FOOD CONSUMPTION PATTERNS, PHYSICAL ACTIVITY AND

i

FOOD CONSUMPTION PATTERNS, PHYSICAL ACTIVITY AND

OVERWEIGHT AND OBESITY AMONG SECONDARY SCHOOL

STUDENTS IN KWARA STATE, NIGERIA

LATEEF OWOLABI JIMOH (BSC. HUMAN NUTRITION)

H60F/24362/2011

A RESEARCH THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF

SCIENCE (FOOD, NUTRITION AND DIETETICS) SCHOOL OF APPLIED

HUMAN SCIENCES, KENYATTA UNIVERSITY

MARCH 2016

ii

DECLARATION

This thesis is my original work and has not been presented for a degree in any other

University or any other award.

Signature.......................................................... Date........................................

Lateef Owolabi Jimoh – H60F/24362/2011

Department of Food, Nutrition and Dietetics

SUPERVISORS

We confirm that the work reported in this thesis was carried out by the candidate

and has been submitted with our approval as University supervisors:

Signature.......................................................... Date........................................

Eunice Njogu (PhD)

Department of Food, Nutrition and Dietetics

Kenyatta University

Signature.......................................................... Date........................................

Festus Kiplamai (PhD)

Department of Recreation and Exercise Science

Kenyatta University

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DEDICATION

This thesis is dedicated to the almighty Allah- the creator of heavens and earth,

Alhaja Fatima Ashabi, Muinat, Ruth and all the Owolabis' and Federal Republic of

Nigeria

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ACKNOWLEDGEMENT

I sincerely appreciate and acknowledge the authority of the Tertiary Education Trust

Fund (TETFUND) in Nigeria and the management of Federal Polytechnic Bauchi,

Nigeria, for the opportunity given to me to improve my professional skills in the

field of Nutrition and Dietetics. I equally express my gratitude to my supervisors-

Dr.Eunice Njogu and Dr. Festus Kiplamai for the sacrifices made for me. All my

lecturers and staff of Department of Foods, Nutrition and Dietetics in Kenyatta

University (KU), my colleagues, Nigerian community in Kenyatta University (KU),

my research assistants and Directorate of International Linkages in KU, I

acknowledge the support you all gave me in the course of my study at Kenyatta

University. Also I deeply appreciate the patience and encouragement of my family

members in ensuring that I complete my study successfully. All the glory and

praises go to my creator who spared my life till the end of this program.

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TABLE OF CONTENTS

DECLARATION ....................................................................................................... ii

DEDICATION .......................................................................................................... iii

ACKNOWLEDGEMENT .......................................................................................... iv

TABLE OF CONTENTS ............................................................................................ v

LIST OF FIGURES .................................................................................................... ix

LIST OF TABLES ...................................................................................................... x

ABBREVIATIONS AND ACRONYMS .................................................................... xi

OPERATIONAL DEFINITION OF TERMS .......................................................... xiii

ABSTRACT............................................................................................................. xiv

CHAPTER ONE: INTRODUCTION....................................................................... 1

1.1 Background to the Study........................................................................................ 1

1.2 Problem Statement ................................................................................................ 3

1.3 Purpose of the Study .............................................................................................. 5

1.4 Objectives of the Study .......................................................................................... 5

1.5 Hypotheses of the Study ........................................................................................ 5

1.6 Significance of the Study ....................................................................................... 6

1.7 Delimitations of the Study ..................................................................................... 6

1.8 Limitation of the Study .......................................................................................... 6

1.9 Conceptual Framework .......................................................................................... 6

CHAPTER TWO: LITERATURE REVIEW .......................................................... 8

2.1 Socioeconomic Status and Emerging Overweight and Obesity Epidemic among

Adolescents .......................................................................................................... 8

2.2 Adolescents Food Consumption Patterns and Risk of Overweight and Obesity ...... 9

2.3 Adolescents Physical Activity, Sedentary Lifestyle and Its Relationship with

Adolescent Overweight and Obesity ................................................................... 11

2.4 Predictors of Overweight and Obesity Status among Adolescent’s Students......... 13

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2.5 Relationships between adolescent food consumption pattern, physical activity

level and overweight and obesity ........................................................................ 15

2.6 Summary of Literature Review ............................................................................ 17

CHAPTER THREE: METHODOLOGY .............................................................. 18

3.1 Research Design .................................................................................................. 18

3.2 Measurement of Variables ................................................................................... 18

3.3 Study Area .......................................................................................................... 18

3.4 Target Population ................................................................................................ 19

3.5 Exclusion and Inclusion Criteria .......................................................................... 19

3.5.1 Inclusion Criteria ............................................................................................ 19

3.5.2 Exclusion Criteria ........................................................................................... 19

3.6 Sampling Techniques .......................................................................................... 19

3.7 Sample Size Determination.................................................................................. 21

3.8 Research Instruments ........................................................................................... 22

3.9 Pre-testing ........................................................................................................... 22

3.10 Validity and Reliability of the Research Instrument ........................................... 22

3.11 Data Collection Procedure ................................................................................. 23

3.12 Data Analysis and Presentation .......................................................................... 24

3.13 Logistical and Ethical Consideration .................................................................. 25

CHAPTER FOUR: RESULTS ............................................................................... 26

4.1. The Demographic Characteristics of Participants ................................................ 26

4.2 Food Consumption Patterns of the Participants .................................................... 28

4.2.1 Breakfast Consumption by the Participants ..................................................... 28

4.2.2 Daily Sugar Intake by the Participants ............................................................ 29

4.2.3 Average Numbers of Times per Week Carbohydrates Foods consumed by the

Participants ...................................................................................................... 30

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4.2.4 Average Numbers of Times per Week Fat and Oil Foods Consumed by the

Participants ...................................................................................................... 31

4.2.5 Average numbers of times per week fatty protein foods consumed by

participants ....................................................................................................... 31

4.2.6Average numbers of times per week sugary beverages, fruit juices and whole

fruits consumed by participants ........................................................................ 32

4.3 Physical activity level of the participants ............................................................. 33

4.3.1 The Daily hours of Sleep by the Participants .................................................. 34

4.3.2 Types, Frequency and Duration of Involvement in Physical Activities by the

Participants Daily ............................................................................................. 35

4.3.3 The Metabolic Equivalent Scores (Mets) Per Week by the Participants........... 37

4.3.4 Participants’ Belief in the Efficacy of Physical Activity ................................ 37

4.3.5 Observation Checklist of the Schools Facilities of the Participants ................. 38

4.4 Distribution of the BMI for Age of the Participants ............................................. 38

4.5 Factors Associated with Overweight and Obesity. ............................................... 41

4.5.1 Relationship between Food Consumption Pattern, Physical Activity and the

Body Mass Index for Age ................................................................................. 41

4.5.2 Relationship between BMI for Age, FC P and PA for the Participants ............ 41

4.5.3 ANOVA Test of FCP and PA in Mets Based On (BMI) for Age of the

Participants ...................................................................................................... 42

CHAPTER FIVE: DISCUSSION .......................................................................... 44

5.1 Demographic Characteristics of the Adolescent Students ..................................... 44

5.2 Breakfast Consumption Pattern of the Participants ............................................... 45

5.2.1 Carbohydrates Consumption Pattern of the Participants .................................. 46

5.2.2 Fats and Oil Consumption Pattern of the Participants ..................................... 47

5.2.3 Proteins Consumption Pattern of the Participants ............................................ 47

5.2.4 Sugary Beverages, Whole Fruits and Fruits Juices Consumption of the

Participants ...................................................................................................... 49

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5.3 Physical Activity Practice of the Participants ....................................................... 50

5.3.1 Hours of Sleep by the Participants .................................................................. 51

5.3.2 Physical Activity Pattern of the Participants ................................................... 51

5.3.3 Physical Activity Facilities in Schools ............................................................ 53

5.4 Body Mass Index (BMI) for Age of the Participants ............................................ 54

5.5 The Relationship between Food Consumption Pattern, Physical Activity Level

and Overweight and Obesity of the Participants .................................................. 56

CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATIONS . 58

6.1 Summary of the Findings ..................................................................................... 58

6.2 Conclusion of the Findings .................................................................................. 59

6.3 Recommendations ............................................................................................... 60

6.3.1 Recommendation for Practice ......................................................................... 60

6.3.2 Recommendations for Policy .......................................................................... 60

6.3.3 Suggestion for Further Research ..................................................................... 60

REFERENCES ........................................................................................................ 62

APPENDICES ......................................................................................................... 80

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LIST OF FIGURES

Figure 1.1 Causes of Overweight and Obesity............................................................7

Figure 3.1 Multistage Sampling Procedure...............................................................20

Figure 4.1 Breakfast Consumption by the Participants.............................................29

Figure 4.2 Daily Sugar Consumption by the Participants.........................................29

Figure 4.3 Daily Hours of Sleep by the Participants................................................ 34

Figure 4.4 Participants’ Belief in Physical Activity Practice....................................38

Figure 4.5 Participants (BMI) for Age Based on Sex compared with WHO (2007)

Standard..............................................................................................................41

Figure 4.6 All participants (BMI) for Age compared with WHO (2007) Standard..40

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LIST OF TABLES

Table 4.1Demographic Characteristics of Participants ..............................................26

Table 4.2 Demographic Characteristics of Participants .............................................27

Table 4.3 Demographic Characteristics of Participants’ Parents or Guardians ...........28

Table 4.4 Average numbers of times per week Carbohydrates Foods were consumed

by the Participants ....................................................................................................30

Table 4.5 Average numbers of times per week Fat and Oil Foods were consumed by

the Participants .........................................................................................................31

Table 4.6 Average numbers of times per week Fatty Protein Foods were consumed

by Participants ..........................................................................................................32

Table 4.7 Average number of times per week Sugary Beverages, Fruit Juices and

Whole Fruits were consumed by Participants............................................................33

Table 4.8 Types, Duration and frequency of Physical Activities by the Participants ..35

Table 4.9 Distribution of the Participants’ Physical Activities in last 7 days .............36

Table 4.10 Metabolic Equivalent Scores (METS) per week of the Participants .........37

Table 4.11 Summary of participants’ Body Mass Index for (BMI for age) as

classified by (WHO, 2007) .......................................................................................39

Table 4.12 Relationships between BMI for Age, FCP and PA for the Participants ....42

Table 4.13 ANOVA test of FCP and PA based on BMI for Age Categories of the

Participants ..............................................................................................................43

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ABBREVIATIONS AND ACRONYMS

BFHI Baby Friendly Hospital Initiative

BMI Body Mass Index

CFS Child Friendly Schools

CVDs Cardiovascular Diseases

CVI Content Validity Index

DHHS Department of Health and Human Services

EMR Eastern Mediterranean Region

EP Essential Package

EST Ecological System Theory

FAO Food and Agricultural Organization

FCP Food Consumption Pattern

FI Fresh Initiative

FND Food, Nutrition and Dietetics

GPAQ Global Physical Activity Questionnaire

HPS Health Promoting Schools

HSES Higher Socioeconomic Status

IOTF International Obesity Taskforce

IPAQ International Physical Activity Questionnaire

JSS Junior Secondary School

KSTSC Kwara State Teaching Service Commission

KSUBEB Kwara State Universal Basic Education Board

KU Kenyatta University

LSES Lower Socioeconomic Status

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METs Metabolic equivalents Score

MVPA Moderate-Vigorous Intensity Physical Activity

NCDs Non-communicable Diseases

NFSI Nutrition Friendly School Initiative

NCHS National Centre for Health Statistics

OB Obesity

OW Overweight

PA Physical Activity

PAL Physical Activity Level

PAQ Physical Activity Questionnaire

PAQ-A Physical Activity Questionnaire for Adolescent

SBSs Sugar Sweetened Beverages

SES Socioeconomic Status

SFNE Schools’ Food and Nutrition Education

SPSS Statistical Package for Social Science

SSS Senior Secondary School

TETFUND Tertiary Education Trust Fund

UNICEF United Nations International Children Emergency Fund

VS Versus

USA United States of America

WFP World Food Programme

WHO World Health Organization

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OPERATIONAL DEFINITION OF TERMS

Adolescent: Any child between the ages of 10 and 19 years.

Food Consumption Pattern: The number of times (frequency), participants

consume certain food items in a week.

Obesity: BMI for age and sex as classified by WHO

(2007) as (≥ 97th) percentiles.

Overweight: BMI for age and sex as classified by WHO

(2007) as (85th - <97

th) percentiles.

Physical Activity: Any human activity that involves energy

Expenditure and can be categorized as low,

moderate or high.

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ABSTRACT

Adolescent overweight and obesity have been observed as one of serious public

health challenges of the 21st century by the World Health Organization (WHO).

