Underweight and overweight in primary school children in eThekwini district in KwaZulu-Natal, South Africa

The challenges of underweight and overweight in South African children: are we winning or losing the battle? A systematic review

Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review available South Africa studies regarding the comprehensive summary of prevalence of underweight and overweight and evaluates government policies in addressing undernutrition and overnutrition in South African children and adolescents. We searched subject-specific electronic bibliographic databases of observational studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African boys and girls from birth to 20 years of age in studies published on or after 1990. A total of sixteen cross-sectional, three longitudinal studies and one report met the criteria for inclusion in this review. Descriptive data synthesis revealed the small number of longitudinal studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. In this review, 0.7%-66% of underweight was reported among children in rural areas compared to a 3.1%-32.4% of overweight in urban areas. All studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight were positively related with health-related physical activity and psychological health problems such as low activity, low fitness, low self-image and self-esteem. Numerous recommendations were made in the reviewed studies, however effective strategic programs in eradicating both underweight and overweight are minimal. It is evident from the reviewed studies that the burden of underweight and overweight are still a problem in South African children. The most highly affected by underweight are rural children, while children in urban areas in transition are faced with burden of overweight. There is little evidence to suggest that government strategic programs are effective in addressing underweight and overweight in South African children. Based on these findings, sustainable school-based feeding schemes and physical education programmes are needed for optimal benefits in children and adolescents.

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

BACKGROUND

Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.

OBJECTIVE

This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.

METHODS

Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.

RESULTS

A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.

CONCLUSIONS

This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.

PROSPERO REGISTRATION NUMBER

CRD42013004399.