Participatory prioritisation of interventions to improve primary school food environments in Gauteng, South Africa (original) (raw)
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BMC Public Health, 2020
Background South Africa is currently undergoing a nutrition transition, and overweight and obesity is on the increase in South African children. Urbanization and other health determinants have led to reduced physical activity and unhealthy eating that have increased the risk of adverse chronic health conditions. This study aims to provide evidence of the effectiveness of a school-based intervention study that targets diet and physical activity for the prevention of child and adolescent overweight and/or obesity. Methods We will employ a mixed method study design which is divided into two phases. Phase 1, namely the qualitative elicitation research phase will inform the development of the quantitative intervention phase (phase 2), consisting of a cluster-randomized trial, based on input from key stakeholders. The study will be undertaken in 16 government-funded primary schools in the iLembe district of KwaZulu-Natal, South Africa. The study will target learners in Grades 4 and 7, the...
International Journal of Environmental Research and Public Health
Rates of obesity and related non-communicable diseases are on the rise in sub-Saharan Africa, associated with sub-optimal diet and physical inactivity. Implementing evidence-based interventions targeting determinants of unhealthy eating and physical inactivity in children and adolescents’ immediate environments is critical to the fight against obesity and related non-communicable diseases. Setting priorities requires a wide range of stakeholders, methods, and context-specific data. This paper reports on a novel participatory study design to identify and address contextual drivers of unhealthy eating and physical inactivity of children and adolescents in school and in their home neighborhood food and built environments. We developed a three-phase mixed-method study in Cameroon (Yaoundé) and South Africa (Johannesburg and Cape Town) from 2020–2021. Phase one focused on identifying contextual drivers of unhealthy eating and physical inactivity in children and adolescents in each settin...
BMC Public Health, 2015
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.
2015
The purpose this study was to explore food habits and nutritional behaviours of adolescents in a school in Lenasia South, in Gauteng Province. Qualitative, explorative research was conducted in order to recommend effective prevention strategies of noncommunicable diseases. Adolescents from the selected secondary school formed the sample of the study. Data collection was done using focus groups' discussions. Three focus group discussions were conducted in the study. The first group comprised of thirteen male adolescents, followed by ten female adolescents and the final group was a combination of both female and male learners to produce a homogenous group. Specific common eating habits and nutritional behaviours emerged from the focus group discussions which included skipping meals, high consumption of high energy dense foods and sweetened beverages. Consequently, when developing intervention programs and policies to improve health of adolescents, environmental influences that undermine efforts to improve adolescent's dietary behaviours must be addressed.
International Journal of Environmental Research and Public Health
Overweight and obesity are growing concerns in adolescents, particularly in females in South Africa. The aim of this study was to evaluate the food and nutrition environment in terms of government policy programs, nutrition education provided, and foods sold at secondary schools in the Eastern Cape province. Sixteen schools and grade 8–12 learners (N = 1360) were randomly selected from three health districts comprising poor disadvantaged communities. Based on age and sex specific body mass index (BMI) cut-off values, 13.3% of males and 5.5% of females were underweight, while 9.9% of males and 36.1% of females were overweight or obese. The main food items purchased at school were unhealthy energy-dense items such as fried flour dough balls, chocolates, candies, and crisps/chips. Nutrition knowledge scores based on the South African food-based dietary guidelines (FBDGs) were poor for 52% to 23.4% learners in Grades 8 to 12, respectively. Female learners generally had significantly hig...
2021
Globally, noncommunicable diseases (NCDs) were responsible for 41 million deaths in 2016, with the majority of these occurring in low and middle-income countries. These diseases were on the rise as a result of unhealthy, low-quality, and unbalanced diets, which resulted in overweight and obesity. The National School Nutrition Programme (NSNP) was created to regulate the foods sold to schoolchildren. To ascertain school management teams' perspectives on the relationship between the NSNP and the development of lifestyle diseases. A phenomenological qualitative study using Focus Group Discussions among 16 purposively selected members of the School Management Teams were conducted in Mt Frere, Eastern Cape in 2016. The narrative data was analyzed using Tesch's eight-phase thematic analysis approach. The data analysis revealed two themes (NSNP and the vendor system) and six sub-themes. The NSNP was viewed as making a significant contribution to children's food security, thereb...
South African Journal of Sports Medicine, 2009
South African children also demonstrate unhealthy eating habits with school tuck-shop choices favouring cooldrinks, chips, cheese curls and fried cakes (70%), and urban primary school learners report eating fruit or vegetables less than 3 times per week. 8 Of concern is that many schools rely on income generated from these tuck-shops for supplemental income and informal vendors, who typically sell foods of low nutritional value, high in fats and sugars, are also very common. Similarly, recent studies suggest that 40% of children and youth are getting little or no moderate to vigorous activity each week. 9 With only just over half of high school learners reporting regularly scheduled physical education classes, less than 60% of these engage in vigorous activity during the actual classes, and in fact, over 30% do not participate. 9 In primary school learners, engagement in physical education classes is even lower than in high school.
Public Health Nutrition, 2014
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.
International Journal of Environmental Research and Public Health
South Africa has a high prevalence of obesity in black female adolescents and a paucity of knowledge regarding contributing dietary practices. The aim of this study was to assess the dietary practices and weight status of male and female adolescents at secondary schools in the Eastern Cape province in urban and rural areas. Sixteen schools and grade 8–12 learners (N = 1360) were randomly selected from three health districts comprising poor disadvantaged communities. A short unquantified food frequency questionnaire was used to collect data on learners’ usual eating practices with regards to weekly meal pattern, breakfast consumption, foods taken to school, takeaways, and snacks eaten while watching television (TV). Body mass index measurements were determined for each learner. Prevalence of combined overweight and obesity differed significantly between genders, 9.9% in males versus 36.1% in females (p < 0.001). Significant gender differences were noted regarding eating practices....
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Despite important nutrition-related policy and programmatic improvements in South Africa, rates of stunting among young children remain unacceptably high, while rates of overweight and obesity in this same population group are simultaneously on the rise. This study sought to examine the changes in the enabling environment for nutrition aimed at young children in South Africa by drawing on a literature review, policy mapping, and stakeholder interviews, for the time period from the end of apartheid in 1994 to 2021. The study focuses on changes and drivers of change at national level but also in three provinces: Western Cape, North West, and KwaZulu-Natal. The study ultimately seeks to better understand the changes and challenges with regards to policy and commitment to nutrition, coordination structures at various levels, and how these led to or did not lead to implementation and impact in these provinces. The study ends with reflections on what these findings mean for food and nutri...