Over the past few decades adolescent food consumption has undergone a great deal

of transition from the starchy carbohydrates from roots and tubers to the highly

refined cereals and sugary beverages. The highly refined cereals consumption

contributes in no small measure to body adiposity. Physical inactivity further

aggravates the calorie-imbalances that will later develop into overweight and

obesity. This study determined the food consumption pattern and physical activity

and overweight and obesity among the secondary school students in Kwara state,

Nigeria. Cross-sectional analytical design was used in this study. A total of 515

adolescent students were randomly selected using multistage and stratified sampling

techniques from 8 public secondary schools in two zonal inspectorate divisions. The

instruments of data collection used were a modified food frequency questionnaire

and Physical Activity Questionnaire for Adolescents (PAQ-A). Digital bathroom

scale and stadiometer were used to measure the weight and height of the students

respectively and observation checklist was used to assess the functionality of school

facilities. Data was analyzed using statistical package for social sciences (SPSS,

Version 20) and WHO anthroplus package. Food consumption pattern of

participants indicated that 77% consumed breakfast and 4.5% added more than 5

teaspoonful of sugar to their beverages daily. The participants mostly consumed

refined carbohydrates was doughnut and biscuits (2.36±0.99) times per week, while

mostly consumed fat and oil was vegetable oil in soup (2.54±0.96) times per week.

Furthermore, the fatty protein mostly consumed was fish pies and fish rolls

(2.71±0.87) times per week and mostly consumed fruit was pawpaw (2.56±0.89)

times per week. Participants’ hours of sleep indicated that 50.3% had 7-8 hours of

sleep daily. Physical activity level indicated that 48.7% were moderately active and

39.4% were highly active per week. Observation checklist results indicated that all

the schools had functional sporting facilities (100%). Body mass index (BMI) for

age of participants showed that 29.1% were underweight, 4.7% were overweight

while less than 1% were obese. The Pearson correlation between BMI for age and

food consumption pattern (FCP) was (r=0.012, p =0.785), BMI for age and physical

activity level (r=-0.105, p= 0.017). ANOVA of BMI for age and food consumption

pattern showed significance (p= 0.001). There was no significant difference between

BMI for age and the metabolic equivalent scores (METs) of the participants

(p=0.725). Despite the relatively low prevalence of overweight and obesity

observed, of concern was high underweight and low BMI for age in this study.

Result findings indicated low frequency of food consumption and moderate physical

activity levels. The parents and guardians should improve on the frequency of

consumption of nutritious food for the adolescent students in public secondary

schools and their physical activity level should be sustained.

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CHAPTER ONE: INTRODUCTION

1.1 Background to the Study

Adolescents as a vulnerable group require special attention and nutritional care

because of the negative nutritional consequences that may occur among them as a

result of inadequate consumption of healthy foods and physical inactivity.

Overweight and obesity in childhood and in adolescents are emerging as one of the

major public health of concern in the last few decades. Overweight and obesity

conditions develop when there is an imbalance between calories consumed and

calories expended mostly due to inadequate consumption of healthy foods and

physical inactivity that cut-across all age groupings. It is known to be associated

with substantial loss of quality of life and social stigmatisation that may trigger

depression, anxiety, low self-esteem, feelings of guilt and chronic diseases

development in the crop of individuals that may constitute a higher percentage of the

world labour force in few years to come (Onyiriuka, Umoru, & Ibeawuchi, 2013).

Globally, the increasing prevalence of overweight and obesity among adolescent

began to draw the world attention as early as 1991 in the United States of America

(USA) when there was a decline in the proportion of students in grade 9 to 12 years

participation in daily physical education from 42% in 1991 to 29% in 1999 (Boyle &

Holben, 2006). In 1997, a World Health Organization (WHO) Consultative group

formally recognized that the obesity epidemic occurs worldwide and that the

prevalence is increasing faster in developing countries than in developed countries

(Hafiz, Ibrahim, & Atiku, 2012; WHO, 2008). The healthy people 2010 initiative of

the US department of health and human services (DHHS) progress review indicated

that the proportion of children and adolescent age six to nine years who were

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overweight had increased from 11% in late 1980s to 16% in 2002. The initiative’s

objectives on the consumption of fruits, vegetable and grain had not been met as at

that time, therefore another goal was set for 2020 (Boyle & Holben, 2006).

According to Ferrara (2009), more than 17% of children in the United State of

America (USA) were overweight or obese and about 35% of college students in

USA were overweight or obese. The prevalence of overweight and obesity among

school children in Eastern Mediterranean Region (EMR) was between 7% and 45%

(Abdurrahman, 2011).

Okoth (2013) reported overweight prevalence of 18.7% for female adolescent and

10.3% for male adolescent while the obesity prevalence for both male and female

adolescents were 0% and 2.1% respectively among adolescents in Kenya. Adamu,

Adjei and Kubuga (2012) put adolescents’ overweight and obesity prevalence in

Ghana between 4% and 7%. In Nigeria the prevalence of overweight and obesity

among adolescent varies according to the regions and between urban and rural, as

well as between private and public school students. For instance in the Southern

Nigeria, the prevalence of overweight was between 13.2% and 24.2% and the

prevalence of obesity was between 1% and 2.5% (Onyiriuka et al, 2013). In the

Northern Nigeria, recent study indicated a high prevalence of underweight (29.6%)

in the adolescent (Hafiz, et al., 2012).

Physical activity is the bodily movement produced by skeletal muscles that requires

energy expenditure. Physical inactivity has been identified as the fourth leading risk

factor of global mortality. It accounted for 6% of death globally and has been

estimated to be the main cause of the following disease conditions 27% diabetes, 21-

25% of breast and colon cancer and about 30% ischemic heart disease burden in the

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world (WHO, 2014). The recent studies conducted around the world indicated that

the nutrition education interventions on school children have significantly improved

their healthy eating habit and informed food choice practices.

However, these interventions are limited in some countries especially in the

Northern Nigeria where there is a great diversity in the cultural practices that

influence adolescent dietary behaviour. According to OlubanjiOjofeitimi,

Ojofeitimi, Olugbenga-Bello, Adekanle, & Adeomi, 2011) the dietary practices of

adolescent girls in private secondary schools studied indicated that majority (60.2%)

were unhealthy. Similarly, overweight and obesity were significantly higher in

adolescent girls who lived sedentary lifestyles in Nigeria as was reported in

(OlubanjiOjofeitimi et al, 2011). Furthermore, the study indicated the difference in

the prevalence of overweight and obesity among adolescents from private schools

and public schools. The difference was concluded to be due to poor healthy dietary

practices and sedentary lifestyles of the adolescents in private schools. Therefore

this study on the food consumption patterns and physical activity and overweight

and obesity will be very useful among adolescent students in public secondary

schools in the North Central Nigeria where Kwara state is situated. This is important

so that appropriate school based intervention can be put in place for the students.

1.2 Problem Statement

Nutrition-related health problems such as overweight and obesity in adolescents are

increasingly significant causes of disability and premature death both in developed

and developing countries including Nigeria (Boyle & Holben, 2006). The epidemic

of obesity alongside continuing problems of undernutrition has plagued African

4

countries. According to Karl and Pengpid (2011) whose study was on the

assessment of overweight and obesity and associated factors in school-going

adolescents in low-income African countries (Ghana and Uganda), adolescents

consumed fruits or vegetables in less than one times in a day, while more than three

quarters of them were physically inactive

Studies on adolescents overweight and obesity among secondary schools students in

Nigeria had shown progressive increase in the prevalence of overweight and obesity

especially in the private secondary schools (Eberechukwu, Eyam, &Nsan, 2013;

Ene-Obong, Ibeanu, Onuoha & Ejekwu, 2012 ; OlubanjiOjofeitimi et al, 2011).

Little information on overweight and obesity is available on the public secondary

schools students particularly in Kwara state. Childhood and adolescents obesity are

strong predictors of adult obesity which has now become the public health

challenges of the 21st century according to World Health Organization (Fadupin &

Olayiwola, 2011; Monyeki, vanLenthe, & Steyn, 1999; Popkin, Adair, & Ng, 2012).

Many co-morbid conditions like metabolic, cardiovascular, psychological,

orthopaedic, neurological, hepatic, pulmonary and renal disorders are seen in

association with childhood obesity (Raj & Kumar, 2010). Therefore, there was need

to determine overweight and obesity prevalence among the public secondary schools

in Kwara state, Nigeria. This study on the food consumption patterns and physical

activity and overweight and obesity among adolescent in public secondary schools

in Kwara state determined the weight status of the public schools students in the

North Central geo-political region which Kwara state is situated.

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1.3 Purpose of the Study

The purpose of the study was to determine the food consumption patterns, physical

activity levels and their association with overweight and obesity among adolescent

students in public secondary schools in Kwara State, Nigeria.

1.4 Objectives of the Study

The specific objectives of the study were to;

1. Determine the demographic characteristics of adolescent students in public

secondary schools in Kwara State.

2. Determine the food consumption patterns of adolescent students in public

secondary school in Kwara state.

3. Determine the physical activity level of adolescent students in public


4. Establish prevalence of overweight and obesity among adolescent students in

public secondary schools in Kwara State.

5. Establish the relationship between food consumption patterns, physical

activity and overweight and obesity of adolescent students in public


1.5 Hypotheses of the Study

H01: There is no relationship between the food consumption patterns and

overweight and obesity among adolescent students in public secondary

schools in Kwara State.

H02: There is no relationship between the physical activity level and overweight

and obesity among adolescent students in public secondary schools in Kwara

State.

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1.6 Significance of the Study

The study findings would enable the ministry of education and schools’

administrators to develop policy framework on student’s food consumption pattern

and physical activity practices at the public secondary school level especially in

Kwara state in Nigeria.

1.7 Delimitations of the Study

The study was conducted in public secondary schools located in the southern

senatorial districts of Kwara State among day students.

1.8 Limitation of the Study

This study was carried out in the school setting which may have influenced the food

consumption pattern and physical activity level of the participants. Also data on

food consumption was collected on recall basis from students and actual weighing of

foods consumed was not made.

1.9 Conceptual Framework

The study was based on the UNICEF (2013) conceptual framework on causes of

malnutrition (overweight, obesity and underweight) in developing countries (Figure

1.1). The main causes of malnutrition in Africa include immediate, underlying and

basic causes. The modified conceptual framework used for this study only

concerned itself with immediate and underlying causes of malnutrition. The study’s

conceptual framework explains the link between food consumption pattern, physical

activity level and overweight and obesity of the adolescent students. Overweight and

obesity are the manifestations of adolescent student food consumption pattern and

their physical activity level.

7

The education level and occupation of the adolescent parents and guardians which

form part of their demographic characteristics influence the adolescent student food

consumption patterns which could manifest in overweight and obesity of the student.

Furthermore, sporting facilities in school influence adolescent student physical

activity practice and this could also manifest in overweight and obesity of the

students. All these variables are interrelated and their manifestations are the level of

malnutrition of the students in form of overweight and obesity (Figure 1.1).

Figure 1.1. Causes of overweight and obesity

Source: Modified from the UNICEF conceptual framework on malnutrition in

developing countries UNICEF (2013)

Types of secondary

schools (public

school)

Overweight and Obesity

Food consumption

patterns

Physical activity

practice

Occupational level

of parents/guardians

Sporting facilities at

school

Educational level of

parents/guardians

Parents/guardians demographic characteristics

Manifestation

(depedent

Manifestation

Dependent

Variable

Immediate

causes

Underlying

causes

8

CHAPTER TWO: LITERATURE REVIEW

2.1 Socioeconomic Status and Emerging Overweight and Obesity Epidemic

among Adolescents

African countries in the last few decades have experienced rapid growth and

development in both social and economic sectors that resulted in improved lifestyle

of the populace. This rapid economic development manifested in the accumulation

of different assets which further widen the socioeconomic strata among the people

and had equally changed the cause of death from infectious to chronic non

communicable disease (NCDs) (Wrotniak et al., 2012). Socioeconomic status

(SES) of adolescents’ parents has been found to be a factor associated with

overweight and obesity in adolescence (Muthuri et al., 2014). However, higher

socioeconomic status (HSES) could be found among students who attend private

schools than those in public schools. The school location, amount of school fees

paid and level of assets acquired by the students’ parents could also indicate HSES.

Only few studies assessed the association between SES of adolescents and emerging

overweight and obesity epidemic among adolescents in semi-urban and rural areas

public secondary school especially in Nigeria.

