Physical activity and gross motor skills in rural South African preschool children

Background: Global levels of overweight and obesity in preschool-aged children have increased dramatically in the last two decades, with most overweight and obese children younger than five years living in low- and middle-income countries (LMICs). Statistics from the 2013 South African National Health and Nutrition Examination Survey (SANHANES-1) confirm that levels of overweight and obesity are high in South African preschool-aged children, with prevalence rates of overweight and obesity up to 18.2% and 4.7%, respectively. This increasing problem of overweight and obesity in South African preschoolaged children highlights the need for intervening in this age group. Overweight and obesity interventions in preschool children typically include one or more of the following behaviours: physical activity, sedentary behaviour and screen time. Aim and objectives: The aim of this study was to characterise the preschool environment in rural South Africa, and to explore physical activity, gross motor skill proficiency, sedentary behaviour and screen time in rural South African preschool-aged children. Additionally, aims of this study were to explore the associations between gross motor skills, body composition and physical activity; and to assess compliance with current physical activity and sedentary behaviour guidelines. Methods: Preschool-aged children (3-5 years old, n=131) were recruited from three Preschools and two Grade R (reception year) settings in Agincourt, a rural village in north eastern South Africa. In order to gain an understanding of the Preschool and Grade R settings, an observation of the preschool environments was conducted using a tool adapted from the Outdoor Play Environmental Categories scoring tool, Environmental and Policy Assessment and Observation instrument, and the Early Learning Environments for Physical Activity and Nutrition Environments Telephone Survey. Each child’s height and weight was measured. Physical activity and sedentary behaviour were measured objectively using a hip-worn ActiGraph GT3X+ accelerometer for 7 days (24 hours, only removed for water-based activities). Gross motor skills were assessed using the Test for Gross Motor Development–Version 2 (TGMD-2). Physical activity and sedentary behaviour, including the contextual information for these behaviours, during the preschool day (08h00 until ±12h00) were measured using the Observational System for Recording Physical Activity in Children (Preschool Version). A separate sample of parents/caregivers were recruited (n=143) to complete a questionnaire that was adapted from the Healthy Active Preschool Years questionnaire and Preschool Physical Activity Questionnaire. Parents reported on their child’s screen time, and on factors within the home and community contexts in which physical activity and sedentary behaviours occur. Results: In terms of the environment, the Preschools and Grade R settings differed in that fixed play equipment only featured in the Preschool settings. Grade R settings had more open space in which to play. All Preschool and Grade R settings provided children with limited portable play equipment, and none of the schools had access to screens. Although all children recruited for the study were preschool-aged, the Grade R children were significantly older than the Preschool children (5.6±0.3years vs. 4.4±0.4 years, p