Prevalence and factors associated with overweight and obesity among children from primary schools in urban areas of Lomé, Togo.

OBJECTIVE: Overweight and obesity in childhood are serious public health issues, both in developing and developed countries. The present study aimed to ascertain overweight and obesity prevalence rates among Togolese schoolchildren in Lomé, Togo, and their correlation with physical activity, socio-economic conditions and eating habits. DESIGN: Cross-sectional survey conducted in December 2015. Overweight and obesity were defined using age- and sex-specific BMI cut-off points of the International Obesity Task Force. Physical activity, socio-economic conditions and eating habits were assessed with a standardized questionnaire. Specially trained medical students interviewed children and collected the data. After bivariate regression analyses, factors associated with overweight/obesity were identified by multivariate logistic regression. Statistical significance was two-sided P<0·05. SETTING: Lomé, Togo. SUBJECTS: Representative sample of 634 children (288 boys, 346 girls), aged 8-17 years, who were studying in primary schools. RESULTS: Overweight and obesity respectively affected 5·2 and 1·9 % of children surveyed. Watching television (>4 h) on weekends (OR; 95 % CI: 3·8; 1·2, 12·0, P=0·02) and medium dietary diversity score (3·0; 1·1, 8·1, P=0·03) were independently associated with overweight/obesity in a multivariate regression model. Eating breakfast in the school cafeteria (0·2; 0·1, 0·8, P=0·03) and eating fruits (0·4; 0·1, 0·9, P=0·03) significantly reduced the risk of overweight/obesity. CONCLUSIONS: Overweight and obesity prevalence were linked with sedentary behaviour and non-optimal food diversity. Promoting physical activity and fruit consumption should be explored as interventions to reduce and prevent overweight and obesity in Lomé schoolchildren. In addition, preventive approaches in the social environment of children should be considered.

Dietary diversity and associated factors among school-aged children and adolescents in Lokossa district of southern Benin: a cross-sectional study.

OBJECTIVE: The main objective of this study was to assess the prevalence of dietary diversity and associated factors. DESIGN: Cross-sectional study. SETTING: Lokossa district, southern Benin. PARTICIPANTS: A survey conducted in a probabilistic sample of 612 students (345 boys and 267 girls), aged 8-17 years old from 26 primary schools. Dietary Diversity Scores were calculated by summing the number of food groups consumed by the schoolchildren and adolescents over a 24-hour recall period. Adequate dietary diversity can be assigned to a consumption that is greater than or equal to five food groups, and inadequate dietary diversity can be assigned to a consumption that is lower than five food groups. Descriptive statistics such as frequency, mean and SD were computed. Statistical analysis was performed on the data to determine which variables were associated with dietary diversity as well as the results of the adjusted OR with a 95% CI. A p<0.05 was considered statistically significant. RESULTS: The proportion of schoolchildren and adolescents with inadequate dietary diversity was 25.8% (95% CI 15.1% to 40.5%). Schoolchildren and adolescents living in rural areas, having low household socioeconomic status, eating breakfast less than 5 days per week and no eating school meals were significantly associated with inadequate dietary diversity. CONCLUSIONS: The results of this study revealed that the diet among schoolchildren and adolescents lacked diversity and is associated with socioeconomic status, rural living, eating breakfast and school meals. Public health interventions, such as school meal programmes in rural and isolated areas, in association with poverty-reducing programmes and nutrition education, are recommended to improve the quality of diet and limit the consequences of poor diet diversity.

Socio-economic determinants of healthy behaviours among primary schoolchildren and adolescents in Lokossa district of southern Benin.

BACKGROUND: There is little information regarding fruit and vegetable (FV) intake and physical activity (PA) among schoolchildren in Benin. In this study we evaluated the differences in breakfast eating, FV consumption and PA according to socio-economic (SE) determinants in primary schoolchildren. METHODS: A cross-sectional study using a probabilistic sample of 612 students (8-17 y of age) from 26 primary schools was done between December 2018 and January 2019. The association was estimated by logistic regression analyses. RESULTS: Of all students, 53% were physically inactive, 60% took breakfast <5 d/week, 84% irregularly ate fruits and 68% irregularly ate vegetables. Younger students (8-10 y) take breakfast regularly and older ones (>15 y) were physically more active. The probability of regular breakfast and fruit consumption were significantly higher in children of educated parents (p<0.01 and p<0.001, respectively) compared with children of non-educated parents. Medium SE status was associated with regular breakfast intake, whereas high SE status was associated with higher fruit intake and lower physical activity compared with low SE status (p<0.001). There was no association between breakfast eating, FV intake, PA and the body mass index. CONCLUSIONS: Findings emphasize the need for interventions to promote healthy eating behaviours in primary schoolchildren and their family environments.

