Global School-based Health Survey Research Articles

Gender-Based Biopsychosocial Correlates of Truancy in Physical Education: A National Survey among Adolescents in Benin

Truancy among in-school adolescents has long been established as a major issue that negatively impacts educational attainment or goals and mental health-related issues. However, research on subjects such as physical education (PE) truancy and its correlates is somewhat limited. This study estimated the prevalence of PE and assessed the factors associated with PE truancy in Benin among in-school adolescents. The 2016 Benin’s Global School-Based Health Survey (GSHS) data from a sample of in-school adolescents (n = 2496; 13–17 years) were used for data analysis. The overall prevalence of past 30-day truancy in PE class was 15.4%, with female adolescents reporting a higher prevalence of PE truancy than their male counterparts. Stratified by gender, the regression analyses showed that males in 3rd–6th grade (aOR = 0.69, CI = 0.50–0.96) experiencing hunger (aOR = 0.51, CI = 0.32–0.81) and having suicidal ideations (aOR = 1.64, CI = 1.07–2.53) predisposed adolescents to PE truant behaviour. For female in-school adolescents experiencing hunger (aOR = 1.75, CI = 1.15–2.65), drinking alcohol (aOR = 0.62, CI = 0.44–0.87), having sedentary lifestyles (aOR = 0.62, CI = 0.40–0.96), and being physically attacked (aOR = 0.53, CI = 0.33–0.87) were significantly associated with PE truancy. However, understanding and supportive parents [aOR = 0.61, 95% CI = 0.41–0.91] was a protective factor against PE truancy. The present findings suggest the design of gender-sensitive school-based interventions to help minimise or prevent PE truancy among in-school adolescents in Benin based on the predisposing factors while emphasising the protective influences.

Physical activity and sedentary behavior among school-going adolescents in low- and middle-income countries: insights from the global school-based health survey.

The Global School Student Health Survey (GSHS) is being carried out by students in various countries across the globe to advance improved health programs for youth. However, in comparison to high-income countries, adolescents in low- and middle-income countries (LMICs) are generally at an early stage of understanding regarding physical activity (PA) and sedentary behavior (SB), often exhibiting low levels of PA and high levels of SB. Furthermore, there is limited evidence connecting PA and SB in school-going adolescents from LMICs. The objective of this review was to synthesize the available evidence regarding PA and sedentary behavior among school-going adolescents in LMICs using data from the GSHS. On March 18, 2023, a systematic literature search was performed across four electronic databases, namely Web of Science, PubMed, ScienceDirect, and EBSCO with n odaterestrictions. Studies were eligible if they: (1) utilization of data sourced from the Global Student-based Health Survey; (2) exploration of physical activity; (3) specific focus on adolescents; (4) conducted in low- and middle-income countries; (5) study design encompassing observational; (6) published as English journal articles. Among the 29 studies included in the analysis, the majority revealed elevated levels of sedentary behavior and diminished levels of PA in low- and middle-income countries. Furthermore, notable disparities in physical engagement and sedentary behavior were noted between male and female adolescents (p < 0.001). Augmented PA among teenagers was observed to correlate with higher consumption of vegetables and fruits (AOR = 1.30; 95% CI [1.13-1.50]; p < 0.001), decreased alcohol consumption, and a reduced prevalence of loneliness and depression (aOR 1.37, 95% CI [1.18-1.59]). The results of this review affirm that in contrast to high-income countries, adolescents in low- and middle-income countries (LMICs) are in the early stages of comprehending physical activity, marked by low levels of PA. Physical activity and sedentary behavior in school-going adolescents from LMICs appear to be influenced by factors such as policies, cultural norms, socioeconomic conditions, as well as gender, and age.

Drug use and its associated factors among in-school adolescents in Harari region of eastern Ethiopia

ABSTRACT This study aimed to determine the magnitude of current drug use and its associated factors among randomly selected 3227 in-school adolescents in eastern Ethiopia using a multistage sampling technique. Data were collected using questionnaires adapted from the Global School-Based Health Survey. The magnitude of current drug use among in-school adolescents was 5.67% (95% CI: 4.92–6.52). Rural residence (AOR = 2.25, 95% CI: 1.43; 3.54), social media use (AOR = 2.53, 95% CI: 1.75; 3.65), being bullied by others at school (AOR = 8.34, 95% CI: 5.67; 12.56), having a father who used drugs (AOR = 2.20, 95% CI: 1.38; 3.39), and having low self-esteem (AOR = 5.83, 95% CI: 2.77; 12.27) were significantly associated with increased odds of current drug use. The magnitude of current drug use is high. The findings highlight that interventions should focus on rural dwellers, social media users, bully victims, adolescents whose fathers use drugs, and adolescents with low self-esteem.

