Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the ...neighborhood and household level, in an urban poor setting in Nairobi, Kenya.
Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.
Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.
The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.
Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, ...consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.
This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.
Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.
A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.
This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.
CRD42013004399.
To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities.
A qualitative study using participatory photography ...(Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the 'stories' of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches.
Three low-income areas of Nairobi (
48) in Kenya and Accra (
62) and Ho (
32) in Ghana.
Adolescents and adults, male and female aged ≥13 years.
The 'people' who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members' food preferences, (2) considerations for family members' health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors' services and social qualities.
The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.
We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 ...males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.
•Food safety, physical distance and affordability were important influencers of diet.•Home gardening helps make healthy, safe food more accessible to households.•Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods.•Policies to enhance food safety in neighbourhood environments are required.•Food pricing policy/social protection could make healthy, safe foods more affordable.
High levels of sedentary behaviours have been independently associated with several negative health indicators, including obesity. Screen time (ST) is often used as a contributing measure of ...sedentary time. It is recommended that children spend no more than 2 hours on recreational sedentary screen-based activities daily. We describe screen-based sedentary time of urban school children and examine the associations between body mass index (BMI) and percent Body Fat (%BF) with ST levels.
Data were collected from 563 children aged 9 to 11 years attending 29 non-boarding primary schools in Nairobi, Kenya, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Data were analysed to test for associations between ST and sex, type of school attended (public verses private), Socioeconomic status, adiposity, and access to electronic devices. We also assessed participants' ST on school and weekend days.
Of the participants recruited, 15.5% had high ST levels, 67.9% spent no more than 2 hours in recreational screen activities on school days while 74.2% did not meet the guidelines on weekend days. Participants sex was associated with daily ST (t = 3.5, p<0.001), ST on the weekend (t = 3.9, p <0.001) and total ST per week (t = 3.5, p<0.001) with males having higher ST than females. ST was associated with type of school for daily ST (t = 3.6, p <0.001), ST on the weekend (t = 4.5, p<0.001) and total ST per week (t = 3.6, p<0.001) where private schools pupils had higher ST. ST was not associated with BMI. ST was not associated with %BF except on weekend days (p = 0.038) where those classified as overfat/obese (fat) had higher ST.
A large proportion of children spend more time than recommended on screen activities particularly on weekend days. Strategies to improve healthy living should focus on the reduction of sedentary ST for school-aged children.
To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context ...of nutrition transition.
Systematic review and meta-analyses, including six online databases and grey literature, 1971-2018 (Protocol CRD42017067718).
Urban Ghana and Kenya.
Population-based studies of healthy adolescents and adults.
The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out.
Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets.
Recent physical activity (PA) and fitness transitions, identified as behavioural shifts from traditionally active lifestyles to more industralised and sedentary lifestyles, have been observed among ...school-aged children. There is a wealth of supporting evidence of such behavioural transitions in high income countries; however, a paucity of data on lower income countries exists. These transitions pose a particular threat to the welfare of children by accelerating the onset of chronic diseases. This systematic review investigated the evidence for a PA and fitness transition among Sub-Saharan Africa's school-aged children. Temporal trends and correlates of PA, SB, and fitness were examined. Studies were identified by searching the Medline, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases, and were included if they measured outcomes of interest in apparently healthy samples of children (5‒17 years). A total of 71 articles met the inclusion criteria (40 informed PA, 17 informed SB, and 37 informed fitness). Vast heterogeneity in study methodology complicated analysis of transitions over time and no temporal trends were immediately discernible. However, higher socioeconomic status, urban living, and female children were found to engage in lower levels of PA, higher SB, and performed worse on aerobic fitness measures compared to lower socioeconomic status, rural living, and male children. Data revealed that urbanization was associated with a trend towards decreased PA, increased SB, and decreased aerobic fitness over time. Representative, temporally sequenced data examining a PA and fitness transition are lacking in this region (PROSPERO Registration Number: CRD42013004399).
