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Long KZ, Beckmann J, Lang C, Seelig H, Nqweniso S, Probst-Hensch N, Pühse U, Steinmann P, Randt RD, Walter C, Utzinger J, Gerber M. Randomized Trial to Improve Body Composition and Micronutrient Status Among South African Children. Am J Prev Med 2024; 66:1078-1088. [PMID: 38309672 DOI: 10.1016/j.amepre.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Physical activity (PA) promotion combined with multimicronutrient supplementation (MMNS) among school-age children may reduce fat mass accrual and increase muscle mass through different mechanisms and so benefit child health. This study determined the efficacy of combined interventions on body composition among South African schoolchildren and determined if micronutrients mediate these effects. STUDY DESIGN Longitudinal cluster randomized controlled trial of children followed from 2019 to 2021. Statistical analyses carried from 2022 to 2023. SETTING/PARTICIPANTS A total of 1,304 children 6-12 years of age recruited from public schools in Gqeberha, South Africa. INTERVENTION Children were randomized by classes to either: (a) a physical activity group (PA); (b) a MMNS group; (c) a physical activity + multimicronutrient supplementation group (PA + MMNS); and (d) a placebo control group. MAIN OUTCOME MEASURES Trajectories of overall and truncal fat free mass (FFM) and fat mass (FM) estimates in modeled at 9 and 21 months using latent growth curve models (LGCM). Changes in micronutrient concentrations at 9 months from baseline. RESULTS An increased FFM trajectory was found among children in the MMNS arm at 9 months (Beta 0.16, 95% CI = 0.12, 0.31). The PA and MMNS arms both had positive indirect effects on this trajectory at 9 months (Beta 0.66, 95% CI = 0.44, 0.88 and Beta 0.32 95% CI = 0.1 0.5, respectively) and similarly at 21 months when mediated by zinc concentration changes. A reduced FM trajectory was found among children in the PA promotion arm at 9 months when using this collection point as the referent intercept. This arm was inversely associated with the FM trajectory at 9 months when mediated by zinc changes. CONCLUSIONS PA and MMNS promotion in school-based interventions directly contributed to reductions in FM and increased FFM among South African children and indirectly through changes in micronutrient status. TRIAL REGISTRATION ISRCTN, ISRCTN29534081. Registered on August 9, 2018 Institutional review board: Ethikkommission Nordwest- und Zentralschweiz" (EKNZ, project number: Req-2018-00608). Date of approval: 2018.
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Affiliation(s)
- Kurt Z Long
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
| | - Johanna Beckmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Ntimana CB, Seakamela KP, Mashaba RG, Maimela E. Determinants of central obesity in children and adolescents and associated complications in South Africa: a systematic review. Front Public Health 2024; 12:1324855. [PMID: 38716247 PMCID: PMC11075369 DOI: 10.3389/fpubh.2024.1324855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/19/2024] [Indexed: 05/23/2024] Open
Abstract
Background Central obesity in children is a global health concern associated with cardiovascular risk factors. In 2019 the World Obesity Federation predicted that in 2025, 206 million children and adolescents aged 5 to 19 will be obese, and the number is estimated to reach 254 million by 2030. There is limited literature on the factors that are associated with the development of central obesity in children. We report a systematic review, aimed to describe the current literature on determinants of central obesity and its associated health outcomes in children and adolescents in the South African population. Methods We searched for peer-reviewed studies in Google Scholar, PubMed, and Science Direct search engines, and about seven studies were included. This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42023457012). This systematic review was conducted and reported according to an updated version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The quality of the included studies was assessed by following guidelines from the Newcastle-Ottawa Scale (NOS). The method considered three main domains: selection, comparability, and outcome across different study designs. Results The prevalence of central obesity in children and adolescents by waist-to-height ratio (WHtR) ranged from 2.0 to 41.0%; waist-to-hip [WHR ranged from 10 to 25%; waist circumference (WC) ranged from 9 to 35%]. Central obesity was associated with age, physical inactivity, gender socio, and demographic profiles of the household. Central obesity in children was associated with cardiovascular diseases and mental health issues. Conclusion Central obesity in children and adolescents was determined by gender, pubertal development, and age of the parents, households with high socioeconomic status, dietary practices, and overweight/obesity. Given the high prevalence of central obesity in children which can ultimately result in cardiometabolic diseases, cardiovascular risk factors, and mental health issues. This highlights the need for systems, jointly initiated by healthcare providers, policymakers, and the general society aimed at reducing the burden of central obesity such as introducing children and adolescents to health-promoting lifestyles.
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Affiliation(s)
- Cairo Bruce Ntimana
- DIMAMO Population Health Research Centre, University of Limpopo, Sovenga, South Africa
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Madela SLM, Harriman NW, Sewpaul R, Mbewu AD, Williams DR, Sifunda S, Manyaapelo T, Nyembezi A, Reddy SP. Area-level deprivation and individual-level socioeconomic correlates of the diabetes care cascade among black south africans in uMgungundlovu, KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0293250. [PMID: 38079422 PMCID: PMC10712896 DOI: 10.1371/journal.pone.0293250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa's rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid's institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.
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Affiliation(s)
| | - Nigel Walsh Harriman
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ronel Sewpaul
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Anthony David Mbewu
- Department of Internal Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - David R Williams
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of African and American Studies, Harvard University, Cambridge, Massachusetts, United States of America
| | - Sibusiso Sifunda
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | | | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Mank I, De Neve JW, Mauti J, Gyengani GA, Somé PA, Shinde S, Fawzi W, Bärnighausen T, Vandormael A. Prevalence of Obesity and Anemia Among Early Adolescents in Junior Secondary Schools: A Cross-Sectional Study in Ouagadougou, Burkina Faso. THE JOURNAL OF SCHOOL HEALTH 2022; 92:1081-1095. [PMID: 35989492 DOI: 10.1111/josh.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/01/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The school presents an ideal environment to positively impact the long-term health and nutrition outcomes of early adolescents, who are at risk of obesity and anemia. METHODS In this cross-sectional survey, we described differences in weight and anemia by sociodemographic, diet and physical activity indicators among 1059 students aged 11 to 15 years from 22 junior secondary schools in Ouagadougou, Burkina Faso. Weight was based on body mass index (BMI) z-scores according to the WHO reference and anemia status was defined by standardized hemoglobin (Hb) measure cut-offs. We calculated dietary diversity scores (DDS) from a 24-hour dietary recall and a global diet quality score (GDQS) from a 7-day dietary recall. RESULTS The prevalence of obesity (5%) and anemia (50%) was relatively high among the students, which differed significantly between gender, household wealth and school grade, but not age groups. Eighteen percent of the female adolescents were overweight or obese and 22% were moderately anemic compared to 13% and 16% of the male adolescents. Dietary diversity was significantly different between weight categories, but not anemia status. For physical activity, those taking transportation to school were significantly more likely to be overweight or obese. In adjusted multivariable Poisson regression analyses, only the DDS was significantly associated with thinness and both thinness and anemia, while taking transportation to school was significantly associated with overweight among adolescents. CONCLUSION We encourage the promotion of school-based interventions and provision of a curriculum on health and healthy eating in order to reduce obesity, anemia, and its comorbidities.
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Affiliation(s)
- Isabel Mank
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, German Institute for Development Evaluation (DEval), Fritz-Schaeffer-Str. 26, Bonn, 53113, Germany
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Joy Mauti
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | | | - Paul-André Somé
- Nanebor Consult Sarl, 06 BP 10518, Ouagadougou, 06, Burkina Faso
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115
| | - Wafaie Fawzi
- Department of Global Health and Population/Department of Epidemiology/Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany/Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, Africa Health Research Institute (AHRI), Africa Centre Building, Via R618 to Hlabisa, Somkhele, P.O. Box 198, Mtubatuba, 3935, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Moore AR, Ta A, Lawson M, Amey F. Uptake of HIV testing among aging adults in Agincourt, South Africa: perception of community, social network, and individual characteristics. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:23-31. [PMID: 35361067 PMCID: PMC9298481 DOI: 10.2989/16085906.2022.2034656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This cross-sectional study examined the impact of perception of community, social network and individual variables on the likelihood of voluntary HIV testing of people 40 years and older living in Agincourt, South Africa. The data came from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in SA (HAALSI) Cohort from Agincourt. We applied three logistic regression models. Results showed that voluntary uptake of HIV testing was significantly associated with two network factors, namely friendships within the network and frequency of fighting in the network. At the community level, attachment to place was significantly associated with voluntary testing, while at the individual level, education, sexual behaviour, employment and age were significantly associated with the voluntary uptake of HIV testing. The implications of these findings are that age-appropriate interventions must be devised to sensitise older people in Agincourt about HIV risks. Also, leadership at the community level and in social networks must encourage members to consider voluntary testing for their own and community interests.
