ASSESSMENT OF LIFESTYLE CHANGES AND THEIR EFFECT ON HEALTH AMONG CHILDREN OF ≤15 YEARS DURING COVID-19 PANDEMIC, IN NORTH INDIA

Objective: The objectives of the study were: (1) To assess life style changes among children of ≤15 years of age during COVID-19 pandemic and (2) to find out the effect of the life style changes on health of children of ≤15 years of age. Methods: The cross-sectional comparative study conducted at department of pediatrics, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow for duration of 1 year and sample size found to be 276 on calculation by applying the formula. Results: Out of 278 children, about 39% (108) were female children. Most of children were studying in primary level classes (52.51%) and most of enrolled children had joint family (66.18%). Level of physical activity reduced significantly due to closure of school and restriction on outdoor activities. Weight of children increased significantly during COVID-19 pandemic seems to be due to decreased in physical activities and consumption of more fast food/fried food (high calorie intake) and sedentary life style. Conclusion: During COVID-19 pandemic due to closure of schools and restricted outdoor activities results in decrease level of physical activities, increased consumption of high calorie food and sedentary behavior lead to increase in weight of children and changes in sleeping pattern of children.


INTRODUCTION
First case of COVID-19 was reported in Wuhan city of china in December month of year 2019 [1].WHO declared COVID-19 as global public health crises in March 2020 [2]. To prevent or slow down the speed of transmission of virus, government enforced lockdown, result in restriction in travelling, opening of market, industries, complete closure gyms, schools and colleges also banned social gathering and outdoor activities. As a results, routine life style of children have been changed [3]. The closures of schools and adoption of COVID-related behavior affecting the lifestyle of children [4]. Restriction in social activity to reduce the spread of COVID-19 results in decrease involvement of children in different type of physical activities . [3,5,6] and adapting in sedentary lifestyle [7,8]. Physical activities and sedentary life style are important factors affecting the health of the children [9][10][11] Adverse effect of prolonged sedentary behavior on health reported even in those who involve on moderate to vigorous physical activities [12,13]. Excessive sedentary behavior along with inadequate level of physical activities results in adverse effect on the health of the children such as excessive weight gain (obesity/overweight) [14]. Guidelines on physical activity released by the WHO in 2020 to promote the physical and mental health of children. The WHO recommended children of age 5-17 year perform at least 60 min moderate to vigorous physical activities and restricting the sedentary behavior <2 h/day [15]. Restriction during COVID-19 pandemic encourages the people to stay at home and work from home results in changes in the dietary pattern. People have more free time thus spending more time on cooking results in overall increase in the consumption of food intake specially increase intake of sugar and fat during lockdown [16]. Some studies reported consumption of snacks and sweets increased during COVID-19 [17][18][19].
This study was conducted to access changes in dietary pattern, changes in level of physical activity and their effect on the children during COVID-19 pandemic.

Objective
The objectives of the study are: 1. To assess life style changes among children of ≤15 years of age during COVID-19 pandemic 2. To find out the effect of life style changes on health of children of ≤15 years.

Study area
The study was conducted by Department of Paediatrics, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow.

Study design
This was a cross-sectional comparative study.

Study duration
The study period was 12 months (November 2020-October 2021).

Sample size
Minimum 276 sample size was calculated by applying the formula

Inclusion criteria
• Children of 5-15 years of age come in OPD/IPD in Department of Paediatric of VPIMS were included in the study.

Exclusion criteria
• Not willing to participate were excluded from the study.

Validation of questionnaire (bilingual)
Before the study, a pilot study was conducted on 10 patients to validate the pre-designed questionnaire and made the changes, if necessary.

Study protocol
Ethical clearance and informed consent (Guardian) were taken. The study was done at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow. Minimum of 276 children ≤15 years attending OPD or IPD were enrolled, and pre-designed questionnaires were used to collect the information about the physical activity performed by children in a week. The question selected to assess the physical activity from questionnaire "Youth in Review Activity Profile" YAP27, used to asses various parameters in pediatric age [20]. These questions were asked to the parents of the children. Mother and father are preferred the most, followed by the closed guardian. In the above process, pre-design questionnaire (Bilingual) asks to the parents, and their response was noted/filled by the primary investigator.

DISCUSSION
In this study, total 278 children were enrolled in OPD and IPD of institute during 1 year of study period. Out of 278 children, about 39% (108) were female and 61% (170) were male. Most of children were studying in primary level classes (52.51%) and most of enrolled children had joint family (66.18%). Table 1 showed level of physical activity reduced significantly due to closure of school and restriction on outdoor activities. About 54.68% of children did not perform any physical activities and 22.66% of children performed only 1 times/week and only little 6.83%, 2.88% performed 3 times/week and daily physical activities during COVID-19, respectively, against percentages of the children performing physical activity before COVID-19 pandemic. Similar finding reported in study of Ammar et al. (2020) [21] and Almandoz et al. [22], Where the      physical activities decrease during COVID-19 due to enforcement of restriction to prevent the spread of COVID-19. This study ( Table 2) showed that consumption of fast food/fried food significantly increased during COVID-19 pandemic may be due to work from home and restricted outdoor activities, parents have lot of free time and trying different type of recipes results in consumption of food intake increased. Similarly, in study of Pujia et al. [23], the consumption of "comfort food" has increased. Chocolate, sweet packaged snacks, ice cream, and desserts, as well as bread, pizza, and bakery products, are popular among children and adolescents. This study (Table 3) depicted that weight of children increased significantly during COVID-19 pandemic seems to be due to decreased in physical activities and consumption of more fast food/fried food (high calorie intake) and sedentary life style. A study of Shook et al. [24] revealed low level of physical activities and uncontrolled energy intake result in gain in the weight of body. Similarly Pujia et al. [23] showed that approximately 16% of the children and adolescents studied gained more than 3 kg in body weight. This study (Table 4) depicted that consumption of fast food or fried food results in constipation/ changes in bowel habits. A study of Delgado-Aros et al. [25] revealed that intake of excessive calorie associated with constipation. Another study of Gupta et al. [26] reported consumption of energy dense food associated with constipation. Table 5 depicted daytime sleepiness and late awakening in the morning found to be increased during covid-19 may be due to disturbances in routine activities such as closure of schools and restriction in outdoor activities.

CONCLUSION
During COVID-19 pandemic due to closure of schools and restricted outdoor activities results in decrease level of physical activities, increased consumption of high calorie food and sedentary behavior lead to increase in weight of children and changes in sleeping pattern of children.

ETHICAL APPROVAL
Taken from the Institutional Ethical Committee.

ACKNOWLEDGMENTS
I would like to acknowledge the study participants and institute for their support.