Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review

Development and implementation of a nutrition education programme for school-going adolescents in the context of double burden of malnutrition: a narrative essay

The early prevention of non-communicable diseases in Cameroon schools program was initiated in 2018 to address the alarming trend of obesity among adolescents through a nutrition education intervention aimed at increasing knowledge on nutrition and the benefits of healthy eating and physical activity. The program included: school surveys to document eating habits and health-risky behaviors in students, the development of a training curriculum, training and sensitization sessions for school staff, school vendors and students, and advocacy meetings with parliamentarians and mayors. We carried out a quasi-experimental study to assess the effect of the intervention on the student's knowledge and eating behavior three months after the training sessions. We compared the knowledge of a sample of students from five schools that were part of the program (IG) to that of students that were not (CG). The mean (±SD) score was 14.4/20 (±2.1) and 9.7/20 (±2.7) for IG and CG, respectively (p<0.001). Those who scored above 12/20 accounted for 89.8% of IG vs 23.8% of CG (p<0.001). Other significant achievements of this program are the amendment of the National School Hygiene Policy to include compulsory training in food hygiene and nutrition education for school canteen vendors and the integration of nutrition education sensitization sessions into the routine activities of school healthcare. The study showed that a well-structured multi-sectoral nutritional education program could be the bedrock to improve healthy nutrition among adolescents, thereby serving as a vehicle for non-communicable disease prevention.

Validation of mid-arm circumference for surveillance of obesity in African adolescent girls and adult women

This study aimed to assess the validity of mid-arm circumference (MAC), also known as mid-upper arm circumference (MUAC), for classification of high body fatness in Namibian adolescent girls and women and to test whether classification accuracy of MUAC was higher than the traditional simple proxy for high fatness, the BMI. In 206 adolescent girls aged 13-19 years and 207 adult women aged 20-40 years, we defined obesity conventionally (BMI-for-age Z score ≥ 2·00, adolescents; adults BMI ≥ 30·0 kg/m2) and also defined obesity using published MAC cut-off values. 2H oxide dilution was used to measure total body water (TBW) to define high body fat percentage (≥ 30 % in the adolescents, ≥ 38 % in the adults), and we compared the ability of BMI and MAC to classify high body fatness correctly using sensitivity, specificity and predictive values. In the adolescents, obesity prevalence was 9·2 % (19/206) using BMI-for-age and 63·2 % (131/206) using TBW; sensitivity of BMI-for-age was 14·5 % (95 % CI 9·1, 22·0 %) but was improved significantly using MAC of 22·6 cm (sensitivity 96·9 %; 95 % CI 92·1 %, 99·3 %). In the adults, obesity prevalence was 30·4 % (63/207) using BMI and 57·0 % (118/207) using TBW, and sensitivity of BMI was 52·5 % (95 % CI 43·6, 62·2 %), but using a MAC of 30·6 cm sensitivity was 72·8 % (95 % CI 66·4, 82·6 %). Surveillance of obesity in African adolescent girls and adult women is likely to be improved substantially by use of MAC as an alternative to the BMI-for-age and BMI.

Factors associated with underweight, overweight, stunting and wasting among primary school-going children participating in a school health initiative in South Africa

BACKGROUND

The double burden of malnutrition among children remains a public health challenge in South Africa. In response, the government of South Africa developed the National Health Policy and Implementation Guidelines for school-going children in 2003. This policy was subsequently upgraded to 'The Integrated School Health Programme' in 2012. An element of the programme is the provision of a meal to school-going children on school days. However, evidence suggests that one-third of school-going children continue to have nutritional deficiencies. This study investigated the sociodemographic as well as the nutritional characteristics of school-going children participating in a school health initiative in KwaZulu-Natal Province, South Africa.

METHODS

This was a retrospective descriptive cross-sectional study involving 1,275 children (50.3% females and 49.7% males) aged 3 to 15 years. Epidemiological data on the screening of the children's nutritional characteristics by school health nurses and school health nutritionists under the integrated school health programme (ISHP) was reviewed and analysed for the study.

RESULTS

Nearly half (50.3%) and 49.7% of the population were females and males, respectively. The average age of participants was 8.4 years old. 'Underweight' (p = 0.000), 'overweight' (p = 0.000), 'at risk of overweight' (p = 0.000),'stunting' (p = 0.000),'severe stunting' (p = 0.005), 'wasting' (p = 0.010), and 'obesity' (p = 0.037) were associated with the 'schools that children attended'. School-going children' living conditions were significantly associated with 'normal weight' (p = 0.000), 'underweight' (p = 0.000), and 'underweight' (p = 0.028). However, the social grant to parents/guardians had some positive effects on the percentage of children who reported 'normal weight' (55.4%), 'wasting' (1.0%), 'underweight' (4.0%), and 'at risk of overweight' (20.2%).

CONCLUSION

Chronic nutritional deficiencies persist among children. Therefore, ISHP implementation must retarget specific regions of the country to ensure that national goals and gains on school-going children nutrition, are met and maintained. Indeed, considering the positive impact of the government's social grant programme on the nutritional status of the children in this study, we recommend policy reforms that will increase parents' and carers' access to means of subsistence in order to meet the health and nutritional needs of children in the study communities.

Adherence to '5-2-1-0' guidelines and multiple risky behaviours among adolescents in nine sub-Saharan African countries: evidence from Global School-based Student Health Survey 2012-2017

OBJECTIVE

Overweight and obesity constitute a new challenge in low-income and middle-countries. The obesity prevention programme, called '5-2-1-0', promotes healthy eating habits, physical activity and limited screen time among young people.This study aimed to assess adherence to the '5-2-1-0' recommendations and to study multiple risky behaviours among adolescents in nine countries in sub-Saharan Africa.

METHODS

Meta-analyses with a random effect were used to calculate overall prevalence. Non-random patterns of the co-occurrence of the four risky behaviours were explored using observed/expected prevalence ratios. Data came from the Global School-based Health Survey and 18 314 adolescents were considered.

RESULTS

Among the participants, 12.7% (95% CI 7.5% to 19.0%) had overweight and 3.2% (95% CI 1.1% to 6.1%) had obesity. In almost all countries studied, girls were more affected by overweight and obesity than boys.While only 0.2% (95% CI 0.1% to 0.4%) of the adolescents fully complied with the recommendations, 4.8% (95% CI 3.1% to 6.9%), 28.4% (95% CI 22.4% to 34.8%), 43.8% (95% CI 41.9% to 45.8%) and 17.0% (95% CI 11.8% to 23.0%), respectively, combined 1, 2, 3 and 4 risky behaviours among the four '5-2-1-0' criteria. The most observed combination was found for co-occurrence of three risky behaviours: insufficient fruit/vegetables consumption, physical activity and non-zero consumption of sugar-sweetened beverages.

CONCLUSION

In conclusion, the insufficient adherence to '5-2-1-0' recommendations and the high prevalence of the co-occurrence of risky behaviours underscore the need to strengthen health interventions and programmes to prevent obesity among adolescents in sub-Saharan Africa.

Effect of school-based nutrition interventions among primary school children in sub-Saharan Africa: a systematic review protocol

INTRODUCTION

Preadolescents are passing through an intensive growth and development period that will benefit from healthy eating practices. For those attending school, school environments offer several potential benefits and have been demonstrated to influence the quality of dietary intakes and consequentially, nutritional status of school-aged children (SAC). Considering the amount of time children spend in school and the enormous potential of evidence-based interventions, the purpose of this review is to critically appraise peer-reviewed literature addressing the impact of school-based interventions on the nutritional status of SAC aged 6-12 years in sub-Saharan Africa.

METHODS AND ANALYSIS

A systematic search will be conducted in the following databases and online search records: Medline, CINAHL, Web of Science, Embase, Global health, Global Index Medicus, Cochrane library, Hinari and Google Scholar using search terms and keywords codeveloped with two librarians. An additional search will also be conducted from the reference list of identified literature. Search results of titles and abstracts will be initially screened for eligibility criteria by two independent reviewers and where there is disagreement, a third reviewer will be consulted. Articles meeting these criteria will then undergo a full-text review for the eligibility and exclusion criteria. The Joanna Briggs Institute critical appraisal tool will be used to assess the risk of bias. Data from articles meeting all study criteria will be extracted, analysed and synthesised. A meta-analysis will also be conducted if sufficient data are available.

