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Prevalence of Overweight and Obesity in Apparently PREVALENCE OF OVERWEIGHT AND OBESITY IN APPARENTLY HEALTHY SCHOOL CHILDREN IN TARAUNI LOCAL GOVERNMENT AREA OF KANO STATE A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FELLOWSHIP OF NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN THE FACULTY OF PAEDIATRICS BY DR. ISMAIL MUSA KALLE MBBS 1998 (MINSK, BELARUS) NOVEMBER, 2016 i DECLARATION I hereby declare that this work is original. The book has not been presented to any other College for a Fellowship nor has it been submitted elsewhere for publication. ii DEDICATION This work is dedicated to my family, both nuclear and extended for their support throughout the period of my training without which I could not have coped with the intensity and the pressure of the work and the training. iii CERTIFICATION We certify that this work was carried out by Dr. Musa Kalle Ismail of the Department of Paediatrics, Aminu Kano Teaching Hospital Kano under our supervision. Professor Mu’uta Ibrahim, MBBS, FMC Paed. FWACP (Paed.), PGDipMedEd (Dundee) Department of Paediatrics Aminu Kano Teaching Hospital, Kano. Sign…………………………………… Date…………………. Dr. G. D. Gwarzo, MBBS, FMCPaed, Department of Paediatrics Aminu Kano Teaching Hospital, Kano. Sign…………………………………… Date……………………….. iv ACKNOWLEDGEMENT I will forever be grateful to the Almighty God for giving me the opportunity to undergo this programme from beginning to the end. I am very thankful to my supervisors Professor Muuta Ibrahim and Dr. G. D. Gwarzo for their immense assistance and support from the beginning to the very end of this project. I am also very grateful to the management of Aminu Kano Teaching Hospital for the opportunity to do this training. I am also grateful to the entire staff of Paediatrics Department for providing healthy learning environment. I am also very thankful to Professor Oyeku Akibu Oyelami of Department Of Child Health OAUTHC Ile-Ife for his assistance and support during the project. Last but not the least, I am grateful to the Tarauni Local Government Official for their support as well as the teachers and pupils/students of these primary and secondary schools who helped me immensely. v TABLE OF CONTENTS Title---------------------------------------------------------------i Declaration………………………………………………ii Dedication………………………………………………iii Certification…………………………………………….iv Acknowledgement………………………………………v Table of contents……………………………………….vi List of abbreviations…………………………………..viii List of figures……………………………………..…... x List of tables……………………………………….…...xi List of appendices……………………………………..xii Summary…………………………………………Page 1 Introduction………………………………………page 4 Justifications………………………………………page 6 Research question………………………………..page 7 Literature review…………………………………page 8 Objectives……………………………………......page 18 Materials and methods…………………………...page 18 vi Results……………………………………………page 26 Discussion………………………………………..page 37 Conclusions………………………………………page 41 Recommendations………………………………..page 42 Limitations………………………………………..page 43 Areas of future studies…………………………....page 44 References………………………………………..page 45 Appendices……………………………………….Page 53 vii LIST OF ABBREVIATIONS ATP III Adult treatment panel III BMI Body mass index BP Blood pressure BIA Bioelectrical impedance analysis CBC Complete blood count CT Computed tomography CVD Cerebro-vascular disease DBP Diastolic blood pressure FBS Fasting blood sugar GFR Glomerular filtration rate GAR Gross attendance ratio HBP High blood pressure HE Hypertensive encephalopathy HPN Hypertension Kg kilogram k Korotkoff L. G.A. Local government area LVH Left ventricular hypertrophy viii MG Milligram NHANES III National health and nutrition examination survey iii SBP Systolic blood pressure SE Side effects WICP Women, infants and children programme W HO World Health Organization WC Waist circumference WHR Waist to hip ratio WHR Waist height ratio ix LIST OF TABLES Table I: Age range distribution of the subjects recruited in the study…………………………………………………………………………….…26 Table-II: General characteristics of BMI of the subjects used in the study…….................................................................................................................27 Table-III: Relationship of BMI percentiles to gender among the subjects in the study…………………………………………………………………………….…28 Table IV: Relationship of BMI percentiles to type of school among the subjects in the study…………………………………………………………………………...29 Table V: Relationship of BMI percentiles to social class among the subjects in the study…………………………………………………………………………….…30 Table VI: Relationship between BMI percent, social class type of school among subjects……………………………………………………………………………31 Table VII: Relationship of BMI percentiles to social class and sex of the subjects in the study…………………………………………………………………….