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Affiliation(s)
- Ami R Moore
- Department of Rehabilitation and Health Services, University of North Texas, Denton, USA,Correspondence:
| | - Anh Ta
- Department of Management, College of Business Administration, University of Nebraska, Omaha, USA
| | - Megan Lawson
- Department of Sociology, University of North Texas, Denton, USA
| | - Foster Amey
- Department of Sociology and Anthropology, Middle Tennessee State University, Murfreesboro, USA
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Kaoutar K, Chetoui A, El Kardoudi A, Boutahar K, El Moussaoui S, Chigr F, Najimi M. Eating habits, lifestyle factors and body weight status among Moroccan school adolescents (12–19 years): The case of Beni Mellal city. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2021. [DOI: 10.3233/mnm-200506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Overweight and obesity among children and adolescents are serious public health issues worldwide. A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. AIMS: This study aimed to assess the prevalence of overweight/obesity and associated factors among schoolchildren aged 12–19 years at Beni Mellal city, Morocco. METHODS: A school based cross sectional study was carried out. A total of 516 children were included in the study. The nutritional status was classified according to the reference curves of WHO (2007). Multivariable logistic regression analysis was used to identify factors associated with overweight/obesity. The association between dependent and independent variables were assessed using odds ratio with 95% confidence interval and p value < 0.05 was considered statistically significant. RESULTS: The prevalence of overweight was 12.40% and that of obesity was 5.20%. Overweight and obesity were statistically associated with gender (Odds Ratio (OR) = 10.15[95% CI 1.37–3.81], p = 0.001); skipping breakfast (OR = 9.19 [95% CI 1.42–5.17], p = 0.002) and eating cake, pastry and biscuit 1 to 3 times per week (OR = 4.14 [95% CI 1.02–3.25], p = 0.04) and 4 or more times a week (OR = 7.83 [95% CI 1.31–4.66], p = 0.005). CONCLUSIONS: This study revealed that prevalence of overweight/obesity among school-aged children in Beni Mellal city was high. Thus, promoting healthy dietary practices, particularly improving fruit and vegetable intake is essential to reduce the burden of overweight and obesity. Furthermore, it is important to strengthen nutrition education about avoiding junk food consumption and encouraging regular physical activity.
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Affiliation(s)
- K. Kaoutar
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - A. Chetoui
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - A. El Kardoudi
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - K. Boutahar
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - S. El Moussaoui
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
- Mohamed VI Hospital University, Marrakesh, Morocco
| | - F. Chigr
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - M. Najimi
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
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Debeila S, Modjadji P, Madiba S. High prevalence of overall overweight/obesity and abdominal obesity amongst adolescents: An emerging nutritional problem in rural high schools in Limpopo Province, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34082550 PMCID: PMC8182488 DOI: 10.4102/phcfm.v13i1.2596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND As the gap in nutritional profiles between urban and rural rapidly reduces because of nutrition transition, rural adolescents are likely to engage in urban lifestyle behaviours. AIM The study determined the prevalence of overweight/obesity amongst adolescents in rural high schools and the association with selected factors. SETTING Fetakgomo Municipality in rural Limpopo Province, South Africa. METHODS A cross-sectional study was conducted amongst 378 adolescents selected through multistage sampling from high schools. Data collected were socio-demography, nutritional knowledge, dietary practices and anthropometry. The International Obesity Task Force age and sex-specific body mass index (BMI) cut-off values were used to determine overweight/obesity, whilst adult BMI cut-off values were used for those ≥ 18 years. Waist-to-height ratio (WHtR) greater than 0.5 indicated abdominal obesity, as well as waist circumference (WC) and waist-to-hip ratio (WHR) above the cut-off values. RESULTS The proportion of overweight/obesity amongst adolescents was 35%, whilst 25% had abdominal obesity by WHR and 21% by WHtR. Multivariate logistic regression showed that being a girl (AOR = 2.9, 95% CI: 1.74-4.85), older adolescent (AOR = 3.1, 95% CI: 1.57-6.29) and living in a household with employed adults (AOR = 2.3, 95% CI: 1.19-4.51) were associated with increased odds of being overweight/obese. Eating breakfast was associated with reduced odds of being overweight/obese (AOR = 0.6, 95% CI: 0.34-0.97). CONCLUSION Overweight/obesity and abdominal obesity amongst adolescents were more prevalent than underweight. The Integrated School Health Programme should have clear guidelines on food items served and sold at schools.
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Affiliation(s)
- Sego Debeila
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa.
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Danquah FI, Ansu-Mensah M, Bawontuo V, Yeboah M, Kuupiel D. Prevalence, incidence, and trends of childhood overweight/obesity in Sub-Saharan Africa: a systematic scoping review. Arch Public Health 2020; 78:109. [PMID: 33292679 PMCID: PMC7599109 DOI: 10.1186/s13690-020-00491-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The growing burden of non-communicable diseases (NDC), particularly in low-and middle-income countries, poses a significant threat to global health. Obesity and overweight constitute major risk factors of NCDs such as heart diseases, diabetes, and kidney disease, and as a result, contribute significantly to the development of chronic morbidities, reduced quality of life, and increased risk of premature death. This study described evidence on the prevalence, incidence, and trends of childhood overweight and obesity in sub-Sahara Africa (SSA). METHODS We conducted a systematic scoping review employing the Arksey and O'Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute guidelines. To obtain relevant published articles for this review, we performed a comprehensive keywords search in PubMed, Google Scholar, Web of Science, and CINAHL via EBSCOhost platform for studies published between 2009 and June 2019. Guided by the eligibility criteria, title and abstracts, as well as the full-text articles were independently screened in parallel by two investigators. All relevant data were independently extracted by two investigators using a piloted form designed in Microsoft and thematic analysis conducted. RESULTS Of the 81 included studies obtained from 250,148 potentially eligible articles, the majority (25) conducted in South Africa followed by 18 in Nigeria. Six studies were conducted in Ethiopia (6), Tanzania (5), Kenya (4), Cameroon (4), Ghana (3), Uganda (2), Mozambique (2), and Sudan (2). One study each was conducted in Botswana, Gambia, Lesotho, Mauritius, Seychelles, Togo, and Zimbabwe. The remaining three articles were multi-country studies. Most (81.5%) of the included studies were cross-sectional surveys and the majority (79) focused on both male and female participants. The majority (80/81) of the included studies reported on the prevalence of childhood overweight/obesity, 8 on the trends of childhood overweight/obesity, and one presented evidence on the incidence of childhood overweight and obesity in SSA. CONCLUSION This review demonstrates limited studies on childhood overweight/obesity in most SSA countries although the included studies suggest an increasing burden. Considering the consequences of childhood obesity, there is a need for more primary researches to inform policies decision and implementation to halt the rise of childhood obesity/overweight in SSA.
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Affiliation(s)
- Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Matilda Yeboah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students. Rev Epidemiol Sante Publique 2020; 68:295-301. [PMID: 32896444 DOI: 10.1016/j.respe.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Overweight and obesity in children and adolescents have become a major public health problem affecting most countries worldwide. The purpose of the study was to assess the prevalence and risk factors of overweight and obesity among public high school students in Eastern Morocco. METHODS A cross-sectional survey was conducted between February and May 2014 among a sample of 2271 students (1086 girls and 1185 boys). References from the International Obesity Task Force (IOTF) were used to determine the prevalence of overweight and obesity. RESULTS The prevalence of overweight and obesity reached 12.2% (14.2% in girls vs 10.4% in boys, P<0.01) and 3.0% (3.1% in girls vs 2.8% in boys), respectively. Risk factors associated with overweight and obesity were urban residence (OR=1.76; [1.18-2.63]; P<0.01), father's income≥5000MAD (OR=1.32; [1.02-1.70]; P<0.05), father's overweight (including obesity) (OR=1.87; [1.38-2.54]; P<0.001) and female sex (OR=1.31; [1.02-1.68]; P<0.05). CONCLUSION The prevalence of overweight/obesity has reached an alarming rate among high school students in the Eastern region of Morocco. The findings of the present study suggest an urgent need to set up a strategy to prevent and combat this epidemic.
