Co-occurrence of and factors associated with health risk behaviors among adolescents: a multi-center study in sub-Saharan Africa, China, and India.

Background: Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. Methods: A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs - physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Findings: Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05). Interpretation: The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. Funding: Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study.

Community-based interventions targeting multiple forms of malnutrition among adolescents in low-income and middle-income countries: protocol for a scoping review.

BACKGROUND: Adolescent malnutrition is a significant public health challenge in low-income and middle-income countries (LMICs), with long-term consequences for health and development. Community-based interventions have the potential to address multiple forms of malnutrition and improve the health outcomes of adolescents. However, there is a limited understanding of the content, implementation and effectiveness of these interventions. This scoping review aims to synthesise evidence on community-based interventions targeting multiple forms of malnutrition among adolescents in LMICs and describe their effects on nutrition and health. METHODS AND ANALYSIS: A comprehensive search strategy will be implemented in multiple databases including MEDLINE (through PubMed), Embase, CENTRAL (through Cochrane Library) and grey literature, covering the period from 1 January 2000 to 14 July 2023. We will follow the Participants, Concept and Context model to design the search strategy. The inclusion criteria encompass randomised controlled trials and quasi-experimental studies focusing on adolescents aged 10-19 years. Various types of interventions, such as micronutrient supplementation, nutrition education, feeding interventions, physical activity and community environment interventions, will be considered. Two reviewers will perform data extraction independently, and, where relevant, risk of bias assessment will be conducted using standard Cochrane risk-of-bias tools. We will follow the PRISMA Extension for Scoping Reviews checklist while reporting results. ETHICS AND DISSEMINATION: The scope of this scoping review is restricted to publicly accessible databases that do not require prior ethical approval for access. The findings of this review will be shared through publications in peer-reviewed journals, and presentations at international and regional conferences and stakeholder meetings in LMICs. SCOPING REVIEW REGISTRATION: The final protocol was registered prospectively with the Open Science Framework on 19 July 2023 (https://osf.io/t2d78).

Why do men with drinking problems change their behaviour? A qualitative study nested in a randomised controlled trial in India.

The aim of this qualitative study, nested in a randomised controlled trial was to assess the mechanisms of the effects in both arms through examining perceptions of the participants about changes in their drinking behaviour and their attributions for any perceived changes. We conducted semi-structured interviews with a sub-sample of trial participants. We used thematic analysis to analyse the data. Self-perceived change, mostly positive, was reported regardless of the objectively measured remission status. Participating in the trial itself was a major catalyst for change. Participants in both arms used a variety of similar strategies to make these changes; additionally, for those who received the intervention, both the style of the counsellor (for example, the non-judgemental stance) as well as specific elements of the intervention were seen to influence change in drinking behaviour. Absence of self-reported change was relatively uncommon and primarily related to the felt need for alcohol (e.g. drinking was perceived to be necessary to maintain good health), or the belief that one did not need to or want to change. Experiences of participating in a trial, the counsellor style and specific elements of a brief psychological treatment, play a role in influencing change in harmful drinking behaviours.

Corrigendum to "Counting adolescents in: the development of an adolescent health indicator framework for population-based settings".

[This corrects the article DOI: 10.1016/j.eclinm.2023.102067.].

Controlled Growth of Single-Crystal Graphene Wafers on Twin-Boundary-Free Cu(111) Substrates.

Single-crystal graphene (SCG) wafers are needed to enable mass-electronics and optoelectronics owing to their excellent properties and compatibility with silicon-based technology. Controlled synthesis of high-quality SCG wafers can be done exploiting single-crystal Cu(111) substrates as epitaxial growth substrates recently. However, current Cu(111) films prepared by magnetron sputtering on single-crystal sapphire wafers still suffer from in-plane twin boundaries, which degrade the SCG chemical vapor deposition. Here, it is shown how to eliminate twin boundaries on Cu and achieve 4 in. Cu(111) wafers with ≈95% crystallinity. The introduction of a temperature gradient on Cu films with designed texture during annealing drives abnormal grain growth across the whole Cu wafer. In-plane twin boundaries are eliminated via migration of out-of-plane grain boundaries. SCG wafers grown on the resulting single-crystal Cu(111) substrates exhibit improved crystallinity with >97% aligned graphene domains. As-synthesized SCG wafers exhibit an average carrier mobility up to 7284 cm2 V-1 s-1 at room temperature from 103 devices and a uniform sheet resistance with only 5% deviation in 4 in. region.

