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Background: Malnutrition remains a public health issue among children in resource poor countries where seasonality affects food availability, food consumption, and nutritional status of a population. The aim of this study was to determine prevalence of anemia, low vitamin A and associated factors in school-age children in dry and wet season in a peri-urban setting. Methods: This was a six months observational study where data and samples were collected from school age children 6–12 years in mid-March (dry season) and mid-August (rainy season) 2020. Data and biological samples collected, were analyzed to determine prevalence of adequate dietary intakes, anemia, low vitamin A, and under-nutrition among participants. Results: The study participants had 40.9% and 32.3% prevalence of anemia, 30.1% and 19.4% prevalence of low vitamin A, 12.9% and 10.8% level of wasting, and 63.4% and 94.6% level of adequate iron intake in the dry and wet seasons respectively. The cohort of anemic participants had mean hemoglobin concentrations as 10.6(1.7)ug/dl and 11.4(91.1)ug/dl in the dry and wet seasons respectively and significantly different at p = 0.001. The prevalence of anemia among them declined from 100.0% in the dry season to 79.0% in the wet season. They had mean serum retinol concentration as 22.4(6.4)ug/dl and 25.0(8.9)ug/dl, (significantly different at p = 0.014), prevalence of low vitamin A at 36.8% and 31.6%, prevalence of wasting as 23.7% and 18.4%, and prevalence of thinness as 10.2% and 7.9% in the dry and wet seasons respectively. Anemia associated significantly with parental monthly income of 1000–1500 cedis (180–269 USD), (OR:046, p = 0.039), and low vitamin A level (

To address the issue of obesity, the World Health Organization (WHO) recommends a set of comprehensive programmes aimed at changing the obesogenic environments to provide opportunities for healthy food options and increased physical activity in the school, home, and at the population level. The objectives of this study were to examine the nature and range of policies related to overweight and obesity prevention in Africa, and to assess how they align with international guidelines. An existing methodological framework was adapted for this scoping review. A search of publicly available national documents on overweight/obesity, general health, and non-communicable diseases (NCDs) was undertaken from relevant websites, including WHO, ministries, and Google Scholar. Additional requests were sent to key contacts at relevant ministries about existing policy documents. The documents were reviewed, and the policies were categorised, using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The framework categorises the environmental drivers of obesity into four domains (physical, economic, legislative, and socio-cultural) and two scales: macro (national, regional, sectors, food industries, media, etc.) and micro (household, institutional, and community). This review included documents from 41 African countries. The policy initiatives to prevent overweight/obesity target the school, family and community settings, and macro environments, and broadly align with global recommendations. The NCD documents were in the majority, with only two on obesity. The majority of the documents detailed strategies and key interventions on unhealthy diets and physical inactivity. The physical, legislative, and sociocultural domains were largely featured, with less emphasis on the economic domain. Additionally, nutrition- and diet-related policies were in the majority. Overlaps and interactions of policies were observed in the application of the ANGELO framework. This study has provided information on national policies and programmes in Africa and can be useful as a first point of call for policymakers. The overlapping and interaction in the initiatives demonstrate the importance of multi-sectoral partnerships in providing supportive environments for healthy behaviours.

Background: The amounts of micronutrients in the diets of infants, and the factors that influence them needs to be monitored at the population level in order to avert detrimental developmental defects that impose lifetime-limitations on an infant’s regulatory and defense systems. This study therefore, sought to evaluate if increasing levels of the toxic metals, Hg, Pb and Cd in breast milk will result in reducing amounts of the micronutrients Zn, Se and Cu in breast milk. Methods: Breast milk samples of 114 women living in two mining areas (57 women each) in Ghana, whose babies’ amounts of breast milk intake at three months postpartum, and amounts of toxic metals had previously been determined in a prospective study, were analyzed for micronutrients by a combination of acid and microwave digestion, and quantifications were by two different modes (hydrogen and helium) of Octapole Reaction System Inductively Coupled Plasma Mass Spectrometer (7500 ce. Agilent), equipped with an ASX-510 Auto-sampler (Cetac). Results: All the breast milk specimen collected contained detectable amounts of Cu, Zn, both at levels less than have been previously reported, and Se. For specimen that did not contain Pb the amount of Se ranged from about 110 to 245 ng/g of milk, however, as the amount of Pb increased, the corresponding highest detected amount of Se reduced steeply, resulting in a right-angle triangle-shaped scatter plot. Similar relationships were observed between other toxic metals and micronutrients studied. A curve fitting regression analysis showed significant quadratic and cubic relationships between the amounts of Hg and Se, as well as between Pb, As and Cu. Conclusion: The results clearly suggest a double burden of malnutrition in these mining areas, where high loads of maternal toxic metals in breast milk, related significantly with a progressive reduction in the amounts of the micronutrients Cu and Se in breast milk, potentially reducing in infants’ intake of these micronutrients.

