In South Africa, overweight and obesity affect 17% of children aged 15-18. School food environments play a vital role in children's health, influencing dietary behaviours and resulting in high ...obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model.
A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or 'very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5).
We identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) "regulate what kinds of foods can be sold at schools", 2) "train school staff through workshops and discussions to improve school food environment", and affix 3) "compulsory, child-friendly warning labels on unhealthy foods".
Prioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa's childhood obesity epidemic effectively.
Background We retrospectively reviewed 20 patients (21 elbows) after arthroscopic debridement and capsulectomy of the elbow for primary osteoarthritis. We aimed to see if there was an improvement in ...pain, function, and range of movement in the medium-term. Materials and methods Outcomes of 20 patients (18 men, 2 women) with primary osteoarthritis of the elbow (21 elbows) operated on by the senior surgeon were reviewed at a mean of 5.5 years postoperatively. Inclusion criteria were patients with undergoing arthroscopic debridement and capsulectomy after failure of previous conservative treatment. Exclusion criteria were patients undergoing additional intra-articular procedures at surgery and patients with post-traumatic or inflammatory arthritis. Mean age was 42 years (range, 22-79 years). Preoperatively, osteoarthritis was classified based on plain x-ray images. Functional outcome was assessed using preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo scores, and range of movement. Results Radiographically, osteoarthritis was assessed as class I in 9 elbows, class II in 10 elbows, and class III in 3 elbows. There was a mean significant improvement in DASH score from 34.0 to 12.7 ( P < .05). This was true for all grades of osteoarthritis and significant for classes II and III ( P < .05). Mayo scores postoperatively were “excellent” in 11 elbows, “good” in 5, “fair” in 4, and “poor” in 1. Nineteen of the 20 patients said they would have had the surgery again. Conclusion Arthroscopic debridement and capsulectomy is an effective procedure for patients with primary osteoarthritis of the elbow. We propose this may work as a partial neurectomy to denervate pain sensation in the joint.
Understanding urban travel behaviour is crucial for planning healthy and sustainable cities. Africa is urbanising at one of the fastest rates in the world and urgently needs this knowledge. However, ...the data and literature on urban travel behaviour, their correlates, and their variation across African cities are limited. We aimed to describe and compare travel behaviour characteristics and correlates of two Kenyan cities (Nairobi and Kisumu). We analysed data from 16,793 participants (10,000 households) in a 2013 Japan International Cooperation Agency (JICA) household travel survey in Nairobi and 5790 participants (2760 households) in a 2016 Institute for Transportation and Development Policy (ITDP) household travel survey in Kisumu. We used the Heckman selection model to explore correlations of travel duration by trip mode. The proportion of individuals reporting no trips was far higher in Kisumu (47% vs 5%). For participants with trips, the mean number lower - upper quartiles of daily trips was similar (Kisumu (2.2 2–2 versus 2.4 2–2 trips), but total daily travel durations were lower in Kisumu (65 30–80 versus 116 60–150 minutes). Walking was the most common trip mode in both cities (61% in Kisumu and 42% in Nairobi), followed by motorcycles (17%), matatus (minibuses) (11%), and cars (5%) in Kisumu; and matatus (28%), cars (12%) and buses (12%) in Nairobi. In both cities, females were less likely to make trips, and when they did, they travelled for shorter durations; people living in households with higher incomes were more likely to travel and did so for longer durations. Gender, income, occupation, and household vehicle ownership were associated differently with trip making, use of transport modes and daily travel times in cities. These findings illustrate marked differences in reported travel behaviour characteristics and correlates within the same country, indicating setting-dependent influences on travel behaviour. More sub-national data collection and harmonisation are needed to build a more nuanced understanding of patterns and drivers of travel behaviour in African cities.
At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a ...high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the potential impact of the COVID-19 pandemic in these contexts. COVID-19 infection control measures have been shown to have some effects in slowing down the progress of the pandemic, effectively buying time to prepare the healthcare system. However, there has been less of a focus on the indirect impacts of these measures on health behaviours and the consequent health risks, particularly in the most vulnerable. In this current debate piece, focusing on two of the four risk factors that contribute to >80% of the NCD burden, we consider the possible ways that the restrictions put in place to control the pandemic, have the potential to impact on dietary and physical activity behaviours and their determinants. By considering mitigation responses implemented by governments in several LMIC cities, we identify key lessons that highlight the potential of economic, political, food and built environment sectors, mobilised during the pandemic, to retain health as a priority beyond the context of pandemic response. Such whole-of society approaches are feasible and necessary to support equitable healthy eating and active living required to address other epidemics and to lower the baseline need for healthcare in the long term.
Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high ...income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs.
The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders.
We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups.
