A randomised controlled school-based nutritional intervention in five Middle Eastern countries: Ajyal Salima improved students' dietary and physical activity habits.

OBJECTIVE: The purpose of this study was to measure the impact of the Ajyal Salima school intervention on nutrition and physical activity outcomes in children aged 9­11 years. DESIGN: The study was a 1-year cluster-randomised controlled trial. Ajyal Salima used a multi-component approach including classroom activities, family programme and food service adaptation. Outcomes included daily intake of breakfast, frequency of healthy and unhealthy food consumption, frequency of physical activity, knowledge score and self-efficacy score. Intervention and control groups were compared for all main outcomes and a post-intervention qualitative evaluation assessed strengths and limitations of the intervention components. SETTING: Schools in five countries ­ Lebanon, Jordan, Palestine, Saudi Arabia and Bahrain. PARTICIPANTS: Schools were selected by Ministries of Health and Education within their jurisdictions. Forty-five intervention schools (6052 students) and forty-six control schools (6200 students) were included in the analysis. RESULTS: The intervention group had a significantly higher odds of consuming breakfast daily (OR 95 % CI = 1·60, 1·35, 1·90), consuming healthy foods (OR 95 % CI = 1·60, 1·39, 1·84) and a decreased odds of consuming unhealthy foods and sweetened beverages (OR, 95 % CI = 0·70, 0·60, 0·81). Additionally, school children in the intervention group, as compared with the control group, were 47 % more likely to exercise outside school hours (OR 95 % CI = 1·47, 1·23, 1·76). Lastly, children in the intervention group had a significantly improved nutritional knowledge score and improved self-efficacy by 1·3 score unit and 1·1 score unit, respectively. CONCLUSIONS: The Ajyal Salima intervention led to significant improvements in dietary and physical activity habits among school children and increased nutritional knowledge scores.

Impact of a one-year school-based teacher-implemented nutrition and physical activity intervention: main findings and future recommendations.

BACKGROUND: The aim of the current study is to describe the effectiveness of a school-based intervention when delivered by a non-nutrition specialist (trained schoolteachers) as compared to an expert in nutrition. METHODS: Two trials of the same school-based intervention using the same intervention package were delivered, one by nutritionists and another by trained schoolteachers. The intervention focused mainly on dietary behaviours, as well as physical activity. In both trials, purposively selected schools were randomized to intervention or control groups; students (aged 9-11 years) in both groups were compared at post-test on knowledge and self-efficacy scores, as well as dietary and physical activity behaviours, controlling for their baseline status on the various measures. All analyses accounted for clustering at the school level. RESULTS: In both trials, a statistically significantly greater improvement was observed for both the knowledge and self-efficacy scores in intervention vs. school students. When the programme was delivered by trained schoolteachers, frequency of breakfast intake was increased, crisps consumption was reduced, but no change in fruit and vegetable consumption was observed (latter increased when delivered by nutrition professionals only). Physical activity did not improve in both trials. CONCLUSION: Trained schoolteachers can have a positive impact on students' dietary behaviours with the appropriate training to ensure they are equipped with the right information, skills, and resources to deliver the programme with the highest fidelity. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT03040271. Retrospectively registered on 2 February 2017.

Ajyal Salima a novel public-private partnership model for childhood obesity prevention in the Arab countries.

The prevalence of childhood overweight and obesity among children is on the rise around the world. Meanwhile, comprehensive multi-sectorial approaches have been found to be effective in improving nutritional status among children. Ajyal Salima is a public-private partnership (PPP) school-based nutrition and physical activity intervention program implemented in six Arab countries. Its objective is to promote healthy eating and physical activity habits among 9-11-year-old students. The stakeholders, involved with the implementation of the program, comprised (1) local authorities, ministries of Education and Health, and non-governmental organizations (NGOs) as public partners, (2) The American University of Beirut (AUB) as the academic/regional scientific partner, and (3) Nestlé as the private partner. The Ajyal Salima program encompasses four coordinated educational components: classroom sessions, family involvement, food service intervention, and training of trainers. The program's educational material has been culturally adapted to each country's needs, as well as pilot tested. This paper describes the strategies used to build the PPP framework of Ajyal Salima, and the role of each stakeholder. The Ajyal Salima program is an example of a promising and sustainable comprehensive PPP program to address childhood obesity, that can be exported to other countries in the region and globally.

Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program.

Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8-12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.