To compare the World Health Organization (WHO) body mass index (BMI)-for-age definition of obesity against measured body fatness in African children.In a prospective multicentre study over 2013 to 2017, we recruited 1516 participants aged 8 to 11 years old from urban areas of eight countries (Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania). We measured height and weight and calculated BMI-for-age using WHO standards. We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as 25% in boys and 30% in girls. We calculated the sensitivity and specificity of BMI z-score +2.00 standard deviations (SD) and used receiver operating characteristic analysis and the Youden index to determine the optimal BMI z-score cut-off for classifying excessive fatness.The prevalence of excessive fatness was over three times higher than BMI-for-age-defined obesity: 29.1% (95% CI: 26.8 to 31.4; 441 children) versus 8.8% (95% CI: 7.5 to 10.4; 134 children). The sensitivity of BMI z-score +2.00 SD was low (29.7%, 95% CI: 25.5 to 34.2) and specificity was high (99.7%, 95% CI: 99.2 to 99.9). The receiver operating characteristic analysis found that a BMI z-score +0.58 SD would optimize sensitivity, and at this cut-off the area under the curve was 0.86, sensitivity 71.9% (95% CI: 67.4 to 76.0) and specificity 91.1% (95% CI: 89.2 to 92.7).While BMI remains a practical tool for obesity surveillance, it underestimates excessive fatness and this should be considered when planning future African responses to the childhood obesity pandemic.Comparer la définition de l'obésité de l'Organisation mondiale de la Santé basée sur l'indice de masse corporelle (IMC) selon l'âge à la masse grasse mesurée chez les enfants africains.Dans le cadre d'une étude prospective multicentrique menée entre 2013 et 2017, nous avons recruté 1516 participants âgés de 8 à 11 ans dans des zones urbaines situées dans huit pays (Ghana, Kenya, Maroc, Maurice, Namibie, République-Unie de Tanzanie, Sénégal et Tunisie). Nous avons mesuré leur taille et leur poids et calculé leur IMC par rapport à leur âge en utilisant les normes de l'OMS. Nous avons mesuré la masse grasse à l'aide de la méthode de dilution du deutérium, et défini le taux de masse grasse excessive comme étant 25% pour les garçons et 30% pour les filles. Nous avons calculé la sensibilité et la spécificité du Z-score de l'IMC+2,00 écarts types (ET) et utilisé une analyse de la fonction d'efficacité du récepteur et l’indice de Youden afin de déterminer la valeur limite optimale du Z-score de l'IMC pour classifier la masse grasse excessive.La prévalence de la masse grasse excessive était plus de trois fois supérieure à la prévalence de l'obésité définie en fonction de l'IMC selon l'âge: 29,1% (IC à 95%: 26,8-31,4; 441 enfants) contre 8,8% (IC à 95%: 7,5-10,4; 134 enfants). La sensibilité du Z-score de l'IMC +2,00 ET était faible (29,7%, IC à 95%: 25,5-34,2), tandis que la spécificité était élevée (99,7%, IC à 95%: 99,2-99,9). L'analyse de la fonction d'efficacité du récepteur a révélé qu'un Z-score de l'IMC de +0,58 ED optimiserait la sensibilité, et qu'à cette valeur limite, l'aire sous la courbe était de 0,86, la sensibilité de 71,9% (IC à 95%: 67,4-76,0) et la spécificité de 91,1% (IC à 95%: 89,2-92,7).Si l'IMC reste est un outil pratique pour surveiller