ETHICS AND DISSEMINATION

This systematic review is limited to publicly accessible data bases not requiring prior ethical approval to access. The results of the systematic review will be disseminated through publications in peer-reviewed journals as well as conference and stakeholder presentations.

PROSPERO REGISTRATION NUMBER

CRD42022334829.

Burden and contributing factors to overweight and obesity in young adolescents in Addis Ababa, Ethiopia

The prevalence of overweight/obesity in adolescents has increased globally, including in low- and middle-income countries. Early adolescence provides an opportunity to develop and encourage positive health and behavioural practices, yet it is an understudied age group with limited information to guide and inform appropriate interventions. This study aims to determine the prevalence of overweight/obesity in young adolescents, aged between 10 and 14 years attending public schools in Addis Ababa, Ethiopia, and to explore the contributing factors. A cross-sectional school-based study was conducted. Adolescents completed individual questionnaires. Weight (kg) and height (m) measurements were converted to BMI-for-age and gender z-scores. Multivariate regression analysis was conducted to determine the associated factors. The overall prevalence of overweight/obesity was 8% among adolescents aged 10-14 years and it was significantly higher in females (13%) than males (2%). The diet quality for the majority of the adolescents was inadequate, putting them at risk for poor health outcomes. The contributors to overweight/obesity were different between males and females. Age and no access to a flush toilet were negatively associated with overweight/obesity in males and access to a computer, laptop or tablet was positively associated. In females, menarche was positively associated with overweight/obesity. Living with only their mother or another female adult and an increase in physical activity were negatively associated with overweight/obesity. There is a need to improve the diet quality of young adolescents in Ethiopia and understand the reasons why females are less physically active to limit the risk of poor diet-related health outcomes.

Youth-onset type 2 diabetes mellitus: an urgent challenge

The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) and its complications are increasing worldwide. Youth-onset T2DM has been reported in all racial and ethnic groups, but Indigenous peoples and people of colour are disproportionately affected. People with youth-onset T2DM often have a more aggressive clinical course than those with adult-onset T2DM or those with type 1 diabetes mellitus. Moreover, the available treatment options for children and adolescents with T2DM are more limited than for adult patients. Intermediate complications of youth-onset T2DM, such as increased albuminuria, often develop in late childhood or early adulthood, and end-stage complications, including kidney failure, develop in mid-life. The increasing frequency, earlier onset and greater severity of childhood obesity in the past 50 years together with increasingly sedentary lifestyles and an increasing frequency of intrauterine exposure to diabetes are important drivers of the epidemic of youth-onset T2DM. The particularly high risk of the disease in historically disadvantaged populations suggests an important contribution of social and environmental factors, including limited access to high-quality health care, healthy food choices and opportunities for physical activity as well as exposure to stressors including systemic racism and environmental pollutants. Understanding the mechanisms that underlie the development and aggressive clinical course of youth-onset T2DM is key to identifying successful prevention and management strategies.

The Influence of a 9-Week Movement Program on the Body Composition of 7- to 8-Year-Old Schoolchildren in the Eastern Cape of South Africa

Pediatric obesity has become a growing global epidemic which has negative health consequences, including for South African children. This study aimed to determine the immediate and sustainable influences of a 9-week movement program on the body composition of 7 to 8-year-old school children in a rural area of South Africa. A two group, pre-test, post-test and re-test after six months experimental design was used to compare anthropometric measurements of the intervention group (IG) and control group (CG). Ninety-three schoolchildren (IG = 57; CG = 36) participated in the study. A 9-week movement program was followed twice a week for 30 min during school hours with an emphasis on improving BMI. Hierarchical Linear Modelling (HLM) was used to analyze the data with time, sex and group as predictors. Effect sizes was computed based on the Cohen's d to assess the practical significance of findings. The intervention positively changed the waist circumference. The subscapular skinfold and BMI showed statistical and practically significant sustainable changes because of the intervention, although gender influenced these effects. School based movement interventions, focusing on improving fundamental movement skills (FMS), have the potential to contribute to a healthier BMI, skinfold thickness and circumferences among young children.

Disparities in Childhood Obesity Prevalence and Spatial Clustering Related to Socioeconomic Factors in Isaan, Thailand

Globally, rapid economic growth has contributed to an overall increase in the incidence of childhood obesity. Although the prevalence of obesity has been well recognized, the disparities related to a region's socioeconomic environment in terms of the incidence of obesity are still less understood. Therefore, the purpose of this study was to examine the spatial pattern of childhood obesity and identify the potential associations between childhood obesity and socioeconomic environment in the northeastern region of Thailand, Isaan. Using nationally collected obesity data from children aged 0-5 years in 2019, we employed a geographic information system (GIS) to perform obesity cluster analysis at the smaller regional level, investigating a total of 322 districts in study area. Global and local statistical approaches were applied to calculate spatial associations between the socioeconomic status of neighborhoods and childhood obesity. The study revealed that 12.42% of the total area showed significant clusters at the district level, with high values observed in the western and northeastern areas. The results of the spatial statistical model revealed that childhood obesity was significantly positively associated with areas exhibiting high levels of socioeconomic environment factors. Identifying the associated factors and highlighting geographic regions with significant spatial clusters is a powerful approach towards understanding the role of location and expanding the knowledge on the factors contributing to childhood obesity. Our findings, as a first step, offer valuable references that could support policy-makers and local authorities in enhancing policy development with the aim of reducing childhood obesity and improving public health.

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey

BACKGROUND

Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda.

METHODS

We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression.

RESULTS

Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95).

CONCLUSION

We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.

Individual‐level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study

Evidence on the individual‐level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage of nutrition transition. The aim of this study was to identify individual‐level factors (biological, demographic, cognitive, practices) influencing dietary behaviours among adolescent girls and women at different stages of the reproductive life course in urban Ghana with the goal of building evidence to improve targeted interventions. Qualitative Photovoice interviews (n = 64) were conducted in two urban neighbourhoods in Accra and Ho with adolescent girls (13–14 years) and women of reproductive age (15–49 years). Data analysis was both theory‐ and data‐driven to allow for emerging themes. Thirty‐seven factors, across four domains within the individual‐level, were identified as having an influence on dietary behaviours: biological (n = 5), demographic (n = 8), cognitions (n = 13) and practices (n = 11). Several factors emerged as facilitators or barriers to healthy eating, with income/wealth (demographic); nutrition knowledge/preferences/risk perception (cognitions); and cooking skills/eating at home/time constraints (practices) emerging most frequently. Pregnancy/lactating status (biological) influenced dietary behaviours mainly through medical advice, awareness and willingness to eat foods to support foetal/infant growth and development. Many of these factors were intertwined with the wider food environment, especially concerns about the cost of food and food safety, suggesting that interventions need to account for individual‐level as well as wider environmental drivers of dietary behaviours.

Time constraints, eating at home, eating out, cooking skills, food preferences and food safety concerns were identified as key factors influencing dietary behaviours at the individual level in urban Ghana.

Ability to eat nutritious, safe food was largely mediated by income and wealth.

Biological factors, such as pregnancy/lactating status influenced behaviours through medical advice, nutrition knowledge and willingness to promote foetal/infant development.

Many individual‐level factors were intertwined with the wider food environment.

Factors influencing dietary behaviour at different levels need to be considered together when developing interventions/policies for healthier diets.

Using wearable devices to generate real-world, individual-level data in rural, low-resource contexts in Burkina Faso, Africa: A case study

Background

Wearable devices may generate valuable data for global health research for low- and middle-income countries (LMICs). However, wearable studies in LMICs are scarce. This study aims to investigate the use of consumer-grade wearables to generate individual-level data in vulnerable populations in LMICs, focusing on the acceptability (quality of the devices being accepted or even liked) and feasibility (the state of being workable, realizable, and practical, including aspects of data completeness and plausibility).

