Exploring the Risk Behaviour of Learners in a South African Private Christian Secondary School

Adolescent learners often express independence with risky health behaviour such as poor eating habits, smoking and consuming alcohol.  The primary aim of this study was to assess whether a school with an ethos of strict discipline and religious education has an impact on the prevention of risky health behaviour. A health risk behaviour questionnaire was distributed amongst all learners in a private Christian secondary school in order to measure behaviour and attitudes towards eating habits, alcohol and drug intake, exercise, sexual activity, smoking and attitude towards Christian values.  A sample of 117 responses from all grades was obtained.The results indicated that these learners were more conservative than learners in other studies.  Most had healthy eating habits; 92.3% consumed dairy products, 64.1% consumed more than two fruits and 81.2% more than two vegetables per day.  More than 78% exercised regularly.  Only 10.2% consumed alcohol, 3.4% smoked and 5.2% used recreational drugs.  Of all learners 93.2% believed that their Christian values have an influence on their lifestyle. As it seems that the strict Christian education of these learners lead to less risky health behaviour, ways in which to promote this school’s strategies to other schools, could be investigated. https://doi.org/10.19108/KOERS.82.1.226

Lifestyle risk behaviour of Emergency Medical Care workers in Nelson Mandela Bay, South Africa

Background: There are few prehospital emergency medical care (PEMC) workers in South Africa and the work environment is demanding, with irregular and long hours. The situation can result in elevated stress levels (especially among younger people) and risky lifestyle behaviour, which can lead to non-communicable diseases. Aim: This article reports on a pilot study that explored factors that influence lifestyle risk behaviour among PEMC workers, with a specific focus on dietary habits that may, in turn, have an influence on work performance. Methods: An explorative, cross-sectional mixed-method pilot study was conducted. Focus groups, a lifestyle risk behaviour questionnaire and three 24-hour recalls for each participant were used as a convenience sample of 20 PEMC workers in a large South African city. Results: Irregular shifts, financial constraints, smoking and the unavailability of healthy food emerged as important factors that contributed to lifestyle risk behaviour. In this group, the incidence of smoking was higher than in the general South African population, but binge drinking was the same. The study found that participants seldom met their energy, dietary fibre, vitamin and mineral requirements, and the intake of fat, saturated fat and refined carbohydrates was high. Conclusion: Dietary interventions should be available for all PEMC workers, and the availability of a counsellor to assist workers in dealing with risky lifestyle behaviour could improve PEMC workers’ ability to perform their work. Further research is necessary in order to confirm these results and determine the need for specific interventions

Disease, activity and schoolchildren's health (DASH) in Port Elizabeth, South Africa: a study protocol

BACKGROUND: An in-depth epidemiological investigation on intestinal parasite infections in an impoverished area of Port Elizabeth, South Africa provides a unique opportunity for research on its impact on children's physical fitness, cognitive performance and psychosocial health. Additionally, we will screen risk factors for the development of diabetes and hypertension in adulthood. METHODS/DESIGN: A 2-year longitudinal cohort study will be conducted, consisting of three cross-sectional surveys (baseline and two follow-ups), in eight historically black and coloured (mixed race) primary schools located in different townships in Port Elizabeth, South Africa. Approximately 1000 Grade 4 primary schoolchildren, aged 8 to 12 years, will be enrolled and followed. At each survey, disease status, anthropometry and levels of physical fitness, cognitive performance and psychosocial health will be assessed. After each survey, individuals diagnosed with parasitic worm infections will be treated with anthelminthic drugs, while children with other infections will be referred to local clinics. Based on baseline results, interventions will be tailored to the local settings, embedded within the study and implemented in half of the schools, while the remaining schools will serve as controls. Implementation of the interventions will take place over two 8-week periods. The effect of interventions will be determined with predefined health parameters. DISCUSSION: This study will shed new light on the health burden incurred by children in deprived urban settings of South Africa and provide guidance for specific health interventions. Challenges foreseen in the conduct of this study include: (i) difficulty in obtaining written informed consent from parents/guardians; (ii) administration of questionnaires in schools where three languages are spoken (Afrikaans, Xhosa and English); (iii) challenges in grasping concepts of psychosocial health among schoolchildren using a questionnaire; and (iv) loss to follow-up due to the study setting where illiteracy, mobility and violence are common. Finally, designing the health interventions together with local principals and teachers will allow all concerned with the research to bolster a sense of community ownership and sustained use of the interventions after the study has ceased