l'obésité, il sous-évalue la masse grasse excessive. Cela doit être pris en compte lors de la planification des futures mesures africaines de lutte contre la pandémie d'obésité chez l'enfant.Comparar la definición de obesidad por edad del índice de masa corporal (IMC) de la Organización Mundial de la Salud (OMS) con la grasa corporal medida en niños africanos.En un estudio prospectivo multicéntrico realizado entre 2013 y 2017, se reclutaron 1516 participantes de edades comprendidas entre los 8 y los 11 años de zonas urbanas de ocho países (Ghana, Kenya, Marruecos, Mauricio, Namibia, República Unida de Tanzania, Senegal y Túnez). Se midieron la altura y el peso y calculamos el IMC por edad utilizando los estándares de la OMS. Se midió la grasa corporal mediante el método de dilución de deuterio y se definió el porcentaje de grasa corporal excesiva como25 % en los niños y30 % en las niñas. Se calculó la sensibilidad y especificidad del IMC con desviaciones estándar (DE) de los valores Z de+2,00 y se utilizó el análisis de las características operativas del receptor y el índice Youden para determinar el límite óptimo del IMC z-score para clasificar el exceso de grasa.La prevalencia de la obesidad excesiva fue más de tres veces superior a la obesidad definida por el IMC por edad: 29,1 % (IC del 95 %: 26,8 a 31,4; 441 niños) en comparación con un 8,8 % (IC del 95 %: 7,5 a 10,4; 134 niños). La sensibilidad del IMC con DE de los valores Z+2,00 fue baja (29,7 %, IC del 95 %: 25,5 a 34,2) y la especificidad fue alta (99,7 %, IC del 95 %: 99,2 a 99,9). El análisis de las características operativas del receptor encontró que un IMC z-score +0,58 DE optimizaría la sensibilidad, y en este corte el área bajo la curva era de 0,86, con una sensibilidad del 71,9 % (IC del 95 %: 67,4 a 76,0) y una especificidad del 91,1 % (IC del 95 %: 89,2 a 92,7).Aunque el IMC sigue siendo una herramienta práctica para la monitorización de la obesidad, subestima el exceso de grasa y esto debería tenerse en cuenta a la hora de planificar las futuras respuestas africanas a la pandemia de obesidad infantil.مقارنة بين السمنة المقيسة في الأطفال الأفارقة، وتعريف البدانة القائم على مؤشر كتلة الجسم (BMI) بالنسبة للسن، والتابع لمنظمة الصحة العالمية.في دراسة استباقية متعددة المراكز خلال الفترة من 2013 إلى 2017، قمنا بتسجيل 1516 مشاركًا تتراوح أعمارهم بين 8 إلى 11 عامًا من المناطق الحضرية في ثماني بلدان (السنغال، والمغرب، وتونس، وجمهورية تنزانيا المتحدة، وغانا، وكينيا، وموريشيوس، وناميبيا).قمنا بقياس الطول والوزن وحساب مؤشر كتلة الجسم (BMI) بالنسبة للسن، باستخدام معايير منظمة الصحة العالمية.قمنا بقياس سمنة الجسم باستخدام طريقة تخفيف الديوتيريوم، وحددنا النسبة المئوية للدهون الزائدة في الجسم لتكون أكثر من 25٪ في الأولاد، وأكثر من 30٪ في البنات.قمنا بحساب حساسية وخصوصية المحصلة المعيارية لمؤشر كتلة الجسم لتكن أكبر من +2.00 بالنسبة للانحرافات المعيارية (SD)، واستعنا بتحليل خصائص التشغيل للمستقبٍل ومؤشر يودنلتحديد الحد الأمثل للمحصلة المعيارية لمؤشر كتلة الجسم، بهدف تصنيف السمنة المفرطة.كان انتشار السمنة المفرطة أعلى أكثر من ثلاث مرات من السمنة التي يحددها مؤشر كتلة الجسم بالنسبة للسن: 29.1٪ (فاصل الثقة 95٪: 26.8 إلى 31.4؛ 441 طفلاً) مقابل 8.8٪ (فاصل الثقة 95٪: 7.5 إلى 10.4، 134 طفلاً).كانت حساسية الانحراف المعياري (SD) - الأكبر من +2.00 بالنسبة للمحصلة المعيارية لمؤشر كتلة الجسم- منخفضة، (29.7٪، بفاصل ثقة 95٪: 25.5 إلى 34.2) وكانت الخصوصية عالية (99.7٪، بفاصل ثقة 95٪: 99.2 إلى 99.9).