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Danquah FI, Ansu-Mensah M, Bawontuo V, Yeboah M, Udoh RH, Tahiru M, Kuupiel D. Risk factors and morbidities associated with childhood obesity in sub-Saharan Africa: a systematic scoping review. BMC Nutr 2020; 6:37. [PMID: 32884829 PMCID: PMC7460801 DOI: 10.1186/s40795-020-00364-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The rising burden of childhood obesity is a major public health concern, particularly in sub-Saharan Africa (SSA), where most health systems are weak and least prepared for complications that may arise. While the need for preventive action is increasingly recognized, policy implementation within the sub-region has often been inadequate, non-systematic, and ad hoc. This study described evidence on the risk factors and morbidities associated with childhood obesity in SSA. METHODS Guided by the Arksey and O'Malley framework incorporating the Levac et al. recommendations, and the Joanna Briggs Institute guidelines, we conducted a scoping study to address the research question. Thorough keywords systematic search was conducted for potentially eligible articles in PubMed, Google Scholar, Web of Science, and CINAHL published between 2009 and June 2019. Articles obtained were screened independently by two investigators at the abstract and full text phases using the eligibility criteria. All relevant data were extracted by two investigators in parallel and thematic analysis conducted. RESULTS A total of 337,229 articles were obtained from the database search of which 68 satisfied the inclusion criteria and were included for data extraction. These 68 included studies were conducted in 19 countries with the majority, 27.9% (19/68) from South Africa followed by Nigeria with 20.6% (14/68). Six of the included studies were conducted in Ethiopia, 5 studies in Kenya, 4 studies each in Tanzania and Cameroon, and 2 studies each in Ghana, Uganda, and Sudan. Of the 68 included studies, one each was conducted in Botswana, Gambia, Lesotho, Mauritius, Mozambique, Seychelles, Togo, and Zimbabwe. Most (80.9%) of the included studies were cross-sectional, and only one was an intervention trial. Of the 68 included studies, 53 reported on risk factors, 12 reported on morbidities, and 3 reported both risk factors and morbidities. We found no evidence in almost 60% (28/47) of countries included in the World Health Organisation Africa region. CONCLUSION This review findings suggest a paucity of literature on the risk factors of childhood obesity and morbidities in most SSA countries. Hence, there is the need to intensify research efforts, especially experimental study designs using innovative strategies to promote healthy lifestyle choices that will prevent or minimize the risks and health consequences of childhood obesity in SSA.
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Affiliation(s)
- Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Matilda Yeboah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Roseline H. Udoh
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Mohammed Tahiru
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Research for Sustainable Development Consult, Sunyani, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
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Taklual W, Baye S, Mekie M, Andualem T. Double Burden of Malnutrition among Female Adolescent Students in Bahir Dar City, Amhara, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6249524. [PMID: 32879884 PMCID: PMC7448125 DOI: 10.1155/2020/6249524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Globally, nearly a third of the population suffers from at least one form of malnutrition. Both over- and undernutrition are a growing concern in developing countries particularly among female adolescents. This study was aimed at assessing nutritional status and associated factors among female adolescents in secondary schools of Bahir Dar City, Amhara, Ethiopia, 2019. METHODS A school-based cross-sectional study was conducted in secondary schools of Bahir Dar City among 682 female adolescent students in 2019. A simple random sampling technique with proportional allocation was used to select study participants. Data were collected using a self-administered questionnaire. Data were entered into Epi Info version 7.1 and analyzed by SPSS version 21. Underweight and overweight statuses of the participants were determined by using the WHO cutoff point. Bivariable and multivariable logistic regressions were used to identify the significance of association at a 95% confidence interval. P value < 0.05 was used to declare statistical significance. RESULTS In this study, the prevalence of underweight, overweight, and obesity was 15%, 8.4%, and 4.7%, respectively. Female adolescents found between age groups of 14-16.5 years old (AOR: 1.7, 95% CI: 1.03-2.69), family size ≥ 4 (AOR: 2.8, 95% CI: 1.05-4.99), participants who did not eat meat once per week (AOR: 1.6, 95% CI: 1.90-2.82), and no onset of menarche (AOR: 4.4, 95% CI: 1.21-15.75) were found to be more likely underweight. In addition, adolescents with family monthly income above 6500 Ethiopian birr (AOR: 12.7, 95% CI: 2.47-65.62), who ate meat two times and more per week (AOR: 2.07, 95% CI: 1.47-9.14), and who ate fruit at least once a week (AOR: 0.20, 95% CI: 0.05-0.78) were more likely to be overweight compared with counterparts. Conclusion and Recommendation. The prevalence of underweight and overweight was found to be high. Design evidence-based adolescent nutritional intervention shall be emphasized by the government and other concerned bodies to avert the dual burden of malnutrition.
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Affiliation(s)
- Wubet Taklual
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sewunet Baye
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Maru Mekie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tesfaye Andualem
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Salari-Moghaddam A, Hajihashemi P, Basirat R, Mousavi SM, Salehi-Abargouie A, Larijani B, Esmaillzadeh A. Household socioeconomic status in relation to childhood general and central obesity in Farrokhshahr, Iran. ARYA ATHEROSCLEROSIS 2020; 15:211-217. [PMID: 31949447 PMCID: PMC6954359 DOI: 10.22122/arya.v15i5.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although the association between socioeconomic status (SES) and general/central obesity has extensively been examined, limited data are available in this regard among children. The aim of this study was to examine the association between household SES and obesity among children. METHODS This cross-sectional study was done in Farrokhshahr, Iran, among primary school children aged 6-12 years in 2009. SES was examined using participants' and their parents' oral responses to a pretested questionnaire. In the current study, participants were classified based on tertiles of SES score to low, medium, and high SES categories. General as well as central obesity was defined based on age- and sex-specific national cut-off points. RESULTS Comparing individuals in the highest versus lowest tertile of SES, there was no significant difference in mean waist circumference (WC), but those in the middle tertile of SES had greater means of body mass index (BMI) than those in the lowest tertile after controlling for potential confounders (16.19 ± 0.27 vs. 15.27 ± 0.27 kg/m2, P = 0.002). We observed a greater chance of general obesity for those in the highest tertile of SES compared with those in the lowest tertile [odds ratio (OR): 4.00, 95% confidence interval (CI): 1.53-10.59, Ptrend = 0.004]. No significant association was seen between SES and central obesity, either before or after controlling for potential confounders. CONCLUSION We found that children in the highest SES class had a greater chance of general obesity than those in the lowest SES class. There was no significant association between SES and central obesity.
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Affiliation(s)
- Asma Salari-Moghaddam
- PhD Candidate, Students Scientific Research Center AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Hajihashemi
- PhD Candidate, Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reyhane Basirat
- PhD Candidate, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Mousavi
- PhD Candidate, Students Scientific Research Center AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Salehi-Abargouie
- Assistant Professor, Nutrition and Food Security Research Center AND Department of Nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bagher Larijani
- Professor, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Professor, Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran AND Food Security Research Center AND Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Esan TA, Schepartz LA. Does nutrition have an effect on the timing of tooth formation? AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 171:470-480. [DOI: 10.1002/ajpa.23987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Temitope A. Esan
- Faculty of DentistryObafemi Awolowo University Ile‐Ife Nigeria
- Human Variation and Identification Unit, School of Anatomical Sciences, Faculty of Health SciencesUniversity of the Witwatersrand Johannesburg South Africa
| | - Lynne A. Schepartz
- Human Variation and Identification Unit, School of Anatomical Sciences, Faculty of Health SciencesUniversity of the Witwatersrand Johannesburg South Africa
- University of Pennsylvania Museum of Archaeology and Anthropology, Physical Anthropology and Mediterranean Sections Philadelphia Pennsylvania
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Turbeville A, Aber JL, Weinberg SL, Richter L, van Heerden A. The relationship between multidimensional economic well-being and children's mental health, physical health, and executive function development in South Africa. Dev Sci 2019; 22:e12846. [PMID: 31070839 DOI: 10.1111/desc.12846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
Abstract
Conceptualizing both economic well-being (EWB) and children's development as multidimensional constructs, the present study examines their association using bioecological developmental theory and structural equation modeling with Zulu children (ages 7-10) in KwaZulu-Natal, a highly impoverished region of South Africa (N = 1,958). Relative EWB within impoverished communities consists of three dimensions: material assets (durable goods and living environment), fiscal appraisal (subjective experiences of access to/allocation of resources), and fiscal capacity (monetary inflow/outflow). Children's development also is measured across multiple dimensions: physical health, mental health, and executive functioning. In addition to an overall association between EWB and children's development across outcomes, the sub-dimensions of EWB are differentially related to aspects of children's development. The dimension of material assets exhibits the greatest association with child outcomes, while fiscal capacity exhibits the least. Implications of these findings are discussed, including the use of multidimensional approaches to measuring EWB to understand, more clearly, its relationship to multiple dimensions of children's development. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=ZcawZ6oOt-Q.
