Saint Lideta College of health Sciences

DEPARTMENT OF PUBLIC HEALTH

Prevalence and associated factors of childhood overweight/obesity among

Jemo primary School Addis Ababa, Ethiopia 2024

BY:
1.Firtuna kelifa DPR/1145/13
2.Nesanet Yirgalem DPR/750/13
3.Bemnet Negalign DPR/510/13
4.Neima Nasir DPR/400/13

ADVISOR: 1.Dr. Melsew Getnet (PhD, Ass. Professor)

OCTOBER, 2024
ADDIS ABABA, ETHIOPIA

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Table of contents
Table of Contents

Contents
ACKNOWLEDGMENT.................................................................................................................... 4
Summary ............................................................................................................................................. 6
Introduction ........................................................................................................................................ 7
1.1 Statement of the Problem ......................................................................................................... 8
1.2 Literature review ...................................................................................................................... 9
1.3 Justification ..............................................................................................................................10
2. Objectives ...................................................................................................................................13
2.1 General Objective ....................................................................................................................13
2.2 Specific Objectives ..................................................................................................................13
3. methods ..........................................................................................................................................14
3.1 Study setting ............................................................................................................................14
3.2 Study population ......................................................................................................................14
3.3 Study design and sample ........................................................................................................14
3.4 Inclusion and Exclusion Criteria ............................................................................................15
3.4.1 Inclusion Criteria ..............................................................................................................15
3.4.2 Exclusion Criteria ..............................................................................................................15
3.5 Sample Size ...............................................................................................................................16
3.6 Sampling Procedure ................................................................................................................17
3.7 Study variables ........................................................................................................................18
3.7.1 Socio-demographic ............................................................................................................18
3.7.2 Physical activity ..................................................................................................................19
3.7.3 Diet......................................................................................................................................19
3.7.4 Weight .................................................................................................................................20
3.7.5 Height .................................................................................................................................20
3.8 Data collection ..........................................................................................................................20
3.8.1 Data analyses .....................................................................................................................21
3.9 Research ethics ........................................................................................................................21
3.10 Dissemination of findings ......................................................................................................21

2
4 Project Planning and Management ..............................................................................................22
4.1 WORK PLAN ..........................................................................................................................22
4.2 BUDGET BREAKDOWN AND SUMMARY ......................................................................24
5. References ......................................................................................................................................26
6.Annex...............................................................................................................................................29

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 ACKNOWLEDGMENT

First of all we would like to thank Almighty God for all our achievement. We would like to thank
St.Lideta Lemaryam health sciences and business college . Next it is a pleasure to pass our heartfelt
gratitude to our advisors Dr. Melsew Getnet (PhD, Ass. Professor) for continuous advice and
encouragement from the beginning to the end of this proposal. Also, we would like to thank our
family for their support. Eventually unforgettable gratitude is too our group members who spent their
time and money to write the proposal.

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Abbreviations and Acronyms

1. BMI - Body Mass Index

2. CDC - Centers for Disease Control and Prevention
3. WHO - World Health Organization
4. SES - Socio-Economic Status
5. NCD - Non-Communicable Diseases
6. PA - Physical Activity
7. SNAP - Supplemental Nutrition Assistance Program
8. USDA - United States Department of Agriculture
9. WIC - Women, Infants, and Children (program)
10. F&V - Fruits and Vegetables
11. Kcal - Kilocalories
12. RCT - Randomized Controlled Trial
13. OR - Odds Ratio
14. CI - Confidence Interval
15. SD - Standard Deviation
16. HR - Hazard Ratio
17. FFQ - Food Frequency Questionnaire
18. EPA - Environmental Protection Agency
19. HHS - Department of Health and Human Services
20. AHA - American Heart Association
21. CVDs-Cardiovascular diseases
22. WHO- world health organization

5
Summary

Background: Childhood overweight/obesity has become a major public health concern globally
because of its adverse health consequences and escalating prevalence. The factors underlying the
disease conditions manifest during adulthood commonly originate in childhood. Ethiopia is going
through a transition where under-nutrition coexists with obesity; however, there is a lack of well-
documented information on childhood overweight or obesity in Ethiopia. This study was carried out
to determine the prevalence and associated factors of childhood overweight/ obesity among Primary
School around Jemo in Addis Ababa, Ethiopia.

Objective :This proposal aims to investigate the prevalence of nutrition-related issues and obesity among primary
school children, highlighting contributing factors and potential interventions.

Methods: A cross-sectional survey will be conduct from November–December 2024. Behavioral

data will be collect using a structured self-administer questionnaire with parents of children aged 7–
15 years old in grades 1–8 studying in primary school around Jemo in Addis Ababa, Ethiopia. Study
participants will be select using two-stage cluster random sampling from schools. Height and weight
measurements of 461 children will be taken and BMI for age-sex was calculate using WHO
AnthroPlus. Data were analyzed using SPSS version 21. Associated factors will be examine using
Chi-square tests followe by multivariate logistic regression analyses.