Recent studies try to avoid asking students in public school about the level of

income, educational background and occupation of their parents in order not to

embarrass them. Certain facilities at home such as television, computer, refrigerator

and other electronic gadget of which their presence have been associated with

adolescents overweight and obesity could serve as a useful strategy to determine the

adolescents level of SES in lower SES (Gewa, 2010; Sharif Ishak, Shohaimi, &

9

Kandiah, 2013;Vik et al., 2013; Muthuri et al., 2014).The study carried out in

Botswana indicated that private school students whose parents have more assets had

higher prevalence of overweight and obesity than public school students whose

parents have fewer assets but the study did not indicate the level of overweight and

obesity within the low socioeconomic status (Wrotniak et al., 2012). The

socioeconomic status of the public secondary students in Irepodun local government

of Kwara state has not been reported by any published literature.

2.2 Adolescents Food Consumption Patterns and Risk of Overweight and

Obesity

Adolescents food requirement and consumption are determined by their

physiological and emotional conditions that are influenced by the hormonal

secretions and parental influence (Anzman, Rollins, & Birch, 2010; Dapi, 2010;

Huffman, KanikiReddy, & Patel, 2010; Lioret et al., 2009). Children and

adolescents food choice is one of the determinants of their food intakes which will

then result in their nutritional status (Gewa, 2010; Sharif Ishak et al., 2013).

Maruapula et al., (2011) reported that as at the year 2000, approximately 10% of

youth aged 5-17 years were overweight (OW) and 2-3% were obese (OB) in

Botswana this was due to their food consumption patterns which was characterised

by snacks and sugary beverages. This trend has increased tremendously among the

low and medium income countries to which most African countries belong. Previous

cross-sectional studies reported adolescents food consumption pattern as being low

in fibre, fruits and vegetables, high in calories and sugary beverages and dairy

products (Krølner et al., 2011). Many studies agreed that overweight and obesity in

adolescents and children are caused by unhealthy eating habits characterized by the

10

consumption of fast foods, drinking of sugar sweetened beverages, low fruits and

vegetable intakes and consumption of empty calories from soda, fruit drinks and

dairy desserts

The risk of being overweight and obese in adolescence begins with what a child is

fed on during childhood. The foods children are fed on have been attributed to the

nature and the risk of diseases in adult life which could manifest in different diseases

conditions such as coronary heart diseases, type 2 diabetes, stroke, certain forms of

cancer, hypertension and mental disorders (Wang et al., 2010). Snacking and fast

food consumption have being identified as a contributory factor to the development

of childhood overweight and obesity in Nigeria (Olumakaiye, Ogbimi, Ogunba, &

Soyebo, 2010).

The study conducted by Wang et al., (2010) on the dietary pattern of low income

urban African American indicated high energy intakes and several unhealthy eating

patterns, this was in agreement with what Sharif Ishak et al., (2013) observed among

Malaysian children. However parental education has greatly been observed to

influence what adolescents eat and their frequency of consumption of certain snacks

and sugary beverages. According to Krølner et al., (2011), larger proportion of

children failed to meet the WHO recommended amount(400gms) of fruits and

vegetables consumption per day. He further observed that the determinants of fruits

and vegetables consumption among children include the time, cost, lack of taste and

access to unhealthy food among others. Vik et al., (2013) reported there has been

consistent association between meals skipping and increased obesity risk in children

as most adolescents woke up late to school due to frequent and unrestricted

television and phone usage. These practices encourage the consumption of high

11

energy dense meals away from home thereby predisposing them to overweight and

obesity. In Irepodun local governments area of Kwara state, the food consumption

patterns of the students in public secondary schools have not been researched on to

establish the foods consumption pattern that may predispose them to overweight and

obesity

2.3 Adolescents Physical Activity, Sedentary Lifestyle and Its Relationship with

Adolescent Overweight and Obesity

Physical activity (PA) has been defined as any bodily movement produced by

skeletal muscles that requires energy expenditure (WHO, 2014). Physical inactivity

is the 4th leading factor of global mortality and increasing physical inactivity has

been seen worldwide with 1 in 3 adult not being so active which prompted the WHO

member states in 2013 to agree to reduce physical inactivity by 10% by 2025.

Physical activity reduces the risk of hypertension, CVDs, strokes, diabetes,

depression and certain forms of colon cancers (Berge, Wall, Bauer, & Neumark-

Sztainer, 2010). Sedentary lifestyle that is characterized by physical inactivity has

been associated with adiposity and increased weight gain.

Childhood is a crucial time to learn basic life skills on sufficient levels of physical

activity in order to attain healthy body weight considering high prevalence of

physical inactivity among the school aged adolescent (Agazzi, Armstrong, &

Bradley-Klug, 2010; Muthuri, Wachira, Onywera, & Tremblay, 2014). According to

Mushtaq, Gull, Mustaq, Shahid, Shad, and Akram (2011). Association of physical

activity and sedentary lifestyle with childhood obesity have been extensively

explored among school aged children globally. However most studies were

12

conducted in the developed countries and literature in this regard is scarce in

developing countries on South Asian and African children including Nigeria.

Exercise is a form of physical activity that if well-structured and purposeful will

balance the energy input with energy output. Certain activities such as dances,

household chores, regular trekking, biking and host of other energy sapping

activities mostly performed by children and adolescents brings health benefits across

age-group. Pizarro, Ribeiro, Marques, Mota, and Santos (2013) reported that there

was association between walking to school and waist circumference after controlling

moderate to vigorous intensity physical activity (MVPA). Most of the literature he

reviewed indicated that children who actively commute to school have healthier

waist adiposity, body weight, cholesterol sub –fractions, lower blood lipid and odds

of being overweight or obese was found to be lower in children who bicycled to

school. Studies conducted in Kenya and Florida by Agazzi et al., (2010),Wachira,

Muthuri, Tremblay, & Onywera., (2014) indicated that majority of Kenyan and

Florida children and youth did not meet the WHO recommended 60 minutes of

moderate to vigorous activity (MVPA) per day.

Furthermore the result of the study conducted in Osun state, Nigeria between the

private and public students by (OlubanjiOjofeitimi et al., 2011) indicated that 64.2%

of the girls from private schools lived sedentary lifestyles which were in contrast to

the girls from public school who lived active lifestyle. Factors such as

socioeconomic status, gender, sedentary behaviour, place of residence (urban vs.

rural) insufficient sleep, television watching contribute to physical inactivity of

individual especially children and adolescents (Muthuri et al., 2014; Ortega et al.,

2010; Vik et al., 2013). Most of the studies carried out on physical activity practice

13

of the secondary schools students in Nigeria did not use the international standard to

determine the physical activity level of the students. This puts some limitations in

their findings and it also makes comparison of the students’ physical activity level

very difficult particularly with the other African countries.

2.4 Predictors of Overweight and Obesity Status among Adolescent’s Students

Certain factors have been identified as predictive factors for overweight and obesity

in adolescents and infants. The factors include personal, behavioural and socio-

environmental predictive factors (Quick, Wall, Larson, Haines, &Neumark-Sztainer,

2013). These predictive factors could be modified through public health

interventions. Other predictive factors such as genetic factors are innate and may not

be easily modified but could also be used to predict overweight and obesity in

adolescents and infants. In a study conducted by Flores and Lin (2013) on factors

predicting overweight in US kindergartners, maternal physiological state was a

predictive factor for overweight of their infants. For instance, the mothers mean

pregnancy weight gain and maternal hypertension during pregnancy were found to

predict overweight in the infants. In addition, mothers who were overweight before

pregnancy and neonate birth weight also predict overweight status of the infants.

Several longitudinal studies on overweight and obesity confirmed that infant and

adolescent overweight could lead to overweight in later in life. Socio-environmental

features that facilitate the consumption of unhealthy foods and promote physical

inactivity (poor housing and schools environments) are established factors for

predicting overweight and obesity in adolescents. For example, schools with limited

facilities for students to play, and policies both at family and national levels that

encourage distribution and accessibility of materials that are the drivers of

14

overweight and obesity among adolescents(Giskes, Van Lenthe, Avendano-Pabon,

& Brug, 2011). According to Galvez, Pearl & Yen, (2010) who highlighted the

ecological system theory (EST), he stated that certain factors in the family, schools

and community at large promote childhood obesity. Guedes, Rocha, Silva, Carvalhal

& Coelho, (2011) reported that available literature have shown complex association

between social and environmental determinants and obesity among the adolescents,

although these studies were conducted in highly industrialized regions of world and

those findings may not be applicable to developing countries like Brazil and most

African countries like Nigeria. However, it was observed in his findings that apart

from age-group and ethnicity that showed no significant association with the

prevalence of overweight and obesity among the Brazilian parents and children,

other determinants such as gender, number of siblings, SES, parents educational

level, paid work, food consumption at schools, transport to school and city

population size were significantly predictive of overweight and obesity among the

school children in Brazil. This finding was in agreement with the study conducted

among the Kenyan women by (Steyn, Nel, Parker, Ayah, & Mbithe, 2011). Berge,

Wall, Bauer & Neumark-Sztainer, (2010), Dawson-McClure et al., (2014), Kimani-

Murage, Pettifor, Tollman, Klipstein-Grobusch & Norris, (2011), Stevenson, (2010)

in their studies on parenting style and association with weight status indicated that

parenting style as an in- built environment factor on social determinant is associated

with high adolescent weight status and authoritarian parenting style common among

higher socioeconomic status while (Dulin-Keita, Thind, Affuso, & Baskin, (2013),

Senbanjo & Oshikoya, (2010) stated that physical activity is largely determined by

neighbourhood physical environment, social, economic and cultural factors and that

perceived neighbourhood disorders was significantly and positively related to

15

obesity. All the studies reviewed agreed that the environment may play an important

role in overweight and obesity development but the dietary behaviours contribution

to obesity development remain unclear and physical activity plays a crucial role in

weight gain, overweight and obesity. The predicting factors for overweight and

obesity among students in public secondary schools in Kwara state have not been

established. Therefore, the need to establish those factors that could predict

overweight in students in public schools is very necessary for policymakers to use in

addressing the students overweight status.

2.5 Relationships between Adolescent Food Consumption Pattern, Physical

Activity Level and Overweight and Obesity

Prevalence of overweight and obesity has increased worldwide (Farhat, Iannotti, &

Simons-Morton, 2010; Kotian, Kumar, & Kotian, 2010; Peltzer & Pengpid, 2011)

and this trend is becoming rampant among the low income earner (Dawson-McClure

et al., 2014). There are an estimated 1.2 billion adolescents aged 10-19 years in the

world and instituting comprehensive health intervention programs will help

preventing the estimated 1.4 million deaths that occurred globally every year in this

population especially those deaths that related to nutritional deficiencies and the

occurrence of no communicable diseases like overweight and obesity (Chandra-

Mouli et al., 2013). Childhood and adolescent obesity are strong predictors of adult

obesity (Fadupin & Olayiwola, 2011; Monyeki et al., 1999; Muthuri, Francis, et al.,

2014; Popkin et al., 2012). According to (Raj & Kumar, 2010) many co-morbid

condition like metabolic syndrome, cardiovascular, physiological, orthopaedic,

neurological, hepatic, pulmonary and renal disorders are seen in association with

childhood and adolescents obesity.

16

This statement supports the finding of (Farhat et al., 2010; Renzaho, Bilal, & Marks,

2014) . Many studies agreed that obesity in adolescents and children are caused by

unhealthy eating habits characterized by the consumption of fast foods, drinking of

sugar sweetened beverages, low fruits and vegetable intakes and consumption of

empty calories from soda, fruit drinks and dairy desserts. Also physical inactivity is

noted as one of the drivers of obesity among the youth especially in urban areas that

are rapidly springing up in African (Beck, Tschann, Butte, Penilla, & Greenspan,

2014).

However, certain intervention programs were developed by WHO to reduce the

prevalence of overweight and obesity among the adolescents in secondary schools.

Nutrition-Friendly Schools Initiative (NFSI) was developed as follow-up to the

WHO Expert Meeting on Childhood Obesity June 2005. The main aim of the NFSI

is to provide a framework for ensuring integrated school-based programs which

addresses the double-burden of nutrition-related ill health, building on and inter-

connecting the on-going work of various agencies and partners. These include the

FRESH Initiative, Essential Package by (UNICEF/WFP), Child-Friendly Schools

(UNICEF), Health Promoting Schools (WHO), School Food and Nutrition

Education programs (FAO) to mention just a few (WHO, 2014).

NFSI applies the concept and principles of the Baby-friendly Hospital Initiative

(BFHI), where schools that meet a set of essential criteria will be accredited as

"Nutrition Friendly Schools". These WHO initiatives are to step down the

prevalence of childhood and adolescent overweight and obesity because if the

prevalence of overweight and obesity continues unchecked, the result will be a

population of children and adolescents with a lot of health problems which will lead

17

to high mortality rates. This will reduce the global lifespan of the people and Africa

being one of continents experiencing the double burden of malnutrition will be

mostly affected (Halpern, Mancini, Magalhaes, Fisberg, Radominoski, and

Bertolami, 2010).

