Effect of a school-based health intervention on the non-communicable disease risk status of schoolchildren from disadvantaged communities

Dolley, Danielle

Title: Effect of a school-based health intervention on the non-communicable disease risk status of schoolchildren from disadvantaged communities
Creator: Dolley, Danielle
Subject: school-based health intervention
Subject: Non-communicable diseases
Subject: Cardiovascular diseases
Date Issued: 2023-04
Date: 2023-04
Type: Doctoral theses
Type: text
Identifier: http://hdl.handle.net/10948/66388
Identifier: vital:75063
Description: Background: Non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs) and dyslipidaemia are a global public health concern, but more so in low- income countries where the underprivileged are exposed to unhealthy lifestyle practices with limited access to primary health care. Poor dietary habits and physical inactivity have also led to the unprecedented rise of NCD risk factors among school- aged children, which places them at greater risk of disease later in life. These NCDs are largely driven by obesity which has continued to rise in sub-Saharan Africa. However, high levels of undernutrition (such as stunting, underweight and wasting) among children are also present, thereby translating to a dual burden of malnutrition. Promoting regular physical activity (PA) among children is crucial for the health of future generations as it assists in weight reduction, improves insulin sensitivity, reduces blood pressure and is associated with good health and wellbeing. However, physical education (PE), the most obvious vehicle to develop the motor abilities of children, creating opportunities for their sports skills development and educating learners about the importance of PA as a lifestyle, has long been overlooked since the transformation of the South African school curriculum. Furthermore, many in-service PE teachers were not trained to teach the new multi-disciplinary Life Skills and Life Orientation subjects, of which PE forms a small part. Evidence shows that many PE teachers lack the content knowledge and practical skills to implement the subject, which raises the question of how many children, especially those in low-income communities, are participating in quality PE needed to foster healthy lifestyles and prevent the risk of NCDs. Therefore, this study aimed to investigate the effect of a 20- week school-based health intervention on NCD risk factors of primary schoolchildren from low-income schools in Gqeberha, South Africa. Methods: A cluster randomised control trial was used to test a 20-week intervention, which included three components, namely [1] the KaziKidz toolkit (comprised of pre- prepared PE, health, hygiene and nutrition lessons, equipment for PE, and painted games) [2] a PE coach (human movement science graduate to assist teachers) and [3]two 90-min training workshops. Eight schools were randomly selected to participatein the study: four intervention schools received the KaziKidz toolkit, while the externalsupport components were staggered across three intervention schools, and the Chapter 1: Introduction 2 remaining four schools served as the control group. Altogether 961 children (491 boys and 511 girls) from grades 4 to 6 (8 - 13 years old, M=10.88±1.19 yrs) participated In the study. Demographic information and socio-economic status were captured with a questionnaire. Further measures included height, weight, waist circumference, blood pressure, glycated haemoglobin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, accelerometer-based PA and cardiorespiratory fitness (CRF). Results: Cross-sectional baseline data showed that 43.1% of the sample presented with at least one NCD risk factor, and 17% presented with an elevated clustered risk score (CRS). In addition, higher CRF and moderate to vigorous PA (MVPA) were associated with a lowered CRS whereby an elevated CRS was halved for every 49 min increase in MVPA (95% CI 27 - 224) or every 2.17 ml/kg/min increase in CRF, as determined via estimated VO2max (95% CI 1.66 - 3.12). Overall, 13% of the cohort were underweight, 12% overweight, 7% obese, and 64% engaged in an average of 60 min MVPA per day. The results also identified an inverse association between body mass index categories and the total duration of MVPA achieved per day as children categorised as underweight to normal‐weight (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 per day of MVPA than overweight to obese children. Finally, the school-based health intervention results revealed improvements in children's NCD risk factors and increased MVPA levels when the intervention conditions included the workshops and, in some cases, the PE coach. The KaziKidz toolkit (on its own) showed little to no improvements in NCD risk factors and MVPA levels. Conclusion: School-based health interventions have the potential to improve the NCD risk factors of children attending low-income schools in South Africa. These findings also add to our understanding of implementing interventions in settings where teachers are not sufficiently trained to teach PE. Therefore, school-based health interventions, including a toolkit, should be accompanied by workshops to equip educators with the necessary tools to confidently facilitate PE lessons and integrate a range of PE activities into their classrooms. Future research is recommended to determine the long-term sustainability of school-based health interventions and the long-term post-intervention impact on NCD risk factors.
Description: Thesis (PhD) -- Faculty of Health Science, Department of Human Movement Science, 2023
Format: computer
Format: online resource
Format: application/pdf
Format: 1 online resource (150 pages)
Format: pdf
Publisher: Nelson Mandela University
Publisher: Faculty of Health Sciences
Language: English
Rights: Nelson Mandela University
Rights: All Rights Reserved
Rights: Open Access

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