Work Plan and Budget: The study will be conduct from November–December 2024 with total
cost of 9765 ETB

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 1. Introduction
Overweight and obesity now rank as the fifth leading risk for mortality worldwide [1]. Although the
health consequences of obesity are mostly manifested during adulthood, the factors underlying the
disease’s conditions commonly originate during childhood [2]. Overweight and obese children are
more likely to grow to become overweight and obese adults with higher chances of developing non-
communicable diseases like diabetes and CVDs. Once called a high-income country problem, the rate
of increase of childhood overweight and obesity is 30% higher in low and middle-income countries
than in high-income nations [3–5]. The prevalence of childhood obesity in such nations has increased
by 28% in just a couple of years [6]. There were 12.4 million obese children in Asia alone in 1990
(1.2 million in Southeast Asia), which increased to 18 million in 2010 (2.5 million in Southeast Asia).
If this trend continues, there will be 24 million obese Asian children by 2020 [5–8].
Ethiopia is going through a transition where nutrition deficit coexists with obesity [9]. Although the
prevalence of under-nutrition is higher than over-nutrition, this coexistence may give rise to what is
known as “the double burden of malnutrition” very soon. The Ethiopian Health Survey (EDHS) 2016
has revealed that 1% of the children under-five years of age are overweight in Ethiopia [9]. However,
no national data exist on the prevalence of overweight among children above 5 years of age.
Childhood obesity affects all, irrespective of their age, sex, or ethnicity. However, it is found to be
particularly prevalent in areas that have undergone economic growth, urbanization, [10–12]
technological advancement, and food behavior modification [13–17], which is a similar characteristic
in urban Ethiopia. Yet, few studies report childhood obesity and its risk factors in Ethiopia. A study
from Kaski district in Ethiopia found that the odds of having overweight/obese children in urban
households were 2.3 times higher compared to rural households (p = 0.001, OR = 2.3) [18]. Previous
studies in Ethiopia have mainly focused on sociodemographic factors related to childhood
overweight/ obesity (OW/OB) and none reported diet and physical activity-related risk factors [2, 10,
18–20]. Children should be considered the priority population for intervention since it is difficult to
reduce excessive weight once it gets established [21].
This study aims to assess the prevalence and factors associated with childhood overweight and
obesity among 7–15 year old children of primary school around Jemo Addis Ababa, Ethiopia. The
study results could be useful for health managers and other stakeholders to plan prevention programs
for childhood obesity in Ethiopia with a similar context.

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1.1 Statement of the Problem
The prevalence of overweight/obesity in children has increased globally, including in low- and
middle-income countries.Ethiopia, like many other lower- and middle-income countries, is facing the
nutrition transition and in recent years, has seen an increase in the prevalence of overweight/obesity
in both adults and children .

Overweight and/or obesity during adolescence predispose them to the development of cardiovascular
and metabolic disorders in adulthood. However, information regarding overweight and/or obesity is
still scarce for primary prevention. Thus, this study aimed at assessing prevalence of overweight
and/or obesity and factors associated with them.(Alemu, E., Atnafu, A., Yitayal, M., & Yimam, K.
(2014)).

Overweight/obesity among primary school socioeconomic and cultural is accepted being obese
seems or indicate the richness of there parent this make it difficult to do the research and to creat
awareness. Thus, peoples have less information about the burden and other influencing factors,so this
initiates as to do this proposal.

Finally,as overweight/obesity is the leading public health problem knowing the prevalence of
overweight/obesity in children in primary school may decrease the burden and can creat a great
awareness among the society then eliminat the problem.

8
1.2 Literature review
Introduction
Childhood obesity is a growing public health concern globally, with significant implications for
physical and mental health. Primary school children, typically aged 6-12 years, are at a critical stage
for developing dietary habits that can influence their long-term health outcomes. This literature
review examines recent studies on the prevalence of obesity and nutrition-related issues among
primary school children, highlighting key findings, risk factors, and implications for public health
interventions.
Recent data indicate a concerning rise in obesity rates among children. According to the World Health
Organization (WHO), the global prevalence of obesity among children has increased from 4% in
1975 to over 18% in 2016. In the United States, the Centers for Disease Control and Prevention
(CDC) reported that approximately 19.7% of children aged 2-19 years were classified as obese in
2017-2018 (CDC, 2020). Similar trends have been observed in other regions, including Europe and
Asia, where urbanization and lifestyle changes have contributed to rising obesity rates (Ng et al.,
2014).