…..32 Table VIII: BMI percentile of the adolescents among the subjects in the Study....33 Table IX: BMI percentile according to gender among adolescents subjects ………………………………………………………………………………….....34 Table X: Baseline data for BMI in children in Tarauni Local Government, Kano ……………………………………………………………………………….…....35 x LIST OF APPENDICES Appendix I: The data proforma……………………………………………53 Appendix II: Oyedeji Classification of Social class………………….…....55 Appendix III: International cut off points for Obesity and Overweight…...56 Appendix IV: Consent/ Assent form………………………………………59 xi SUMMARY The prevalence of child obesity is increasing rapidly worldwide. And this is associated with several risk factors for heart disease and other chronic diseases later in life. These chronic diseases include hyperlipidaemia, hyperinsulinaemia, hypertension, and early atherosclerosis. The aim of this study was to determine the prevalence of overweight and obesity in apparently healthy school children in the study area. The study aimed to find out whether there is an association between overweight and obesity and social class. It also aimed at generating baseline data for overweight and obesity in school children in the study area. The study, a cross-sectional, school based survey involving 720 subjects from primary and secondary schools in Tarauni Local Government Area (LGA) Kano State was carried out from July to November 2013. The study subjects were selected from the 57 public and private primary schools and 50 public and private junior secondary schools using multistage sampling technique. Body mass index percentiles were used to determine overweight and obesity as defined by The International Obesity Task Force (IOTF) in children. The prevalence of overweight and obesity in this study were 8.9% and 3.3% respectively while the combined prevalence (overweight and obesity) was 12.2%. Among the study subjects 15.6 % ( 42) from social class I-III were overweight while 7.0 % (19) were obese compared to their counterparts in social class IV-V where 5.1 % (23) were overweight and 1.1 % (5) were obese. The difference were statistically significant (χ2 =4.41,df=3 p< 0.001).Among the study subjects 10.9% (39) of the female were overweight and 3.6% (13) were obese while 7% (25) of their male counterpart were overweight and 3% (11) were obese. The difference was statistically significant xii for overweight (χ2=10.18, df=2, p<0.002) but not for obesity. The prevalence of overweight and obesity among the subjects from private schools were 12.8 % (46) and 5.8 % (21) respectively, while among the subjects from public schools overweight were 5.0 % (18) and 0.8 % (3) respectively. The difference was also statistically significant (χ2=4.43, df=2 and p<0.001). There were 469 subjects in the adolescent age-group. Out of this, 37.6 % (176) were underweight, 55.5 % (260) had normal weight, 4.8 % (23) were overweight and 2.1 % (10) were obese. Among the adolescent subjects 45.6% (214) were females while 54.4 % (255) were males. Of the total number of adolescent females, 15.0 % (32) were underweight, 70.1 % (150) were of normal weight, 10.7 % (23) and 4.2 % (9) were overweight and obese respectively. Of the male adolescents 32.4% (83) were underweight, 58.5 % (149) were of normal weight, while 7.1 % (18) and 2.0 % (5) were overweight and obese respectively. The results showed that females of the adolescent age group had higher prevalence of overweight (10%) and obesity (4.2%) compared with their male counterparts who had 7.1% overweight and 2.0% obesity. This was statistically significant (χ2=12.16, df=2.32 p=0.001).There were 251 subjects from the age-group 6-9years. Fifty six percent (140) were underweight, 17 % (43) were of normal weight, 20 % (50) were overweight and 7 % (18) were obese. Body-mass-index (BMI) of the subjects was generated and mean BMI calculated and tabulated. The mean BMI of the subjects showed highest value around the age of 11years for both the male and the female subjects in the study. However, mean BMI for the male subjects were highest between the ages of 9-11 years. The mean BMI for the female subjects were highest between the ages of nine to thirteen years. xiii The prevalence of overweight and obesity documented in this study is in keeping with findings in similar studies done elsewhere in the country. The study showed that female gender and high social class were associated with a higher prevalence of overweight and obesity. Twin approaches should be made on one hand to curb the high prevalence of overweight and obesity as well as measures to tackle the high prevalence of underweight among the school children in the study area. xiv INTRODUCTION: The prevalence of child obesity
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