Nutritional status of school children
This study examined nutritional status according to anthropometric indicators and associated factors in public elementary school children aged 5 to 14 years in the Central Plateau region of Burkina Faso. The prevalence of undernutrition (stunting, underweight, leanness) was 24.5%, with 12.9%, 9.1% and 13.8% stunting, underweight and thinness respectively. The prevalence of undernutrition (24.5%) in this study is lower than the results of a similar study carried out in 2017 in the Central Plateau and Centre-Ouest regions of Burkina Faso, with 35.1% (Erismann et al., 2017). Undernutrition in the present study was higher than in studies carried out in Cameroon and Nigeria. In Cameroon, Tabi et al. (Tabi et al., 2019) found a 9.25% prevalence of undernutrition among primary school children. On the other hand, Umeokonkwo et al. (Umeokonkwo et al., 2020) reported that 15.7% of school-age children were undernourished in Nigeria. Also, a lower prevalence of undernutrition than in the present study was found in Ghana (21.5%) (Aboagye et al., 2022).
Stunting, with a prevalence of 12.9%, was the most common form of undernutrition in this study, after wasting (13.8%). The prevalence of stunting was higher than that of a similar study in Burkina Faso 11.2% (Erismann et al., 2017) and another in Ghana 10.4% (Aboagye et al., 2022). Similar studies carried out in other countries give higher prevalence’s, such as in the Abakaliki metropolis in Nigeria with 15.7% (Umeokonkwo et al., 2020), in Kenya in public elementary school 24.5% (Mwaniki & Makokha, 2013), 34.9% in rural Madagascar (Aiga et al., 2019), 41.9% in Ethiopia (Tariku et al., 2018) and a prevalence of 40.3% in south-west Nigeria (Adenuga et al., 2017). In the present study, there was no relationship between the sex of the pupil and the occurrence of stunting, contrary to the results of other studies (Mwaniki & Makokha, 2013).
The prevalence of underweight is 9.1% among public elementary school pupils in the region. This indicator measures past and recent weight loss or inability to gain weight (Mwaniki & Makokha, 2013), which is largely due to insufficient food supply, availability or consumption. A relationship has been established between underweight and food insecurity (Isanaka et al., 2007). Underweight in the present study was higher than in other studies conducted in Ghana 3.8% (Aboagye et al., 2022). A high prevalence of underweight was found in Madagascar (36.9%) (Aiga et al., 2019). The prevalence of underweight therefore reflects the presence of both long-term chronic malnutrition and recent food insecurity or illness. Underweight in schoolchildren may reflect prenatal undernutrition, a possible infection, or the presence of a disease (Isanaka et al., 2007).
Thinness is a measure of acute undernutrition. The present study shows that in the Central Plateau region 13.8% of pupils in public elementary school are underweight, which is comparable to the 13.7% found in the NFSI study (Daboné et al., 2011). The prevalence of thinness in this study is higher than the 8.0% found 11.2% in Burkina Faso (Erismann et al., 2017). The level of thinness in the present study is similar to that of a study carried out in Ghana (12.1%) (Aboagye et al., 2022).
Overweight represented 0.7% of schoolchildren in the Central Plateau region. Similar results were recorded in a similar study in Ghana (Kwabla et al., 2018). No cases of obesity were recorded in this study. The prevalence of overweight found in our study is insignificant compared with the prevalence of 24.8% and 22.6% reported in the District of Tongu in Ghana and Dar es Salaam in Tanzania (Aboagye et al., 2022; Pangani et al., 2016). Higher results than those of the present study have also been reported, 11.1% in Ghana (Aboagye et al., 2022) and 4.9% among pupils in semi-urban schools in Nigeria (Adetunji et al., 2019). Increased consumption of fatty and caloric foods, coupled with increasingly frequent sedentary behaviors, such as spending long hours in front of the TV, playing video games, could explain the differences in prevalence (Agbozo et al., 2017). A similar study carried out in the Central Plateau and Centre-Ouest region revealed an overweight prevalence of 1.1% (Erismann et al., 2017), also higher than observed in our study.