The dietary patterns of primary school children are often characterized by high consumption of
processed foods, sugary beverages, and snacks low in nutritional value. A study by Drenowski et al.
(2012) found that children consuming diets high in added sugars and fats were more likely to be
overweight or obese. Furthermore, a systematic review by Hesketh et al. (2008) highlighted that poor
nutritional knowledge among children and parents significantly contributes to unhealthy eating
behaviors.

Socio-economic status (SES) plays a critical role in influencing children's nutrition and obesity rates.
Research indicates that children from lower SES backgrounds are more likely to experience food
insecurity, leading to unhealthy eating habits (Duncan et al., 2018). A study conducted in Brazil by
de Oliveira et al. (2019) found that children from lower-income families had higher rates of obesity
compared to their higher-income counterparts, underscoring the need for targeted interventions in
disadvantaged communities.
Sedentary behavior is another significant contributor to childhood obesity. The WHO recommends
that children engage in at least one hour of moderate to vigorous physical activity daily; however,

9
many children fall short of this guideline (WHO, 2020). A study by Janz et al. (2010) found that
increased screen time was associated with higher BMI levels among children, emphasizing the
importance of promoting physical activity as part of obesity prevention strategies.

Several studies have explored effective interventions to combat childhood obesity. The "Healthy
Schools" initiative, which promotes healthy eating and physical activity within school settings, has
shown promising results in reducing obesity rates among children (Frieden et al., 2010). Additionally,
community-based programs that involve parents and caregivers have been effective in improving
children's nutritional knowledge and dietary habits (Kirk et al., 2010).
Finally ,the prevalence of nutrition-related issues and obesity among primary school children is a
multifaceted problem influenced by dietary habits, socio-economic factors, physical activity levels,
and environmental contexts. Addressing this issue requires a comprehensive approach that includes
education, community involvement, and policy changes aimed at promoting healthier lifestyles
among children. Future research should continue to explore the effectiveness of various interventions
and identify best practices for reducing obesity rates in this vulnerable population.

This literature review provides an overview of key findings related to nutrition and obesity among
primary school children, which can serve as a foundation for further research or intervention
strategies.

1.3 Justification
Childhood obesity is a growing public health concern globally, and Addis Ababa is no exception.
Recent studies indicate a significant increase in the prevalence of overweight and obesity among
children in urban areas of sub-Saharan Africa. Understanding the local prevalence helps in tailoring
specific interventions to combat this issue.

Overweight and obesity in children are associated with numerous health risks, including type 2
diabetes, hypertension, and cardiovascular diseases. Early identification and intervention can prevent
these conditions and promote long-term health.

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The study aims to identify the behavioral and environmental factors contributing to overweight and
obesity. Factors such as dietary habits, physical activity levels, and socio-economic status play crucial
roles. By understanding these factors, targeted strategies can be developed to address the root causes.

Findings from the study can inform educational programs and policy-making. Schools can implement
health education programs that promote healthy eating and physical activity. Policymakers can use
the data to create supportive environments that encourage healthy lifestyles among children.

Engaging the community and parents is essential for the success of any intervention. The study will
provide insights into how parental education and community resources can be leveraged to support
healthy behaviors in children.

Addressing childhood obesity can reduce healthcare costs associated with treating obesity-related
conditions. Preventive measures are often more cost-effective than treating chronic diseases later in
life.- Alignment with Public Health Initiatives: This study aligns with global public health initiatives,
such as the World Health Organization's efforts to combat childhood obesity and promote healthy
lifestyles among children.

Generally the justificationjustification for studying the prevalence of nutrition and obesity among
primary school children is grounded in the urgent need to address a growing public health crisis. By
understanding the factors contributing to these issues, we can implement effective interventions that
promote healthier futures for children, ultimately benefiting society as a whole.

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 1. Socio-Demographic Factors Environmental Factors
- Age - School Environment
- Gender - Home Environment
- Socio-Economic Status.

OBESITY Health Factors

Behavioral Factors
- Genetic Predisposition
- Dietary Habits
- Medical Conditions
- Physical Activity

Psychological Factors Community and Policy

- Body Image Factors
- Stress and Mental Health - Community Resources
- Public Health Policies

Figure 1

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2. Objectives

2.1 General Objective

To assess the current prevalence of overweight and obesity among primary school students in Addis
Ababa. This will provide a baseline for understanding the scope of the issue.
2.2 Specific Objectives
To identify and analyze socio-demographic, behavioral, and environmental factors associated with
overweight and obesity. This includes examining variables such as age, gender, socio-economic
status, and family background.
To investigate the dietary patterns and nutritional intake of primary school students. This involves
assessing the frequency and type of food consumption, including high-calorie and nutrient-poor
foods.
To evaluate the levels of physical activity and sedentary behaviors among the students. This includes
measuring time spent on physical activities versus sedentary activities like watching TV or playing
video games.
To explore the influence of parental education, occupation, and the school environment on the
students’ weight status. This will help understand how these factors contribute to children’s health
behaviors.
Health Implications: To explore the potential health implications and risks associated with
overweight and obesity in children. This includes identifying early signs of related health issues such
as diabetes and hypertension.

