|Year : 2015 | Volume
| Issue : 2 | Page : 107-114
Pattern and determinants of the weight status of school-age children from rural and urban communities of Osun state, Nigeria: A comparative study
Adeleye Abiodun Adeomi1, Oluwatosin Adediran Adeoye1, James Olusegun Bamidele2, Olugbemiga Lanre Abodunrin3, Olusola O Odu2, Olaitan Abolanle Adeomi4
1 Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
2 Department of Community Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
3 Department of Community Medicine, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Oyo State, Nigeria
4 Department of Nematology, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
|Date of Web Publication||4-Aug-2015|
Oluwatosin Adediran Adeoye
Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State
Source of Support: None, Conflict of Interest: None
Background: Owing to progressive urbanization and the associated changes in lifestyle, childhood overweight/obesity is becoming a challenging problem in many emerging countries while malnutrition is far from being over. This study, which was carried out in the school setting, therefore, aimed to compare the pattern and determinants of the weight status of school-age children from rural and urban communities of Osun State, Nigeria.
Methodology: A total of 300 respondents each was selected from a rural and an urban community using multi-stage sampling technique. Information from respondents was obtained using pretested semi-structured questionnaires and their weights and heights were measured and used to calculate their body mass index (BMI). Data collection was done from September to December, 2013. The BMI was used to classify them into those underweight, normal and overweight/obese using the IOTF criteria. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 16.
Results: The children differed significantly in their nutrition history and activity patterns according to their residence. With the IOTF criteria, the prevalence rates of underweight and overweight/obesity in the children from rural communities were 36.7% and 0.0% respectively; and 17.3% and 9.7% in the children from urban communities, respectively.
Conclusion: Underweight is still a major problem among school-age children in Osun State, especially for those living in rural communities. There is also a rising trend of overweight/obesity in the urban communities in the State. A comprehensive school health program for the primary schools with emphasis on good nutrition is hereby recommended.
Keywords: Rural, school-age children, urban, weight
|How to cite this article:|
Adeomi AA, Adeoye OA, Bamidele JO, Abodunrin OL, Odu OO, Adeomi OA. Pattern and determinants of the weight status of school-age children from rural and urban communities of Osun state, Nigeria: A comparative study. J Med Nutr Nutraceut 2015;4:107-14
|How to cite this URL:|
Adeomi AA, Adeoye OA, Bamidele JO, Abodunrin OL, Odu OO, Adeomi OA. Pattern and determinants of the weight status of school-age children from rural and urban communities of Osun state, Nigeria: A comparative study. J Med Nutr Nutraceut [serial online] 2015 [cited 2018 Dec 9];4:107-14. Available from: http://www.jmnn.org/text.asp?2015/4/2/107/151800
| Introduction|| |
Thirty years ago, the focus of international nutritionists was on childhood malnutrition and the related problem of how to feed the world's burgeoning population, especially the children.  Today, the World Health Organization finds itself needing to deal with the new pandemic of obesity and its accompanying noncommunicable diseases, while the challenge of childhood malnutrition is still far from being over. 
Deficiency in macro- and micronutrients has been the major problem among children in low-income countries for many years. ,, Nevertheless, owing to progressive urbanization, economic growth and the associated changes in lifestyle, the energy balance is shifting;  childhood overweight and obesity is becoming equally challenging, yet under-recognized, problem in many emerging countries. ,,,,,, Childhood overweight/obesity was previously a health problem for developed countries because of their high calorie foods, labor-saving devices and dwindling levels of physical activity, but it is now spreading to developing countries. These countries are now reporting unprecedented levels of childhood obesity with substantially rising trends every year.  This epidemic of obesity sits alongside the problem of undernutrition in many developing countries thereby creating a double burden of nutrition-related ill health among children, ,,, which has been more appropriately referred to as the "double burden of malnutrition (DBM)." 
de Onis et al.  did a systemic analysis in the year 2000, on nationally representative data derived from surveys conducted in developing countries and found that nearly one-third of the children in the developing world were either underweight or stunted and more than 30% of them suffered from micronutrient deficiencies.  The United Nations University in collaboration with UNICEF in the year 2000 reported that more than 200 million school-age children are stunted and if no action is taken, and at this rate, about 1 billion stunted school children will be growing up by 2020 with impaired physical and mental development.  According to Wang and Lobstein,  the prevalence of overweight and obesity among school-age children is rising in almost all industrialized countries for which data are available, and in several lower-income countries.