اكتشف تحليل خصائص التشغيل للمستقبٍل أن الانحراف المعياري بنسبة +0.58 - للمحصلة المعيارية لمؤشر كتلة الجسم- سوف يُحسن من الحساسية، وأنه عند هذا الحد كانت المساحة تحت المنحنى 0.86، وكانت الحساسية 71.9٪ (فاصل ثقة 95٪: 67.4 إلى 76.0)، وخصوصية 91.1٪ (فاصل ثقة 95٪: 89.2 إلى 92.7).بينما يظل مؤشر كتلة الجسم أداة عملية لمراقبة السمنة، إلا أنه يقلل من السمنة المفرطة، ويجب وضع ذلك في الاعتبار عند التخطيط لاستجابات أفريقية مستقبلية لوباء البدانة في مرحلة الطفولة.将世卫组织 (WHO) 年龄别身体质量指数 (BMI-for-age) 对肥胖的定义与所测量的非洲儿童体脂率进行对比。.在 2013 年至 2017 年的一项前瞻性、多中心的研究中，我们从 8 个国家的城市地区（加纳，肯尼亚，摩洛哥，毛里求斯，纳米比亚，塞内加尔，突尼斯和坦桑尼亚联合共和国）招募了 1516 名 8 至 11 岁的参与者。我们使用 WHO 标准测量了参与者的身高和体重，并计算了年龄别身体质量指数。我们使用重水同位素法测量了参与者的体脂，并定义过度肥胖百分位数为男孩 25％，女孩 30％。我们计算了 BMI z 评分 +2.00 标准差 (SD) 的敏感性和特异性，并使用受试者工作特征分析和约登指数来确定过度肥胖分类的最佳 BMI z 评分的界限值。.过度肥胖的患病率比年龄别身体质量指数所定义的肥胖高出三倍以上：29.1％（95％ 置信区间，CI：26.8 至 31.4；441 名儿童）与 8.8％（95％ 置信区间，CI：7.5 至 10.4；134 名儿童）。BMI z 评分 +2.00 标准差 (SD) 的敏感性低（29.7％，95％ 置信区间，CI：25.5 至 34.2），特异性高（99.7％，95％ 置信区间，CI：99.2 至 99.9）。受试者工作特征分析发现 BMI z 评分 +0.58 标准差 (SD) 将优化敏感性，并在此界限值时，曲线下区域为 0.86，敏感性为 71.9％（95％ 置信区间，CI：67.4 至 76.0），特异性为 91.1％（95％ 置信区间，CI：89.2 至 92.7）。.虽然身体质量指数 (BMI) 仍然是肥胖监测的实用工具，但它低估了过度肥胖的患病率，因此，在规划未来非洲应对儿童肥胖率快速上升的情况时应慎重考虑。.Сравнение определения ожирения, принятого Всемирной организацией здравоохранения (ВОЗ) на основании значения «индекс массы тела (ИМТ)-возраст», с измеренными величинами упитанности африканских детей.В перспективном многоцентровом исследовании в период с 2013 по 2017 год приняли участие 1516 участников в возрасте от 8 до 11 лет из городских районов восьми стран (Гана, Кения, Маврикий, Марокко, Намибия, Объединенная Республика Танзания, Сенегал и Тунис). Детей взвешивали и измеряли их рост, после чего вычисляли показатель «ИМТ-возраст» согласно стандартам ВОЗ. Также измерялось содержание жировой ткани в организме методом дейтериевого разбавления; содержание жировой ткани считалось избыточным, если оно превышало 25% у мальчиков и 30% у девочек. Авторы вычислили чувствительность и специфичность z-оценки ИМТ + 2,00 стандартного отклонения (СО) и воспользовались методом анализа характеристических показателей правильности обнаружения сигналов индексом Юдена для определения оптимального порога z-оценки по ИМТ в вопросе классификации наличия избытка жировой ткани.Распространенность избытка жировой ткани более чем в три раза превышала частоту ожирения, определяемую показателем «ИМТ-возраст»: 29,1% (95%-й ДИ: 26,8–31,4; 441 ребенок) в сравнении с 8,8% (95%-й ДИ: 7,5–10,4; 134 ребенка). Чувствительность z-оценки ИМТ + 2,00 СО была низкой (29,7%, 95%-й ДИ: 25,5–34,2), а специфичность — высокой (99,7%, 95%-й ДИ: 99,2–99,9). Анализ характеристических особенностей правильности обнаружения сигналов позволил обнаружить, что оптимизация чувствительности возможна при использовании z-оценки ИМТ + 0,58 СО и что при этом пороговом значении площадь под кривой составляла 0,86, чувствительность — 71,9% (95%-й ДИ: 67,4–76,0), а специфичность — 91,1% (95%-й ДИ: 89,2–92,7).Несмотря на то что измерение ИМТ остается практическим средством выявления ожирения, оно недооценивает содержание избыточной жировой ткани в организме, и это следует учитывать при планировании мероприятий по борьбе с пандемией детского ожирения в Африке.

