ABSTRACT
This study was conducted to assess childhood obesity and its association with type of school (private vs. public), parental education, lifestyle factors and eating habit among school-aged children (6–12 years) in the Oredo Local Government area, Edo State. This cross-sectional school-based study was conducted in Benin metropolis in Edo state. Using multi-stage random sampling, 240 children aged 6-12 years were selected from 4 schools. Anthropometric measurements of, height and weight were measured. Cut-off points for BMI defining obese and overweight in children were classified in accordance with the WHO growth reference charts in children using the BMI for Age Z score. All data collected were analyzed using Statistical Package for Service Solution. The prevalence of childhood obesity was found to be (10.3%). The prevalence of obesity was higher among school age children aged 6-7years (15.9%) than children aged 8-9years (3.3%) and 10-12years (11.0%). Obesity was found higher among the female (52.4%) than males (47.6%). The prevalence of obesity was higher in children who attend public school (14.5%) than children who attend private schools (7.5%). Socioeconomic class, eating habits, lifestyle and activity pattern were significantly associated with students BMI. This study found that high prevalence of obesity among school aged children (6-12years) in Edo State was associated more in children who attend public schools. High prevalence of obesity among public school children could be associated to low socioeconomic status or genetics.
TABLE OF CONTENT
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENTS v
LIST OF TABLES viii
ABSTRACT x
CHAPTER 1 1
INTRODUCTION 1
Statement of problem 3
Objectives of the study 5
Significance of study 6
CHAPTER 2 7
LITERATURE REVIEW 7
2.0 Childhood Obesity (Pediatric Obesity) 7
2.1 Definition of Childhood Obesity 7
2.2 Factors Influencing Overweight and Obesity 9
2.3 Childhood Obesity Burden 15
2.4 The Double Burden of Malnutrition in Developing Economies 16
2.5 The Effects of Childhood Overweight and Obesity 17
2.6 Nutritional Assessment for Children 19
2.7 Interventions 27
2.8 Consequences of Childhood Obesity 34
2.9 Prevention and Treatment 35
`CHAPTER 3 40
3.0 MATERIALS AND METHODS 40
3.1 Study Design 40
3.2 Area of Study 41
3.3 Population of Study 41
3.4 Sampling and Sampling Techniques 41
3.4.1 Sample Size 41
3.4.2 Sampling Procedure 42
3.5 Preliminary Activities 42
3.5.1 Preliminary Visit 42
3.5.2 Training of Research Assistants 43
3.6 Data Collection 43
3.61 Questionnaire Administration 43
3.6.2 Interview 44
3.6.3 Anthropometric Measurements 44
3.7 Data Analysis 45
3.8. Statistical Analysis 45
CHAPTER 4 46
4.0 RESULTS AND DISCUSSIONS 46
4.1 Background Information of the Respondents 46
4.2 Socioeconomic Characteristics of Respondents (Parents) 49
4.3 Nutritional Status of School Children Using Anthropometry 51
4.4 Lifestyle and Eating Habits of the School Age Children 54
4.4.1 Lifestyle and Activity Pattern of the School Age Children 54
4.4.2 Eating Habits of School Age Children 61
4.4.3 Snacks Intake of School Age Children 66 4.5 Effect of Socioeconomic Characteristics, Lifestyle and Eating Habit on 69
Nutritional Status
CHAPTER 5 75
5.0 CONCLUSION AND RECOMMENDATIONS 75
5.1 Conclusion 75
5.2 Recommendations 76
REFERENCES 77
APPENDIX I 91
LIST OF TABLES
Table 2.1: World Health Organization Growth Reference Chart in Children 9
Table 4.1: Background Information of the parents/guardian 48
Table 4.2: Socioeconomic Characteristics of the parents/ guardian 50
Table4.3a: Nutritional status of school Age children using Anthropometry 51
Table 4.3b: BMI for age Z score distribution among the different age groups 52
of the study population
Table 4.3c: BMI for age Z score distribution among the different sex 52
of the school children
Table 4.4.1a: Life Style of School Age Children 56
Table 4.4.1b: Use of household facilities by the Children. 58
Table 4.4.1c: Activities of School Age Children during Leisure 60
Table 4.4.2a: Eating Habits of the School Age Children 64
Table 4.4.2b: Eating Habits of the School Age Children 65
Table 4.4.3a: Snack Intake of School Age Children 67
Table 4.4.3b: Beverages and Drink Intake of School Age Children 68
