Rapidly increasing body mass index among children, adolescents and young adults in a transitioning population, South Africa, 2008-15.

Background: There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors. Methods: We analysed mean BMI of 28 247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals. Results: From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country. Conclusions: We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.

Available data sources for monitoring non-communicable diseases and their risk factors in South Africa.

BACKGROUND: Health information systems for monitoring chronic non-communicable diseases (NCDs) in South Africa (SA) are relatively less advanced than those for infectious diseases (particularly tuberculosis and HIV) and for maternal and child health. NCDs are now the largest cause of premature mortality owing to exposure to risk factors arising from obesity that include physical inactivity and accessible, cheap but unhealthy diets. The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013 - 17 developed by the SA National Department of Health outlines targets and monitoring priorities. OBJECTIVES: To assess data sources relevant for monitoring NCDs and their risk factors by identifying the strengths and weaknesses, including usability and availability, of surveys and routine systems focusing at national and certain sub-national levels. METHODS: Publicly available survey and routine data sources were assessed for variables collected, their characteristics, frequency of data collection, geographical coverage and data availability. RESULTS: Survey data sources were found to be quite different in the way data variables are collected, their geographical coverage and also availability, while the main weakness of routine data sources was poor quality of data. CONCLUSIONS: To provide a sound basis for monitoring progress of NCDs and related risk factors, we recommend harmonising and strengthening available SA data sources in terms of data quality, definitions, categories used, timeliness, disease coverage and biomarker measurement.

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland.

OBJECTIVE: To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland. DESIGN: Cross-sectional survey of primary care physiotherapists. METHOD: Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data. RESULTS: A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapist's role, and patient's lack of interest in changing their unhealthy behaviour. CONCLUSION: The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors.

Social science perspectives on schistosomiasis control in Africa: past trends and future directions.

New ways of integrating and scaling up control of neglected tropical diseases (including schistosomiasis) are presently underway. In this context consideration of social science perspectives is essential. In this article, we review social science publications of relevance to sustained control of schistosomiasis in Africa including diagnosis and screening, treatment, supply of clean water and improved sanitation, as well as health communication. Studies of community involvement and links between schistosomiasis control programmes and broader health care systems are also explored. Directions for future social science of relevance to sustainable schistosomiasis control are outlined, including ways of ensuring equitable access to health services as well as involvement of endemic communities and local health care systems based on equal partnership.

School children as health change agents in Magu, Tanzania: a feasibility study

The feasibility of an action-oriented and participatory educational approach, where school children function as health change agents, in a rural community of (Magu district) Tanzania was explored. Observations, in-depth interviews and focus group discussions with pupils, teachers and parents were undertaken. Findings showed that study participants favoured an approach where school children played an active role as health change agents in a combined school and community health education project. This conclusion contradicts traditional views in many African cultures where power, status and wisdom are usually closely associated with old age. However, a number of barriers were found, including the curriculum, time constraints, class size, teaching materials and teachers' skills and working conditions. The idea that pupils act as health change agents in the community as part of an action-oriented and participatory health education approach in schools was supported. A list of factors to consider when planning an action-oriented health education project is provided and discussed. (AU)

School children as health change agents in Magu, Tanzania: a feasibility study.

The feasibility of an action-oriented and participatory educational approach, where school children function as health change agents, in a rural community of (Magu district) Tanzania was explored. Observations, in-depth interviews and focus group discussions with pupils, teachers and parents were undertaken. Findings showed that study participants favoured an approach where school children played an active role as health change agents in a combined school and community health education project. This conclusion contradicts traditional views in many African cultures where power, status and wisdom are usually closely associated with old age. However, a number of barriers were found, including the curriculum, time constraints, class size, teaching materials and teachers' skills and working conditions. The idea that pupils act as health change agents in the community as part of an action-oriented and participatory health education approach in schools was supported. A list of factors to consider when planning an action-oriented health education project is provided and discussed.

Ethnoecology of traditional leafy vegetables of the Luo people of Bondo district, western Kenya.

Diversity of traditional leafy vegetables consumed by the Luo people of Nyang'oma, Bondo District, western Kenya, was evaluated in relation to their ecological habitats. The study generally revealed high species diversity within different ecological areas. A total of 60 leafy vegetable species (domesticated and wild) belonging to 47 genera and 29 families were collected. Most of the vegetable species were gathered from the wild but a few were domesticated on farmlands and kitchen gardens. Plant families that comprised most leafy vegetable species were Fabaceae, Amaranthaceae, Acanthaceae, Asteraceae and Solanaceae.

Mineral content of traditional leafy vegetables from western Kenya.

