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Background Inconsistent data exist regarding the influence of parasitic infection on the prevalence of allergic sensitization and disorders. Objective To investigate the impact of geohelminth and protozoan infections on sensitization patterns and allergic symptoms of children living in low-income communities in Gqeberha, South Africa. Methods In a cross-sectional study, 587 school children aged 8-12 years were recruited in June 2016 and screened for reactivity to common allergens by skin prick tests and for parasitic infections by stool tests. Additionally, questionnaires were completed to record allergic symptoms the children may have experienced. Results Positive SPT were found in 237/587 children (40.4%), about one third of whom were polysensitized. Sensitizations were most frequently detected against the house dust mites (HDM) Dermatophagoides spp . (31.9%) and Blomia tropicalis (21.0%). Infections with geohelminths ( Ascaris lumbricoides , Trichuris trichiura ) were found in 26.8% and protozoan infections ( Gardia lamblia , Cryptosporidia spp .) in 13.9% of study participants. Mixed logistic regression analyses revealed negative associations between parasite infection and sensitization to Blomia tropicalis (OR: 0.54, 95%CI 0.33-0.89) and to Dermatophagoides spp . (OR 0.65, 95%CI 0.43-0.96), and between protozoan infection and allergic sensitization to any aeroallergen, although these associations were not significant when adjusted for false discovery. Geohelminth infection and intensity of geohelminth infection were both associated with reduced risk of polysensitization (OR 0.41, 95%CI 0.21-0.86), and this association remained significant with adjustment for false discovery. Reported respiratory symptoms were associated with HDM sensitization (ORs from 1.54 to 2.48), but not with parasite infection. Conclusions and clinical relevance Our data suggest that geohelminth infection and high geohelminth infection intensity are associated with a reduced risk of polysensitization.

ObjectiveSchool-aged children in low- and middle-income countries carry the highest burden of intestinal helminth infections, such as soil-transmitted helminths (STH). STH infections have been associated with negative consequences for child physical and cognitive development and wellbeing. Thus, the aim of this study was to determine the association of STH infections in schoolchildren from Gqeberha, focusing on physical activity, physical fitness, and clustered cardiovascular disease (CVD) risk score.MethodsThis cross-sectional study involved 680 schoolchildren (356 girls and 324 boys; mean age 8.19 years, SD±1.4) from disadvantaged communities in Gqeberha (formerly, Port Elizabeth), South Africa. Stool samples were collected and examined for STH infections using the Kato-Katz method. Physical activity (accelerometer) and physical fitness (grip strength, 20 m shuttle run) were measured using standard procedures. Furthermore, anthropometry, blood pressure, as well as glycated haemoglobin and lipid profile from capillary blood samples were assessed. We employed one-way ANOVAs to identify the associations of STH infections in terms of species and infection intensity with physical activity, physical fitness, and clustered CVD risk score.ResultsWe found a low STH infection prevalence (7.2%) in our study, with participants infected with at least one intestinal helminth species. In comparison to their non-infected peers, children infected with STH had lower mean grip strength scores, but higher mean VO2max estimation and higher levels of MVPA (pA. lumbricoidesinfection and MVPA was found. In contrast, lightT. trichiura-infected children had significantly lower grip strength scores compared to non-infected children. VO2max and MVPA were positively associated with lightT. trichiurainfection. No significant association between the clustered CVD risk score and infection with any STH species was evident.ConclusionsSTH-infected children had lower grip strength scores than their non-infected peers, yet, achieved higher VO2max and MVPA scores. Our study highlights that the type and intensity of STH infection is relevant in understanding the disease burden of STH infections on children’s health. The findings of our study must be interpreted cautiously due to the low infection rate, and more research is needed in samples with higher prevalence rates or case-control designs.

This study aimed to establish the prevalence of underweight, overweight and obesity, the level of moderate-to-vigorous physical activity (MVPA) and the association thereof among vulnerable children from low-income communities in South Africa. Cross-sectional data were collected from 916 children (467 boys and 449 girls) aged 8–13 years (x̄ = 10.4 ± 1.2 years) attending eight low-income schools in Gqeberha, South Africa. Measured outcomes included accelerometery-measured physical activity (PA), weight, height and body mass index (BMI). Analysis of variance was used to determine the mean difference of total MVPA stratified by sex and BMI classification. Overall, 13% of the cohort were underweight, 19% were overweight/obese and 64% engaged in 60 min of MVPA per day. Girls presented nearly twice the odds of being overweight or obese than boys (95% CI: 1.40–2.77). Underweight to normal-weight children (boys: OR = 3.89, 95% CI: 2.18–6.93; girls: OR = 1.78, 95% CI: 1.13–2.80) were more likely to engage in 60 min/day of MVPA than overweight to obese children. There is an inverse association between BMI categories and theduration of MVPA achieved per day. Special attention should be aimed at increasing awareness of healthy nutrition and promoting a variety of PA, especially among girls and children with excess weight.

