THE PREVALENCE OF OVERWEIGHT AND OBESITY IN PRE-SCHOOL AND SCHOOL AGED CHILDREN (2-12YEARS) IN RURAL AND URBAN AREAS OF EBONYI STATE.

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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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