Until now, most national public health programs and policies, as well as national-level research on children of low-and middle-income countries, have focused on undernutrition and its effects on the survival and mortality of mothers and children. However, based on current knowledge and extrapolation from studies carried out in adults and high-income countries, it may be more appropriate to consider childhood overweight/obesity and its complications, in addition to nutritional deficiencies. 
This study therefore aimed at describing the pattern and finding out the determinants of the weight status of school-age children from a rural and an urban community in Osun State, Nigeria. It further compared the weight status and the determinants in rural and urban communities.
| Methodology|| |
This was a comparative cross sectional study, carried out among school-age children attending primary schools in Osun State, Southwestern Nigeria. The multi-stage sampling technique was used to select 300 respondents each from selected rural and urban communities in Osun State, and data were collected with pretested, semi-structured questionnaires which were interviewer administered. Data collection was done from September to December, 2013. Data were collected by authors and research assistants at the schools attended by these children.
The instruments for anthropometric measurements were the Seca ® electronic bathroom weighing scale for measuring weight in kilograms (kg). Height was measured with a stadiometer. From these, the body mass index (BMI) was calculated, defined as body weight in kilograms divided by the square of height in meters (kg/m 2 ), and used as the measure of weight status in this study.
The weight of each pupil was measured in their underclothes, barefoot and the pupils stood still without support, and a research assistant of the same sex took the measurements for privacy, especially for the older children. Measurements were taken to the nearest tenth of a gram. The height of each pupil was taken as the maximum vertical distance from the floor to the highest point on the skull (i.e. the vertex) when the head is held in the Frankfort plane. The pupils stood erect, barefoot, heels together, both heels touching the base of the stadiometer and arms hanging freely by the sides. Measurements were taken to the nearest tenth of a centimeter. Measurements were taken in the mornings (between 8 a.m. and 12 p.m.), and the measurement recorded was the mean of three readings.
The frequencies of consumption of some selected food groups in the week preceding the survey were also scored. For food groups considered healthy such as fruits, vegetables, meats, fish, egg and starchy foods/tubers; those who did not take the food group at all were scored 0, <3 times were scored 1, >3 times were scored 2 and daily/more than once daily were scored 3. For food groups considered unhealthy like food from eateries, pastries, sugar sweetened drinks and sweets; those who did not take the food group at all were scored 3, <3 times were scored 2, >3 times were scored 1 and daily/more than once daily were scored 0. All these scores were added and the mean calculated was 18.49 (range: 9.0-28.0). Those who scored less than the mean were regarded as having unhealthy food patterns while those who scored up to or above the mean were regarded as having healthy food patterns.
The activities of the respondents were also scored. Those who went to school on foot or bicycle, helped in parents' business, involved in house chores, involved in vigorous sports 3 or more days a week, slept 10 h or less daily and spent 2 h or less for media consumption were scored 2 each for all these activities, others were scored 1. All these scores were added and the mean calculated was 11.59 (range: 7.0-14.0). Those who scored less than the mean were regarded as having sedentary lifestyles while those who scored up to or above the mean were regarded as having active lifestyles.
The questionnaires were sorted out, entered into a computer and the obtained data was analyzed using SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 16.0. Chicago: SPSS Inc. Frequency distribution tables were generated from variables while cross-tabulations using Chi-square for bivariate analysis were done as applicable. t-test, analysis of variance, regression and correlation were also used in the analysis of continuous variables as appropriate. Level of significance was set with P < 0.05.
