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Czarniecka-Skubina E, Hamulka J, Jeruszka-Bielak M, Gutkowska K. Do Food and Meal Organization Systems in Polish Primary Schools Reflect Students' Preferences and Healthy and Sustainable Dietary Guidelines? The Results of Qualitative Research for the Junior-Edu-Żywienie (JEŻ) Project. Foods 2023; 13:61. [PMID: 38201089 PMCID: PMC10778281 DOI: 10.3390/foods13010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The school environment, together with that of the family, shapes students' eating behaviors, and is an important element of formal and informal nutrition education. The informal and practical dimensions can be realized through the food and meals offered/sold in school canteens, shops, and vending machines. As children and adolescents spend 6-10 h/day in schools and consume at least two meals there, the school food environment is important from a public health perspective. The aim of this study is to assess food and meal organization in primary schools in Poland. The study was conducted using individual in-depth interviews (IDIs) involving 24 school headmasters and 24 representatives of people employed in school canteens or catering companies involved in meal organization in schools. The nutritional food on offer at schools is important for shaping students' food preferences and choices, consequently influencing the development, functioning, and health of this subpopulation. The school environment can be an ideal place for hands-on nutrition education. In addition to the knowledge provided, there must be a consistent message concerning the provision of nutrition information to students between the teachings of parents, teachers, and, indirectly, the food and meals available at school. Our qualitative study is confirmed by the results of quantitative research to better understand the organization of nutrition and the problems and needs of primary schools in this area.
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Affiliation(s)
- Ewa Czarniecka-Skubina
- Department of Food Gastronomy and Food Hygiene, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland
| | - Jadwiga Hamulka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.)
| | - Marta Jeruszka-Bielak
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.)
| | - Krystyna Gutkowska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland;
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Nedzingahe V, Tambe BA, Zuma MK, Mbhenyane XG. Associations among Food Systems, Food Environments, Food Choices, Food Security, and Nutrition Transition in Limpopo Province, South Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6557. [PMID: 37623143 PMCID: PMC10454841 DOI: 10.3390/ijerph20166557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
A cross-sectional study was applied to investigate the influence of food systems and food environments on food choices and nutrition transition of households in Limpopo province, South Africa. A sample of 429 households was systematically selected using a paper selection draw from three districts. This paper determines the association among food systems, food environments, food choices, and nutritional measurements of the respondents. A validated questionnaire was used. Most of the respondents responsible for food procurement were females (80.4%). There was a significant association (p < 0.001) between proximity to food stores and dietary diversity of the households. Staple foods such as bread, maize, rice, samp, and mealie rice were available in almost all surveyed households (95.6%). More than half of the households (59.8%) had home gardens in their yards. Almost half of the households (48.4%) had a low Dietary Diversity Score. The study further revealed that 46.0% of households were food secure. Over a third (36.2%) of the respondents were obese, and 32.5% were diabetic. The mean total blood cholesterol was 3.69 ± 0.74 mmol/L. A high percentage of both females (89.6%) and males (91.5%) had normal hemoglobin levels. Almost half of the respondents had normal systolic blood pressure levels (45.6%), and nearly a quarter had high diastolic levels (21.4%). The 25 coping strategies were applied during food shortage periods. Even though the food environments provided both obesogenic and protective foods, the consumption of unhealthy foods was high.
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Affiliation(s)
- Vhushavhelo Nedzingahe
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
| | - Betrand Ayuk Tambe
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea P.O. Box 63, Cameroon
| | - Mthokozisi Kwazi Zuma
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
- Impact and Partnerships Division, Agricultural Research Council, P.O. Box 8783, Pretoria 0084, Gauteng, South Africa
| | - Xikombiso Gertrude Mbhenyane
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, Western Cape, South Africa; (V.N.); (B.A.T.); (M.K.Z.)
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Mauti J, Mank I, De Neve JW, Gyengani GA, Somé PA, Shinde S, Fawzi W, Bärnighausen T, Vandormael A. The Food and Health Environment in Junior Secondary Schools in Urban Burkina Faso: A Cross-Sectional Study of Administrators, Food Vendors and Early Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312689. [PMID: 34886415 PMCID: PMC8656836 DOI: 10.3390/ijerph182312689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 12/25/2022]
Abstract
School enrolment rates have increased globally, making the school environment a unique setting to promote healthy nutrition and eating outcomes among early adolescents. In this cross-sectional study, we describe the food and health environment of junior secondary schools in Ouagadougou (Burkina Faso, West Africa). We evaluated the food and health environment using three components: (1) the implementation of health-related policies or guidelines in the schools, (2) the provision of health, nutrition and water, sanitation & hygiene (WASH) services in the schools, and (3) the quality of the school food environment, including foods sold by vendors. We used stratified random sampling to recruit 22 junior secondary schools from the five Ouagadougou districts in 2020. Trained fieldworkers collected standardized questionnaire data from 19 school administrators, 18 food vendors, and 1059 in-school adolescents. We report that only 7 out of 19 school administrators were aware of existing health-related policies and guidelines at their school and only 3 schools had a school health and nutrition curriculum in place. The overall provision of health, nutrition and WASH services was low or inadequate. Likely because of the lack of school canteens, 69% of the students bought snacks and unhealthy foods from food vendors. There is a critical need to improve the food and health environment of junior secondary schools in urban Burkina Faso.
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Affiliation(s)
- Joy Mauti
- Faculty of Medicine, Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.M.); (I.M.); (J.-W.D.N.); (T.B.)
| | - Isabel Mank
- Faculty of Medicine, Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.M.); (I.M.); (J.-W.D.N.); (T.B.)
| | - Jan-Walter De Neve
- Faculty of Medicine, Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.M.); (I.M.); (J.-W.D.N.); (T.B.)
| | - Guillaume Alfred Gyengani
- Institut Superieur des Sciences de la Population (ISSP), Blvd Charles de Gaulle, Ouagadougou 03 BP 7118, Burkina Faso; (G.A.G.); (P.-A.S.)
| | - Paul-André Somé
- Institut Superieur des Sciences de la Population (ISSP), Blvd Charles de Gaulle, Ouagadougou 03 BP 7118, Burkina Faso; (G.A.G.); (P.-A.S.)