Background Although breastfeeding of infants is recommended globally, the fact that maternal toxic metal stores are mobilised into breast milk implies infants, whose mothers live and work in mining communities, are at risk of multiple exposure to mining related toxic metals, such as Lead (Pb), Mercury (Hg), Cadmium (Cd) and Arsenic (As), through breast milk intake, in addition to in utero exposure. Method A total of 114 mother-baby pairs, recruited from two community hospitals servicing mining communities in two different regions in Ghana (57 each), were involved in this study. When the babies were 3 months old, the amount of breast milk intake, concentrations of selected toxic metals in the breast milk and therefore the amount of toxic metals exposure through breast milk were determined. The study also, determined the amount of these toxic metals in the hair and urine of each mother-baby pair at 3 months postpartum. Results Based on the amounts of milk intake and non-milk oral intakes (geometric mean of 0.701 (95% CL 0.59–0.81) Kg/day and median of 0.22 Kg/day respectively), 90% of the babies were determined to have been exclusively breastfed. The amounts of most of the toxic metals in breast milk were higher than the WHO set limits and for 46.4%, 33.3% and 4.4% of the babies, their intake of As, Hg and Pb respectively were above the WHO provisional tolerable daily intake (PTDI) values. Conclusion An appreciable proportion of babies living within the communities served by the Mangoasi Community Hospital in the Obuasi Municipality of the Ashanti Region and the Dompime Health Centre in the Tarkwa Municipality of the Western Region were exposed to Hg, As and Pb through breast milk in excess of what they should and these may have health implication for the infants and therefore calls for interventions.

