South African Primary School Children Research Articles

Evaluation of a Physical Activity and Multi-Micronutrient Intervention on Cognitive and Academic Performance in South African Primary Schoolchildren.

Executive functions (EFs) are essential for optimal academic development. Appropriate nutrition and physical activity (PA) have been shown to facilitate optimal cognitive development. Therefore, this study examined whether a 12-week school-based PA and multi-micronutrient supplementation (MMNS) intervention would improve cognitive and academic performance. A cluster-randomized controlled trial (RCT) was conducted. Children from four schools located in a peri-urban area of South Africa were randomly assigned to (i) PA + MMNS, (ii) PA + placebo, (iii) MMNS or (iv) placebo. Information processing and inhibitory control were measured with a computerized Flanker task. End-of-year results provided insight into academic achievement. Anthropometric measures were used to determine nutritional status. Data were analyzed with linear mixed-models, adjusting for baseline scores, school classes and age; 932 children (458 girls (49.1%), Mage (mean age) = 8.42 ± 1.94 years) completed baseline and post-intervention assessments. Cognitive performance improved among all four groups, with no significant group × time effects. For academic achievement, there was no significant interaction effect between the combined intervention group and placebo. We encourage future studies in this neglected area in order to determine the most optimal design of school-based nutrition and PA programs to enhance overall cognitive performance.

Impact of a school-based health intervention program on body composition among South African primary schoolchildren: results from the KaziAfya cluster-randomized controlled trial

BackgroundThe prevalence of overweight and obesity is increasing among African children potentially predisposing them to greater obesity and non-communicable diseases (NCDs) in adulthood. This risk may be higher among growth-impaired children who may have greater fat mass. Therefore, we examined the effects of school-based physical activity (PA) promotion and multi-micronutrient supplementation (MMNS) on body composition among South African children enrolled in a longitudinal school-based randomized controlled trial.MethodsChildren were cluster-randomized by class to one of four groups: (a) a physical activity group (PA), (b) a multi-micronutrient supplementation group (MMNS), (c) a physical activity + multi-micronutrient supplementation group (PA + MMNS), and (d) control group, and were being followed for 3 years. Linear random effects regression models with random intercepts for school classes tested the associations of each intervention arm with overall fat mass (FM), fat-free mass (FFM), truncal fat mass (TrFM), and truncal fat-free mass (TrFFM) at 9 months (T2) for boys and girls. These differences were then explored among children who differed in height velocity (HV).ResultsA total of 1304 children (614 girls, 667 boys) in twelve clusters were assessed at baseline and after 9 months follow-up (T2). At baseline, approximately 15% of children were classified as overweight or obese while approximately 38% of children were classified as mildly stunted or moderately/severely stunted. Among girls, promotion of PA was associated with reduced FM and TrFM at T2 while MMNS was associated with increased FFM. Children with reduced HV in the PA arm had reduced FM while children in the MMNS arm with lower HV had increased FFM compared to children in the control arm. Similarly, children with lower HV in the MM and PA groups had reduced TrFM compared to children in the control arm.ConclusionsOur study suggests that the promotion of school-based physical activity programs and micronutrient supplementation can reduce childhood adiposity and so reduce the risk of obesity and chronic diseases later in adulthood.Trial registrationISRCTN, ISRCTN29534081. Registered on August 9, 2018. The trial was designed, analyzed, and interpreted based on the CONSORT protocol (Additional file 1: CONSORT checklist for randomized trial)

How are academic achievement and inhibitory control associated with physical fitness, soil-transmitted helminth infections, food insecurity and stunting among South African primary schoolchildren?

BackgroundCardiovascular fitness has been associated with both executive function and academic achievement in multiple cohort studies including children and adolescents. However, research is scarce among children from low- and middle-income countries. Hence, this paper focuses on South African primary schoolchildren living in marginalized areas and examines if academic achievement and inhibitory control can be explained by children’s age, socioeconomic status, soil-transmitted helminth infections, food insecurity, stunting, grip strength, and cardiorespiratory fitness.MethodsThe sample of this cross-sectional study consisted of 1277 children (48% girls, mean age: 8.3 years). Data were assessed via questionnaires, stool samples, anthropometric measurements, 20 m shuttle run test, grip strength test, Flanker task, and school grades. Data were analysed with mixed linear regression models with random intercepts for school classes, separately for boys and girls.ResultsHigher socioeconomic status was most closely associated with academic achievement among boys (p < 0.05), whereas higher levels of cardiorespiratory fitness and not being stunted explained most variance in academic achievement in girls (p < 0.05). Higher age turned out to be associated with better performance in the Flanker task (p < 0.01). Additionally, in boys, higher grip strength was associated with better information processing and inhibitory control of attention (p < 0.01), whereas in girls, higher cardiorespiratory fitness levels were positively associated with these cognitive abilities (p < 0.05).ConclusionsAcademic performance has been shown to be compromised in schoolchildren living in marginalised areas, compared to schoolchildren in less disadvantaged parts of South Africa. The present study suggests that cardiorespiratory fitness and grip strength are two potentially modifiable factors that are associated with children’s academic achievement and cognitive performance, and that should be targeted in future school-based interventions.