A Cross-Sectional Survey on the Use of Tobacco, Attempts on Cessation, and Locus of Control Among College Students.

Background Socio-cultural considerations (such as drug availability) and psychological traits play a significant role in predicting whether a person will use drugs in the future and dependency on the drugs. Second-, third-, and fourth-hand smoking and E-cigarettes are influencing factors for the use of tobacco in college students. This study conducted research to ascertain whether there is a potential relationship between tobacco consumption and various factors, including internal and external control sites and demographics. Materials and methods Participants in the study were found by walk-up distribution at multiple campus-wide smoking places, department announcements, and on-campus advertisements. Social media and participant references were also used in this study as recruitment tools. In addition, the locus of control questionnaire also identifies if the participating individual had extrinsic or intrinsic reinforcing routines. The classification of the participating individuals into respective internal and external locus of control was in accordance with their response survey after which a statistical analysis was done. Results This study found an association between smoking on campus and reported attempts to quit. Additionally, there is a strong association (r(85) = 0.31, p < 0.01) between reported tobacco use status and cigarette use on campus. Participants' gender and smoking status also had r(85) = 0.39, p-value < 0.01 correlation. The bulk of respondents indicated that they were seniors and off-campus living concluding for 36% (n = 34) and 60% (n = 51) of the total. Twenty-seven percent (n = 24) of the respondents were first-year college students and the rest 33% (n = 29) said their parents had no college education at all or incomplete college education. Conclusion Whenever there is a strong perception of organizational support for anti-tobacco policies, and improving compliance, there is a drastic increase in cigarette cessation and a drop in tobacco usage among those who still smoke. Perceived organizational support is strongly and positively connected with cessation among the organization's members.

Electrically Tunable Nonlinearity at 3.2 Terahertz in Single-Layer Graphene.

Graphene is a nonlinear material in the terahertz (THz) frequency range, with χ(3) ∼ 10-9 m2/V2 ∼ 15 orders of magnitude higher than that of other materials used in the THz range, such as GaAs or lithium niobate. This nonlinear behavior, combined with ultrafast dynamic for excited carriers, proved to be essential for third harmonic generation in the sub-THz and low (<2.5 THz) THz range, using moderate (60 kV/cm) fields and at room temperature. Here, we show that, for monochromatic high peak power (1.8 W) input THz signals, emitted by a quantum cascade laser, the nonlinearity can be controlled using an ionic liquid gate that tunes the graphene Fermi energy up to >1.2 eV. Pump and probe experiments reveal an intense absorption nonlinearity at 3.2 THz, with a dominant 3rd-order contribution at EF > 0.7 eV, hence opening intriguing perspectives per engineering novel architectures for light generation at frequencies > 9 THz.

Experimental and Numerical Investigation of the Degelation Behavior and Non-Isothermal Flow Restart of a Waxy Oil Pipeline.

Flow assurance challenges associated with waxy crude oil precipitation at low ambient conditions are significant concerns for oil industries during production, transportation, and storage. Numerous methods have been employed to mitigate wax deposition and gelation issues. Since wax precipitation is temperature-sensitive, heating has emerged as a promising method to enhance oil flowability. The present work intends to examine the degelation behavior of waxy oil using rheometry, differential scanning calorimetry, and microscopy techniques. In addition, a non-isothermal flow restart simulation is performed using an in-house numerical simulator consisting of a rheological model of sol-gel transition developed in the current work. A numerical simulation of a preheated gelled pipeline demonstrates the significance of the degelation temperature. The effects of the wax concentration, initial gel temperature, and aging period on the degelation temperature are examined. The observed degelation temperature is higher than the gelation temperature, leading to thermal hysteresis. The extent of thermal hysteresis reduces with a decrease in the heating rate. The numerical simulation uses the finite volume method with variables placed on a staggered grid. The gel heated above and below the degelation temperature shows a significant variation in axial velocity profiles. However, further heating does not affect the velocity profiles. A shear banding type of effect is observed in the axial velocity profile above the degelation temperature. Heating the gelled oil to the degelation temperature instead of the wax disappearance temperature saves excessive heating energy during storage and transport operations.

