Disease, activity and schoolchildren’s health (DASH) in Port Elizabeth, South Africa: a study protocol

Yap et al. BMC Public Health (2015) 15:1285 DOI 10.1186/s12889-015-2636-y STUDY PROTOCOL Open Access Disease, activity and schoolchildren’s health (DASH) in Port Elizabeth, South Africa: a study protocol Peiling Yap1,2*†, Ivan Müller1,2,3†, Cheryl Walter4, Harald Seelig3, Markus Gerber3, Peter Steinmann1,2, Bruce P. Damons6, Danielle Smith4, Stefanie Gall3, Dominique Bänninger3, Thomas Hager3, Nan S. N. Htun1,2, Liana Steenkamp5, Annelie Gresse5, Nicole Probst-Hensch1,2, Jürg Utzinger1,2, Rosa Du Randt4 and Uwe Pühse3 Abstract Background: An in-depth epidemiological investigation on intestinal parasite infections in an impoverished area of Port Elizabeth, South Africa provides a unique opportunity for research on its impact on children’s physical fitness, cognitive performance and psychosocial health. Additionally, we will screen risk factors for the development of diabetes and hypertension in adulthood. Methods/Design: A 2-year longitudinal cohort study will be conducted, consisting of three cross-sectional surveys (baseline and two follow-ups), in eight historically black and coloured (mixed race) primary schools located in different townships in Port Elizabeth, South Africa. Approximately 1000 Grade 4 primary schoolchildren, aged 8 to 12 years, will be enrolled and followed. At each survey, disease status, anthropometry and levels of physical fitness, cognitive performance and psychosocial health will be assessed. After each survey, individuals diagnosed with parasitic worm infections will be treated with anthelminthic drugs, while children with other infections will be referred to local clinics. Based on baseline results, interventions will be tailored to the local settings, embedded within the study and implemented in half of the schools, while the remaining schools will serve as controls. Implementation of the interventions will take place over two 8-week periods. The effect of interventions will be determined with predefined health parameters. Discussion: This study will shed new light on the health burden incurred by children in deprived urban settings of South Africa and provide guidance for specific health interventions. Challenges foreseen in the conduct of this study include: (i) difficulty in obtaining written informed consent from parents/guardians; (ii) administration of questionnaires in schools where three languages are spoken (Afrikaans, Xhosa and English); (iii) challenges in grasping concepts of psychosocial health among schoolchildren using a questionnaire; and (iv) loss to follow-up due to the study setting where illiteracy, mobility and violence are common. Finally, designing the health interventions together with local principals and teachers will allow all concerned with the research to bolster a sense of community ownership and sustained use of the interventions after the study has ceased. Trial registration: Controlled-trials.com; identifier: ISRCTN68411960 (date assigned: 14 February 2014). Keywords: Anthropometry, Cognitive performance, Diabetes, Health interventions, Intestinal parasite infections, Physical fitness, Physical activity, Psychosocial health, South Africa * Correspondence: † Equal contributors 1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland 2 University of Basel, P.O. Box, CH-4001 Basel, Switzerland Full list of author information is available at the end of the article © 2015 Yap et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Yap et al. BMC Public Health (2015) 15:1285 Background As traditional lifestyle and diet change alongside socioeconomic developments, countries are starting to experience a double burden of communicable and non-communicable diseases in the face of weak health systems [1, 2]. Many countries still struggle to meet the existing challenges stemming from infectious diseases, such as malaria and intestinal parasite infections. Meanwhile, non-communicable diseases, such as diabetes, cardiovascular diseases, obesityrelated conditions and cancers, impose a growing burden on them [3]. This phenomenon has been recognised by the global health community and must be addressed in the new era of the sustainable development goals (SDGs), particularly “to ensure healthy lives and promote well-being for all at all ages” [4], while the unfinished agenda of the communicable diseases during the millennium development goal (MDG) era must be accelerated. In South Africa, investigations of physical activity patterns of primary schoolchildren attending schools in disadvantaged neighbourhoods have confirmed that physical activity levels are insufficient [5]. These school environments are usually not conducive for the promotion of physical activity due to inadequate sport and recreation facilities, a lack of qualified teachers and an irregular physical education program. In 2010, KimaniMurage et al. [6] reported that in a low-income South African setting, the co-prevalence of early stunting and adolescent obesity in girls is a result of increasing levels of physical inactivity. This observation was particularly prevalent among black girls, who were found to have the highest rates of physical inactivity [7]. As physical inactivity during childhood can lead to poor health outcomes in adulthood [8], there is a pressing need to promote physical activity among school-aged children in disadvantaged communities in order to prevent obesityrelated conditions and other non-communicable diseases. Additionally, infectious diseases that are intimately connected with poverty may also occur in disadvantaged South African schools [9]. These infections can have a negative impact on children’s nutritional status, cognitive abilities and physical fitness [10, 11]. Such a dual burden of disease can put children at a high risk of compromised health, poor subjective well-being, hampering their growth and economic perspectives. In particular, it is hypothesized that, first, intestinal parasite infections have a negative influence on the physical fitness, cognitive performance, nutritional status and psychosocial health of school-aged children in deprived urban South Africa. Second, the development of setting-specific health interventions can decrease the incidence of parasitic infections and insulin resistance as well as elevated blood pressure, and thereby the risk of developing non-communicable conditions later in life, such as (...truncated)