Ethical clearance for the study was obtained from the Ethical Review Committee of LAUTECH Teaching Hospital. The limitations of the study were that some of the children (especially the very young ones) found it difficult to recall their feeding patterns and socioeconomic status could not be directly assessed as income and educational background of the parents could not be assessed because of the age of the pupils.
| Results|| |
Totally 600 questionnaires were administered in all, 300 in the rural and 300 in the urban communities. All the questionnaires were completed, giving a response rate of 100%. The distribution of respondents according to religion, tribes, family setting and the number of children in the family were significantly different between the rural and urban communities (P < 0.05), as seen in [Table 1].
|Table 1: Sociodemographic profile of the respondents by their residence |
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Significantly more of the respondents in the urban community had television sets (P < 0.001), generating sets (P < 0.001), cars (P < 0.001) and air conditioner sets (P < 0.001) than respondents in the rural community. Majority of the fathers of respondents in the urban community (151, 50.3%) were skilled workers (such as professionals) while majority of those in the rural community (141, 47.0%) were semi-skilled workers (such as artisans), and this difference was statistically significant. Similarly, there was a significant difference in the mothers' occupation between respondents in the urban and rural communities.
Significantly more respondents in the urban community took fruits, sugar sweetened drinks, sweets, pastries and ate vegetables, food from eateries, meats, fish and eggs more frequently than those from the rural community, while those in the rural community consumed starchy foods significantly more frequently than those in the urban community. After the scoring and categorization of feeding patterns, majority of respondents in the urban community (175, 58.3%) had unhealthy feeding patterns, and this was significantly different for rural dwellers where majority (163, 54.3) had healthy feeding patterns (χ2 = 9.64; df = 1; P = 0.002).
Significantly more respondents in the rural areas walked to school (P < 0.001), involved in their parents' businesses (P < 0.001), involved in vigorous sports (P = 0.002), slept less (P < 0.001) and consumed less of mass media (P < 0.001). After scoring and categorizing the activity pattern of the respondents, significantly more of the respondents in the rural community lived active lifestyles (χ2 = 48.94; df = 1; P < 0.001) than those in the urban community.
The pattern of the weight status of respondents by their residence is shown in [Table 2]. The mean BMI for the children from the urban and rural communities was 16.24 ± 2.42 and 14.90 ± 2.02 respectively, and their difference was statistically significant. Using IOTF criteria, 52 (17.3%) and 29 (9.7%) were underweight and overweight/obese respectively among the urban children, while 110 (36.7%) were underweight and none were overweight/obese among the rural children.
|Table 2: Pattern of the weight status of respondents by their residence |
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The effect of sociodemographic factors on the weight status of respondents according to IOTF is as shown in [Table 3]. The weight status of the pupils was significantly associated with their age groups (P < 0.001), family setting (P = 0.018) and number of children in the family (P = 0.046), while other factors such as sex, tribe and class groups were not significantly associated with the weight status of the respondents. The weight status of the pupils was significantly associated with their parents' possession of cars (P < 0.001) and air conditioner sets (P < 0.001), and with other factors such as their school type (P < 0.001) and their parents' occupations (P < 0.001) as shown in [Table 4].
|Table 3: Effect of sociodemographic factors on the weight status of respondents |
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|Table 4: Effect of socioeconomic status on the weight status of respondents |
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The weight status of the respondents was significantly associated with their consumption pattern of all the selected food groups (P < 0.05). There was, however no significant association between the weight status of the respondents and their categorized food patterns (P > 0.05). The effect of physical activity on the weight status of respondents is as shown in [Table 5]. The weight status of the pupils was significantly associated with all the variables used to assess physical activity, except their involvement in chores at home. There was also a significant association between the weight status of respondents and their activity patterns.
|Table 5: Effect of physical activity on the weight status of respondents |
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| Discussion|| |
About two-fifth of children from the rural community were underweight, as compared to the less than a fifth of children in the urban community that were underweight. Although this prevalence is lower than the 70% and the 50% reported by Oninla et al.  in rural and urban communities of Osun State, the study similarly found that underweight rates were significantly higher among rural children than in the urban children. Fotso in 2007  similarly reported urban-rural differentials in malnutrition in Nigeria, while other researchers have also generally reported that the prevalence of malnutrition is higher in rural than urban areas. ,,
The overall prevalence rate for obesity in this study was relatively low and this corroborates the finding of previous authors who reported that the prevalence of childhood overweight and obesity was low in Nigeria. ,,, However, the prevalence was higher than what many authors had previously reported. ,,,, It is even more instructive that about 10% of the urban dwellers were overweight/obese, while there was no single case of overweight/obesity in the rural community. The prevalence of childhood overweight/obesity in the urban community is already nearing the global estimate of 10% as reported by Lobstein in 2010.  Childhood overweight/obesity therefore seems to be rising in Nigeria especially in urban communities while undernutrition is still a big nutritional problem in the country especially in the rural communities. This corroborates the DBM ,, that has been much talked about and poses a particular challenge for the government and other stakeholders in nutrition and health.