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (S.S.); (W.F.)
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (S.S.); (W.F.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Till Bärnighausen
- Faculty of Medicine, Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.M.); (I.M.); (J.-W.D.N.); (T.B.)
- Africa Health Research Institute (AHRI), Africa Centre Building, Via R618 to Hlabisa, Somkhele, P.O. Box 198, Mtubatuba 3935, South Africa
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA
| | - Alain Vandormael
- Faculty of Medicine, Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.M.); (I.M.); (J.-W.D.N.); (T.B.)
- Correspondence:
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O’Halloran SA, Eksteen G, Polayya N, Ropertz M, Senekal M. The Food Environment of Primary School Learners in a Low-to-Middle-Income Area in Cape Town, South Africa. Nutrients 2021; 13:nu13062043. [PMID: 34203651 PMCID: PMC8232268 DOI: 10.3390/nu13062043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
Rapid changes in food environments, where less nutritious foods have become cheaper and more accessible, have led to the double burden of malnutrition (DBM). The role food environments have played in shaping the DBM has attained global interest. There is a paucity of food environment research in low-to-middle-income countries. We conducted a case study of the food environments of school aged learners. A primary school in Cape Town was recruited. A multi-method design was used: a home food and eating behaviours questionnaire completed by 102 household respondents and four questions completed by 152 learners; learner participatory photography; a semi-structured school principal interview; a tuckshop inventory; observation of three-day tuckshop purchases. Foods that were commonly present in households: refined carbohydrates, fats/oils, chicken, processed meats, vegetables, fruit, legumes, snacks/drinks. Two thirds of households had rules about unhealthy drinks/snacks, ate supper together and in front of the TV, ate a home cooked meal five–seven times/week and ate breakfast together under two times/week. Vegetables were eaten under two times/week in 45% of households. A majority of learners (84%) took a lunchbox to school. Twenty-five learners photographed their food environment and 15 participated in semi-structured interviews. Six themes emerged: where to buy; what is available in the home; meal composition; family dynamics; peer engagement; food preparation. Items bought at informal food outlets included snacks, drinks and grocery staples. The principal interview revealed the establishment of a healthy school food environment, including a vegetable garden, although unhealthy snacks were sold at the tuckshop. Key dimensions of the food environment that require further investigation in disadvantaged urban and informal settlement areas include the home availability of unhealthy foods, eating behaviours in households and healthfulness of foods sold by informal food outlets.
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Affiliation(s)
- Siobhan A. O’Halloran
- Faculty of Medicine, Institute of Medical Sciences, University of Oslo, 0372 Oslo, Norway;
| | - Gabriel Eksteen
- Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (G.E.); (N.P.); (M.R.)
| | - Nadene Polayya
- Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (G.E.); (N.P.); (M.R.)
| | - Megan Ropertz
- Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (G.E.); (N.P.); (M.R.)
| | - Marjanne Senekal
- Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (G.E.); (N.P.); (M.R.)
- Correspondence:
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Ehlen S, Rehaag R, Fitschen J, Okan O, Pinheiro P, Bauer U. Gesundheitsförderung und Prävention bei vulnerablen Kindern und Jugendlichen in Kitas und Schulen – Ansätze zur Erhöhung der Reichweite. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2021. [DOI: 10.1007/s11553-021-00850-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dia OEW, Løvhaug AL, Rukundo PM, Torheim LE. Mapping of outdoor food and beverage advertising around primary and secondary schools in Kampala city, Uganda. BMC Public Health 2021; 21:707. [PMID: 33845809 PMCID: PMC8042698 DOI: 10.1186/s12889-021-10661-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Marketing of unhealthy foods and beverages is recognized as a contributing factor to the global increase in overweight and obesity, particularly among children. Such marketing negatively affects children's dietary preferences, food choices, purchasing requests, and consumption patterns. Given that little is known about food marketing in Africa, including in Uganda, monitoring children's exposure to food marketing is essential to generate evidence on the problem and develop meaningful policy responses. The aim of this study was to describe the food and beverage marketing environment surrounding schools in urban and peri-urban areas of Kampala city. METHODS Outdoor advertising around 25 randomly sampled primary and secondary schools within a radius of 250 m of each school was mapped. Information on size, setting, type, and position of the advertisements and the healthiness of the foods and beverages promoted was collected using the INFORMAS Outdoor Advertising Protocol. The occurrence of advertising was described using frequencies, median, and density per 100m2. RESULTS A total of 1034 branded advertisements were identified around the schools. Of these, 86% featured unhealthy products, 7% healthy products, and 7% miscellaneous products. The most advertised products were sugar-sweetened beverages and alcoholic beverages (51 and 23%, respectively). Schools in the urban area were surrounded by more unhealthy ads than those in the peri-urban areas (median of 45 vs 24 advertisements). CONCLUSION The widespread extent of unhealthy food and beverage advertisements around primary and secondary schools highlights the need for food marketing regulation in Uganda, in line with the World Health Organization's recommendations, to ensure that young people are protected from unhealthy food marketing.
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Affiliation(s)
- Oumy Erica Wie Dia
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Peter Milton Rukundo
- Department of Human Nutrition and Home Economics, Kyambogo University, P.O. Box 1, Kyambogo, Uganda
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway.
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Erzse A, Christofides N, Stacey N, Lebard K, Foley L, Hofman K. Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study. Glob Health Action 2021; 14:1898130. [PMID: 33910480 PMCID: PMC8288764 DOI: 10.1080/16549716.2021.1898130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/28/2021] [Indexed: 10/31/2022] Open
Abstract
Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment.Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge.Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted.Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45-63%) of schools with tuck shops and advertised in 31% (CI: 25-39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs.Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Nicola Christofides
- Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Nicholas Stacey
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kelsey Lebard
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, UK
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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Hawkes C, Ruel MT, Salm L, Sinclair B, Branca F. Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms. Lancet 2020; 395:142-155. [PMID: 31852603 DOI: 10.1016/s0140-6736(19)32506-1] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.