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Affiliation(s)
| | - J Lawrence Aber
- NYU Global TIES, New York University, New York City, New York
| | | | - Linda Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Alastair van Heerden
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.,Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa
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Wrottesley SV, Pedro TM, Fall CH, Norris SA. A review of adolescent nutrition in South Africa: transforming adolescent lives through nutrition initiative. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1607481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Titilola M Pedro
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline H Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
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Araújo FG, Velasquez-Melendez G, Felisbino-Mendes MS. Prevalence trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age based on sociodemographic characteristics. Health Care Women Int 2019; 40:386-406. [PMID: 30986134 DOI: 10.1080/07399332.2019.1570516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The authors estimated the prevalence and trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age. A time series was constructed with Vigitel data from 2008 to 2015 and we analyzed trends of the prevalence of these conditions, considering sociodemographic characteristics. We observed an increasing trend in prevalence of overweight, obesity, and diabetes (for some sociodemographic characteristics), and stationary trends for hypertension. Our results highlight the need for early interventions in lifestyle of this population to reduce the NCDs risk factors burden and potentially contribute to improve maternal and neonatal outcomes and reduce the NCDs load.
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Affiliation(s)
- Fernanda Gontijo Araújo
- a Programa de Pós-Graduação em Enfermagem , Escola de Enfermagem, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Gustavo Velasquez-Melendez
- b Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem , Universidade Federal de Minas Gerais , Belo Horizonte, Minas , Brazil
| | - Mariana Santos Felisbino-Mendes
- b Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem , Universidade Federal de Minas Gerais , Belo Horizonte, Minas , Brazil
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Climate Change and Healthcare Sustainability in the Agincourt Sub-District, Kruger to Canyons Biosphere Region, South Africa. SUSTAINABILITY 2019. [DOI: 10.3390/su11020496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As low-income communities are most vulnerable to climate-associated health concerns, access to healthcare will increase in importance as a key priority in South Africa. This study explores healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region in Mpumalanga, South Africa. A rapid assessment and response methodology (RAR) was implemented, which includes the examination of previous studies conducted in the sub-district, the mapping of healthcare facilities in the area, and the implementation of a facility infrastructure and workforce capacity investigation by means of key informant (KI) interviews at eight healthcare facilities. Findings indicate that the greatest need across the facilities relate to access to medical doctors and pharmacists. None of the facilities factored climate associations with health into their clinical care strategies. The necessity to train healthcare facility staff on aspects related to climate change, health, and sustainability is highlighted. Environmental health practitioners should also be incorporated in grassroots community climate adaptation strategies. Outcomes further indicate the need for the advancement of integrated healthcare and climate adaptation strategies that focus on strengthening healthcare systems, which may include novel technological approaches such as telemedicine. Policy makers need to be proactive and pre-emptive in finding and improving processes and models to render healthcare services prepared for climate change.
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Said-Mohamed R, Prioreschi A, Nyati LH, van Heerden A, Munthali RJ, Kahn K, Tollman SM, Gómez-Olivé FX, Houle B, Dunger DB, Norris SA. Rural-urban variations in age at menarche, adult height, leg-length and abdominal adiposity in black South African women in transitioning South Africa. Ann Hum Biol 2018; 45:123-132. [PMID: 29557678 PMCID: PMC5964443 DOI: 10.1080/03014460.2018.1442497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The pre-pubertal socioeconomic environment may be an important determinant of age at menarche, adult height, body proportions and adiposity: traits closely linked to adolescent and adult health. Aims: This study explored differences in age at menarche, adult height, relative leg-length and waist circumference between rural and urban black South African young adult women, who are at different stages of the nutrition and epidemiologic transitions. Subjects and methods: We compared 18–23 year-old black South African women, 482 urban-dwelling from Soweto and 509 from the rural Mpumalanga province. Age at menarche, obstetric history and household socio-demographic and economic information were recorded using interview-administered questionnaires. Height, sitting-height, hip and waist circumference were measured using standardised techniques. Results: Urban and rural black South African women differed in their age at menarche (at ages 12.7 and 14.5 years, respectively). In urban women, a one-year increase in age at menarche was associated with a 0.65 cm and 0.16% increase in height and relative leg-length ratio, respectively. In both settings, earlier age at menarche and shorter relative leg-length were independently associated with an increase in waist circumference. Conclusions: In black South African women, the earlier onset of puberty, and consequently an earlier growth cessation process, may lead to central fat mass accumulation in adulthood.
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Affiliation(s)
- Rihlat Said-Mohamed
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa
| | - Alessandra Prioreschi
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa
| | - Lukhanyo H Nyati
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa
| | - Alastair van Heerden
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa.,b Human and Social Development Research Programme , Human Sciences Research Council , Pretoria , South Africa
| | - Richard J Munthali
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa
| | - Kathleen Kahn
- c MRC/Wits Rural Public Health and Health Transitions Research Unit , School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg Parktown , South Africa.,d INDEPTH Network , Accra , Ghana.,e Umeå Centre for Global Health Research , Umeå University , Umeå , Sweden
| | - Stephen M Tollman
- c MRC/Wits Rural Public Health and Health Transitions Research Unit , School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg Parktown , South Africa.,d INDEPTH Network , Accra , Ghana.,e Umeå Centre for Global Health Research , Umeå University , Umeå , Sweden
| | - Francesc Xavier Gómez-Olivé
- c MRC/Wits Rural Public Health and Health Transitions Research Unit , School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg Parktown , South Africa.,d INDEPTH Network , Accra , Ghana
| | - Brian Houle
- c MRC/Wits Rural Public Health and Health Transitions Research Unit , School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg Parktown , South Africa.,f School of Demography , The Australian National University , Acton , Australia
| | - David B Dunger
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa.,g Department of Paediatrics , University of Cambridge , Cambridge , UK
| | - Shane A Norris
- a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa
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Kambondo G, Sartorius B. Risk Factors for Obesity and Overfat among Primary School Children in Mashonaland West Province, Zimbabwe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E249. [PMID: 29393863 PMCID: PMC5858318 DOI: 10.3390/ijerph15020249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 12/16/2022]
Abstract
Associated childhood obesity risk factors are not well established in developing countries such as Zimbabwe and this information is essential for tailored intervention development. This study aimed to identify prominent risk factors for overweight/obese and overfat/obese among primary school children of Mashonaland West Province in Zimbabwe. A school-based cross-sectional study was conducted using multi-stage random cluster sampling approach (30 × 30). Bivariate and multivariable logistic regression was employed and identified the risk factors for overweight/obese and overfat/obese. A total of 974 participants were enrolled in the study. Prominent significant risk factors of overweight/obese after multivariable adjustment were higher socio-economic households; parental diabetes status; and living in Makonde, Zvimba, Sanyati or Mhondoro-Ngezi district as opposed to Hurungwe district. Risk factors for overfat/obese that remained statically significant were children in urban areas (aOR = 3.19, 95% CI: 2.18-4.66, p = 0.000), being one child in a household, and parents who have diabetes mellitus. Living in Makonde, Sanyati, and Zvimba district remained associated with overfat/obese compared to Hurungwe district. This study has identified prominent proximal determinants of overweight/obese and overfat/obese among primary school children in Zimbabwe, to better assist policy guidance. Aggressive education on good nutrition activities should be tailored and targeted to most affected urban areas within high-risk districts.
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Affiliation(s)
- George Kambondo
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa.
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Prevalence and factors associated with overweight and obesity among children from primary schools in urban areas of Lomé, Togo. Public Health Nutr 2018; 21:1048-1056. [DOI: 10.1017/s1368980017003664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjectiveOverweight and obesity in childhood are serious public health issues, both in developing and developed countries. The present study aimed to ascertain overweight and obesity prevalence rates among Togolese schoolchildren in Lomé, Togo, and their correlation with physical activity, socio-economic conditions and eating habits.DesignCross-sectional survey conducted in December 2015. Overweight and obesity were defined using age- and sex-specific BMI cut-off points of the International Obesity Task Force. Physical activity, socio-economic conditions and eating habits were assessed with a standardized questionnaire. Specially trained medical students interviewed children and collected the data. After bivariate regression analyses, factors associated with overweight/obesity were identified by multivariate logistic regression. Statistical significance was two-sided P<0·05.SettingLomé, Togo.SubjectsRepresentative sample of 634 children (288 boys, 346 girls), aged 8–17 years, who were studying in primary schools.ResultsOverweight and obesity respectively affected 5·2 and 1·9 % of children surveyed. Watching television (>4 h) on weekends (OR; 95 % CI: 3·8; 1·2, 12·0, P=0·02) and medium dietary diversity score (3·0; 1·1, 8·1, P=0·03) were independently associated with overweight/obesity in a multivariate regression model. Eating breakfast in the school cafeteria (0·2; 0·1, 0·8, P=0·03) and eating fruits (0·4; 0·1, 0·9, P=0·03) significantly reduced the risk of overweight/obesity.ConclusionsOverweight and obesity prevalence were linked with sedentary behaviour and non-optimal food diversity. Promoting physical activity and fruit consumption should be explored as interventions to reduce and prevent overweight and obesity in Lomé schoolchildren. In addition, preventive approaches in the social environment of children should be considered.
