Inequalities in physical activity among children from low- and middle-income countries: the SUNRISE International Study

Regular symposium submission

Title: Inequalities in physical activity among children from low- and middle-income countries: evidence from the SUNRISE International Study.

Purpose: 1) To present evidence from five low- or middle-income countries on differences in participation in physical activity between children living in urban and rural areas; 2) to provide insights on how to address inequities based on level of rurality in each of the countries; and 3) to provide a forum for researchers from underrepresented countries to present their work to an international audience.

Description
The chair will introduce the speakers and provide a brief introduction on the SUNRISE Study and how it aims to address inequalities at a global level, especially by providing data from low- and middle-income countries (LMICs) and, within LMICs, on differences between urban and rural locations (10 mins). Each speaker will then present for 8 minutes with 2 minutes for audience questions after each presentation (50 mins). At the conclusion, there will be an active moderated discussion with the audience focusing on addressing urban-rural inequalities in physical activity in LMICs (15mins). TOTAL=75mins.

Chair: Anthony Okely, University of Wollongong, Australia
Presenter 1: Gabriela Argumedo, Instituto Nacional de Salud Pública, Mexico
Presenter 2: Chalchisa Abdeta, University of Wollongong, Australia and Adama Hospital Medical College, Ethiopia
Presenter 3: Tawonga Mwase-Vuma, University of Malawi, Zomba, Malawi
Presenter 4: Denise Koh, Universiti Kebangsaan Malaysia, Selangor, Malaysia
Presenter 5: Amine Ltifi, University of Manouba, Tunis, Tunisia
Moderator: Alex Florindo, University of São Paulo, Brazil
 
Title: Rural and urban settings differences on 24h movement behaviours levels in Mexican preschoolers: the SUNRISE pilot study in Mexico.

Authors: Gabriela Argumedo,1 Deborah Salvo,2 Armando Olvera, 1 Daniel Velázquez, 1 Anthony Okely,3 Alejandra Jáuregui1

Affiliations:
1 Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
2The University of Texas at Austin College of Education Department of Kinesiology and Health Education.
3Early Start, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia tokely@uow.edu.au.

Background: In Mexico, more children (aged 10-14 years) in rural settings meet physical activity and screen time recommendations, compared to their urban counterparts1. There is currently no known data available regarding children’s sleep time in Mexico.2 To date, these figures are unknown among Mexican children under 5 years of age.

Purpose: To identify differences in physical activity, sleep, and screen time, namely 24h movement behaviours, among Mexican children under 5 years of age living in urban and rural settings.

Methods: Cross-sectional study among children aged 3-4 years attending Early Childhood Education and Care centres located in urban and rural settings. Physical activity and sleep time were objectively measured with an ActiGraph (GT3X, GT3X+) accelerometer worn on children’s waist for seven days, while screen time and sleep time were reported by caregivers.

Results: Of the 139 Mexican children who participated in the study, 87 had valid accelerometry data (rural=37%, urban= 63%). Children in rural settings spent more time in total physical activity (M=234.7 min/day, SD=61.0 vs. M=204.2min/day, SD=48.8, p=0.01) than those in urban settings, respectively. No significant differences were identified in the time spent in moderate- to vigorous-intensity physical activity (M=113.1 min/day, SD=34.3 vs. M=99.2min/day SD=33.3, p=0.07 respectively), screen time (rural: M= 82.1 min/day, SD=83.8 vs. urban: M=92.0 min/d, SD=61.4, p=0.53), or sleep time (rural: M= 11 hours/day, SD=1.3 vs. urban: M=10.7 hours/day, SD=1.0, p=0.26).

Conclusions: Consistent with nationally representative data for older children, results from this study of children in Mexico suggest that those aged 3-4 years living in rural settings are more physically active than their urban counterparts.

Practical implications: It is important to implement a national surveillance system of movement behaviours among children under 5 years of age, and to strengthen physical activity participation among this age-group, particularly among those living in urban settings.

Funding: Fogarty Grant A66864.

References:
1. Shamah-Levy, T., Vielma-Orozco, E., Heredia-Hernández, O., Romero-Martínez, M., Mojica-Cuevas, J., Cuevas-Nasu, L., Santaella-Castell, JA., & Rivera-Dommarco, J. (2020). Encuesta Nacional de Salud y Nutrición (ENSANUT) 2018-19. Resultados Nacionales. https://www.insp.mx/produccion-editorial/novedades-editoriales/ensanut-2018-nacionales.
2. Instituto Nacional de Salud Pública. (2016). Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Informe de Resultados. In Informe final de resultados. https://doi.org/10.21149/8593
 
Title: Compliance with the global 24-hour movement guidelines among rural and urban pre-schoolers in Malawi: The SUNRISE Malawi Study

Authors: Tawonga W. Mwase-Vuma1,2, Xanne Janssen2, Anthony D. Okely3, Janine J. Kayange1, Kar Hau Chong3, Penny Cross3, Seth Evance1, and John J. Reilly2

Affiliations:
1 Centre for Social Research, University of Malawi, Zomba, Malawi.
2 Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland.
3 Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Australia.