Methods

We utilized a mixed-methods approach within the health and demographic surveillance system (HDSS) to conduct a case study in Nouna, Burkina Faso (BF). All HDSS residents older than 6 years were eligible. N = 150 participants were randomly selected from the HDSS database to wear a wristband tracker (Withings Pulse HR) and n = 69 also a thermometer patch (Tucky thermometer) for 3 weeks. Every 4 days, a trained field worker conducted an acceptability questionnaire with participants, which included questions for the field workers as well. Descriptive and qualitative thematic analyses were used to analyze the responses of study participants and field workers.

Results

In total, n = 148 participants were included (and n = 9 field workers). Participant's acceptability ranged from 94 to 100% throughout the questionnaire. In 95% of the cases (n = 140), participants reported no challenges with the wearable. Most participants were not affected by the wearable in their daily activities (n = 122, 83%) and even enjoyed wearing them (n = 30, 20%). Some were concerned about damage to the wearables (n = 7, 5%). Total data coverage (i.e., the proportion of the whole 3-week study duration covered by data) was 43% for accelerometer (activity), 3% for heart rate, and 4% for body shell temperature. Field workers reported technical issues like faulty synchronization (n = 6, 1%). On average, participants slept 7 h (SD 3.2 h) and walked 8,000 steps per day (SD 5573.6 steps). Acceptability and data completeness were comparable across sex, age, and study arms.

Conclusion

Wearable devices were well-accepted and were able to produce continuous measurements, highlighting the potential for wearables to generate large datasets in LMICs. Challenges constituted data missingness mainly of technical nature. To our knowledge, this is the first study to use consumer-focused wearables to generate objective datasets in rural BF.

Eating behaviors, attitudes, and beliefs that contribute to overweight and obesity among women in Lilongwe City, Malawi: a qualitative study

Background

Obesity is increasingly a public health concern in low- and middle-income countries, including Malawi where 36% of women have body mass index in overweight/obese categories in urban areas. Eating behaviors, attitudes, and beliefs are associated with body size, but have not been studied in-depth in sub-Saharan African countries. This study therefore, explored eating behaviors, attitudes, and beliefs of women in Lilongwe, Malawi.

Methods

This was a descriptive ancillary qualitative study utilising in-depth interviews with 27 women (13 in normal weight range and 14 in overweight/obesity ranges) puporsively selected in Lilongwe City, Malawi from October to November 2017. The concept of data saturation guided data collection, and it was reached with the 27 interviewed participants when there was no new information coming from the participants. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were analysed manually using thematic content analysis.

Results

Majority of participants perceived overweight as an indication of good health such that with food affordability, women deliberately gain weight to demonstrate their good health. Most normal weight respondents said they ate less food than they wanted to because of financial constraints. Most women in overweight/obese ranges in our sample reported that they eat large portions and eat frequently due to the desire to portray a good image of their marital life since there is a societal expectation that when a woman is married, her weight should increase to show that the marriage is successful. The perceived contributors to weight gain include eating behaviors, feelings about weight gain, and gender roles and social expectations to gain weight.

Conclusion

Beliefs and attitudes related to eating behaviors may have contributed to women being in overweight range and should be considered in designing obesity prevention interventions targeting women in Malawi.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01811-0.

N. Rodrigues EL, Etuge P, Warner Y, Kessler H, Mitchell A. School Meal Programs in Africa: Regional Results From the 2019 Global Survey of School Meal Programs

Introduction

School meal programs operate throughout Africa, serving as a social safety net and aiming to improve children's nutrition, influence their dietary choices, and strengthen the agrifood economy through local procurement. Despite their rapid expansion in the past decade, there has been no systematic effort to comprehensively document school feeding activities across the continent.

Methods

Detailed information on school feeding activities in each country was captured in the Global Survey of School Meal Programs©, which launched in 2019. An invitation to participate was extended to each government, which appointed a national-level respondent to gather information on every large-scale school meal program in the country.

Results

Forty-one countries in Africa (38 in sub-Saharan Africa) responded to the survey in 2019 with information on 68 large-scale programs that together reached 60.1 million children. Across these countries, the aggregate school feeding budget was USD 1.3 billion. Diversity in school meal programs is evident across regions, country income levels, and levels of national commitment. Coverage rates tended to be highest in southern Africa, in countries with school feeding as a line item in the national budget, and in countries with the greatest domestic share of the school feeding budget. Diversity in the school menu tended to be greatest in programs that sourced food through domestic purchase rather than relying on foreign in-kind donations. To address micronutrient malnutrition, about two-thirds of the programs served fortified foods, and one-quarter included micronutrient supplements. Even as rates of overweight/obesity are rising among African school children, just 10% of school meal programs identified its prevention as an objective.

Conclusion

The extent to which school meal programs in Africa are supported with domestic funding reflects a dramatic shift in favor of national ownership and domestic food procurement. At the same time, programs have grappled with inadequate and unpredictable budgets and challenges related to supply chains and logistics—impediments that need to be addressed if these programs are to achieve their objectives. Overall, the survey results underscore the important position of school meal programs within African food systems and their potential (if well-designed) to sustainably improve food security, child health, and nutrition.

Risk Factors for Overweight and Obesity within the Home Environment of Preschool Children in Sub-Saharan Africa: A Systematic Review

Sub-Saharan Africa (SSA) is experiencing an increasing prevalence of young children being overweight and obese. Many feeding and physical activity-related behaviours are established at home during preschool years, yet the precise factors that contribute to preschool overweight and obesity have not been fully elucidated. This review aims to identify factors in the home environment associated with overweight and or obesity in preschool children in SSA. Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Africa Journals Online (AJOL) and the African Index Medicus databases were systematically searched for qualitative and quantitative studies published between 2000 and 2021. Eleven studies (ten quantitative, one qualitative) met the inclusion criteria. Overall, the results highlight the paucity of studies exploring factors in the home environment associated with overweight and obesity in preschool children in Sub-Saharan Africa. The home food environment and maternal BMI appear to be important factors associated with overweight and obesity in preschool children; however, the information for all other factors explored remains unclear due to the lack of evidence. For successful obesity prevention and treatment interventions to be developed, more research in this area is required to understand how different aspects of the home environment contribute to overweight and obesity in preschool Sub-Saharan African children.

Blood pressure profile of primary school children in Eastern Cape province, South Africa: prevalence and risk factors

Abstract

Background

The problem of cardiovascular diseases and lack of adequate information about the blood pressure profiles among children in South Africa has enormous consequences for public health and the general well-being of communities.

Aim

The aim of this study is to determine the blood pressure profiles and associated risk factors of primary school children in South Africa.

Methods

A cross sectional study was conducted among 876 children aged 9 to 14 years from 18 randomly selected schools in the Eastern Cape province of South Africa. Standardised blood pressure measuring instruments were used and an average of three readings was considered. Blood pressure status was classified according to the percentiles of systolic blood pressure (SBP).

Results

The overall prevalence of hypertension was 5.2% and pre-hypertension was 18.5% while normal blood pressure was 76.3%. The multilevel binary logistic regression’s crude and adjusted analysis revealed that increase in age was significantly associated with elevated BP in children ([crude OR = 1.17 [1.05 – 1.29] and [adjusted OR = 1.12 [1.01 – 1.25]). In addition, increase in BMI was significantly associated with elevated BP in children ([crude OR = 1.08 [1.04 – 1.12] and [adjusted OR = 1.06 [1.02 – 1.11]). There was no statistically significant association between elevated BP and gender for both the univariate and multivariate models. There was also no statistical significant risk for elevated BP associated with place of residence.

Conclusions

In this sampled population the established proportion of primary school children with elevated BP is of great concern. In addition, older children and those with high BMI (that is, overweight/obesity) were associated with elevated BP. Interventions towards promoting healthy lifestyles among school learners is a necessity if we are to prevent cardiovascular diseases.