Socio-economic changes that have taken place in Africa have influenced people's eating habits in both rural and urban set-ups. Most people prefer introduced foods to traditional foods, including plant foods whose consumption is widely regarded as a primitive culture manifesting poor lifestyles. However, recent studies on traditional plant foods have shown that some are highly nutritious; containing high levels of both vitamins and minerals. They also have potential as a remedy to counter food insecurity since most are well adapted to the local environment, enabling them to resist pests, drought and diseases. This paper describes the mineral (calcium, iron and zinc) contents in some 54 traditional vegetable species collected from Nyang'oma area of Bondo district, western Kenya. Atomic absorption spectroscopy was used to determine the mineral content. We found that most traditional leafy vegetables, domesticated and wild, generally contain higher levels of calcium, iron and zinc compared with the introduced varieties such as spinach (Spanacia oleracea), kale (Brassica oleracea var. acephala) and cabbage (Brassica oleracea var. capitata). The results of this study could contribute towards identification, propagation and subsequent domestication and cultivation promotion of nutrient-rich and safe species within the farming systems of the local communities in Kenya, sub-Saharan Africa or elsewhere.

The potential of schoolchildren as health change agents in rural western Kenya.

A prospective, quasi-experimental study was carried out in Bondo district in western Kenya to determine the potential of schoolchildren as health change agents in a rural community. A group of 40 schoolchildren were given health education using action-oriented and participatory approaches and their knowledge and practices as well as the influence on recipient groups consisting of peers at school and parents/guardians at home, were studied. The study, which used questionnaire surveys, involved a pre-test of knowledge about malaria, diarrhea and hygiene among the recipient groups. After the baseline surveys they underwent health communication training conducted by the 40 schoolchildren. An identical post-test questionnaire was administered to all participants at 4 and 14 months. Health-related practices were studied regularly through observation in schools and homes over 14 months. Significant improvement in knowledge was detected in all recipient groups. Behavioral changes were more evident among the children than among the adults. The impact of the project was reflected in concrete changes in the school environment as well as the home environments. The implications of the findings for health education projects and public health programs are outlined.

Changing concepts of health and illness among children of primary school age in Western Kenya.

This paper examines changes in children's concepts of health and illness following an action-oriented health education intervention in Bondo district of Western Kenya. The study is a feasibility study exploring a specific educational approach, and it combines elements of health education research and anthropological research. Forty primary schoolchildren aged 10-15 years of age underwent a 2-month intervention and were thereafter enrolled as health communicators in a longitudinal study for an additional period of 12 months. Data were collected before, during and after the intervention using in-depth interviews and the draw-and-write technique. Students' actions and their active participation were key elements in the intervention. Although the intervention from the beginning focused on two specific diseases (malaria and diarrhea), the students were involved in developing their own ideas and visions about which changes to make, which actions to carry out and which target groups to approach. Data showed that children had acquired new concepts of health, some of which incorporated elements of the old ones. More action-oriented health concepts were identified and a general change from an external locus of control towards an internal locus of control was found. The study concludes that students can modify and broaden their concepts of health and illness through action-oriented health education. Key factors are the development of students' ownership through active and participatory teaching and learning approaches.

Schistosomiasis-related perceptions, attitudes and treatment-seeking practices in Magu district, Tanzania: public health implications.

A study on perceptions, attitudes and treatment-seeking practices related to schistosomiasis was conducted among the Wasukuma in the rural Magu district of Tanzania at the shore of Lake Victoria where Schistosoma haematobium and mansoni infections are endemic. The study applied in-depth interviews, focus group discussions and a questionnaire survey among adults and primary school children. The perceived symptoms and causes were incongruous with the biomedical perspective and a number of respondents found schistosomiasis to be a shameful disease. Lack of diagnostic and curative services at the government health care facilities was common, but there was a willingness from the biomedical health care services to collaborate with the traditional healers. Recommendations to the District Health Management Team were: that collaboration between biomedical and traditional health care providers should be strengthened and that the government facilities' diagnostic and curative capacity with regard to schistosomiasis should be upgraded. Culturally compatible health education programmes should be developed in collaboration with the local community.

Self-treatment by Kenyan and Ugandan schoolchildren and the need for school-based education.

Studies on Kenyan and Ugandan primary schoolchildren's knowledge of medicines and self-treatment practices show that children aged between 10 and 18 years have a broad knowledge of herbal and biomedical remedies and that they use them frequently, often without adults' involvement. They use pharmaceuticals, including prescription-only drugs, but lack knowledge about indications and dosages. There is a gap between the children's life worlds and the school health education as it is presently designed and taught in Kenya and Uganda. It limits itself to disease prevention and health promotion, and does not teach treatment or medicine-use. Self-treatment based on insufficient knowledge poses a threat to children's health and to the health of the wider community. Therefore, education on the critical and appropriate use of medicines needs to be developed and tested for possible use in Kenya, Uganda and other countries in which home-treatment is common. The proposed education on medicines should go beyond providing information on accurate dosage and indication: it should create critical awareness with regard to medicine-use, enabling children to use them appropriately and cautiously. Kenyan and Ugandan primary schoolchildren are active agents within pluralistic medical fields. By taking the children seriously as competent health care agents, the dangers of self-treatment could be reduced, and the potential of children could be guided to fruitful use. Educational interventions cannot solve the problems of self-treatment, which are related to the wider social and economic context, but they could contribute to increased awareness as a necessary condition for change.

Policy implications of the inadequate support systems for orphans in western Kenya.