Undernutrition and associated factors in primary schoolchildren in Lokossa, Benin: a cross-sectional study.

OBJECTIVES: to estimate the prevalence of stunting and thinness and sociodemographic, household, family, dietary, and scholar associated factors in schoolchildren living in Lokossa-Benin. METHODS: a survey conducted in a probabilistic sample (n=615) of primary schoolchildren (8-17 years), from 12/2018 to 01/2019, using structured questionnaire and 24-hour dietary recall. Thinness and stunting were defined as Height-for-age and Body Mass Index-for-age below-2 standard deviations, respectively. Associations were estimated by chi-square test and logistic regression. RESULTS: thinness and stunting prevalence was 13.1% (95%CI:9.0-18.7) and 25.5% (95%CI:20.6-31.2), respectively. Odds of thinness were higher among older schoolchildren and those who experienced hunger at school. Odds of stunting increased with age, low diet diversity, experiencing hunger at school, and having school meal five days a week (OR:2.09; 95%CI:1.29-3.36). CONCLUSIONS: stunting was the most common problem. Older schoolchildren and those with food deprivation or poor diet diversity were the most affected.

Undernutrition and associated factors in primary schoolchildren in Lokossa, Benin: a cross-sectional study / Desnutrición y factores asociados en estudiantes de primaria en Lokossa, Benin: un estudio transversal / Desnutrição e fatores associados em escolares de escolas primária em Lokossa, Benin: um estudo transversal

ABSTRACT Objectives: to estimate the prevalence of stunting and thinness and sociodemographic, household, family, dietary, and scholar associated factors in schoolchildren living in Lokossa-Benin. Methods: a survey conducted in a probabilistic sample (n=615) of primary schoolchildren (8-17 years), from 12/2018 to 01/2019, using structured questionnaire and 24-hour dietary recall. Thinness and stunting were defined as Height-for-age and Body Mass Index-for-age below-2 standard deviations, respectively. Associations were estimated by chi-square test and logistic regression. Results: thinness and stunting prevalence was 13.1% (95%CI:9.0-18.7) and 25.5% (95%CI:20.6-31.2), respectively. Odds of thinness were higher among older schoolchildren and those who experienced hunger at school. Odds of stunting increased with age, low diet diversity, experiencing hunger at school, and having school meal five days a week (OR:2.09; 95%CI:1.29-3.36). Conclusions: stunting was the most common problem. Older schoolchildren and those with food deprivation or poor diet diversity were the most affected.

RESUMEN Objetivos: estimar la prevalencia de baja estatura y delgadez en estudiantes de Lokossa-Benin y factores sociodemográficos, domésticos, familiares, dietéticos y escolares asociados. Métodos: encuesta en una muestra probabilística (n=615) de escolares de 8 a 17 años mediante cuestionario estructurado y recordatorio de 24 horas. La baja estatura y la delgadez se definieron como la talla para la edad y el índice de masa corporal para la edad inferior a-2 desviaciones estándar, respectivamente. Las asociaciones se estimaron mediante la prueba de chi-cuadrado y regresión logística. Resultados: las prevalencias de delgadez y baja estatura fueron 13,1% (IC95%:9,0-18,7) y 25,5% (IC95%:20,6-31,2). Las probabilidades de estar delgadas eran más altas entre los estudiantes mayores que informaron tener hambre en la escuela. Las posibilidades de estatura baja aumentaron con la edad, la diversidad dietética baja, y los informes sobre el hambre en la escuela y los almuerzos escolares cinco días a la semana (OR:2,09; IC95%:1,29-3,36). Conclusiones: la baja estatura fue el problema más común y los estudiantes mayores, con privación de alimentos o baja diversidad alimentaria fueron los más afectados.