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Twine R, Hundt GL, Kahn K. The 'experimental public' in longitudinal health research: views of local leaders and service providers in rural South Africa. Glob Health Res Policy 2017; 2:26. [PMID: 29202094 PMCID: PMC5683227 DOI: 10.1186/s41256-017-0046-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/28/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The concept of 'experimental public' has been recently applied to publics involved in clinical trials. This term could also be applied to publics involved in longitudinal research such as health and demographic surveillance systems. The ethics of practice and public engagement with these experimental publics are of key importance and include issues of informed consent, confidentiality, collection of body tissue samples and fair local benefit. METHODS Individual (n = 11) and focus group (n = 5) qualitative semi-structured interviews were conducted with 56 local leaders and service providers regarding their views about research activities in a longitudinal health research study site run by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in rural South Africa. Deductive and inductive thematic analysis was undertaken using NVivo software to identify the emergent themes. RESULTS There was an understanding of the usefulness of collecting demographic data, but reasons for gathering other contextual data such as on food security, as well as the reasons for collection of blood was less clear. While appreciation was expressed for feedback of individual results such as blood pressure levels during home-based data collection, there were requests for more results from biomarkers, and for these to be given at home, rather than at the clinic. There were reports of indirect refusals, and offers by leaders to assist in reducing refusal rates. There were concerns about confidentiality, especially in the publication of results. Some leaders would have liked to receive more individual level data for planning of services, although they understood this would breach confidentiality. Service providers were concerned about the withdrawal of some services post intervention trials. CONCLUSIONS This experimental public has, over time, developed a nuanced understanding of the reasons for research and the procedures undertaken. Discussions concerning fair benefit ranged from requests for more individual clinically-relevant results for participants, to understanding how research results could assist in planning of public health services at local and national levels. The concerns illustrate the complexity of the ethics of practice which has implications for policy, practice and governance for those working in longitudinal health research sites globally.
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Affiliation(s)
- Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gillian Lewando Hundt
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Iqbal S, Zakar R, Zakar MZ, Fischer F. Perceptions of adolescents' sexual and reproductive health and rights: a cross-sectional study in Lahore District, Pakistan. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:5. [PMID: 28231860 PMCID: PMC5324303 DOI: 10.1186/s12914-017-0113-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/18/2017] [Indexed: 11/10/2022]
Abstract
Background Sexual and reproductive health (SRH) is a significant aspect of adolescents’ growth, safeguarded by SRH rights (SRHR). Despite various global efforts to promote adolescents SRHR (ASRHR), the majority of adolescents still lack awareness and autonomy to access SRH related information and services. This research aimed to explore the knowledge and perceptions of adolescents’ sexual and reproductive health rights and highlights key constraints hindering adolescents from accessing and exercising SRHR in the district of Lahore, Pakistan. Methods The research uses a mixed methods approach including both quantitative and qualitative methods. For quantitative component, household survey was conducted with 600 respondents including adolescents (15–19 years) and their parents/caregivers. A multistage cluster random sampling technique was performed, based on the population proportion of administrative towns in Lahore district, Pakistan. A structured interview schedule was used to collect data. Quantitative data were collected by a standardized quantitative questionnaire; analysis was performed using SPSS version 21. For qualitative data collection, 12 in-depth interviews with teachers and doctors and four focus group discussions with adolescents were conducted, and analysed using thematic areas. Results The research revealed a low level of perception of ASRHR amongst the respondents and identified socio-cultural and structural constraints as the major underlying issues. Although more than half of the respondents were found to be aware of ASRHR, agreed to their importance and were in favour for adolescents to have access to requisite information, nonetheless they believed that adolescents had limited ability to exercise these rights. Conclusions The research found a low level of perception amongst adolescents and their parents/caregivers about ASRHR in Lahore district emphasising the rights-based approach. There is an urgent need to design specific policies and educational programmes to promote healthy practices. Research is recommended to inform and advocate Punjab Government and communities, including partners, teachers, doctors, religious scholars and media groups, to empower adolescents through health education. This can be achieved through the inclusion of SRH topics in educational curricula, establishing a virtual knowledge centre, encouraging debate competitions, and organising orientation sessions for professionals/experts and community etc.
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Affiliation(s)
- Sarosh Iqbal
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan
| | - Florian Fischer
- Department of Public Health Medicine, Bielefeld University, School of Public Health, P.O. Box 100 131, 33501, Bielefeld, Germany.
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Hanson M, Barker M, Dodd JM, Kumanyika S, Norris S, Steegers E, Stephenson J, Thangaratinam S, Yang H. Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol 2017; 5:65-76. [PMID: 27743974 DOI: 10.1016/s2213-8587(16)30108-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 01/07/2023]
Abstract
Prevention of obesity in women of reproductive age is widely recognised to be important both for their health and for that of their offspring. Weight-control interventions, including drug treatment, in pregnant women who are obese or overweight have not had sufficient impact on pregnancy and birth outcomes, which suggests that the focus for intervention should include preconception or post-partum periods. Further research is needed into the long-term effects of nutritional and lifestyle interventions before conception. To improve preconception health, an integrated approach, including pregnancy prevention, planning, and preparation is needed, involving more than the primary health-care sector and adopting an ecological approach to risk reduction that addresses personal, societal, and cultural influences. Raising awareness of the importance of good health in the period before pregnancy will require a new social movement: combining bottom-up mobilisation of individuals and communities with a top-down approach from policy initiatives. Interventions to reduce or prevent obesity before conception and during pregnancy could contribute substantially to achievement of the global Sustainable Development Goals, in terms of health, wellbeing, productivity, and equity in current and future generations.
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Affiliation(s)
- Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jodie M Dodd
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Women's and Babies Division, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Shiriki Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shane Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eric Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Judith Stephenson
- Department of Reproductive Health, Institute for Women's Health, University College London, London, UK; Children, Young People and Maternal Health Programme, UCL Partners Academic Health Science Partnership, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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24
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Agyemang C, Meeks K, Beune E, Owusu-Dabo E, Mockenhaupt FP, Addo J, de Graft Aikins A, Bahendeka S, Danquah I, Schulze MB, Spranger J, Burr T, Agyei-Baffour P, Amoah SK, Galbete C, Henneman P, Klipstein-Grobusch K, Nicolaou M, Adeyemo A, van Straalen J, Smeeth L, Stronks K. Obesity and type 2 diabetes in sub-Saharan Africans - Is the burden in today's Africa similar to African migrants in Europe? The RODAM study. BMC Med 2016; 14:166. [PMID: 27769239 PMCID: PMC5075171 DOI: 10.1186/s12916-016-0709-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. METHODS A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. RESULTS In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04-13.57; women, 33.9 %; PR: 4.11, 3.13-5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98-37.84; women, 54.2 %; PR: 6.63, 5.04-8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73-5.40; women, 9.2 %; PR: 1.81, 1.25-2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50-7.98; women, 10.2 %; PR: 2.21, 1.30-3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. CONCLUSION Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Karlijn Meeks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ama de Graft Aikins
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Ghana
| | | | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism; DZHK (German Centre for Cardiovascular Research), partner site Berlin; Center for Cardiovascular Research (CCR), Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - Tom Burr
- Source BioScience, Nottingham, UK
| | - Peter Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen K Amoah
- Institute of Tropical Medicine and International Health, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,ResearchGate, Invalidenstrasse 115, D-10115, Berlin, Germany
| | - Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Peter Henneman
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD, USA
| | - Jan van Straalen
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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25
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Abstract
Food insecurity is an important issue in public health even in developed societies, particularly for vulnerable populations. Food insecurity refers to the uncertain or limited access to adequate and safe foods. Emerging evidence shows an association between food insecurity, type 2 diabetes risk factors, and management of type 1 and type 2 diabetes. A review of the current literature describing the association between food insecurity and diabetes reveals possible mechanisms and pathophysiologic pathways. There is less evidence for effective interventions, and much of the current literature is limited to cross-sectional studies. Future work should evaluate longitudinal associations and ways to help vulnerable patients with diabetes access adequate food for effective diabetes management.
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Affiliation(s)
- Utibe R Essien
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA
| | - Naysha N Shahid
- Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Seth A Berkowitz
- Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA.
- Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA, USA.
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26
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Juwara A, Huang N, Chien LY, Chen HJ. Stunting and weight statuses of adolescents differ between public and private schools in urban Gambia. Int J Public Health 2016; 61:717-726. [PMID: 27220546 DOI: 10.1007/s00038-016-0836-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/18/2016] [Accepted: 05/11/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This study assessed the disparity in nutritional status of adolescents between public and private schools in urban Gambia. METHODS This is a school-based cross-sectional study in six private and six public upper basic schools in urban Gambia. This study recruited 491 students from public and 469 students from private schools (13-15 years of age). RESULTS The prevalence of stunting (WHO height-for-age Z < -2SD) was 13.4 % for public school students and 4.5 % for private schools. After adjustment for children's sex, age, and family socioeconomic status, the differences in prevalence of stunting and underweight were significant between public and private schools. Private school students are more likely to be overweight/obese (WHO BMI-for-age Z > +1SD) (OR = 2.85, 95 % CI 1.55-5.22), but less likely to be thin (BMI-for-age Z < -2SD) (OR = 0.61 [0.39-0.96]), compared to public school students. Children from lower income families had lower odds for overweight/obese than normal weight, compared to those from higher income families (OR = 0.34 [0.15-0.76]). CONCLUSIONS Public and private schools in urban regions of the Gambia may face different nutritional challenges due to differences in school environment and resources.
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Affiliation(s)
- Alimatou Juwara
- International Health Program, National Yang-Ming University, Taipei, Taiwan
| | - Nicole Huang
- International Health Program, National Yang-Ming University, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Ying Chien
- International Health Program, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical and Community Health Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Jen Chen
- International Health Program, National Yang-Ming University, Taipei, Taiwan. .,Institute of Public Health, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St., Medical Building II, R213, Beitou District, Taipei, 112, Taiwan, ROC.
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27
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Fruhstorfer BH, Mousoulis C, Uthman OA, Robertson W. Socio-economic status and overweight or obesity among school-age children in sub-Saharan Africa - a systematic review. Clin Obes 2016; 6:19-32. [PMID: 26781602 DOI: 10.1111/cob.12130] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/14/2015] [Accepted: 11/24/2015] [Indexed: 12/24/2022]
Abstract
Childhood overweight and obesity have emerged as a public health concern in sub-Saharan Africa. We conducted a systematic review with the aim to examine the association between socio-economic status (SES) and overweight or obesity among school-age children in sub-Saharan Africa. In March 2014 we searched five electronic databases for reports which presented cross-sectional data on prevalence levels of overweight or obesity stratified by SES groups among school-age children in sub-Saharan Africa. We used a random-effect model to pool the relative indexes of inequality of the association from the individual studies. In total, 20 reports satisfied the inclusion criteria providing results of 21 datasets. The risk of overweight or obesity in children from highest SES households was 5.28 times as high as that of children from lowest SES households (95% confidence interval [CI] 2.62 to 10.66). On subgroup analysis, this association was statistically significant for household income and composite SES measures but not for parental educational attainment and occupation type. Similarly, the risk of overweight or obesity in children attending affluent (private) schools was 15.94 times as high as that of children going to either urban or rural public schools (95% CI 5.82 to 43.68). The magnitude of the association tended to be stronger for area or school-type compared with composite measures. In summary, children from higher SES households and those attending private schools tended to be overweight and obese.
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Affiliation(s)
- B H Fruhstorfer
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - C Mousoulis
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - O A Uthman
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - W Robertson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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28
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Overweight and Obesity and Associated Factors among School-Aged Adolescents in Six Pacific Island Countries in Oceania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14505-18. [PMID: 26580638 PMCID: PMC4661663 DOI: 10.3390/ijerph121114505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/01/2015] [Accepted: 09/07/2015] [Indexed: 12/15/2022]
Abstract
The aim of this study was to assess overweight and obesity and associated factors in school-going adolescents in six Pacific Island countries in Oceania. The sample included 10,424 school-going adolescents predominantly 13–16 years old from Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu. Bivariate and multivariable analyses were conducted to assess the relationship between dietary behaviour, substance use, physical activity, psychosocial factors, social-familial influences, and overweight or obesity. The prevalence of overweight and obesity was determined based on self-reported height and weight and the international child body mass index standards. Results indicate a prevalence of overweight or obesity of 24.3% and obesity of 6.1% in the six countries, ranging in terms of overweight or obesity and obesity from 12.0% and 0.4% in Vanuatu to 58.7% and 21.1% in Tonga, respectively. In multivariable regression analysis, being female was associated with overweight, carbonated soft drink use with obesity, sedentary behaviour with overweight or obesity, suicidal ideation with overweight, having close friends and peer support with overweight and obesity, parental or guardian supervision with overweight, and parental or guardian bonding was associated with overweight or obesity. High prevalence rates of overweight and obesity were found and several factors identified which can help guide interventions.
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29
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Arthur SS, Nyide B, Soura AB, Kahn K, Weston M, Sankoh O. Tackling malnutrition: a systematic review of 15-year research evidence from INDEPTH health and demographic surveillance systems. Glob Health Action 2015; 8:28298. [PMID: 26519130 PMCID: PMC4627942 DOI: 10.3402/gha.v8.28298] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022] Open
Abstract
Background Nutrition is the intake of food in relation to the body's dietary needs. Malnutrition results from the intake of inadequate or excess food. This can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity. Objective To perform a systematic review to assess research conducted by the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) of health and demographic surveillance systems (HDSSs) over a 15-year period on malnutrition, its determinants, the effects of under and over nutrition, and intervention research on malnutrition in low- and middle-income countries (LMICs). Methods Relevant publication titles were uploaded onto the Zotero research tool from different databases (60% from PubMed). Using the keywords ‘nutrition’, ‘malnutrition’, ‘over and under nutrition’, we selected publications that were based only on data generated through the longitudinal HDSS platform. All titles and abstracts were screened to determine inclusion eligibility and full articles were independently assessed according to inclusion/exclusion criteria. For inclusion in this study, papers had to cover research on at least one of the following topics: the problem of malnutrition, its determinants, its effects, and intervention research on malnutrition. One hundred and forty eight papers were identified and reviewed, and 67 were selected for this study. Results The INDEPTH research identified rising levels of overweight and obesity, sometimes in the same settings as under-nutrition. Urbanisation appears to be protective against under-nutrition, but it heightens the risk of obesity. Appropriately timed breastfeeding interventions were protective against malnutrition. Conclusions Although INDEPTH has expanded the global knowledge base on nutrition, many questions remain unresolved. There is a need for more investment in nutrition research in LMICs in order to generate evidence to inform policies in these settings.
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Affiliation(s)
- Samuelina S Arthur
- INDEPTH Network, Accra, Ghana.,Department of Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa;
| | - Bongiwe Nyide
- INDEPTH Network, Accra, Ghana.,Library Department, Systems and Technical Services, Mangosuthu University of Technology, Umlazi, Durban, South Africa.,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Abdramane Bassiahi Soura
- INDEPTH Network, Accra, Ghana.,Ouagadougou HDSS, ISSP, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Kathleen Kahn
- INDEPTH Network, Accra, Ghana.,MRC Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Osman Sankoh
- INDEPTH Network, Accra, Ghana.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Public Health, Hanoi Medical University, Hanoi, Vietnam
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30
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Nutrient patterns and their association with socio-demographic, lifestyle factors and obesity risk in rural South African adolescents. Nutrients 2015; 7:3464-82. [PMID: 25984738 PMCID: PMC4446762 DOI: 10.3390/nu7053464] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to identify and describe the diversity of nutrient patterns and how they associate with socio-demographic and lifestyle factors including body mass index in rural black South African adolescents. Nutrient patterns were identified from quantified food frequency questionnaires (QFFQ) in 388 rural South African adolescents between the ages of 11-15 years from the Agincourt Health and Socio-demographic Surveillance System (AHDSS). Principle Component Analysis (PCA) was applied to 25 nutrients derived from QFFQs. Multiple linear regression and partial R2 models were fitted and computed respectively for each of the retained principal component (PC) scores on socio-demographic and lifestyle characteristics including body mass index (BMI) for age Z scores. Four nutrient patterns explaining 79% of the total variance were identified: PCI (26%) was characterized by animal derived nutrients; PC2 (21%) by vitamins, fibre and vegetable oil nutrients; PC3 (19%) by both animal and plant derived nutrients (mixed diet driven nutrients); and PC4 (13%) by starch and folate. A positive and significant association was observed with BMI for age Z scores per 1 standard deviation (SD) increase in PC1 (0.13 (0.02; 0.24); p = 0.02) and PC4 (0.10 (-0.01; 0.21); p = 0.05) scores only. We confirmed variability in nutrient patterns that were significantly associated with various lifestyle factors including obesity.
