7% and 5.2%
respectively among Nigerian pre-school children; prevalence rate of 4%
overweight in Nigerian under 5 was also reported by NDHS (2013). The prevalence
in overweight of 0-8.1% and 1.3-8.1% in males and females respectively and
obesity prevalence of 0-2.7% and 0-1.9% in males and females respectively was
reported by Akinpelu et al. (2008) in
school children, also prevalence of overweight, 9.1% and obesity, 4.3% in
adolescents was reported by (Shalom et al.,
2012). The WHO consultation forum on obesity reported that the clusters,
Classes were stratified according to age, and fundamental causes of obesity
epidemic were sedentary lifestyle and the intake of high fat-energy-dense diets
which results from the effects of rise in urbanization and industrialization on
the society and the behavioral patterns of communities (WHO, 2000).
There
is scarcity of data on overweight and obesity in preschool and school aged
children in Ebonyi State. This study therefore is aimed at determining the
prevalence of overweight and obesity among preschool and school aged children
in rural and urban areas of Ebonyi State.
1.1 STATEMENT OF PROBLEM.
Several problems have been associated with
overweight and obesity among preschool children. A Study by Freedman et al., (2005) has shown that children
who become obese as early as two years of life are likely to be obese adults
who are prone to developing health problems such as heart diseases, type 2
diabetes, stroke, several types of cancer and osteoarthritis. Elevated blood
pressure, Dyslipidemia and a higher prevalence of factors associated with
insulin resistance and type 2 diabetes appear as frequent co morbidities in the
overweight and obese pediatric population. In some populations, type 2 diabetes
is now the dominant form of diabetes in children and adolescents. Disturbingly,
obesity in childhood, particularly in adolescence, is a key predictor for
obesity in adulthood. Obese children are
often teased, harassed and discriminated against by their peers and family
members, putting them at risk of developing psychological problems and school
phobia (Puhl and Heuer, 2009). These chronic diseases are a huge burden on the
health system. Concerted efforts must therefore be made to prevent obesity and
overweight in preschool and school aged children in other to ensure a healthy
adult population in the future.
1.2 OBJECTIVES OF STUDY.
1.2.1 The general objective of the study is to determine the
prevalence of overweight and obesity in
pre-school and school aged children (2-12years) in rural and urban areas
of Ebonyi State.
1.2.2
The Specific objective of the study are to
(i) determine the prevalence of
overweight and obesity among preschool and school aged children (2-12 years).
(ii) Determine the prevalence of
overweight and obesity in male and female children
(iii) establish
if prevalence increased with age.
(iv) determine the influence of socio economic and
demographic variables on the prevalence
of overweight and obesity in children aged 2-12 years.
(v) compare the prevalence of overweight and obesity
in rural and urban areas of Ebonyi State.
(vi) access the feeding pattern of the child using
food frequency questionnaire through the child’s family diet.
1.3 SIGNIFICANCE OF
STUDY.
Obesity-associated
chronic disease risk factors are present in adults and also manifest in
overweight and obese children. For example, data from the Bogalusa Heart Study
showed that 60% of overweight 5 to 10-year-old children had one cardiovascular
risk factor, such as high blood pressure, hyperlipidemia, or elevated insulin
levels (Freedman et al., 1999). From
the same cohort of 5 to 10-year-olds, 20% of overweight children had two or
more cardiovascular risk factors (Freedman et
al., 1999), risk factors that would increase substantially the risk of
these individuals for earlier cardiovascular disease if they were tracked into
adulthood. Similar to adults, children who are moderately over- weight showed
that an elevation of low-density lipoprotein (LDL) cholesterol levels and
hypercholesterolemia does not increase substantially with higher degrees of
obesity. With more marked degrees of obesity, rises in plasma triglyceride
levels and decreases of high-density lipoprotein cholesterol are more common,
and blood pressure elevations are more common with significant obesity than
with moderate over- weight, similar to what occurs in adults.
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