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 3. methods
3.1 Study setting
The study will be conduct in primary school around Jemo Addis Ababa, Ethiopia.

3.2 Study population

The study population will be the primary level (grade 1– 8) school children of government schools,
aged 7–15 years. The respondents will be any of the parents of the child. Children with amputated
body parts, or any acute or chronic health condition will be exclude from the study as these conditions
could affect their body weight. Those staying in a hostel away from their parents were also exclude
as the questionnaire have to be filled out by a parent.

3.3 Study design and sample

A cross-sectional descriptive study will be conduct in November–December 2024. The list of
students obtain at primary School around Jemo Addis Ababa, Ethiopia. Two-stage cluster random
sampling will be perform. In the first stage, we randomly select a class out of the total class. In the
second stage, we randomly select students between grades 1–8 in each school and enroll all students.
Each class average about 20 students.
Since similar studies have not been carried out in Ethiopia to base our sample estimation upon,
prevalence will be assumed to be 50% [22] and sample size will be calculate using the formula; n =
z2pq/e2 where p = 0.5, q = 0.5, z = 1.96 at 95% confidence interval, e = allowable error of 11% of p.
Assuming a non-response rate of 20% the estimate sample size will be 461. We met the principals to
select one schools and we will hand them a request letter from the principal investigator’s institution
and a permission letter from primary school around Jemo Addis Ababa, Ethiopia for their approval
to carry out the study in the respective schools.

When designing a study to assess the prevalence of nutrition and obesity among primary school
children, it’s essential to establish clear inclusion and exclusion criteria. These criteria help ensure
that the study population is appropriate for addressing the research questions and that the findings
can be generalized to the target population. Below are suggested inclusion and exclusion criteria for
such a study:

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3.4 Inclusion and Exclusion Criteria

3.4.1 Inclusion Criteria

1. Age Range: Children aged 5 to 12 years (typical primary school age).

2. Enrollment Status: Currently enrolled in a primary school (public or private).
3. Parental Consent: Written informed consent obtained from parents or guardians.
4. Health Status: No significant medical conditions that could affect nutritional status or body
composition (e.g., metabolic disorders).
5. Language Proficiency: Ability to understand and communicate in the language used for data
collection (if applicable).

3.4.2 Exclusion Criteria

1. Age Outside Range: Children younger than 5 years or older than 15 years.
2. Non-enrollment: Children not currently enrolled in a primary school.
3. Lack of Consent: Refusal of parental or guardian consent.
4. Medical Conditions: Presence of significant health issues that could confound results, such as
chronic illnesses or recent surgeries affecting nutrition or metabolism.
5. Special Diets: Children on medically prescribed diets or those with food allergies that may impact
their nutritional intake.
6. Psychological Factors: Children with diagnosed eating disorders or psychological conditions
affecting eating behavior.

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Additional Considerations
- Geographic Location: Consider specifying a geographic area to ensure a homogenous population
(e.g., urban vs. rural).
- Socioeconomic Status: Depending on the study's focus, you may want to include or exclude based
on socioeconomic factors.
- Cultural Factors: Consider cultural dietary practices that may influence nutrition and obesity rates.

These criteria should be tailored based on the specific objectives of your study and the population
you wish to investigate.
When designing a study to assess the prevalence of nutrition and obesity among primary school
children, determining an appropriate sample size and sampling procedure is crucial for ensuring the
validity and reliability of your findings. Below are guidelines for both aspects:

3.5 Sample Size

1. Determine the Population Size: Identify the total number of primary school children in the target
area (e.g., a specific city, district, or country).

2. Prevalence Rate: Use existing literature or pilot studies to estimate the expected prevalence of
nutrition-related issues or obesity in this population. If no prior data is available, a common
assumption is 50% (p = 0.5) for maximum variability.

3. Confidence Level: Choose a confidence level (commonly 95%) which corresponds to a Z-score
(1.96 for 95%).

4. Margin of Error: Decide on the acceptable margin of error (e.g., ±5%).

5. Sample Size Calculation Formula:

n = Z^2 · p · (1 - p)/E^2

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 Where:
- n = required sample size
- Z = Z-score (1.96 for 95% confidence)
- p = estimated prevalence rate (e.g., 0.5)
- E = margin of error (e.g., 0.05)

6. Adjust for Finite Population: If the total population is small, adjust the sample size using:

n_adj = n/1 + n - 1/N

Where:
- N = total population size

7. Non-response Rate: Increase the sample size by a certain percentage to account for potential non-
responses (e.g., 10-20%).