Knowledge, attitude and practice of Lebanese parents towards childhood overweight/obesity: the role of parent-physician communication

Background

Childhood overweight and obesity is one of the most challenging public health problems facing both developed and developing countries. Several studies carried worldwide assessed predisposing risk factors for childhood obesity, however, few addressed the Middle East region and particularly Lebanon. We aimed in our study to assess factors associated with knowledge, attitude and practice of Lebanese parents regarding childhood overweight, particularly the parent-physician communication.

Methods

This cross-sectional study conducted between September and December 2019. The questionnaire used was the standardized questionnaire of “Parent Questionnaire Curriculum” from the “We Can program” (Ways to Enhance Children’s Activity and Nutrition).

Results

A higher parent-physician communication score (Beta = 0.05) was significantly associated with higher knowledge, whereas having a higher intermediate vs low income (Beta = -0.65) was significantly associated with lower knowledge. A higher knowledge global score (Beta = 1.25), a higher parent-physician communication score (Beta = 0.18), and having a university education level compared to illiterate/primary/complementary (Beta = 2.59) were significantly associated with better attitude. A better attitude (Beta = 0.92) and a higher global knowledge score (Beta = 0.6) were significantly associated with a better practice.

Conclusion

This study found that a better parent-physician communication and higher knowledge were associated with better attitude and practice towards obesity. Given the rise in childhood obesity worldwide, identifying factors that help reduce childhood obesity, is becoming mandatory. Our results can open up to future studies addressing strategies to prevent childhood obesity in Lebanon.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03279-1.

'Children eat all things here': a qualitative study of mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in two Nigerian states

INTRODUCTION

The perception of mothers about causes of underweight and overweight among children or adolescents and associated cultural beliefs may influence nutritional status. However, data from qualitative studies on this subject and regarding age 6-19 are scarce in Nigeria.

OBJECTIVE

This study aimed to explore mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in a northern and a southern Nigerian state.

DESIGN

This was a qualitative study using focus group discussions (FGD). Eight FGD sessions were held. The interviews were transcribed verbatim, and the transcripts were coded and analysed using NVivo V.11, and direct quotations representing the themes generated from the perspectives were cited as appropriate.

SETTING

The study was carried out in eight randomly selected rural and urban communities in Gombe and Osun states of Nigeria.

PARTICIPANTS

Seventy-six mothers of children and adolescents aged 6-19 years.

RESULTS

The mothers identified concepts, causes and community experience of underweight and overweight children and adolescents, however, some gaps and misconceptions were observed. These included perspectives that suggest a limited understanding of the concepts of mild and moderate malnutrition and stunting and citing of 'witches and wizards' as causes of malnutrition. The mothers observed that being underweight was more prevalent in rural communities of Osun and Gombe states, while overweight was more prevalent in urban communities in Osun state. The majority of the women reported no known food taboo or restrictions, and no cultural beliefs relating to the nutrition of children and adolescents.

CONCLUSION

Gaps and misconceptions exist in the perceptions of mothers on underweight and overweight children and adolescents. Food taboos, food restrictions and other cultural beliefs were not reported by majority of the mothers. Educational programmes for mothers on child/adolescent nutrition should target identified gaps and misconceptions.

Prevalence of Obesity and Associated Risk Factors among Children and Adolescents in the Eastern Cape Province

Obesity is a global public health concern that begins in childhood and is on the rise among people aged 18 and up, with substantial health consequences that offer socioeconomic challenges at all levels, from households to governments. Obesity and associated risk factors were investigated in children and adolescents in the Eastern Cape Province of South Africa. A cross-sectional study was conducted at Mt Frere among 209 conveniently selected participants using anthropometric measurements and a structured questionnaire. Chi-squared statistics or Fisher's exact test were used to evaluate the risk factors predicting different outcomes such as hypertension or diabetes mellitus. A 5% level of significance was used for statistical significance (p-value 0.05). The prevalence of overweight or obesity among females when using waist circumference (2.7%), triceps skinfold (6.9%), and body mass index cut-offs (16.4%) were respectively higher when compared to those of males. About 89% engaged in physical activities. After school, 53% watched television. About 24.9% of participants did not eat breakfast. Most of overweight or obese participants (92.9%) brought pocket money to school. Use of single anthropometric measurements for assessing nutritional status indicated inconclusive results. Strengthening parental care, motivation for consumption of breakfast and limiting pocket money for children going to school are important steps to improve child health.

Sleeve gastrectomy in the surgical management of obesity in Cameroon (a sub-Saharan country): A single-institute retrospective review of 30-day postoperative morbidity and mortality

BACKGROUND

METHODS

RESULTS

CONCLUSION

•

Sleeve gastrectomy is a safe procedure in a sub-Saharan African low setting.

•

Bleeding is the only intraoperative complication encountered in 14.3% of cases.

•

The prevalence of 30-day postoperative morbidity of sleeve gastrectomy is 38.1%.

•

Postoperative 30-day complications after sleeve gastrectomy are minor.

•

The 30-day postoperative mortality after sleeve gastrectomy is nil.

Food Security, Dietary Diversity, Dietary Patterns and the Double Burden of Malnutrition among School-Aged Children and Adolescents in Two Nigerian States

Background: Little evidence exists on the relationship between diet-related factors and child/adolescent malnutrition in Nigeria. This study aimed to assess the associations between household food insecurity (HFI), dietary diversity (DD), and dietary patterns (DP) with the double burden of malnutrition (DBM) among 6–19-year-olds in two Nigerian States. Methods: This community-based cross-sectional study was carried out among 1200 respondents (6–19 years in age) in the Gombe and Osun States of Nigeria. HFI was assessed using the HFI access scale. DD was assessed using a 24-h dietary recall. DP were determined by principal component analysis using a 30-day food frequency questionnaire. DP scores were categorized into quartiles (Q) for statistical analysis. Diet-related predictors of DBM were assessed using logistic regression. Results: HFI was experienced by 568 (47.3%) respondents. The median DD score was 7.0 (maximum of 14). Two DPs were identified, diversified DP (DDP) and traditional DP (TDP). TDP was significantly associated with both thinness (Q4:OR: 2.91; 95% CI: 1.52–5.55; Ptrend: 0.002) and overweight/obesity (Q4:OR: 2.50; 95% CI: 1.43–4.35; Ptrend: 0.007), while DDP was inversely related with thinness (Q4:OR: 0.36; 95% CI: 0.21–0.61; Ptrend: 0.008) as compared to Q1. Conclusions: TDP increased the odds for DBM, while the DDP reduced the odds.

Life style, dietary patterns and physical activity in different obesity phenotypes of 2–18 years old children in Tabriz, Iran

BACKGROUND: This study aimed to evaluate the eating habits, physical activity, and body size perception by obesity status among 2–18 years old children in Iran. METHODS: This cross sectional study included 250 children and adolescents aged between 2 and 18. Participants’ anthropometric measurements were measured, adherence of Mediterranean Diet was evaluated by a questionnaire, the Mediterranean Diet Quality Index for children and adolescents (KIDMED), body satisfaction, and perception of body size. RESULTS: Mean age of subjects was 9.07±4.80 years, and 52.4% were girls. The KIDMED index score was 16.3% low, 54.3% moderate and 29.4% good. 72.7% of parents with overweight children and 36.4% with obese children, were perceived that their child was normal, and compared with 58.3% of overweight and 7.7% of obese participants perceived normal body size. There were no significant differences between physical activity in any weight status (p >  0.05) and between boys and girls in the KIDMED index and any of foods intake. There was a significant difference in mean differences of KIDMED index in boys in the four obesity statuses (P = 0.04), as well as in food consumption (P = 0.04), except for pulses in boys and girls. CONCLUSION: The percentage of obesity in boys is more compared to girls, the lowest KIDMED index score is for boys in the obesity group. Therefore, adopting healthier dietary habits and lifestyle in childhood is especially important for boys and also for girls.