Prevalence of Stunting and Relationship between Stunting and Associated Risk Factors with Academic Achievement and Cognitive Function: A Cross-Sectional Study with South African Primary School Children

Childhood stunting can have negative long-term consequences on cognitive development, academic achievement, and economic productivity later in life. We determined the prevalence of stunting and examined whether stunting and associated risk factors (low dietary diversity, insufficient hemoglobin, food insecurity, and soil-transmitted helminth (STH) infections) are associated with academic achievement and cognitive function among South African children living in marginalized communities. A cross-sectional sample of 1277 children (aged 5-12 years) was analyzed. Stunting was defined according to 2007 WHO growth references. Cognitive functioning was measured with the computerized Flanker task and academic performance via school grades. Blood and stool samples were collected to obtain hemoglobin level and STH infection. Dietary diversity was assessed by a food frequency questionnaire. Associations were examined via mixed linear regression (with school class as a random intercept). Nine percent of the children were stunted (95% CI: 7.6-10.8%). Low dietary diversity (β = 0.13,; p; = 0.004), food insecurity (β = -0.12,; p; = 0.034), and stunting (β = -0.13,; p; = 0.031) were associated with poorer end of the year results among girls. No such associations were found among boys. No significant associations were found for socioeconomic status and hemoglobin levels. The prevalence of stunting and STH infections were low in the present sample. Risk factors seem differently associated with girls' and boys' academic achievement. Promoting nutrition may help to promote academic achievement among girls living in low- and middle-income countries

Evaluation of a Physical Activity and Multi-Micronutrient Intervention on Cognitive and Academic Performance in South African Primary Schoolchildren

Executive functions (EFs) are essential for optimal academic development. Appropriate nutrition and physical activity (PA) have been shown to facilitate optimal cognitive development. Therefore, this study examined whether a 12-week school-based PA and multi-micronutrient supplementation (MMNS) intervention would improve cognitive and academic performance. A cluster-randomized controlled trial (RCT) was conducted. Children from four schools located in a peri-urban area of South Africa were randomly assigned to (i) PA + MMNS, (ii) PA + placebo, (iii) MMNS or (iv) placebo. Information processing and inhibitory control were measured with a computerized Flanker task. End-of-year results provided insight into academic achievement. Anthropometric measures were used to determine nutritional status. Data were analyzed with linear mixed-models, adjusting for baseline scores, school classes and age; 932 children (458 girls (49.1 completed baseline and post-intervention assessments. Cognitive performance improved among all four groups, with no significant group x time effects. For academic achievement, there was no significant interaction effect between the combined intervention group and placebo. We encourage future studies in this neglected area in order to determine the most optimal design of school-based nutrition and PA programs to enhance overall cognitive performance

Effects of a school-based health intervention program in marginalized communities of Port Elizabeth, South Africa (the KaziBantu Study): protocol for a randomized controlled trial

The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers.; The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers.; A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching.; This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings.; The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa's Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers' productivity with trickle-down effects on the children they teach and train.; International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542.; DERR1-10.2196/14097

Effects of a traditional African diet on the metabolic control of black patients with type II diabetes mellitus