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Affiliation(s)
- Corinna Hawkes
- Centre for Food Policy, City, University of London, London, UK.
| | - Marie T Ruel
- International Food Policy Research Institute, Washington, DC, USA
| | - Leah Salm
- International Food Policy Research Institute, Washington, DC, USA
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Kupolati MD, MacIntyre UE, Gericke GJ, Becker P. A Contextual Nutrition Education Program Improves Nutrition Knowledge and Attitudes of South African Teachers and Learners. Front Public Health 2019; 7:258. [PMID: 31620415 PMCID: PMC6759471 DOI: 10.3389/fpubh.2019.00258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 08/27/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Evaluating the impact of a nutrition education program could provide insight into the effectiveness of an intervention. Researchers tested the hypothesis that a theory-based contextual nutrition education program (NEP) would improve the nutrition knowledge, attitudes, and dietary practices (KAP) of teachers and learners. Methods: Twenty three teachers who taught nutrition in Grades 4-7 (treatment school, n = 12) and 681 learners (treatment school, n = 350) participated in the study. In this quasi-experimental study, two primary schools were randomly selected to implement a contextual NEP. The nutrition KAP were assessed using previously validated questionnaires. The treatment school teachers taught nutrition using a developed nutrition education manual, while the control school teachers taught nutrition in the usual manner. Random effects Generalized Least Squares regression estimated the difference in the teachers' and learners' KAP for the treatment and control schools; p = 0.025 for a one-tailed test. Results: At post-implementation, the treatment school teachers' had higher total nutrition knowledge mean score (85.5% ± 8.2, p = 0.003) compared to the control school. Within the treatment school, total nutrition knowledge mean score of the teachers improved by 14.1%, p ≤ 0.001. Learners in the treatment school had higher total nutrition knowledge (53.2% ± 16.9, p = 0.002) and nutrition attitude (63.9% ± 19.7, p = 0.001) scores compared to learners in the control school. Within the treatment school, learners' total nutrition knowledge and nutrition attitudes scores increased by 4.9%, p ≤ 0.001 and 6.9%, p ≤ 0.001, respectively. The dietary practices of the teachers and the learners, and the nutrition attitudes of the teachers in the treatment school showed no significant within school improvement or in comparison with the control school (p > 0.025). Conclusions: The NEP led to the improvement in the teachers' and the learners' nutrition knowledge and the learners' nutrition attitudes. However, no significant improvement in the dietary practices of either teachers or learners was found.
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Affiliation(s)
| | - Una E. MacIntyre
- Human Nutrition Department, University of Pretoria, Pretoria, South Africa
| | - Gerda J. Gericke
- Human Nutrition Department, University of Pretoria, Pretoria, South Africa
| | - Piet Becker
- Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation. Public Health Nutr 2019; 23:374-383. [PMID: 31179956 DOI: 10.1017/s1368980019001356] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption. DESIGN We conducted six focus group discussions using a semi-structured guide. SETTING The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented. PARTICIPANTS Adults aged 18 years or above living in Soweto (n 57). RESULTS Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons. CONCLUSIONS While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.
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Childhood Obesity Prevention in Africa: A Systematic Review of Intervention Effectiveness and Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071212. [PMID: 30987335 PMCID: PMC6480149 DOI: 10.3390/ijerph16071212] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 01/22/2023]
Abstract
Childhood obesity is of increasing concern in many parts of Africa. We conducted a systematic search and review of published literature on behavioural childhood obesity prevention interventions. A literature search identified peer-reviewed literature from seven databases, and unindexed African journals, including experimental studies targeting children age 2–18 years in African countries, published in any language since 1990. All experimental designs were eligible; outcomes of interest were both behavioural (physical activity, dietary behaviours) and anthropometric (weight, body mass index, body composition). We also searched for process evaluations or other implementation observations. Methodological quality was assessed; evidence was synthesised narratively as a meta-analysis was not possible. Seventeen articles describing 14 interventions in three countries (South Africa, Tunisia and Uganda) were included. Effect scores indicated no overall effect on dietary behaviours, with some beneficial effects on physical activity and anthropometric outcomes. The quality of evidence was predominantly weak. We identified barriers and facilitators to successful interventions, and these were largely resource-related. Our systematic review highlights research gaps in targeting alternative settings to schools, and younger age groups, and a need for more rigorous designs for evaluating effectiveness. We also recommend process evaluations being used more widely.
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Tomaz SA, Jones RA, Hinkley T, Bernstein SL, Twine R, Kahn K, Norris SA, Draper CE. Gross motor skills of South African preschool-aged children across different income settings. J Sci Med Sport 2018; 22:689-694. [PMID: 30606626 DOI: 10.1016/j.jsams.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/17/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES No studies have investigated gross motor skill (GMS) proficiency of preschool-aged children across different income settings in South Africa. Research from high-income countries suggests that children from low-income settings display poorer GMS proficiency compared to higher-income peers. This study aimed to (1) describe GMS proficiency of preschool-aged children in urban high-income (UH), urban low-income (UL) and rural low-income (RL) settings; and (2) explore differences in proficiency between income settings and sex. DESIGN Descriptive cross-sectional study. METHODS The Test of Gross Motor Development-Edition 2 (TGMD-2) was used to assess GMS. The TGMD-2 gross motor quotient, standardised scores and raw scores were used to describe proficiency. RESULTS GMS proficiency was assessed in n=259 3-6-year-old children (n=46 UH, n=91 UL, n=122 RL). Overall, 93% of the children were classified as having 'average' or better GMS. According to TGMD-2 standardised scores, the RL children performed significantly better than UH and UL children (p=0.028 and p=0.009, respectively). RL children were significantly more proficient than UH and UL children in the strike and horizontal jump when comparing raw scores. Overall, boys performed significantly better than girls in the strike, stationary dribble, kick and leap when comparing raw scores (all p<0.001). CONCLUSIONS This study reports high GMS proficiency in preschool-aged children across income settings in South Africa. The factors associated with higher GMS in low-income settings are not immediately obvious. Thus, future research should explore potential factors and identify opportunities to ensure that GMS proficiency is capitalised on as preschool-aged children enter formal schooling.