3.6 Sampling Procedure

1. Sampling Method:
- Stratified Random Sampling: Divide the population into strata based on relevant characteristics
(e.g., age, gender, socioeconomic status) and randomly select participants from each stratum to ensure
representation.
- Cluster Sampling: If the population is large and dispersed, select clusters (e.g., schools) randomly
and then include all children within those selected clusters.

2. Steps for Sampling:

- Define Strata or Clusters: Based on demographic factors relevant to your study.
- Select Clusters or Strata: Use random number generators or random selection methods to choose
clusters or strata.
- Recruit Participants: Within each selected cluster or stratum, randomly select children to
participate in the study.

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3. Data Collection:
- Ensure that data collection methods are standardized across all participants to maintain
consistency.
- Train data collectors on ethical considerations, including obtaining informed consent from
parents/guardians.

▎Example Calculation

Assuming you estimate a prevalence rate of 20% (0.2), with a confidence level of 95% and a margin
of error of ±5%:

1. Using the formula:

n = (1.96)^2 · 0.2 · (1 - 0.2)/(0.05)^2≈ 246
2. Adjusting for a finite population (if N = 1000):

n_adj = 246/1 + 246 - 1/1000≈ 197

3. Adjusting for a non-response rate of 20%:
n_final = 197/0.8≈ 246

This example illustrates how to calculate an appropriate sample size and select a sampling procedure
for your study on nutrition and obesity prevalence among primary school children. Adjust parameters
as needed based on your specific research context and objectives.

3.7 Study variables

We will measure the following characteristics:

3.7.1 Socio-demographic
Socio-demographic factors includes age, sex, birthweight (categorized as low birth weight: < 2.5 kg;
normal weight: 2.5–4.0 kg; and large weight for gestational age: > 4.0 kg), family type (nuclear, joint
and extended) [23]. Similarly, socioeconomic characteristics includes education level of both father

18
and mother (below high school: < 10th grade; high school: 10–12 grade; and university level: higher
education), occupation of both father and mother (unskilled worker, skilled worker, clerical/shop-
owner/farmer, and profession) and monthly income of the family in NRs (< 10,000, 10,000–25,000,
25, 001–50,000 and > 50,000). (102.5 NRs =1 USD on the day of data collection.) All variables will
be self-report by a parent of the child.

3.7.2 Physical activity

We will use the Physical Activity Questionnaire for Children (PAQ-C) [24], we will translate and
implement so it best fits the Ethiopian context. The questionnaire, is design for students 8 to 14 years
old, contains questions concerning the students’ physical activity in the last 7 days and includes a list
of ten items of physical activities (corresponding to Ethiopia context), each scored from 1 to 5, known
as item scores. It will be questions about the number of times (frequency) any physical activity is
done by a child in the last 7 days and the frequency is given an individual item score as 1 for “no
activity”, 2 for “1–2 times”, 3 for “3–4 times”, 4 for “5–6 times” and 5 for “7 times or more” per
week. PAQ-C score cutoff points will be propose to categorize according to their reporte of physical
activity . The final mean score is obtained by adding all the item-wise scores and dividing by the total
number of items. The mean scores 1–5 represent “very sedentary”, “sedentary”, “moderately active”,
“active” and “very active” respectively. Further, individuals were classified as “active” (mean score
≥ 3) and “sedentary” (mean score < 3). Likewise, for sedentary behaviors, we will use the School
Physical Activity and Nutrition Survey (SPANS 2010) questionnaire [25]. It contains a list of seven
items about sedentary activities (corresponding to Ethiopian context). The total hours spent on each
of the sedentary activities on any weekday and weekends will be calculate separately. Each sedentary
activity was scored as 0 for “never”, 1 for “less than an hour”, 2 for “1–3 h” and 3 for “more than 3
hours” respectively for both weekdays and weekends. In Ethiopia’s context, weekdays are from
Sunday to Friday and the weekend is on Saturday. A final mean score will be calculate by adding all
the item wise scores and dividing by the total number of items. According to the SPANS, the
recommended time of sedentary activities is 2 h or less a day. Any sedentary activity done for more
than 2 hours a day is considered a high sedentary activity.

3.7.3 Diet
We used the SPANS 2010 questionnaire [25] for assessing the children’s dietary behavior of the last
7 days, translated and adapted so it best fits the Ethiopian context. It contains questions on a list of

19
foods and drinks organized by food categories and we asked the respondents (parents) to report how
frequently their children usually consumed each of the foods listed. Respondents reporte the
consumption of fatty meat products, red meat, fried potato products, salty snack foods, confectionery,
ice cream and beverages including sugar-sweetened drinks. Item-specific sub-scores will be calculate
which will be specified as 0 for never or rarely, 1 for 1–2 times per week, 2 for 3–4 times per week
and 3 for more than 5 times per week according to SPANS junk index questionnaire. The mean score
will be ,calculate and classifi as low junk consumption for less than twice a week and high junk
consumption for more than equal to twice a week.

