This was a cross-sectional study that involved the use of interviewer-administered structured questionnaires to collect information on socio-demographics. The questionnaire was pretested prior to data collection. Sociodemographic data collected included age, sex and level of education. Weight, height, waist circumference and body composition measurements of all participants were taken. The height of each participant was entered in to the body composition analyzer which was used to measure the weight and other body components. Body Mass Index (BMI) was generated from the weight and height measurement (weight in kilograms/ height in metres2).
Study site
The study was conducted in two communities in the Ashanti region of Ghana; Ahodwo, an urban community and Ejuratia, a rural community. Data collection was done by visiting households within the selected communities.
Sample size and sampling
A total of 600 individuals participated in this study. The sample size of 600, 300 from rural and 300 from urban was determined by the ROFE research team to be adequate for the study. Out of this number, 35 did not complete anthropometric and body composition measurement and were omitted from this analysis. This paper therefore, reports data on 565 participants. A Systematic sampling was used to select households and any household member either male or female eighteen years and above was included. One household was randomly selected within each house. For each household, only one member was included and where there were both a male and a female who qualified, the male was selected to ensure gender balance as it was more difficult to find males in households. Additionally, the first adult seen in the household was the one selected to be part of the study unless he or she refused and another was selected. In the urban area, the main streets of the town were used to divide the locality into six parts. After a random start at each main street, every fifth household was selected to form part of the study. In the rural community, the main station was used as the central point to divide the town into four parts and after a random start at each point, every third household was selected. The difference in intervals was due to the smaller sample frame in the rural area compared to the urban area. Households with no adult member present and households who declined to participate in the study were excluded.
Dietary consumption
Twenty four-hour recall and household food frequency was used to collect information on food consumption. The household food frequency consisted of commonly consumed food groups. Participants were also asked of any likely foods under each of the food groups they had consumed that were not captioned. Participants were to indicate how often they consumed each food item. One twenty-four-hour recall was taken for each participant to assess previous day food consumption. Principal component analysis was used to generate patterns of consumption among participants. Nutrient analysis template; a food composition table consisting of only Ghanaian foods was used to estimate quantity of nutrient intakes and dietary diversity from the 24-h recall.
Body composition and anthropometric measurement
Participants were made to remove their footwear and put on light clothing prior to the taking of anthropometry. Height was taken using Seca stadiometre, model 213 with participants standing up right with feet together and hands at the sides. Weight and body composition were measured using the Omron body composition monitor, model HBF-514. Height, gender and age of participants were entered into the body composition monitor before participants were made to stand on it. This generated body composition results as well as BMI of participants. Body mass index (kg/m2) was classified using WHO criteria for adults; < 18.5 underweight, 18.5–24.9 normal, 25–29.9 overweight and ≥ 30 obese. Visceral fat of > 9% was definitive of central obesity and body fat cut-offs were based on gender and age of participants as suggested by Gallager [19, 21]. Waist circumference was taken with a flexible tape measure. Central obesity was defined as waist circumference of > 88 cm for females and > 102 cm for males.
Assessment of physical activity
The World Health Organization’s Global Physical Activity Questionnaire (GPAQ) was used to assess the physical activity levels of study participants. The total minutes of different level of physical activities performed by participants in a typical week was calculated from the number of days in a week for engaging in such activity and the time spent on the particular activity. The activity ranged from moderate to vigorous intensity activity or sports as well as walking and bicycling as a means of travelling. Total time for vigorous intensity activities for the week was multiplied by 8 while moderate intensity activities, walking and bicycling were multiplied by 4 to convert the minutes to metabolic equivalents. The World Health Organization (WHO) suggests a minimum of 600 metabolic equivalents per week for adults as a way to promote cardiometabolic health. Participants were stratified in to two groups based on those meeting the recommendation and those not meeting the recommendation.
Ethical clearance
Ethical clearance for the study was granted by the Council for Scientific and Industrial Research (CSIR), Ghana; RPN 011/CSIR-IRB/2017. Written permission was sought from local government officials before data collection and all participants signed or thumb printed an inform consent form to indicate voluntary participation.
Statistical analysis
Statistical Package for Social Sciences (IBM SPSS) 23 was used for data analysis. Normality test revealed that data was positively skewed. Mann-Whitney U test was used to compare the median age, body composition and nutritional intakes among rural and urban participants. Chi-Square was used to determine the difference in obesity prevalence and physical activity levels among males and females as well as among rural and urban dwellers. In instances where cell counts were less than five, Fisher Exact Test was used. Spearman correlation was used to determine the relationship between BMI and body composition measures. Principal component analysis was used to determine the patterns of consumption. Multinomial logistic regression was used to determine the predictors of obesity measured by waist circumference. Waist circumference was used because it determined the highest prevalence of obesity and strongly correlated positively with all other body composition measures. A p-value of < 0.05 was set as statistically significant.