Backgound The disease profile of low- to middle-income countries is moving towards one seen in Westernised countries, where deaths are mainly attributed to chronic diseases. Children develop risk factors at a young age predisposing them to noncommunicable diseases in adulthood. Most of the risk factors are preventable through healthy lifestyles. Results from South Africa (SA) show that many children, particularly from marginalized communities, do not achieve the minimal requirements of physical activity (PA). Thus, more emphasis needs to be placed on primary prevention strategies, such as incorporating health promotion interventions within established educational and workplace structures. Primary schools present unique opportunities for holistic prevention interventions. Methods Using an ecosystem approach, an interprofessional team of PA researchers, public health specialists and digital innovators, together with partners from the ministry of education and ministry of health in SA, was set up to map and tackle the role of physical education (PE) in the SA school system. Experts identified actionable changes at the school, teacher and policy levels. First, a comprehensive health intervention was developed and implemented in primary schools in low resourced settings in the Eastern Cape of SA. The intervention was followed to learn and adapt. Finally, changes in the educational system will be scaled-up and sustained through governmental institutionalization. Results In 1994 PE lost its stand-alone subject status and became part of Life Orientation. Ever since, non-specialist teachers lack the confidence and understanding to adequately teach the subject. The interdisciplinary team developed ‘the KaziBantu model (Healthy Schools for Healthy Communities)’, to promote PA and healthy lifestyles in public primary schools through two complementary programs: KaziKidz, a PE toolkit for schoolchildren, and KaziHealth, a workplace health intervention program for teachers. Furthermore, Short Learning Programs have been developed for continued professional development of life orientation teachers, thereby introducing lasting changes within the educational system. Discussion/Conclusion PE and health literacy are oftentimes neglected in the SA curriculum, especially in marginalized areas. System-wide changes initiated and sustained through local ownership are critical to ensure long-lasting impact. Our multilateral intervention aimed to achieve this to offer children and teachers a quality education.

Childhood hypertension drives hypertension in later life; hence, assessing blood pressure in children is an important measure to determine current and future cardiovascular health. There is, however, a paucity of childhood blood pressure data, particularly for sub-Saharan Africa. This study explores blood pressure and associations with age, sex, socioeconomic status, physical activity, fitness, and cardiovascular risk markers. In the 'Disease, Activity and Schoolchildren's Health' (DASH) study, a cross-sectional analysis was conducted in disadvantaged neighbourhoods in the Eastern Cape province of South Africa. Assessments included blood pressure, accelerometer-measured physical activity, physical fitness, and cardiovascular risk markers. The study consisted of 785 children (383 boys, 402 girls, M = 12.4+/-0.9 years). Overall, 18% of the children were classified as hypertensive, while 20% were either overweight/obese, and almost four out of ten children did not meet global daily physical activity recommendations. Hypertensive children were more likely to be overweight/obese, chi(2) (2,785) = 14.42, p < 0.01, but only if they did not meet physical activity recommendations, chi(2) (2,295) = 11.93, p < 0.01. Considering the moderating effect which sufficient activity has on the relationship between hypertension and body weight, more emphasis should be placed on early primary health intervention and education strategies.

The coexistence of multiple cardiovascular risk factors has been reported in school-aged children from the age of nine years, but most evidence stems from high-income countries. This cross-sectional study aimed at describing the cardiovascular health risk, physical activity (PA) behavior and cardiorespiratory fitness (CRF) levels of South African primary schoolchildren, and at examining the associations between PA/CRF and a composite measure of cardiovascular risk. Cross-sectional data from 832 primary schoolchildren (grade 1–4) were analyzed. Total cholesterol/HDL ratio, triglycerides, systolic/diastolic blood pressure, body fat, and glycated hemoglobin were assessed as cardiovascular risk markers. Data were analyzed via mixed linear regressions and analyses of covariance. Overall, 24.2% of the participants did not meet current PA standards. Higher CRF/PA were associated with lower body fat and lower clustered cardiovascular risk (p &lt, 0.05). When categorizing children into CRF/PA quartiles, a lower clustered cardiovascular risk gradient was found in children with higher CRF (p &lt, 0.05) or PA (p &lt, 0.05). Our data shows that higher CRF/PA is associated with lower clustered cardiovascular risk already from a young age. Given that clustered cardiovascular risk present during childhood can track into adulthood, we advocate for PA participation and a healthy weight from a young age onwards.

