E-ISSN 1858-8360 | ISSN 0256-4408
 

Original Research (Original Article) 


SUDANESE JOURNAL OF PAEDIATRICS

2018; Vol 18, Issue No. 2

ORIGINAL ARTICLE

Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan

Mohamed D. Hussein (1), Noufa A. Alonazi (2), Sarar Mohamed (2,3)

(1) Dongola Police Hospital, Dongla, Northern Sudan

(2) Prince Sultan Military Medical City, Riyadh, Saudi Arabia

(3) Prince Abdullah bin Khaled Coeliac Disease Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Correspondence to:

Mohamed D. Hussein Police Hospital, Dongla, Northern Sudan.

Consultant Pediatrician, Al Fashir Hospital,

Email: diabhtoma [at] gmail.com

Received: 14 December 2018 | Accepted: 15 December 2018

How to cite this article:

Hussein MD, Alonazi NA, Mohamed S. Prevalence of obesity, overweight, underweight and stunting among school children in Argo city, Northern Sudan. Sudan J Paediatr. 2018;18(2):15–19.

https://doi.org/10.24911/SJP.106-1544799078


ABSTRACT

School children pass through great physical and mental changes, which affect both their growth and school performance. We aim at determining the prevalence of obesity, overweight, underweight, and stunting among the primary school children in Argo city, Northern Sudan. This cross-section study recruited all primary school children aged 6 to 14 years in the city. Out of 1,387 participants, 1,223 were enrolled in the study (88.2%). The rest were excluded because of age over 14 years or parental refusal to participate in the study. Growth analysis of this cohort showed that 19 children (1.5%) were obese, 76 (6.2%) overweight, 56 (4.6%) underweight, 45 (3.7%) severely underweight, and 46 (3.8%) children were stunted. These findings indicate that establishing intervention measures to prevent risk factors leading to obesity and overweight is highly needed.


KEYWORDS:

School children; Obesity; Overweight; Underweight; Stunting; Sudan.


INTRODUCTION

The nutritional status of school children is an important indicator of community health [1,2]. While underweight and stunting are major health problems in developing countries, overweight and obesity are emerging due to sedentary life. The prevalence of overweight and obesity among school children ranged from 7% to 45% in the Eastern Mediterranean Region (EMR countries) [3,4]. In Sudan, the rate of overweight and obesity in primary school children was found to be 14.8% and 10.5%, respectively [5]. Stunting is the most severe and common form of malnutrition in children. It is estimated that more than 165 million children were stunted, with the majority of them living in the developing countries [6]. In sub-Saharan Africa, the number of stunted children increased by 12.4 million between 1990 and 2015 [6]. Sudan is one of the poorest counties in Africa. Therefore, Sudanese children suffer many nutritional health problems. A previous study of school children in the rural area in the northern state reported that 7.1% were stunted and 23.1% were underweight [7]. Not only the prevalence of malnutrition is high in the northern state of Sudan, but also the prevalence of diabetes was alarmingly high as reported by Altom et al. [8,9]. These disorders may result from the changes in the demography as well as the lifestyle of the population in Northern Sudan. In this report, we aimed at determining the prevalence of obesity, overweight, underweight, and stunting among primary school children in Argo city, Northern Sudan.


MATERIALS AND METHODS

This descriptive cross-section study was conducted in September 20016 and enrolled all primary school children aged 6–14 years who live in Argo city, Northern Sudan. Exclusion criteria included age above 14 years or parental refusal to participate in the study. Argo is located on the east bank of the river Nile, 40 kilometers north to the capital of the state (Dongola). Around 10,000 people live in Argo, some of them are of Egyptian (white) descent while the rest are native Sudanese (colored). The educational and health facilities in this city include one hospital run by four medical officers and four primary schools, two for boys and two for girls, and two secondary schools, one for boys and the other for girls.