Prevalence and predictors of lifetime amphetamine use among in-school adolescents in Sierra Leone.

ObjectiveThis study examined the prevalence of amphetamine use and its associated factors among in-school adolescents in Sierra Leone.DesignData for the study was sourced from the 2017 Sierra Leone Global School-based...

Participation in physical education classes and social isolation among adolescents: A harmonized analysis with 266,156 participants from 69 countries

ObjectiveTo analyze the association between participation in physical education (PE) classes and social isolation among adolescents. MethodsWe used data from the Global School-based Health Survey, comprising 266,156 adolescents from 69 countries/territories. Participation in PE classes (days/week) was reported by the students. Social isolation was assessed through questions regarding the number of friends and loneliness perception. Poisson regression models were used to identify the association of weekly participation in PE classes with social isolation, and harmonized meta-analyses were used to estimate a summary association. Results were expressed through prevalence ratios (PR) and their respective confidence intervals (95%CI). ResultsAdolescents who participated in PE classes on one [PR:0.87 (95%CI:0.83; 0.92)], two [0.84 (0.79; 0.89)], and three or more days per week [0.77 (0.73; 0.82)] had a lower prevalence of having a low number of friends than their peers with no PE classes. The loneliness perception was lower among those who participated in PE classes on one [0.86 (0.81; 0.90)], two [ 0.93 (0.87; 0.98)], and three or more days per week [0.94 (0.90; 0.98)] than among those who did not participate in PE classes. Participation in PE classes was also associated with lower social isolation (combined indicator: a low number of friends + loneliness perception) [1 PE day/wk: 0.88 (0.85; 0.92); 2PE days/wk: 0.88 (0.84; 0.92); ≥3 PE days/wk: 0.85 (0.82; 0.89)]. ConclusionsParticipating in at least one PE class per week is associated with a lower perception of social isolation among adolescents. Countries should seek to promote student participation in PE classes as a way of reducing social isolation.

Bullying victimization among in-school adolescents in Sierra Leone: A cross-sectional analysis of the 2017 Sierra Leone Global School-Based Health Survey.

Adolescent bullying victimization is recognized as a public health and mental health problem in many countries. However, data on bullying victimization's prevalence and risk factors is scarce in sub-Saharan Africa Sierra Leone. This research aimed to determine bullying victimization prevalence and its associated factors among Sierra Leonean school-going adolescents. The Sierra Leone 2017 Global School-based Health Survey (GSHS) dataset was analyzed. The outcome variable was the respondent's self-report of bullying victimization ("How many days in the previous 30 days were you bullied?"). Descriptive, Pearson chi-square and binary logistic regression analyses were conducted. The regression analysis yielded adjusted odds ratios (aOR) with 95% confidence intervals (CIs) and a significance level of p 0.05. Bullying victimization was prevalent among 48.7% of the in-school adolescents. Adolescents who drank alcohol [aOR = 2.48, 95% CI = 1.50-4.10], who reported feelings of loneliness [aOR = 1.51, 95% CI = 1.07-2.14] and who had attempted suicide [aOR = 1.72, 95% CI = 1.03-2.87] were also more likely to be bullied. Also, school truancy [aOR = 1.53, 95% CI = 1.24-1.88] among teenagers was associated with an increased risk of being bullied. Our findings suggest that bullying is a widespread problem among Sierra Leonean school-aged youth, and alcohol drinking, loneliness, suicide attempt and school truancy are potential risk factors. In light of the aforementioned causes of bullying in schools, policymakers and school administrators in Sierra Leone need to develop and execute anti-bullying policies and initiatives that target the underlying risk factors of bullying among teenagers.

