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Physical activity and sedentary time in a rural adult population in Malawi compared with an age-matched US urban population
  1. Michael Pratt1,
  2. James F Sallis2,
  3. Kelli L Cain2,
  4. Terry L Conway2,
  5. Amparo Palacios-Lopez3,
  6. Alberto Zezza3,
  7. Chad Spoon2,
  8. Carrie M Geremia2,
  9. Isis Gaddis3,
  10. Akuffo Amankwah3,
  11. Jed Friedman3,
  12. Talip Kilic3
  1. 1Institute for Public Health, University of California, San Diego, La Jolla, California, USA
  2. 2Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
  3. 3World Bank Group, Washington, District of Columbia, USA
  1. Correspondence toMichael Pratt; mipratt{at}ucsd.ed


Objectives This study was designed to assess patterns of objectively measured physical activity (PA) and sedentary behaviour in a sample of adults in a rural setting from a low-income Sub-Saharan African country (Malawi). The patterns of PA and sedentary behaviour in Malawi were compared with US data collected and analysed using the same methodology.

Methods The Malawi PA data were collected as part of a survey experiment on the measurement of agricultural labor conducted under the World Bank Living Standards Measurement Study program. ActiGraph accelerometers (model GT3X) were worn on the right hip in a household-based sample of 414 working-age adults (15–85 years).

Results Mean total and 95% CIs for PA by category in min/day for Malawi adults were: sedentary 387.6 (377.4–397.8), low-light 222.1 (214.7–229.5), high-light 136.3 (132.7–139.9), moderate 71.6 (68.8–74.5), vigorous 1.1 (0.5–1.8) and moderate-to-vigorous physical activity (MVPA) 72.8 (69.7–75.9). Mean of PA and sedentary behavior (min/day) summed across age and sex groups are compared between Malawi and US samples: sedentary behaviour, 387.6 vs 525.8 (p<0.001); low-light, 222.1 vs 217.0 (p=ns); high-light, 136.3 vs 45.6 (p<0.001); moderate, 71.6 vs 28.0 (p<0.001); vigorous, 1.1 vs 2.5 (p<0.001); MVPA, 72.8 vs 30.5 (p<0.001). Compared with the USA, Malawi participants averaged consistently less sedentary time/day and more minutes/day in all intensity levels of PA, except for low-light and vigorous PA.

Conclusion Overall, levels of MVPA and high-light activity in adults in Malawi were substantially higher and sedentary time was substantially lower than those observed in US samples using near identical data collection, scoring and analysis.

  • Physical activity
  • sedentary
  • epidemiology

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  • Contributors JF, TK, JFS, AZ, and MP conceived the idea for this study. The entire author team was involved in study design and implementation. TLC and KLC led the statistical analysis with input and review from all authors. MP, JFS, TLC and KLC drafted the manuscript and all authors contributed to reviewing and editing. All authors approved the final version of the paper and are accountable for all aspects of the work. MP served as the guarantor for the submission. The findings, interpretations and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organisations, or those of the Executive Directors of the World Bank or the governments they represent.

  • Funding The ‘Measuring Welfare Well – Malawi Physical Activity Tracking Subcomponent’ project was funded as contract number 1240680 by the World Bank.

  • Competing interests None declared.

  • Patient consent for publication Patients or the public were involved in the design, or conduct, or reporting, or dissemination plans of our research, providing feedback on survey design and protocol.

  • Ethics approval The US-based studies providing comparison data were approved by the Institutional Review Boards at the academic institutions that participated in conducting the US research (San Diego State University protocol #s: 2179, 1294, 2203; University of California San Diego protocol #s: 121250X, 130615, 121232). The World Bank does not require institutional ethics approval for household surveys, however, informed consent was received from all survey participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The requests for the anonymised, unit-record data that would be required to replicate the analyses presented in this paper should be directed to Talip Kilic (Senior Economist, World Bank,, ORCID:

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