MSc (Dietetics), North-West University, Potchefstroom CampusDiabetes mellitus has become more prevalent in developing cultures and takes an enormous human and monetary toll each year. Previous research has indicated that the traditional African diet may possibly be the optimal dietary treatment of westernised black non-insulin-dependent diabetes mellitus (NIDDM) subjects. The main hypothesis tested in this study was therefore that the traditional African diet, compared to the westernised diabetic diet as followed by local black people with NIDDM, improves metabolic control, reduces weight, and minimises the risk for macro-vascular complications. The study consisted of three phases. Firstly, a pilot study was undertaken to develop a suitable food frequency questionnaire and to determine the food and nutrient intakes of the local black NIDDM population. It was found that these patients followed a three-meal-per-day pattern. The distribution of dietary energy was 17 % from protein, 35 % from fat and 48 % from carbohydrate. It became clear that the eating habits of these NIDDM patients were in a process of westernisation. Vitamin and mineral intakes were relatively low. Nutrition education and dietary counselling were recommended. In the second phase, the acute or short-term effects of a traditional African meal on blood glucose responses were examined. The glycaemic index (GI) and second meal response of a traditional African meal, consisting of maize meal porridge, soya mince and "morogo" (cooked green leaves) were measured in 14 black NIDOM subjects. A standard reference meal of white bread plus tea, was used as control. The GI of the traditional meal was significantly lower in the women than in the men. In the women, it resembled predicted values based on published GI values of individual foods optained in healthy subjects. A true Staub-Traugott effect (a facilitated glucose disposal during the second meal) was present in both men and women. A second meal response was only observed when the GI of the first meal was low. Lastly, the long-term effects of a traditional African diet on the metabolic control of black patients with NIDDM were determined. A control group of eight men and 13 women followed an adapted, westernised diabetic diet and a test group of eleven men and 19 women followed a low GI African diet, rich in maize meal porridge, soya and green leafy vegetables for a period of five months. Results showed that the patients could follow the diet success= fully. The test diet resulted in statistically significant, but not clinically significant weight loss. It did not, however, influence either glycated haemoglobin, nor fructosamine values. It was concluded that dietary intervention will improve glycaemic control possibly only if accompanied by substantial weight loss in these obese NIDDM subjects. Lipid profiles were normal to slightly high, in contrast with the high values reported for white NIDDM patients. The weight loss in the test group was accompanied by small but statistically significant decreases in plasma triglycerides, apolipoprotein B, fibrinogen and total cholesterol (in men). It is possible that the lower GI of the test diet contributed to the improvement in lipoprotein profiles. It is recommended that: * a reducing diet with a low energy content as well as a low GI combined with moderate exercise, should be prescribed for overweight black NIDDM patients; * the high prevalence of hypertension and overweight in these patients should get attention; and * the energy needs of black obese NIDDM patients, and the relationship between weight and glycaemic control should be investigated further. From the results of this study it is clear that the dietitian should be an integral part of the medical team and that he/she can play an important role in improving and maintaining quality a£ life for the NIDDM patient. The insight of the dietitian in the nutritional problems of the OM patient should enable him/her to provide education, motivation and attention, form diagnosis of diabetes, throughout the course of the disease.Master

Effects of a traditional African diet on the metabolic control of black patients with type II diabetes mellitus