RESUMO Objetivos: estimar a prevalência de baixa estatura e magreza em escolares de Lokossa-Benin e fatores sociodemográficos, domiciliares, familiares, alimentares e da escola associados. Métodos: inquérito em amostra probabilística (n=615) de escolares com idade entre 8 e 17 anos usando questionário estruturado e recordatório-24 horas. Baixa estatura e magreza foram definidas como Estatura-para-idade e Índice de Massa Corporal-para-idade inferior a-2 desvios-padrão, respectivamente. Associações foram estimadas pelo Teste do Qui-Quadrado e regressão logística. Resultados: prevalências de magreza e baixa estatura foram 13,1% (IC95%: 9,0-18,7) e 25,5% (IC95%: 20,6-31,2). As chances de magreza foram maiores entre escolares mais velhos e que relataram sentir fome na escola. Chances de baixa estatura aumentaram com idade, baixa diversidade alimentar, relatar fome na escola e merenda escolar cinco dias/semana (OR:2,09; IC95%:1,29-3,36). Conclusões: a baixa estatura foi o problema mais comum e escolares mais velhos, com privação alimentar ou baixa diversidade alimentar foram os mais afetados.

Estado nutricional e saúde de escolares do município de Lokossa ­ Benin / Nutritional status and health of schoolchildren in the municipality of Lokossa ­ Benin

INTRODUÇÃO: As crianças e os adolescentes constituem um grupo populacional especialmente sensível às mudanças comportamentais e culturais que afetam o estado nutricional e de saúde. OBJETIVOS: Este estudo objetivou descrever indicadores nutricionais, cardiometabólicos e de consumo alimentar em escolares da última série do ensino primário em Lokossa, Benin, e identificar fatores associados com indicadores de pior estado nutricional. MÉTODOS: Estudo transversal com amostra representativa (n=615) de escolares do sexto ano do ensino primário de 26 escolas públicas e privadas das áreas urbana e rural do município de Lokossa (dezembro/2018-janeiro/2019). A coleta de dados, precedida de um estudo piloto, foi realizada por auxiliares de pesquisa treinados, utilizando questionário estruturado autopreenchido, recordatório-24 horas, aferição de medidas antropométricas e de pressão arterial, bem como coleta de sangue na ponta do dedo para dosagem da hemoglobina. Em subamostra (n=165), foram obtidas medidas bioquímicas. O projeto foi aprovado no comitê de ética do Benin e foram obtidos Termo de Consentimento Livre e Esclarecido e Termo de Assentimento Livre e Esclarecido. No Artigo 1, foram realizadas análises estratificadas por sexo baseadas em média e desvio padrão e prevalência com intervalo de confiança de 95%. Diferenças entre médias e proporções foram testadas por regressão linear e qui-quadrado de Person. No Artigo 2, fatores associados à magreza e à baixa estatura foram estimados pelo Odds Ratio e seu intervalo de confiança de 95% foi obtido por regressão logística binária. RESULTADOS: Artigo 1: A média de idade foi de 11,6 (0,1) anos, sem diferenciação por sexo. A prevalência de magreza e de baixa estatura foram, respectivamente, 13,1% (IC95%: 9,0-18,7) e 25,5% (IC95%: 20,6-31,2), sendo a baixa estatura mais frequente em meninos (31,3%; IC95%:24,8-38,5) do que em meninas (18,3%; IC95%:13,0-25,0). A prevalência de excesso de peso foi de 6,5% (IC95%:3,9-10,6), enquanto a anemia foi o indicador de carência nutricional mais frequente (47,5%; IC95%:39,7-55,3), sem diferenças estatisticamente significantes relacionadas ao sexo. O colesterol HDL baixo (34,3%; IC95%:20,0-52,1) e a pressão arterial elevada (31,2%; IC95%:21,6-42,7) foram observados em cerca de um terço dos escolares: 11,6% (IC95%:3,9-16,6) tinham colesterol total elevado e menos de 10% (8,3; IC95%:3,9-16,6) tinham hiperglicemia, também sem diferenças estatisticamente significantes relacionadas ao sexo. Os alimentos saudáveis com maior frequência de consumo regular foram peixe e hortaliças; enquanto salgados fritos e biscoitos doces destacaram-se como alimentos não saudáveis. Apenas o consumo de guloseimas variou entre os sexos, sendo mais frequente entre meninas (p<0.001). Metade dos escolares apresentaram alta diversidade alimentar. De acordo com o Artigo 2, as chances de magreza foram maiores entre escolares mais velhos e que relataram sentir fome na escola. Chances de baixa estatura aumentaram com idade, baixa diversidade alimentar, relatos de fome na escola e merenda escolar em cinco dias/semana (OR:2,09; IC95%:1,29-3,36), e diminuíram com a maior escolaridade materna (OR:0.36; IC95%:0,18­0,70). CONCLUSÃO: A desnutrição crônica e a anemia foram os problemas nutricionais mais importantes entre os escolares. Essas carências nutricionais coexistem com o excesso de peso e, especialmente, com alterações metabólicas e pressão arterial elevada, sugerindo a dupla carga da desnutrição nessa população. Os resultados deste estudo sustentam a relevância da insegurança alimentar, particularmente a privação alimentar, para explicar a magreza e o nanismo. A baixa diversidade alimentar também parece contribuir para a desnutrição crônica, enquanto a maior escolaridade materna parece atenuar o problema.

