ORIGINAL

Niger J Paed 2015; 42 (2): 107 –110

Alkali YS

Ambe JP

Sabin M

Socio-economic status, lifestyle and

childhood obesity in Gombe.

Zacharin M

DOI:http://dx.doi.org/10.4314/njp.v42i2.7

Accepted: 7th January 2015

A b s t r a c t : B a c k g r o u n d :

Childhood obesity is a complex

condition resulting from an

i n t e r p l a y o f g e n e t i c

predisposition, environmental

factors and socio-economic status.

The prevalence has been

increasing all over the world,

probably due to economic

transition and rapid urbanization

as well as globalisation. This

relationship should be well

established for Improved Health

Planning in Gombe State and

Nigeria.

Objectives: To establish the

prevalence of Childhood Obesity

and it`s relationship with the

Socio-Economic Status of Parents

and guardians.

Methodology:Anthropometric

measurements of children and

adolescents in both public and

private schools from primary to

secondary levels were taken and

their BMI calculated. The socio-

economic statuses of their parents,

as well as the lifestyle of the chil-

dren were assessed.

sions and computers in their rooms

and were driven to school

(

)

Alkali YS

Conclusion: The picture is com-

pletely the reverse of what is ob-

tainable in the developed and in-

dustrialised nations where over-

weight and obesity are more

prevalent in children of the lower

socio-economic class.

Department of Paediatrics,

Federal Teaching Hospital.

Gombe, Nigeria.

Email: ysalkali@yahoo.com

Ambe JP

Department of Paediatrics,

University of Maiduguri. Nigeria

Authors` contribution: The first

author is the lead researcher and is

Sabin M, Zacharin M

a

staff of Federal Teaching

Murdoch Children’s Research Institute

The Royal Children’s Hospital and

University of Melbourne. Australia.

Hospital Gombe while the second

author, a staff of University of

Maiduguri is the first supervisor

who gave guidelines and made

corrections. The second and the

third authors are members of staff

of the University of Melbourne in

Australia; the third author

provided a template on which the

questionaire was based while the

fourth author who is also the

second supervisor, is a tutor of the

European Society for Pediatric

Endocrinology; she facilitated the

acceptance of the proposal and the

sponsorship for the research. The

research was carried out in

Gombe, the capital of Gombe State

in North Eastern Nigeria

Results: Overweight and obesity

were more prevalent in children

whose parents belonged to the

middle and upper socio-economic

class; these children had televi-

Keywords: Socio-Economic,

Childhood, Obesity, Nigeria

Introduction

men, the thigh and the buttocks and may generate free

fatty acids when metabolised. This results in generation

of oxidant stress molecules, reduced nitric oxide (NO)

production and impairment of endothelial relaxation

Obesity is a complex disease but is thought to mainly

arise from a long-term imbalance in the number of calo-

ries expended to those consumed . The global increase

1

7

along with insulin resistance . Obesity in childhood is

in obesity is driven by economic transition, globalisation

associated with a number of metabolic disorders such as

Type 2 diabetes mellitus, non-alcoholic₈steatohepatitis,

dyslipidaemia and hypertension , as well

2

and unplanned urbanization . In children and adoles-

th

cents, it is defined as a body mass index (BMI) >95

3

9

percentile for age and sex . Though genetic factors are

asmusculoskeletal problems .

4

estimated to explain 30₅ - 50% of habitability of obesity ,

environmental factors as well as medical conditions

such as hypothyroidism and Cushing`s disease are rec-

In a recent report, the World Health Organization stated

that obesity is a risk factor for type 2 diabetes, high

6

10

ognised . Fat accumulation may occur in the intra-

blood pressure, stroke and various types of cancers .

abdominal organs or subcutaneous tissues of the abdo-

Obese children may also face discrimination and rejec-

1

08

1

tion , and may subsequently become depressed and

GmbH & Co) which was standardized daily with known

weights. Body Mass Index was calculated and compared

to the Centre for Disease Control cut-points. Overweight

th

was defined as a Body Mass Index between 85 and 94

1

2

withdrawn . Childhood obesity seems to be related to

socio-economic status in both the developed and the

1

3

th

developing countries though differently . Whereas in

the developed world, children belonging to the lower

socioeconomic strata are at increased risk of developing

obesity, in the developing nations, higher prevalence

rates of obesity are seen in children from the higher so-

th

19

percentile and obesity ≥95 percentile . The lifestyle

parameters of the children and their families was also

assessed by discussing with the children. These

parameters include means of transport to school,

presence of televisions and computers in the home or

even the child`s room, number of hours spent on outdoor

activities and the degree of activies carried out. The

Socio-economic status of the parents was determined

1

4

cioeconomic strata, especially in urban areas .