Dual Burden of Malnutrition Among Adolescents With Hunger Aged 12-15 Years in 41 Countries: Findings From the Global School-Based Student Health Survey

Background: Hunger is a pandemic among adolescents, resulting in both underweight and obesity, and posing a substantial health challenge.

Objective: To estimate the dual burden of malnutrition among adolescents with hunger.

Design: Data were from the Global school-based Student Health Survey (GSHS). In total, data from 26,986 adolescents with hunger across 5 regions and 41 countries between 2010 and 2015 were analyzed in this study. Weighted prevalence and mean estimates of underweight, overweight, and obesity were calculated by gender, age, and country. Prevalence and 95% confidence intervals (CI) were calculated for regional and country-level income.

Results: The total prevalence of underweight, overweight and obesity among young adolescents with hunger was 6.2% (95% CI: 4.4–8.0%), 25.1% (95% CI: 20.3–29.9%) and 8.9% (95% CI: 6.5–11.3%), respectively. Southeast Asia had the highest prevalence of underweight (17.2%; 95% CI: 7.3–27.0%). America had the highest regional prevalence of obesity (11.1%; 95% CI: 7.2–15.1%) and overweight (28.9%; 95% CI: 21.9–35.9%). Low income countries had relatively high prevalence of underweight (11.5%; 95% CI: 3.2–19.9%). High income countries had the highest prevalence of obesity (17.4%; 95% CI: 14.9–19.9%) and overweight (38.7%; 95% CI: 32.0–45.4%). The co-existence of underweight and overweight among adolescents with hunger was highest in the Eastern Mediterranean region, and in upper-middle and high-income countries.

Conclusions: There is a dual burden of underweight and obesity among adolescents with hunger aged 12–15 years, which differs between geographical regions. The integration of targeted interventions and policies is required to simultaneously address both underweight and increasing rates of obesity among adolescents with hunger in different regions.

Physical activity and active transportation behaviour among rural, peri-urban and urban children in Kenya, Mozambique and Nigeria: The PAAT Study

Background

Physical activity (PA) is associated with numerous health benefits among children and youth. However, few studies have examined how active transportation (AT) and device-based measures of PA vary within and between countries in sub-Saharan Africa.

Purpose

This cross-sectional study sought to investigate the prevalence and correlates of AT and device-measured PA among children living in urban, peri-urban and rural areas in three African countries representing Eastern, Western and Southern regions of Africa.

Methods

3,205 participants (53.3% girls; 46.7% boys) aged 10–12 years were recruited in Kenya, Nigeria and Mozambique. Data were collected using a child questionnaire, a parent/guardian questionnaire and PiezoRx® pedometers. ANCOVA and binary logistic regression analyses were used to examine the correlates of AT and PA while controlling for gender, age, parent education and vehicle ownership.

Results

Participants accumulated an average of 45.6±23.5 min/day of moderate-to-vigorous physical activity (MVPA) and 11,215±4,273 steps/day. Kenyan and Mozambican children were significantly more active than their Nigerian counterparts (p<0.001). Only 23% met the MVPA guidelines of 60 min/day. 65.1% of participants engaged in AT to school (and 67.8% for the trip back home) with no gender differences. Living in a rural area, lower parent education, lower vehicle ownership and higher motorcycle ownership were associated with higher odds of AT. Other correlates of AT were country-specific. Girls accumulated less daily MVPA than boys in all countries. MVPA was positively associated with living in less urbanized areas in Nigeria and Mozambique. In Kenya, lower parental education and AT were associated with higher MVPA. Nigerian children’s daily MVPA decreased with age and the number of parent-perceived barriers to AT.

Conclusions

Majority of children engaged in AT, but still failed to meet MVPA recommendations. Most correlates of AT and PA were country-specific, suggesting that strategies to encourage both behaviours should be informed by local evidence.

Has the double burden of malnutrition reached pupils in rural western Kenya?

BACKGROUND

Undernutrition and overnutrition have been considered separate challenges caused by the distinct factors in distinct settings. The double burden of malnutrition is defined as the coexistence of both undernutrition and overnutrition, which has now spread globally, especially in low- and middle-income countries. In Kenya, the double burden of malnutrition is present in the capital city but the situation in rural areas currently remains unknown. The aim of this study was therefore to analyze nutritional status in rural Kenya.

METHODS

Data from height and weight measurements conducted by teachers in the third term of school year 2013 were collected from primary schools. Teachers were trained by experts before starting the measurements. The Z-scores of height-for-age, weight-for-age, and body mass index-for-age were calculated using AnthroPlus, and nutritional status was defined according to the World Health Organization guidelines.

RESULTS

Data analyzed from 7,447 pupils (3,763 boys and 3,684 girls) showed that 12.4% were stunted and 7.8% were underweight among those ≤120 months old, and 11.7% were thin among those >120 months old. Boys were more likely to be stunted than girls. Boys were more likely to be underweight and girls were more likely to be overweight in the older age group.

CONCLUSION

The double burden of malnutrition was not found, and undernutrition was still common among schoolchildren in the study area. However, it is important to monitor nutritional status due to adverse effects of rapid urbanization. Height and weight measurements in schools may be useful for monitoring the nutritional status of schoolchildren.

Double burden of malnutrition among school-aged children and adolescents: evidence from a community-based cross-sectional survey in two Nigerian States

Background: Double burden of malnutrition (DBM) is the co-existence of overweight/obesity and undernutrition. Rising prevalence rates of childhood overweight/obesity in Nigeria have been reported, whilst undernutrition continues to be prevalent. This study aimed to estimate the prevalence and distribution of underweight, stunting, thinness, overweight/obesity, and DBM among school-aged children and adolescents in two Nigerian States. Methods: This was a community-based cross-sectional study carried out in Osun and Gombe States. A total of 1,200 children aged 6 - 19 years were recruited using multi-stage sampling technique. Weight, height and data on demographic, socio-economic, household/family characteristics of the children were collected using structured interviewer administered questionnaires. Nutritional status was calculated using the WHO 2007 reference values using BMI-for-age (thinness, overweight/obesity), height-for-age (stunting) and weight-for-age (underweight). DBM was described at the population and individual levels. Results: The mean age of the respondents was 11.6 ± 3.8 years. The overall prevalence rate of stunting was 34.9%, underweight was 13.5%, thinness was 10.3% and overweight/obese was 11.4% and 4.0% had individual level DBM, which typifies the DBM at individual and population levels. These rates differed significantly across demographic, socio-economic and household/family characteristics (p < 0.05). Gombe State, which is in the Northern part of Nigeria, had significantly higher burden of stunted, underweight and thin children than Osun State, while Osun State, in the Southern part of Nigeria, had a significantly higher burden of overweight/obesity. Conclusions: The study found evidence of DBM both at population and individual levels. The overall prevalence rates of stunting, underweight, thinness and overweight/obesity in this study were high, and they differed significantly across the demographic, socio-economic and household/family characteristics. There is the need for government and all other stakeholders to design nutritional educational programmes that will target both under- and over-nutrition among older children in the different contexts.

Prevalence of Excessive Weight and Underweight and Its Associated Knowledge and Lifestyle Behaviors among Urban Private School-Going Adolescents in New Delhi

With rapid urbanization and the Indian nutrition transition, Indian adolescents face a high risk of developing an energy imbalance. This study aims to assess the prevalence of excessive weight, underweight, and associated knowledge and lifestyle behaviors among private school-going adolescents in Delhi. A cross-sectional study was conducted in students (6th–7th grades) of eight randomly selected private schools in Delhi, India in 2019. A self-administered survey was used to assess students’ dietary-and-physical-activity-related knowledge and behavior. Anthropometric measurements (height, weight, and waist circumference) were also conducted. Out of 1567 participants, 7.2% were underweight, 61.3% normal, and 31.5% excess in weight. Underweight was associated with significantly more eating whilst studying for exams (relative risk ratio (RRR) 1.7 (1.0–2.9)). Excessive weight was associated with less incorrect knowledge on behaviors causing overweight (RRR 0.7 (0.5–0.9)), more often reading nutritional labels of packed food items (RRR 0.6 (0.4–0.9)), and less frequent vegetable-intake (RRR 0.7 (0.4–0.9)). Underweight students showed more suboptimal knowledge and unhealthy behaviors, whilst students with excessive weight showed more correct knowledge and healthy behaviors. This study highlights the immediate need for effective health-promoting interventions focused on the importance of healthy lifestyle at least in underweight adolescents.

Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.

Continuum of maternity care in Zambia: a national representative survey

Background

Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia.

Methods

We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25.

Results

Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces.

Conclusion

Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04080-1.

Long-Term Influences of Stunting, Being Underweight, and Thinness on the Academic Performance of Primary School Girls: The NW-CHILD Study

Poor socio-economic status contributes to undernutrition which, in turn, can increase the risk of academic underachievement. This study wants to determine if stunting, being underweight, and thinness show long term relations with academic performance in primary school girls aged 6 to 13 in the North West province of South Africa. A randomized and stratified longitudinal research design including a baseline and two time-point measurements over seven school years was used. The sample included girls aged 6 to 13 years (N = 198) in the North West province of South Africa. Academic performance in the June school assessments and national and provincial assessments in grades 1, 4, and 7 were used to determine academic performance. Independent t-testing was used to determine differences between thinness, underweight and stunted girls as opposed to a reference group with no undernutrition indices. A repeated measures ANOVA and post hoc Bonferroni adjustment analyzed relations over time. Normal weight girls significantly outperformed stunted girls academically (p < 0.05) over time. Stunting had prolonged and significant negative influences on language, mathematics, and grade point average (p < 0.05). Early identification of undernutrition, especially stunting, is important for intervention and the implementation of timely prevention strategies, especially during early childhood years.

Factors associated with childhood overweight and obesity in Uganda: a national survey

Background

Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016.

Methods

We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda.

Results

The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3–5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2–4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8–1.5). Mother’s nutritional status, sex of the child, and child’s age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49–59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North.

Conclusion

The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age.

Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio-Metabolic Risk in Children and Adolescents

Simple Summary

The prevention and treatment of childhood and adolescent overweight and obesity raises the need for accurate body fat assessment. Precise methods are at high technical expense, require exposure to ionizing radiation and are limited to institutional investigations, while common body indicators fail to identify excess body fat. Subcutaneous adipose tissue measured by ultrasound is an alternative approach, which was evaluated in relation to commonly applied body indicators to assess cardio–metabolic risk and its applicability in the field. Subcutaneous adipose tissue measured by ultrasound indicated a clear advantage over commonly applied body indicators and implies that severe body fat assessment errors are to be expected when BMI is used as a measure for body fatness in children. Children or adolescents with identical BMIs may have large differences (>200%) in their amount of subcutaneous adipose tissue. Ultrasound provides an easily applicable, reliable and safe method for accurate assessment of obesity and monitoring treatment responses in children and adolescents at cardio–metabolic risk.

Abstract

Monitoring of children at heightened risk of cardio–metabolic diseases raises the need for accurate assessment of obesity. A standardized approach for measuring subcutaneous adipose tissue (SAT) by bright-mode ultrasound was evaluated in relation to body indices and anthropometry in a cross-sectional sample of 76 South African children (7–10 years) and 86 adolescents (13–17 years) to assess cardio–metabolic risk. SAT was higher in girls as compared to boys (children: 50.0 ± 21.7 mm > 34.42 ± 15.8 mm, adolescents: 140.9 ± 59.4 mm > 79.5 ± 75.6 mm, p < 0.001) and up to four times higher in adolescents than in children. In children, measures of relative body weight showed only a poor correlation to SAT (BMI: r = 0.607, p < 0.001), while in adolescents, BMI correlated high with SAT (r = 0.906, p < 0.001) based on high rates of overweight and obesity (41.8%). Children with identical BMIs may have large differences (>2–3-fold) in their amount of SAT. The moderate association to systolic (r = 0.534, r = 0.550, p < 0.001) and diastolic blood pressure (r = 0.402, r = 0.262, p < 0.001) further substantiates that SAT measured by ultrasound provides an accurate, safe and easy applicable approach for monitoring in children and adolescents at cardio–metabolic risk.

High prevalence of overall overweight/obesity and abdominal obesity amongst adolescents: An emerging nutritional problem in rural high schools in Limpopo Province, South Africa

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.

Blount disease and familial inheritance in Ghana, area cross-sectional study

Objective

The objective of this study is to study familial inheritance for Blount disease to create better understanding of the aetiology of Blount disease.

Methods

After reviewing patient files and conventional roentgenologic imaging, 139 patients with Blount disease were included in this cross-sectional study, of which 102 patients were interviewed. During the interviews, patient characteristics and family history were collected. Blood samples were taken from five patients and three families and a whole exome sequencing was performed.

Results

Although patients came from all over the country, 90% of the patients belonged to the Akan tribe. A positive family history was found in 63 families (62%), of which, almost two-third had a positive family history in a first-degree family member. In most of the cases (64%), the varus legs resolved over time. In 9%, severe bowing remained 'just like the patient'. The results of the whole exome sequencing did not show a genetic predisposition.

Conclusion

This study describes a large group of Blount patients. Because of the high numbers of positive family history and the centralisation of patients in the Akan region, a familial predisposition is suggested. Further genetic research is essential for better understanding of the possible multifactorial aetiology in Blount disease.

Dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia

BACKGROUND

The purpose of this study was to determine the dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia.

METHOD

This was a school-based cross-sectional study and 1008 students from eight Senior Secondary Schools in Region one of The Gambia participated in it. Data were collected through questionnaire self-administered method, and weight and height measurements. Using the age and gender-specific cutoff points proposed by World Health Organization, body mass index (BMI) was calculated using the weight and height measures. The data were analyzed using frequencies for underweight, overweight, and obesity, and the association between dietary factors and weight status of participants was determined using the Chi-square test.

FINDINGS

Out of the 1008 students recruited in the study, 981 of them completed and returned the questionnaires, resulting in a total response rate of 97%. The mean age of the participants was 17.3 years (SD = 1.9) and 385 of them (39.2%) were from grade 10. There were 627 (63.9%) females. The mean BMI for all the students was 20.0 ± 3.4 kg/m2. Most of the students (n = 672; 68.5 %) had normal body weight, but 226 (23%), 76 (7.7 %) and 7 (0.7%) of them were underweight, overweight and obese respectively. There was a significantly higher number of female students who were overweight (n = 64, 10.2%) than their male counterparts (χ2 = 72.336, p < 0.001). The frequency of drinking sugar added juices and full cream milk, eating fish, shrimps, oysters, lobsters, and snacks such as cakes and biscuits were significantly associated with overweight and obesity among the participants (p < 0.05). In conclusion, the problem of under-nutrition and over-nutrition co-existed among the students which were associated with poor eating habits.

10-Year Changes in Adiposity in Cameroon School-Age Children: Evidence for Increasing Central Adiposity and Higher Adiposity Levels in Tallest-for-Age Children

OBJECTIVE

To examine changes in measures of adiposity and determine the prevalence of excess adiposity in relation to height in school children between 2010 and 2020.

METHODS

5-12-year-old urban school-age children participated in two cross-sectional surveys in 2010 (n = 1274) and 2020 (n = 1550). Standard procedures were used for anthropometric measurements. Changes in BMI, waist circumference (WC), and waist-to-height ratio (WHtR) and the corresponding proportions of children with excess adiposity were analyzed and adjusted for design variables (class and school type) and age. Children were classified according to quartiles of height z-score and prevalence of excess adiposity estimated across each quartile.

