See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/310458794 Results From Ghana's 2016 Report Card on Physical Activity for Children and Youth Article  in  Journal of Physical Activity and Health · November 2016 DOI: 10.1123/jpah.2016-0272 CITATIONS READS 17 414 9 authors, including: Reginald Ocansey Richmond Aryeetey University of Ghana University of Ghana 37 PUBLICATIONS   1,594 CITATIONS    197 PUBLICATIONS   2,482 CITATIONS    SEE PROFILE SEE PROFILE Seidu Sofo Delali Badasu Southeast Missouri State University UNIVERSITY 62 PUBLICATIONS   612 CITATIONS    30 PUBLICATIONS   280 CITATIONS    SEE PROFILE SEE PROFILE All content following this page was uploaded by Seidu Sofo on 18 November 2016. The user has requested enhancement of the downloaded file. Journal of Physical Activity and Health, 2016, 13 (Suppl 2), S165 -S168 http://dx.doi.org/10.1123/jpah.2016-0272 © 2016 Human Kinetics, Inc. ORIGINAL RESEARCH Results From Ghana’s 2016 Report Card on Physical Activity for Children and Youth Reginald Ocansey, Richmond Aryeetey, Seidu Sofo, Alex Nazzar, Margaret Delali, Prince Pambo, Vida Nyawornota, John Nartey, and Rachel Sarkwa Background: Currently, there is limited evidence on estimates for physical activity (PA) behavior and sedentary behavior (SB) in Ghana. This report card (RC) is intended to increase awareness and sensitivity about issues surrounding PA and SB in Ghana. Methods: Data were collected from peer-reviewed literature, graduate students’ theses, physical education and sports docu- ments, and a survey of opinions of stakeholders covering the 10 key RC indicators and benchmarks. The principal investigator harmonized all grades. A consensus meeting of the RC team was held to assign the final grades. Results: School and Community grades declined from a D in 2014 to an F in 2016. SB declined from B to D. Family and Active Play were not graded in 2014 and now received an F and a B, respectively. Family and Built Environment were graded F, Active Transportation received a C, and Government and Overall PA were graded D. Conclusions: A conscious national investment effort can increase overall PA among children. Keywords: transportation, exercise, policy The Republic of Ghana is a middle-income country in West Ghana’s 2016 report card (RC) is a synthesis of the available Africa. With a population of about 26 million people, Ghana is a evidence on the PA levels of children and youth and produced by rapidly urbanizing society. As a middle-income country with a free the Active Healthy Kids Ghana (AHKG).8 This RC is intended to market system, Ghana is becoming increasingly exposed to tech- increase awareness and sensitivity about issues surrounding PA and nologies and environments that contribute to health and nutrition SB of children and youth, by highlighting areas where Ghana is transition.1,2 The disease burden is on the rise and can be attributed making progress as a nation and placing emphasis on areas where to a selected number of risk factors including, but not limited to, more attention/action is needed. This is indeed a sustainable and physical inactivity and sedentary lifestyle.3 Physical inactivity and effective way of monitoring and surveilling the PA levels of chil- sedentary behavior (SB) are associated with childhood obesity and dren and youth. Thus, Active Healthy Kids Ghana (AHKG) plans are persistent risk factors for noncommunicable diseases.4,5 The to periodically develop PA report cards for routine monitoring and World Health Organization’s (WHO) 2002 report on reducing risks surveillance of healthy active living behaviors of Ghanaian children and promoting healthy life reveals that much of this burden could and youth. This way, effective strategies and interventions can be be lowered in the next 20 years if these risk factors were reduced.6 developed and implemented to fight the risks that affect the healthy Further, the WHO classifies physical inactivity as the fourth leading lives of children and youth. cause of global mortality and one of the greatest health challenges and determinants for various chronic diseases, such as heart disease, hypertension, diabetes, and psychosocial problems.7 Currently, there Methods is limited evidence on estimates for physical activity (PA) and SB This RC is a public sensitivity and awareness PA document devel- among children and youth in Ghana. The meager data obtained oped by AHKG and under the auspices of 12 experts from multi- for the development of this report present major challenges for disciplinary areas in government ministries (n = 7), nongovernment the development of effective strategies to combat these risks and organizations (n = 2), and institutions of higher learning (n = 3). establish monitoring and surveillance mechanisms to appropriately 8,9 Self-report data were collected through a survey of the opinions of assess and evaluate strategies and interventions. key stakeholders in public health (n = 5), sports and exercise science (n = 8), town and country planning (n = 2), local government (n = 2), and physical education (PE) and sports (n = 10). Data for the 2016 RC were collected from sources, including Ocansey, Nazzar, Nartey, and Sarkwa are with Active Living &Wellness peer-reviewed literature, published/unpublished graduate students’ Alliance Group, Research & Education Center, Nungua, Ghana. Aryeetey theses/dissertations,8,10–12 school PE/sports documents and syllabi— is with the School of Public Health; Delali is with the Regional Institute of all relating to PA among Ghanaian children. No year limits were Population Studies; University of Ghana, Legon, Ghana. Sofo is with the observed for the document search. The peer-reviewed literature Dept of Health and Human Services, Southeast Missouri State University, search was, however, limited to 1975 through 2015. Only 3 