Countries with food insecurity and under nutrition prob-

lems are also paradoxically not spared by childhood

obesity probably due to misdistribution of₅r_,e₁₆sources and

1

20

affluence co-existing with abject poverty . There are

using the Olusanya and Okperi classification system .

1

7

few studies of childhood obesity from Nigeria and we

were therefore interested in assessing rates of childhood

obesity, and it’s association with socioeconomic status

and lifestyle parameters in North Eastern Nigeria. The

broad objective was to determine the prevalence of obe-

sity in both private and public school children in Gombe

Local Government Area of Gombe State, Nigeria.

Data entry and analysis

Data was recorded on SPSS spreadsheet version 7.5 and

analysed using Epi-info 2002. Chi-square test was used

and statistical significance was set at a p-value of <0.05.

Results

Subjects and methods

Four hundred and fifty children were recruited for the

study. Exactly half(225) of them were from a public

school and the other half (225) from a private school.

Seventy-one (16%) of them were aged between 5 and 10

years and 379 (84%) were between 11 and 18 years.

Two hundred and thirty seven (52%) of them were boys

while 213(48%) were girls.

Study Area; The study area was Gombe, which is the

seat of Gombe Local Government Area as well as the

Headquarters of Gombe State. It is situated almost in the

centre of North Eastern Nigeria.

Study Procedure;Study design was a cross-sectional one

in which two schools (one public and one private) were

chosen in a multistage random sampling method; each

of the schools had two sections, A and B. The B – sec-

tion of each school which attended in the morning was

studied. Inclusion criteria were age 5-18 years, resident

in Gombe Metropolis, attending one of the schools be-

ing studied, and being physically and mentally healthy.

Ethical approval for the study was from the State Minis-

try of Education and Federal Medical Centre Gomb₈e.

Table 1: Distribution of the children according to age, gender

and school

Factors

Public School Private School

Total

237

Gender

Male

121

116

Female

Total

104

225

109

225

213

450

1

Age group

5-10 years

The Sample Size was determined by the formula - N=

2 2

(Z1-a) (1-P)(P)/d – where the minimum sample size was

25

46

71

1

Total

1-18 years

200

225

179

225

379

450

calculated as 384, using the assumptions that P (the best

estimate of prevalence of childhood obesity) = 0.5 and

BMI (Percentile

2

0% attrition rate built in, giving a total sample size

<

8

>

85th

5th -95th

95th

Total

206

11

8

214

6

5

420

17

13

needed of 450.

The principal researcher attended one of the Parents/

Teachers` Association meetings of each of the selected

schools, during which details of the project were dis-

cussed. The selection was done in a stratified sampling

manner and proformas were distributed to all children

who fulfilled the inclusion criteria. The height and

weight of each child were measured three times and the

average was recorded. The height was measured to the

nearest O.1 meters using a standard Stadiometer (Glaxo-

SmithKline) with the child standing in a “Frankfort”

position, after removing shoes and headgears with the

back and buttocks in a straight line against the

stadiometer.

225

450

Ninety-four percent had a Body Mass Index of less than

5th percentile, 17(4%) between 85th and 94th

percetiles (overweight) giving a prevalence of 3.7% and

3(2%) 95th percentile and above (obese) giving a

8

1

prevalence of 2.8%. The overall prevalence of

overweight/obesity was 6.5%. The age distribution,

socio-economic class and the type of school attended by

the obese/overweight children can be seen in Table 2.

The weight was measured to the nearest O.1Kg without

shoes and bags using a digital bathroom scale (Seca

1

09

Table 2: Distribution of overweight/obesity in children in

Table 2: Lifestyle parameters of the obese children

terms of school, sex, age and socio-economic class

Parameter

Public

Private Total

Factors

Public Private

school school

Total

Transport to school

Walking

1

0

12

1

12

P = 0.007

Gender

Male

Female

Car/Motorcycle

3

6

15

P= 0.7

9

21

Physical Activity

A bit

A lot

0

1

12

0

12

1

Age group

5

1

-10yrs

1-18yrs

4

5

7

14

P= 0.6

11

19

P = 0.007

Room TV/Compu

Yes

No

0

9

4

0

4

9

P = 1.7

Socio economic status

-Upper

-Middle

-Lower

5

3

1

15

6

0

P=0.03

20

9

1

Playtime outdoor

<1 hour

3

4

5

1

8

5

P = 0.26

1

-2hours

Fig 1 shows that most(8) of the obese children came

from the upper socio-econmic class and two were from

the middle socio economic class, all enrolled in the

private school. There was only one obese child from

each of the three socio-economic classes in the public

school.

