Le double fardeau de la malnutrition à l’âge scolaire en milieu urbain : une étude au Burkina Faso

The aim of this study carried out in Ouagadougou was to assess the nutritional status of schoolchildren and to assess their lifestyle practices as well as their food habits and determinants, for the guidance and evaluation of a nutrition intervention.  The cross-sectional survey included 799 schoolchildren in 5th grade (mean age 11.7 ± 1.4y) attending 12 private or public, urban or peri-urban schools. Weight, height, blood pressure and haemoglobin were measured and thyroid palpation was performed. Fasting serum lipids, glycaemia and serum retinol were measured in a sub-sample (N=208). A questionnaire was filled in classroom to assess consumption frequency of ‘healthy’ foods (fruits, vegetables, meat, fish, legumes) and ‘unhealthy’ items (cakes, cookies, candies, ice, soda) and underlying factors as well as hygiene and physical activity practices. Deficiencies signs were: low serum retinol, anaemia, thinness, stunting and goitre whereas cardiometabolic risk factors (CRF) signs consisted of elevated blood pressure (BP), overweight/obesity, hyperglycaemia, and dysglyceamia.  At least one malnutrition sign was found in 57% pupils. Anaemia (40.4 %) and vitamin A deficiency (VAD) (38.7 %) were highly prevalent. Stunting affected 8.8% of children while thinness affected 13.7 % of them. Anaemia (p = 0.001) and DVA (p < 0.001) were significantly higher in public than private schools. Goitre was not detected. Overweight/obesity was rare (2.3 %). Thinness and stunting were significantly higher in peri-urban compared to urban schools.  At least one CRF was found in 36% schoolchildren. The main risk factors were low HDL-cholesterol (HDL-C) (19.3%) followed by high total cholesterol, high LDL-cholesterol (11.6% each) and elevated systolic blood pressure (9.7%). Being a girl was independently associated with increased serum lipids including HDL-C paradoxically. Body Mass Index was independently associated with increased BP.  It was found that the double burden of malnutrition (DBM) affected 27.5% children. Consumption scores of unhealthy food were significantly higher than healthy foods’ (p= 0.001). During the week prior to the survey, 25% of children had eaten no fruit, 20% no meat, 20% no legume, while 18.3% ate ice pop every day. Compared to public-school pupils, those from private schools consumed both healthy and unhealthy items more frequently. Urban school children had significantly higher unhealthy food scores compared to peri-urban schools. Children’s healthy and unhealthy food consumption was primarily explained by perceived control and availability for both types of foods, and maternal reinforcement for healthy foods and peers’ reinforcement for consumption of unhealthy items among the investigated explanations.  This study showed that malnutrition is widely prevalent in schoolchildren in cities, concurrently with a sizeable prevalence of cardiometabolic risk factors. Preventive measures should be tailored to prevent both dietary inadequacies and excess.

Keyphrases: Anaemia, Vitamin A deficiency, Stunting, Thinness, Cardiometabolic risk, Healthy/unhealthy, Food behaviour, Schoolchildren, Africa