Exploring urban-rural differences in 24-h movement behaviours among tunisian preschoolers: Insights from the SUNRISE study

Abstract

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. We aimed to: (i) assess the proportion of preschool-aged children (3.0-4.9 years) meeting the global movement guidelines, (ii) evaluate the feasibility of the methods for the SUNRISE study, (iii) examine gender- and urban-rural differences in health and behavior outcomes. 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 urban), (n ​= ​62 girls, 41 urban). The results showed that 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 (h) per day. There is a clear need to promote healthy movement behaviours among preschool-aged children through targeted interventions that address their unique challenges related to gender and urban/rural residence.

Keywords

24-h movement behaviors / Sedentary behavior / Screen time / Early childhood development / Urban/rural residence / Executive function

Ethical approval statement

All procedures were approved by the Ethics Committee of the Faculty of Medicine of Sousse (CEFMS 121/2022). Written informed parental consent, and participants’ assent were obtained prior to commencement of study. All participants and their parents/legal representatives were fully informed about the protocol and its potential risks and benefits.

CRediT authorship contribution statement

Mohamed Amine Ltifi: Writing - review & editing, Writing - original draft, Visualization, Validation, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Olfa Turki: Writing - review & editing, Writing - original draft, Visualization, Validation, Supervision, Resources, Methodology, Investigation, Formal analysis, Conceptualization. Ghaith Ben-Bouzaiene: Writing - review & editing, Writing - original draft, Validation, Project administration, Investigation, Data curation, Conceptualization. Kar Hau Chong: Writing - review & editing, Writing - original draft, Visualization, Validation, Supervision, Resources, Project administration, Methodology, Funding acquisition, Formal analysis, Data curation. Anthony D. Okely: Writing - review & editing, Writing - original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Mohamed Souhaiel Chelly: Writing - review & editing, Writing - original draft, Visualization, Validation, Supervision, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

[1] S. Boukthir, L. Essaddam, S. Mazigh Mrad, et al.. Prevalence and risk factors of overweight and obesity in elementary schoolchildren in the metropolitan region of Tunis, Tunisia. Tunis Med, 89 (1) ( 2011), pp. 50-54

[2] 2.K. Wilhite B. Booker B.H. Huang, et al.. Combinations of physical activity, sedentary behavior, and sleep duration and their associations with physical, psychological, and educational outcomes in children and adolescents: a systematic review. Am J Epidemiol, 192 (4) ( 2023), pp. 665-679, DOI: 10.1093/aje/kwac212

[3] J.P. Chaput, R.C. Colley, S. Aubert, et al.. Proportion of preschool-aged children meeting the Canadian 24-Hour Movement Guidelines and associations with adiposity: results from the Canadian Health Measures Survey. BMC Publ Health, 17 (Suppl 5) ( 2017), p. 829, DOI: 10.1186/s12889-017-4854-y

[4] M.S. Tremblay, A.G. LeBlanc, M.E. Kho, et al.. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Activ, 8 ( 2011), p. 98, DOI: 10.1186/1479-5868-8-98

[5] J.P. Chaput, C.E. Gray, V.J. Poitras, et al.. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metabol, 41 (6 Suppl 3) ( 2016), pp. S266-S282, DOI: 10.1139/apnm-2015-0627

[6] World Health Organization. Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children under 5 Years of Age. ( 2019). int/publications/i/item/9789241550536

[7] D.P. Cliff, J. McNeill, S.A. Vella, et al.. Adherence to 24-Hour Movement Guidelines for the Early Years and associations with social-cognitive development among Australian preschool children. BMC Publ Health, 17 (Suppl 5) ( 2017), p. 857, DOI: 10.1186/s12889-017-4858-7

[8] T. Manyanga, J.D. Barnes, J.P. Chaput, P.T. Katzmarzyk, A. Prista, M.S. Tremblay.Prevalence and correlates of adherence to movement guidelines among urban and rural children in Mozambique: a cross-sectional study. Int J Behav Nutr Phys Activ, 16 (1) ( 2019), p. 94, DOI: 10.1186/s12966-019-0861-y

[9] N. Swindell, L.J. Wachira, V. Okoth, et al.. Prevalence and correlates of compliance with 24-h movement guidelines among children from urban and rural Kenya-The Kenya-LINX project. PLoS One, 17 (12) ( 2022), Article e0279751, DOI: 10.1371/journal.pone.0279751

[10] A. Prista, L. Nhantumbo, S. Silvio, et al.. Physical activity assessed by accelerometry in rural African school-age children and adolescents. Pediatr Exerc Sci, 21 (4) ( 2009), pp. 384-399, DOI: 10.1123/pes.21.4.384

[11] S. Whiting, M. Buoncristiano, P. Gelius, et al.. Physical activity, screen time, and sleep duration of children aged 6-9 Years in 25 countries: an analysis within the WHO European childhood obesity surveillance initiative (COSI) 2015-2017. Obes Facts, 14 (1) ( 2021), pp. 32-44, DOI: 10.1159/000511263

[12] D. Vieira, E.C. Gomes, S. Negrão Â, M. Thuany, T.N. Gomes.Movement behaviour and health outcomes in rural children: a systematic review. Int J Environ Res Publ Health, 20 (3) ( 2023), p. 2514, DOI: 10.3390/ijerph20032514

