Describing objectively measured physical activity levels, patterns, and correlates in a cross sectional sample of infants and toddlers from South Africa

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Study Justification:
This study aimed to investigate the physical activity levels, patterns, and correlates in infants and toddlers under the age of two years in South Africa. This is important because physical activity has health benefits throughout life, but little is known about physical activity in this age group. Understanding physical activity in infants and toddlers can inform interventions and policies to promote healthy behaviors from an early age.
Study Highlights:
– The study found significant age and sex differences in the distribution of time spent in different physical activity intensities.
– Boys tended to spend more time in higher intensity physical activity and less time in lower intensity activity than girls.
– Time spent outside was higher in boys, and this reached significance at 18 months.
– Maternal beliefs about floor play were associated with higher physical activity at 12 months in females only.
– The majority of children exceeded TV time recommendations.
– TV time was positively associated with BMI z-score when controlling for age and sex.
Study Recommendations:
– Infants and toddlers should be provided with as many opportunities to be active through play as possible.
– TV time should be limited to promote healthy behaviors.
Key Role Players:
– Researchers and scientists in the field of child development and physical activity.
– Healthcare professionals, including pediatricians and nurses.
– Policy makers and government officials responsible for early childhood development and public health.
Cost Items for Planning Recommendations:
– Research funding for conducting further studies and interventions.
– Resources for developing and implementing educational materials and programs for parents and caregivers.
– Training and professional development for healthcare professionals to promote physical activity in infants and toddlers.
– Public health campaigns to raise awareness about the importance of physical activity and the risks of excessive TV time in this age group.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it presents findings from a study that objectively measured physical activity levels in a sample of South African infants. The study used a wrist-worn accelerometer to measure physical activity and collected data on various correlates of physical activity. The abstract provides detailed information on the methods used, the results obtained, and the conclusions drawn. However, to improve the evidence, the abstract could include more information on the sample size, the representativeness of the sample, and the limitations of the study.