Background There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children. Methods Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity. Results The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese. Conclusions A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

Background Little is known about the impact of the school environmental context on the emerging trend of childhood obesity in Africa. We examined the association of the schools’ contextual factors with body mass index (BMI), abdominal obesity and overweight (including obesity) in urban Ghana. Method Using cross-sectional data from 543 school children aged 8–11 years attending 14 primary schools, we applied multilevel logistic regressions and linear regression models to investigate the association of child- and school level attributes with overweight, abdominal obesity, and BMI. Results We observed significant variance of the random effects of schools in BMI (2.65, p

Background: Overweight/obesity is an emerging health concern among African children. The aim of this study was to summarise available evidence from school-based interventions that focused on improving nutrition and physical activity knowledge, attitude, and behaviours, and weight status of children aged 6−15 years in the African context. Methods: Multiple databases were searched for studies evaluating school-based interventions of African origin that involved diet alone, physical activity alone, or multicomponent interventions, for at least 12 weeks in duration, reporting changes in either diet, physical activity, or body composition, and published between 1 January 2000 and 31 December 2018. No language restrictions were applied. Relevant data from eligible studies were extracted. Narrative synthesis was used to analyse and describe the data. Results: This systematic review included nine interventions comprising 10 studies. Studies were conducted among 9957 children and adolescents in two African countries, namely South Africa and Tunisia, and were generally of low methodological quality. The sample size at baseline ranged from 28 to 4003 participants. Two interventions reported enrolling children from both urban and rural areas. The majority of the study participants were elementary or primary school children and adolescents in grades 4 to 6. Participants were between the ages of 12.4 and 13.5 years. All but one intervention targeted children of both sexes. Four studies were described as randomised control trials, while five were pre- and post-test quasi-experiments. Except for one study that involved the community as a secondary setting, all were primarily school-based studies. The duration of the interventions ranged from four months to three years. The interventions focused largely on weight-related behaviours, while a few targeted weight status. The results of the effectiveness of these interventions were inconsistent: three of five studies that evaluated weight status (body mass index (BMI), BMI z-score, overweight/obesity prevalence), three of six studies that reported physical activity outcomes (number of sports activities, and physical activity duration ≥ 30 min for at least six days/week), and four of six reporting on nutrition-related outcomes (number meeting fruit and vegetable intake ≥ 5 times/day) found beneficial effects of the interventions. Conclusion: Given the dearth of studies and the inconsistent results, definite conclusions about the overall effectiveness and evidence could not be made. Nonetheless, this study has identified research gaps in the childhood obesity literature in Africa and strengthened the need for further studies, the findings of which would contribute valuable data and inform policy.

Background: There is an increasing trend in the global prevalence of childhood overweight and obesity, presenting major public health challenge in developed and developing countries. We report the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to different diagnostic criteria and population level characteristics. Methods: A comprehensive search of multiple databases was conducted to identify relevant research articles published between June 1980 and Feb 2017. Random effects models were used to pool prevalence data within and across population level characteristics, after variance stabilisation through arcsine transformation. Findings: Data from 45 studies across Africa comprising 92,379 and 89,468 participants for overweight and obesity estimates were included in the meta-analysis. Study quality was moderate. The overall overweight prevalence estimates by the major criteria were: 10.5% [95% CI: 7.1-14.3] by WHO, 9.5% [6.5-13.0] by IOTF and 11.5% [9.6-13.4] by CDC respectively and these differed significantly across criteria (p=0.0027). Obesity prevalence estimates for WHO, IOTF and CDC criteria were 6.1% [3.4-9.7], 4.0% [2.5-5.9] and 6.9% [5.0-9.0] with significance difference across criteria (p 0.128), major geographic regions (all p≥0.125) and varied less by publication year (p > 0.154), or study sample size (p>0.532). Substantial heterogeneities in the estimates across and within criteria were not always explained by major studies level characteristics. Artefactual publication bias was apparent across studies with WHO and IOTF criteria but not for CDC criterion. Interpretations: Overweight and obesity are common among primary school-going African children, particularly those attending urban schools and in private schools. Our results support the urgent need for intervention strategies, policies and programmes to address the lifestyle changes contributing to the growing excess weight in children in African settings. Funding Statement: There was no funding source for this study. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Declaration of Interests: The authors declare no competing interest.

