ABSTRACT
There is a global concern that children are insufficiently active to experience health benefits of physical activity (PA). The World Health Organization recommends that children should engage in at least one hour of moderate to vigorous intensity PA (MVPA) daily, or accumulate at least 12,000 steps a day to achieve health benefits associated with the PA. This study investigated the contribution of recess PA towards alleviating the burden of overweight and obesity among children in Nairobi City County, Kenya, to help form the basis for intervention. The current cross-sectional design study evaluated PA participation using pedometers to count steps accumulated by learners during recess periods in relation to gender and the type of school attended (socioeconomic status) in selected primary schools in Westlands Constituency, Nairobi City County. The participants were grade/class five pupils (N = 262: Male n = 137; 52.3%; Female n = 125; 47.7%). Most of the participants (n = 164; 62.6%) were pupils in public schools compared to those enrolled in private schools (n = 98; 37.4%). Data was collected using belt clip piezo-electric pedometers. The dependent variable was the average steps collected twice a day for three days using a pedometer. The independent variables were the socioeconomic status of schools (represented by private and public schools), gender (male and female) and the duration of recess (short and long). Consent was sort from the pupils, parents, Headteachers, KUERC, NACOSTI and MoE before carrying out the research. Data was analyzed using IBM statistics SPSS version 24. Independent-Samples t-Tests were conducted to test the first two hypotheses associated with the study while the Paired-Samples t-Test was also conducted to test the third hypothesis with the confidence level for the three tests set at alpha = .05. There was no significant difference in mean three-day steps during recess between public and private primary school pupils, t(259.79)
= 1.69, p = .09. The mean steps between male and female participants was significant,
t(259.50) = 4.85, p = .001. Male pupils (M = 4,775.19, SD = 1,208.88), on average,
accumulated more steps compared to female pupils (M = 4,097.29, SD = 1,055.24). The mean steps for short and long recess were significantly different, t(261) = 23.17, p = .001. The participants on average accumulated significantly more steps during long recess (M = 2,708.49, SD = 834.15) compared to short recess (M = 1,743.27, SD = 484.09). The researcher recommends replicating this study in more schools within Nairobi City County to establish whether the results obtained in this study are a true reflection of the whole population (urban schools), conduct a similar study to establish PA participation level during recess in rural public schools, and to evaluate PA participation level during PE lessons, before/after school, and during non-school days to comprehensively evaluate PA trends of Kenya’s school children. Based on the results from this study, the researcher recommends that schools in Westlands Constituency, Nairobi City County should encourage recess time PA since it contributes to 37% of the recommended 12,000 steps per day.
CHAPTER ONE: INTRODUCTION
Background to the Study
World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat that may impair health and wellbeing (WHO, 2020). While several factors have been linked to excess body fat such as genetics; it is noted that nutrition and physical activity behaviour stand out regarding the rising obesity epidemic globally (Crossman, 2015; De Onis, Blössner, & Borghi; 2010; Gregg & Shaw, 2017; Powers & Dodd, 2017). Obesity can be prevented by making the choice of healthier foods and regular physical activity. The WHO lists healthy foods as reduced calories from fats and sugars and increased portions of daily intake of fruit, vegetables, legumes, whole grains, and nuts (2020). In addition, children are recommended to engage in at least one hour of moderate to vigorous physical activity (MVPA) a day, or 12,000 steps a day to achieve health benefits associated with the PA participation (CDC, 2019; Chiarlitti & Kolen, 2018; Jaunzarins, Gauthier, King, Lariviere & Dorman, 2014; Morera, Rudisill, Wadsworth & Robinson, 2014; Wang, 2018). There is a global concern that children are not meeting the recommended physical activity (PA) dosage enough to experience health benefits (Centers for Disease Control and Prevention (CDC), 2019; Fryar, Carrol & Ogden, 2014; Hales, Carrol, Fryar & Ogden, 2017; Chebet et al., 2014; Muthuri, Wachira, Leblanc, et al., 2014; Onywera et al., 2016). Meeting these guidelines has become a challenge since PA is rapidly being replaced by sedentary activities such as the use of motorized transport, passive leisure time activities and mechanization/automation of household chores (Carlsson & Akerstedt, 2018; Christensen et al., 2014; Gebel et al., 2015; Torun, Gokçe, Aydın & Cesur, 2014; Peer, 2015). The engineering of streets/roads
has not been friendly to walking/cycling, and the neighbourhoods have also become unsafe or unconducive for children to play unsupervised (Wolch, Byrne & Newell, 2014; Bhurosy & Jeewon, 2014; Haregu et al., 2016; Child et al., 2014). Children spend most of their day in school, thus rendering the school environment an ideal place for children to meet the daily PA targets through physical education (PE) lessons. However, Moderate to Vigorous Physical Activity (MVPA) in PE classes alone has been found not to meet the recommended daily PA for health (Chow et al., 2015; Brusseau & Burns, 2015).
