Prevalence and factors associated with overweight and obesity among children aged 8-12 years in private primary schools in Kampala City, Uganda

Abstract

Background: Childhood overweight and obesity is a significant public health issue in developing countries. There is a dearth of data on populations at increased risk to guide targeted interventions. This study aimed to assess the prevalence and factors associated with overweight and obesity among children aged 8-12 years in private primary schools in Kampala, Uganda. Methods: We conducted a cross-sectional study among 606 children and six key informants across three purposively selected schools and collected quantitative and qualitative data. Children were systematically sampled per school, and data were analyzed using Stata version 15 and Atlas.ti 9. To assess overweight and obesity we used BMI for Age Z-scores based on the WHO 2007 reference population, using the Zanthro software package on Stata version 15. The Modified Poisson regression was used to assess the association between selected exposures and the outcome. Results: A total of 10.6% (64/606) of the children were overweight and 3.8% (23/606) were obese. Factors associated with childhood overweight and obesity were; mother’s with formal occupations (aPR=1.40, 95%CI: 1.06-1.86) compared to children whose mothers had informal jobs, consumption of snacks and processed foods 1-2 times a day (aPR=1.85, 95% CI: 1.21-2.82, ≥3 times a day: aPR=1.59, 95% CI: 1.49-1.70), nuts and seeds 1-2 times a day: (aPR=0.80, 95%CI: 0.66-0.97), sugar and sweeteners 1-2 times a day : (aPR = 0.52, 95% CI: 0.34-0.79; ≥3 times a day: aPR = 0.46, 95% CI: 0.39-0.54) compared to children who never consumed any of these foods, commuting by car (aPR=3.48, 95% CI: 2.83-4.27) compared to children who walked, watching television often during their leisure time (aPR = 1.40, 95% CI: 1.32-1.54) compared to children who played indoor games, being active for ≥ 60 minutes ≥2 times a day (aPR = 0.25, 95% CI: 0.08-0.77 ) compared to those who were never active, Children who played outdoor games often during their leisure time (aPR = 0.63, 95% CI: 0.46-0.87) compared to those who played indoor games, and had ≥2 hours of screen time on weekdays (aPR = 0.66, 95% CI: 0.58-0.74) compared to children who had ≤2 hours of screen time. Furthermore, facilitators for childhood overweight and obesity included; unhealthy eating habits, presence of a school canteen, limited engagement in physical activity, increased sedentary behavior, inadequate facilities, and parental influence. In contrast, access to healthy food options and regulations, active participation in sports, adequate facilities, and parental support were barriers. Conclusions and recommendations: More than a seventh of the children were overweight and obese. These findings suggest that children in private schools should be targeted for public health interventions aimed at reducing childhood obesity. Our findings add voice to previous studies that recommend that parents should set clear guidelines for screen time and encourage active physical activities, e.g., playing outdoors. Schools should integrate nutrition education into their curriculum to enable children make healthier food choices. Policymakers should advocate for mandatory physical education requirements in schools, with an emphasis on age-appropriate physical activity. Several factors, including the mother’s occupation, consumption of snacks and processed foods, nuts and seeds, sugar and sweeteners, commuting by car, watching television, being active for ≥ 60 minutes, playing outdoor games, and having ≥ 2 hours of screen time on weekdays, were statistically associated with childhood overweight and obesity.