The first author and two nutritionists held a one-day course and trained two teachers from each primary school on how to measure and report the height and the weight of the school children. The training was conducted by the first author including a demonstration of how to measure height, weight, and how to calculate BMI using standard methods and equipment. All measurements were taken first in the morning and completed in 15 days for all participants. The age of the participants was calculated from school records. BMI of each child was calculated and plotted on WHO BMI 5–19 years chart (WHO growth reference 2007). Z score > 3 SD was considered obese, 2 < SD overweight, < 2 SD underweight, and < 3 SD severe underweight. Consent was obtained from all parents or guardians of participants.


Statistical Analysis

We analyzed the data using the Statistical Package for Social Science (SPSS, Version 20). Qualitative data were expressed as numbers and percentage. A p-value of less than 0.05 was used to determine the level of significance, and multinomial logistic regression test was used for analyses.


RESULTS

All children attending the four primary schools (1,387) were asked to participate in the study. One hundred and twenty-nine children were excluded because their parents declined to consent for the study and other 35 were excluded because their age was above 14 years. Data of 1,223 (88.2%) children were available for the analysis. Data showed that 50.1% (n = 613) were females, 51.3% (n = 628) of the study group were 10 years of age or less, 52.2% (n = 638) were native (colored), while 47% (n = 585) were of Egyptian descent (white), as shown in Table 1. BMI analysis revealed that 19 (1.5%) were obese, 76 (6.2%) overweight, 56 (4.6%) underweight, and 45 (3.7%) were severely underweight as shown in Table 2. Height for age analysis showed that 46 (3.8%) children were stunted and 14 of them (1.1%) were severely stunted (Table 3). Overweight is significantly common among children older than 10 years and children of Egyptian descent with a p-value of 0.001 and 0.00, respectively. On the contrary, underweight and severe underweight were significantly common among native Sudanese (colored) with a p-value of 0.005 and 0.02, respectively (Table 4). Severe stunting is significantly common among children older than 10 years of age (p < 0.05), as shown in Table 5.

Table 1. - Characteristics of 1,223 school age children.

Number %
10 year or less 628 51.3
More than 10 years 595 48.7
Female 613 50.1
Male 610 49.9
White 585 47.8
Colored 638 52.2

Table 2. Body mass index of 1,223 school age children.

BMI Frequency Percentage (%) Cumulative
Normal 1,027 83.97 83.97
Over weight 76 6.21 90.19
Obese 19 1.55 91.74
Underweight 56 4.58 96.32
Severe underweight 45 3.68 100
Total 1,223 100

BMI = body mass index.

Table 3. Height for age of 1,223 school age children.

Height Frequency Percentage (%) Cumulative
Normal 1,126 92.07 92.07
Tall 29 2.37 94.44
Very tall 8 0.65 95.09
Short 46 3.76 98.86
Very Short 14 1.14 100

Table 4. Body mass index of 1223 school age children according to age, gender and color.

BMI Age <10 years Age = 10 years p value White colored p value female male p value
Normal 549 (87.4%) 478 (80.4%) - 489 (83.6%) 538 (84.3%) - 530 (86.5%) 497 (81.5%) -
obese 8 (1.3 %) 11 (1.8%) 0.304 13 (2.2%) 6 (0.9%) 0.07 9 (1.5%) 10 (1.6%) 0.655
Over weight 25 (4%) 51 (8.6%) 0.001 55 (9.4%) 21 (3.3%) 0.00 43 (7%) 33 (5.4%) 0.025
Under weight 26 (4.1%) 30 (5%) 0.314 15 (2.6%) 41 (6.4%) 0.005 19 (3%) 37 (6.1%) 0.015
Severe under weight 20 (3.2%) 25 (4.2%) 0.231 13 (2.2%) 32 (5%) 0.024 12 (2%) 33 (5.4%) 0.002
Total 628 (100%) 595 (100%) - 585 (100%) 638 (100%) - 613 (100%) 610 (100%) -

BMI = body mass index.