The number of overweight or obese infants and children has increased from 32 million globally in 1990 to 41 million in 2016. Obese children are likely to carry this condition into adulthood if no intervention is done (WHO, 2019). Furthermore, obesity has been associated with the risk of developing diseases and complications including cardiovascular disease, colon cancer, diabetes, hypertension, kidney disease among others (Fischer, 2016; Crossman, 2015; Powers & Dodd, 2017). Currently, overweight and obesity are linked to more deaths worldwide than underweight (WHO, 2020). The cost of treating and managing conditions associated with overweight and obesity has imposed a tremendous economic burden on individuals and countries. In 2014 the global economic impact of obesity was estimated to be US $2.0 trillion or 2.8% of the global gross domestic product (GDP) (Dobbs et al., 2014). Obesity has also imposed other costs in the form of lost productivity and foregone economic growth because of lost workdays, lower productivity at work, mortality and permanent disability (Tremmel, Gerdtham, Nilsson & Saha, 2017).
WHO (2019) reported that a vast majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that
of developed countries. In Africa, it has been reported that the number of overweight children under 5years has increased by nearly 24% since 2000 (WHO, 2020). This finding has been confirmed by a research by Muthuri (2014) which reported lower levels of PA and higher levels of sedentary behaviour among school-aged children in sub- Saharan Africa and linked this to Higher Socioeconomic Status (HSES) and urban living. There is growing evidence that there is a decrease in participation in PA among Kenyan children primarily due to urbanization (Muthuri, Wachira, Leblanc, et al., 2014; Onywera et al., 2016; Chebet, Nsibambi, Otala & Goon, 2014). In Nairobi, children from HSES were found to be engaging more in sedentary and low-intensity PA, both at home and school, compared to children from LSES (Tremblay et al., 2016; Muthuri, 2014; Onywera et al., 2016). The documented trend recommends that Kenya’s children need PA intervention measures to ensure that they meet the daily PA dose.
Since children spend most of their awake hours in schools, a school environment is the most ideal, safe, and convenient place for PA intervention (Belton, O’Brien, Meegan, Woods & Issartel, 2014). Schools should have scheduled time for PE just like any other subject, facilities and equipment, and employ qualified/trained health and physical education teachers to teach developmentally-appropriate PA and concepts to the students for lifetime health/wellness (Holt, Hale, & Hall, 2016). There is, however, a growing global concern that curricular time allocated to PE is not sufficient to meet the PA dosage required (Pawlowski, Andersen, Troelsen & Schipperijn, 2016; Belton et al., 2014). In most Kenyan schools, even though PE lessons are not offered daily, teachers often use PE periods to teach other examinable subjects (Zuraikat & Dugan, 2015). In addition, the quality of instruction has been compromised due to lack of adequate and trained PE
teachers (Kamenju, Rintaugu & Mwangi, 2016; Edward, 2015). The challenges facing availability and quality of PE programs in schools can be partially resolved by utilizing recess, the only consistent time across all schools when children can be physically active within the school environment (Zavacky & Michael, 2017). Recess is one or more breaks from academic work during a typical school day. During recess, students are provided with discretionary time and opportunities to engage in PA (Pasquale, 2014).
Several studies have highlighted interventions that have been adapted to make the children more active during recess. A study by Hynynen et al. (2016) recommended that the school environment should be made more activity-friendly for the children to have abundant opportunities to engage in quality PA during recess. Additional studies have also advocated for spacious environments to trigger students’ participation (De Meester et al., 2014; Hyndman, 2017; Burji, 2019), fewer pupils per square meter on the playground (Reunamo et al., 2014), and offering diverse and movable equipment instead of fixed equipment (Escalante, Garcia-Hermoso, Backx & Saavedra, 2014; Nardo et al., 2016; Woods, Graber, Daum & Gentry, 2015; Black et al., 2015).
There is a paucity of data assessing the quality and quantity of PA during recess in Kenyan schools. Thus, there is not much known about the potential of recess in alleviating the deficiency of PA among school going children. Schools must be encouraged to provide as many opportunities as possible to children to partake PA. To this effect, this study aimed at evaluating PA participation during recess among grade/class five pupils enrolled in public and private schools in Westlands Constituency of the Nairobi City County. It sought to assess differences in PA participation during
recess between long and short recess periods, between boys and girls and between children in LSES and HSES.
