31st Jan 2024

Introduction
Despite the publication of the World Health Organization (WHO) guidelines on movement behaviours (physical activity, sedentary behaviour, and sleep) for the Under 5s five years ago, there is limited evidence on compliance with the guidelines in a low-income Sub-Saharan African context. We examined the prevalence and correlates of meeting the total physical activity (TPA), sedentary behaviour, and sleep guidelines among 3- and 4-year-olds in Malawi.

Methods
Our study comprised 417 children (51.5% girls) aged 3-4 years from 24 urban and rural early childhood education and care (ECEC) centres in Malawi. Daily step-count was measured by hip-worn ActiGraph GT3X accelerometers, and children were classified as meeting the TPA guideline if they averaged at least 11,500 steps/day. Child’s restrained sitting, sedentary screentime, and sleep duration were reported by parents using a questionnaire. We determined the correlates of meeting the WHO guidelines using multivariable survey logistic regression.

Results
On average, children reportedly slept for 11.2 hours/day (standard error [SE]=0.1) and accumulated 24,269 steps/day (SE=391). The prevalence of meeting the TPA, restrained sitting and sedentary screen time, and sleep duration guidelines were 98.4% (95% confidence interval [CI]=96.0–99.4), 90.9% (95% CI=84.2–94.9), 79.4% (95% CI=71.2–85.7), and 90.6% (95% CI=87.3–93.2), respectively. Nearly three-quarters met the combined guideline (70.5%; 95% CI: 62.4–77.4). Girls had significantly higher odds of meeting the restrained sitting guideline (adjusted OR=3.59; 95% CI=1.36–9.48; p=0.012). Additionally, children from urban settings had significantly lower odds of meeting the restrained sitting, sedentary screentime, and sleep duration guidelines. We did not identify any correlates for meeting the TPA guideline.

Conclusions
We found exceptionally high prevalence meeting the WHO 24-hour movement behaviour guidelines in our sample of young children from a low-income Sub-Saharan African context, which is suggestive of a population in a pre-physical activity transition. Meeting the guidelines was influenced by factors such as residential settings and sex.