MSc (Dietetics), North-West University, Potchefstroom CampusDiabetes mellitus has become more prevalent in developing cultures and takes an enormous human and monetary toll each year. Previous research has indicated that the traditional African diet may possibly be the optimal dietary treatment of westernised black non-insulin-dependent diabetes mellitus (NIDDM) subjects. The main hypothesis tested in this study was therefore that the traditional African diet, compared to the westernised diabetic diet as followed by local black people with NIDDM, improves metabolic control, reduces weight, and minimises the risk for macro-vascular complications. The study consisted of three phases. Firstly, a pilot study was undertaken to develop a suitable food frequency questionnaire and to determine the food and nutrient intakes of the local black NIDDM population. It was found that these patients followed a three-meal-per-day pattern. The distribution of dietary energy was 17 % from protein, 35 % from fat and 48 % from carbohydrate. It became clear that the eating habits of these NIDDM patients were in a process of westernisation. Vitamin and mineral intakes were relatively low. Nutrition education and dietary counselling were recommended. In the second phase, the acute or short-term effects of a traditional African meal on blood glucose responses were examined. The glycaemic index (GI) and second meal response of a traditional African meal, consisting of maize meal porridge, soya mince and "morogo" (cooked green leaves) were measured in 14 black NIDOM subjects. A standard reference meal of white bread plus tea, was used as control. The GI of the traditional meal was significantly lower in the women than in the men. In the women, it resembled predicted values based on published GI values of individual foods optained in healthy subjects. A true Staub-Traugott effect (a facilitated glucose disposal during the second meal) was present in both men and women. A second meal response was only observed when the GI of the first meal was low. Lastly, the long-term effects of a traditional African diet on the metabolic control of black patients with NIDDM were determined. A control group of eight men and 13 women followed an adapted, westernised diabetic diet and a test group of eleven men and 19 women followed a low GI African diet, rich in maize meal porridge, soya and green leafy vegetables for a period of five months. Results showed that the patients could follow the diet success= fully. The test diet resulted in statistically significant, but not clinically significant weight loss. It did not, however, influence either glycated haemoglobin, nor fructosamine values. It was concluded that dietary intervention will improve glycaemic control possibly only if accompanied by substantial weight loss in these obese NIDDM subjects. Lipid profiles were normal to slightly high, in contrast with the high values reported for white NIDDM patients. The weight loss in the test group was accompanied by small but statistically significant decreases in plasma triglycerides, apolipoprotein B, fibrinogen and total cholesterol (in men). It is possible that the lower GI of the test diet contributed to the improvement in lipoprotein profiles. It is recommended that: * a reducing diet with a low energy content as well as a low GI combined with moderate exercise, should be prescribed for overweight black NIDDM patients; * the high prevalence of hypertension and overweight in these patients should get attention; and * the energy needs of black obese NIDDM patients, and the relationship between weight and glycaemic control should be investigated further. From the results of this study it is clear that the dietitian should be an integral part of the medical team and that he/she can play an important role in improving and maintaining quality a£ life for the NIDDM patient. The insight of the dietitian in the nutritional problems of the OM patient should enable him/her to provide education, motivation and attention, form diagnosis of diabetes, throughout the course of the disease.Master

Objective understanding of five front-of-pack labels among consumers in Nelson Mandela Bay, South Africa

Objective: This study aimed to assess the objective understanding of five front-of-pack label formats, namely the Reference Intake, Multiple Traffic Light label, Nutri-Score, health endorsement logo and warning label, among consumers in Nelson Mandela Bay, South Africa. Design: This was a cross-sectional, exploratory study. Setting: Interviewer-administered surveys were conducted at 12 randomly selected food retail outlets in an urban setting. Subjects: A total of 359 adult participants were included in this study. Outcome measures: Objective understanding was measured by asking participants to rank food products according to their nutritional quality, using the displayed front-of-pack label. Results: The type of front-of-pack label significantly influenced ranking ability (p < 0.00001). All the evaluative front-of-pack labels significantly improved the participants’ ability to identify healthier food products compared with the no-label control. The reductive Reference Intake, however, showed no significant impact on consumer understanding. Conclusion: Evaluative front-of-pack labels significantly improved the participants’ ability to identify healthier food products, when compared with the Reference Intake and no-label control. Future research should test the objective understanding of culturally diverse groups in South Africa, particularly among rural populations

THE INFLUENCE OF STUDENT ACCOMMODATION ON DIETARY PATTERNS, ACTIVITY AND ALCOHOL CONSUMPTION: EXPERIENCES FROM NMMU

Leaving home to study together with changes in living arrangements may contribute to unhealthy lifestyles in higher education students. The objectives of this study were to describe eating patterns, physical activity and alcohol use among students at the Nelson Mandela Metropolitan University (NMMU) in the context of student accommodation. A convenience sample (n=619) participated in a cross-sectional electronic self-administered survey after providing informed consent. Of the 257 students who regularly skip meals, significantly more were residing in hostels than in other accommodation. Hostel students also reported a significantly lower consumption of fruit, vegetables and dairy products, with 25% indicating insufficient funds as reason. An inactive lifestyle was reported by 49% (n=296) of participants As long-term health can be affected by lifestyle choices, these findings can be used in intervention strategies to improve behaviour. The researchers recommend that an investigation be undertaken into the social problems that may contribute to risk, especially in hostel students