[13] T. Okely, J.J. Reilly, M.S. Tremblay, et al.. Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol. BMJ Open, 11 (10) ( 2021), Article e049267, DOI: 10.1136/bmjopen-2021-049267

[14] World Health Organization.WHO Child Growth Standards: Length/height-For-Age, Weight-For-Age, Weight-For-Length, Weight-For-Height and Body Mass Index-For-Age: Methods and Development. ( 2006)

[15] R.R. Pate, M.J. Almeida, K.L. McIver, K.A. Pfeiffer, M. Dowda. Validation and calibration of an accelerometer in preschool children. Obesity, 14 (11) ( 2006), pp. 2000-2006, DOI: 10.1038/oby.2006.234

[16] C. Blair, C.C. Raver. School readiness and self-regulation: a developmental psychobiological approach. Annu Rev Psychol, 66 ( 2015), pp. 711-731, DOI: 10.1146/annurev-psych-010814-015221

[17] Y.A. Smith, E. Hong, C. Presson. Normative and validation studies of the nine-hole peg test with children. Percept Mot Skills, 90 (3 Pt 1) ( 2000), pp. 823-843, DOI: 10.2466/pms.2000.90.3.823

[18] N. Munambah, P. Gretschel, F. Muchirahondo, et al.. 24 hour movement behaviours and the health and development of pre-school children from Zimbabwean settings: the SUNRISE pilot study. S Afr J Sports Med, 33 (1) ( 2021), Article v33i31a10864, DOI: 10.17159/2078-516X/2021/v33i1a10864

[19] M. Gülü, H. Yapici, E. Mainer-Pardos, A.R. Alves, H. Nobari.Investigation of obesity, eating behaviors and physical activity levels living in rural and urban areas during the covid-19 pandemic era: a study of Turkish adolescent. BMC Pediatr, 22 (1) ( 2022), p. 405, DOI: 10.1186/s12887-022-03473-1

[20] S.E. Neil-Sztramko, H. Caldwell, M. Dobbins. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev, 9 (9) ( 2021), Article Cd007651, DOI: 10.1002/14651858.CD007651

[21] C. Delisle Nyström, C. Alexandrou, M. Henström, et al.. International study of movement behaviors in the early years (SUNRISE): results from SUNRISE Sweden's pilot and COVID-19 study. Int J Environ Res Publ Health, 17 (22) ( 2020), p. 8491, DOI: 10.3390/ijerph17228491

[22] M.S. Hossain, I.M. Deeba, M. Hasan, et al.. International study of 24-h movement behaviors of early years (SUNRISE): a pilot study from Bangladesh. Pilot Feasibility Stud, 7 (1) ( 2021), p. 176, DOI: 10.1186/s40814-021-00912-1

[23] J.Y.Y. Ng, Q. He, K.H. Chong, A.D. Okely, C.H.S. Chan, A.S. Ha. The impact of COVID-19 on preschool-aged children's movement behaviors in Hong Kong: a longitudinal analysis of accelerometer-measured data. Int J Environ Res Publ Health, 18 (22) ( 2021), Article 11907, DOI: 10.3390/ijerph182211907

[24] H. Guan, Z. Zhang, B. Wang, et al.. Proportion of kindergarten children meeting the WHO guidelines on physical activity, sedentary behaviour and sleep and associations with adiposity in urban Beijing. BMC Pediatr, 20 (1) ( 2020), p. 70, DOI: 10.1186/s12887-020-1969-6

[25] C.E. Draper, S.A. Tomaz, C.J. Cook, et al.. Understanding the influence of 24-hour movement behaviours on the health and development of preschool children from low-income South African settings: the SUNRISE pilot study. S Afr J Sports Med, 32 (1) ( 2020), Article v32i31a8415, DOI: 10.17159/2078-516X/2020/v32i1a8415

[26] C. Shearer, C. Blanchard, S. Kirk, et al.. Physical activity and nutrition among youth in rural, suburban and urban neighbourhood types. Can J Public Health, 103 (9 Suppl 3) ( 2012), pp. eS55-eS60, DOI: 10.1007/BF03403836

[27] L.J. Wachira, S.O. Hayker, R. Larouche, et al.. Physical activity and active transportation behaviour among rural, peri-urban and urban children in Kenya, Mozambique and Nigeria: the PAAT Study. PLoS One, 17 (1) ( 2022), Article e0262768, DOI: 10.1371/journal.pone.0262768

[28] M.H. Leppänen, C. Ray, H. Wennman, et al.. Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study. BMC Publ Health, 19 (1) ( 2019), p. 1618, DOI: 10.1186/s12889-019-7967-7

[29] M. De Craemer, D. McGregor, O. Androutsos, Y. Manios, G. Cardon.Compliance with 24-h movement behaviour guidelines among Belgian pre-school children: the ToyBox-study. Int J Environ Res Publ Health, 15 (10) ( 2018), p. 2171, DOI: 10.3390/ijerph15102171

[30] M. Schlieber, J. Han. The role of sleep in young children's development: a review. J Genet Psychol, 182 (4) ( 2021), pp. 205-217, DOI: 10.1080/00221325.2021.1908218

[31] R. Guthold, T. Ono, K.L. Strong, S. Chatterji, A. Morabia. Worldwide variability in physical inactivity a 51-country survey. Am J Prev Med, 34 (6) ( 2008), pp. 486-494, DOI: 10.1016/j.amepre.2008.02.013