Discussions

Excess weight may have a great impact on the health

and quality of life of individuals; unfortunately it has

now become a global problem spreading to the

developing countries . In this study the prevalence of

overweight is 3.7% and obesity 2.8% which is higher

than what was reported earlier by Adegoke et al in Ile-

Fig 1: Distribution of obesity among the three socio-economic

classes

1

0

1

7

Ife South Western Nigeria ; this may be due to the

difference in cut-off points study area and sample size

used by the two studies. This study also used calculation

of BMI while other studie₁₃s used bio-electric impedance

1

and skinfold thickness . However this study showed

that overweight and obesity occurred commonly in chil-

dren who attended private schools compared with public

s₁₄chools which is similar to what was reported by Gupta

17

and the Ile-Ife study . Most of the children who were

found to be either overweight or obese were those whose

parents or guardians belonged to the upper or middle

socio-economic class. Such parents may belong to the

working class with little or no free time to plan proper

5

nutrition and cook healthy meals for their children .

The lifestyle parameters of the obese children is shown

in Table 2. It can be seen that12(92%) of the children

were dropped at school by either a car or a motocycle

and so were not involved in much of physical activity.

This is statistically significant with a p-value of less than

Such mothers have also been known to indulge their

children with a f₈airly constant flow of sweet-treats and

high-fat snacks . The situation is worsened by

aggressive advertising practices, relatively low cost of

7

energy-dense foods and improved purchasing power ,

0

.05. Eight(61%) of the obese children spent less than

which drives children and adolescents into consuming

foods high in saturated fats, refined carbohydrates,

sweetened carbonated beaverages and diets low in

an hour on out-door activities and four (30%) of them

had either a computer or a television in their rooms;

these were not statistically significant.

8

polyunsaturated fatty acids and fibers . This is in

contrast to the findings in developed countries where

obesity and overweight was found to be more preva₁l₂e_,₁n₅t

in children of the lower socio-economic class

.

Those who were obese, admitted that they were not en-

gaged in much physical activity as they were almost all

dropped at school by car or motorcycle. They also had

televisions or computers in their rooms and spent less

than one hour on outdoor activities.

observation was reported by Gupta in India in 2005 ,

who attributed the rapid increase in childhood obesity to

A similar

14

1

10

a shift in actvity pattern from outdoor play to indoor

entertainment like television viewing, internet and

computer games. Such lifestyles apparently can be af-

forded by the affluent only and that explains why their

children have a higher tendency to be obese. On the

other hand, parents who are of the lower socio-economic

class may not be able to afford such luxuries and so their

children are usually enrolled in public schools and walk

to school. The schools are usually spacious enough for

so many outdoor activities. Such children have a lower

tendency to develop overweight or obesity. A similar

observation was made by Ankpa and Mato in other parts

Conclusion

Childhood overweight and obesity in Gombe local Gov-

ernment Area in North Eastern Nigeria is 3.7% and

2.8% respectively.This is higher in the upper and middle

socio-economic class unlike what is obtainable in

Western Europe and America where the reverse is the

case.It is also higher in children who have Televisions

and computers in their rooms.

Lifestyle parameters like being taken to school by a car

or a motorcycle and not being involved in much physi-

cal activity are related to childhood obesity with a statis-

tical significance. Possessing a television or computer in

the house/room may be a predictor of childhood over-

weight/obesity but the relationship is not statistically

significant

1

6

of Nigeria . In this study, a good number of the obese

children were adolescent girls and this is similar to

reports ₉_,₁₁b_,₁y₃_,₁₈ workers both within and outside

Nigeria

. This may be attributed to the socio-

cultural barriers in this part of the world where

adolescent girls have very low levels of physical

Limitations

1

3

activities as is obtained in many developing countries .

It may however be due to hormonal changes that take

The major limitations of this study are sample size may

be too small to draw a generalised conclusion and study

was carried out in the State capital which may not give a

real picture of the whole state

4

place during the adolescent period . On the other hand,

gender-wise distribution of overweight and obesity

prevalence did not show any signifi_,c₆ant difference in

4

other studies in developing countries Whitaker and co-

2

workers reported thatchildren from families in which

Future study

one or both parents are overweight have a substantially

higher risk of becoming obese than do children whose

parents are not overweight. This aspect was not

considered in this study even though some of the

children admitted having one or two parents being

obese;this was revealed during discussions of the

resultsthat took place after the measurements and

calculations of BMI were made.

There is a need to carry out further studies on a wider

scale covering a good part of the state with a larger

sample size, putting prental obesity as one of the

determinats of childhood obesity

Conflict of Interest: None

Funding: None

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