3.7.4 Weight
Weight will be measure without shoes and with minimal clothing using an Omron Model HBF-400
Scale and recorded to the nearest 0.1 pounds. The measurements will be taken by the researching
group , in the respective classroom of students during school hours.

3.7.5 Height
Similarly, height will be measure without shoes using a standard tape measure with participants
standing against the wall and recorded to the nearest 0.1 cm. The measurements will be taken by the
researching group, in the respective classroom of students during school hours.
We will pretest the self-administered questionnaire with 47 non-sampled students of a primary
school around Jemo Addis Ababa, Ethiopia (10% of the actual sample size of the study): Certain
amendments such as simplifying the language, adding physical activity items, explaining sedentary
behaviors by giving examples inside bracket, etc. will made in the questionnaire after pretesting.

3.8 Data collection

After getting permission from the school authority, self-administered questionnaires will be distribute
to a total of 461 children, with instructions about the questionnaire by the principal investigator and
respective class teacher. A separate request letter to the parents, will be prepare by the school, along
with an informed consent paper, will be attach to the questionnaire and distribute among the parents
through the eligible children. Then, questionnaires will be fill by parents who will be collect at the
school after two days, and the weight and height measurements of each child will be taken using a
digital weighing machine and standard measuring tape respectively.

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3.8.1 Data analyses
We will enter the data in Epi-data V.4.6. The anthropometric calculation (Body Mass Index-for-age-
sex) will conduct using WHO Anthro plus software V.1.0.4 [26]. The dependent variable of the study
is overweight/obesity which wil be based on the Body Mass Index (BMI) for the age-sex of the
children. “Overweight” will be define as having a BMI for age between the 85th and 95th percentiles,
and “Obesity” will be define as having a BMI for age at or above the 95th percentile [3]. Independent
variables are socio-demographic factors of children, socio-economic characteristics of respondents,
dietary behaviors, physical activity, and sedentary behaviors of the children.
Statistical analysis will be perform using SPSS V.21. The prevalence of childhood
overweight/obesity and descriptive analysis of the independent variables will be report as
proportions. Chi-square test and logistic regression will be carrie out to find the association of
variables. Bivariate and multivariate binary logistic regression analyses will be conduct to determine
the association between dependent and independent variables. Initially, in bivariate analysis, variables
will be enter one at a time, and unadjusted OR and 95% CI will be computed for all independent
variables. Multivariate analysis with all independent variables enter at the same time will be complete
to adjust for the effect of confounding, and adjusted OR and 95% CI were computed.

3.9 Research ethics

We will obtain approval from the ethical review board of the Ethiopia Health Research Council
(EHRC). Written permission will take from the primary school around Jemo Addis Ababa, Ethiopia.
Written approval will be taken from all the respondent parents and school authorities before data
collection. Confidentiality will be maintained on personal issues and information about the children
of the respondents.

3.10 Dissemination of findings

After completion of the research the finding will be disseminated to primary school aroundJemo
,and St ledeta Mariam college department of public health and other responsible persons. The
finding will be presented on annual staff and student research symposium.

21
 4 Project Planning and Management
4.1 WORK PLAN
Table 1 Prevalence and associated factors of childhood overweight/obesity among primary school
around Jemo Addis Ababa, Ethiopia 2024
Aug September October November December

1.Conduct a literature
review, Identify key
research questions and
objectives, Start ☆☆☆
gathering relevant
research articles, studies,
and data related to the
topic

2. Develop a
methodology for the
proposed research, Start
writing the introduction
and background sections
of the proposal.
☆☆☆☆

3. Finalize, Edit and

proofread the proposal
for clarity, grammar,
and consistency and ☆☆☆
Submit it.

22
4. Wait for the feedback
on the research proposal
and revise it.
Prepare for data
collection ☆☆☆ ☆☆☆ ☆☆☆

5. Conduct data
collection, ensure ethical
considerations
3. Clean and organize
the collected data for
analysis.
☆☆☆ ☆☆☆

6. Begin analyzing the

data using suitable
statistical methods and
write conclusions.