DISCUSSION

The prevalence rate of obesity and overweight in school-aged children is comparatively lower than the prevalence rate reported in the rural areas in the same province as well as in the capital city (Khartoum) [7,10]. The prevalence of obesity in this study is also lower than that reported in other Middle East countries [4,11,12]. This prevalence of obesity may be explained by the lifestyle and the nutritional habits of the population in this area. Food consumed in this area is generally derived from natural and organic sources.

Overweight in our cohort is significantly increased among children who were more than ten years old. This pattern is expected because of the hormonal changes and the growth spurt that occur at the teen's age [3].

Table 5. Height for age of 1,223 school age children according to age, gender and color.

Height Age <10 years Age = 10 years p value White colored p value female male p value
Normal 605 (96.3%) 558 (93.8%) - 559 (95.5%) 604 (94.7%) - 579 (94.4%) 584 (95.7%) -
Stunted 20 (3.2 %) 26 (4.4%) 0.323 21 (3.6%) 25 (3.9%) 0.718 28 (4.6%) 18 (3 %) 0.17
Severely stunted 3 (0.5%) 11 (1.8%) 0.05 5 (0.9%) 9 (1.4%) 0.3 6 (1 %) 8 (1.3%) 0.5
Total 628 (100%) 595 (100%) - 585 (100%) 638 (100%) - 613 (100%) 610 (100%) -

Interestingly, overweight is more prevalent among children of Egyptian descent, while underweight and severe underweight are more prevalent among native Sudanese (colored). This pattern may result from the perception that families with Egyptian descent tend to have better income as most parents are merchants or employees with better income compared with the native Sudanese who are mostly farmers [4]. Moreover, the two ethnic groups have different nutritional habits. Similarly, obesity is more prevalent among blacks compared with whites in the United States [15,16].

Our study also showed that the prevalence rate of underweight and severe underweight was comparatively lower than the prevalence rate reported in the rural area in the same province [7] and other regions of Sudan [17,18]. This growth status indicates that the nutritional status of our cohort who lives in this urban area is better than that of rural children in the same area. Also, the mixed ethnicity of our cohort with different socioeconomic status and nutritional habits compared with the homogenous farmer population who live in the rural area may have contributed to these differences in growth.

It is clear that lifestyle, feeding habits, education of the parents, and socioeconomic status affect the obesity prevalence more than color, race, or genetic factors [1518]. Unlike the pattern in developed countries, the education level of the parents in the developing countries similar to Sudan showed a high incidence of overweight in children of highly educated parents [1518]. This may be attributed to the fact that a high caloric diet and fast food are easily accessible to high socioeconomic group compared with poor families in the developing countries [1518]. However, in developed countries, fast food is affordable for the majority of the population, while a healthy balanced diet is more expensive [1519].


CONCLUSION

In conclusion, this study showed that a total of 7.7% of the participants were either overweight or obese, while 8.3% were either underweight or severely underweight. These findings suggest the need to improve the school health program to detect the nutritional problems among school children and manage it early.


Authors’ contribution

Mohamed D. Hussein designed, collected, and did statistical analysis and editing of the manuscript.

Noufa A. Alonazi and Sarar Mohamed did statistical analysis and editing of the manuscript.

All authors read and approved the final manuscript.