The burden of psychological distress and unhealthy dietary behaviours among 222,401 school-going adolescents from 61 countries

We aimed to calculate the sex-specific prevalence of psychological distress and unhealthy eating habits among adolescents across countries and regions, and to explore their potential associations. We used data from the Global School-Based Health Survey (GSHS) for 61 countries. Psychological distress was defined based on the existence of ≥ 2 factors from the following: loneliness, anxiety, suicide ideation, suicide planning, and suicide attempt. Four unhealthy dietary behaviours were examined: inadequate fruit intake, inadequate vegetable intake, daily consumption of soft drinks, and weekly fast-food consumption. We used random-effects meta-analysis to estimate the overall and regional pooled prevalence. Mixed-effect multilevel logistic regressions were used to estimate adjusted odds ratios (aORs) of unhealthy dietary behaviours in relation to psychological distress. Among 222,401 school-going adolescents (53.3% girls), the prevalence of psychological distress was 17.9%, with girls reporting higher than boys (20.8% vs. 14.9%). Adolescents in the African region reported the highest prevalence (22.5%), while those in the South-East Asia region reported the lowest (11.3%). The prevalence of inadequate fruit intake, inadequate vegetable intake, daily soft drink consumption, and weekly fast-food consumption was 37.0%, 28.5%, 50.0%, and 57.4% respectively. Psychological distress was associated with inadequate fruit intake (pooled aOR = 1.19, 95% CI 1.17–1.23), inadequate vegetable intake (pooled OR = 1.19, 1.16–1.22), daily consumption of soft drinks (pooled aOR = 1.14, 1.12–1.17), and weekly consumption of fast food (pooled aOR = 1.12, 1.09–1.15). Our findings indicate a substantial variance in the burden of psychological distress and unhealthy dietary behaviours across different regions. Adolescents experiencing psychological distress were more likely to have unhealthy dietary habits.

Prevalence and Associated Factors of Adolescent Obesity among Rural School Adolescents in Nepal: A Cross-Sectional Study.

Overweight and obesity are major risk factors for chronic diseases and are the leading cause of mortality worldwide. Obesity during adolescence is strongly associated with adulthood obesity leading to increased morbidities and mortality. As a developing country undergoing rapid urbanization, Nepal is in a transitional phase where undernutrition coexists with obesity; however, there is a dearth of literature on the status of adolescent obesity in the rural section of Nepal. The aim of this study was to determine the prevalence of adolescent obesity in a rural district of Nepal and find out its associated factors. An institution-based cross-sectional study was conducted among the adolescent students studying in classes 8, 9, and 10 in four secondary schools of Gosaikunda rural municipality of Rasuwa district, Nepal. Total enumerative sampling was used, and Global School-based Health Survey (GSHS) standard questionnaires were used in collecting the information. Height and weight measurements were taken, and the body mass index was classified according to Asia-Pacific criteria. The collected data were analyzed using "SPSS" version 22. Logistic regression analysis was used to evaluate the associated factors, and a p value of ≤0.05 was considered statistically significant. Out of 267 adolescents, 14.6% were obese and 14.6% were overweight. Of the female participants, 39.6% were either obese or overweight, while 12.6% of the male adolescents were overweight/obese. Among the total participants, 16.5% were underweight, including 14.0% females and 20.4% males. Female adolescents were about five times (AOR: 5.2, 95% CI (2.5-10.9), p < 0.01) more likely of being overweight/obese than male adolescents. More than one-quarter of the adolescents were found to be obese/overweight, and the prevalence was significantly more among female adolescents. It emphasizes the necessity of school-based programs promoting a healthy lifestyle among students to maintain healthy weight status.

Risk Factors of Suicide Attempt among Adolescents with Suicide Ideation in Low- and Middle-Income Countries across the Globe

Suicide is a serious public health problem for adolescents. Based on the framework of ideation-to-action, it is important to examine the factors associated with the translation from suicide ideation to suicide attempt. The present study aimed to investigate the risk factors of suicide attempts among adolescents with suicide ideation in low-income and middle-income countries (LMICs). We analyzed data of students aged 12–18 years who participated in the 2009–2013 Global School-based Health Surveys (GSHS) in 39 LMICs. The Chi-square test was used to compare the prevalence of suicide attempts among participants with suicide ideation, the multilevel logistic regression model was used to identify significant factors associated with suicide attempts among suicide ideators. Among 22,655 adolescents with suicide ideation, 55.1% of them reported having made a suicide attempt in the past year. Loneliness, anxiety, alcohol use, and drug use were risk factors for suicide attempts among suicide ideators. Strategies should be implemented to reduce the likelihood of adolescents acting on their suicidal thoughts, such as community psychological crisis line, school-based mental health and skills training programs, and family support for adolescents with psychological problems.