What happens when a whole-school health promotion research trial ends? a case study of the SEHER program in India.

Background: Health promotion interventions that are developed and evaluated by researchers and other external providers are at risk of not being sustained beyond the initial implementation period. When delivered by a lay school health worker, the SEHER study of a whole-school health promotion intervention in Bihar, India was found to be feasible, acceptable and effective in improving school climate and student health behaviors. The objective of this case study is to describe the decision-making processes, barriers, and enablers to continuing the SEHER intervention following its official closure. Methods: For this exploratory qualitative case study, data were collected from four government-run secondary schools, two of which continued SEHER and two of which discontinued it after official closure. Thirteen school staff were interviewed, and 100 girls and boys (aged 15-18 years old) participated in eight focus groups discussing their experiences of the process of continuing the intervention (or discontinuing) following its official closure. Thematic analysis was conducted in NVivo 12 using grounded theory. Results: No school sustained the intervention as originally delivered in the research trial. In two schools, the intervention was adapted by selecting sustainable components, whereas in two others it was discontinued altogether. We identified four interrelated themes that explained the complex decision-making process, barriers, and enablers related to program continuation: (1) understanding of the intervention philosophy among school staff; (2) school capabilities to continue with intervention activities; (3) school attitudes and motivation about implementing the intervention, and; (4) the education policy environment and governance structures. Suggestions for overcoming barriers included adequate resource allocation; training, supervision, and support from external providers and the Ministry of Education; and formal government approval to continue the intervention. Conclusion: Sustaining this whole-school health promotion intervention in low-resource school settings in India depended on individual, school and government factors as well as external support. These findings suggest that health interventions will not necessarily become embedded in a school's operations merely because they are designed as a whole-school approach or because they are effective. Research should identify the resources and processes required to balance planning for future sustainability while awaiting trial results about an intervention's effectiveness.

Counting adolescents in: the development of an adolescent health indicator framework for population-based settings.

Changing realities in low- and middle-income countries (LMICs) in terms of inequalities, urbanization, globalization, migration, and economic adversity shape adolescent development and health, as well as successful transitions between adolescence and young adulthood. It is estimated that 90% of adolescents live in LMICs in 2019, but inadequate data exist to inform evidence-based and concerted policies and programs tailored to address the distinctive developmental and health needs of adolescents. Population-based data surveillance such as Health and Demographic Surveillance Systems (HDSS) and school-based surveys provide access to a well-defined population and provide cost-effective opportunities to fill in data gaps about adolescent health and well-being by collecting population-representative longitudinal data. The Africa Research Implementation Science and Education (ARISE) Network, therefore, systematically developed adolescent health and well-being indicators and a questionnaire for measuring these indicators that can be used in population-based LMIC settings. We conducted a multistage collaborative and iterative process led by network members alongside consultation with health-domain and adolescent health experts globally. Seven key domains emerged from this process: socio-demographics, health awareness and behaviors; nutrition; mental health; sexual and reproductive health; substance use; and healthcare utilization. For each domain, we generated a clear definition; rationale for inclusion; sub-domain descriptions, and a set of questions for measurement. The ARISE Network will implement the questionnaire longitudinally (i.e., at two time-points one year apart) at ten sites in seven countries in sub-Saharan Africa and two countries in Asia. Integrating the questionnaire within established population-based data collection platforms such as HDSS and school settings can provide measured experiences of young people to inform policy and program planning and evaluation in LMICs and improve adolescent health and well-being.

Near- and Far-Field Observation of Phonon Polaritons in Wafer-Scale Multilayer Hexagonal Boron Nitride Prepared by Chemical Vapor Deposition.

Polaritons in layered materials (LMs) are a promising platform to manipulate and control light at the nanometer scale. Thus, the observation of polaritons in wafer-scale LMs is critically important for the development of industrially relevant nanophotonics and optoelectronics applications. In this work, phonon polaritons (PhPs) in wafer-scale multilayer hexagonal boron nitride (hBN) grown by chemical vapor deposition are reported. By infrared nanoimaging, the PhPs are visualized, and PhP lifetimes of ≈0.6 ps are measured, comparable to that of micromechanically exfoliated multilayer hBN. Further, PhP nanoresonators are demonstrated. Their quality factors of ≈50 are about 0.7 times that of state-of-the-art devices based on exfoliated hBN. These results can enable PhP-based surface-enhanced infrared spectroscopy (e.g., for gas sensing) and infrared photodetector applications.