Prevalence of Stunting and Relationship between Stunting and Associated Risk Factors with Academic Achievement and Cognitive Function: A Cross-Sectional Study with South African Primary School Children.

Childhood stunting can have negative long-term consequences on cognitive development, academic achievement, and economic productivity later in life. We determined the prevalence of stunting and examined whether stunting and associated risk factors (low dietary diversity, insufficient hemoglobin, food insecurity, and soil-transmitted helminth (STH) infections) are associated with academic achievement and cognitive function among South African children living in marginalized communities. A cross-sectional sample of 1277 children (aged 5–12 years) was analyzed. Stunting was defined according to 2007 WHO growth references. Cognitive functioning was measured with the computerized Flanker task and academic performance via school grades. Blood and stool samples were collected to obtain hemoglobin level and STH infection. Dietary diversity was assessed by a food frequency questionnaire. Associations were examined via mixed linear regression (with school class as a random intercept). Nine percent of the children were stunted (95% CI: 7.6–10.8%). Low dietary diversity (β = 0.13, p = 0.004), food insecurity (β = −0.12, p = 0.034), and stunting (β = −0.13, p = 0.031) were associated with poorer end of the year results among girls. No such associations were found among boys. No significant associations were found for socioeconomic status and hemoglobin levels. The prevalence of stunting and STH infections were low in the present sample. Risk factors seem differently associated with girls’ and boys’ academic achievement. Promoting nutrition may help to promote academic achievement among girls living in low- and middle-income countries.

Attention-deficit/hyperactivity disorder and behavioural planning deficiencies in South African primary school children.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is defined as a cognitive or behavioural developmental disorder. Inattentiveness, overactivity and impulsivity are regarded as the main clinical symptoms of ADHD. These symptoms may occur together or separately resulting in three recognised presentations: predominantly inattentive, predominantly hyperactive–impulsive and combined presentations.AimThis study investigated deficiencies in behavioural planning in South African primary school children with and without ADHD.SettingTzaneen area in Limpopo province, South Africa.MethodsA total of 156 children (78 with ADHD and 78 matched controls without ADHD) of both genders, who were medication naïve and aged 6–15 years, participated in the study. The performance of the two groups was compared on a test of planning and problem-solving, the Tower of London (ToL) task. The results were analysed as a function of gender, age and ADHD presentation.ResultsChildren with ADHD especially ADHD-PI and ADHD-C used significantly more moves and took a longer time to complete the task than the controls (p < 0.001). There were no significant differences in the number of moves and time taken by the predominantly hyperactive-impulsive presentations of ADHD when compared to the controls. Gender and age did not influence the performance.ConclusionThe results showed that children with ADHD showed significantly more deficits mainly the ADHD-PI and ADHD-C presentations, which indicates that inattention is mainly responsible for deficiencies in behaviour planning. The ADHD-HI presentations and the control group were not affected.

Physical activity and dual disease burden among South African primary schoolchildren from disadvantaged neighbourhoods