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Affiliation(s)
- S A Tomaz
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa
| | - R A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia
| | - T Hinkley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - S L Bernstein
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa
| | - R Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - K Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Umeå Centre for Global Health Research, Umeå University, Sweden; INDEPTH Network, Ghana
| | - S A Norris
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - C E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa; South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
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Karnincic H, Cavala M, Rogulj N. The Relationship Between Handball Players and Alcohol and Smoking Habits. J Hum Kinet 2018; 63:127-136. [PMID: 30279948 PMCID: PMC6162977 DOI: 10.2478/hukin-2018-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Recent studies have revealed that sport activity is a protective factor regarding smoking, but a risk factor for alcohol abuse. Considering these findings, it is necessary to investigate the occurrence of substance misuse. Sports that are associated with a substantial amount of physical/mental stress are very interesting from the perspective of substance misuse (e.g., handball). This research was performed to more closely study the population engaged in handball regarding the risk for alcohol and/or tobacco consumption. The sample of respondents consisted of 150 senior handball players who were members of 9 first-league handball clubs from Croatia and abroad. The respondents were grouped into sub-samples according to sex, age, experience, the number of weekly training sessions and their social environment (clubs). Alcohol consumption data were obtained using the AUDIT questionnaire. The differences between groups were tested using the Kruskal-Wallis and Mann-Whitney U tests. The study revealed that handball players engaged in alcohol misuse, and they were grouped in the harmful drinking category (AUDIT score, 16-19 for all groups). Regarding tobacco product consumption, the risk groups were women (who smoked significantly more than men, MWU test: Z = 3.30. p < 0.001), handball players with less experience (who smoked significantly more than experienced players, MWU test: Z = 3.68, p < 0.001). Borderline significance was observed for the impact made by social environments, and age was not a significant predictor of tobacco consumption. Regarding alcohol consumption, the highest hazard group were national handball players, who drank much more than foreign players did (MWU test: Z = 2.04, p = 0.04); however, sex, age, experience and training habits were not alcohol consumption predictors in handball. This study reveal that the typical behaviors regarding alcohol and tobacco consumption followed by the general population do not apply to handball players. Targeted prevention can be much more precisely established considering this research.
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Affiliation(s)
| | | | - Nenad Rogulj
- University of Split, Faculty of Kinesiology, Split, Croatia
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14
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de Villiers A, Senekal M, Nel J, Draper CE, Lambert E, Steyn NP. The HealthKick Study: Modifiable Lifestyle Factors in Primary Caregivers of Primary School Learners from Two School Districts in the Western Cape Province, South Africa. Ethn Dis 2018; 28:93-98. [PMID: 29725193 DOI: 10.18865/ed.28.2.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The HealthKick (HK) study showed that educators (teachers) had a high prevalence of risk factors for the development of non-communicable diseases (NCDs). Little data are available on parents or other primary caregivers of learners from disadvantaged schools. Aim The aim of our study was to determine modifiable risk factors for the development of NCDs in a sample of caregivers of schools included in the HK intervention program. Participants Caregivers of grade 4 children from 25 schools were invited to take part in the study and 175 participated. Caregivers were Black Africans and of mixed ethnic origin. Methods Dietary intake was measured using a validated frequency questionnaire. Physical activity was measured by completing the Global Physical Activity Questionnaire (GPAQ). Caregivers described their smoking habits and alcohol usage. Weight and height were measured for each participant and body mass index (BMI) was calculated. Results Eighty percent women and 50% men had a BMI ≥25 (overweight or obese). The most frequently consumed categories of foods were processed foods, energy-dense foods, and high-fat foods representing unhealthy food choices. More than half of the total group (81.7%) and both males and females were meeting physical activity recommendations of 600 METs/week. Many caregivers, particularly men (53%), smoked cigarettes and reportedly consumed alcohol during the week and on weekends. Conclusion Caregivers of children in the HK study population presented with a large number of modifiable health risk behaviors. These results highlight the importance of engaging caregivers, as part of a whole school intervention, to promote healthy eating and physical activity.
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Affiliation(s)
- Anniza de Villiers
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town
| | - Marjanne Senekal
- Division of Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Johanna Nel
- Department of Logistics, University of Stellenbosch, Stellenbosch
| | - Catherine E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Estelle Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Nelia P Steyn
- Division of Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
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Horta RL, Andersen CS, Pinto RO, Horta BL, Oliveira-Campos M, Andreazzi MARD, Malta DC. Health promotion in school environment in Brazil. Rev Saude Publica 2017; 51:27. [PMID: 28380209 PMCID: PMC5575721 DOI: 10.1590/s1518-8787.2017051006709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/07/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Evaluate the school environments to which ninth-year students are exposed in Brazil and in the five regions of the country according to health promotion guidelines. METHODS Cross-sectional study from 2012, with a representative sample of Brazil and its macroregions. We interviewed ninth-year schoolchildren and managers of public and private schools. We proposed a score of health promotion in the school environment (EPSAE) and estimated the distribution of school members according to this score. Crude and adjusted odds ratios (OR) were used, by ordinal regression, to determine the schoolchildren and schools with higher scores, according to the independent variables. RESULTS A student is more likely to attend a school with a higher EPSAE in the South (OR = 2.80; 95%CI 2.67–2.93) if the school is private (OR = 4.52; 95%CI 4.25–4.81) and located in a state capital, as well as if the student is 15 years of age or older, has a paid job, or has parents with higher education. CONCLUSIONS The inequalities among the country’s regions and schools are significant, demonstrating the need for resources and actions that promote greater equity.
