Thesis

Compliance with global 24-hour movement behaviours in 3-4 year-olds : a low-income sub-Saharan African country perspective

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Awarding institution
  • University of Strathclyde
Date of award
  • 2025
Thesis identifier
  • T17445
Person Identifier (Local)
  • 202076755
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Abstract
  • Malawi, like other low-income sub-Saharan African (SSA) countries, is experiencing economictransition that may result in lifestyle changes, such as physical inactivity, increased sedentarybehaviours, and poor nutrition. This shift may further increase the burden of movementbehaviour-related non-communicable diseases (NCDs) and obesity in the country and globally.The 2019 global 24-hour movement behaviour guidelines for the under 5s were published topromote children’s healthy growth and development and to tackle NCDs and obesity globally.Despite publication over five years ago, there is limited evidence of compliance from low- andmiddle-income countries, particularly in SSA. Additionally, no studies have assessed feasiblemeasurement methods for large-scale surveillance globally.Guided by the Behavioural Epidemiology Framework, this thesis provides novel evidence in thefield of 24-hour movement behaviours in early childhood. Parent reports and daily step countswere validated against accelerometry for assessing total physical activity (TPA) in 3–4 year oldsglobally (Chapter 3). The step count threshold of 11,500 steps/day, equivalent to 180minutes/day of TPA, provided valid measures but parent reports did not. This threshold wasthen used in cross-sectional studies to examine the prevalence and correlates of meeting theglobal guidelines (Chapters 4 and 5).Chapter 4 revealed that only 31% of 3-4 year olds from diverse backgrounds met the TPAguideline based on step counting, and compliance was influenced by sex, age, residence(urban/rural), and country income. Chapter 5, focused on Malawi, revealed relatively highprevalence (60%) of meeting all four 24-hour movement guidelines (physical activity, restrainedsitting, screen time, sleep duration) among 3-4 year olds. Meeting guidelines waspredominantly influenced by residential setting (23% urban versus 70% rural), suggesting thatphysical activity transition maybe underway particularly in urban areas.This thesis provides evidence to inform practical surveillance systems for monitoring movementbehaviours among young children in resource-limited settings and can help develop tailoredinterventions to sustain healthy lifestyles during ongoing economic transformations, delay thephysical activity transition, and reduce NCDs in Malawi and similar contexts.
Advisor / supervisor
  • Reilly, John
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