People from low- and middle-income countries still face challenges stemming from parasitic infections. Additionally, non-communicable diseases (NCDs) and their risk factors are rapidly increasing, which puts South African children at an elevated risk of a dual disease burden, with negative consequences for child development and wellbeing. Contrastingly, regular physical activity (PA) is associated with decreased cardiovascular disease (CVD) risk. Therefore, the objective of this study was to examine whether PA is associated with the double infection-CVD phenotype burden in South African schoolchildren. 801 children (402 boys, 399 girls; mean age 9.5 years) from eight schools from disadvantaged neighbourhoods were included. Data assessment took place between February and March 2015 in Port Elizabeth, South Africa. Children who achieved PA recommendations (physically active on 6–7 days/week for at least 60 min), who were active, but below recommended standards (2–5 physically active days/week), or who were insufficiently active on almost all days (0–1 physically active days/week) were compared with regard to systolic and diastolic blood pressure, body mass index (BMI), percent body fat, and infection with soil-transmitted helminths. Moderate and high self-reported PA levels were associated with lower BMI, lower body fat, and lower risk of being hypertensive. Conversely, children with high self-reported PA were more likely to be infected with soil-transmitted helminths than peers with low PA levels. Promoting PA in disadvantaged areas is worthwhile to prevent NCD later in life, but should be combined with regular anthelminthic treatment to comprehensively improve children's health and wellbeing.

A framework of Afrocentric hope: Rural South African children's conceptualizations of hope

AbstractThere is a growing need to explore and understand indigenous knowledge and subjective experiences around hope from children raised in rural African communities. This engagement sought to address the question: What are rural South African primary school children's conceptualizations of hope? A visual participatory methodology (using collage‐making, drawing, Mmogo method, and photovoice) enabled an exploration of hope with 12 children (9‐13 years) attending an aftercare center in rural QwaQwa region of South Africa. Using evidence generated from the study, and drawing on Scioli's theory of integrated hope, this article posits a framework of Afrocentric hope that develops along four interdependent and interrelated levels: contextual, personal, relational, and collective. These interactions are mediated by the spiritual/cultural worldview dimension. Understanding rural South African children's perspectives of hope contributes toward engagements aimed at nurturing, shaping, and strengthening hope in collective‐oriented communities.

Hope for the Future and Literacy Achievement in a Sample of Impoverished South African Primary School Children

ABSTRACTThis article reports on a study that investigated the problem of hope for the future and literacy achievement in a sample of impoverished South African primary school children. data was collected through a quantitative survey that was administered to 160 learners from four classes of grades 5 to 7 at a school in Soweto township, Johannesburg, South Africa. The survey comprised five literacy tests that were standardised by Do-IT Profiler, an institute based in the United Kingdom (UK), and Shape the learner, a South African based consultancy. The results showed a statistically significant relationship between hope for the future and literacy scores, with learners who had less hope for the future scoring significantly lower on the literacy tests used in the study. Specifically, learners with less hope for the future performed noticeably lower in the real word test, followed by spelling, words spelt correctly, reading fluency, and non-word spelling. Based on social constructivist learning theory, positive psychology, and hope theory, the author discusses the implications of the findings for literacy achievement in children living in poverty. Several important recommendations are made, namely: the use of a methodological tool to identify specific literacy skills in children; the support that could be provided by educators and school psychologists; and a multilevel focus in targeting poverty eradication.

Is School Lunch Connected to Literacy Achievement in Primary School Children? A South African Perspective

This study investigated school lunch and achievements in literacy in a sample of South African primary school children. Data was collected through a quantitative survey administered with pupils (N= 160) from four grade 5 to 7 classes in a school in Soweto. The survey consisted of five literacy tests that were standardized by Do-It- Profiler, a UK based institute, and Shape the Learner, a South African based consultancy. Additionally, the survey included questions pertaining to the children taking lunch to school. The results show that learners who sometimes do not have lunch obtained statistically significantly lower marks on the combined learner profiler tests than learners who had some form of lunch provided. More specifically, learners who sometimes do not have lunch performed noticeably lower in the sound text, correct word, and most likely real word test. Based on social justice theory the author discusses the implications of the findings for literacy achievement in children who do not take lunch to school.

Relationships between different nutritional anthropometric statuses and health-related fitness of South African primary school children

Background: A double burden of both under- and over-nutrition exists among South African children.Aim: To describe associations between nutritional statuses and health-related fitness test performances.Subjects and methods: Height and weight of 10 285 children (6–13 years; n = 5604 boys and 4681 girls) were measured and used to calculate body mass index (BMI) and prevalence of overweight and obesity, stunting, wasting and underweight. Physical fitness scores for standing long jump, shuttle run, sit-and-reach, sit-up (EUROFIT) and cricket ball throw were assessed. Age- and gender-specific z-scores were calculated for these variables. Physical fitness for each nutritional status group was compared to children of normal weight.Results: Compared to normal weight children, overweight and obese children scored lower on all fitness tests (p < .001), except cricket ball throw (p = .235) and sit-and-reach (p = .015). Stunted and underweight children performed poorer than normal weight children on most fitness tests (p < .001), except sit-and-reach (stunted: p = .829; underweight: p = .538) and shuttle run (underweight: p = .017). Performance of wasted children was not as highly compromised as other under-nourished groups, but they performed poorer on the cricket ball throw (p < .001).Conclusions: When compared to normal weight children, both under- and over-nourished children performed poorer on some, but not all, health-related fitness tests.