Background: Physical activity is considered to have health benefits across the lifespan but levels, patterns, and correlates have not been well described in infants and toddlers under the age of two years. Methods: This study aimed to describe objectively and subjectively measured physical activity in a group of South African infants aged 3- to 24-months (n=140), and to investigate individual and maternal correlates of physical activity in this sample. Infants’ physical activity was measured using an Axivity AX3 wrist-worn accelerometer for one week and the mean vector magnitude was calculated. In addition, mothers reported the average amount of time their infant spent in various types of activities (including in front of the TV), their beliefs about infants’ physical activity, access to equipment in the home environment, and ages of motor development milestone attainment. Analysis of variance (ANOVA) and pair-wise correlations were used to test age and sex differences and associations with potential correlates. Results: There were significant age and sex effects on the distribution of time spent at different physical activity intensities (Wilks’ lambda=0.06, p1 h, and removed [23]. Remaining data was summarised to generate average acceleration (mg), as well as time (hourly and weekly) spent in intensity thresholds (10 mg increments from 0 to 400 mg). During summation, non-wear periods were taken into account in order to minimize potential diurnal bias [28]. At least 45 h of wear time (equating to three days of at least 15 h data per day [29]) spread equally across the 24-h day (at least 4 h each day during morning, noon, afternoon, and night) were required for inclusion in the analysis. Mothers were asked to report their date of birth and their infants’ date of birth and sex. Infant age was calculated and categorised to the nearest month. Mothers’ height was taken to the nearest 1 mm using a wall-mounted stadiometer (Holtain, UK). Infant length was measured to the nearest 1 mm using an infantometer (Chasmors Ltd., UK). Weight of mothers and infants was measured to the nearest 0.1 kg using a digital scale (Dismed, USA). All anthropometry measurements were taken twice, by trained research staff according to standardised procedures, and the average of the two values was reported. Mother and infant body mass index (BMI) was calculated as (weight(kg)/height(m)2). Infant weights, lengths and BMIs were converted to age-specific z scores according to the 2006/2007 World Health Organisation (WHO) growth standards [30] using the WHO Anthro software [31]. Mothers were asked to report how many hours per day they looked after their infant, and were considered primary caregivers if they reported looking after their infant for 8 or more hours per day. All questionnaires used in this study were based on previously developed and reliability tested items [19], which were then adapted for language and setting based on pilot work conducted on mothers from Soweto. These adaptations mainly consisted of rewording sections that were not well understood in a South African context (i.e.: “…a baby that is very active” was changed to “…a baby that moves a lot”). Infant activities were assessed at 3-, 6-, 12-, and 18-months. Mothers reported the amount of time (minutes) their infant spent in various activities, on an average day. Activities were age-specific, but included tummy time (only 3- and 6-months), time spent playing games with an adult, time spent being physically active with the mother, time spent on the floor, time spent with other babies of a similar age, time spent with older toddlers or children, time spent outside, time spent in front of a television (TV), time spent strapped to the mother’s back (only 3-, 6- and 12-months), and time spent restrained (in a highchair, car chair, pushchair etc). Activities were pooled to determine total time restrained (i.e. sum of time spent strapped to mother’s back, time spent in a highchair, car chair, pushchair, or cot), and total time free to play (i.e. sum of tummy time, time spent playing games with an adult, time spent being physically active with mother, time spent on the floor, time spent with other babies of a similar age, time spent with older toddlers or children, time spent outside). All activities are presented as minutes per day. Maternal reported time that infants spent in front of a TV was extracted from this questionnaire and used as proxy for TV time in order to examine potential correlates thereof. During the measurement period, mothers were asked to complete sleep diaries recording the time at which their infant was put to bed at night, and the time at which they were picked up from bed in the morning in order to provide an estimate of time in bed. If sleep diary data were missing, values were imputed based on trends for other infants’ days and times. Maternal beliefs about their infant’s physical activity, and attitudes and intentions around their infant’s physical activity and TV viewing, were assessed at 6- and 12-months using a 24-item questionnaire with a 4-point likert-type scale and response options: 1 = strongly agree to 4 = strongly disagree. Based on previous studies [19], 7 factor variables were created, including physical activity knowledge (7 questions examining the importance of physical activity for infant health and development), positive views about physically active children (3 questions examining maternal perceptions of active children), negative views about physically active children (4 questions examining maternal fears and concerns about physically active children), physical activity optimism (3 questions examining the anticipated ease of engaging children in physical activity), self-efficacy for promoting physical activity (3 questions examining mothers’ confidence for promoting physical activity), future expectations around infant’s physical activity and TV viewing (2 questions examining maternal expectations of infant’s future physical activity and TV viewing behaviours), and floor play concerns (2 questions examining perceptions of safety of floor play). Scores for each factor variable were then generated by averaging the item scores within each factor, where a higher score indicates lower agreement with the factor variable. The internal consistency in the present sample (mean Cronbach alpha = 0.60) for these factor variables was acceptable and comparable to previous studies [19], with only one factor variable (positive views about physical activity) scoring below 0.60. Mothers of infants aged 3-, 6-, 12-, and 18-months were asked to report, using a 4 point likert-type scale, whether their child had access to, or was likely to have access to age-specific toys and equipment (such as balls, push toys, bicycles, etc) in the home or at nearby facilities within the next year. Each response was coded as “3” if mothers responded that they had the equipment already, “2” if they were very likely to get it within the next year, “1” if mothers responded they would possibly get the equipment in the next year, and “0” if mothers responded that they were unlikely to get the equipment within the next year. Thereafter a sum of the responses for each item was created, with a higher score indicating better access to equipment or intention to provide access, and a lower score indicating no access and/or less intention to provide access. Mothers of infants aged 3-, 6-, 12-, and 18-months were asked to report whether their infant had attained specific motor development milestones according to the age of the child (based on the CDC recommendations: www.cdc.gov/ActEarly). Milestones included: holding up head at 3-months; sitting, crawling, and rolling to both sides at 6-months; crawling, pulling up to stand, and starting to walk at 12-months; and walking and running at 18-months. Milestones were recorded as attained/not attained. Thereafter, infants were categorised as either not yet mobile (this assumed all 3-month infants, as well as those aged 12-months who were not yet crawling); crawling (if 18-month infants were not yet walking/running they were presumed to be crawling); or walking/running (all infants aged 24-months were presumed to be walking/running). Assumptions were based on WHO reported ages for milestone attainment [32]. All statistical analyses were conducted using Stata 13 for Mac. Participant characteristics and all questionnaire data were summarised by age and presented as mean (SD), n (%), or median (IQR). Since there is no consensus on intensity thresholds for sedentary, light, moderate, and vigorous activities in non-ambulatory infants (which made up the majority of the sample), objectively measured infant physical activity intensity distribution was presented as time spent in each systemic acceleration category from 0 to 400 mg by age and sex. Furthermore, hourly mean vector magnitude (diurnal patterns) of activity were compared between ages, sex, and developmental stages. These differences were tested using multivariate analysis of variance (ANOVA) through Wilks’ lambda test. Two-way ANOVAs, linear regressions, and students’ unpaired t-tests were used to test age and sex differences in the time spent in various activities as reported by mother, as well as for objectively measured physical activity. Thereafter, pairwise correlations were run by age for maternal variables (home environment, maternal BMI and age, maternal-reported infant activities, and maternal beliefs factor variables) on infant objectively measured physical activity. Regressions were also run for potential correlates of maternal reported infant TV time controlling for age and sex, and margins were calculated. Chi-squared tests were used to determine the proportion of infants meeting TV time guidelines according to developmental stage. A p < 0.05 was considered significant in all cases.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile apps that provide information and resources on maternal health, including prenatal care, nutrition, and exercise. These apps can also offer reminders for appointments and medication, as well as connect women to healthcare providers for virtual consultations.

