The potential role of nutrition education in reduction of overweight and the associated risk factors among school children (9-14 years) in Nairobi, Kenya
Obesity among children is increasing at an alarming rate worldwide, With research linking both childhood malnutrition and obesity to increased risk of morbidity and mortality in adulthood, more attention is now shifting to addressing the pandemic among children so as to alleviate the generational calamity in the future. This study investigated the prevalence of overweight, the associated risk factors and the potential of nutrition education as an intervention among school children aged 9-14 years attending private and public schools in Nairobi. From two randomly selected divisions, four schools, two public and two private, were randomly selected for inclusion in the study. At baseline, nutrition status of the children was determined using anthropometric indices. Dietary practices were assessed using the 24 hour dietary intake recall method. Sociodemographic characteristics and physical activity were collected using a pre-tested questionnaire. One public and one public school were randomly allocated into two study groups, an intervention (IG) and a control group (CG). Pupils in the IG received a nutrition education package while those in the CG did not receive the intervention. The children were followed up for eleven months (3 school terms) and assessments were carried out at the end of every school term. Data were analysed using WHO AnthroPlus, OpenEpi and SPSS version 17.0. Descriptive statistics were used to describe characteristics of the study children while inferential statistics were used to establish differences in various variables between the control and intervention groups, and relationships between selected variables and overweight. Chi-square tests and Odds Ratio (OR), were used to test relationships between categorical variables. Tvtests and MannWhitney U tests were used to compare continuous variables with normal distribution and those without normal distribution, respectively. The Wilcoxon test was used to compare trends in anthropometric characteristics throughout the study. A p value <0.05 was considered significant. Out of 344 study children, 40.4% were from private schools and 52.3% were female. The mean age of the children was 12.0ﾱ0.84 years, with 79.9% within age 11-12 years. The prevalence of obesity was 5.9%, while combined overweight and obesity was 19.0%, with prevalence in private schools significantly higher (29.0%) than public schools (11.5%). Prevalence was highest among girls in private schools (30.9%), followed by boys in private schools (27.1 %). Socio-dernographic and economic factors found to be positively associated with overweight included being in a private school, not having siblings, mother's occupation, type of residence, access to a family computer with computer games, having a personal cell phone, number of cell phones, use of motorised transport to and from school and time spent on sedentary activities after school. Dietary factors included consumption of margarine, white bread, githeri and sugar sweetened black tea/coffee. On the other hand, factors found to be negatively associated with overweight included having physical education ePE) scheduled in the class timetable, participation in physical education, active commuting to and from school, having family meals and receiving food rewards, consumption of vegetables, cake, maandazi and eggs. The predictors of overweight included being in a private school, having a self-employed mother, being a single child, having access to a family mobile phone and not having family meals. The intervention resulted in significant increase in participation in physical education (PE) and swimming, decrease in consumption of white bread, maandazi and crisps and an increase in consumption of wholemeal bread and fruits (p<O.05), but no significant decrease in overweight. In conclusion, the overweight rate in the study group is of public health concern. The school curriculum should be revised to include compulsory participation of all children in physical education. Advocacy among parents is needed so that the benefits of increased physical activity in school are complimented by active lifestyles and healthy diets at home.