This paper describes the support systems available for orphans in a rural Luo community in Nyang'oma sub-location in Bondo District of Western Kenya. Qualitative data were collected through in-depth interviews with orphaned children and their caretakers as well as key informants, and through focus group discussions with orphaned children, widows and community elders. Quantitative data were obtained by questionnaires administered to 100 caretakers of orphaned children. The most serious problem was inability of the orphan households to afford school fees, although lack of food, medicare and clothing were also prominent. The traditional, kinship-based support systems made a major contribution to catering for the orphans though the resources were far from enough. Various community-based groups in the area did not contribute significantly. The problem is getting desperate due to a combination of an exponentially increasing prevalence of orphans, poor socio-economic conditions and decline of the traditional support systems. For health planners and policy makers there are two major concerns. In the short term, a big and rapidly growing group of children are without adequate access to health services, while in the long term, the negative consequences for (in particular the girl) orphans' schooling pose a serious threat to the health of their future children. Based on the study findings, two recommendations are made: that the responsible parties address the issue of education for orphans rapidly and sufficiently and with due consideration of their food security and medicare; and that potential community resources such as kinship networks and community groups are mobilised in order to assist in achieving the goal.

Children and medicines: self-treatment of common illnesses among Luo schoolchildren in western Kenya.

In a rural area of western Kenya, primary schoolchildren's health seeking behaviour in response to common illnesses was investigated. 57 primary schoolchildren (age 11-17 years, median 13 years) were interviewed weekly about their health status and health seeking activities for 30 weeks. The children each experienced on average 25 illness episodes during this period. Most episodes could be categorised into 4 groups: 'cold', 'headache', 'abdominal complaints' and 'injuries'. One fifth (21%) of the illness episodes were serious enough to keep the children from school. In 28% of them, an adult was consulted, while 72% were not reported to an adult caretaker. Of the episodes without adult involvement, 81% remained untreated, while 19% were treated by the children themselves with either herbal or Western medicines. Of all the medicines taken by the children, two thirds were provided or facilitated by adults (assisted treatment) and one third taken by the children themselves without adult involvement (self-treatment). Among boys, the proportion of illnesses, which were self-treated increased with age from 12% in the youngest age group (< 13 years) to 34% in the oldest (> 14 years). In girls, the proportion of illnesses which were self-treated was consistently lower than among boys and remained constant around 9% for all age groups. The proportion of Western pharmaceuticals used for self-treatment increased with age from 44% in the youngest age group to 63% in the oldest (average 52% Western pharmaceuticals). Again, there were differences between boys and girls: among the youngest age group, boys were twice as likely to use pharmaceuticals than girls (62 versus 32% of the self-treatments, respectively) and in the oldest age group they were nearly three times more likely (75 versus 25%, respectively). These differences in self-treatment practices and choice of medicines between girls and boys may reflect the higher income potential of boys, who can earn money by fishing. Pharmaceuticals were generally preferred for the treatment of headache and fevers, or colds, while herbal remedies were the preferred choice for the treatment of abdominal complaints and wounds. The most commonly used pharmaceuticals were antimalarials (mainly chloroquine), painkillers and antipyretics (mainly aspirin and paracetamol), which were stocked in most small shops in the village at low prices and readily sold to children. Throughout primary school age Kenyan children are growing into a pluralistic medical practice, integrating Western pharmaceuticals into the local herbal medical system, and gradually become autonomous agents in their health care.

Lymphatic filariasis related perceptions and practices on the coast of Ghana: implications for prevention and control.

A qualitative study to investigate lymphatic filariasis related perceptions and practices that may be relevant for the design of appropriate health education and control programmes was conducted in four endemic villages in coastal Ghana. The villagers were aware of the common manifestations of filariasis, such as adenolymphangitis (ADL), lymphoedema, elephantiasis and hydrocele, which were specifically described with local terminology. ADL attacks were identified as the most dreaded health problem in the communities, and elephantiasis and hydrocele also ranked high in importance among reported diseases. Generally the respondents did not accept the mosquito theory of transmission, but they believed in other physical, and in spiritual and hereditary causes. Hydrocele was considered to have no link to the other disease manifestations. The manifestations were most often treated with herbal preparations which were used orally, smeared on affected parts or given as enema. In some cases the affected parts were scarified before herbal preparations were applied. The manifestations affected the work output of its victims and subjected them to hardships such as teasing, unsuitability for marriage, sexual dysfunction and divorce. Although the etiology was seen as different, the local perception of the developmental process of elephantiasis closely paralleled that of the biomedical understanding. It is suggested that this coincidence is used as an entry point for health education, to advance a broader biomedical knowledge on etiology, transmission and treatment options, and thereby to ensure co-operation of the target populations in the control of this complex disease.

[Back health of students]. / Skoleelevers rygsundhed.

The current knowledge of back symptoms among children and young people is sparse but studies indicate that their extent, at least among older pupils, resembles that in the adult age group. The design of school furniture, the sedentary way of life, the stressful practice of sports, and unsuitable gainful employment are some of the etiological factors. The dorsal health of schoolchildren is a field in great need of research and at the same time one with a great potential for prophylaxis.