Association of built environment constructs and physical activity among children and adolescents in Africa: a systematic review and meta-analysis

Objective: The objective of this review was to synthesize the association between built environment constructs and physical activity among children and adolescents in Africa. Introduction: Previous reviews have found that several built environment constructs, such as residential density, crime safety, and availability of physical activity facilities and infrastructure, are associated with physical activity in children and adolescents; however, these reviews have tended to focus on non-African countries. Therefore, this systematic review synthesized the association between the built environment and physical activity among children and adolescents in Africa. Inclusion criteria: This systematic review included comparative observational studies that assessed the relationship between built environmental constructs and physical activity among children and adolescents (between the ages of 5 and 19 years) in Africa. Methods: Comprehensive electronic searches of MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, SPORTDiscus, EThOS, and ProQuest Dissertations and Theses from inception to October 22, 2021, were conducted to identify relevant published and unpublished studies. Two reviewers independently screened papers, assessed the quality of the included studies using the JBI standard critical appraisal tool, and extracted data using a pre-piloted form. Where possible, data were synthesized using random effects meta-analyses, with effect sizes reported as mean differences (MDs) with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the findings. Results: Of the 10,706 identified records, six cross-sectional studies were included, which comprised 4628 children and adolescents. Three of the studies had a high-quality score of 7 or 8 out of 8. Seven built environment constructs were reported within the included studies, namely, residential density, street connectivity, crime safety, availability of physical activity facilities and infrastructure, walkability, esthetics, and traffic safety. Three of the constructs were assessed with objective measures. Results from individual studies found significant associations between physical activity and objective measure of traffic safety (MD 2.63 minutes per day; 95% CI 0.16 to 5.1; one study) and an objective measure of crime safety (MD 2.72 minutes per day; 95% CI 0.07 to 5.37; one study). No significant associations were found between active transportation and any of the built environment constructs. The GRADE evidence for all of the assessed constructs was either low (the built environment constructs may lead to little or no difference in physical activity or active transportation) or very low (it was uncertain whether the built environment constructs affect physical activity). Conclusion: In African settings, the evidence base for the association between built environment constructs and physical activity is limited, with no consistent evidence of an association. Therefore, further high-quality studies should be conducted before firm conclusions can be drawn. Systematic review registration number: PROSPERO CRD42019133324