‘I want to be a hope champion!’ – Research as hope intervention with rural South African children

This study explored how visual participatory research-as-intervention enabled a strengthening of hope among a group of South African primary school children. Twelve learners aged 9–13 years from a rural village in the QwaQwa region of South Africa participated in the study. Data on the children’s experiences of hope were co-constructed with them, applying various visual participatory approaches, while data on their engagement in the research itself was generated using group discussion, individual interviews, and notes captured in a research journal. Thematic analysis of the data revealed a strengthening of the children’s hope on personal, relational, and collective levels from engaging in hope-oriented visual participatory processes. The findings suggest that research-as-intervention has hope-enhancing value for rural South African children.

Self‐reported sun‐related knowledge, attitudes and behaviours among schoolchildren attending South African primary schools

Skin cancer and other adverse health effects result from excess solar ultraviolet radiation exposure. Sun protective practices are important interventions for skin cancer prevention, particularly when implemented early in life. Several international studies have assessed children's sun-related knowledge, attitudes and behaviours in school settings but never before in Southern Africa, where multiethnic populations exist. The purpose of this study is to describe the sun-related knowledge, attitudes and behaviours as self-reported by South African primary schoolchildren and consider the roles of sex and skin type. A randomly selected sample of 707 schoolchildren from 24 government, urban schools in all nine provinces of South Africa were surveyed regarding their sun-related knowledge, attitudes and behaviours. Approximately 56% of students reported experience of sunburn last summer and 59% stated that they had got a suntan. Many students (64.5%) believed that one could protect oneself from getting skin cancer by avoiding getting sunburnt. Other means reported to do so by the students were to use sunscreen (65.4%), stay out of the summer sun (48.0%), cover up with clothing (45.5%) and eat the right foods (38.0%). Only about a quarter of the students (22.4%) wrongly agreed that it is safe to get sunburnt once or twice a year. Few students (8.7%) agreed that they like to have a suntan because they feel healthier and agreed that they think a suntan makes them feel more attractive to others (17.3%). Few also agreed that most of their friends (16.1%) and family (14.2%) think that a suntan is a good thing. Children reporting to have white/light brown skin (69.4%) were more likely to agree that they used sunscreen to protect themselves from getting sunburnt compared with children having brown/dark brown/black skin (54.8%) (P = 0.0005). South African schoolchildren at urban government schools do have some knowledge about sun protection, and they do have some positive sun behaviours; however, the reported occurrence of sunburn, a risk factor for skin cancer, was relatively high. There were few differences in responses by sex and some differences by skin type. These findings are important for the development of appropriate sun protection programmes aimed at schoolchildren in South Africa and other countries with similar multi-ethnic populations.

Physical Fitness of South African Primary School Children, 6 to 13 Years of Age: Discovery Vitality Health of the Nation Study

Basic physical fitness was measured using 8 different measures for 10,295 South African children and youths (5,611 boys, 4,684 girls) ages 6 to 13 years. These measurements included height, weight, Body Mass Index, standing long jump, shuttle run, sit-and-reach, sit-up (EUROFIT testing battery), and cricket ball throw scores. Due to the effects of earlier apartheid laws on separating communities, it was hypothesized that scores for different ethnic groups may differ. Therefore, in addition to the calculation of basic norms and sex differences, ethnic differences were also tested. Height and weight, relative to age, were different between the various ethnic groups (Black, White, and Mixed ancestry) for boys, with Black boys being shorter and lighter than White boys. There were no differences in sit-and-reach flexibility scores between the groups. With the exception of the cricket ball throw for girls, White children had higher scores in most tests. Although not significantly different from the White children, in the majority of cases, the children of mixed ancestral origin had scores that ranged between the other two ethnic groups. These results suggest a need for encouraging fitness in school children, and the reintroduction of formal physical education into the South African school curriculum, especially into schools in which Black children predominate.