Social isolation is associated with higher leisure-time sedentary behavior and lower physical activity practice: A multi-country analysis of data from 79 countries from the Global School-Based Student Health Survey

AimTo investigate the association of social isolation with physical activity and leisure-time sedentary behavior among adolescents. MethodsWe used data from the Global School-based Health Survey, including a representative sample of 296,861 adolescents (11-18y) from 79 countries (48.9% girls, 14.5 ± 1.6 years). Social isolation was estimated by combining the self-reported number of friends and loneliness perception. Physical activity and leisure-time sedentary behavior were assessed through questionnaires. Multinomial logistic regression models were created to analyze the associations of social isolation with physical activity and leisure-time sedentary behavior. ResultsCompared with those practicing ≥60 min of physical activity during 1‐4 days/week, social isolation was associated with a higher prevalence of not practicing physical activity (Prevalence ratio [PR]:1.24; 95%CI:1.19–1.29), and a lower prevalence of practicing during ≥5d/wk. (PR:0.91; 95%CI:0.88–0.94). Compared with <4 h/d of leisure-time sedentary behavior, being socially isolated was also associated with a higher prevalence of 4-7 h/d (PR: 1.08; 95%CI:1.03–1.14) and ≥ 8 h/d (PR: 1.24; 95%CI:1.16–1.33) of leisure-time sedentary behavior. Compared with those participants without elevated leisure-time sedentary behavior and with those practicing adequate physical activity, social isolation was independently associated with a higher prevalence of physical inactivity (PR: 1.20; 95%CI: 1.15–1.26) and elevated leisure-time sedentary behavior (PR: 1.21; 95%CI: 1.14–1.30), as well as with both risk factors simultaneously (PR: 1.36; 95%CI: 1.28–1.45). ConclusionReducing social isolation could be an important component of future interventions to reduce sedentary behavior and physical inactivity among adolescents.

Association of Bullying Victimization With Suicide Ideation and Attempt Among School-Going Adolescents in Post-conflict Liberia: Findings From the Global School-Based Health Survey.

Background School-based bullying is a global problem that negatively impacts the victims' and perpetrators' health and well-being. There is a paucity of data regarding bullying in schools and its association with suicide behaviors among adolescents in Liberia. Objective The study investigated the impact of bullying victimization on suicidal thoughts and suicide attempts among adolescents in Liberia. It aimed to provide insights into the consequences of bullying victimization on adolescents' mental health regarding their thoughts of self-harm and suicide attempts. Methods The study utilized data from the 2017 Liberia Global School-based Health Survey (GSHS) to analyze information on 2744 students between the ages of 11 and 18 years, with 52.4% being males. Prevalence rates of bullying victimization and suicide behaviors were calculated using descriptive statistics. Multiple logistic regressions were used to model the relationship between being bullied and experiencing suicidal behaviors (ideation and attempts). Results Among the 2744 adolescents examined, 20% experienced suicidal thoughts, with about 30% of the adolescents reporting suicide attempts at some point in the year preceding the survey. Within 30 days prior to the survey, the prevalence of bullying victimization was 50%, with 44.9% experiencing frequent victimization (3 or more days). Bullying victimization was significantly linked to increased odds of suicidal ideation with planning (aOR: 1.86; P < 0.001), at least a suicide attempt (aOR: 2.16; P < 0.001), and multiple attempts at suicide (aOR: 2.67; P < 0.001). We also observed that a greater number of days bullied was dose-dependently associated with higher odds for suicide ideation and attempts. Conclusion These findings support and extend those from other developing countries, highlighting the association between school-based bullying and suicidal behaviors. The relatively high prevalence of bullying among adolescents in Liberia underscores the importance of implementing effective anti-bullying policies and suicide prevention strategies in schools.

Adherence to ‘5-2-1-0’ guidelines and multiple risky behaviours among adolescents in nine sub-Saharan African countries: evidence from Global School-based Student Health Survey 2012–2017

ObjectiveOverweight and obesity constitute a new challenge in low-income and middle-countries. The obesity prevention programme, called ‘5-2-1-0’, promotes healthy eating habits, physical activity and limited screen time among young people.This...