Table 4.5a: Effect of Socioeconomic Characteristics on Nutritional 71
Status of the School Age Children
Table 4.5b: Effect of Lifestyle and Activity Pattern on Nutritional Status of the 72
School Age Children
Table 4.5c: Effect of Eating Habits on Nutritional Status of the School Age Children 73
Table 4.5d: Effect of Eating Habits on Nutritional Status of the school Age Children 74
CHAPTER 1
INTRODUCTION
Childhood obesity is one of the most serious public health challenges of the 21st century (WHO,2014). As early as 1998, the World Health Organization (WHO,1998) declared obesity in childhood a major public health epidemic requiring urgent intervention. WHO reported in 2008 that 1.5billion people above the age of 20years and 43million children around the age of 5years are overweight worldwide (WHO,2008). Obesity is often defined as a condition of abnormal or excessive fat accumulation in adipose tissues to the extent that may be impaired (Garrow, 1988). Childhood obesity is mostly caused by genetics, overeating and lack of exercise. Childhood obesity is associated with several risk factors which may include type 2 diabetes, coronary heart disease, insulin resistance, impaired glucose tolerance, menstrual irregularity and hypertension (Anrig, 2003; Canadian Press, 2003, Nieman, 2004).
Overweight and obesity are emerging as major risk factors for chronic diseases in adults. The last quarter of the 20th century has seen childhood obesity emerging as an epidemic in developed countries and a cause of concern worldwide. At least 155million school aged children are said to be overweight and obese. Obesity in childhood causes a wide range of complications and increases the risk of premature illness and death rate in life. According to World Health Organization (WHO) and Food and Agricultural Organization (FAO)., 60% of children who are overweight have at least one of additional risk factor for cardiovascular diseases such as hypertension or hyperinsulinemia, while obese children are at increased risk for type 2 diabetes which was previously considered an adult disease (WHO/FAO,2003).
World trend in childhood obesity in 25 countries for the school aged population (6-12 years) and in 42 countries for the preschool population observed that the prevalence of childhood overweight has increased in almost all countries for which data were available (De Onis et al, 2000). This emerging public health problems lead to increased childhood mortality or higher risk of chronic diseases later in life.
Childhood malnutrition according to Caulfield (2006), diminishes adult intellectual ability and work capacity, causing economic hardship for individuals and their families. It also leads to poor school readiness and performance, resulting in fewer years of schooling, reduce productivity, increase the risk of numerous chronic diseases later, leading to high adult health care cost (Caulfield et al, 2006). Childhood is a critical period for the development of obesity associated with the imbalance between energy consumed and expended through physical activity. The calculated global prevalence of overweight and obesity in children 5 to 17 years of age was estimated by the International Obesity Task Force (IOTF) (2003), to be 10%. In Africa, Cole et al., (2007), and IOTF (2003), reported the prevalence of obesity and overweight to be 0.1% and 1.2% for males and 0.3% and 1.4% for females 5 to 17 years respectively. Owa and Adejuyigbe (1997) found that 18% of children 5 to 15 years from a relatively privileged section of the Nigerian society were obese.
The body of research linking obesity in childhood to short- and long-term health consequences and obesity in adulthood is increasing. Obesity is associated with hypertension, dyslipidemia, atheroma, type ii diabetes mellitus, the metabolic syndrome, systemic inflammation and oxidative stress (Molnár, 2008). Concern is growing for the future health of our nation, the economic burden and the effect obesity will have on our health care system. While this problem spans all age ranges, childhood obesity can be considered unique in its diagnostic, treatment and follow-up considerations. Identification and early intervention of overweight and obesity is critical in preventing or delaying the onset of chronic diseases (Molnár, 2008).