Validity of Childhood Career Development Scale scores in South Africa

The purpose of this study was to provide evidence of the construct and concurrent validity of the Childhood Career Development Scale’s (CCDS) scores among South African primary school children. Using a sample of 808 children in grades four through seven, evidence for the CCDS’s construct validity was provided using confirmatory factor analysis, with eight factors confirmed. Evidence for the CCDS’s concurrent validity was also presented by analyzing the relationship between subscales of the Childhood Career Development Scale and measures of self-esteem, locus of control, and children’s industry. The CCDS continues to emerge as a promising theoretically-driven assessment tool.

School and work: connections made by South African and Australian primary school children

This exploratory-descriptive research focuses on whether children can connect school-based experiences to future jobs that interest them. A cross-national sample of 497 South African and 365 Australian upper primary school children participated in the study. The data from one item of the Revised Career Awareness Survey were analysed using descriptive and inferential statistics. Differences between nation and gender were examined. The results revealed that the majority of children were able to make curricular, extra-curricular, or general school connections to future jobs that interested them. Males made fewer curricular and general school connections and more connections to extracurricular activities than females. The implications of the findings for career education in primary schools and for future research are discussed.

Obesity and overweight in South African primary school children—the Health of the Nation Study

To determine the prevalence of overweight and obesity in a sample of South African children aged 6 - 13 years. Random sampling of schools within each provincial and socio-economic category. Primary school children from 5 South African provinces. 10 195 (5 611 male and 4 584 female) primary school children. Height and weight were measured and body mass index (BMI) (weight (kg)/height (m) (2)) was calculated for each grouping (age x gender x ethnic group). Cut-off points for BMI defining obese and overweight for gender and age (6 - 13 years) were calculated in accordance with international standards. There were significant differences in height and mass between the different ethnic groups and genders. This trend was not evident for the BMI values. The prevalence of obesity within the sample was 3.2% for boys and 4.9% for girls, whereas overweight prevalence was 14.0% for boys and 17.9% for girls. When the contribution of each ethnic group was adjusted to the demographics of South Africa these values were only slightly different. The prevalence of obesity and overweight among boys was 2.4% and 10.9% respectively, while obese and overweight girls comprised 4.8% and 17.5%, respectively. South African children show trends of obesity and overweight, similar to values in developed countries about 10 years ago. Intervention strategies to combat an increasingly sedentary lifestyle may need to be developed for the South African context.

Relationship between Physical Activity and Physical Fitness of Ellisras Rural Primary School Children of South Africa

LANGUAGE NOTE | Document text in English; abstract also in Chinese.The aim of this study was to determine the relationship between physical activity and fitness in 212 South African rural primary school children. A questionnaire was used to gather physical activities performed during the whole week. The results show a few significant relationships between physical activity and sit-ups, shuttle run and 1600m run in girls, but none in boys. The gender difference may be explained by a ceiling effect in boys. The general absence of significant findings may be explained by the low nutritional status, unrecorded physical activity duration, high levels of physical activity, and heterogeneity in growth and maturation.本文旨在探討南非鄉鎮地區小學生身體活動量與體適能的關係，以問卷方式進行調查學童過去一星期的身體活動量，結果顯示女學童的身體活動量與仰臥起坐，來回跑及一千六百米跑有顯著相關，而男生的活動量與體適能卻沒有相關，這現象可能受其他因素影響所致。

Body composition and physical fitness of undernourished South African rural primary school children

