Magnitude of overweight and obesity and associated factors among first cycle primary school children in DireDawa town, Eastern Ethiopia.

Conference place: Desalegn Hotel By: Mohammed Abdulahi( MPH) , Birhanu Seyoum (PhD) , Gudina Egata (PhD)

Content

• Introduction

• Objectives

• Methodology

• Results and discussion

• Conclusion and recommendation

• Acknowledgement

Introduction─ Childhood overnutrition (overweight and obesity) has

become a major public health concern in many industrialized countries

(Low et al., 2009, WHO, 2013)• Globally , 10% of school age children aged 5-17 years were

overweight, out of which 2-3% were obese

─ Emerging as a threat to the public health in low- income –countries

─ Evidence from these settings revealed that the prevalence of overweight and obesity ranged from 1.2% to 17.4%

(Bharati et al., 2008 , Caleyachetty et al., 2012, Mogre et al., 2013)

Introduction . . . .• Some factors associated with overweight/ obesity among school

children included: -─ Higher parental socio-economic status (SES), parity

(McDonald et al., 2009 , Mushtaq et al., 2011)─ Children born to overweight/obese parents

(McDonald et al., 2009) Lazzeri et al., 2011,Bhuiyan et al., 2013,,

─ Consumption of energy-dense foods that are high in fat, salt and sugars

(Matthews et al., 2011, WHO, 2013, Salawi et al., 2014)─ Decreased physical activity

( WHO, 2013, Bhuiyan et al., 2013}

• However, there is limited information on the extent of overnutrition among first cycle primary school children in developing countries like Ethiopia.

Conceptual framework

ObjectivesGeneral objective

• To assess the magnitude of overweight and obesity and associated factors among first cycle primary school children in DireDawa Town East Ethiopia from February 25 to March 14 , 2014

Specific objectives

• To determine the magnitude of overweight and obesityamong first cycle primary school children

• To identify factors associated with overweight and obesityamong first cycle primary school children

Methodology• Study setting

─ DireDawa is situated at 515 km east of Addis Ababa.

─ Has a population of 341,834, of which 171,461 are men and 170,461 women;

─ 233,224 or 68.23% of the population are urban inhabitants [CSA, 2007].

─ Are schools 27 public and 33 private primary schools in DireDawa Town in 2013/14 academic year, containing 14,935 and 8,535 first cycle school children respectively

Study design and sample size

• A school based cross-sectional study was conducted on a total of 484 randomly selected first cycle primary school children

• Sample size was calculated using Open Epi -Epidemiologic calculator using single population proportion with the following assumptions (for objective I) :

Sample size assumptions (objective I)

• estimated prevalence of overweight/obesity to be 17.4% (Mogre et al., 2013) ,

• 95% confidence level to be 1.96 ,

• 5% margin of error, and

• 10% for non - response yielding a total sample size of 243

Sample size assumptions (objective II)

• Double population proportion formula with the following assumptions:

─ prevalence of overweight and obesity among exposed children to be 38%, 20% among unexposed group to capture factors associated with overnutrition (Mushtaq et al., 2011 )

─ 95% Confidence interval, Power of 80%, and

─ 10% non - response giving the final sample size of 484 for both groups which was used in this study.

Sampling procedures

Data collection

• A structured questionnaire:

─ adopted from WHO step instrument for chronic disease risk surveillance

─ Global physical activity questionnaire analysis guide

─ related studies

─ prepared in English then translated in to local language (Amharic, Afan Oromo and Somali)

Data collection . . . .

• Portable electronic weight scale with a digital screen designed and manufactured under the authority of UNICEF , and

• Commercial standiometer were used to collect anthropometric data

Study variables • Dependent variable:

─ Overnutrition (overweight / obesity)

• Independent variables:

• Parental demographic and socioeconomic characteristics :

─ income, occupation, family size, educational status,

• Parenting style and Family characteristics:

─ parent’s food preference, types of food available at home, parent encouragement of child activity and parent monitoring of child sedentary behaviour

• Child’s characteristics :

─ sex, age, energy intake (energy-dense nutrient poor foods, sugared and non-diet soft drinks), energy output (physical activity and sedentary behaviour)

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Operational definition

• First cycle primary School students: refer to those children attending grade 1 to 4 in any public or private primary schools in DireDawa town.