Predictors of Incidence and Remission of Anemia among Never-Married Adolescents Aged 10-19 Years: A Population-Based Prospective Longitudinal Study in India.

Background: Dynamics of the anemia burden among Indian adolescents are poorly understood because of a lack of population-based longitudinal data. Objectives: To examine the burden of anemia among never-married adolescents aged 10-19 y from the states of Bihar and Uttar Pradesh, India, and a wide range of predictors of its incidence and remission. Methods: A sample of 3279 adolescents (male: 1787 and female: 1492) aged 10-19 y were included from baseline (2015-2016) and follow-up (2018-2019) surveys of the UDAYA (Understanding the Lives of Adolescents and Young Adults) project in India. In 2018-2019, all new cases of anemia were considered as incidence, whereas a return to the nonanemic status from being anemic in 2015-2016 was considered remission. Univariate and multivariable modified Poisson regression models with robust error variance were deployed to attain the study objective. Results: The crude prevalence of anemia among males decreased from 33.9% (95% CI: 30.7%-37.3%) in 2015-2016 to 31.6% (95% CI: 28.6%-34.7%) in 2018-2019 but increased among females from 57.7% (95% CI: 53.5%-61.7%) in 2015-2016 to 63.8% (95% CI: 59.9%-67.5%) in 2018-2019. Anemia incidence was estimated to be 33.7% (95% CI: 30.3%-37.2%), whereas nearly 38.5% (95% CI: 35.1%-42.1%) of adolescents experienced remission of anemia. Older adolescents (aged 15-19 y) were less likely to experience anemia incidence. Consumption of eggs daily or weekly was negatively associated with anemia incidence compared with occasional or never consumption. Females had a higher risk of experiencing an incidence of anemia and decreased risk of experiencing anemia remission. The likelihood of adolescents experiencing anemia increased with an increased patient health questionnaire score. Household size was also associated with an increased risk of anemia incidence. Conclusions: Interventions that are sensitive to socio-demographic factors and encouraging access to mental health services and nutritious food consumption could be helpful in further anemia mitigation.

Burden and contributing factors to overweight and obesity in young adolescents in Addis Ababa, Ethiopia.

The prevalence of overweight/obesity in adolescents has increased globally, including in low- and middle-income countries. Early adolescence provides an opportunity to develop and encourage positive health and behavioural practices, yet it is an understudied age group with limited information to guide and inform appropriate interventions. This study aims to determine the prevalence of overweight/obesity in young adolescents, aged between 10 and 14 years attending public schools in Addis Ababa, Ethiopia, and to explore the contributing factors. A cross-sectional school-based study was conducted. Adolescents completed individual questionnaires. Weight (kg) and height (m) measurements were converted to BMI-for-age and gender z-scores. Multivariate regression analysis was conducted to determine the associated factors. The overall prevalence of overweight/obesity was 8% among adolescents aged 10-14 years and it was significantly higher in females (13%) than males (2%). The diet quality for the majority of the adolescents was inadequate, putting them at risk for poor health outcomes. The contributors to overweight/obesity were different between males and females. Age and no access to a flush toilet were negatively associated with overweight/obesity in males and access to a computer, laptop or tablet was positively associated. In females, menarche was positively associated with overweight/obesity. Living with only their mother or another female adult and an increase in physical activity were negatively associated with overweight/obesity. There is a need to improve the diet quality of young adolescents in Ethiopia and understand the reasons why females are less physically active to limit the risk of poor diet-related health outcomes.

Access to digital media and devices among adolescents in sub-Saharan Africa: A multicountry, school-based survey.