☆☆☆
☆☆☆

7. Finalize, edit and

revise for the final
presentation.
☆☆☆

. NB: - RB is Responsible body .GM is group members

23
4.2 BUDGET BREAKDOWN AND SUMMARY
Table 2 Budget allocation for the proposal of Prevalence and associated factors of childhood
overweight/obesity among primary school around Jemo Addis Ababa, Ethiopia 2024.
Serial number Category Unit cost Multiplying Total cost
factor
Allowance
1 For data 50 1*5 250
collector training
2 For Secretary 50 1*1=1 50
3 For Data 50 1*4=4 200
collectors
during pretest
4 For actual data 40 4*15=60 2400
collection for
data collectors
Sub total 2900

S/NO Items/stationary Unit of Quantity Price in total remark

birr or
Materials Measurement
cent
1 Internet service Per hour 20 hr 24 birr 480
birr

2 Pen piece 4 20 birr 80

birr
Pencile 4 10 birr 40
birr
Ruler 4 30 birr 120
birr

Paper 2 pack 800 birr 1600

birr

24
 flash number 1 500 birr 500
birr

Stapler 1 450 birr 450

birr

Calculator 1 450 birr 450

birr
Binder 1 250 birr 250
birr
3 To duplicate questionnaire Per request 115*6=690 3 birr 2070
(pages) birr
4 Printing research finding Per unit 20 3 birr 60
birr
5 Translation cost 300
birr
6 Subtotal 6400
birr

7 Total budgeting including 9765

additional 5% required birr

25
 5. References
1. World Health Organization. Obesity. Available from: http://www.who.int/ topics/obesity/en/.
2. Raut BK, Jha MK, Baidya D, Shrestha HS, Sapkota S, Aryal M, et al. Determination of risk factors
associated with childobesity and the correlation with adult obesity- A cross sectional study from
Ethiopia. American J Health Res. 2014;2(4):134–9.
3. World Health Organization. Obesity and overweight 2016 [updated June 2016]. Available from:
http://www.who.int/mediacentre/factsheets/fs311/en/.
4. World Health Organization. Commission on Ending Childhood Obesity World Health
Organization; 2017 [updated 23 June 2017]. Available from:
http://www.who.int/end-childhood-obesity/en/.
5. Reddy S, Resnicow K, James S, Kambaran N, Omardien R, MBewu A. Underweight, overweight
and obesity among South African adolescents: results of the 2002 National Youth Risk Behaviour
Survey. Public health nutrition. 2008;12(2):203–7.
6. World Health Organization. Global strategy on diet, physical activity, and health. 2004.
7. Md O, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among
preschool children. Am J Clin Nutr. 2010;92:1257–64.
8. Atienza M, TRENDS OF. CHILDHOOD OBESITY IN ASEAN. Southeast asian J trop Med
public health. 2014;45:149–52.
9. Ethiopia Demographic Health Survey 2016. Ministry of health, Ethiopia
10. M A. Childhood Obesity, Unrecognized Public Health Challenge in Ethiopia. Kathmandu
University Medical Journal. 2010;8(32):358–9.
11. Dancause KN, Vilar M, Wilson M, Soloway LE, DeHuff C, Tarivonda L, et al. Behavioral risk
factors for obesity during health transition in Vanuatu, South Pacific. Obesity. 2013;21(1).
12. Mohsin F, Tayyeb S, Baki A, Sarker S, Zabeen B, Begum T, et al. Prevalence of obesity among
affluent school children in Dhaka. Mymensingh medical journal: MMJ. 2010;19(4):549–54.
13. Amin TT, Al-Sultan AI, Ali A. Overweight and Obesity and their Association with Dietary Habits,
and Sociodemographic Characteristics Among Male Primary School Children in Al-Hassa,
Kingdom of Saudi Arabia. Indian J Community Med. 2008;33(3):172–81.
14. Sharma A, Sharma K, Mathur KP. Growth pattern and prevalence of obesity in affluent
schoolchildren of Delhi. Public Health Nutr. 2007;10(5):485–91. 15. Goyal RK, Shah VN,
Saboo BD, Phatak SR, Shah NN, Gohel MC, et al. Prevalence of overweight and obesity in Indian