Childhood overweight/obesity and inadequate physical activity burden Western countries, and now, pose a growing threat to the health of children in low and middle income countries. Behavioural ...transitions toward more sedentary lifestyles coupled with increased consumption of high calorie foods has resulted in rising proportions of overweight/obesity and decreasing levels of physical activity in school-aged children. The objective of this study was to determine the prevalence and to investigate factors associated with overweight/obesity and physical activity in Kenyan children aged 9 to 11 years.
Body composition and physical activity measures of participating children were accomplished by anthropometric assessment, accelerometry, and administration of questionnaires related to diet and lifestyle, and the school and neighbourhood environments. Data collection was conducted in the city of Nairobi as part of a larger International Study of Childhood Obesity, Lifestyle and Environment.
A total of 563 participants (46.5% boys, 53.5% girls) were included in the analyses. Of these, 3.7% were underweight, 14.4% were overweight, and 6.4% were obese based on WHO cut-points. Mean daily sedentary time was 398 minutes, time spent in light physical activity was 463 minutes, and time spent in moderate-to-vigorous physical activity was 36 minutes based on activity cut-points developed by Treuth et al. Only 12.6% of participating children were meeting the recommendation of ≥ 60 minutes of daily moderate-to-vigorous physical activity, and 45.7% of participants used active transportation to/from school. Increasing parental education level, total annual household income, and attending a private rather than public school were associated positively with being overweight/obese and negatively with meeting physical activity guidelines.
This study provided the evidence for an existing prevalence of childhood overweight/obesity in Nairobi. Children were spending a considerable amount of time in sedentary and light intensity physical activity, with few meeting physical activity guidelines. Higher socioeconomic status and parental education attainment were associated with a higher likelihood of children being overweight/obese and a lower likelihood of children meeting the physical activity recommendations. Interventions and strategies should be attentive to the potential health consequences of lifestyle transitions resulting from urbanisation and economic prosperity.
Globally, the high prevalence of overweight and low levels of physical activity among children has serious implications for morbidity and premature mortality in adulthood. Various parental factors ...are associated with childhood overweight and physical activity. The objective of this paper was to investigate relationships between parental education or overweight, and (i) child overweight, (ii) child physical activity, and (iii) explore household coexistence of overweight, in a large international sample.
Data were collected from 4752 children (9-11 years) as part of the International Study of Childhood Obesity, Lifestyle and the Environment in 12 countries around the world. Physical activity of participating children was assessed by accelerometry, and body weight directly measured. Questionnaires were used to collect parents' education level, weight, and height.
Maternal and paternal overweight were positively associated with child overweight. Higher household coexistence of parent-child overweight was observed among overweight children compared to the total sample. There was a positive relationship between maternal education and child overweight in Colombia 1.90 (1.23-2.94) odds ratio (confidence interval) and Kenya 4.80 (2.21-10.43), and a negative relationship between paternal education and child overweight in Brazil 0.55 (0.33-0.92) and the USA 0.54 (0.33-0.88). Maternal education was negatively associated with children meeting physical activity guidelines in Colombia 0.53 (0.33-0.85), Kenya 0.35 (0.19-0.63), and Portugal 0.54 (0.31-0.96).
Results are aligned with previous studies showing positive associations between parental and child overweight in all countries, and positive relationships between parental education and child overweight or negative associations between parental education and child physical activity in lower economic status countries. Relationships between maternal and paternal education and child weight status and physical activity appear to be related to the developmental stage of different countries. Given these varied relationships, it is crucial to further explore familial factors when investigating child overweight and physical activity.
Single motherhood exposes women to poorer socioeconomic and health outcomes, which may also negatively impact child outcomes. The Demographic and Health Surveys of 1989, 1993, 1998, 2003, and 2009 ...were used to investigate trends over time and factors associated with single motherhood in Kenya. Urban residence, older age, and poorer economic status were associated with single motherhood over time. Women with more than one child, and those with children under 15 years living at home were less likely to be single mothers. As women become single mothers at different stages, targeted and supportive strategies are required to mitigate associated risks.
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