2.6 Summary of Literature Review

The following gaps were observed in the literature reviewed on the research topic-

food consumption pattern and physical activity in relation to overweight and obesity

among adolescents in secondary schools in Kwara state, Nigeria. There were very

scanty studies on the food consumption pattern of secondary schools in Africa

especially in public schools in northern Nigeria. Only few studies associated socio-

economic status with overweight and obesity in the public schools in the rural areas.

Most studies reviewed on childhood overweight and obesity was carried out in urban

private schools and their results were only compared within the urban setting. There

were few published studies on the regional overweight and obesity among

adolescents in public secondary school in Nigeria and none was from the north

central in which the Kwara state is located thereby making this study unique. Also

the predicting factors of overweight and obesity among students in public secondary

schools in Kwara state were not available for review. Furthermore, published

research work on physical activity practice in developing countries is very scanty

especially in Nigeria where motorized equipment usage is on the increase. The

intervention programs initiated were selectively applied to countries with enough

data on the contributing factors to overweight and obesity in their area. Therefore it

is very crucial to determine the food consumption patterns and the physical activity

practice of the students in public secondary schools in order to evaluate their

overweight and obesity status and establish a database in the state.

18

CHAPTER THREE: METHODOLOGY

3.1 Research Design

Cross-sectional analytical design was used in this study because it was ideal for

rapid data collection in which a large sample size was involved (Oso & Onen, 2011;

Tolmie et al., 2011). According to Mugenda & Mugenda (2003), a cross-sectional

design is applied in collecting data from numbers of a population in order to

determine the current status of that population with respect to one or more variables.

3.2 Measurement of Variables

The dependent variables were overweight and obesity. These variables were

determined using the BMI for age (WHO, 2007) standard cut-offs for overweight

and obesity. The independent variables were demographic characteristics, food

consumption patterns and physical activity of the adolescents. The food

consumption patterns variable was measured using food consumption frequency

questionnaire and physical activity was measured with physical activity

questionnaire for adolescent (PAQ-A)

3.3 Study Area

This study was carried out in the Southern Senatorial district of Kwara State,

Nigeria. The Kwara State capital is Ilorin which is about 700 km from Abuja

(Federal Capital Territory) and 350 km from Lagos. The main ethnic group in

Kwara State is Yoruba with significant number of minority tribes which include the

Nupe, Bariba and Fulani. The State borders Niger State in the North, Oyo, Osun and

Ekiti States in the South, Kogi State in the East and the Republic of Benin in the

West. Because of its unique geographical position the State is referred to as a

“gateway” State between the Northern and Southern Nigeria. Agriculture is the main

19

occupation of the people of the State and solid mineral deposits are also being

explored in Kwara State (Appendices F and G).

3.4 Target Population

Students in public secondary school aged 10-19 years were the target population,

with 2014 estimated population of 330,035 students (Adeyemi, 2009).

3.5 Exclusion and Inclusion Criteria

3.5.1 Inclusion Criteria

Students in the public day schools in Kwara state within the ages of (10-19) were

selected.

3.5.2 Exclusion Criteria

Students with chronic diseases, those with pregnancy and those on transfers from

other states three months before the commencement of this study were excluded.

3.6 Sampling Techniques

The sampling techniques used in this study were both stratified sampling and

multistage simple random sampling which was carried out in four stages. In this

study, one local government was randomly selected from the seven local

government areas in the Southern Senatorial districts of Kwara State. Ajase-ipo and

Omu-aran zonal inspectorates of education were randomly selected from eight zonal

inspectorates in the local government and also eight public secondary schools was

selected from thirty-two public secondary schools. Finally, students were allowed to

pick from the container containing scrapped piece of papers in which numbers 1 or 2

were written in order to qualify to participate in the study. All the students that

picked number 1 were selected for the study. The selection was based on the gender

20

1 Senatorial districts

343 Girls 172 Boys

Stratified

sampling

8 Public secondary schools

515 Participants (sex ratio 2:1) (NDHS, 2008)

1 local government

(8 zonal education inspectorates)

2 Zonal education inspectorates: (32

public secondary schools)

(Ajase and Omu-aran)

32 public secondary schools

3 Senatorial districts

ratio of 2: 1(NDHS, 2008) using stratified sampling technique. A total of five

hundred and fifteen students (343 girls and 172 boys) were randomly selected from

the eight public secondary schools.

1st random sampling

3rd

random sampling

Figure 3.1. Multistage sampling procedure

2nd

random sampling

4th random sampling

21

3.7 Sample Size Determination

The sample size for this study was calculated using Cochran (1963) formula for

determining sample size in a research.

no =

Where; no = Sample size for the study

z = desired confidence interval (95% CI)

P = Prevalence = 19% or 0.19

e = desired level of precision 5% or 0.05

q = 1- p

2 = is a constant (design effect for research that has not been conducted on

the target population in sampled area)

Therefore, n= 1.922 x 0.19(1-0.19)

(0.05)2

n= 3.8416 x 0.19 (0.81)

0.0025

n = 473 Students

Ƒ (finite) = 473

1+ 0.0095

Finite sample = 473 = 468.57

1.01

Sample size + 10% for non-response = 468.57 + 46.86

Total sample size = 515

Using sex ratio of 2:1(NDHS, 2008) -the sample comprised of 343 girls and 172

boys.

2

2

22

3.8 Research Instruments

A modified Food Frequency Consumption Questionnaire produced by Harvard

University on adolescent food consumption pattern (Lee & Nieman, 2010), was used

to collect data on students’ food consumption pattern. A modified Physical Activity

Questionnaire for adolescent (PAQ-A) was constructed from Global Physical

Activity Questionnaire (GPA-Q) to collect data on physical activity. Digital

bathroom scale was used to measure students’ weight to the nearest 0.1 kilogram

and Stadiometer was used to measure the students’ height to the nearest 0.1 meters

and observation checklist was used to assess the school physical facilities and usage.

3.9 Pre-testing

The research instruments were pre-tested in one public secondary school in the

research area, this school was randomly selected and it was not part of the schools

selected for the main study. Fifty two students were randomly selected for the pre-

test. All the data collection tools such as the digital bathroom weighing Scale,

Stadiometer and food consumption pattern and physical activity questionnaire were

administered on the selected students. The pre-testing exercise was carried out in

order to minimize problems that students might encounter in answering the

questions and also to reduce error in data recording. Pre-testing allowed for some

assessment of the validity and reliability of the data that were collected during the

main study. Research instruments were standardized before the actual study was

carried out to minimize error.

3.10 Validity and Reliability of the Research Instrument

In order to control the quality of the research findings in this study, the research

instruments were pretested in a school which was not included in the sample schools

23

for this study. Two nutrition experts and the researcher’s supervisors in the

department of Food, Nutrition and Dietetics (FND) evaluated the relevance of each

item in the research instruments in relation to the stated objectives and rated each

item accordingly. The content validity was calculated using appropriate statistical

formula for determining the content validity. The content validity index (CVI) was

the summation of the items rated 3 or 4 by all the nutrition experts divided by the by

number of items in the questionnaire. The calculated content index for the pretesting

was 0.89 or 89%which was deemed to be appropriate for this study Kathuri and

Pals, (1993) cited Oso and Onen (2011) reported that items with validity or

reliability of a minimum of 70% or 0.70 are considered acceptable as being valid

and reliable in research.

3.11 Data Collection Procedure

Anthropometric data of the adolescent secondary students was collected by the

researcher and two research assistants with diploma certificate in Human nutrition

using stadiometer and digital weighing scales. Each student’s weight was measured

twice and average weight determined for every student. Students were weighed one

after the other when wearing light clothing; their feet placed side by side and were

pointing straight with their hands by their sides with no heavy object on them. Each

student height was measured twice and average height determined. Students’ heights

were measured when the students stood erect with heels, shoulder, back and head all

resting on the wall. Food consumption and physical activity questionnaires were

administered to the students individually when they were comfortably seated in the

classroom and schools facilities were observed and ticked accordingly on the

24

observation checklist. The optional responses on the questionnaires were ticked

accordingly in response to the corresponding question on the questionnaire.

3.12 Data Analysis and Presentation

The measurements obtained from the height and weight were entered into the

Anthroplus software to determine the BMI of the student using WHO (2007) BMI

for age and sex cut-offs. The information on physical activity, food consumption

pattern scores was entered into the Statistical Package for Social Science (SPSS)

version 20 to generate data on the scores. The BMI for age were categorized into

underweight (<15th

percentile), normal weight (15th to <85

th percentile), overweight

(85th to <97

th percentile), and obese (> = 97

th percentile) and each category of the

BMI for age was expressed as percentages to determine the prevalence of

overweight and obesity (Appendix G and H). Food consumption patterns were

expressed in mean consumption per week. Food consumption patterns (FCP) was

calculated as a composite score of 20 food items selected. A score of 80 means that

all 20 foods were consumed 5 or more times in a week. A score of 20 is the

minimum, meaning the student never consumed any of the 20 foods. Physical

activity was categorized according to international physical activity questionnaire

(IPAQ) guidelines. IPAQ based physical activity intensity on metabolic equivalent

score per minutes per week (METs-minutes/week).The categories are, low physical

activity intensity (<600METs), moderate physical activity intensity (600-

3000METs), and high physical activity intensity (>3000 METs) for individuals.

Overweight and obesity status of participants were determined according to WHO

(2007) BMI for age classifications. The Pearson correlation (r) and ANOVA were

used to determine the relationship and significant differences of the composite

25

means between dependent (overweight and obesity) and independent variables (food

consumption pattern and physical activity level) at p< 0.05 for significant

differences respectively.

3.13 Logistical and Ethical Consideration

Kenyatta University Graduate School granted approval for data collection. The

ethical clearance was obtained from the Ethical Review Committee of the Kwara

state Universal Basic Education Board (KSUBEB). The research permit was

obtained from the Kwara State Teaching Service Commission (KSTSC) and the

authority to conduct the research was obtained from the school administrators of the

selected schools. Written letters of informed consent were endorsed by the

principals of the selected schools on behalf of the sampled students’ parents who

were below 18 years while the students who were above 18 years appended their

signatures on the consent forms individually after the students had been duly

informed of the purpose of the study. Assurance of the students’ privacy and

confidentiality was given to the students by explaining to the students that the

information given will not be used for any other purposes apart from the academics

publications.

26

CHAPTER FOUR: RESULTS

4.1. The Demographic Characteristics of Participants

The study population comprised of eight secondary schools in Irepodun local

government area of Kwara state in Nigeria. A total of 515 adolescents participated in

the study, 33.4% were boys and 66.6% were girls. The participants in this study

were adolescents whose ages were between (10-19) years and 54% were (16-18)

years. This indicates that majority of participants may have an established food

consumption pattern .The sampled schools were 12.5% boys only, 12.5% girls only

and 75% mixed (Table 4.1)

Table 4.1. Demographic characteristics of participants

Participants

characteristics (n=515)

No. of participants % of participants

Sex

Male

Female

172

343

33.4

66.6

TOTAL 515 100%

Age distribution

(years/months)

9.6-12.5

12.6-15.5

15.6-18.5

18.6-19.5

26

162

278

49

5.0

31.5

54.0

9.5

TOTAL 515 100%

Type of school

Boys

Girls

Mixed

1

1

6

12.5

12.5

75.0

TOTAL 8 100%

The participants used different means of transport to get to schools daily of which

61.7% walked to school and 10.1% used their parent or guardian cars as means of

27

transport to school. The study findings showed that 50.3% of the participants lived

with their parents, only 25.8% the participants lived alone (Table 4.1)

Table 4.2. Demographic characteristics of participants

Participants

characteristic


Participants means of

transportation to school

Motorcycles

Public transport

Walked

Parents/guardians or cars

119

26

318

52

23.1

5.1

61.7

10.1

TOTAL 515 100%

Participants by whom

they lived with

Parents

Guardians

Alone

259

123

133

50.3

23.9

25.8

TOTAL 515 100%

The educational background of the participants’ parent or guardian in the study

showed that, 1.2% had not attained any formal education, 62.1% completed primary

school level of education and only 11.5% completed university level of education.

The participant’s parent and guardian engaged in different occupations of which

13.3% were civil servants while 68.1% were farmers (Table 4.3).