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31
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Craig E, Reilly JJ, Bland R. Risk factors for overweight and overfatness in rural South African children and adolescents. J Public Health (Oxf) 2015; 38:24-33. [PMID: 25742718 PMCID: PMC4750520 DOI: 10.1093/pubmed/fdv016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To determine risk factors for overweight/overfatness in children and adolescents from rural KwaZulu-Natal, South Africa. Methods Anthropometric data were collected from a cross-sectional sample (n = 1519, ages 7, 11 and 15 years) and linked to demographic information (n = 1310 and n = 1317 in overweight and overfat analyses, respectively). Candidate risk factors for overweight/overfatness were identified and tested for associations with overweight (BMI-for-age >+1SD, WHO reference) and overfatness (>85th centile body fatness, McCarthy reference) as outcomes. Associations were examined using simple tests of proportions (χ2/Mann–Whitney U tests) and multivariable logistic regression. Results Sex was a consistent variable across both analyses; girls at significantly increased risk of overweight and overfatness (overweight: n = 180, 73.9 and 26.1% females and males, respectively (P < 0.0001); overfat: n = 187, 72.7 and 27.3% females and males, respectively (P < 0.0001)). In regression analyses, sex and age (defined by school grade) were consistent variables, with boys at lower risk of overweight (adjusted odds ratio (AOR) 0.40 (confidence interval (CI) -0.28–0.57)) and risk of overweight increasing with age (AOR 0.65 (CI- 0.44–0.96), 0.50 (CI-0.33–0.75) and 1.00 for school grades 1, 5 and 9, respectively). Results were similar for overfatness. Conclusions This study suggests that pre-adolescent/adolescent females may be the most appropriate targets of future interventions aimed at preventing obesity in rural South Africa.
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Affiliation(s)
- E Craig
- Section of Human Nutrition, University of Glasgow, Yorkhill Hospitals, Glasgow G3 8SJ, UK Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal 3935, South Africa
| | - J J Reilly
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1QE, UK
| | - R Bland
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal 3935, South Africa Royal Hospital for Sick Children, University of Glasgow, Glasgow G3 8SJ, UK
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32
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Draper CE, Micklesfield LK, Kahn K, Tollman SM, Pettifor JM, Dunger DB, Norris SA. Application of Intervention Mapping to develop a community-based health promotion pre-pregnancy intervention for adolescent girls in rural South Africa: Project Ntshembo (Hope). BMC Public Health 2014; 14 Suppl 2:S5. [PMID: 25080940 PMCID: PMC4120156 DOI: 10.1186/1471-2458-14-s2-s5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND South Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women. Adolescence is key to addressing trans-generational risk and a window of opportunity to intervene and positively impact on individuals' health trajectories into adulthood. Using Intervention Mapping (IM), this paper describes the development of the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the inter-generational transfer of risk of metabolic disease, in particular diabetes risk. METHODS This paper describes the application of the first four steps of IM. Evidence is provided to support the selection of four key behavioural objectives: viz. to eat a healthy, balanced diet, increase physical activity, reduce sedentary behaviour, and promote reproductive health. Appropriate behaviour change techniques are suggested and a theoretical framework outlining components of relevant behaviour change theories is presented. It is proposed that the Ntshembo intervention will be community-based, including specialist adolescent community health workers who will deliver a complex intervention comprising of individual, peer, family and community mobilisation components. CONCLUSIONS The Ntshembo intervention is novel, both in SA and globally, as it is: (1) based on strong evidence, extensive formative work and best practice from evaluated interventions; (2) combines theory with evidence to inform intervention components; (3) includes multiple domains of influence (community through to the individual); (4) focuses on an at-risk target group; and (5) embeds within existing and planned health service priorities in SA.
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Affiliation(s)
- Catherine E Draper
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Sports Science Institute of South Africa, Boundary Road, Newlands, Cape Town, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - John M Pettifor
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David B Dunger
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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33
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Muthuri SK, Francis CE, Wachira LJM, LeBlanc AG, Sampson M, Onywera VO, Tremblay MS. Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review. PLoS One 2014; 9:e92846. [PMID: 24676350 PMCID: PMC3968060 DOI: 10.1371/journal.pone.0092846] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 02/27/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts. OBJECTIVE This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa. METHODS Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included. RESULTS A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status. CONCLUSIONS This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions. PROSPERO REGISTRATION NUMBER CRD42013004399.
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Affiliation(s)
- Stella K. Muthuri
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E. Francis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Allana G. LeBlanc
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Vincent O. Onywera
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Kenyatta University, Nairobi, Kenya
| | - Mark S. Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Kenyatta University, Nairobi, Kenya
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Micklesfield LK, Pedro TM, Kahn K, Kinsman J, Pettifor JM, Tollman S, Norris SA. Physical activity and sedentary behavior among adolescents in rural South Africa: levels, patterns and correlates. BMC Public Health 2014; 14:40. [PMID: 24433276 PMCID: PMC3897951 DOI: 10.1186/1471-2458-14-40] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is increasing among children and adolescents and may be contributing to the increasing prevalence of overweight and obesity. This study examines physical activity and sedentary behavior patterns, and explores associations with individual, maternal, household, and community factors amongst rural South African adolescents. METHODS In 2009, 381 subjects, stratified by ages 11-12-years and 14-15-years, were randomly selected from 3511 children and adolescents who had participated in a growth survey two years previously. Weight and height were measured and self-reported Tanner pubertal stage was collected. A questionnaire quantifying frequency and duration of physical activity (PA) domains and sedentary time for the previous 12 months was administered. Moderate-vigorous physical activity (MVPA mins/wk) was calculated for time spent in school and club sport. Socio-demographic and other related data were included from the Agincourt health and socio-demographic system (HDSS). The Agincourt HDSS was established in 1992 and collects prospective data on the community living in the Agincourt sub-district of Mpumalanga Province in rural north-east South Africa. RESULTS Puberty, maternal education and socio-economic status (SES) contributed significantly to the mulitiple linear regression model for sedentary behavior (R2 = 0.199; adjusted R2 = 0.139; p < 0.000), and sex, SES and maternal education contributed to the tobit regression model for school and club sport MVPA (p < 0.000). MVPA, calculated from school and club sport, was higher in boys than girls (p < 0.001), and informal activity was lower (boys: p < 0.05 and girls: p < 0.01) while sedentary time was higher (girls: p < 0.01) in the older than the younger groups. Ninety-two percent (92%) of the sample reported walking for transport. CONCLUSIONS In this study of rural South African adolescent boys and girls, SES at the maternal, household and community level independently predicted time spent in sedentary behaviors, and school and club MVPA. This study provides local data that can be used to develop health promotion strategies specific to this community, and other similar communities in developing countries.
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Affiliation(s)
- Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Mayosi BM, Forrester T. Commentary: 'serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda' by AG Shaper and KW Jones. Int J Epidemiol 2013; 41:1233-5. [PMID: 23045199 DOI: 10.1093/ije/dys169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Kimani-Murage EW. Exploring the paradox: double burden of malnutrition in rural South Africa. Glob Health Action 2013; 6:19249. [PMID: 23364082 PMCID: PMC3556706 DOI: 10.3402/gha.v6i0.19249] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This article is a review of the PhD thesis by Elizabeth Kimani-Murage that explores the double burden of malnutrition in rural South Africa. This is in the context of a worryingly rapid increase in obesity and obesity-related diseases in low- and middle-income countries (LMICs) including South Africa, and in the wake of on-going nutrition transition and lifestyle changes in these countries. OBJECTIVE To understand the profiles of malnutrition among children and adolescents in a poor, high HIV prevalent, transitional society in a middle-income country. METHODS A cross-sectional growth survey was conducted in 2007 targeting 4,000 children and adolescents aged 1-20 years. In addition, HIV testing was carried out on children aged 1-5 years and Tanner pubertal assessment among adolescents aged 9-20 years. RESULTS The study shows stunting at an early age and adolescent obesity, particularly among girls, that co-exists in the same socio-geographic population. The study also shows that HIV is an independent modifiable risk factor for poor nutritional outcomes in children and makes a significant contribution to nutritional outcomes at the individual level. Significant predictors of undernutrition at an early age, documented at individual, household, and community levels, include child's HIV status, age and birth weight, maternal age, age of household head, and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease during adolescence, documented at individual and household levels include child's age, sex, and pubertal development, household-level food security, socio-economic status, and household head's highest education level. CONCLUSIONS The combination of early stunting and adolescent obesity raises critical concerns in the wake of the rising public health importance of metabolic diseases in LMICs. This is because, both paediatric obesity and adult short stature are risk factors for metabolic syndrome and metabolic diseases in adulthood. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged and gender-sensitive.