Background Suicide is a significant public health concern among the pediatric population in the United States. This study aims to comprehensively analyze suicide attempts among adolescents using data ...from the Youth Risk Behavior Surveillance System (YRBSS) maintained by the Centers for Disease Control and Prevention (CDC). Methods The pediatric population of grades 9-12 students (13-17 years old) was included in the study population, and data were collected from multiple cycles of the YRBSS survey. Descriptive statistics and time-trend analyses were conducted to examine attempted suicide rates based on location, gender, race/ethnicity, school grade level, and sexual orientation. Results Significant variations in attempted suicide rates were observed among different demographic groups. In 2021, of the subset with suicide attempt, females reported a higher prevalence of attempted suicide (13.3%, n=211), while males exhibited a lower rate (6.6%, n=104). Of the total studied population in 2021, Palau had the highest attempted suicide rate (25.2%, n=3924), followed by the Northern Mariana Islands (17.6%, n=2740). Over 1991-2021, no significant location-based variations were observed. In 2021, American Indian/Alaska Native adolescents had the highest attempted suicide rate at 16% (n=2491), followed by Black adolescents (14.5%, n=2258). Ninth-grade students reported higher rates in 2021 (11.6%, n=1806). Adolescents reporting both opposite-sex (36.7%, n=5715) and same-sex-only sexual contacts or both (32.9%, n=5123) exhibited notably higher rates in 2021. Conclusion This study highlights alarming attempted suicide rates in the US pediatric population, emphasizing the need for tailored prevention efforts and mental health support. It offers essential guidance for policymakers, researchers, and mental health professionals in developing evidence-based strategies to promote youth well-being and combat the impact of suicide attempts.
In South Africa, overweight and obesity affects 13% of children and 17% of adolescents. School food environments play a vital role in dietary behaviours and resulting obesity rates. Interventions ...targeting schools can be effective if evidence-based and context relevant. There are substantial gaps in policy and implementation of government strategies to promote healthy nutrition environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model.
A multiphased secondary analysis of individual interviews with 25 primary school staff was undertaken. First, we identified risk factors influencing school food environments using MAXQDA software; then deductively coded these using the Capability, Opportunity, Motivation–Behaviour model, which informs the Behaviour Change Wheel framework. To identify evidence-based interventions, we used the NOURISHING framework and matched interventions to risk factors. Last, interventions were prioritised through a Delphi survey, administered to stakeholders (n=38) representing health, education, food service, and not-for-profit sectors. Consensus for priority interventions was defined as an intervention being either somewhat or very important and feasible, with high level of agreement (quartile deviation ≤0·5).
We identified 21 interventions to improve school food environments. Of these, seven were endorsed as important and feasible to enable school stakeholders’, policy makers’, and children's capability, motivation, and opportunity of having healthier foods within schools. Prioritised interventions targeted a range of protective and risk factors, including issues of affordability and availability of unhealthy foods within school premises. As such, top priority interventions included (1) regulations on what kinds of foods can be sold at schools; (2) compulsory, child-friendly warning labels on unhealthy foods; and (3) training of school staff through workshops and discussions to improve school nutrition environment.
This is the first study to use the Behaviour Change Wheel and stakeholder engagement to identify intervention priorities to improve food environments in South African schools. Prioritisation of evidence-based, feasible, and important interventions that are underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to effectively tackle South Africa's childhood obesity epidemic.
This research was funded by the National Institute for Health Research (NIHR; grant number 16/137/34) using UK Aid from the UK Government to support global health research. AE, PK, TR-P, SG, and KJH are supported by the SAMRC/Wits Centre for Health Economics and Decision Science–PRICELESS SA (grant number 23108).
The literature on urban travel behaviour in Africa is sparse, limiting our understanding of how urban transport policies respond to human and planetary needs. We conducted a cross-sectional household ...telephone survey on 1334 participants, using a 24 h time-use diary, to investigate travel behaviour and barriers to active travel (walking and cycling) in Yaoundé, Cameroon. We found that two-thirds of all participants reported at least one trip; the median (IQR) numbers of trips per capita and per participant with trips were 2 (0–3) and 2 (2–3), respectively. The main trip modes were shared taxi (46%), walking (27%), private cars (11%), and motorcycle taxis (10%), with 25%, 56%, and 45% of all participants reporting the use of active, motorised, and public transport, respectively. The mean (IQR) trip duration was 48 (30–60) min; for participants who reported trips, the daily overall and active travel durations were 121 (60–150) and 28 (0–45) min, respectively. Women were less likely to travel, making fewer and shorter trips when they did. Participants in less wealthy households were more likely to travel. The primary barriers to both walking and cycling were the fear of road traffic injuries and the inconvenience of active travel modes. Therefore, local urban transport authorities need to improve the safety and convenience of active mobility and promote gender equity in transport. Restrictions to movements during the COVID-19 pandemic and the relatively small survey sample might have biased our results; thus, a representative travel survey could improve current estimates. More generally, high-quality research on travel behaviours and their correlates is needed in low-resource settings.
Adolescence is a life stage critical to the establishment of healthy behaviours, including physical activity (PA). Factors associated with the built environment have been shown to impact PA across ...the life course. We examined the sociodemographic differences in, and associations between, perceived neighbourhood walkability, PA, and body mass index (BMI) in South African adolescents. We recruited a convenience sample (n = 143; 13-18 years; 65% female) of students from three high schools (middle/high and low-income areas). Participants completed a PA questionnaire and the Neighbourhood Environment Walkability Scale (NEWS)-Africa and anthropometry measurements. Multivariable linear regression was used to examine various relationships. We found that, compared with adolescents living in middle/high income neighbourhoods, those living in low-income neighbourhoods had lower perceived walkability and PA with higher BMI percentiles. The associations between neighbourhood walkability and PA were inconsistent. In the adjusted models, land use diversity and personal safety were associated with club sports participation, street connectivity was positively associated with school sports PA, and more favourable perceived walkability was negatively associated with active transport. Overall, our findings suggest that the perceived walkability of lower income neighbourhoods is worse in comparison with higher income neighbourhoods, though the association with PA and BMI is unclear.
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