28

Table 4.3. Demographic characteristics of participants’ parents or guardians

Participants

characteristic


Educational background

of participant’s

parents/guardians

None

Primary

Secondary

University

Others

6

320

105

59

25

1.2

62.1

20.4

11.5

4.9

TOTAL 515 100%

Occupation of

participant’s

parents/guardians

Civil servants

Artisan

Farmers

Business activities

17

36

351

111

3.3

7.0

68.1

21.6

TOTAL 515 100%

4.2 Food Consumption Patterns of the Participants

The food consumption patterns questionnaire was used to obtain information on the

breakfast meal. Also, types and frequency of consumption of certain foods and

drinks listed in the questionnaire from the respondents.

4.2.1 Breakfast Consumption by the Participants

The participants’ breakfast meal consumption showed that, 77% usually ate

breakfast before going to school daily while 23% skipped breakfast (Figure 4.1)

29

Figure 4.1. Breakfast meal consumption by the participants

4.2.2 Daily Sugar Intake by the Participants

The results of daily sugar intake of the participants indicated that 52% added 1-2

teaspoons of sugar to their beverages daily and 4.5% added 5 or more teaspoons of

sugar (Figure 4.2)

Figure 4.2. Daily sugar intake by the participants

30

4.2.3 Average Numbers of Times per Week Carbohydrates Foods consumed by

the Participants

The average numbers of times per week that carbohydrates foods were consumed by

the participants showed that boiled Irish potatoes was consumed in 1.78±0.81 times

per week and doughnut and biscuits were consumed in 2.36±0.99 times per week

but potatoes chips was consumed in 2.14±0.84 times per week as well as spaghetti

and noodles in 2.14±0.85 times per week. However, doughnuts and biscuits had the

highest average number of times of consumption per week by the participants (Table

4.4)

Table 4.4. Average numbers of times per week carbohydrates foods consumed by the

participants

Starchy roots, tubers and refined cereals consumption (n=515)

Food items

consumed

Never 1-2

times

3-4 times 5 or

more

times

% total Average

number

of times

per week

Boiled

yam/cassava

21.9 52.0 14.8 11.3 100

2.15±0.89

Boiled Irish

potatoes

42.9 40.0 13.6 3.5 100 1.78±0.81

Boiled sweet

potatoes

26.0 40.4 22.3 11.3 100 2.19±0.95

Boiled bran

rice

16.9 45.8 22.3 15.0 100 2.35±0.93

Maize

boiled/roasted

38.4 32.8 24.1 4.7 100 1.95±0.90

Oat bran meal 22.1 51.7 20.4 5.8 100 2.09±0.81

Doughnuts&

biscuits

23.3 28.2 40.0 8.5 100 2.36±0.99

Potatoes chip

26.6 34.8 35.9 2.7 100 2.14±0.84

Spaghettis&

noodles

24.3 43.3 26.4 6.0 100 2.14±0.85

31

Fat and oil rich foods consumption (n= 515)

Food items

consumed

Never 1-2

times

3-4

times

5 or

more

times

%

total

Average

number

of times

per week

Peanut butter 28.7 34.0 11.5 25.8 100 2.34±1.15

Vegetable oil (soup) 15.7 31.8 34.4 18.1 100 2.54±0.96

Butter/margarine 29.5 45.0 20.6 4.9 100 2.0±0.83

Salad

dressing/mayonnaise

33.8 42.7 18.6 4.9 100 1.94±0.85

Boiled/roasted

peanut groundnut

42.3 21.9 24.5 11.3 100 2.04±1.06

Soybeans cheese 29.9 31.8 22.1 16.1 100 2.24±1.05

4.2.4 Average Numbers of Times per Week Fat and Oil Foods Consumed by the

Participants

The average numbers of times per week that fat and oil foods were consumed by the

participants showed that peanut butter was consumed in 2.34±1.15 times per week,

vegetable oil (soup) was consumed in 2.54±0.96 times per week and butter/

margarine was consumed in 2.0±0.83 times per week. However, vegetable oil had

the highest average number of times of consumption per week by the participants

(Table 4.5)

Table 4.5. Average numbers of times per week fat and oil foods consumed by the

participants

4.2.5 Average Numbers of Times per Week Fatty Protein Foods Consumed by

Participants

The average number of times per week fatty protein foods were consumed by the

participants indicated that pork/bacon was consumed in 1.86±0.98 times per week

and pies/fish rolls was consumed in 2.71±0.87 times per week while fried

32

eggs/boiled eggs were consumed in 2.15±0.69 times per week. However, pies/ fish

rolls had the highest average number of times of consumption per week by the

participants (Table 4.6).

Table 4.6. Average numbers of times per week fatty protein foods consumed by

participants

Fatty proteins foods consumption (n=515)

Food items Never 1-2 times 3-4 times 5 or

more

times

% total Average

number

of times

per week

Fried fish

/roasted

meat

40.2 39.6 10.3 9.9 100 1.89±0.94

Whole

milk/ milk

shakes

18.6 57.9 20.8 2.7 100 2.08±0.71

Burgers/hot

dogs

41.0 25.6 18.6 14.8 100 2.07±1.09

Pork/bacon 48.5 22.5 22.5 6.4 100 1.86±0.98

Ice-cream/

frozen

yogurt

13.8 68.9 10.1 7.2 100 2.10±0.72

Pies/fish

roll

5.8 38.3 34.6 21.4 100 2.71±0.87

Fried

eggs/boiled

eggs

11.8 65.4 17.7 5.0 100 2.15±0.69

4.2.6 Average Numbers of Times per Week Sugary Beverages, Fruit Juices and

Whole Fruits Consumed by Participants

The average number of times per week that sugary beverages, fruits juices and

whole fruits consumed by the participants indicated that soda/soft drinks were

consumed in 2.14±1.05 times per week and malted drinks were consumed in

1.83±0.77 times per week, pawpaw was consumed in 2.56±0.89 times per week

while other fruits were consumed in 2.23±0.99 times per week. However pawpaw

33

had the highest average number of times of consumption per week by the

participants (Table 4.7).

Table 4.7. Average number of times per week sugary beverages, fruit juices and

whole fruits consumed by participants

Sugary beverages, fruits juices and whole fruits consumption (n=515)

Food

items

consumed

Never 1-2 times 3-4 times 5 or

more

times

% total Average

number

of times

per week

Soda

drinks

/soft

drinks

32.4 36.9 14.2 16.5 100 2.14±1.05

Chocolate

drinks

28.7 48.9 22.4 0.00 100 1.93±0.71

Malted

drinks

36.3 46.8 14.2 2.7 100 1.83±0.77

banana 8.2 56.5 29.7 5.6 100 2.32±0.71

mangoes 13.6 41.0 41.0 4.5 100 2.36±0.77

Pawpaw 8.9 43.5 29.3 18.3 100 2.56±0.89

Other

fruits

21.2 48.8 13.7 16.3 100 2.23±0.99

4.3 Physical Activity Level of the Participants

Physical activity questionnaire for adolescents (PAQ-A) was used to obtain

information on the physical activity practices by the public secondary schools

students in Irepodun local government area of Kwara state in Nigeria. The (PAQ-A)

was used to analyse the number of times a respondent participated in the physical

activities in schools and at home and also for how long the respondent engaged in

physical activities in a week. The physical activities included in this study were

skipping, walking for exercise, bicycling, jogging/ running, football playing,

34

basketball playing, volleyball playing, swimming, dancing, and other forms of

energy sapping activities at home or in school. The (PAQ-A) was also used to assess

the hours of sleep among the participants. The observation checklist was used to

obtain information on the sporting facilities, duration for physical activity practices

of the respondents and students participation in the physical activity. The checklist

was also used to obtain information on availability of a functional field for physical

activity and other energy consuming activities that the schools engaged the

participants in.

4.3.1 The Daily Hours of Sleep by the Participants

The daily hours of sleep by the students in public secondary schools in Irepodun

local government area of Kwara state in Nigeria indicated that 10.3% slept for

between (3-4) hours and 50.3% slept between (7-8) hours daily (Figure 4.3).

Figure 4.3. Daily hours of sleep by the participants

35

4.3.2 Types, Frequency and Duration of Involvement in Physical Activities by

the Participants Daily

The results of types of physical activities involved-in by the participants indicated

that 32.8% involved in (running/jogging) and 2.1% in skipping. However, 27.8%

were rarely involved in physical activity daily while 27.8 engaged in a little physical

activity. Furthermore, 41.9% were involved in physical activity for between (30-40)

minutes daily while 7% engaged in physical activity for only 10 minutes (Table 4.8).

Table 4.8. Types, duration and frequency of daily physical activities by the

participants

Items

n = 515

No. of participants

% of participants

Type of daily physical

activity

Bicycling 155 30.1

Jogging/ running 169 32.8

Skipping 11 2.1

Walking 150 29.1

Other forms of physical

activities

Total

30

515

5.8

100

Frequency of engaging in daily physical activity

A little 143 27.8

Rarely 143 27.8

Sometimes 115 22.3

Regularly

Total

114

515

22.1

100

Duration for daily physical activity

10 minutes 36 7.0

20- 30 minutes 68 13.2

30- 40 minutes 216 41.9

50- 60 minutes 135 26.2

1 hour

Total

60

515

11.7

100

36

The distribution of the respondents’ physical activities in the last 7 day of the week

indicated that 60% of the participants sometimes participated in physical education

class. Also, 41% of the participants ran and played hard after lunch in the previous

week. Furthermore, 36.3% of the participants engaged in games at least 1 time in the

previous week (Table 4.9).

Table 4.9. Distribution of the participant’s physical activities in last 7 days

Physical Activities

in last 7 days

n=515

Number Participants

(%)

Average number

of days in the last

7 days

Participation in

Physical education

class

Hardly Ever

Sometimes

Quite often

Always

Total

Activities engaged-

in after lunch

Relaxed and slept

Ran and played a

little

Ran and played

hard

Sat down

Walked around

Total

Number of days

engaged-in games

and were very

active

None

1time last week

2/3 times last week

4 times last week

5times last week

Total

116(22.5)

309(60.0)

42(8.2)

48(9.3)

515(100)

36(7.0)

133(25.8)

211(41.0)

32(6.2)

103(20.0)

515(100)

47(9.1)

187(36.3)

63(12.2)

109(21.2)

109(21.2)

515(100)

2.82±1.25

3.06±1.18

3.09±1.33

37

4.3.3 The Metabolic Equivalent Scores (Mets) Per Week by the Participants

The metabolic equivalent scores (METs) per week by the respondents showed that

11.8% of the respondents had (<600 METs) which indicated low physical activities

intensity, 48.7% had between (600-3000 METs) which indicated moderate physical

activities intensity and 39.4% had above (3000 METs) which indicated high

physical activity intensity (Table 4.10).

Table 4.10. Metabolic equivalent scores (METS) per week of the participants

n=515

IPAQ METs

Categories

per week

Number of participants % of participants Physical activities

intensity

<600 61 11.8 low

600-3000 251 48.7 medium

>3000 203 39.4 high

4.3.4 Participants’ Belief in the Efficacy of Physical Activity

The participants’ beliefs in the statement that ``physical activity practice as an ideal

means of maintaining ideal weight and for the prevention of certain body ailments’’

indicated that 2.1% of the participants strongly disagreed with the statement, 12.1%

of the participants disagreed with the statement, 55.5% of the participants were

undecided with the statements, 16.7% of the participants agreed with the statement

and 13.6% of the participants strongly agreed with the statement (Figure 4.4).

38

Figure 4.4. Participants’ belief in physical activity practice

4.3.5 Observation Checklist of the Schools Facilities of the Participants

The observation checklist used to assess the schools facilities, students participation

in physical activities and trainers’ involvement in the physical activity practice.

Results showed that all the schools in this study had functional physical activities

facilities (sporting and functional fields).The result also indicated that physical

activity participation in their schools was compulsory as entrenched in the school’s

timetable. The schools physical activity trainers were involved in physical activity

practice during the schools games.

4.4 Distribution of the BMI for Age of the Participants

The body mass index (BMI) for age of the respondents as classified by (WHO,

2007) showed that 29.1% were underweight, 66.0% were of normal weight, 24.7%

were overweight and 0.2% obese. Furthermore, based on the sex of the participants,

39

47.7% of the male participants were underweight, 0.6% was overweight and 0% was

obese. Also, 19.8% of the female participants were underweight, 6.7% was

overweight and 0.3% was obese (Table 4.11).