Assessment of the magnitude of behavioural risk factors among school going adolescents of Kashmir valley: a cross sectional study

Background: Adolescents are one sixth of the world’s population and account for 6% of the global burden of disease and injury. The unique health issues associated with adolescence have been little understood. Adolescence is a period when many behaviours are consolidated which have major effects on future adult health. Methods: A cross sectional study was conducted in a total of 8 schools in order to assess the magnitude of various behavioural risk factors among school going adolescents. 614 students in the age group of 10-19 years were included in the study. Data was collected using modified WHO global school-based health survey questionnaire. Weight and height of the adolescents were also taken to assess their nutritional status. Results: In the present study 45% of the participants resorted to diet restriction. 19.2% of the adolescents felt lonely. 18.2.5% of the participants had disturbed sleep and 8.8% of them reported having had suicidal thoughts. 3.9% of the participants had ever smoked cigarettes, 3.9% had ever consumed alcohol and 1.8% had ever used drugs. 28.3% of the adolescents reported having been physically attacked and 12.5% reported having been bullied. 29.5% had a screen time of 3 hours or more. Conclusions: It was observed that behavioral risk factors like unhealthy eating habits and lack of physical activity and substance abuse were quite prevalent in the adolescents. Health education on all these behavioural risk factors and incorporation of life skills education in the school curriculum will help in improving the overall health of the adolescents.

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background: Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports. However, it still remains largely unknown regarding the associations between social support(s) and depressive symptoms among adolescents living in low- and middle-income countries (LMICs). The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs. Methods: Data were retrieved from the Global School-based Health Survey (GSHS) in which 92,551 adolescents (50.6% females) were included with mean of 15.6 years. Depressive symptoms in the past one month as the dependent variable were measured in combination with social support (was measured by “During the past 30 days, how often were most of the students in your school kind and helpful?”). Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms, and the heterogeneity of the associations across the countries, respectively. Results: The prevalence of depressive symptoms was 30.9% of adolescents from LMICs. Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents. However, the associations of peer support and parental connectedness with depressive symptoms were significant in males and females, respectively. The country-wise analysis indicated that varied inconsistency (small to large) across the associations of peer support and parental connectedness with depressive symptoms in adolescents. Conclusion: Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents. However, the association between social support and depression symptoms may be moderated by sex and types of social support. Although we found that social support may be an important protective factor against depressive symptoms in adolescents from LMICs, specifically designed interventions should be implemented based on sex difference and country difference.

Nutritional status and dietary habits among Quranic school's (Khalwa) students in Khartoum State, Sudan: a cross-sectional study.

Khalawi are non-governmental, traditional educational boarding institutions, widely scattered in Sudan. Many Khalawi are resource-limited with deficient feeding and poor housing conditions, which could seriously affect the students' health. A cross-sectional study was conducted, involving all students of a Khalwa in Sharg Al-Neel Locality, Khartoum State. Demographic data were collected using a structured questionnaire with anthropometric measurements, along with laboratory and clinical assessments for anaemia. The dietary behaviours of students were also assessed using Global School-based Health Survey. Statistical analysis was conducted using SPSS software. A total of 131 students were included in this study. Their mean age was 13.7 ± 2.7 years, nearly half of them were from Darfur State in western Sudan, and the majority of them are primary school students. Upon assessment, many displayed serious symptoms and signs of anaemia namely: conjunctival pallor, palmar pallor, fatigability, lightheadedness and palpitation. Based on their haemoglobin testing, 95% were anemic and 24% had severe anaemia. Although 63.6% of them had normal body mass index (4.5%), 11.4%, were found 'severely thin' and 'thin', respectively. Regarding their dietary habits, 46.8% of them consumed milk or milk products less than one time per day, while 20.6% did not consume milk products in the past 30 days. Moreover, 39.4%, 44.9% and 39.4% did not consume any vegetables, fruits or fruit juice, respectively, in the past month. Students of Khalwa displayed poor dietary habits, which resulted in nutritional deficiencies. Programmes must be directed towards improving the quality of diet provided at these schools.

Substance use and adolescent injuries: a multi-country analysis of the association and mediating effect of interpersonal violence among 122,945 in-school paediatric populations in 29 countries.