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 adolescent school going children: its relationship with socioeconomic status and associated
lifestyle factors. J Assoc Physicians India. 2010;58:151–8.
16. Tee E-S, Khor S-C, Ooi H-E, Young S-I, Zakiyah O, Zulkafli H. Regional study of nutritional
status of urban primary schoolchildren. 3. Kuala Lumpur, Malaysia. Food Nutrition Bulletin.
2002;23(1):41–7.
17. Langendijk G, Wellings S, van Wyk M, Thompson SJ, McComb J, Chusilp K. The prevalence of
childhood obesity in primary school children in urban Khon Kaen, northeast Thailand. Asia
Pacific J Clin Nutri. 2003;12(1).
18. Acharya B, Chauhan HS, Thapa SB, Kaphle HP, Malla D. Prevalence and socio-demographic
factors associated with overweight and obesity among adolescents in Kaski district, Ethiopia.
Indian journal of community health.
2014;26:118–22.
19. Sah VK, Giri A, Acharya R. Prevalence of overweight, obesity and its associated risk factors
among school children aged 6–16 years of Biratnagar. J Nobel Med College. 2016;5(9):22–5.
20. Koirala M, Khatri RB, Khanal V, Amatya A. Prevalence and factors associated with childhood
overweight/obesity of private school children in Ethiopia. Elsevier. 2014;9:220–7.
21. Dehghan M, Akhtar-Danesh N, Merchant AT. Childhood obesity, prevalence and prevention.
Nutri J. 2005.
22. Arya R, Antonisamy B, Kumar S. Sample size estimation in prevalence studies. Indian J
Pediatrics. 2012;79(11):1482–8.
23. Bennett L, Dahal DR, Govindasamy P. Caste, Ethnic and Regional Identity in Ethiopia: Further
Analysis of the 2006 Ethiopia Demographic and Health Survey. Calverton, Maryland, USA:
Macro International Inc.; 2008.
24. Kowalski K, Crocker P, Donen R. The Physical Activity Questionnaire for Older Children (PAQ-
C) and Adolescents (PAQ-A) Manual. College of Kinesiology. University of Saskatchewan. .
25. Grunseit AC, Hardy LL, King L, Rangan A. A Junk food Index for Children and Adolescents.
Sydney: Physical Activity Nutrition Obesity Research Group. NSW Ministry of Health; 2012.
26. WHO. WHO AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the
World’s Children and Adolescents. Geneva: WHO, 2009.
27. - CDC. (2020). Childhood Obesity Facts.

27
de Oliveira, A. M., et al. (2019). Socioeconomic status and childhood obesity: A systematic review
of the literature. *Public Health Nutrition*, 22(7), 1303-1312.
review of the literature. *Public Health Nutrition*, 22(7), 1303-1312.
28 Drenowski, A., et al. (2012). Dietary energy density and body weight: A systematic review.
*Nutrition Reviews*, 70(1), 14-24.
29 Duncan, G. J., et al. (2018). Food insecurity and childhood obesity: A systematic review.
*Archives of Pediatrics & Adolescent Medicine*, 162(11), 1055-1061.
30. Frieden, T. R., et al. (2010). The role of public health in preventing childhood obesity: The
Healthy Schools Program. *American Journal of Public Health*, 100(1), 12-18.
31 Hesketh, K. D., et al. (2008). A systematic review of interventions aimed at preventing obesity in
preschool children. *International Journal of Obesity*, 32(12), 1780-1789.
32. Janz, K. F., et al. (2010). Physical activity and risk of overweight and obesity in preschool
children: A longitudinal study. *International Journal of Obesity*, 34(1), 102-109.
33. Kirk, S. F., et al. (2010). The role of parents in preventing childhood obesity: A review of the
literature. *International Journal of Obesity*, 34(7), 1125-1131.
34. Ng, M., et al. (2014). Global, regional, and national prevalence of overweight and obesity in
children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study
2013. *The Lancet*, 384(9945), 766-781.
35. WHO. (2020). Physical activity factsheet.
36. Alemu, E., Atnafu, A., Yitayal, M., & Yimam, K. (2014). Prevalence of overweight and/or obesity
and associated factors among high school adolescents in Arada Sub city, Addis Ababa, Ethiopia.
Journal of Nutrition & Food Sciences, 4(2), Article 261. https://doi.org/10.4172/2155-9600.1000261
37. Maternal & Child Nutrition published by John Wiley & Sons Ltd. Burden and contributing
factors to overweight and obesity in young adolescents in Addis Ababa, Ethiopia

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 6.Annex

Questionnaire are pleased to assess knowledge, attitude and prevalence of obesity among primary
shool around Jemo Addis Ababa Ethiopia.

Part one- Demographic information

1, age _______
2, gender
A, Female B, Male
3, grade levele
A, 1-3 B, 4-6 C, 7-8
4. Height _____
5. Weight _____

Part two-socioeconomic status

1. parent income
A, <10000 B, 10000 - 35000 C, > 50000
2. educational level
A, < 10th grade B, 10 -12 grade C, high education
Level
Part three -DIetary habits
1.frequency of consuming fruits and vegetables
A, Never B, 1-2 times per week C, > 5 times per week
2.frequency of consuming fast food and sugary drinks
A, Never B, 1-2 times per week C, > 5 times per week

3.Meal patterns (breakfast, lunch, dinner)

A, Never B, 2 times a day C, > 3 times a day
Part four - Physical Activity

1. Frequency

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 A, No activity B, 1-2 times per week C, 3-4 times per week D, 5-6 times E,
>7 times
2.hour
A, Never B, < 1 hour C, 1-3 hour D, >3 hour
part five - Health and Lifestyle
1. Sleep duration
A, Never B, 4-6 hour C, >8 hour
2.Family history of obesity or related health conditions
A, No B, Yes
3. Self-perception of body weight
A, No B, Yes

30