Table 4.11. Summary of participants body mass index for age (BMI for age) as

classified by (WHO, 2007)

BMI for

age

Categories of

weight status

Male

participants

n=172

Female

participants

n=343

Total

participants

n=515

Mean (BMI)

for age of all

the

participants

(kg/m2)

<15th

percentile

Underweight 82 47.7% 68 19.8% 150 29.1%

19.76±2.62

15th

-84.5th

percentile

Normal

weight

89 51.7% 251 73.2% 340 66.0%

85th -97

th

percentile

Overweight 1 0.6% 23 6.7% 24 4.7%

>97th

percentile

Obese 0 0% 1 0.3% 1 0.2%

Total 172 100% 343 100% 515 100%

Footnote.- * BMI for age in (kg/m2

) was calculated to give the mean BMI for age of all the participants

40

Figure 4.5. Participants (BMI) for age by sex compared with WHO (2007)

Standard

Figure 4.6. All participants (BMI) for age compared with WHO (2007) Standard

41

4.5 Factors Associated with Overweight and Obesity.

The relationship between overweight and obesity, food consumption pattern and

physical activity of the adolescents’ students in public secondary schools in Kwara

state of Nigeria was in investigated based on the Body Mass Index (BMI) for age.

4.5.1 Relationship between Food Consumption Pattern, Physical Activity and

the Body Mass Index for Age

Pearson’s correlation was used to determine the relationship between the dependent

variable (overweight and obesity) based on BMI for age (WHO, 2007) and

independent variables (food consumption pattern and physical activity level). The

relationships were determined at p< 0.05 level of significance. ANOVA was used to

test the hypothesis on the variance between food consumption pattern score of the

respondents and the BMI for age categories as well the variance between the

metabolic equivalent scores (METs scores) of physical activity of the respondents

and Body Mass Index for age categories at p< 0.05 level of significance.

4.5.2 Relationship between BMI for Age, FC P and PA for the Participants

Bivariate correlation analysis was done using SPSS version 20. The BMI for age,

FCP and PA correlated using correlation coefficient. The BMI for age has weak

relationship with FCP (r=0.012, p=0.785).The BMI for age has negative relationship

with PA(r= -0.105, p = 0.017) (Table, 4.12).

42

Table 4.12. Relationships between BMI for age, FCP and PA for the participants

Variables P value Coefficient of

correlation(r)

BMI and food

consumption

pattern(FCP)

P=0.785

0.012

BMI and physical

activity level(PA)

P=0.017

-0.105

4.5.3 ANOVA Test of FCP and PA in Mets Based On (BMI) for Age of the

Participants

Mean composite score for food consumption pattern was calculated as a composite

score of the 20 foods selected from the questionnaire. In group 1 (carbohydrates)

foods selected were (potatoes chips, spaghetti, doughnut, and yams). Group 2 (fats

and oils), foods selected were (roasted peanut, margarine, salad dressing and peanut

butter). Group 3 (fatty proteins), foods selected were (milk shakes, pork, burger and

ice-cream). Group 4 (sugary beverages and fruits drinks and whole fruits), food

selected were (soda, chocolate, fruits drinks and fruits). A score of 80 means

participants ate all the 20 selected foods in 5 or more times in a week. A score of 20

is the minimum, meaning participants never eat any of the 20 selected foods. The

result indicated that food consumption pattern mean scores were 61.36±11.44 for

underweight, 65.84±11.64 for normal weight and 70.24±9.58 for overweight. The

respondents food consumption pattern based on their BMI for age categories varied

significantly p<0.01(Table, 4.13).Furthermore, the mean METS scores were

2235.72±1670.86METs for underweight, 2263.81±1534.69 METs for normal weight

and 2506.56±1376.69 METs for overweight. The mean METs score based on the

BMI for age categories did not vary significantly (p=0.725) (Table, 4.13).

43

Table 4.13. ANOVA test of FCP and PA based on BMI for age categories of the

participants

Body mass index (BMI)

For age categories

Number of

participants

n=515

Mean composite

scores for (FCP)

Physical activity

(METs)

Underweight 150 61.36±11.44a

2235.72±1670.86a

Normal weight 340 65.84±11.64b

2263.81±1534.69a

Overweight 25 70.24±9.58c

2506.56±1376.69a

P-value (ANOVA) 515 p=0.001 p=0.725

Foot note- scores with different letters varied significantly with BMI for age categories while scores with same letters did not

vary significantly with the BMI for age categories

44

CHAPTER FIVE: DISCUSSION

5.1 Demographic Characteristics of the Adolescent Students

The demography of the participants in this study indicates that 54% of the

participants were between (16-18) years old, 50.3% of them lived with parents and

about 61.7% of the participants walked to school. The demography further indicates

that about 62.1% of the parents and guardians of participants attained primary level

of education and 68.1% of the parents and guardians engaged in farming as their

occupation. This result was similar to the findings reported by (Olubanji-Ojofeitimi

et al., 2011) among public and private students in secondary schools in Osun State,

Nigeria. Olubanj-Ojofeitimii et al findings reported that 60.8% of the participants in

his study were between (15-19) years old, and about 50.3% of them lived with their

parents. Furthermore, about 74.8% of participants’ parents and guardians engaged in

unskilled occupation, meaning that they engaged in any form of work to earn a

living. This study demography result clearly illustrates that majority of the

participants come from the lower socioeconomic background where facilities such

as motor cars and motorcycles are rarely used. In addition to that, the parents and

guardians of participants’ low educational level limit their ability to engage in

professional occupations which could fetch them more income thereby improving

their standard of living. Conversely, participants’ ability to engage in walking to

school may influence their physical activity level. The demographic characteristics

of the participants in this study might have contributed to the low prevalence of

overweight and obesity among the adolescents.

Studies from related literature confirmed that the level of education attained by

children’s parents and type of occupation engaged- in were among the

45

socioeconomic factors that encouraged high prevalence of overweight and obesity

among the adolescents especially in the cities and urban areas (Hafiz et al., 2012)

The result of this study also agreed with Ene-Obong et al., (2012) findings where it

was found that overweight prevalence among adolescents in Nigeria was affected

by location. The demography characteristics of participants in this study is in

contrast with most studies of similar nature that were mostly carried out among the

private schools students especially in urban areas. This has put the students in public

schools at a disadvantage because there is a fewer data on the prevalence of

overweight in adolescent in the rural areas (Gupta, Goel, Shah, & Misra,

2012;Steyn, Nel, Parker, Ayah, &Mbithe, 2011; Viner et al., 2012; Wrotniak et al.,

2012).

5.2 Breakfast Consumption Pattern of the Participants

Breakfast is one such meal that most people usually skip particularly by the

adolescent and this could lead to over consumption. Excess food consumption

influences adolescent weight gain and results in overweight and obesity (Agostoni

et al., 2011; Arora et al., 2012; Basch, 2011; Fulkerson et al., 2011; Hallström et al.,

2013). Breakfast consumption pattern in this study indicates that about 77% of the

participants eat breakfast meal before going to school. However, this finding was in

contrast to the finding reported by (Doku et al, 2013) in Ghana in which only 31%

of the adolescents take breakfast. Skipping breakfast may lead to low blood sugar

level thereby causing dizziness and inactivity especially among adolescents who are

rapidly going through emotional, physical, and intellectual developmental stages

(Arora et al., 2012; Izuora et al., 2013; Sawyer et al., 2012). Breakfast consumption

pattern of the participants in this study might have influenced their low food

46

consumption and this could reduce the prevalence of overweight and obesity among

the participants.

5.2.1 Carbohydrates Consumption Pattern of the Participants

Carbohydrates in form of snacks were mostly consumed by the participants in this

study. About 40% of the participants consume snacks (doughnut and biscuits)

between 3-4 times per week. The finding of similar study carried out by (Wang et al

2010) in Chicago among African- American adolescents was in contrast with the

finding in this study because about 75% of the adolescent in Chicago study consume

snacks in three or more times per day. However, the finding of this study was

similar to the finding in a study carried out among 401 adolescents in secondary

schools in Osun state, Nigeria by (Olumakaiye et al., 2010). Olumakaiye et al.

reported that about 33% of the adolescents consume 2-3 times per week. The finding

in this study clearly illustrates that snacks consumption among adolescents is

gradually on the increase. Although, snacks consumption might be relatively lower

among adolescents in African countries compared to their counterpart in more

developed countries such as United State of America.

Studies on adolescents’ dietary consumption pattern both in Africa and among

African emigrants in USA and Europe revealed that Africans irrespective of their

age were consuming more refine foods than their traditional starchy roots and tubers

which are very rich in fibre and some B Vitamins (Salvo, Frediani, Ziegler, & Cole,

2012; Smpokos et al., 2013; Vernarelli, Mitchell, Hartman, & Rolls, 2011).This

study’ finding on carbohydrates consumption pattern of the adolescents also agreed

with the study carried out by (El-Gilany & Elkhawaga, 2012) in Egypt where about

34% adolescents of both sexes eat snacks daily. Snacking is becoming a norm

47

among adolescents and adults alike because of the increasing outlet for fast foods,

food marketing and advertisements. This trend has contributed immensely to high

prevalence of non-communicable diseases that are being experienced in Africa and

other developing world (Chiang et al., 2011; Kearney, 2010; Morrell, Lofgren,

Burke, & Reilly, 2012; Orsi, Hale, & Lynch, 2011; Pollock et al., 2012).

Comparatively, low frequency of snacks consumption may be a factor in reducing

overweight and obesity among the participants in this study

5.2.2 Fats and Oil Consumption Pattern of the Participants

The mostly consumed fats and oil rich foods were peanut butter, vegetable oil and

Groundnut and soybeans cheese. These are energy dense foods that contain fat

soluble vitamins such as Vitamins A, D, E, and K. They also facilitate absorption of

these vitamins from other source. The mean consumption of fat and oil by the

respondents was low and this was in contrast with the study conducted by (Sedodo,

Akinlotan, Akinlua, Abosede, & Isaac, 2014) on dietary diversity scores among

undergraduate students in western Nigeria, the fat and oil consumption was high

compared to the recommended allowance. However, intervention studies on dietary

consumption pattern and nutritional status of adolescents have shown that dietary

consumption which comprises of between 10-15 % of fat has positive relationship

in maintaining ideal weight among the adolescents (Hamilton-Ekeke, 2013).

5.2.3 Proteins Consumption Pattern of the Participants

Fatty protein consumption in form of dairy products (ice-cream and yogurt) is

consumed by the majority of participants in this study. The finding in this study

shows that 68.9% of participants consume dairy products between 1-2 times in a

week. A similar study by (Palenzuela et al., 2014) revealed that about 66.7% of

48

adolescents in his study consume dairy products daily. However, the finding of this

study disagrees with the finding of a similar study conducted in Ghana among

children between (9-12) years old by (Abibat et al., 2013). Abibat et al., reported

that animal protein consumption (dairy products) was low, and about 73% of the

participants did not consume eggs and fish and meat were consume occasionally.

Similarly, a study on food intake and meal pattern of adolescents in schools that was

conducted in Ila-Orangun, south-west, Nigeria by (Ogunkunle and Oludele, 2013)

indicated that 42% of the adolescents had low protein intake and 51% of the

adolescents also had low fat and oil intakes. Protein is one of the macronutrients that

are very essential for tissues production, development, body fluids synthesis, and its

deficiency can result in retarded growth and wasting. The mean protein consumption

of the respondents was two times per week; this was far below the expected

consumption requirement for adolescents that are still going through another stage

of rapid growth. The findings of this study was supported by the similar study

conducted by Dapi et al., (2011) among adolescents in secondary schools in urban

Cameroon in which more than 50% of the adolescents’ boys and girls consumed

proteins below the recommendations.

However the findings of this study was in contrast with a study conducted by

Adebusoye et al., (2014) in which most of the adolescents assessed consumed

proteins adequately. Generally African consumed more carbohydrates than other

macronutrients; this could be as a result of poverty, food insecurity and poor

livestock managements as was observed by various studies on animal protein

consumption among African (Salvo et al., 2012; Smith et al., 2013; Vorster, Kruger,

& Margetts, 2011). Low frequency of fatty protein consumption observed in this

49

study makes the participants food consumption inadequate and unhealthy, and this

can lead to both low weight gain and deficiencies in some essential amino-acids.

The low frequency of protein consumption can also contribute to participants’ low

prevalence of overweight and obesity.

5.2.4 Sugary Beverages, Whole Fruits and Fruits Juices Consumption of the

Participants

Fruits and vegetables consumption are very essential for the supply of

micronutrients such as vitamins, minerals, edible fibres’ and simple sugars that are

required in some amounts for physiological processes of individuals. The finding of

this study shows that about 56.5%, 41.0%, 43.5% of participants consumed one

form of fruits or the other and 48.9% consume chocolate drinks between (1-2) times

in a week. The result of this study was in agreement with (Onyiriuka et al., 2013) in

which only 15% of the adolescents consumed fruits and vegetables. Other studies

have also reported low fruits and vegetables consumption by the adolescents but

they were equally associated the paradigm to low level of familial meals, meal

skipping and accessibility to sugary fruit drinks (Ding et al., 2012; Goldfield et al.,

2011; Grimes, Riddell, Campbell, & Nowson, 2013; Hu & Malik, 2010; Pollock et

al., 2012).

