Prevalence of Overweight and Obesity in Pre-School Children at La Nkwantanang-Madina Municipality

Abstract

Background Overweight and obesity epidemic has become one of the most urgent global health challenges of the 21st century. Studies have shown that over ten times more children and adolescents were obese in the year 2016; 124 million compared to the year 1975; 11 million, according to findings by (WHO, 2017). Overweight and obesity is understood to be imminent before reception year at school thus at 8 months prevalence could be determined (Perry, Thurston, & Arch, 2016). Currently the rate of overweight and obesity is not only related to develop industrialized countries but also to developing countries as well. This study was conducted to determine the prevalence of overweight and obesity in preschool children at the University of Ghana Basic School, Legon and Baby Nest School, Legon. Methods A cross-sectional study was carried out from 1st June to 6th July, 2018 at University of Ghana Basic School (public) and Baby Nest, Legon (private) in the La Nkwantanang-Madina Municipality. Random sampling was used to select 201 pre-schoolers out of a population of 332. Children were at exact age 2, 3, 4, and 5 years at last birthday. A combination of self and interviewer administered questionnaire was used to collect data on food frequency and 24 hour recall; WHO Global Physical Activity Questionnaire (G-PAQ); Child Eating Behaviour Questionnaire (CEBQ) and Anthropometric measurement (weight and height). Data obtained from the structured questionnaire; food frequency and child eating behaviour questionnaire (CEBQ) was analysed using Stata statistical package version 15.0 StataCorp LLC to generate frequencies, percentages and means (standard deviations). The child eating behaviour questionnaire was analysed by using a five-point Likert scale. Anthropometric measurement – weight (kg) and height (cm) was classified using the WHO Child Growth Chart cut-off point for age-and-sex (WHO, 2007). Assessment of 24-hour recall was done using the nutritional guidelines of WHO healthy diet fact sheet (2015). Associations between dietary habits, physical activity, sociodemographic characteristics and, overweight and obesity was tested using bivariate and multiple logistic regression model. Statistically significant p-values; p<0.001 and p< 0.05 was noted in the final regression model. Informed consent was sought from the caregivers of the children whilst ethical clearance was taken from the Ghana Health Service (reference number GHS-ERC: 039/01/18). Results The study revealed an overall prevalence of normal weight, overweight and obesity respectively 90.1%, 1.5% and 8.4%. Overweight and obesity was higher in private schools than public schools. The prevalence of overweight was 3% and obese children was 11% respectively. None of the selected participants at the public School was overweight however, the prevalence of obesity was 6% and normal weight was 94%. Girls reported a higher overweight and obesity prevalence 11.7% than boys 7.8%. The study showed that children in nursery two had 70% less likelihood of being overweight or obese compared to preschool children in nursery one (OR = 0.3; 95% CI = 0.1 – 0.8). Consequently, children who ate fruits in between meals instead of snack showed an 80% reduction in the odds of being overweight or obese compared to children who took in snack. (OR = 0.2; 95% CI 0.04 - 0.8). Children found overeating even when full had an increased odds of being overweight or obese [(OR = 3.9; 95% CI = 1.3 - 11.3), p = 0.01]. In the same vein, care givers who preferred their children to be eating all the time had significantly 9 times the odds of being overweight or obese [(OR = 9.0; 95% CI = 1.8 - 45.9), p = 0.008]. Finally, slightly over 38% children engaged in moderate physical activity for at least thirty (30) minutes, a minimum of one to two times a week whilst nearly 40% of children engaged in vigorous physical activity for at least sixty (60) minutes, a minimum one to two times a week. Conclusion At the end of the study, it was found that overweight and obesity persist in public and private school at Legon; 1.5%, and 8.4% respectively. The study further revealed that there was a higher prevalence of overweight and obesity in private schools than in public schools and that sex difference in prevalence was higher in girls than in boys. This indicated on the one hand that there are contemporary changes in the Ghanaian food system, the social environment, and the consequent dietary and lifestyle practices therein contributing to increasing obesity and diet-related NCDs in vulnerable groups. It further suggested that child and adolescent risk of developing NCDs is worsened by malnutrition, often beginning from early childhood years. These prevalence rate could also be explained by the higher socioeconomic status of parents and the urban lifestyle along with parent-child dietary lifestyle. Ghana Education Service should collaborate with Ghana Health Service in ensuring that schools engage the services of nutritionist or dietician to assist in promoting nutritional knowledge among care givers to entail addressing the poor dietary practices. This could be done during Parent Teacher Association Meetings (PTA) and organizing periodic educational training sessions for parents, care givers and staff. Care-givers and schools should be responsible for determining the activities that children engage in during their free time, and to create an active lifestyle in the home and at school that will minimize sedentary behaviours. Schools should provide display learning materials on healthy living on classroom walls and canteens to inculcate early behaviour modification to promote healthy lifestyle.