new Cape Girardeau, MO, USA. Pambo is with the National Sports Authority documents (from the Ghana Statistical Service and the Ministry Medical Directorate, Accra, Ghana. Nyawornota is with Labone Senior of Roads and Highways, Ministry of Health, and the Journal of High School, Accra, Ghana. Ocansey (rocansey@gmail.com) is corre- Physical Activity and Health) were added for the development of sponding author. the 2016 RC.3,8,9,13 S165 S166 Ocansey et al The self-report data were collected through a survey of Table 1 Grades According to Physical Activity the opinions of key stakeholders. The survey contained the key Indicator in the 2016 Ghana Report Card on Physical benchmarks for each indicator. Stakeholders completed the survey Activity for Children and Youth by grading each benchmark under each of the 10 indicators. The principal investigator harmonized the benchmark grades from the Indicator Grade stakeholders’ self-reports and assigned a grade for each indicator. Overall Physical Activity Levels D Thereafter, consensus meetings were held by the RC PA team via Organized Sport Participation C online and face-to-face platforms to discuss the grades from the stakeholder survey data, literature published between 2014–2016 Active Play B and other documents and reports. Through discussions and consen- Active Transportation C sus agreements, the final grades were assigned. Sedentary Behaviors D The tools, benchmarks, and indicators included in the survey for the key stakeholders and the development of the current Ghana- Family and Peers F ian RC were based on those reported in the 2013 and 2014 Active School—infrastructure, policies and programs D Healthy Kids Canada reports.14,15 The grades according to PA Community and the Built Environment F indicator in the 2016 Ghana RC on PA for children and youth are Government Strategies and Investments D displayed in Table 1. The front cover for the 2016 Ghana RC is presented in Figure 1. Note. The grade for each indicator is based on the percentage of children and youth meeting a defined benchmark: A is 81% to 100%; B is 61% to 80%; C is 41% to 60%, D is 21% to 40%; F is 0% to 20%; INC is Incomplete data. Results and Discussion The 2016 Ghana RC findings are similar to that of the 2014 Ghana RC. No changes in PA levels were observed. Of the 9 indicators, 3 were assigned a grade of D and 2 were assigned a grade of C. The best performing indicator was assigned a grade of B. Three remaining indicators were assigned a grade of F. Table 1 shows all grades according to RC indicator in the 2016 Ghana RC on PA for children and youth. Overall Physical Activity Levels: D The grade D assigned to this indicator is based on documented reports and research on PA levels of Ghanaian children, all of which reported that less than 40% of Ghanaian children accrue adequate levels of PA.12,16–20 The existing evidence suggests that over 60% of Ghanaian children do not meet minimum levels of PA for health- enhancing benefits. Organized Sports Participation: C A C grade was assigned to Organized Sports Participation based mainly on documentation obtained from the Ghana Education Ser- vice (GES)18–20 pertaining to sporting activities commonly organized by GES at various levels, including school, zonal, district, regional, national, and community levels. School-level sports participation is within school and includes interclass and interhouse games. Zonal level sports participation is interschool and includes groups of schools assigned to zones. Qualifying schools advance to district-, regional-, and national-level sports participation, respectively. In addition, the GES reports provide evidence indicating that school PE is biased with sports and games activities.10,18–20 Active Play: B Active Play emerged with the highest grade assignment (B). Unlike the incomplete (INC) grade assignment in 2014, new evidence emerging from interviews and self-reports obtained from school teachers and not-for-profit organizations (that emphasize learning through play) influenced the grading of Active Play in the current RC. Self-reports from school settings revealed that, where playtime was enforced, children engaged spontaneously in a wide range of local active games. Considering the persistent active nature Figure 1 — Front cover of the 2016 Ghana Report Card. JPAH Vol. 13, Suppl. 2, 2016 Downloaded by on 11/17/16, Volume 13, Article Number 11 Suppl 2 2016 Ghanaian Report Card S167 of cultural games among Ghanaian children, including ampe children and youth. Limited research exists on built environment. and tumatu (both involve active jumping while playing), it is not A street level audit of environment barriers to PA in Accra revealed uncommon to see children engage in these games during school significant environmental barriers to outdoor PA.11 The barriers break periods. However, in the future, active play may be limited are mainly due to either the absence of sidewalks, poor access to by the increasing absence of playing areas in schools and playtime sidewalks, or poor conditions of sidewalks. More rapid real estate on school timetables, although having a playing field has been development and commercialization of living spaces makes it more a requirement for operating a school since colonial times. More difficult to achieve PA goals. These findings necessitated a grade research is needed in this area. of F for this indicator. Active Transportation: C Government—Strategies, Policies, Investments: D A C grade was assigned to this indicator based on 1 study12 reporting The Ministry of Education has no policy on school physical educa- that 36% of high school students walked or biked to school. Another tion and sports, but it biannually organizes national competitions for study reported that 53% of school children were attending schools basic and senior