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Cusick SE, Kuch AE. Determinants of undernutrition and overnutrition among adolescents in developing countries. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2012; 23:440-56. [PMID: 23437681 PMCID: PMC5577917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Sarah E Cusick
- Division of Global Pediatrics, University of Minnesota Medical School, 717 Delaware Street SE, Room 365, Mail Code 1932, Minneapolis, MN 55414, USA.
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Ginsburg C, Griffiths PL, Richter LM, Norris SA. Residential mobility, socioeconomic context and body mass index in a cohort of urban South African adolescents. Health Place 2012; 19:99-107. [PMID: 23211581 PMCID: PMC3895683 DOI: 10.1016/j.healthplace.2012.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/20/2012] [Accepted: 09/29/2012] [Indexed: 11/17/2022]
Abstract
Adolescents who are changing residence, as well as their social and economic circumstances may experience lifestyle changes that have an effect on body composition outcomes such as undernutrition, overweight or obesity. This paper uses data from Birth to Twenty, a birth cohort of South African urban children, to determine the relationship between residential mobility and body mass index (BMI) amongst Black adolescents aged 15 (n=1613), and to examine the role of changes in household socioeconomic status (SES). The prevalence of overweight and obesity in the sample was 25% in females and 8% in males. Amongst the females, a strong positive association between residential mobility and BMI was observed for those who also experienced an increase in household SES between birth and 15 years (β=0.42, SE=0.13), while no effect was identified for males. The study shows the potential for environmental change and increased resources to influence the risk for obesity. It also highlights the value in considering the range of social environmental factors and changes across the early life course that might play a part in evolving nutritional patterns in urban transitioning environments.
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Affiliation(s)
- Carren Ginsburg
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Determinants and spatial patterns of adult overweight and hypertension in a high HIV prevalence rural South African population. Health Place 2012; 18:1300-6. [PMID: 23085938 PMCID: PMC3989767 DOI: 10.1016/j.healthplace.2012.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 08/29/2012] [Accepted: 09/04/2012] [Indexed: 11/24/2022]
Abstract
We conducted a large population-based survey among adults measuring weight, height, and blood pressure nested within an HIV survey in rural KwaZulu-Natal, South Africa, to identify and characterize clusters of overweight and hypertension in a typical rural African population and to explore whether geographic clusters can be accounted for by established individual-level risk factors. 58.4% of the participants were overweight and 22.6% were hypertensive. One cluster of high prevalence of overweight (RR=1.50, p<0.001) was identified using Kulldorff spatial scan statistic as the most likely cluster, whereas a low-risk cluster was identified in the nearby high-density settlement area (RR=0.62, p<0.05). No geographic clusters of hypertension were identified. After controlling for age, sex, educational attainment, household wealth, marital status, place of residence, and HIV status, no spatial clustering of overweight remained. The results provided clear evidence for the localized clustering of overweight. Identification of clustering of chronic disease could provide additional insights into the prevention and control for the rural South African population.
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Scott A, Ejikeme CS, Clottey EN, Thomas JG. Obesity in sub-Saharan Africa: development of an ecological theoretical framework. Health Promot Int 2012; 28:4-16. [DOI: 10.1093/heapro/das038] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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41
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Kahn K, Collinson MA, Gómez-Olivé FX, Mokoena O, Twine R, Mee P, Afolabi SA, Clark BD, Kabudula CW, Khosa A, Khoza S, Shabangu MG, Silaule B, Tibane JB, Wagner RG, Garenne ML, Clark SJ, Tollman SM. Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol 2012; 41:988-1001. [PMID: 22933647 PMCID: PMC3429877 DOI: 10.1093/ije/dys115] [Citation(s) in RCA: 387] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2012] [Indexed: 12/12/2022] Open
Abstract
The Agincourt health and socio-demographic surveillance system (HDSS), located in rural northeast South Africa close to the Mozambique border, was established in 1992 to support district health systems development led by the post-apartheid ministry of health. The HDSS (90 000 people), based on an annual update of resident status and vital events, now supports multiple investigations into the causes and consequences of complex health, population and social transitions. Observational work includes cohorts focusing on different stages along the life course, evaluation of national policy at population, household and individual levels and examination of household responses to shocks and stresses and the resulting pathways influencing health and well-being. Trials target children and adolescents, including promoting psycho-social well-being, preventing HIV transmission and reducing metabolic disease risk. Efforts to enhance the research platform include using automated measurement techniques to estimate cause of death by verbal autopsy, full 'reconciliation' of in- and out-migrations, follow-up of migrants departing the study area, recording of extra-household social connections and linkage of individual HDSS records with those from sub-district clinics. Fostering effective collaborations (including INDEPTH multi-centre work in adult health and ageing and migration and urbanization), ensuring cross-site compatibility of common variables and optimizing public access to HDSS data are priorities.
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Affiliation(s)
- Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Rai RK. Factors Associated With Nutritional Status Among Adult Women in Urban India, 1998-2006. Asia Pac J Public Health 2012; 27:NP1241-52. [DOI: 10.1177/1010539512450606] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study attempts to understand the factors associated with chronic energy deficiency (CED) and overweight/obesity together with change in CED and overweight/obesity among urban Indian women during 1998-2006. Both National Family Health Survey (NFHS) 1998-1999 and NFHS 2005-2006 data sets were used. The standard cutoff points for both CED (BMI < 18.5 kg/m2) and overweight/obesity (BMI ≥ 23 kg/m2) were considered. The Phi and Cramer’s V tests and predicted probabilities were used to fulfill the study objective. Results indicate an almost 3% reduction in CED and a 6% increase in overweight/obesity during 1998-2006. The probability of CED has reduced among nonliterate women and women belonging to the poorest wealth quintile; on the other hand, the likelihood of being overweight/obese has increased among women with high school education and above and women belonging to the richest wealth quintile. Interventions to promote physical activities and nutritional awareness programs, which are effective in addressing nutritional problems, have been proposed.
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Abstract
Decades ago, discussion of an impending global pandemic of obesity was thought of as heresy. But in the 1970s, diets began to shift towards increased reliance upon processed foods, increased away-from-home food intake, and increased use of edible oils and sugar-sweetened beverages. Reductions in physical activity and increases in sedentary behavior began to be seen as well. The negative effects of these changes began to be recognized in the early 1990s, primarily in low- and middle-income populations, but they did not become clearly acknowledged until diabetes, hypertension, and obesity began to dominate the globe. Now, rapid increases in the rates of obesity and overweight are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels. Concurrent rapid shifts in diet and activity are well documented as well. An array of large-scale programmatic and policy measures are being explored in a few countries; however, few countries are engaged in serious efforts to prevent the serious dietary challenges being faced.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina 27516, USA.
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Peltzer K, Pengpid S. Overweight and obesity and associated factors among school-aged adolescents in Ghana and Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:3859-70. [PMID: 22073017 PMCID: PMC3210586 DOI: 10.3390/ijerph8103859] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 09/23/2011] [Accepted: 09/26/2011] [Indexed: 12/19/2022]
Abstract
The aim of this study was to assess overweight and obesity and associated factors in school-going adolescents in low income African countries (Ghana, Uganda). The total sample included 5,613 school children aged 13 to 15 years from nationally representative samples from two African countries. Bivariate and multivariable analyses were conducted to assess the relationship between dietary behavior, substance use, physical activity, psychosocial factors and overweight or obesity. The prevalence of overweight and obesity was determined based on self-reported height and weight and the international child body mass index standards. Results indicate a prevalence of overweight or obesity of 10.4% among girls and 3.2% among boys, and 0.9% and 0.5% obesity only among girls and boys, respectively. Among girls smoking cigarettes and loneliness and among boys smoking cigarettes were found to be associated with overweight or obesity in multivariable analysis. Overweight status was not associated with the intake of fruits, vegetables, and sedentary behavior. Low prevalence rates of overweight or obesity were found in Ghana and Uganda. Smoking cessation and social programs could be integrated into strategies to prevent and treat overweight and obesity in youth.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, 134 Pretorius Street, Pretoria 0002, South Africa
- Department of Psychology, University of Limpopo, P/B X1106, Sovenga 0727, South Africa
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +27-12-302-2000; Fax: +27-12-302-2601
| | - Supa Pengpid
- Department of Health System Management and Policy, University of Limpopo, PO Box 197, Medunsa 0204, South Africa; E-Mail:
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