However high sugary beverages and fruit drinks as well as low vegetables

consumption have significantly been attributed to increase prevalence of overweight

and obesity, colon cancer, diabetes and other manifestation of non- communicable

diseases that are becoming rampant among the children and adolescents all over the

world (Juonala et al., 2011). Excessive consumption of these beverages is associated

with weight gain and obesity. Intake of more than one to two drinks per day is also

50

linked to the metabolic syndrome (MS), insulin resistance, type 2 diabetes,

cardiovascular diseases, hypertension, gout and non-alcoholic fatty liver disease

(Brand-Miller, Atkinson, & Rowan, 2013; Caballero, 2015; Grimes, Riddell,

Campbell, & Nowson, 2013; Irabor & others, 2014).While sugar sweetened

beverages (SSBs) contributed significantly to the daily caloric intake, the reports on

the food consumption of people around the world indicated that millions of people

consume as much as 20% of their caloric intake from the SSBs and healthy

individuals can fulfil their daily energy needs without having to consume caloric

fluids in form of added sugar and sugar sweetened beverages (Caballero, 2015). The

low frequency of fruits and vegetables observe in this study may influence the

prevalence of overweight and obesity among participants because the energy content

of most fruits and vegetables are very minimal compared to other nutrients.

5.3 Physical Activity Practice of the Participants

Physical activity involvement has been confirmed to be beneficial to human

physiology because it improves oxygen retention capacity of the lungs and blood

circulation (Brambilla, Pozzobon, & Pietrobelli, 2011). The World Health

Organization (WHO) has recommended moderate to vigorous physical activity

practice for children and adolescents daily in order to reduce sedentary lifestyles.

The physical activity also reduces symptoms of anxiety and depression, build self-

confidence and develop neuromuscular awareness (coordination and movement

control) of adolescents and maintain healthy body weight among them. Globally,

81% of adolescents aged 11-17 years were insufficiently physically active in 2010

according to WHO’s report and adolescent girls were less active than adolescent

boys, with 84% vs. 78% not meeting WHO recommendations (WHO, 2014).

51

5.3.1 Hours of Sleep by the Participants

The hours of sleep by the participants indicated that more than 50% of them slept for

between seven to eight hours in a day. The total duration for both afternoon and

night sleep met the recommendations by the physical education experts (Garaulet et

al., 2011). The finding of this study agrees with the study conducted by Garaulet et

al., among 3311 adolescents from 10 European cities in Austria where it was found

that average sleep of the adolescent was eight hours of sleep in a day. Adolescents

who slept less than 8 hours per day were more sedentary and they have higher

values of BMI, body fat, waist and hip circumferences and fat mass. Studies have

associated short sleep duration with weight gain in people and adolescents short

sleeps were attributed to the use of electronics particularly television and social

media use. These phenomena contribute to adolescent frequent snacks consumption

and poor active life (Gubbels, Assema, &Kremers, 2013; Lipsky & Iannotti, 2012;

Peltzer, 2010).

Furthermore, adequate sleep will be very beneficial to children and adolescents if it

is complemented with physical activity because accumulation of energy without the

means of its expenditure could lead to high prevalence of non-communicable

diseases among adolescents especially female adolescents who are highly prone to

weight gain and obesity. The higher proportion of the participants in this study who

had the recommended duration of sleep in a day may be one of the contributing

factors to their low overweight and obesity of the participants.

5.3.2 Physical Activity Pattern of the Participants

Certain physical activities have been classified as moderate to vigorous intensity by

the sports experts and physical education specialists. These activities promote

52

energy expenditure and the level of the energy that may be expended depended on

the type of activity and length of involvement in such physical activity daily or in a

week. The physical activity pattern of the participants indicates that only about 32%

of them involved in jogging/running daily and about 40% of the participants spend

between (30-40) minutes in a day on one form of physical activity or the other. The

participants’ physical activity intensities per week based on IPAQ guidelines

indicates that more than forty five per cent of the participants is moderately active in

a week. The finding of this study supports the study conducted by (Eberechukwu et

al., 2013) in Nigeria among the rural and urban adolescents. The results showed that

rural adolescents were proportionately active than their urban counterparts but their

physical actively practice was still low because only about 14% per cent of the rural

adolescents performed sporting activities daily. Walking from home to school could

be attributed to some participants’ ability to meet the moderately recommended

physical activity intensity as a lot of the participants’ energy might have been

expended. This finding clearly illustrates certain physical activity practice of

participants may reduce overweight and obesity among the participants in this study.

Majority of the participants were undecided in their attitude towards physical

activity practice as a means of preventing certain ailments and maintaining ideal

weight. Most studies report low physical activities practice among adolescents in

schools which is attributed to schools and neighbourhood environments that are not

conducive. This phenomenon contributes immensely to the high prevalence of

overweight and obesity among the adolescents in the developing countries (Berge,

Arikian, Doherty, & Neumark-Sztainer, 2012; Mugwang’a, 2014; Vilchis-Gil,

Galván-Portillo, Klünder-Klünder, Cruz, & Flores-Huerta, 2015).

53

5.3.3 Physical Activity Facilities in Schools

One of the factors that can discourage children and adolescents to actively

participate in sporting activity in the schools as a form of physical activity is the lack

of sport and recreation facilities in schools or at home, lack of parks, sidewalks, air

pollution and dirty environment, high density traffic, fear of violence and crime in

outdoor areas (Chatterton, Younger, Fischer, Khunti, & others, 2012; Dobbins,

Husson, DeCorby, &LaRocca, 2013; Tremblay, Boudreau-Larivière, & Cimon-

Lambert, 2012). However the schools in this study, participants’ schools (100%)

were well equipped with sporting facilities. The facilities available in the

participants’ schools include the functional field, games materials (i.e. balls, table

tennis, hockey sticks).

Furthermore, finding on schools facilities shows that all the schools made physical

activity compulsory and certain period allocated for its practice daily in their

schools’ time-table. Other factors that encourage physical activity practice and

participation among the participants include the involvement of the school trainers

in the physical activity and also the engagement of the participants in other energy

reduction activity in the schools. Available physical activity facilities may contribute

to low prevalence of overweight and obesity among participants in this study

because those facilities could encourage participants’ participation in physical

activity. According to WHO (2014), In 2013, WHO Member States agreed to a

target of reducing insufficient physical activity by 10% by 2025 and included

strategies to achieve their target in "Global Action Plan for the Prevention and

Control of Non-communicable Diseases 2013-2020". The strategies to be adopted

to achieve this lofty goal include the provision of safe spaces and facilities for

54

students to spend their free time actively; quality physical education supports,

inculcating in children attitude of developing behaviour patterns that will keep them

physically active throughout their lives and making sports and recreation facilities

available for everyone to do sports. Other strategies include making walking,

cycling and other forms of active transportation accessible and safe for all and

establishing labour and workplace policies to encourage physical activity.

5.4 Body Mass Index (BMI) for Age of the Participants

Adolescence is the foundation of the future health of the nations (Sawyer et al.,

2012).Healthful eating habits and active lifestyle through improved physical activity

practice will help adolescents to maintain appropriate weight and reduce pandemic

of obesity especially in developing countries like Nigeria. Finding in this study on

body mass index (BMI) for age indicate that overweight prevalence based on sex of

participants is 0.6% in male and 6.7% in female. In addition to that, obesity

prevalence based on sex is 0% in male participants and 0.3% in female participants.

Furthermore, overweight prevalence for all participants is 4.7% and obesity is 0.2%.

Equally worthy of mentioning here is the underweight and normal weights of

participants which are 29.1% and 66.0% respectively.

The finding of this study agrees with finding from similar study conducted by

(Olubanji-Ojofeitimi et al., 2011) among adolescents in private and public schools

in Osun state, Nigeria. Olubanji-Ojofeitimi et al., reported that 4.0% of adolescents

girls in private schools were overweight and 1.2% of them were obese, while 2.3%

of adolescent girls in public schools were overweight and none was obese. However,

the finding in this study is in contrast with another similar study conducted by (Ene-

Obong et al., 2012) on prevalence of overweight, obesity and thinness among urban

55

school aged children and adolescents in southern, Nigeria. Ene-Obong et al., (2012)

reported that overweight prevalence in his finding was 11.4% while obesity

prevalence was 2.8%, and that overweight was higher (13%) among adolescents 10

to 18 years than among children 5 to 9 years which was (9.4%).The finding was

similar to many of the results obtained by African researchers on adolescents’ body

mass index where it was discovered that many of the adolescents studied were

underweight, while overweight and obesity among them were less than 10%

especially in the rural areas of Africa (Izuora et al., 2013; Manyanga, El-Sayed,

Doku, & Randall, 2014; C. Napier &Oldewage-Theron, 2015; Nti, Pecku, &Opare-

Obisaw, 2015; Oladunni & Sanusi, 2014) .

However the finding was in contrast with the results obtained by most western and

European researchers where the prevalence of overweight and obesity were

proportionally higher than Africans but underweight prevalence was much lower

than what was found in Africa (Gupta, et al., 2012; C. E. Napier & Hlambelo, 2014;

C. Napier &Oldewage-Theron, 2015;Wells, Marphatia, Cole, & McCoy, 2012). This

should be expected as most African families are still experiencing the double burden

of malnutrition and underweight, stunting and wasting are very common among

African children. These situations are closely attributed to food insecurity, poor

sanitation, inadequate maternal and child care and endemic tropical diseases (Maher,

et al., 2010; Popkin, et al., 2012; Seligman, et al., 2010; Thompson, et al., 2010).

Low overweight and obesity prevalence observe among the participants in this study

shows clearly that overweight and obesity is still lower in rural setting than in urban

adolescents. This further illustrates that overweight and obesity is comparatively

56

fewer in public schools among adolescents than their counterpart in private schools

especially in Kwara state, Nigeria.

5.5 The Relationship between Food Consumption Pattern, Physical Activity

Level and Overweight and Obesity of the Participants

The finding on relationship between food consumption pattern and BMI for age of

participants in this study indicates that a relationship(r=0.012) exits between the two

variables but the relationship is not significant (p=0.785). Furthermore, finding on

relationship between physical activity level and BMI for age of participants shows

that a negative relationship(r=-0.105) exits between the two variables and the

relationship is significant (p=0.017).The finding of this study varies with finding of

similar study conducted by (Bruenning et al., 2012) on the relationship between

adolescent and eating behaviour. Bruenning et al., (2012) reported that relationship

exists on the eating behaviour of adolescent and the relationship was significant

(p=0.038). However, the finding agrees with the finding of similar study carried out

by (Alkahtari et al., 2015) on relationship between self-reported dietary intakes and

measured physical activity among male students in Saudi Arabia. Alkahatari et al.,

(2015) reported that relationship exist between physical activity level and BMI of

the students, and the relationship was significant (p=0.048). The findings on

relationships between food consumption and physical activity and BMI for age of

participants in this study clearly illustrates that food consumption pattern and

physical activity have influence on the participants overweight and obesity status.

Overweight and obesity status of participants will increase as they consume more

foods, meaning that this study fails to reject the null hypothesis that states that there

is no significant relationship between food consumption pattern and overweight and

57

obesity of the students. On the hand, overweight and obesity status of the

participants will reduce as they engage in more physical activity. Therefore, this

study failed to accept the Null hypothesis which stated that there was no significant

relation between the respondents’ physical activity level and BMI for age. Other

findings in this study show that participants eat according to the BMI for age

categories as the result shows, mean composite scores for underweight is

(61.36±11.44), normal weight is (65.84±11.64) and overweight mean composite

scores is (70.24±9.58). This clearly illustrates that food consumption pattern (FCP)

is proportional to the weight categories of the participants, meaning that overweight

participants consume more than those who are within normal weight and so on.

This finding of this study agrees and confirms several studies conclusion that

overweight and obesity is strongly associated with the food consumption and

frequency of its consumption (Aounallah-Skhiri et al., 2012; Cutler, Flood, Hannan,

Slavin, &Neumark-Sztainer, 2012; Dubois, Farmer, Girard, Burnier, &Porcherie,

2011; Franks et al., 2010; Fulkerson et al., 2011).

Several literature have attributed the high prevalence over weight and obesity among

people to the rising level of other non-communicable disease condition such as

diabetes, hypertension, certain form of cancer, arthritis, kidney problems and

metabolic syndrome in general This shows that the lower the BMI of the people the

less the risk of the non-communicable diseases and the healthier the people will be

especially the adolescents who are the future leaders of tomorrow.