Background. South African (SA) children from disadvantaged communities are plagued by a double burden of under- and over-nutrition. The resulting overweight and obesity on the one hand, and stunting on the other, are risk factors for chronic diseases in adulthood. Objective. To determine the effect of school-based interventions on body composition of grade-4 children from lower socioeconomic communities in the Gqeberha region, SA. Methods. A cluster-randomised controlled trial was carried out with children from 8 schools. Schools were randomly assigned, either to a 10-week school-based intervention (4 schools) or a control condition (4 schools). The intervention comprised several arms, with each intervention school receiving a different combination of the following measures: physical activity, health and hygiene education, and nutrition education with supplementation. Effects on children’s body composition were evaluated using standardised, quality-controlled methods. Height and weight were assessed to calculate body mass index (BMI), and percentage body fat was measured via thickness of skinfolds (triceps and subscapular). Results. Overall, 898 children (458 boys and 440 girls) aged 8 - 11 years participated in the trial. Children’s BMI, BMI-for-age and percentage body fat increased significantly over time. Increases were similar in boys and girls. Body fat remained unchanged in underweight children, whereas increases occurred in normal weight and (particularly) overweight/obese peers. In normal-weight children, the physical activity intervention (either alone or combined with health education) mitigated increments in body fat levels. A similar pattern was observed in overweight/obese children, but only in the physical activity intervention cohort alone. Conclusion. Our study shows that normal-weight children are at risk of becoming overweight and children who are already overweight/ obese are at even greater risk of gaining weight. The physical activity intervention (alone or in combination with health education) can mitigate increases in body fat in normal-weight children as well as in overweight/obese children. Our findings reveal that school-based physical activity, nutrition and health and hygiene interventions can have beneficial effects on children’s body composition. Further analyses are needed to examine how (school-based) physical activity interventions should be designed to improve children’s health in lower socioeconomic areas.

Background/AimPhysical inactivity (PIA) is a growing global health problem and evidence suggests that PIA is a key driver for cardiovascular and chronic diseases. Recent data from South Africa revealed that only about half of the children achieved recommended daily physical activity (PA) levels. Assessing the intensity of PA in children from low socioeconomic communities in low-income and middle-income countries is important to estimate the extent of cardiovascular risk and overall impact on health.MethodsWe conducted a cross-sectional survey in eight quintile 3 primary schools in disadvantaged communities in the Port Elizabeth region, South Africa. Children aged 10–15 years were subjected to PA, blood pressure, cholesterol, blood glucose and skinfold thickness assessments. Cardiovascular risk markers were converted into standardised z-scores and summed, to obtain a clustered cardiovascular risk score.ResultsOverall, 650 children had complete data records. 40.8% of the children did not meet recommended PA levels (ie, logged ConclusionsCRF and objectively assessed PA are closely linked with children’s clustered cardiovascular risk. Given that 4 out of 10 South African schoolchildren from marginalised communities do not meet international PA recommendations, efforts should be made to ensure that promoting a physically active lifestyle is recognised as an important educational goal in primary schools.Trial registration numbersISRCTN68411960 and H14-HEA-HMS-002.

Hypertension and overweight are growing public health concerns in school-aged children. We examined whether cardiorespiratory fitness and sport participation contribute to the prevention of hypertension and overweight. We conducted a cluster-randomized controlled trial with 853 children aged 8–13 years in eight primary schools in Port Elizabeth, South Africa. Cardiorespiratory fitness, sport participation, body mass index, and blood pressure were assessed at baseline and after a physical activity intervention, which took place at two time-points (July–September 2015 and February–April 2016) for 10 weeks each. Mixed logistic regressions were employed to analyze the data. At baseline, 18.8% of the children were classified as overweight/obese and 13.5% as hypertensive. High cardiorespiratory fitness and high sport participation were negatively associated with overweight/obesity, while high sport participation was associated with lower risk for hypertension. Longitudinally, normal weight children who initially had higher cardiorespiratory fitness showed less decrease in this variable, while those who participated in the physical activity intervention were less likely to become overweight/obese. High cardiorespiratory fitness and sport participation are linked with children’s weight status. Children who are fit and participate regularly in sport outside school hours are less likely to be hypertensive. Our findings highlight the importance of regular extracurricular physical activity and maintaining cardiorespiratory fitness levels.