Adolescent use of substances and injury experiences such as head injury have become increasingly prevalent. However, information regarding their association and the potential pathways linking them remains limited. This study examined the association between substance use and injuries, emphasizing the mediating role of interpersonal violence among adolescents. We employed a multi-country analysis of Global School-based Health Surveys of 122,945 in-school adolescents aged 11-18 from 29 countries. This study was a cross-sectional school-based, nationally representative study developed by the World Health Organization and the United States Centers for Disease Control and Prevention, other United Nations allies, and country-specific institutions. Random-effects meta-analysis was performed to estimate the overall prevalence of injury and substance use and the I-square ( statistic was used to investigate the between-country heterogeneity. Logistic regression models were fitted to examine the association between substance use and injuries. A path analysis was used to examine the potential mediation effect of interpersonal violence and employed decomposition of effects into total, direct, and indirect. Prevalence of substance use and injuries were 33.6% (95%CI = 28.5, 38.6%) and 41.7% (95%CI = 37.3, 46.1%), respectively. Substance use (37.8% vs. 29.4%, p = 0.001) and injuries (47.3% vs. 36.4%, p = 0.001) were significantly higher among male adolescents than females, respectively. After adjustment, substance users had 40% higher odds of injuries. The path analysis showed a mediation effect of perpetration of and victimization by interpersonal violence on the association of substance use with injuries, with total positive effects of perpetration [β = 0.18; 95%CI = 0.16, 0.19; p = 0.001] and victimization on injuries [β = 0.22; 95%CI = 0.21, 0.24; p = 0.001]. In a further subgroup analysis, tobacco users were 3.98 times more likely to sustain a gunshot wound whiles marijuana users had 2.81 times higher odds of sustaining gunshot wounds. Cigarette smokers had 45% lower odds of sustaining cut/stab wounds. Alcohol users were 53% more likely to sustain concussion/head injury and two and half times more likely to sustain gunshot wound. A significant association exists between substance use and severe injuries among adolescents, mediated by interpersonal violence exposure. Our findings may have utility in informing substance use and interpersonal violence control policies and interventions to address adolescent injuries.

Association of single child family with subjective health complaints in children and adolescents

The number of single-child families has been increasing across developing countries during the last decades. We aimed to examine the association between being a single child (SC) and subjective health complaints (SHCs) in Iranian children and adolescents. This study was conducted as a part of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V). This national survey included a total of 14,400 students 7–18 years and their parents from rural and urban areas in 30 provinces of Iran. Data on demographic characteristics, lifestyle variables, and SHCs were measured using the questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS). Multivariate logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for the association of being an SC with SHCs. Data on 14,151 participants were available for this study, of whom 7.7% (1092) were SCs. The most frequent SHCs were irritability (37.1%, 95%CI: 36.3–37.9%), feeling nervous 32.5%, 95% CI: (31.7–33.3%), and headache 24.3%, 95%CI: (23.6–25.0% ). In the multivariate model, being an SC significantly increased the odds of dizziness [adjusted OR (95% CI): 1.37(1.08–1.72)] and backache complaint [1.22(1.01–1.47)]. The association of being an SC with other SHCs (feeling low, irritability, feeling nervous, difficulty in getting to sleep, headache, stomachache) was not statistically significant (p value > 0.05). Our results suggest that being an SC may be associated with higher odds of dizziness and backache complaints.

Estimated prevalence and gender disparity of physical activity among 64,127 in-school adolescents (aged 12-17 years): A multi-country analysis of Global School-based Health Surveys from 23 African countries.

The Africa sub-region currently lacks quantitative normative data to illustrate the extent of burden and gender inequities of physical activity level in order to inform policy and education, towards meeting the WHO's 2030 physical activity milestone. The study aimed to provide insights on the current prevalence of sufficient physical activity and gender disparity, using a nationally representative data from the Global School-based student Health Survey (GSHS) from 23 African countries. The study used the multi-country GSHS data from 23 African countries (2003-2017). Sufficient physical activity was measured through self-administered questionnaire. The prevalence of sufficient physical activity among in-school adolescents in each country was estimated by proportion with corresponding 95% confidence intervals. Meta-analysis with random effect was employed to pool the prevalence of physical activity level in the 23 African countries. Additionally, sub-group, sensitivity, and meta-regression analyses were performed. The study included 23 African countries representing 64,127 in-school adolescents aged 12-17 years. Overall, only 20% [95% CI: 18%-22%] of adolescents in Africa engaged in sufficient physical activity. With respect to sex, only 25% [95% CI: 22%-28%] of males and 16% [95% CI: 14%-18%] of females met the WHO recommendation of sufficient physical activity. Sufficient physical activity ranged from 11.6% [9.2%-14.5%] in Sudan to 38.3% [CI:30.2%-47.1%] in Benin. Sufficient physical activity in boys ranged from 7.5% [95% CI: 6.2%-9.0%] in Zambia to 29.2% [95% CI: 22.5%-36.8%] in Benin, and ranged from 2.5% [95% CI: 1.6%-4.0%] in Senegal to 12.2% [95% CI:10.6%-14.1%] in Tanzania for girls. Only 20% of in-school adolescents met the WHO's recommended physical activity level. Generally, adolescent girls in Africa are less active than adolescent boys. Addressing the rising burden of insufficient physical activity in adolescents and narrowing the gender gap could ultimately increase the overall physical activity engagement and achieve the WHO's global physical activity target by 2030.