REFERENCES

  1. Perignon M, Marion F, Khov K, Kurt B, Megan P, Sisokhom S, et al. Stunting poor iron status and parasite infection are significant risk factorsfor lower cognitive performance in Cambodian school-aged children. PLoS One. 2014;11(9):1–11. https://doi.org/10.1371/journal.pone.0112605
  2. Best C, Neufinger N, van Geel L, van den Briel T, Osendarp S. The nutritional status of schoolaged children: why should we care? Food Nutr Bull. 2010;31(3):400–17. https://doi.org/10.1177/156482651003100303
  3. Musaiger A. Overweight and obesity in Eastern Mediterranean Region: prevalence and possible causes. J Obes. 2011;6:e407237. https://doi.org/10.1155/2011/407237
  4. Muss TH, Ali E, Musa H, Khan A. Anthropometric parameters in children 5 to 15 years old in Khartoum state Sudan. J. Public Health Epid. 2013;5(8):313–8.
  5. Musaiger A. Overweight and obesity in the Eastern Mediterranean Region: can we control it. East Mediterr Health J. 2004;10(6):789–93.
  6. Salman Z, Kirk GD, DeBoer MD. High rate of obesity-associated hypertension among primary school children in Sudan. Int J Hypertens. 2011;e629492
  7. Campici SC, Cherian AM, Bhuta ZA. Perspective on the epidemiology of stunting between 1990 and 2015. Horm Res Paediatr. 2017;88:70–8. https://doi.org/10.1159/000462972
  8. Mohamed S, Hussein MD. Prevalence of thinness, stunting, and anemia among rural school aged Sudanese children: a cross-section study. J Trop Pediatr. 2015;61(4):260–5. https://doi.org/10.1093/tropej/fmv028
  9. Elbagir M, Eltom M, Elmahdi E, Berne C. A population-based study of the prevalence of diabetes and impaired glucose tolerance in adult in north Sudan. Diabetes Care. 1996:19(10):1126–8. https://doi.org/10.2337/diacare.19.10.1126
  10. Elbagir M, Eltom M, Elmahdi E, Kadam IM, Berne C. A high prevalence of diabetes and impaired glucose tolerance in the Danagla community in northern Sudan. Diabet Med. 1998;15(5): 164–9. https://doi.org/10.1002/(SICI)1096-9136(199802)15:2<164::AID-DIA536>3.0.CO;2-A
  11. Osama A. Underweight, overweight and obesity among secondary school children in Khartoum. Ahfad J. 2007;24(1):59.
  12. Salazar M, Allen B, Fernandez OC, Torres MG, Galal O, Lazcano-Ponce E. Overweight and obesity status among adolescent from Mexico and Egypt. Arch Med Res. 2006;37(4):535–42. https://doi.org/10.1016/j.arcmed.2005.10.014
  13. Soliman A, De Sanctis V, Elalaily R. Nutrition and pubertal development. Ind J Endocrinol Metab. 2014;18(Suppl 1):S39–47. https://doi.org/10.4103/2230-8210.145073
  14. Lieb DC, Snow RE, DeBoer MD. Socioeconomic factors in the development of childhood obesity and diabetes. Clin Sports Med. 2019;28(3):349–78. https://doi.org/10.1016/j.csm.2009.02.004
  15. Cynthia LO, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adult and youth: USA, 2011-2014. U.S. Department of health and human services. Centers for Disease Control and Prevention. NCHS Data Brief, No.219, Nov 2015.
  16. Wang Y. MA. Beydoun. The obesity epidemics in the United States–gender, age, socioeconomic, racial/ethnic characteristics: a systemic review and meta-regression analysis. Epidemiol Rev.2007;29:6–28. https://doi.org/10.1093/epirev/mxm007
  17. Nabag FO. Comparative study of nutrition status of urban and rural school girl's children Khartoum state, Sudan. J Sci Technol. 2011;12(2):60–8.
  18. Shashaj B, Graziani MP, Contoli B, Ciuffo C, Cives C, Facciolini S, et al. Energy balancerelated behaviors, perinatal, sociodemographic, and parental risk factors associated with obesity in Italian preschoolers. J Am Coll Nutr. 2016;35(4):362–71. https://doi.org/10.1080/07315724.2015.1070699
  19. Syahrul S, Kimura R, Tsuda A, Susanto T, Saito R, Fitheria A. Prevalence of overweight and underweight among school-aged children and its association with children's sociodemographic and lifestyle in Indonesia. Int J Nurs Sci. 2016;3(2): 169–77.