Background: Information about the relationships between physical fitness, body composition and nutrition has increased in recent years; however, little is known about physical fitness and the coexistence of under-/overnutrition among children living in disadvantaged areas. Objectives: To determine the physical fitness status and its association with body composition, growth and selected socio- demographics in primary schoolchildren from disadvantaged communities in the Nelson Mandela Bay region. Methods: Nine hundred and sixty-five children (49% girls, M=9.5 years) participated in this cross-sectional study. Height and weight were measured to establish body mass index, and height-for-age z-scores. Physical fitness was assessed using tests from the Eurofit Physical Fitness test battery (flexibility, upper/lower body muscular strength and cardiorespiratory fitness). Between- group differences and cross-sectional associations were examined with univariate (Chi2-tests, analyses of variance) and multivariate methods (mixed linear/logistic regression). Results: Most children had normal weight (76.7%), while 4.5% were underweight and 18.7% were overweight/obese. Underweight children and children with stunted growth (11.5%) had lower average upper body strength (p

Introduction: Regular physical activity is associated with multiple health benefits for children. Evidence from cross-sectional studies suggests that physical activity is positively associated with health-related quality of life (HRQoL). The promotion of physical activity, and hence HRQoL, through a school-based intervention is therefore an important endeavor, particularly in disadvantaged areas of low- and middle-income countries, including South Africa. Methods: We designed a multicomponent physical activity intervention that was implemented over a 20-week period in 2015 in eight disadvantaged primary schools of Port Elizabeth, South Africa. Overall, 758 children aged 8–13 years participated. HRQoL was measured with the 27-item KIDSCREEN questionnaire. Self-reported physical activity was assessed with a single item of the Health-Behavior of School-Aged Children test, and cardiorespiratory fitness with the 20-m shuttle run test. Post-intervention scores were predicted with mixed linear regression models, taking into consideration the clustered nature of the data. Results: Higher baseline levels as well as increasing levels of self-reported physical activity predicted all dimensions of children's HRQoL. Baseline levels and increases in cardiorespiratory fitness predicted children's self-perceived physical well-being (one of the HRQoL subscales). Participation in the multicomponent physical activity intervention did not affect children's HRQoL. Conclusion: Higher and increasing self-reported physical activity predict all assessed HRQoL dimensions, which underlines that the promotion of regular physical activity among children living in disadvantaged settings is an important public health measure. Policy makers should encourage schools to create physical activity friendly environments, while schools should implement regular physical education as proposed by the school curriculum.

BACKGROUND 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. OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542 INTERNATIONAL REGISTERED REPOR DERR1-10.2196/14097

Neste artigo realizam-se algumas reflexões acerca da mulher negra e sua relação com a moda como ferramenta de luta sociopolítica. Elegemos como campo de estudo a revista Raça Brasil, que teve seu nome alterado em meados do ano de 2016 para Afro Brasil. A partir do periódico e da seleção de alguns de seus exemplares e colunas, abordamos a presença e representação da mulher negra relacionando a mesma aos elementos culturais e políticos presentes na moda. A partir das colunas de moda e beleza, foi possível relacionar a luta do feminismo negro presente na sociedade brasileira através de um discurso de valorização étnico-racial que nos leva a pensar a moda como uma ferramenta de reivindicação social e, portanto, política. This article discusses about black woman and the relationship with fashion as a tool for socio-political struggle. We chose as field of study the magazine Raça Brasil, that had its name changed in the middle of the year 2016 for Afro Brazil. From the periodical and the selection of some of its issues and columns, we address the presence and representation of the black woman relating it to the cultural and political elements present in fashion. From the columns of fashion and beauty, it was possible to relate the struggle of black feminism present in the Brazilian society through a discourse of ethnic-racial valorization that leads us to think of fashion as a tool of social and therefore political claim. En este artículo se realizan algunas reflexiones acerca de la mujer negra y su relación con la moda como herramienta de lucha sociopolítica. Elegimos como campo de estudio la revista Raza Brasil, que tuve su nombre alterado a mediados del año 2016 a Afro Brasil. A partir del periódico y la selección de algunos de sus ejemplares y columnas, abordamos la presencia y representación de la mujer negra relacionándola a los elementos culturales y políticos presentes en la moda. A partir de las columnas de moda y belleza, fue posible relacionar la lucha del feminismo negro presente en la sociedad brasileña a través de un discurso de valoración étnico-racial que nos lleva a pensar la moda como una herramienta de reivindicación social y, por lo tanto, política.

