Comparison of Malnutrition Indicators and Associated Socio-Demographic Factors among Children in Rural and Urban Public Primary Schools in South Africa.

Most children in South Africa attending public schools are predisposed to malnutrition due to poor infrastructure and social inequality. This is despite the implementation of the National School Nutrition Programme to address barriers to learning associated with hunger and malnutrition and the National Development Plan to reduce child malnutrition through provision of social grants. In view of this, we compared malnutrition indicators and associated socio-demographic factors among children in rural Mpumalanga and urban Gauteng in South African public primary schools selected using a multistage cluster random sampling. A validated researcher-administered questionnaire was used to collect socio-demographic data of caregivers, along with primary school children data collected on age, sex, learning grade, and anthropometric measures. Malnutrition indicators, which are stunting (low height-for-age z-scores), underweight (low weight-for-age z-scores), thinness (low body-mass-index-for-age z-scores), and overweight/obesity (high body mass index) were computed using WHO Anthro Plus 1.0.4 and data were analyzed using Stata 18. A total of 903 children (rural = 390 and urban = 513) with a mean age of 10 ± 2 years in the foundation phase (learning grades one to three) and the intermediate learning phase (learning grades four to seven) participated with their caregivers (mean age: 39 ± 8 years). Significant levels of poor socio-demographic status were observed among caregivers living in the rural setting compared to in the urban setting. Overall, thinness (18%), stunting (12%), underweight (10%), and overweight/obesity (24%) were observed among school children. Children in the rural schools had a significantly higher prevalence of stunting (20% vs. 3%; p < 0.0001), underweight (17% vs. 2%; p < 0.0001) and thinness (28% vs. 7%; p < 0.001) than their urban counterparts. In the urban, the odds of stunting, underweight and thinness were less among school children, while overweight/obesity was twice as likely in the urban setting. The multivariate final model showed lower odds of underweight [adjusted odds ratio (AOR) = 0.16; 95% confidence interval (CI): 0.06-0.42] and stunting [AOR = 0.33; 95% CI: 0.13-0.87] in the urban compared to the rural schools. The association of stunting with sex [AOR =0.53; 95% CI: 0.30-0.94] and the intermediate learning phase [AOR = 7.87; 95% CI: 4.48-13.82] was observed in the rural setting, while thinness was associated with living in households with an income of USD 52.51 to USD 262.60/month [AOR = 2.89; 95% CI: 1.01-8.24] and receiving the child social grant [AOR = 2.49; 0.90-6.86] in the urban setting. Overweight/obesity was associated with living in a household with an income of USD 52.51 to USD 262.60/month [AOR = 1.80; 95% CI: 1.02-3.10]. The findings suggest nutritional intervention approaches that are accustomed to the context of settings to effectively tackle malnutrition.

Ellisras Longitudinal Study 2017: Childhood underweight and blood pressure status in a rural black population of South Africa (ELS 26).

AIM: Childhood underweight is a problem being faced by rural black South African populations but little is known about its risk factors. The aim of this study was to investigate the risk factors related to childhood underweight in rural black South African children within the area known as Ellisras. METHODS: A cross-sectional study was conducted as part of the ongoing Ellisras Longitudinal Study. The current study comprised a total of 1 811 pre-primary and primary school children (934 males and 877 females) aged between five and 16 years. The chi-squared automatic interaction detection (CHAID) decision tree model was used to identify factors and determine their relationships with childhood underweight. RESULTS: A total of 1 811 children were involved in the study, of whom about 81% were severely underweight. The CHAID model showed that the variables: nutrition, age group, gender and school level were the four main predicting variables affecting childhood underweight. Hypertension was not significantly associated with childhood underweight. CONCLUSIONS: The prevalence of childhood underweight was found to be high in children aged between five and 16 years. To address this problem, well-thought-out intervention systems are need.

Ellisras Longitudinal Study 2017: the association of fat patterning with blood pressure in Polokwane private school children aged five to 15 years (ELS 22).

BACKGROUND: Obesity is a risk factor for non-communicable diseases and is a global public health concern. OBJECTIVE: The main objectives of this study were to investigate the association of fat patterning and blood pressure among five- to 15-year-old black children attending private schools in Polokwane, South Africa, and to determine the prevalence of obesity and hypertension. METHODS: A total of 1 665 subjects (846 boys and 819 girls), aged five to 15 years and attending three private schools in Polokwane, were included in the study. All anthropometric measurements were taken according to standard procedures of the International Society for the Advancement of Kinanthropometry. All data were analysed using SPSS. RESULTS: Girls showed a higher prevalence of over-fatness (10.2-12.3%) and hypertension (1.4-33.0%) than boys (7.3-10.3, 3.6-21.3%, respectively). The sum of four skinfolds, trunk skinfolds relative to limb skinfold, and body mass index (BMI) were positively associated with systolic and diastolic blood pressure (p < 0.01). There was a significant positive (p < 0.001) association between over-fatness and hypertension, both unadjusted (OR = 3.11; 95% CI = 2.17-4.46) and adjusted for age and gender (OR = 3.29; 95% CI = 2.22-4.86). CONCLUSIONS: These Polokwane private school children with high body fatness were at risk for developing high blood pressure.

The Amsterdam Growth and Health Longitudinal Study: how important is physical activity in youth for later health? (ELS 33).

BACKGROUND: Three important results came from the Amsterdam Growth and Health Longitudinal Study (AGAHLS). This study followed three birth cohorts (1962, 1963 and 1964) of boys and girls in the Amsterdam region in the Netherlands. The follow-up period was 25 years, with 10 measurements from age 12 to 42 years. The main purpose of the AGAHLS was to detect changes in health and lifestyle over time during the teenage and young adult period. METHODS: In total, 617 subjects were recruited from two secondary schools in Amsterdam and Purmerend. We measured aerobic fitness (VO2 peak), bone mineral density (BMD), obesity from body mass index (BMI) and body fatness from the sum of four skinfolds (S4S). Daily physical activity (DPA) was measured from heart rate, pedometers and an interview. Daily food intake (DFI) was measured by a cross-check dietary history interview. RESULTS: Longitudinal data analyses revealed that: (1) aerobic fitness, as measured by direct measurement of maximal oxygen uptake (VO2 max), increased more significantly in the physically active percentile (P > 75) of males and females than in the physically inactive percentile (P < 25), (2) BMD, as measured with dual X-ray absorptiometry (DEXA) in the wrist, hip and lumbar region, showed that physical activity in youth with a high mechanical load on the bones (mostly weight bearing) increased bone formation in the hip and lumbar region of males and females in adulthood, (3) the longitudinal relationship between DPA and DFI with the development of overweight and obesity (measured from BMI and S4S) showed that more DPA resulted in significantly lower fat mass, but no relationship could be demonstrated with DFI . CONCLUSIONS: The main conclusion from this 25-year longitudinal research is that the promotion of physical activity (including physical education and sport) in adolescence can potentially be a strong tool to prevent chronic diseases and reduce healthcare costs later in life.