How to Cite this Article
Pubmed Style

Hussein MD, Alonazi NA, Mohamed SM. Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. Sudan J Paed. 2018; 18(2): 15-19. doi:10.24911/SJP.106-1544799078


Web Style

Hussein MD, Alonazi NA, Mohamed SM. Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. http://www.sudanjp.com/?mno=21587 [Access: June 26, 2019]. doi:10.24911/SJP.106-1544799078


AMA (American Medical Association) Style

Hussein MD, Alonazi NA, Mohamed SM. Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. Sudan J Paed. 2018; 18(2): 15-19. doi:10.24911/SJP.106-1544799078



Vancouver/ICMJE Style

Hussein MD, Alonazi NA, Mohamed SM. Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. Sudan J Paed. (2018), [cited June 26, 2019]; 18(2): 15-19. doi:10.24911/SJP.106-1544799078



Harvard Style

Hussein, M. D., Alonazi, . N. A. & Mohamed, . S. M. (2018) Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. Sudan J Paed, 18 (2), 15-19. doi:10.24911/SJP.106-1544799078



Turabian Style

Hussein, Mohamed D, Noufa A Alonazi, and Sarar Mohamed Mohamed. 2018. Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. Sudanese Journal of Paediatrics, 18 (2), 15-19. doi:10.24911/SJP.106-1544799078



Chicago Style

Hussein, Mohamed D, Noufa A Alonazi, and Sarar Mohamed Mohamed. "Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan." Sudanese Journal of Paediatrics 18 (2018), 15-19. doi:10.24911/SJP.106-1544799078



MLA (The Modern Language Association) Style

Hussein, Mohamed D, Noufa A Alonazi, and Sarar Mohamed Mohamed. "Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan." Sudanese Journal of Paediatrics 18.2 (2018), 15-19. Print. doi:10.24911/SJP.106-1544799078



APA (American Psychological Association) Style

Hussein, M. D., Alonazi, . N. A. & Mohamed, . S. M. (2018) Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan. Sudanese Journal of Paediatrics, 18 (2), 15-19. doi:10.24911/SJP.106-1544799078





Most Viewed Articles
  • Rheumatic heart disease in North Darfur: an alarmingly high burden and control initiative
    Nagwa Salih, Ishag Eisa, Daresalam Ishag, Intisar Ibrahim, Sulafa Ali
    Sudan J Paed. 2018; 18(1): 24-27
    » Abstract » doi: 10.24911/SJP.2018.1.4

  • Evaluation of Science. [eng]
    Adnan Mahmmood Usmani; Sultan Ayoub Meo
    Sudan J Paed. 2011; 11(1): 6-7
    » Abstract

  • Blood tests are not always helpful in predicting bacterial meningitis in children.
    Taha I Yousif, Katie O'Reilly, Montasser Nadeem
    Sudan J Paed. 2016; 16(2): 77-79
    » Abstract

  • Commitment to the wellbeing of children worldwide. [eng]
    Mustafa Abdalla M Salih; Satti Abdelrahim Satti
    Sudan J Paed. 2011; 11(2): 4-5
    » Abstract

  • X-linked hypophosphatemic rickets (PHEX mutation): A case report and literature review.
    Badi Alenazi, M A Maleque Molla, Abdullah Alshaya, Mahmoud Saleh
    Sudan J Paed. 2017; 17(1): 61-65
    » Abstract

  • Four decades of the Sudanese Journal of Paediatrics and milstones.
    Mustafa Abdalla M Salih, Mohammed Osman Swar
    Sudan J Paed. 2017; 17(1): 5-9
    » Abstract

  • About the Cover. [eng]

    Sudan J Paed. 2016; 16(2): i-i
    » Abstract

  • Bartter syndrome associated with nephropathic cystinosis.
    Nader M Osman, Ali Al Sanosi
    Sudan J Paed. 2016; 16(2): 93-98
    » Abstract