OBJECTIVES: To evaluate the effect of a 20-week school-based physical activity intervention program on academic performance and selective attention among disadvantaged South African primary school children. DESIGN: Cluster randomized control trial. METHODS: The study cohort included 663 children from eight primary schools, aged 8-13 years. Data assessment took place between February 2015 and May 2016 following the implementation of a 20-week school-based physical activity program. The d2 test was employed to assess selective attention, while the averaged end-of-year school results (math, life skills, home language, and additional language) were used as an indicator of academic performance. Physical fitness was assessed using the 20-m shuttle run test (VO2 max) and grip strength tests. We controlled for cluster effects, baseline scores in selective attention or academic performance, and potential confounders, such as children's age, gender, socioeconomic status, self-reported physical activity (as determined by a pre-tested questionnaire), body mass index, hemoglobin (as a proxy for anemia, as measured by blood sampling), and soil-transmitted helminth infections (as assessed by the Kato-Katz technique). RESULTS: Our multivariate analysis suggested that the physical activity intervention had a positive effect on academic performance (p = 0.032), while no effect was found on selective attention (concentration performance; p = 0.469; error percentage; p = 0.237). After controlling for potential confounders, the physical activity condition contributed to the maintenance of academic performance, whereas a decrease was observed in learners in the control condition. Furthermore, physically active and fit children tend to have better concentration performance (CP) than their less fit peers (self-reported activity; p0.021). CONCLUSION: A 20-week physical activity intervention contributes to the maintenance of academic performance among socioeconomically deprived school children in South Africa. School administrators should ensure that their school staff implements physical activity lessons, which are a compulsory component of the school by the curriculum.

People from low- and middle-income countries still face challenges stemming from parasitic infections. Additionally, non-communicable diseases (NCDs) and their risk factors are rapidly increasing, which puts South African children at an elevated risk of a dual disease burden, with negative consequences for child development and wellbeing. Contrastingly, regular physical activity (PA) is associated with decreased cardiovascular disease (CVD) risk. Therefore, the objective of this study was to examine whether PA is associated with the double infection-CVD phenotype burden in South African schoolchildren. 801 children (402 boys, 399 girls; mean age 9.5 years) from eight schools from disadvantaged neighbourhoods were included. Data assessment took place between February and March 2015 in Port Elizabeth, South Africa. Children who achieved PA recommendations (physically active on 6-7 days/week for at least 60 min), who were active, but below recommended standards (2-5 physically active days/week), or who were insufficiently active on almost all days (0-1 physically active days/week) were compared with regard to systolic and diastolic blood pressure, body mass index (BMI), percent body fat, and infection with soil-transmitted helminths. Moderate and high self-reported PA levels were associated with lower BMI, lower body fat, and lower risk of being hypertensive. Conversely, children with high self-reported PA were more likely to be infected with soil-transmitted helminths than peers with low PA levels. Promoting PA in disadvantaged areas is worthwhile to prevent NCD later in life, but should be combined with regular anthelminthic treatment to comprehensively improve children's health and wellbeing.

Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542 International Registered Report Identifier (IRRID): DERR1-10.2196/14097

Obesity-related conditions impose a considerable and growing burden on low- and middle-income countries, including South Africa. We aimed to assess the effect of twice a 10-week multidimensional, school-based physical activity intervention on children&rsquo, s health in Port Elizabeth, South Africa. A cluster-randomised controlled trial was implemented from February 2015 to May 2016 in grade 4 classes in eight disadvantaged primary schools. Interventions consisted of physical education lessons, moving-to-music classes, in-class activity breaks and school infrastructure enhancement to promote physical activity. Primary outcomes included cardiorespiratory fitness, body mass index (BMI) and skinfold thickness. Explanatory variables were socioeconomic status, self-reported physical activity, stunting, anaemia and parasite infections. Complete data were available from 746 children. A significantly lower increase in the mean BMI Z-score (estimate of difference in mean change: &minus, 0.17, 95% confidence interval (CI): &minus, 0.24 to &minus, 0.09, p &lt, 0.001) and reduced increase in the mean skinfold thickness (difference in mean change: &minus, 1.06, 95% CI: &minus, 1.83 to &minus, 0.29, p = 0.007) was observed in intervention schools. No significant group difference occurred in the mean change of cardiorespiratory fitness (p &gt, 0.05). These findings show that a multidimensional, school-based physical activity intervention can reduce the increase in specific cardiovascular risk factors. However, a longer and more intensive intervention might be necessary to improve cardiorespiratory fitness.