There were significant associations between many of the sociodemographic characteristics and the weight status of the children in this study. Age was found to be significantly associated with the weight status of the children such that the younger children tended to have higher rates of overweight/obesity. This corroborates the finding of Daboné et al. in Burkina Faso, were it was detected that a higher prevalence trend of overweight/obesity were found in the youngest group of children.  The gender of the children had no significant effect on the weight status, and this is contrary to what has been reported by other previous studies in sub-Saharan Africa, were gender was significantly associated with nutritional status. ,,, It is however largely unclear what the reason for this association could be, although some authors have proposed a cultural reason.
The significant relationship between family size and the weight status may not be difficult to understand. Large families will put a great strain on the family income and hence only little will remain to ensure food security for the family. Even in agrarian communities, heads of large families may be forced to sell most of the food they produce on the farm in order to take care of their large families. All these will result into limited food for the family with many mouths to feed, and the little children usually have to bear the brunt.
All the variables used to measure socioeconomic characteristics including the occupation of the parents, the school types, the possession of air conditioner sets and cars were also found to be significantly associated with their weight status. The relationship between weight status and the occupation of the parents was such that children of skilled workers were less likely to be underweight and more likely to be overweight/obese, while the children of unemployed or unskilled workers were more likely to be underweight and less likely to be overweight/obese. It was interesting to find that about 8 out of 10 overweight/obese children had a skilled worker as a father, while there was 0% prevalence of overweight/obesity among unemployed mothers. Furthermore, nearly 90% of overweight/obese children attended private schools and children whose parents possessed more expensive properties like cars and air conditioner sets were less likely to be underweight and more likely to be overweight/obese. This finding corroborates the reports by previous authors who have all highlighted the relationship between weight status and socioeconomic factors. ,,,
Concerning the children's feeding patterns and their effect on their weight status; all the food categories considered were found to be significantly associated with the weight status of the children. It was such that those who consumed the food categories for >3 times in the week preceding the survey were less likely to be underweight and more likely to be overweight/obese. This corroborates the work of Fishman et al. in 2005 where it was reported that the diets of many children in developing countries were inadequate, and that the dietary deficiencies were an important determinant of childhood nutritional status.  Many other researchers have similarly reported an association between food patterns and nutritional status of children. ,,,,
The activity patterns of the children had a significant effect on their weight status, such that the urban children who lived more sedentary lifestyles had a higher rate of overweight/obese children. This pattern has been similarly reported by various authors who have all reported activity patterns as an important determinant for childhood overweight/obesity. ,,, The extensive use of electrical/electronic appliances such as television and video games has also been shown to put children at risk of childhood overweight/obesity. , As it is important for physical exercise to be included in the school curriculum, so also is the need for parents to regulate their children's consumption of the electrical/electronic media. This will help to nip in the bud this rising prevalence of childhood overweight and obesity especially for the urban dwellers.
| Conclusion and Recommendation|| |
The prevalence rate of underweight in the rural community was 36.7% and 17% in the urban community. The prevalence rate of obesity for the urban community was 9.7%, but 0% for the rural community. Therefore, underweight is still a major problem among school-age children in Osun State, especially for those living in rural communities. There is also a rising trend of overweight/obesity in the urban communities in the State. The factors associated with these patterns of weight status among the school-age children included sociodemographic and socioeconomic factors, feeding patterns and activity patterns. A comprehensive school health program for the primary schools with emphasis on good nutrition is hereby recommended. Decision makers in primary education should also include sports as a mandatory component of primary school education in Nigeria.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]