58

CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATIONS

6.1 Summary of the Findings

The demographic characteristics of the students indicated that adolescent student

girls were twice adolescent student boys. Majority of the adolescent parents and

guardians only had primary school education and farming was their main

occupation. Higher proportion of the adolescents lived with their parents and

guardians while others lived alone.

The majority of the adolescents consumed breakfast before going to school and

about a quarter of them skipped their breakfast. More than a half of them added two

teaspoonful of sugar to their beverages daily while a third of them added up to four

teaspoonful of sugar to their beverages during consumption daily. The adolescent’s

consumption of refined carbohydrates was about three times in a week and starchy

roots and tubers were consumed once in a week. The fatty protein foods and fat and

oil rich foods were consumed two times in a week while fruits, sugary beverages

and whole fruits were consumed three times in a week.

More than 50% of the adolescents slept for more than seven hours daily while only

about 10% slept for about four hours. Adolescents students mainly walked to

schools from their homes and a proportion of them went to school on motorcycle.

The physical activity level of the adolescents based on the metabolic equivalents

scores (METS) were between moderate and high intensity. The schools had

functional facilities to promote sporting activities in form of physical activities.

Schools made sport compulsory for all students to participate fully in the games and

recreations. The weekly physical activity practice of the adolescents was three times

59

in a week and majority of them did not believed that regular physical activity can

prevent certain body ailments and as well as help to maintain an ideal weight.

A significant proportion of the adolescents was underweight and only 4% were

overweight with less 1% of the adolescent classified as obese. The finding was an

indication of low frequency of food consumption, moderate to high physical activity

intensities of the adolescents and low socio economic status of most of their parents.

There was a weak positive relationship between food consumption pattern and BMI

for age of the participants. Furthermore, there was a weak negative relationship

between physical activity level and BMI for age of participants

6.2 Conclusion of the Findings

The participants’ demographics might have influenced their low food consumption

pattern. Walking to school could have improved their physical activity level. The

prevalence of overweight and obesity of the participants was low and this was in line

with several similar studies. The low body mass index (BMI) for age and the high

underweight observed could be attributed to the rural area they lived, their frequency

of food consumption and energy reducing activity they engaged in within their

domain. The schools as the agents of behavioural change can curtail any weight

abnormalities that may develop among the adolescents because of the structured

system that were put in place in form of games and available functional sporting

facilities. The participants’ food consumption pattern and physical activity level

greatly relate to participants overweight and obesity.

60

6.3 Recommendations

6.3.1 Recommendation for Practice

The low BMI for age within the normal range and the high underweight observed in

the study points to a need for the adolescent parents and guardians to ensure that

frequency of food consumption of their children are improved. This can be achieved

by increase frequency meals of the participants and also prepare lunch from home

should be given to them to take to school daily. This will help to improve their food

consumption. In addition, the schools authorities should establish appropriate food

cafeteria in their schools where nutritious meals will be served for those students

who may not come with their lunch.

6.3.2 Recommendations for Policy

The high underweight and low BMI observed could be attributed to the adolescent’s

demography which indicated that majority of their parents had low level of

education and engaged in farming as their main occupation. Empowering the

adolescent parents by ensuring an improvement in the resources allocation to the

rural communities in form of improved social amenities to stimulate economic

development will enhance the majority of the parents and guardians standard of

living.

6.3.3 Suggestion for Further Research

This study could be extended to other local governments’ areas in the state so as to

obtain adequate information on the food consumption pattern, physical activity level

and the overweight and obesity prevalence of the adolescents in public schools in

the state.

61

Further research can also be conducted on the factors that determine the physical

activity practice among the adolescents in public and private schools and how those

factors contribute to the prevalence of overweight and obesity of the adolescents.

Intervention studies can be carried out on the socio-economic status and food

consumption pattern of the families in the rural area and its effect on overweight and

obesity prevalence of adolescents and children.

Studies on the food consumption and physical activity of boarding and day students

in Kwara state can also be research into so as to compare the level of activity and

food consumption of the two groups.

62

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APPENDICES

Appendix A

LETTER OF INTRODUCTION

I am Mr. Lateef O. Jimoh a postgraduate student from the department of foods,

nutrition and dietetics of Kenyatta University Nairobi in Kenya. I am in your school

to carry out a research on the Food consumption patterns and physical activity in

relation to overweight and obesity among secondary school students in Kwara

State. The benefits of this study include the opportunity for you to measure your

weight and height. It will also help you to know your food consumption pattern and

how physically active you have been. This study will not harm you in any way but

rather make you to be conscious of the food you eat and the physical activity you

engage- in. You will be required to fill a food frequency table and physical activity

questionnaire. Also your body weight and height will equally be measured.

Therefore if you are interested and willing to participate in the research, you should

signify by writing your name in the space provided below and append your signature

or thumb print.

LETTER OF CONSENT

I..............................................., as the parent of...............................................have

been duly informed about this study and I have directed my child to participate in

the study willingly. I therefore append my signature/thumb print on this letter of

consent and confidentiality.

Signature................................................... Date............................................

81

Appendix B:

QUESTIONNAIRE

SECTION A: DEMOGRAPHIC CHARACTERISTICS

1). Student Questionnaire Number …….........................................................

2). Sex: Male Female

3). Date of Birth: ………………………….. Age (years) .......………………….........

4). School: …………………………...... Year of Admission: .....……………….......

5). Residence: …………………………… City: ………………………………........

6). Who do you live with?

…………………………………………………………………................................

7). The highest education level that your parents have attained (Father/Mother)

(a) None (b) primary (c) secondary (d) university (e) others..................................

8). What is the occupation of your parents......................... (Father/Mother)

9). What mode of transport do you use to come to school (a) bicycle (b) motorcycle

(c) public transport ( d) trekking ( e) parent’s car

SECTION B - WEIGHT AND HEIGHT MEASUREMENT (to the nearest

meters)

10). Weight Measurement (Kg) 1st Reading ……… 2nd Reading ……….

Average ………

11). Height Measurement (M) 1st Reading ………. 2nd Reading ……….

Average ……….

82

SECTION C: FOOD CONSUMPTION FREQUENCY TABLE

1). Do you normally eat breakfast every morning?

(a) Yes (b) No

2). Where do you usually eat breakfast? 1. Where do you usually eat breakfast?

At home at school don’t eat breakfast others,

Specify............................................................................................................

3). How many times each week (including weekdays and weekends) do you usually

eat breakfast prepared away from home?

Never or almost never

1 – 2 times per week

3 – 4 times per week

5 or more teaspoon per day

4). How many teaspoons of sugar do you ADD to your beverages (tea, porridge,

coffee, etc) or food each day?

None/less than 1 teaspoon per day

1-2 teaspoon per day

3–5 teaspoons per day

More than 6 teaspoons

83

5). How often do you eat any of these foods items at home or school in a week?

(Weekend inclusive)

S/N FOOD ITEMS Never per

week

1-2

times

Per

week

3-4

times

Per

week

5 or more

times per

week

Starchy roots ,tubers & refined cereals

1. Yam/cassava(boiled/roasted)

2 Boiled Irish potatoes

3 Boiled sweet potatoes

4 Boiled whole bran rice

5 Maize (boiled/roasted)

6 Oat bran meal

7 Doughnuts & biscuits

8 Potatoes chips& fried potatoes

9 Spaghettis, noodles &

Popcorn

Fat & oil rich foods

10 Peanut butter

11 Vegetable oil in soup/stew

12 Butter/margarine

13 Salad dressing/mayonnaise

14 Groundnut (boiled/roasted)

15 Soybeans cheese

Fatty proteins foods

16 Fried fish & roasted meat

17 Whole milk& milk shakes

18 Burgers/hot dogs

19 Pork/bacon

20 Ice-cream & frozen yogurt

21 Meat pies & fish rolls,

84

22 Fried eggs, boiled Eggs &

Eggrolls

Sugary beverages, fruits juices and whole fruits

23 Soda drinks/soft drinks

24 Chocolate drinks

25 Malt drinks e.g. maltonic /maltina

26 Banana

27 Mangoes

28 Pawpaw

29 Any other fruits (specify..........)

30 Any other drinks (specify.........)

SECTION D: PHYSICAL ACTIVITY QUESTIONNAIRE

Instruction: tick appropriately

1). For how long do you normally sleep at night?

3-4 hours 5-6 hours 7-8 hours More than 8 hours

2). How often do you exercise your body daily?

A little Rarely Sometimes None Regularly

3). What physical activity do you usually do in a day?

Skipping Walking Bicycling Jogging/running

Others, Specify

...........................……………………………………………………………………

4). For how long do you engage in any physical activity daily?

10 mins 20-30 mins 30-40 mins 50-60 mins > 1 hour

5). In the last 7 days, during your physical education (PE) classes, how often were

you very active (playing hard, running, play football and volleyball)

Hardly ever Sometimes Quite often Always

85

6). In the last 7 days, what did you normally do after (besides eating lunch?)

Relax and sleep-off Ran/played a little Ran/played hard most of

the time

Sat down (talking, reading, doing schoolwork) Stood/walked round

7). In the last 7 days, how many days right after school did you do sport, dance or

play games in which you were very active?

None 1 time last week 2 or 3 times last week

4 times last week 5 times last week

8). How much time do you spend doing moderate – intensity activities at work on a

typical day?

Hours …………………………………. Minutes …………………………….

9). On the last weekend, how many times did you do sport, dance or play games that

caused small increase in breathing or heart beat such as brisk walking, carrying light

load for at least 10 Minutes continuously?

None 1 time 2-3 times 4 times 5 times

10). Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously

to get to and from places Yes No

11). Mark how often you do physical activity (like playing, sport, games and dance)

or any other physical activity for each day last week.

Days None Little bit Medium Often Very often

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

86

12). Which of the following statements describe your best for the last 7 days?

All or most of my free time was spent doing things that involve little

physical effort

I sometimes (1-2 times last week) did physical things in my free time (e.g.

played sport, went running, swimming, bike riding, aerobics)

I often (3-4 times last week) did physical things in my free time.

I quite often (5-6 times last week) did physical things in my free time.

I very often (7 or more times last week) did physical things in my free time.

13). Were you sick last week or did anything prevent you from doing your normal

physical activities? Yes No

14). If yes, what prevented you? Specify..................................................................

15). Do you agree that engaging oneself in physical activity regularly can prevent

certain ailment and helps you to maintain ideal weight?

Strongly disagree Disagree Undecided Agree Strongly Agree

.

87

Appendix C:

OBSERVATION CHECKLIST

S/N

During research data collection process, does

the school has/done any of the following

1-Yes 2-No

1

Are there available field/play grounds for

physical activity practice in the school?

2

Does the school have physical activity trainers/

games masters?

3

Is physical activity practice part of the daily

school ‘time table?

4

Are the students observed while engaging in

physical activity practice?

5

For how long does the students engage in

physical activity practice daily <30mins,

>30mins.

6

Do the students participate fully in the school

physical activity practice?

7

Is the school playing ground functional? (over

grown grass, well-cut out lawn and dilapidated

wood wall)

8

Are there physical activity facility items such as

football, basketball, table tennis, etc in the

school?

9

Does the school make physical activity

compulsory for the students?

10

Does the physical activity trainer usually brief

the students at the beginning of the practice?

11

Are there other energy consuming activities that

the students engaged-in?

12

Are the trainers involved in the physical

activity practice in order to encourage students’

participation?

88

Appendix D:

THE MAP OF NIGERIA

A map of Nigeria- 36 states and federal capital territory (FCT) Abuja

Source: http://realfilmcareer.com/photowqdb/maps-of-nigerian-states

89

Appendix E:

THE MAP OF KWARA STATE

Source: Regional Challenges to HIV/AIDS Prevention in a Rural Community

in Kwara State, Nigeria: Nutritional and Educational Strategies

(Olasehinde et al., 2009)

NB: Kwara state is safe and had not experienced any civil or political crisis in the

recent past

90

Appendix F:

WHO BMI FOR AGE FOR BOYS GRAPH

91

Appendix G:

WHO BMI FOR AGE FOR GIRLS

92

Appendix H:

KENYATTA UNIVERSITY APPROVAL FOR RESEARCH DATA

COLLECTION

93

Appendix I:

KWARA STATE TEACHING SERVICE COMMISSION (KSTSC) PERMIT FOR

RESEARCH

EXERCISE

94

Appendix J:

KWARA STATE UNIVERSAL BASIC EDUCATION BOARD (KSUBEB)

ETHICAL REVIEW COMMITTEE APPROVAL TO CONDUCT RESEARCH.

95

Appendix K:

PERMISSION OBTAINED FROM THE SELECTED SCHOOLS FOR THE

RESEARCH STUDY

Documents

FOOD CONSUMPTION PATTERNS, PHYSICAL ACTIVITY AND