INTRODUCTION: Children and adolescents constitute a population group that is particularly sensitive to behavioral and cultural changes that affect nutritional status and health. OBJECTIVES: This study aimed to describe nutritional and cardiometabolic indicators and food consumption in schoolchildren in the last grade of primary school in Lokossa, Benin; and identify factors associated with indicators of worse nutritional status. METHODS: Cross-sectional study with a representative sample (n=615) of schoolchildren in the sixth year of primary school from 26 public and private schools in the urban and rural areas of the municipality of Lokossa (December/2018-January/2019). Data collection, preceded by two pilot studies, was performed by trained research assistants, using a structured self-completed questionnaire, 24-hour recall, anthropometric measurements, blood pressure measurements and blood collection at the fingertip for hemoglobin measurement. In a subsample (n=165) biochemical measurements were obtained. The project was approved by the Benin Ethics Committee and obtained a consent form and an informed consent form. In Article 1, analyzes stratified by sex were performed based on mean and standard deviation and prevalence and its 95% confidence interval. Differences between means and proportions were tested by linear regression and Person chi-square. In Article 2, factors associated with thinness and stunting were estimated by the Odds Ratio and 95% confidence interval obtained by binary logistic regression. RESULTS: Article 1: The mean of age was 11.6 (0.1) years with no difference by sex. The prevalence of thinness and stunting were respectively 13.1% (95%CI: 9.0-18.7) and 25.5% (95%CI: 20.6-31.2), being stunting more frequent in boys (31.3%; 95%CI: 24.8-38.5) than girls (18.3%; 95%CI: 13.0- 25.0). The prevalence of overweight and obesity was 6.5% (95%CI: 3.9-10.6), while anemia was the most frequent indicator of nutritional deficiency (47.5%; 95%CI: 39.7- 55.3), with no statistically significant differences by sex. Low HDL cholesterol (34.3%; 95%CI: 20.0-52.1) and high blood pressure (31.2%; 95%CI: 21.6-42.7) were observed in about one third of the schoolchildren, 11.6% (95%CI: 3.9-16.6) had high total cholesterol and in less than 10% (8.3; 95%CI: 3.9-16.6) hyperglycemia, with no statistically significant differences for sex. The healthy foods with the highest frequency of regular consumption were fish and vegetables; while fried snacks and sweet biscuits stood out as unhealthy foods; only the consumption of sweets varied between genders, being more frequent among girls (p<0.001). Half of the schoolchildren showed high dietary diversity. In Article 2, the chances of thinness were higher among older schoolchildren who reported feeling hungry at school. Chances of stunting increased with age, low dietary diversity, reporting hunger at school and school meals five days/week (OR: 2.09; 95%CI: 1.29-3.36), while they decreased with greater maternal education (OR:0.36; 95%CI:0.18-0.70). CONCLUSION: Chronic malnutrition and anemia were the most important nutritional problems among schoolchildren. These nutritional deficiencies coexist with excess weight and especially metabolic changes and high blood pressure, suggesting the double burden of malnutrition in this population. The results of this study support the importance of food insecurity, particularly food deprivation, to explain thinness and stunting. Low dietary diversity also seems to contribute to chronic malnutrition, while greater maternal education seems to mitigate the problem.