Introduction The increasing prevalence of obesity and overweight in childhood in developing countries is a public health concern to many governments. Schools play a significant role in the obesity epidemic as well as provide favourable environments for change in behaviours in childhood which can be carried on into adulthood. There is dearth of information on intervention studies in poor-resource settings. This review will summarise the available evidence on school-based interventions that focused on promoting healthy eating and physical activity among learners aged 6–15 years in Africa and to identify factors that lead to successful interventions or potential barriers to success of these programmes within the African context. Methods and analysis This protocol is developed following the guidelines of PRIMSA-P 2015. Relevant search terms and keywords generated from the subject headings and the African search filter will be used to conduct a comprehensive search of MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Register Academic Search Complete (EbscoHost) and ISI Web of Science (Science Citation Index) for published literature on school-based interventions to prevent and control obesity in learners in Africa. Grey literature will be also be obtained. The searches will cover 1 January 2000 to 30 June 2016. No language limitations will be applied. Full-text articles of eligible studies will be screened. Risk of bias and quality of reporting will be assessed. Data will be extracted, synthesised and presented by country and major regional groupings. Meta-analysis will be conducted for identical variables across studies, where data allow. This protocol is developed following the guidelines of PRISMA-P 2015. Ethics and dissemination No primary data will be collected hence ethics is not a requirement. The findings will be submitted for publication in peer-reviewed journals, in conferences and in policy documents for decision-making, where needed.

Introduction Obesity and overweight are an emerging problem in Africa. Obese children are at increased risk of developing hypertension, high cholesterol, orthopaedic problems and type 2 diabetes as well as increased risk of adult obesity. Prevention of childhood overweight and obesity therefore needs high priority. The review approach is particularly useful in establishing whether research findings are consistent and can be generalised across populations and settings. This systematic review aims to assess the magnitude and distribution of overweight and obesity among primary school learners within populations in Africa. Methods and analysis A comprehensive search of key bibliographic databases including MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost) and ISI Web of Science (Science Citation Index) will be conducted for published literature. Grey literature will be also be obtained. Full-text articles of eligible studies will be obtained and screened following predefined inclusion criteria. The quality of reporting as well as risk of bias of included studies will be assessed, data extracted and synthesised. The results will be summarised and presented by country and major regional groupings. Meta-analysis will be conducted for identical variables across studies. This review will be reported following the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies. Ethics and dissemination Ethics is not a requirement since no primary data will be collected. All data that will be presented in this review are based on published articles. The findings of this systematic review will be submitted for publication in peer-reviewed journals and disseminated in national and international conferences and also in policy documents to appropriate bodies for decision-making, where needed. It is expected that the findings will identify some research gaps for further studies.

Objective:There is an increasing trend in the global estimates of childhood overweight and obesity presenting major public health crisis in developed and developing countries. We report the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among pr

Background: Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs. Objective: To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C–rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren. Methods: The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal –vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants’ blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively. Results: Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal–vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal–vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%. Conclusion: Cowpea-based food containing 3% fish meal and served with vitamin C–rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.

Introduction The obesity epidemic is a public health challenge for all, including low-income countries. The behavioural patterns known to contribute to the rise in obesity prevalence occur in an environmental context which is not conducive for healthy choices. A policy approach to obesity prevention constitutes a form of public intervention in that it extends beyond individuals to influence entire populations and is a mechanism for creating healthier environments. Little is known about obesity prevention policies in Africa. This scoping review seeks to examine the nature, extent and range of policies covering obesity prevention in Africa in order to assess how they align with international efforts in creating less obesogenic environments. This will help identify gaps in the approaches that are adopted in Africa. Methods and analysis Using the Arksey and O9Malley9s scoping methodological framework as a guide, a comprehensive search of MEDLINE (PubMed), MEDLINE (EbscoHost) CINAHL (EbscoHost), Academic Search Complete (EbscoHost) and ISI Web of Science (Science Citation Index) databases will be carried out for peer reviewed journal articles related to obesity prevention policies using the African search filter. A grey literature search for policy documents and reports will also be conducted. There will be no language and date restrictions. Eligible policy documents and reports will be obtained and screened using the inclusion criteria. Data will be extracted and results analysed using descriptive numerical summary analysis and qualitative thematic analysis. Ethics and dissemination No primary data will be collected since all data that will be presented in this review are based on published articles and publicly available documents, and therefore ethics committee approval is not a requirement. The findings of this systematic review will be presented at workshops and conferences; and will be submitted for publication in peer-reviewed journal. This will also form a chapter of a PhD thesis.