1.1 STATEMENT OF PROBLEM
The increase in childhood obesity over the past several decades, together with the associated health problems and cost is raising grave concern among health care professionals, children advocates and parents (Patricia and Kristin, 2006). All are concerned that today’s overweight and obese children will turn into tomorrow’s overweight and obese adults, destined to suffer from all the health problems and health cost associated with obesity (Patricia and Kristin, 2006). Obesity is common among children nowadays. This emerging public health problem has led to increase in childhood mortality and higher risk of chronic diseases later in life (De Onis et al., 2000).
Obesity among children is associated with the imbalance between energy consumed and energy expended during physical activity, eating pattern, socioeconomic status and environment (De Onis et al., 2000). In our modern days, children prefer sweets and fatty processed foods to natural foods. Every year in Edo state and across the nation, there are more children who are overweight or obese (Patricia and Kristin, 2006). As the prevalence continues to rise, so does the incidence of co-morbidities and poor health outcomes for these children (De Onis et al., 2000). Early identification of children who are obese, or who are at risk for becoming obese improves health outcomes and may be reliant upon the monitoring practices of providers who care for children. There may also be a gap in knowledge regarding current monitoring practices for childhood obesity which in turn reflects on the care offered to children. Therefore, information about current measurement practices offers a place to begin the task of reversing the incidence of childhood obesity (Patricia and Kristin, 2006).
The calculated global prevalence of overweight and obesity in children 5 to 17 years of age was estimated by the International Obesity Task Force (IOTF) (2003), to be 10%. In Africa, Cole et al., (2007), and IOTF (2003) reported the prevalence of obesity and overweight to be 0.1% and 1.2% respectively for males and 0.3% and 1.4% respectively for females 5 to 17 years. Owa and Adejuyigbe (1997) found that 18% of children and adolescents 5 to 15 years from a relatively privileged section of the Nigerian society were obese. Opara et al., (2010) reported an obesity prevalence of 11.3% among primary school children in Uyo, South South Nigeria, while Yusuf et al., (2013) found obesity and overweight prevalence of 0.84% and 1.98% respectively among adolescents in Kano metropolis, North West, Nigeria. In a more representative study in Benue State, North Central Nigeria, Danladi et al., (2012) studied 3240 children aged 9-16 years and reported obesity prevalence of 1.8% and overweight 9.7% respectively. Obesity rate of 2.5% among children aged 2-15 years has also been reported in Lagos, South South Nigeria (Akodu, 2012).
Due to the arising increase in childhood obesity and the health complications and cost associated with this increase, this study is set aside to assess childhood obesity among Nigerian school aged children particularly in Edo State, southern Nigeria, how it can be prevented and bring about possible recommendations and direction.
1.2 OBJECTIVE OF THE STUDY
The general objective of this study was to asses childhood obesity among school age children (6-12 years) in selected public and private primary schools in Oredo Local Government Area of Edo State.
The specific objectives were to:
i. compile the socioeconomic characteristics of the school age children using a well validated and pretested questionnaire
ii. determine the nutritional status of school age children using anthropometric measurement (weight and height).
iii. asses the lifestyle and eating habits of the school age children.
iv. determine the effect of socioeconomic characteristics of their parents, life style and eating habits of children on their nutritional status.
1.3 SIGNIFICANCE OF THE STUDY
Information obtained from this study will be relevant in creating awareness among school age children about the risk factors and long term effect of obesity. It is also important for teachers and home economics extension workers in educating school age children on healthy eating practices. The findings of this study will motivate care givers to establish a healthy lifestyle and adequate feeding habit of their children thus, improving parental care. The ministry of health and other health practitioners (dietitians, nutritionists, and doctors) will harness the findings from this study in the fight against the major killer diseases. This work will also provide aid to researchers who will like to carry out further research on this topic or related topics.
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