Assessment of mental health problems among adolescents in Sri Lanka: Findings from the cross-sectional Global School-based Health Survey.

Background and AimsMental health condition among adolescents is a leading cause of health‐related disability in Sri Lanka. The study aims to estimate the prevalence and evaluate the associated risk factors in three major mental health domains—loneliness, anxiety and suicidal ideation—among Sri Lankan adolescents.MethodsWe conducted a secondary analysis of cross‐sectional data of 3262 adolescents from the Global School‐based Health Survey (GSHS) conducted by the WHO in 2016. We modeled the binary outcome variables using multivariable logistic regression models with exposures representing demography, food habits, personal hygiene, behavior, substance abuse, parental and social engagement of the respondents.ResultsWe estimated the prevalence of loneliness, anxiety and suicidal ideation as 30.8% (95% CI: 29.3, 32.5), 20.2% (95% CI: 18.8, 21.6) and 3.7% (95% CI: 3.1, 4.4), respectively, and the overall prevalence as 40.3% (95% CI: 38.6, 42.0). Mental health problems were more prevalent among females than males. Engagement with parents and close friends, adequate nutritional intake and physically active lifestyles reduced the risk of common mental health problems. Exposure variables like food insecurity, truancy, second‐hand smoking, physical fight, and being bullied increased adolescents’ risk of reported psychological problems.ConclusionsWe conclude that the prevalence of mental health problems in the Sri Lankan adolescent population was higher than the global average. Results suggest that future policy decisions to mitigate mental health problems among Sri Lankan adolescents should incorporate an integrated approach involving the individual, family and community to promote positive home and school environments combined with an active and healthy lifestyle.

Mental Health and Parental Factors among Adolescents during the COVID Pandemic in Malaysia

Purpose: The study aims to determine the prevalence of mental health problems among early adolescents and their associations with parental relationships. Methods: A cross-sectional study was conducted on 535 adolescents aged 13 to 14 on the east coast of Peninsular Malaysia using online surveys from February 2021 to April 202. Mental health status was assessed using the Depression, Anxiety and Stress Scale- 21 (DASS-21), and parental or guardian supervision, connectedness, bonding, respect for privacy, physical activity, and risk behaviours were asked using the Malaysian Global School-based Student's Health Survey. Multiple logistic regression analysis was done to examine the associations of the variables. Results: The prevalence of depression, anxiety and stress were 28.2%, 38.1% and 18.5%, respectively. Adolescent with low parental/guardian connectedness and bonding were associated with depression (AOR = 3.82, 95% CI =1.80 – 8.08), anxiety (AOR 2.17,95% CI = 1.34 – 3.50) and stress (AOR 2.29, 95% CI = 1.13 – 4.65). Low parental supervision (AOR = 2.37, 95% CI = 1.19 – 4.54), low academic performance (AOR = 3.57, 95% CI = 1.10 – 11.62), stress (AOR = 8.56, 95% CI = 4.38 – 16.70) and anxiety AOR = 7.83, 95% CI = 4.48 – 13.70) were predictors for depression. Adolescent who had divorced or separated parents/guardians (AOR = 3.57, 95%CI = 1.10 – 11.62) and married parents/guardian but living apart due to working (AOR = 3.57, 95% CI = 1.10 – 11.62) were higher risk for stress. Conclusions: Depression and anxiety were prevalent among adolescents in Malaysia. Poor relationship with parents or guardians was a significant factor for mental health problems among adolescents during the COVID pandemic.