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Affiliation(s)
- Rogério Lessa Horta
- Programa de Pós-Graduação em Saúde Coletiva. Unidade de Pesquisa e Pós-Graduação. Universidade do Vale do Rio dos Sinos. São Leopoldo, RS, Brasil
| | - Cristine Scattolin Andersen
- Núcleo de Saúde e Segurança do Trabalho. Gestão de Pessoas. Instituto Federal de Educação, Ciência e Tecnologia. Farroupilha, RS, Brasil
| | - Raquel Oliveira Pinto
- Hospital Escola. Universidade Federal de Pelotas. Empresa Brasileira de Serviços Hospitalares. Pelotas, RS, Brasil
| | - Bernardo Lessa Horta
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Maryane Oliveira-Campos
- Departamento de Ciências Básicas e da Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina, MG, Brasil
| | - Marco Antonio Ratzsch de Andreazzi
- Coordenação de População e Indicadores Sociais. Diretoria de Pesquisa. Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro, RJ, Brasil
| | - Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. Secretaria de Vigilância em Saúde. Ministério da Saúde. Brasília, DF, Brasil.,Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
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Nortje N, Faber M, de Villiers A. School tuck shops in South Africa—an ethical appraisal. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2017. [DOI: 10.1080/16070658.2017.1267401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nico Nortje
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Mieke Faber
- Department of Dietetics, University of the Western Cape; and Non-Communicable Diseases Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Anniza de Villiers
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Bellville, South Africa
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17
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Nguyen KA, De Villiers A, Fourie JM, Hendricks M. Challenges to implementing the food-based dietary guidelines in the South African primary school curriculum: a qualitative study exploring the perceptions of principals and curriculum advisors. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2016.1230971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Steyn N, Eksteen G, Senekal M. Assessment of the Dietary Intake of Schoolchildren in South Africa: 15 Years after the First National Study. Nutrients 2016; 8:nu8080509. [PMID: 27548214 PMCID: PMC4997422 DOI: 10.3390/nu8080509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/02/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022] Open
Abstract
There has not been a national dietary study in children in South Africa since 1999. Fortification of flour and maize meal became mandatory in October 2003 to address micronutrient deficiencies found in the national study in 1999. The purpose of this review was to identify studies done after 1999 in schoolchildren, 6–15 years old, in order to determine whether dietary intakes reflected improvements in micronutrients, namely: iron, zinc, vitamin A, folate, thiamine, riboflavin, vitamin B6, and niacin. An electronic and hand search was done to identify all studies complying with relevant inclusion criteria. The search yielded 10 studies. Overall, there is a paucity of dietary studies which have included the fortified nutrients; only four, of which only one, reported on all micronutrients; making it difficult to determine whether fortification has improved the micronutrient intake of schoolchildren. This is further complicated by the fact that different dietary methods were used and that studies were only done in three of the nine provinces and thus are not generalizable. The results of these studies clearly point to the importance of doing a national study on the dietary intake of schoolchildren in order to confirm the outcomes of the fortification process.
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Affiliation(s)
- Nelia Steyn
- Division of Human Nutrition, Department of Human Biology, University of Cape Town, Cape Town 8000, South Africa.
| | - Gabriel Eksteen
- Division of Human Nutrition, Department of Human Biology, University of Cape Town, Cape Town 8000, South Africa.
- South African Heart and Stroke Foundation, Cape Town 8000, South Africa.
| | - Marjanne Senekal
- Division of Human Nutrition, Department of Human Biology, University of Cape Town, Cape Town 8000, South Africa.
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Early nutrition transition in Haiti: linking food purchasing and availability to overweight status in school-aged children. Public Health Nutr 2016; 19:3378-3385. [DOI: 10.1017/s1368980016001671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractObjectiveThe primary aim was to examine the association of socio-economic factors and diet with overweight (including obesity) among school-aged children in Haiti. The secondary aim was to describe food availability and the physical activity built environment in participating schools.DesignThis cross-sectional study examined baseline data from the intervention Mamba study assessing the effectiveness of a fortified peanut butter paste in school-aged children. Logistic regression modelling was used to test hypothesized factors in association with overweight status.SettingSix primary schools in Cap-Haitien, the second largest city in Haiti.SubjectsChildren (n 968) aged 3–13 years, in good health and enrolled in a participating school for the 2012/13 school year.ResultsChild age (adjusted OR (AOR); 95 % CI=0·25; 0·12, 0·56), child age squared (1·08; 1·03, 1·13), always purchasing food at school (3·52; 1·12, 11·08), mother’s BMI (1·10; 1·04, 1·16) and household ownership of a bicycle (0·28; 0·11, 0·71) were significantly associated with overweight (likelihood ratio=36, P<0·0001). Consumption of fish was significantly lower in overweight children in the binary analysis (P=0·033) and improved the fit of the model. Schools had limited time and space for physical activity and foods sold by vendors were predominantly high in sugar or fat.ConclusionsTo our knowledge the present study is the first to examine the covariates of childhood overweight or describe school food availability and physical activity built environments in Haiti. Further research is necessary to identify intervention targets and feasible, cost-effective approaches for prevention of obesity in Haiti children.
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de Villiers A, Steyn NP, Draper CE, Hill J, Gwebushe N, Lambert EV, Lombard C. Primary School Children's Nutrition Knowledge, Self-Efficacy, and Behavior, after a Three-Year Healthy Lifestyle Intervention (HealthKick). Ethn Dis 2016; 26:171-80. [PMID: 27103767 DOI: 10.18865/ed.26.2.171] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effects of HealthKick(HK), a healthy lifestyle intervention, on nutrition knowledge, behavior, and dietary self-efficacy of school children in the Western Cape Province of South Africa. DESIGN A three-year cluster randomized control trial at primary schools in low socioeconomic settings with a baseline study in 2009 and follow-up in 2010 and 2011. PARTICIPANTS Participants were Grade four children (n=500) at eight schools in the intervention group and at eight schools in the control group (n=498). METHODS An action planning process was followed with educators whereby they identified their own school health priorities and ways to address them. Schools were provided with nutrition resources, including curriculum guidelines and the South African food-based dietary guidelines. Children completed a questionnaire comprising nutrition knowledge, self-efficacy and behavioral items. RESULTS The intervention significantly improved the knowledge of the intervention group at the first (mean difference =1.88, 95%CI: .32 to 3.43, P=.021) and second follow-up (mean difference=1.92, 95%CI: .24 to 3.60, P=.031) compared with the control group. The intervention effect for self-efficacy was not significant at the first follow-up (mean difference=.32, 95%CI: -.029 to .94, P=.281) whereas a significant effect was observed at the second follow-up (mean difference=.71, 95%CI: .04 to 1.38, P=.039). There were no significant differences between the intervention and control groups for nutritional behavior scores at any of the follow-up time points. CONCLUSIONS The HK intervention improved nutrition knowledge and self-efficacy significantly in primary schoolchildren; however, it did not improve their eating behavior.