  • Article authored by three generations: International lifetime commitment to child health
    Mustafa Abdalla M Salih, Mohammed Osman Swar
    Sudan J Paed. 2017; 17(2): 5-10
    » Abstract » doi: 10.24911/SJP.2017.2.1

  • The Editors of Sudanese Journal of Paediatrics would like to thank. [eng]

    Sudan J Paed. 2016; 16(2): 99-99
    » Abstract

  • Most Downloaded
  • Why mothers are not exclusively breast feeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia
    Hafsa Raheel, Shabana Tharkar
    Sudan J Paed. 2018; 18(1): 28-38
    » Abstract » doi: 10.24911/SJP.2018.1.5

  • Inborn errors of metabolism associated with hyperglycaemic ketoacidosis and diabetes mellitus: narrative review
    Majid Alfadhel, Amir Babiker
    Sudan J Paed. 2018; 18(1): 10-23
    » Abstract » doi: 10.24911/SJP.2018.1.3

  • Severe desquamation in Kawasaki disease: Is it somehow protective?
    Jubran Theeb Alqanatish, Amir Babiker
    Sudan J Paed. 2017; 17(2): 56-59
    » Abstract » doi: 10.24911/SJP.2017.2.7

  • Article authored by three generations: International lifetime commitment to child health
    Mustafa Abdalla M Salih, Mohammed Osman Swar
    Sudan J Paed. 2017; 17(2): 5-10
    » Abstract » doi: 10.24911/SJP.2017.2.1

  • Ethical considerations about changing parental attitude towards end-of-life care in twins with lethal disease
    Mohamad-Hani Temsah
    Sudan J Paed. 2018; 18(1): 76-82
    » Abstract » doi: 10.24911/SJP.2018.1.11

  • Presacral Neuroblastoma in an 11 months old infant
    Sunil Malik, Sonal Saran, Annu Kharbanda
    Sudan J Paed. 2018; 18(1): 87-89
    » Abstract » doi: 10.24911/SJP.2018.1.14

  • Prevalence of obesity, overweight, underweight, and stunting among school children in Argo city, Northern Sudan
    Mohamed D Hussein, Noufa A Alonazi, Sarar Mohamed Mohamed
    Sudan J Paed. 2018; 18(2): 15-19
    » Abstract » doi: 10.24911/SJP.106-1544799078

  • A journey from being preterm to pediatric neurology
    Rana Abdullah AlSheikh, Rawan Abdullah AlSheikh
    Sudan J Paed. 2018; 18(2): 72-73
    » Abstract » doi: 10.24911/SJP.106-1545214668

  • Burosumab - a new drug to treat hypophosphatemic rickets
    Stepan Kutilek, Amir Babiker, Badi Alenazi
    Sudan J Paed. 2017; 17(2): 71-73
    » Abstract » doi: 10.24911/SJP.2017.2.11

  • Medical education and services in an extreme environment
    Mustafa Abdalla M. Salih, Mohammed Osman Swar
    Sudan J Paed. 2018; 18(1): 2-5
    » Abstract » doi: 10.24911/SJP.2018.1.1

  • Most Cited Articles
  • Commitment to the wellbeing of children worldwide. [eng]
    Mustafa Abdalla M Salih; Satti Abdelrahim Satti
    Sudan J Paed. 2011; 11(2): 4-5
    » Abstract
    Cited : 4 times [Click to see citing articles]

  • Evaluation of Science. [eng]
    Adnan Mahmmood Usmani; Sultan Ayoub Meo
    Sudan J Paed. 2011; 11(1): 6-7
    » Abstract
    Cited : 1 time [Click to see citing article]

  • Burosumab - a new drug to treat hypophosphatemic rickets
    Stepan Kutilek, Amir Babiker, Badi Alenazi
    Sudan J Paed. 2017; 17(2): 71-73
    » Abstract » doi: 10.24911/SJP.2017.2.11
    Cited : 1 time [Click to see citing article]