Digital technologies provide unprecedented opportunities for health and nutrition interventions among adolescents. The use of digital media and devices among young adolescents across diverse settings in sub-Saharan Africa is unclear. This cross-sectional study aimed to assess the use of digital media and devices and the socioeconomic determinants of use among young adolescents in Burkina Faso, Ethiopia, South Africa, Sudan and Tanzania. The study included 4981 adolescents aged 10-15 from public schools selected by multistage sampling. Access to various digital media and devices was self-reported by adolescents. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between sociodemographic characteristics and access to digital media and devices. Approximately 40% of the adolescents in Burkina Faso and South Africa, 36% in Sudan, 13% in Ethiopia and 3% in Tanzania owned mobile phones. Compared with boys, girls had a lower ownership of mobile phones (odds ratio [OR] = 0.79; 95% confidence interval [CI]: 0.68, 0.92; p = 0.002), computers (OR = 0.83; 95% CI: 0.70, 0.99; p = 0.04) and social media accounts (OR = 0.68; 95% CI: 0.56, 0.83; p < 0.001). Higher maternal education and greater household wealth were positively associated with access to digital media and devices. While digital media and devices are promising platforms for interventions in some settings due to relatively high levels of access, their utility in delivering health and nutrition interventions to adolescents in these contexts should be further examined.

Correlates of internalizing and externalizing problems among school-going young adolescents in Sub-Saharan Africa.

Mental health in adolescence is important for health and well-being throughout the life course, but evidence from Sub-Saharan Africa is sparse. This study aimed to assess the correlates of internalizing, externalizing and cumulative problems among early adolescents. This study used cross-sectional survey data from 3516 school-going adolescents in Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia and Dar es Salaam, Tanzania. We used a 25-item Strengths and Difficulties Questionnaire to measure internalizing, externalizing and cumulative problems. We carried out multi-variable linear regression analyses with the estimation of adjusted mean differences and 95% confidence intervals, to determine the factors associated with internalizing, externalizing and cumulative problems. Overall, 1 in 8 adolescents had internalizing problems, while 1 in 10 had externalizing problems. In two sites, having friends was related to lower internalizing problems, while repeating a grade, physical fights and household food insecurity were related to greater internalizing problems. Household food insecurity and involvement in physical fights were associated with greater externalizing problems across sites, while repeating a grade was linked with greater externalizing problems in two sites. Having a caring adult in school was associated with fewer externalizing problems across sites, while having friends was associated with fewer externalizing problems in two sites. Overall, having friends was related to fewer cumulative problems, while physical fights and household food insecurity were related to higher cumulative problems. School-based mental health and food programs may be useful in addressing social-emotional problems among school-aged adolescents in Burkina Faso, Ethiopia and Tanzania.

Dietary intake and quality for young adolescents in sub-Saharan Africa: Status and influencing factors.

Adolescents face the risk of the triple burden of malnutrition-the co-existence of micronutrient deficiencies, underweight and overweight and obesity and related noncommunicable diseases. Poor-quality diets are a modifiable risk factor for all forms of malnutrition in adolescents. However, there is limited knowledge about diet quality for African adolescents. We analyzed data from 4609 school-going adolescents aged 10-15 years in Burkina Faso, Ethiopia, Sudan and Tanzania. Dietary intake was assessed using food frequency questionnaires, and diet quality computed using the Global Diet Quality Score (GDQS). Generalized estimating equations linear regression models were used to evaluate factors associated with adolescent diet quality. Mean adolescent age was 12.4 (±1.4) years and 54% of adolescents were female. Adolescents reported physical activity on 1.5 (±1.7) days/week. The mean GDQS (±SD) was 20.6 (±4.0) (maximum 40). Adolescent consumption of vegetables, fruit, nuts and seeds, eggs, fish and poultry was low, and refined grain consumption was relatively high. Boys consumed unhealthy foods less frequently but consumed fewer cruciferous vegetables and deep orange tubers. Older adolescents had higher fish and lower red meat consumption. Having an unemployed mother versus farmer (estimate -2.60, 95% confidence interval [CI]: -4.81, -0.39), and having 3-4 days of physical activity per week versus none (estimate 0.64, 95% CI: 0.11, 1.17) were associated with GDQS. We found evidence of poor-quality adolescent diets and gender and age differences in the consumption of healthy diets. Programs to address poor-quality diets should consider tailoring interventions for adolescent girls and boys of different ages and also consider the role of physical activity in these contexts.

Construction of Waste Chalk Powder into mpg-C3N4-CaSO4 as an Efficient Photocatalyst for Dye Degradation under UV-Vis Light and Sunlight.