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Affiliation(s)
- Anniza de Villiers
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town
| | - Nelia P Steyn
- Division of Nutrition, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Catherine E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town
| | - Nomonde Gwebushe
- Biostatistics Unit, South African Medical Research Council, Cape Town
| | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town
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Moodley G, Christofides N, Norris SA, Achia T, Hofman KJ. Obesogenic Environments: Access to and Advertising of Sugar-Sweetened Beverages in Soweto, South Africa, 2013. Prev Chronic Dis 2015; 12:E186. [PMID: 26513442 PMCID: PMC4651143 DOI: 10.5888/pcd12.140559] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Rates of obesity and overweight among South Africans are increasing. Food marketing has a profound impact on children and affects their lifelong eating patterns; in urban areas of South Africa, disposable incomes are growing and ultra-processed food is increasingly available at low cost. The combination of these factors will strain an already fragile health system. Our aim was to investigate the density of outdoor sugar sweetened beverage (SSB) advertising and the number of formal and informal vendors selling SSBs in a transforming, historically disadvantaged urban setting of South Africa. METHODS A digital camera and global positioning system navigation system were used to record the location of SSB advertisements and food vendors in a demarcated area in Soweto. Data were collected by walking or driving through each street; a food inventory was completed for every food vendor. Spatial analyses were conducted using a geographic information system. RESULTS A total of 145 advertisements for SSBs were found over a driven or walked distance of 111.9 km. The density of advertisements was 3.6 per km(2) in relation to schools, and 50% of schools had branded advertising of SSBs on their school property. Most (n = 104; 58%) of the 180 vendors in the study sold SSBs. CONCLUSION This is the first study in South Africa to document the location of billboard advertisements and vendors in relation to schools. Marketing of products that contribute to obesity is common in urban Soweto. Our findings have implications for policies that regulate SSB advertising, especially in the proximity of schools.
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Affiliation(s)
- Gillian Moodley
- School of Public Health, Faculty Health Sciences University of Witwatersrand, Priority Cost Effective Lessons for Systems Strengthening, Johannesburg, South Africa
| | - Nicola Christofides
- School of Public Health, Faculty Health Sciences University of Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- Faculty Health Sciences University of Witwatersrand, MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Johannesburg, South Africa
| | - Thomas Achia
- School of Public Health, Faculty Health Sciences University of Witwatersrand, Johannesburg, South Africa
| | - Karen J Hofman
- Priority Cost Effective Lessons for Systems Strengthening, MRC/Wits Rural Public Health and Health Transitions Unit, Room 231, Wits School of Public Health, Education Campus, 27 St Andrews Rd, Parktown 2193, Johannesburg, South Africa.
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Steyn NP, de Villiers A, Gwebushe N, Draper CE, Hill J, de Waal M, Dalais L, Abrahams Z, Lombard C, Lambert EV. Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa? BMC Public Health 2015; 15:948. [PMID: 26400414 PMCID: PMC4581099 DOI: 10.1186/s12889-015-2282-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. METHODS Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. RESULTS The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: -0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. DISCUSSION The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty. CONCLUSIONS The HK intervention did not significantly improve quality of diet of children.
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Affiliation(s)
- Nelia P Steyn
- Division Human Nutrition, University of Cape Town, P/Bag X3, Observatory, Cape Town, 7925, South Africa.
| | - Anniza de Villiers
- Non-communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
| | - Nomonde Gwebushe
- Biostatistics Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg, Cape Town, 7505, South Africa.
| | - Catherine E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 8001, South Africa.
| | - Jillian Hill
- Non-communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
| | - Marina de Waal
- Non-communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
| | - Lucinda Dalais
- Division Nutrition, University of Cape Town, Cape Town, 8001, South Africa.
| | - Zulfa Abrahams
- BroadReach Healthcare, Park Lane Office Park, cnr Alexandra Road & Park Lane Pinelands, Cape Town, 7405, South Africa.
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg, Cape Town, 7505, South Africa.
| | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, Sports Science Institute of South Africa, Boundary Road, Newlands, 8001, Cape Town, South Africa.