Background: Despite the publication of the World Health Organization (WHO) guidelines on physical activity (PA), sedentary behaviours, and sleep for the under-fives in 2019, there is currently limited evidence on compliance with the guidelines from low-income countries.

Purpose: We examined the levels of meeting the total PA, sedentary behaviours, and sleep guidelines among Malawian 3-4 year olds, and determined sex and urban/rural differences in meeting the guidelines.

Methods: This study comprised 417 children (51.5% girls; mean age 4.0 years) from 24 urban and rural childcare centres in Malawi. The child’s total PA was assessed using step-count data from hip-worn ActiGraph GT3X accelerometers worn continuously for at least five consecutive days. Children were classed as meeting the TPA guideline if they averaged 11,500 steps/day. Parents reported their child’s sedentary screen time, sleep duration, and sociodemographic characteristics. Descriptive analyses were conducted to describe the levels of meeting the guidelines and 95% confidence intervals (CI) were calculated. Sex and urban/rural differences were assessed using a chi-squared test. All analyses accounted for post-stratification weights and were conducted in Stata.

Results: Of the 417 pre-schoolers, 75.9% were from rural settings. Children accumulated an average of 24,269 steps/day (standard error [SE]=391) and reportedly spent a daily average of 43.0 (SE=7.1) minutes in screen time and 11.2 (SE=0.1) hours of sleep. The overall prevalence of meeting the TPA, sedentary screen time, sleep, and combined guidelines were 98.4% (95% CI=96.0–99.4), 79.4% (95% CI=71.2–85.7), 90.6% (95% CI=87.3–93.2), and 70.5% (95% CI: 62.4–77.4), respectively. An exceptionally high proportion of children from rural settings met the sedentary screen and combined guidelines compared to their urban counterparts (p<0.05). No sex differences were observed in meeting the guidelines.

Conclusions: A very high proportion of Malawian pre-schoolers aged 3-4 years in our sample met the WHO guidelines. Children from rural settings were more physically active than their urban counterparts, suggestive of a ‘pre-physical activity transition’ environment.

Practical implications: The very physically active children from rural than urban settings is suggestive of a ‘pre-physical activity transition’ environment. Targeted interventions are needed to promote and sustain physical activity behaviours to delay the transition and improve childhood health.

Funding: Sir Halley Stewart Trust (2674)
 
Title: Adherence to the WHO Guidelines and Associations with Socio-demographic Factors: The SUNRISE Ethiopia Study

Authors: Chalchisa Abdeta1*, Dylan Cliff1, Katharina Kariippanon2, Alem Deksisa3, Sileshi Garoma3, Debrework Tesfaye4, Kar Hau Chong2, Devan Antczak1, Anthony D. Okely2

Affiliations:
1Early Start, School of Education, University of Wollongong, Wollongong, Australia
2Early Start, School of Health and Society, University of Wollongong, Wollongong, Australia
3Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
4Department of Sport Sciences, Wolaita Sodo University, Wolaita, Ethiopia

Background: The World Health Organisation (WHO) has called for more evidence on 24-hour movement behaviours from low-income countries.

Purpose: We examined the proportion of Ethiopian children (3.0-4.9 years) who met the WHO guidelines on physical activity, sedentary behaviour and sleep for children under the age of five, and differences between children who lived in urban and rural areas.

Methods: A cross-sectional study was conducted in Adama and Lume Woreda, Ethiopia. Children were recruited through kindergartens and rural villages. Physical activity and sleep were measured using ActiGraph. Accelerometers raw data were processed using the “PhysicalActivity” package, and subsequently, the “PhysActBedRest” package was used in the R software to identify sleep periods using a decision tree algorithm. Sedentary screen time and restrained sitting were parent-reported. Multivariable logistic regression models tested associations between meeting the WHO guidelines and socio-demographic factors.

Results: A total of 430 children participated in the study. More than half the children (58.0%) met all the WHO guidelines. A higher proportion met the physical activity (96.1%) and sleep guidelines (91.9%) compared to the sedentary screen time guideline (63.5%). Children who lived in rural areas were more likely to meet the sedentary behaviour (84.6% vs 38.2%, AOR= 7.31; 95%CI: 3.93, 14.02), sleep (98.6% vs 83.8%, AOR= 8.60; 95%CI: 3.55, 23.73) and combined (81.3% vs 30.1%, AOR= 7.41; 95%CI: 4.04, 13.97) guidelines than those who lived in urban areas.

Conclusions: A high proportion of Ethiopian children met the WHO guidelines. Children from rural areas were more compliant than their urban counterparts. Strategies to reduce screen time and promote healthy movement behaviours in urban areas are needed.