2. Telemedicine: Implement telemedicine services to allow pregnant women to consult with healthcare professionals remotely. This can help overcome barriers such as distance and transportation issues, ensuring that women have access to necessary prenatal care and support.

3. Community Health Workers: Train and deploy community health workers to provide education and support to pregnant women in underserved areas. These workers can offer guidance on prenatal care, nutrition, and breastfeeding, as well as assist with accessing healthcare services.

4. Maternal Health Clinics: Establish dedicated maternal health clinics in areas with limited access to healthcare facilities. These clinics can provide comprehensive prenatal care, including regular check-ups, screenings, and education on maternal and infant health.

5. Public Awareness Campaigns: Launch public awareness campaigns to educate women and their families about the importance of maternal health and the available resources. These campaigns can utilize various media channels, including radio, television, and social media, to reach a wide audience.

6. Financial Support Programs: Develop programs that provide financial assistance to pregnant women, particularly those from low-income backgrounds, to help cover the costs of prenatal care, medications, and transportation to healthcare facilities.

7. Maternal Health Hotlines: Establish toll-free hotlines staffed by trained healthcare professionals who can provide information, support, and guidance to pregnant women. These hotlines can be available 24/7 to address any concerns or questions related to maternal health.

8. Maternal Health Education in Schools: Integrate comprehensive maternal health education into school curricula to ensure that young girls and boys receive early education on reproductive health, pregnancy, and the importance of maternal care.

9. Partnerships with Non-Profit Organizations: Collaborate with non-profit organizations that focus on maternal health to leverage their expertise, resources, and networks. These partnerships can help expand access to maternal health services and support in underserved communities.

10. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with access to essential maternal health services, including prenatal care, delivery, and postnatal care. These vouchers can be distributed through healthcare facilities, community organizations, or government agencies.

It’s important to note that the specific innovations implemented may vary depending on the local context, resources, and needs of the community.
AI Innovations Description
The study described in the provided text aimed to objectively and subjectively measure physical activity levels, patterns, and correlates in a sample of South African infants aged 3 to 24 months. The findings of the study highlighted several important factors related to physical activity in infants. Here are some recommendations that can be developed into an innovation to improve access to maternal health:

1. Increase awareness: Develop educational programs and campaigns to increase awareness among mothers about the importance of physical activity for infant health and development. This can include providing information on the benefits of physical activity, guidelines for age-appropriate activities, and strategies to incorporate physical activity into daily routines.