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Sutherland R, Campbell E, Lubans DR, Morgan PJ, Okely AD, Nathan N, Wolfenden L, Wiese J, Gillham K, Hollis J, Wiggers J. 'Physical Activity 4 Everyone' school-based intervention to prevent decline in adolescent physical activity levels: 12 month (mid-intervention) report on a cluster randomised trial. Br J Sports Med 2015; 50:488-95. [PMID: 26359346 PMCID: PMC4853531 DOI: 10.1136/bjsports-2014-094523] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adolescence is a recognised period of physical activity decline, particularly among low-income communities. We report the 12-month (midpoint) effects of a 2-year multicomponent physical activity intervention implemented in disadvantaged secondary schools. METHODS A cluster randomised trial was undertaken in 10 secondary schools located in disadvantaged areas in New South Wales, Australia. Students in Grade 7 were recruited, with follow-up in Grade 8. The intervention was guided by socioecological theory and included seven physical activity strategies, and six implementation adoption strategies. The primary outcome was mean minutes of moderate-to-vigorous physical activity (MVPA) per day assessed using Actigraph GT3X accelerometers. Outcome data were analysed using repeated measures linear mixed models. RESULTS At baseline, 1150 (93%) students participated in the data collection (mean age 12 years, 48% boys) and 1050 (79%) students participated at 12-month follow-up. By the 12-month follow-up, the six implementation adoption strategies had been used to support schools to deliver four of the seven physical activity elements. There was a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p ≤ 0.01), including significantly more vigorous physical activity (2.45 min, p ≤ 0.01), equating to 27 min more MVPA per week. SUMMARY At 12-month follow-up, the intervention had reduced the decline in physical activity among adolescents from disadvantaged schools. The intervention may assist students to meet physical activity guidelines.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Wallsend, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - David R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, New South Wales, Australia
| | - Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anthony D Okely
- Early Start Research Institute and School of Education, University of Wollongong, Wollongong, New South Wales, Australia Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jarrod Wiese
- Hunter New England Population Health, Wallsend, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Wallsend, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jenna Hollis
- Rowett Institute of Nutrition and Health, University of Aberdeen, Scotland, UK
| | - John Wiggers
- Hunter New England Population Health, Wallsend, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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de Villiers A, Steyn NP, Draper CE, Hill J, Dalais L, Fourie J, Lombard C, Barkhuizen G, Lambert EV. Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation. BMC Public Health 2015; 15:818. [PMID: 26297447 PMCID: PMC4546332 DOI: 10.1186/s12889-015-2157-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls. METHODS The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator's manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities. RESULTS Overall uptake of events offered by the research team was 65.6% in 2009, 75% in 2010 and 62.5% in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5% of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2% actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20% were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations. CONCLUSIONS The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and 'buy-in' from schools.
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Affiliation(s)
- Anniza de Villiers
- Non-communicable Diseases Research Unit (NCDRU), South African Medical Research Council (SAMRC), Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Nelia P Steyn
- Division of Human Nutrition, University of Cape Town Medical Campus, Anzio Road, Observatory, 7925, South Africa.
| | - Catherine E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, PO Box 115, Newlands, 7725, South Africa.
| | - Jillian Hill
- Non-communicable Diseases Research Unit (NCDRU), South African Medical Research Council (SAMRC), Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Lucinda Dalais
- Division of Human Nutrition, University of Cape Town Medical Campus, Anzio Road, Observatory, 7925, South Africa.
| | - Jean Fourie
- Non-communicable Diseases Research Unit (NCDRU), South African Medical Research Council (SAMRC), Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Carl Lombard
- Biostatistics Unit, SAMRC, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
| | | | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, PO Box 115, Newlands, 7725, South Africa.
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Ferguson GD, Naidoo N, Smits-Engelsman BCM. Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit, but Differently. Phys Occup Ther Pediatr 2015; 35:147-62. [PMID: 25984808 DOI: 10.3109/01942638.2015.1009230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Poor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances. AIMS To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6-10 years) with and without DCD attending a low-income primary school. METHODS The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks. RESULTS Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than the control group in motor performance and the control group showed greater improvement on one of the anaerobic fitness outcomes. CONCLUSIONS A school-based HPP that focuses on increasing opportunities for physical activity may be effective in improving motor performance in children with DCD and can increase fitness levels in general.
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Affiliation(s)
- Gillian D Ferguson
- 1University of Cape Town, Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, Cape Town, South Africa
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Senekal M, Seme Z, de Villiers A, Steyn NP. Health status of primary school educators in low socio-economic areas in South Africa. BMC Public Health 2015; 15:186. [PMID: 25880662 PMCID: PMC4358724 DOI: 10.1186/s12889-015-1531-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/13/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Non-communicable Diseases (NCDs) are major health concerns in South Africa. According to the life cycle approach NCD prevention strategies should target children. Educators are important external factors influencing behaviour of learners. The objective of this study was to assess the prevalence of selective NCD risk factors in educators of primary school learners. METHODS A cross-sectional design was used to assess the body mass index (BMI) and waist circumference (WC), blood glucose (BG), cholesterol (BC), blood pressure (BP), perceived health and weight, and parental NCD history of 517 educators in the Western Cape of South Africa. RESULTS The sample included 40% males and 60% females; 64% urban and 36% rural, 87% were mixed ancestry, 11% white and 2% black. Mean age for the total group was 52 ± 10.1 years, BMI 30 ± 1.2 kg/m(2) (31% overweight, 47% obese), diastolic BP 84 ± 10.0 mmHg, systolic BP 134 ± 18.7 mmHg (46% high BP), BG 4.6 ± 2.3 mmol/L (2% high BG), BC 4.4 ± 0.9 (30.4% high BC) and WC 98 ± 14.1 cm for males (38% high WC) and 95 ± 15.3 for females (67% high WC). BMI was higher (p = 0.001) and systolic (p = 0.001) and diastolic (p = 0.005) BP lower in females. Rural educators were more obese (p = 0.001). BMI (p = 0.001) and systolic BP (p = 0.001) were lower in younger educators. Correct awareness of personal health was 65% for BP, 79.2% for BC and 53.3% for BG. Thirty-eight percent overweight/obese females and 33% males perceived their weight as normal. CONCLUSION The findings of this study demonstrated a number of characteristics of educators in the two study areas that may influence their risk for developing NCDs and their potential as role models for learners. These included high levels of obesity, high blood pressure, high waist circumference, high cholesterol levels, and high levels of blood glucose. Furthermore, many educators had a wrong perception of their actual body size and a lack of awareness about personal health.
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Affiliation(s)
- Marjanne Senekal
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, UCT Medical campus, Anzio Road, Anatomy Building, Floor 2, Room 2.04, Observatory 7925, Cape Town, South Africa.
| | - Zibuyile Seme
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, UCT Medical campus, Anzio Road, Anatomy Building, Floor 2, Room 2.04, Observatory 7925, Cape Town, South Africa.
| | - Anniza de Villiers
- Chronic Diseases of Lifestyle Unit, Medical Research Council (MRC), Francie van Zyl Ave, Tygerberg, 7505, South Africa.
| | - Nelia P Steyn
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, UCT Medical campus, Anzio Road, Anatomy Building, Floor 2, Room 2.04, Observatory 7925, Cape Town, South Africa.