In this article, we present the synthesis of calcium sulfate nanoparticles (CaSO4 NPs) from waste chalk powder by the calcination method. These CaSO4 NPs were utilized for the construction of a mesoporous graphitic carbon nitride-calcium sulfate (mpg-C3N4-CaSO4) photocatalyst. Synthesized materials were confirmed by several characterization techniques. The photocatalytic performance of the synthesized samples was tested by the degradation of methylene blue (MB) in the presence of both UV-vis light and sunlight. The efficiency of photocatalytic degradation of MB dye using the optimized mpg-C3N4-CaSO4-2 composite reached 91% within 90 min in the presence of UV-vis light with superb photostability and recyclability after five runs compared to individual mpg-C3N4 and CaSO4 NPs and reached 95% within 120 min under sunlight. Histotoxicological studies on fish liver and ovary indicated that the dye containing the solution damaged the structure of the liver and ovary tissues, whereas the photodegraded solution of MB was found to be less toxic and caused negligible alterations in their typical structure similar to the control group.

Burden and determinants of anaemia among in-school young adolescents in Ethiopia, Sudan and Tanzania.

Anaemia among adolescents is a global health problem. However, evidence regarding its burden and risk factors, particularly for younger adolescents and in sub-Saharan Africa (SSA), remains scarce. We aimed to assess the prevalence and potential determinants of anaemia among urban and semi-urban in-school young adolescents in Ethiopia, Sudan and Tanzania. We conducted a school-based survey among 3558 adolescents aged 10-14 years. A capillary blood sample was used to assess haemoglobin concentration. We assessed anaemia prevalence and examined associations between measures at the individual, household and school levels and anaemia using Poisson regression models adjusted for school and country-level clustering. The prevalence of anaemia was 32.0% overall, and 10.8% in Ethiopia, 25.0% in Sudan and 58.3% in Tanzania. Being a boy [adjusted risk ratio (RR): 1.11, 95% confidence interval (CI): 1.08-1.15, p < 0.001], poorer diet quality (RR: 1.12, 95% CI: 1.02-1.23 p = 0.015), no school handwashing stations (RR: 1.26, 95% CI: 1.20-1.32, p < 0.001) and food insecurity (RR for moderate/severe anaemia: 1.06, 95% CI: 1.02-1.10, p = 0.002) were associated with increased anaemia risk. Younger age (RR: 0.91, 95% CI: 0.86-0.96, p < 0.001) and increasing height-for-age z-score (RR: 0.93, 95% CI: 0.91-0.95, p < 0.001) were associated with decreased anaemia risk. Associations were consistent for moderate or severe anaemia. There was no evidence of effect modification by sex. This study highlights anaemia as a public health problem and identified nutritional, dietary and hygiene measures as key risk factors of anaemia among young adolescents in SSA. School-based interventions addressing these factors could reduce the burden of anaemia in adolescence.

School-based health and nutrition interventions addressing double burden of malnutrition and educational outcomes of adolescents in low- and middle-income countries: A systematic review.

School system is a promising platform for addressing all forms of malnutrition in adolescents. However, little is known about the impact of integrated school health and nutrition programmes on adolescent nutrition and educational outcomes in low- and middle-income countries (LMICs). This systematic review sought to characterize school-based health and nutrition interventions among adolescents in LMICs and analyze their effects on nutritional status and educational outcomes. Four databases were searched for studies evaluating school-based health and nutrition interventions for adolescents in LMICs, reporting changes in either nutritional status or educational outcomes. A narrative synthesis was used to analyze and describe the evidence. Our review included 68 articles evaluating 58 interventions, of which a third had moderate to strong methodological quality. Forty-two studies evaluated single-domain interventions, while 26 evaluated multi-component interventions. A third of all interventions were based on a theoretical framework. Three-fourths of the interventions were shorter than 11 months, which may make identifying their effect difficult. The results of the effectiveness of these interventions were mixed and inconsistent across intervention types. Sixteen out of 21 studies evaluating multi-component interventions and 12 out of 23 studies evaluating nutrition education reported improving nutritional or diet-related outcomes. One out of six studies reported positive effects on educational outcomes. Our review has identified that research needs include: a greater inclusion of theory-based approaches to guide the implementation of interventions; more studies of integrated interventions that involve parents and the wider community in LMICs; and extension of outcomes beyond nutritional status to include educational outcomes.