2. Promote active play: Encourage mothers to provide as many opportunities as possible for infants to be active through play. This can involve providing age-appropriate toys and equipment that promote physical activity, such as balls, push toys, and bicycles. Additionally, mothers can be encouraged to engage in interactive play with their infants to promote physical activity.

3. Limit screen time: Given that the majority of infants in the study exceeded TV time recommendations, it is important to promote strategies to limit screen time in infants. This can include educating mothers about the potential negative effects of excessive screen time on infant development and providing alternative activities that promote physical activity and cognitive development.

4. Supportive home environment: Enhance access to age-specific toys and equipment in the home environment. This can involve providing resources and support to mothers to ensure they have the necessary equipment to facilitate physical activity for their infants. Additionally, promoting a safe and stimulating home environment that encourages physical activity can contribute to improved access to maternal health.

5. Maternal beliefs and attitudes: Address maternal beliefs and attitudes that may impact infant physical activity. For example, addressing concerns around floor play and providing information on the safety and benefits of floor play can encourage mothers to engage in activities that promote physical activity. Additionally, addressing misconceptions or negative views about physically active children can help create a positive environment for promoting physical activity in infants.

By implementing these recommendations, it is possible to improve access to maternal health by promoting physical activity in infants and creating a supportive environment for mothers to engage in activities that benefit both their own health and the health of their infants.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Increase awareness and education: Develop and implement educational programs to raise awareness about the importance of maternal health and the available resources for accessing healthcare services. This can be done through community outreach programs, workshops, and informational campaigns.

2. Improve healthcare infrastructure: Invest in improving healthcare facilities, especially in underserved areas, to ensure that pregnant women have access to quality maternal healthcare services. This includes increasing the number of healthcare providers, improving equipment and technology, and expanding the availability of essential medicines and supplies.

3. Strengthen referral systems: Establish effective referral systems to ensure that pregnant women can easily access specialized care when needed. This involves improving communication and coordination between different levels of healthcare facilities, such as primary healthcare centers, hospitals, and specialized clinics.

4. Enhance transportation services: Address transportation barriers by providing reliable and affordable transportation options for pregnant women to reach healthcare facilities. This can include setting up transportation networks, providing subsidies for public transportation, or implementing mobile healthcare clinics in remote areas.

5. Promote community engagement: Engage local communities in promoting maternal health by involving community leaders, volunteers, and organizations. This can be done through community-based initiatives, support groups, and peer education programs.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations on improving access to maternal health. This can include indicators such as the number of pregnant women receiving prenatal care, the percentage of women delivering in healthcare facilities, and the reduction in maternal mortality rates.

2. Collect baseline data: Gather baseline data on the current status of maternal health access in the target population. This can be done through surveys, interviews, and data collection from healthcare facilities and relevant government agencies.

3. Implement the recommendations: Implement the recommended interventions and strategies to improve access to maternal health. This may involve implementing educational programs, improving healthcare infrastructure, strengthening referral systems, enhancing transportation services, and promoting community engagement.

4. Monitor and evaluate: Continuously monitor and evaluate the implementation of the recommendations. Collect data on the indicators identified in step 1 to assess the impact of the interventions on improving access to maternal health. This can be done through surveys, interviews, and data collection from healthcare facilities and relevant government agencies.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations. Compare the baseline data with the post-intervention data to determine the changes in the indicators. This can be done using statistical analysis techniques such as regression analysis, chi-square tests, and t-tests.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any gaps or areas for improvement and make recommendations for further interventions or modifications to existing strategies.

7. Disseminate the findings: Share the findings of the impact assessment with relevant stakeholders, including healthcare providers, policymakers, and community members. Use the findings to advocate for further investment and support for initiatives aimed at improving access to maternal health.

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