The purpose of this study was to determine the relationships between the body composition characteristics, body mass index (BMI), sum of skinfolds (SSF), % body fat (%BF), fat-free mass (FFM) and waist-to-hip ratio (WHR), and nine physical fitness items in undernourished rural primary school children in Ellisras, South Africa. A cross-sectional study. The study consisted of 462 boys and 393 girls who were aged 7-14 y. Five body composition measures were assessed: BMI, SSF, %BF, FFM and WHR. Nine physical fitness test items were assessed: standing long jump, bent arm hang, sit-ups, 10 x 5 m shuttle run, 50 m sprint, 1600 m run, flamingo balance, sit and reach, plate tapping. BMI was highly correlated with FFM (r = 0.7, P < 0.001). In line with findings from Western countries, regression coefficients (B) showed that children with higher BMI or SSF performed worse in bent arm hang (girls, B = -0.84, P < 0.001, and B = -0.06, P = 0.02, respectively) and in 1600m run (B = 6.68, P < 0.001). BMI was significantly associated with flamingo balance (B = 0.26, P = 0.04). WHR was positively associated with bent arm hang (B = 9.37, P = 0.03), and inversely with sit and reach (B = -7.48, P = 0.01). In contrast, significant relationships were found between BMI and standing long jump (B = 0.74, P = 0.04), sit and reach (B = 0.51, P < 0.001), flamingo balance (B = 0.26, P = 0.04) and plate tapping (B = -19, P = 0.01). SSF was significantly associated with sit and reach (B = 0.04, P = 0.03). Significant inverse associations were found between FFM and bent arm hang (girls, B = -0.06, P = 0.05), 1600 m run (girls, B = -2.33, P = 0.003) and 50 m run (boys, B = -0.11, P = 0.006). FFM was significantly associated with standing long jump (boys, B = 0.99, P < 0.001; girls, B = 0.73, P < 0.001), flamingo balance (B = 0.17, P < 0.001), and with sit and reach (boys, B = 0.59, P = 0.03). In the present study in undernourished children, body composition was significantly related to physical fitness, but not always in the expected direction. It is therefore important to note that in this population, BMI should not be interpreted as a measure of fatness/overweight, but rather as an indicator of muscle mass.

Cross-cultural Similarities in ADHD-Like Behaviour Amongst South African Primary School Children

This study investigates whether the Disruptive Behaviour Disorders (DBDs) rating scale measures the same constructs in South African as in Western cultures, and explores the differences in scale scores as a function of language, gender and age. Teacher ratings between 1997 and 1999 of the 18 DSM-IV symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in 6 094 primary school children of six language groups in the Limpopo Province of South Africa were collected and analysed. For all language groups, the results were consistent with a two-factor model of ADHD with correlated factors. There were gender and age effects on both scales. The prevalence rates for ADHD sub-types were in line with rates in the United States of America (US) and Europe. Similarities across language groups, as well as to results reported in the US and Europe, were striking. Despite the limitations discussed, teacher ratings of ADHD symptoms on the DBD scale can be used as a screening instrument in South Africa. Separate norms for different language groups are not indicated.

Implications of the prevalence of stunting, overweight and obesity amongst South African primary school children: a possible nutritional transition?

To investigate the relationship between stunting and levels of overweight/obesity among South African school children, using two definitions of overweight and obesity, based on the WHO and International Obesity Task Force (IOTF) criteria. Cross-sectional descriptive analysis of the nutritional status of primary school children, using primary data from a rural community-based study undertaken in 1995 and secondary data from the South African National Primary Schools (SANPS) survey conducted in 1994. Stunting was measured according to the WHO definition of -2 Z scores height-for-age. Two sets of criteria were used to measure overweight and obesity-the WHO/NCHS standard based on the 85th and 95th centiles and the IOTF criteria. The primary data source was from a rural KwaZulu-Natal community based survey. The secondary data source SANPS consisted of data at National and Provincial level; for this study only data from the province of KwaZulu-Natal was considered. Primary school children aged between 8 and 11 y of age; 802 from the primary data source and 24 391 from the secondary source. Moderate stunting ranged from 2.9 to 40.2%, and mild stunting ranged from 31.4 to 75%. The prevalence of overweight ranged from 0.4 to 13.3% (WHO criteria) and from 0.4 to 11.9% using the IOTF criteria; while obesity ranged from 0.1 to 3.7% (WHO) and from 0.1 to 1.5% (IOTF criteria). The prevalence of overweight and obesity was observed to be higher using the WHO definition than that of IOTF (0.05<P<0.10). However, good kappa coefficient (kappa) levels of agreement were observed between the WHO and IOTF definitions of overweight and obesity (kappa>0.55, in all cases). The levels of agreement in all cases were less for obesity than overweight (both ranged from 0.55 to 1.0). Females were observed to have higher kappa levels than their male counterparts; they also had higher prevalence levels of overweight and obesity across age and geographical group. Uniformly high levels of both mild and moderate stunting were observed both nationally and provincially. However, no excess relative risk of being overweight if stunted was observed in this study (P>0.05). Caution must be applied when using either definition for obesity. However, very high levels of agreement occur for overweight. There is no obvious relationship between overweight and stunting in this study, but high levels of mild stunting were observed. Regular clinical and epidemiological monitoring of nutritional status needs to be undertaken in South Africa to examine possible future trends of overweight/obesity and their relationship with stunting, and for comparisons with global trends.