RESULTS

There was a 2.4% and 3.3% increase in adjusted mean BMI and WC, respectively, between 2010 and 2020. The prevalence of central overweight/obesity (WC) and WHtR ≥ 0.5 increased by 7.3% (X ² = 27.151, p < 0.001) and 5.3% (X ² = 26.117, p < 0.001), respectively, between the two surveys except BMI overweight/obesity. The odds of excess adiposity significantly increased in 2020 for central overweight/obesity (WC) (OR 2.8, 95% CI 2.0-3.6) and WHtR ≥ 0.5 (OR 1.8, 95% CI 1.3-2.4) and not for BMI overweight/obesity (OR 1.3, 95% CI 0.8-1.7). The prevalence of BMI overweight/obesity significantly increased from 33% in 2010 to 51.5% in 2020 in the fourth quartile of height z-score (X ² = 19.198, p < 0.001). Similarly, the prevalence of central overweight/obesity (WC) significantly increased from 23.5% in 2010 to 42.4% in 2020 in the fourth quartile of height z-score (X ² = 18.733, p < 0.001).

CONCLUSION

Central overweight/obesity has increased more than BMI overweight/obesity over the last decade. Children with a higher height-for-age tend to accumulate more adiposity. Objective monitoring of adiposity levels and height of children is needed in future to identify groups for targeted intervention and prevention of chronic diseases.

Association between tracking of extracurricular sports practice and weight status during childhood: a prospective cohort study

BACKGROUND

Overweight and obesity have reached epidemic prevalences. Obesity control involves many factors and needs to begin early in childhood.

OBJECTIVES

To ascertain the association between tracked extracurricular sports practice and weight status; and to analyze tracking of overweight and obesity among school-aged children.

DESIGN AND SETTING

Prospective cohort study conducted in 13 public schools in Cianorte, Paraná, in 2012-2016.

METHODS

The sample comprised 2459 schoolchildren in Cianorte, of mean age 6.3 years at baseline and 9.4 years at follow-up. Body mass index was calculated from body mass and height measurements. The children were grouped as normal weight, overweight or obese. Information on extracurricular sports practice was collected through the dichotomous question "Do you participate in any extracurricular sports?" ("yes" or "no").

RESULTS

Tracking of weight status showed that 75.5% maintained this, with kappa of 0.530. Tracking of extracurricular sports practice showed that 80.9% maintained this, with low concordance (kappa of 0.054). Weight status correlation between baseline and follow-up showed that overweight or obese individuals were 4.65 times (CI: 4.05-5.34) more likely to maintain the same classification or move from overweight to obese at follow-up. Correlation of extracurricular sports practice with overweight or obesity at follow-up was not significant.

CONCLUSIONS

These results demonstrated that overweight or obese children were at higher risk of gaining weight than were normal-weight children. In addition, the proportion of these children who maintained extracurricular sports practices over the years was low. Maintenance of this variable was not associated with weight status.

Ethnicity, socioeconomic status and the nutritional status of Chinese children and adolescents: Findings from three consecutive national surveys between 2005 and 2014

BACKGROUND

Economic development has brought rapid shifts in the food environment of Chinese children and adolescents.

OBJECTIVES

To assess the changes in childhood nutritional status across ethnic groups and economic status from 2005 to 2014.

METHODS

664 094 Chinese Han and 224 151 ethnic minority children and adolescents aged 7 to 18 years were assessed in three national cross-sectional surveys (2005, 2010 and 2014). Gross domestic product (GDP) per capita of each ethnic group was categorized into four strata of socioeconomic status. To assess ethnic disparities at each time point, we used logistic regression to estimate the prevalence odds ratios (OR) for thinness, overweight and obesity in the 24 ethnic minority groups vs Han Chinese.

RESULTS

Children in the two upper economic strata (over about US$4000 GDP per capita) had a high prevalence of overweight and obesity, while those in the two lower economic strata (below US$4000 GDP per capita) had a high prevalence of thinness. From 2005 to 2014, the prevalence of thinness decreased from 18.6% to 13.1% in Han children, and from 20.4% to 17.1% in ethnic minority students. At the same time, the prevalence of overweight and obesity increased from 10.4% to 17.7% in Han children, and from 4.3% to 9.2% in ethnic minority students, respectively.

CONCLUSIONS

A rapid nutritional transition has occurred from 2005 to 2014 with shifts from thinness to overweight and obesity in both Han and ethnic minority children and adolescents, reflecting local GDP per capita.

Prevalence, incidence, and trends of childhood overweight/obesity in Sub-Saharan Africa: a systematic scoping review

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-020-00491-2.

Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students

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.

A scoping review of literature describing the nutritional status and diets of adolescents in Côte d'Ivoire

OBJECTIVE

Adolescents living in resource-limited settings remain a neglected population regarding their nutritional health. We reviewed what studies on nutrition have been conducted for adolescents living in Côte d'Ivoire.

DESIGN

A scoping literature review, searching for any quantitative studies published from 1 January 2000 to 1 May 2019, referenced in PubMed and grey literature, related to adolescent nutritional status and diet, written in English or French.

SETTING

Côte d'Ivoire, West Africa.

SUBJECTS

Adolescent girls and boys (aged 10-19 years).

RESULTS

We used three search strategies to explore studies related to (1) diet and nutritional practices, (2) anthropometry and (3) micronutrient intakes/status. Each identified 285, 108 and 84 titles and abstracts, respectively, resulting in 384 full-text articles to review. Finally, after adding five relevant studies from the grey literature, thirty articles were included. Two-thirds were cross-sectional observation studies. The main topics were anaemia and parasitic diseases. Among seven intervention studies, most focused on micronutrient supplementation or deworming. No studies on macronutrients or food supplementation were found. Overall, studies showed a high prevalence of undernutrition, along with emerging overweight and obesity. Anaemia and Fe deficiency were highly prevalent, with Fe supplementation showing modest improvements. Malaria and gut parasite infections remain a major burden, affecting adolescents' nutritional status.

CONCLUSIONS

Few specific relevant studies have been published regarding adolescent nutrition in Côte d'Ivoire, and most studies being focused on younger children. There are knowledge gaps about many nutritional aspects in this population, which urgently need to be addressed.

Risk factors and morbidities associated with childhood obesity in sub-Saharan Africa: a systematic scoping review

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.

Adolescent nutrition and physical activity in low-income suburbs of Abidjan, Côte d'lvoire: the gap between knowledge, aspirations and possibilities

OBJECTIVE

To explore adolescents' perceptions, knowledge and behaviours regarding nutrition and physical activity in low-income districts of Abidjan, Côte d'Ivoire, taking into consideration their caregivers' perspectives.

DESIGN

Two investigators conducted six focus group discussions.

SETTING

The study was carried out in two low-income suburbs, Yopougon and Port-Bouët, in Abidjan, Côte d'Ivoire.

PARTICIPANTS

Adolescents and their caregivers were recruited into the study via local head teachers and heads of settlement.

RESULTS

Overall, seventy-two participants, including forty-six adolescents and twenty-six caregivers, took part. Participants demonstrated good nutrition knowledge, relating nutritional health to a balanced diet and hygiene. Sustained physical activity was reported. However, adopting good practices was challenging due to participant's economic circumstances. Their environment was a barrier to improving health due to dirtiness and violence, with a lack of space limiting the possibility to practice sport. Adolescents and their caregivers differed in their response to these constraints. Many caregivers felt powerless and suggested that a political response was the solution. Alternatively, adolescents were more likely to suggest new creative solutions such as youth-friendly centres within their community.

CONCLUSIONS

Participants were aware that their nutritional habits were not in line with what they had learnt to be good nutritional practices due to socio-economic constraints. Physical activity was part of adolescent life, but opportunities to exercise were restricted by their environment. Strategies for improving adolescent health in these settings need to be developed in collaboration with adolescents in a manner that accommodates their opinions and solutions.

Public health surveillance of habitual physical activity in adolescents and adults in Namibia: a cross-sectional validation of activity questionnaires against accelerometry

BACKGROUND

Monitoring population-level physical activity is crucial for examining adherence to global guidelines and addressing obesity. This study validated self-reported moderate-to-vigorous physical activity (MVPA) against an accurate device-based method in Namibia.