• Overnutrition: refers to overweight (BMI >+1 SD to < +2SD) and obesity (BMI >+2 SD) among school children

• Sedentary behavior: the time spent inactively by watching TV/playing video game/computers

• Severe thinness: BMI for age less than -3SD (WHO, 2007)

Data processing and analysis

• Data were double entered on to Epi data version 3.02 by data clerk and exported to SPSS version 20.0 for further data analysis

• Height, weight, age and sex of the study participants were used to calculate BMI for age

• Overnutrition was determined using Body Mass Index (BMI) - for-age Z-scores based on WHO) cut offs for 5 -19 years of age

Data processing and analysis . . . .

• Descriptive, bivariate and multivariable logistic regression analyses were done to analyze the data

• Odds ratio along with 95%CI was estimated to identify factors associated with overnutrition

• Level of statistical significance was declared at p-value (p<0.05)

Data quality control

• Training of data collectors and supervisors

• Pretest of the questionnaire

• Calibration of anthropometric instruments after

each measurement

• Supervision of data collection process

• Cross – checking of the questionnaire for its

completeness on daily basis

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Ethical clearance • Ethical Review Committee of Haramaya

University, College of Health and Medical Sciences

• Letter of cooperation was written from Education Bureau to selected primary schools

• Informed verbal and written consent was obtained from parents of each respondent before data collection

• School children were also informed about the study

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Result and Discussion

• Of 484 study participants initially sampled in the study,446 have participated in the study making a responserate of 92%

• The overall magnitude of overnutrition was [20% ;95%CI (16.4 , 23.8)] of which overweight was[15.5% ; 95% CI (11.9 , 19.3 )] and obesity was[4.5% , 95% CI ( 2.7 , 6.5 ) ].

[Combined prevalence of overnutrition in Kenya=19% (Kyallo et al., 2013)], Turkey (14.3%, 6.5% ), Columbia (11.1 and 1.8%,), Nigeria (11.4% and 2.8%, ), South Africa (15.7% overweight and 6.2% )

Result and Discussion . . . .

Result and Discussion . . .

Result and Discussion . . .

Result and Discussion . . .

Result and Discussion . . . .• Children who learn at private schools are 2 times more

likely to be overnourished compared with their counterparts [ (AOR=2.5, 95%CI= (1.21-5.09)]. ( Nairobi , Kyallo et al., 2013), Turkey , (Kaya et al).

• Children who often eat sweets are 3 times more likely to be overnpurished compared with those who seldom eat sweets [(AOR=3.56, 95% CI= (1.78-7.10)] - ( Canada , Salawiet al., 2014)

• Children who do not participate in sport or physical activity are 3 times more likely to be overnourishedcompared with their counterparts [(AOR=3.47, 95%CI= (1.6-7.53)] - (Veugelers and Fitzgerald, 2005 ,Bharati et al., 2008)

• Children who watch Television / play video games > 2 hours per day were 2 times more likely be overonurished compared to those who watch/play < 2 hours per day [(AOR=2.28, 95%CI= (1.22-4.27)) - (Netherland ,Jong et al., 2013)

Conclusion and Recommendation• The magnitude of overweight/obesity is high

among the study population .

• Learning in private schools, consumption ofsweet food items, frequent watching oftelevision / video games, and sedentary activitywere significantly contributed to overnutrition.

• Awareness must be created on the risingmagnitude of overweight/obesity and associatedfactors among the study participants , schoolteachers , parents , and other relevant actors toovercome the problem

Acknowledgement

• Haramaya University

• DireDawa city administrators

• Primary school directors

• Data enumerators and supervisors

• Study participants and their parents

• Others relevant bodies

Thank You !