Practical implications: Most rural preschool children met WHO movement guidelines than those who lived in urban areas. This study helps to fill the evidence gap seen in Africa and supports healthy childhood development in Ethiopia.

Funding: CA is supported by a Higher Degree Research Scholarship funded by the University of Wollongong, Australia.
 
Title: Impact of Urban-Social Divide on 24-hour Movement Behaviours among Preschool Children in Malaysia: Preliminary Results from SUNRISE Study

Authors:
Denise Koh1, Cho Li Bing1, Wong Jyh Eiin2, Poh Bee Koon2, Anthony D Okely3

Affiliations:
1School of Education and Community Well-being, Faculty of Education, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia.
2Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
3School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong NSW 2522, Australia

Background: Understanding movement behaviours among preschool children is important as health behaviours begin at a young age and track into adulthood. The WHO’s 2019 guidelines recommend that children aged 3-4 years should participate in at least 180 minutes daily of physical activity (PA) daily including at least 60 minutes daily of moderate-to-vigorous-intensity PA (MVPA), <60 minutes daily of sedentary time (ST), and 10-13 hours quality sleep including naps.

Purpose: This study aims to explore differences in time spent on three main behaviours, namely PA, sedentary behaviour and sleep, between urban and rural children.

Methods: This cross-sectional study involved preschool children aged 4 years recruited from urban and rural localities in Peninsular Malaysia. PA and ST were measured using Actigraph GT3X+ accelerometers worn on the waist for five consecutive days, from Monday to Friday. Children with at least one 24-hour day of data were included in this analysis. Sleep was measured via a parents’ questionnaire.

Results: A total of 81 children completed the study protocol. There was good representation from urban (51.8%, n=42) and rural (48.2%, n=39) areas. Children from rural areas significantly more time in total PA (Urban:149.4±46.6 minutes/day vs Rural:175.6±54.7 minutes/day, p=0.02). However, no significant differences were found in MVPA (Urban: 65.5±29.2 minutes/day vs Rural: 79.2±31.5 minutes/day, p=0.05); ST (Urban:103.2±102.5 minutes/day vs Rural:91.3±76.9 minutes/day, p=0.56) and sleep (Urban:10.4±1.2 hrs/day vs Rural:10.5 ±0.9 hrs/day, p=0.55).

Conclusion: Children in rural areas were more active throughout the day compared to their urban counterparts. The average ST was above the recommended <60 minutes/day among urban and rural children.

Practical Implications: Urban localities need more child-friendly outdoor spaces where parents feel safe bringing their young children for active play outdoors.

Funding: This research is funded by the Research University Grant by Universiti Kebangsaan Malaysia (GUP-2018-142)
 
Title: Exploring urban-rural differences in 24-hour movement behaviours among Tunisian preschoolers: Insights from the SUNRISE Study.

Authors: Mohamed-Amine Ltifi1, Olfa Turki1,2, Ghaith Ben-Bouzaiene1, Kar_Hau Chong3, Anthony D. Okely3, Mohamed-Souhaiel Chelly1,2.

Affiliations:
1: Research Laboratory (LR23JS01) « Sport Performance, Health & Society», Higher Institute of Sport and Physical Education of Ksar Saîd, University of Manouba, Tunis, Tunisia.
2: Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Tunis, Tunisia
3: Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia.

Background: Little is known about differences in physical activity among children from urban and rural areas in low- to middle-income countries and some previous investigations revealed disparities in physical activity levels among children and adolescents residing in urban and rural environments.

Purpose: We aimed to: (i) assess the proportion of preschool-aged children (3.0-4.9 years) meeting the global movement guidelines, and (ii) examine urban-rural differences in health and behaviour outcomes.

Methods: Urban and rural location was based on national classifications. Physical activity (waist-worn ActiGraph); sleep duration, screen time and movement behaviors; Gross and fine motor skills (Lower body strength and mobility, Supine-Timed up and go (S-TUG), One-leg standing balance test, hand grip dynamometer, 9-hole peg-board test); and executive functions (visual-spatial working memory and inhibition) were assessed in 112 preschoolers (n=50 boys, 33 rural), (n=63 girls ,41 rural).

Results: Only 18% of children met all movement guidelines, with 53% and 41% meeting the recommendations for sedentary screen time and total physical activity, respectively. A large proportion of children (81%) met the recommended sleep duration of 10-13 hours per day. A significantly lower proportion of children living in urban residential settings met each of the recommendations compared with their rural counterparts.

Conclusions: Urban girls adhered more to the recommended sleep duration, while rural boys were more physically active. Urban boys spent more time in front of screens than rural boys, while rural girls had less screen time.

Practical implications: There is a clear need to promote healthy movement behaviours among preschool-aged children in Tunisia through targeted interventions that address the unique challenges related to urban/rural residence.

Funding: The SUNRISE Coordinating Centre is supported by a NHMRC Investigator Grant awarded to Prof Anthony Okely (APP1176858).