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Faber M, Laurie S, Maduna M, Magudulela T, Muehlhoff E. Is the school food environment conducive to healthy eating in poorly resourced South African schools? Public Health Nutr 2014; 17:1214-23. [PMID: 24171913 PMCID: PMC10282470 DOI: 10.1017/s1368980013002279] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/01/2013] [Accepted: 07/25/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the school food environment in terms of breakfast consumption, school meals, learners' lunch box, school vending and classroom activities related to nutrition. DESIGN Cross-sectional survey. SETTING Ninety purposively selected poorly resourced schools in South Africa. SUBJECTS Questionnaires were completed by school principals (n 85), school feeding coordinators (n 77), food handlers (n 84), educators (n 687), randomly selected grade 5 to 7 learners (n 2547) and a convenience sample of parents (n 731). The school menu (n 75), meal served on the survey day, and foods at tuck shops and food vendors (n 74) were recorded. RESULTS Twenty-two per cent of learners had not eaten breakfast; 24 % brought a lunch box, mostly with bread. Vegetables (61 %) were more often on the school menu than fruit (28 %) and were served in 41 % of schools on the survey day compared with 4 % serving fruit. Fifty-seven per cent of learners brought money to school. Parents advised learners to buy fruit (37 %) and healthy foods (23 %). Tuck shops and vendors sold mostly unhealthy foods. Lack of money/poverty (74 %) and high food prices (68 %) were major challenges for healthy eating. Most (83 %) educators showed interest in nutrition, but only 15 % had received training in nutrition. Eighty-one per cent of educators taught nutrition as part of school subjects. CONCLUSIONS The school food environment has large scope for improvement towards promoting healthy eating. This includes increasing access to vegetables and fruit, encouraging learners to carry a healthy lunch box, and regulating foods sold through tuck shops and food vendors.
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Affiliation(s)
- Mieke Faber
- Nutritional Intervention Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
| | - Sunette Laurie
- Agricultural Research Council – Roodeplaat Vegetable and Ornamental Plant Institute, Pretoria, South Africa
| | - Mamokhele Maduna
- Department of Basic Education, National School Nutrition Programme Directorate (Sustainable Food Production in Schools (SFPS) and Nutrition Education), Pretoria, South Africa
| | - Thokozile Magudulela
- Department of Basic Education, National School Nutrition Programme Directorate (Sustainable Food Production in Schools (SFPS) and Nutrition Education), Pretoria, South Africa
| | - Ellen Muehlhoff
- Nutrition Education and Consumer Awareness Group, Nutrition Division, Food and Agriculture Organization, Rome, Italy
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The feasibility of implementing food-based dietary guidelines in the South African primary-school curriculum. Public Health Nutr 2013; 18:167-75. [DOI: 10.1017/s1368980013003194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo explore the perceptions of educators from the Western Cape Province about the feasibility of implementing South African food-based dietary guidelines (FBDG) in the national curriculum of primary schools.DesignCombined quantitative and qualitative methods. We report on the quantitative component.SettingTwelve public primary schools of different socio-economic status in three education districts of the Western Cape: Metro Central, Metro East and Cape Winelands.SubjectsEducators (n256) participated in the self-completed questionnaire survey.ResultsEducators assessed that FBDG were appropriate to South African schoolchildren (94%), could be used as an education tool (97%) and fill gaps in the current curriculum about healthy dietary habits (91%). Besides Life Orientation, FBDG could be taught in other learning areas from grades 3 to 7 (9–13 years old). Important barriers to implementing FBDG in the curriculum were educators’ workload (61%), insufficient time (46%), learners’ disadvantaged background (43%) and educators’ lack of knowledge (33%). Other approaches to teach children about FBDG included linking these to the National School Nutrition Programme (82%), school tuck shops (79%), parent meetings (75%), school nutrition policy (73%) and school assembly (57%). Educators in high-income schools perceived that learners’ lifestyle was significantly worse (P< 0·001) and that tuck shops and the school assembly were the best means to teach pupils about FBDG (P< 0·001 andP< 0·05).ConclusionsImplementing FBDG in the national school curriculum is seen as important together with optimizing the school physical environment. Key factors required for successful implementation in the curriculum are sufficient educational materials, adequate time allocation and appropriate educator training.
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Ferguson GD, Jelsma D, Jelsma J, Smits-Engelsman BCM. The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2449-2461. [PMID: 23747936 DOI: 10.1016/j.ridd.2013.05.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/24/2013] [Accepted: 05/02/2013] [Indexed: 06/02/2023]
Abstract
Neuromotor Task Training (NTT) and Nintendo Wii Fit Training (Wii training) are both task-based interventions used to improve performance in children with motor coordination problems. The aim of this study was to compare the efficacy of these two interventions on the motor performance, isometric strength and cardiorespiratory fitness (aerobic and anaerobic capacity) of children with Developmental Coordination Disorder (DCD) attending mainstream schools in a low-income setting. A pragmatic, quasi-experimental study design was utilized. Children between the ages of 6-10 years, who scored at or below the 16th percentile on the Movement Assessment Battery for Children-2 (MABC-2) and whose teacher reported a functional motor problem, were allocated to either NTT (n=37) or Wii training (n=19) groups depending on school of attendance. The MABC-2, a hand-held dynamometer, the Functional Strength Measure, the Muscle Power Sprint Test and the 20m Shuttle Run Test were used to assess performance at baseline and after the intervention. The main findings show that the mean motor performance scores of both groups improved over the study period. However, significant differences in improvement were detected between groups, with the NTT group showing greater improvement in motor performance, functional strength and cardiorespiratory fitness. No improvements in isometric strength were seen in either group. The Wii training group showed significant improvement in anaerobic performance. This study provides evidence to support the use of both the Wii Training and NTT for children with DCD. However, in comparison to Wii training, the NTT approach yields superior results across measures of motor proficiency, cardiorespiratory fitness and functional strength. The decision to use either approach may be influenced by resources and time constraints.
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Affiliation(s)
- G D Ferguson
- Department of Health and Rehabilitation Sciences, University of Cape Town, South Africa.
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