high schools in the country as a whole. Government that were less than 1 kilometer from their place of residence while syllabi18–20 and requirements (not policies) exist for participation 17% had their school located at distances between 1 and 2 kilome- in PE in Ghanaian schools. ters. Only 7% were living 5 or more kilometers from their school. A majority of students (74%) walked to school on foot, while 7% Strengths and Limitations commuted by bicycle. The situation is similar for the return journey from school.21 More recent data showed that less than 30% of basic This current Ghana RC on the PA of children and youth relied mainly school pupils were transported in an automobile to school every on the meager evidence available. Only 1 new report was added day. Further evidence suggested that active transportation persisted to the data gathered for the 2014 RC. A more comprehensive and in rural communities even more so than in urban. For example, in systematic approach is needed to expand the literature search and rural Upper West, 87% of children went to school on foot while the discovery of pertinent policy documents and reports on PA for in rural Upper East and Northern regions, 86% and 81% went to children and youth. Obtaining opinions of key stakeholders through school on foot, respectively. In urban Greater Accra only 64%of self-report augmented data from the peer-reviewed publications and children went to school on foot.13 documents. This is a major strength of the report. Furthermore, the diversity of expertise in the RC working group Sedentary Behaviors: D and the key multidisciplinary nature of the stakeholders drawn from different areas in the country added tremendously to the strength For Sedentary Behavior, a grade of D was assigned based on of the report. research evidence12 and the 2012 Ghana School Health Survey,22 A major limitation was the lack of nationwide representative which indicated that between 20% and 70% of children and youth data. Available evidence is seriously scant. There is a need for more were sedentary. Children attending private schools are more sed- studies focusing on PA of children and youth in Ghana. Negligible entary and more likely to be transported in a car to school, use a evidence exists in universities on the PA levels of children and computer often, and watch television more frequently and for longer youth. Future research in the universities in Ghana on PA will go a hours.12,22 There are currently no national guidelines on screen time long way toward laying the foundation for future use of larger and or sedentary behavior in general in Ghana. more representative samples from around the country, including both urban and rural populations. Family and Peers—Infrastructure, Support, Parental/Peer Behaviors: F Conclusion This indicator was graded F based on meager evidence obtained through self-report (surveys) from fitness-related organizations, Even though both the 2014 and the 2016 Ghana RC revealed low families, and children. There is increasingly limited opportunity levels of overall PA, there is still inadequate effort to constructively for families to engage in community walks, active play, and other develop and introduce effective interventions to improve the situ- forms of active transportation. Experts considered that household ation. For example, the absence of PE and sports policies, and the chores, occupational engagement, and communal living constitutes inadequacy of programs and PE teaching periods on school time- family and peer influence on PA. However, this often occurs in rural tables, are major concerns that pose serious challenges for surveil- areas and to a limited extent in urban areas. lance and monitoring in PA settings. There is a need for investment in monitoring and surveillance of PA and the development of SB guidelines for Ghanaian children and youth. The grades as reported School—Infrastructure, Policies, and Programs: D in the 2016 Ghanaian RC should be treated with caution due to the There are limited data on school environment for PA. The 1 available very limited evidence base on which they were based. study12 indicated that 49% of private schools and 57% of public The situation of inadequate PA evidence for children and schools had spacious playgrounds for children and youth and thus youth persists from the 2014 RC.8 The existing evidence on PA the indicator was assigned a D grade. behavior among children is terribly limited. Therefore, there is an urgent need for investing in primary research that will generate Community and the Built Environment— population-based evidence. Such research must be designed to be Infrastructure, Policies, Programs, Safety: F representative of differences across rural and urban areas, in-school and out-of-school children, and across other vulnerability groups, There are no national guidelines or recommendations for com- particularly children and youth exposed to child labor. The 2016 munity built environment to promote PA behavior for Ghanaian RC further calls for investment in routine monitoring in addition to JPAH Vol. 13, Suppl. 2, 2016 Downloaded by on 11/17/16, Volume 13, Article Number 11 Suppl 2 S168 Ocansey et al the primary research in PA and its determinants among Ghanaians, 10. Ocansey R, Seidu S, Jatong J. Physical education and after-school with particular focus on children and youth. sport programs in Ghana: The role of public and private structures. In: Chepyator-Thomson JR, Hsu S, eds. Global Perspectives on Physical Acknowledgments Education and After-School Sports. 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The Development of Education PubMed doi:10.1123/jpah.2014-0177 in Ghana. London: Longman; 1975. JPAH Vol. 13, Suppl. 2, 2016 View publication stats Downloaded by on 11/17/16, Volume 13, Article Number 11 Suppl 2