Associated factors with undernutrition
Malnutrition is the result of multidimensional and interdependent circumstances and factors, ranging from immediate to underlying causes. The present study showed that children's age is significantly associated with stunting. Children aged between 5 and 10 years are more likely to suffer from stunting than older children. A study of school-age children in northern Ethiopia (Herrador et al., 2014) shows a similar relationship between age and stunting, particularly for children aged 10 to 14 years. A study carried out in schoolchildren in the Gedeo zone in southern Ethiopia (Argaw et al., 2022) also shows that children in the 10-14 age group are at greater risk of stunting. This trend could be an indication of the continuity of the stunting process during school age in low- and middle-income countries. This could probably be explained by the fact that older children are in the transition phase to adolescence, when several unique challenges arise, including an increase in the body's nutritional requirements (Akseer et al., 2017).
The present study reveals a statistically significant association between stunting and the sources of drinking water consumed in the household. These findings are in line with the results of studies carried out in low- and middle-income countries by Black et al. (Black et al., 2013) and in the Tongu district of Ghana (Aboagye et al., 2022). Corresponding results have been reported in studies carried out in Iran (Kavosi et al., 2014) and in Tanzania (Pangani et al., 2016) all of which reported similar findings to those of the present study. However, such an association was not proven in a study based on data from Niger and Lesotho (Oyekale, 2012). This can be justified by the fact that access to drinking water considerably reduces the occurrence of diarrheas diseases (Saheed et al., 2022).
Also, children in the 5 to 10 age group are at greater risk of stunting. This result is contrary to that of a study carried out in Dori in the Sahel region of Burkina Faso (Ouédraogo et al., 2019), in Ethiopia (Tariku et al., 2018), which show that schoolchildren aged 10 to 15 years are more likely to be stunted than children aged 5 to 9 years. This trend could be an indication of the continuity of the stunting process during school age in Burkina Faso.
The economic situation of the household in which the child lives has been identified as one of the main determinants of the child's nutritional status, and it has been established that the economic situation of the household and inappropriate dietary practices can have a negative effect on the child's growth and development, particularly in developing countries, where access to basic health services is inadequate (Vollmer et al., 2014).
The results of the present study revealed a significant association p = 0.05 between underweight and the father's level of education. Another cross-sectional study carried out in the Dang district of Nepal revealed instead a significant association between underweight and the mother's level of education (Sigma & Chet Kant, 2019). The association between underweight and the mother's level of education was also found in a study by Li et al. in 35 low- and middle-income countries (Li et al., 2020).
Thinness is often associated with short-term risk factors, such as seasonal climatic variations and increased disease (Egata et al., 2013). Our study was conducted during the dry season (March-June) (Mishra et al., 2008), suggesting that the cause of undernutrition was mainly food insufficiency, associated with long-term risk factors. The results of the logistic regression analyses show that the risk of leanness is significantly higher in children in the 5-10 age group. The results reveal also a statistically significant relationship (p = 0.05) between non-deworming in the last 6 months and thinness. Undernutrition and intestinal parasitic infections are intrinsically linked. While undernutrition and inadequate food intake lead to weight loss and weakened immunity, making the child more vulnerable to infection, parasitic infections contribute to stunting by causing a vicious circle of reduced food intake (loss of appetite), diarrhea, malabsorption and/or increased nutrient wastage (Pullan et al., 2013). The association observed in this study reinforces the evidence for the frequent coexistence of these conditions in children (Bhargava et al., 2003). This study shows an association between the father's trading function and the occurrence of leanness.
Limits of the study
This study has limitations in terms of the accuracy of individual schoolchildren's dietary data, given that 24-hour parental food recalls and school feeding program records were the sources of the data. The study also failed to assess intestinal parasites and anemia status, which influence undernutrition. Another limitation of this study is that it was carried out in schools where the canteen was functional, which may underestimate the prevalence of thinness. However, despite these limitations, the results of the study highlight a number of important issues for the Ministry of Education and Health.