Abstract
BackgroundIn low- and middle-income countries, infectious diseases remain a key public health issue. Additionally, non-communicable diseases are a rapidly growing public health problem that impose a considerable burden on population health. One way to address this dual disease burden, is to incorporate (lifestyle) health promotion measures within the education sector. In the planned study, we will (i) assess and compare physical activity, physical fitness, micronutrient status, body composition, infections with soil-transmitted helminths, Schistosoma mansoni, malaria, inflammatory and cardiovascular health risk markers, cognitive function, health-related quality of life, and sleep in schoolchildren in Côte d’Ivoire, South Africa and Tanzania. We will (ii) determine the bi- and multivariate associations between these variables and (iii) examine the effects of a school-based health intervention that consists of physical activity, multi-micronutrient supplementation, or both.MethodsAssuming that no interaction occurs between the two interventions (physical activity and multi-micronutrient supplementation), the study is designed as a cluster-randomised, placebo-controlled trial with a 2 × 2 factorial design. Data will be obtained at three time points: at baseline and at 9 months and 21 months after the baseline assessment. In each country, 1320 primary schoolchildren from grades 1–4 will be recruited. In each school, classes will be randomly assigned to one of four interventions: (i) physical activity; (ii) multi-micronutrient supplementation; (iii) physical activity plus multi-micronutrient supplementation; and (iv) no intervention, which will serve as the control. A placebo product will be given to all children who do not receive multi-micronutrient supplementation. After obtaining written informed consent from the parents/guardians, the children will be subjected to anthropometric, clinical, parasitological and physiological assessments. Additionally, fitness tests will be performed, and children will be invited to wear an accelerometer device for 7 days to objectively assess their physical activity. Children infected with S. mansoni and soil-transmitted helminths will receive deworming drugs according to national policies. Health and nutrition education will be provided to the whole study population independently of the study arm allocation.DiscussionThe study builds on the experience and lessons of a previous study conducted in South Africa. It involves three African countries with different social-ecological contexts to investigate whether results are generalisable across the continent.Trial registrationThe study was registered on August 9, 2018, with ISRCTN. https://doi.org/10.1186/ISRCTN29534081.
Highlights
In low- and middle-income countries, infectious diseases remain a key public health issue
The study builds on the experience and lessons of a previous study conducted in South Africa
This investigation has scientific relevance because it is among the first to explore the associations between objectively assessed physical activity/fitness, micronutrient deficiencies, body composition, infectious diseases, inflammatory and cardiovascular health risk markers and sleep indicators in schoolchildren in three African settings
Summary
In low- and middle-income countries, infectious diseases remain a key public health issue. In low- and middle-income countries (LMICs), infectious diseases remain a key public health issue, negatively impacting children’s physical and cognitive development [2]. Children from low SES families are less likely to have access to health care or health insurance and are more prone to be absent from school, which may have negative consequences on their academic performance. These deficiencies can prevent school-aged children from realising their full potential and perpetuate a vicious cycle of poverty and poor health
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