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INTRODUCTION: The increasing prevalence of obesity and overweight in childhood in developing countries is a public health concern to many governments. Schools play a significant role in the obesity epidemic as well as provide favourable environments for change in behaviours in childhood which can be carried on into adulthood. There is dearth of information on intervention studies in poor-resource settings. This review will summarise the available evidence on school-based interventions that focused on promoting healthy eating and physical activity among learners aged 6–15 years in Africa and to identify factors that lead to successful interventions or potential barriers to success of these programmes within the African context. METHODS AND ANALYSIS: This protocol is developed following the guidelines of PRIMSA-P 2015. Relevant search terms and keywords generated from the subject headings and the African search filter will be used to conduct a comprehensive search of MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Register Academic Search Complete (EbscoHost) and ISI Web of Science (Science Citation Index) for published literature on school-based interventions to prevent and control obesity in learners in Africa. Grey literature will be also be obtained. The searches will cover 1 January 2000 to 30 June 2016. No language limitations will be applied. Full-text articles of eligible studies will be screened. Risk of bias and quality of reporting will be assessed. Data will be extracted, synthesised and presented by country and major regional groupings. Meta-analysis will be conducted for identical variables across studies, where data allow. This protocol is developed following the guidelines of PRISMA-P 2015. ETHICS AND DISSEMINATION: No primary data will be collected hence ethics is not a requirement. The findings will be submitted for publication in peerreviewed journals, in conferences and in policy documents for decision-making, where needed. ; ISI

Background: There is current concern for the health and well-being of children and youth in South Africa, including habits of physical activity (PA) and sedentary behavior. The 2014 Healthy Active Kids South Africa Report Card evaluates the current activity status of children and youth. Methods: The Research Working Group was comprised of 23 experts in physical education, nutrition, sport science, public health and journalism. The search was based on a systematic review of peer-reviewed literature (previous 5 years), dissertations, and nonpeer-reviewed reports ('gray' literature) dealing with the PA and nutritional status of South African children and youth 6–18 years of age. Key indicators were identified and data extracted. Grades for each indicator were discussed and assigned. Results: Overall PA levels received a D grade, as roughly 50% or more of children and youth were not meeting recommended levels. Organized sports participation fared better with a C, and government policies were promising, receiving a B. Screen time and sedentary behavior were a major concern and received a grade of F. Under- and over-weight were highlighted, but overweight is on the rise and this indicator was assigned a D grade. Most of the other indicators in South Africa remained the same or became worse so that grades declined from C- to D. In particular, sedentary behavior, soft-drink and fast food consumption, and an ineffectual regulatory environment to control advertising to children were a concern. There is need to engage parents and communities for advocacy and social mobilization.

Background: There is current concern for the health and well-being of children and youth in South Africa, including habits of physical activity (PA) and sedentary behavior. The 2014 Healthy Active Kids South Africa Report Card evaluates the current activity status of children and youth. Methods: The Research Working Group was comprised of 23 experts in physical education, nutrition, sport science, public health and journalism. The search was based on a systematic review of peer-reviewed literature (previous 5 years), dissertations, and nonpeer-reviewed reports ('gray' literature) dealing with the PA and nutritional status of South African children and youth 6–18 years of age. Key indicators were identified and data extracted. Grades for each indicator were discussed and assigned. Results: Overall PA levels received a D grade, as roughly 50% or more of children and youth were not meeting recommended levels. Organized sports participation fared better with a C, and government policies were promising, receiving a B. Screen time and sedentary behavior were a major concern and received a grade of F. Under- and over-weight were highlighted, but overweight is on the rise and this indicator was assigned a D grade. Most of the other indicators in South Africa remained the same or became worse so that grades declined from C- to D. In particular, sedentary behavior, soft-drink and fast food consumption, and an ineffectual regulatory environment to control advertising to children were a concern. There is need to engage parents and communities for advocacy and social mobilization. ; http://journals.humankinetics.com/jpah ; http://dx.doi.org/10.1123/jpah.2014-0185

<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>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.</p><p><strong>Participants: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><em>Ethn Dis. </em>2018;28(2):93-98; doi:10.18865/ed.28.2.93</p>

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 higher nutrition knowledge scores compared to their male counterparts (p = 0.016). Questions poorly answered by more than 60% of learners, included the number of fruit and vegetable portions required daily, food to eat when overweight, foods containing fiber, and importance of legumes. It was noted that the majority of teachers who taught nutrition had no formal nutrition training and their responses to knowledge questions were poor indicating that they were not familiar with the FBDGs, which are part of the curriculum. Nutrition assessment as part of the Integrated School Health Program was done on few learners. Overall however, despite some challenges the government national school meal program provided meals daily to 96% of learners. In general, the school food and nutrition environment was not conducive for promoting healthy eating.

<strong>Objectives</strong>: This study aimed to evaluate the effects of HealthKick(HK), a healthy lifestyle intervention, on nutrition knowledge, behavior, and dietary selfefficacy of school children in the Western Cape Province of South Africa.<br />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.<br /><strong>Participants:</strong> Participants were Grade four children (n=500) at eight schools in the intervention group and at eight schools in the control group (n=498).<br /><strong>Methods:</strong> 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.<br /><strong>Results</strong>: 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:<br />.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<br />effect was observed at the second followup (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.<br /><strong>Conclusion</strong>: The HK intervention improved nutrition knowledge and self-efficacy significantly in primary schoolchildren; however, it did not improve their eating behavior. <em>Ethn Dis.</em> 2016;26(2):171-180;<br />doi:10.18865/ed.26.2.171<strong></strong>

Obesity and childhood overweight is a worldwide epidemic that has significant long-term public health implications both in developed and developing countries. South Africa, which has a well-documented burden of HIV/AIDS, tuberculosis, and other infectious diseases, now also has an increasing burden of obesity and noncommunicable diseases (NCD) such as diabetes and cardiovascular diseases. This article describes results of formative research on childhood obesity risk factors with parents of school-age children in the Western Cape region of South Africa. We interviewed parents living in low-income urban, rural, and township communities on nutrition and physical activity, media use, and potential social marketing messages. Study aims were threefold: to collect formative information on media use and health knowledge, attitudes, beliefs, and behaviors to support the development of an obesity prevention social marketing campaign targeting youth; to identify parents' preferred sources of health information, and to obtain reactions to potential obesity prevention social marketing messages. Overall, the family and community nutrition and physical activity environments in the Western Cape are highly complex. Parents report major safety concerns, lack of organized markets or other sources of healthy foods in rural and township areas, and lack of resources for physical activity. We also identified preferred sources for health information primarily through print and radio, obtained information about possible channels to reach parents, and identified potential message strategies to promote healthy lifestyles similar to some HIV/AIDS social marketing campaigns in Africa. This information supports future childhood obesity prevention social marketing.