METHODS

Adolescent girls (n = 52, mean age 16.2 years [SD 1.6]) and adult women (n = 51, mean age 31.3 years [SD 4.7]) completed the PACE+/GPAQ self-report questionnaires and were asked to wear an Actigraph accelerometer for 7 days. Validity of self-reported MVPA was assessed using rank-order correlations between self-report and accelerometry, and classification ability of the questionnaires with Mann-Whitney tests, kappa's, sensitivity and specificity.

RESULTS

In the adolescents, Spearman's rank coefficients between self-reported MVPA (days/week) and accelerometry measured MVPA were positive but not significant (r = 0.240; P = 0.104). In the adults, self-reported MVPA (minutes/day) was moderately and significantly correlated with accelerometer-measured MVPA (r = 0.396; P = 0.008). In both groups, there was fair agreement between accelerometry and questionnaire-defined tertiles of MVPA (adolescents κ = 0.267; P = 0.010; adults κ = 0.284; P = 0.008), and measured MVPA was significantly higher in the individuals self-reporting higher MVPA than those reporting lower MVPA.

CONCLUSIONS

The PACE+ and GPAQ questionnaires have a degree of validity in adolescent girls and adult females in Namibia, though more suitable for population than individual level measurement.

Childhood Obesity and Overweight in Ghana: A Systematic Review and Meta-Analysis

The increasing prevalence of childhood obesity and overweight is considered a public health issue in both developed and developing countries. This systematic review and meta-analysis estimates the prevalence of childhood obesity and overweight in Ghana. A multiple database search was conducted for articles published between January 1, 2001, and October 31, 2019, reporting the prevalence of childhood obesity and overweight in Ghana. Databases searched include PubMed, Google Scholar, Scopus, Cochrane Library, World Health Organization (WHO) Library Information System, and Africa Journals Online. Data were pooled from the articles to calculate an overall estimate of childhood obesity and overweight using a random-effects model after variance stabilization with Freeman–Tukey double arcsine transformation. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixteen studies with a combined sample size of 29,160 were included in the review. Analysis indicates that approximately 19% of children in Ghana either have obesity or are overweight. The prevalence of childhood obesity and overweight was 8.6% (95% CI: 4.8%–13.4%) and 10.7% (95% CI: 5.9%–16.6%), respectively. Although not significant, higher obesity (4.6% vs. 2.6%) and overweight (11.0% vs. 7.2%) prevalence were estimated for females than for males. There was a significantly higher obesity prevalence estimate (17.4% vs. 8.9%) in rural settings than in urban settings (p=0.0255). The high prevalence of childhood obesity and overweight estimated in this review is of worrying concern. It is a significant public health problem that has implications on the health of present and future generations in Ghana and as such calls for proactive measures to be put in place. Also, the driving forces behind the increasing prevalence of childhood obesity in Ghana need to be investigated.

Overweight/obesity and associated cardiovascular risk factors in sub-Saharan African children and adolescents: a scoping review

INTRODUCTION

Recently, childhood and adolescence overweight/obesity has increased disproportionately in developing countries, with estimates predicting a parallel increase in future cardiovascular disease (CVD) burden identifiable in childhood and adolescence. Identifying cardiovascular risk factors (CVRF) associated with childhood and adolescence overweight/obesity is pivotal in tailoring preventive interventions for CVD. Whilst this has been examined extensively in high-income countries, there is scant consistent or representative data from sub-Saharan Africa (SSA).

OBJECTIVE

This scoping review synthesises contemporary studies on CVRF associated with overweight and obesity in SSA children and adolescents to provide evidence on the current burden of overweight/obesity and CVD in this population.

METHODS

We searched MEDLINE and Google Scholar up to July 31, 2019 for observational and experimental studies and systematic reviews addressing childhood and adolescence overweight/obesity and CVRF in SSA without language restriction. Four investigators working in four pairs, independently selected and extracted the relevant data. The methodological quality of all included studies was assessed.

RESULTS

We included 88 studies with a total of 86,637children and adolescents from 20 SSA countries. The risk of bias was low in 62 (70.5%), moderate 18 (20.5%), and high in eight (9%) studies. Overweight/obesity in SSA children and adolescents is rising at an alarming rate. Its main associations include physical inactivity, unhealthy diets, high socio-economic status, gender and high maternal body mass index. Identified CVRF in overweight/obese SSA children and adolescents are mainly metabolic syndrome, hypertension, dyslipidaemia, diabetes and glucose intolerance. There is a dearth of guidelines or consensus on the management of either childhood overweight/obesity or CVRF in overweight/obese SSA children and adolescents.

CONCLUSION

The current findings suggest an urgent need to review current health policies in SSA countries. Health education and transforming the current obesogenic environment of the SSA child and adolescent into one which promotes physical activity and healthy dietary habits is required.

Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso

Objective

Body dissatisfaction and eating disorders (ED) among young females may increase in limited‐resource settings as exposure to media and higher‐resource cultures increases. We examined ED prevalence and its predictors among adolescent girls in rural north‐western Burkina Faso.

Methods

Fieldworkers interviewed 696 female adolescents aged 12‐20 years in the Nouna Health and Demographic Surveillance System (HDSS). ED were evaluated using the Structured Clinical Interview for DSM‐5 (SCID‐5), self‐perceived appearance and body ideal were measured using Thompson and Gray’s Contour Drawing Rating Scale (CDRS) and eating disorder predictors by the Eating Disorder Examination Questionnaire (EDE‐Q). We assessed media exposure to magazines, radio, television, and the internet.

Results

16% of respondents had a BMI below WHO age‐standardised 5th percentile, while 4% were above the 85th percentile; most respondents wanted to be larger. DSM‐5 criteria for anorexia nervosa (AN) were fulfilled by four of 696 respondents (0.6%), those for bulimia nervosa by none, and those for binge eating disorder by two (0.3%). In multivariable regression, more AN symptoms were associated with greater EDE‐Q body dissatisfaction, desiring a thinner body and a history of sexual harassment or assault, but not with media exposure. A thinner desired body was associated with greater media exposure, higher BMI z‐score and greater EDE‐Q disordered eating.

Conclusion

ED were very rare in rural Burkinabé female adolescents, but factors predictive of ED in higher‐resource settings were also predictive of ED precursor symptoms here. Our findings suggest that increasing media exposure in resource‐limited settings may lead to increased body dissatisfaction, and potentially to increased future ED prevalence.

Diagnostic Accuracy of Body Mass Index in Defining Childhood Obesity: Analysis of Cross-Sectional Data from Ghanaian Children

Background: Screening methods for childhood obesity are based largely on the published body mass index (BMI) criteria. Nonetheless, their accuracy in African children is largely unknown. The diagnostic accuracies of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the International Obesity Taskforce (IOTF) BMI-based criteria in defining obesity using deuterium dilution as a criterion method in a sample of Ghanaian children are presented. Methods: Data on anthropometric indices and percent body fat were collected from 183 children aged 8–11 years. The sensitivity, specificity, and predictive values were calculated. The overall performance of the BMI criteria was evaluated using the receiver operating characteristics area under the curve (AUC). Results: Overall sensitivity of WHO, CDC, and IOTF were 59.4% (40.6–76.3), 53.1% (34.7–70.9), and 46.9% (29.1–65.3) respectively. The overall specificity was high, ranging from 98.7% by WHO to 100.0% by IOTF. The AUC were 0.936 (0.865–1.000), 0.924 (0.852–0.995), and 0.945 (0.879–1.000) by the WHO, CDC, and IOTF criteria respectively for the overall sample. Prevalence of obesity by the WHO, CDC, IOTF, and deuterium oxide-derived percent body fat were 11.5%, 10.4%, 8.2%, and 17.5% respectively, with significant positive correlations between the BMI z-scores and percent body fat. Conclusions: The BMI-based criteria were largely specific but with moderate sensitivity in detecting excess body fat in Ghanaian children. To improve diagnostic accuracy, direct measurement of body fat and other health risk factors should be considered in addition to BMI.

Gender differences in nutritional status, diet and physical activity among adolescents in eight countries in sub-Saharan Africa

OBJECTIVE

The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa.

METHODS

This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined.

RESULTS

The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively).

CONCLUSION

Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.