WHO Global School-Based Student Health Research Articles

Intakes from healthy and unhealthy food groups and obesity among 5- to 9-year-old South African children

The global pandemic of paediatric overweight and obesity, along with undernutrition among children in low-income countries pose challenges for future health. Unhealthy dietary intake among children is of great concern(1). The aim of this study was to determine the association between intakes from healthy and unhealthy food groups and adiposity among 5- to 9-year-old South African children (n = 920). Conventional dietary intake assessment methods are burdensome; therefore, a short unquantified food frequency questionnaire was developed based on the WHO Global school-based student health survey, which focused on healthy and unhealthy food groups. The new questionnaire includes four healthy food groups (fruits, vegetables, milk, meats) and six unhealthy food groups (hot sugar-sweetened beverages (SSBs), cold SSBs, cookies, candies, salty snacks, fast foods) with five different responses of frequency of intake per week. The food groups reflect foods generally eaten by South African school children. The questionnaire was completed by the parents. Weight and height were measured and WHO BMI z-score (BAZ) was calculated(2). Descriptive statistics were reported using median and interquartile range. Frequency of intakes from food groups were compared across tertiles of BAZ using the Kruskal-Wallis test. The correlation between frequency of intakes from different food groups, and between the food groups and BAZ was calculated. The children reported similar daily intakes from the milk (35.3%), cold SSBs (33%) and hot SSBs groups (27%). Fruit (14%) and vegetables (9.6%) were consumed daily by a small percentage of children, while animal source protein foods (meat, fish, poultry, eggs) were consumed daily by 39% of children. The most frequent daily consumed snacks were salty snacks, e.g. crisps (13.2%), candy (11.1%) and cookies (5.3%), while fast foods were consumed once per week by the largest proportion of children (60.7%). Based on the WHO BMI z-scores, 15.2% of children were overweight, 4.4% were obese and 3.8% were underweight. Children in the highest two tertile groups of BAZ had a higher median weekly frequency of SSB intake (5, IQR 1,7), compared to those in the lowest BAZ tertile (3, IQR 1,7). No other differences were found between frequency of food group intake across BAZ tertiles. There was a weak positive correlation between BAZ and the frequency of SSB intake (r = 0.08, = 0.015), as well as between frequency of milk intake and frequency of SSB intake (r = 0.13, P<0.001), but a weak negative correlation between the frequency of vegetable intake and frequency of SSB intake (r = −0.08, P = 0.01). In conclusion, low fruit and vegetable intakes, combined with regular SSB intakes are evident in this group of children. The frequency of SSB intake was positively associated with adiposity, and SSB intake apparently replaced vegetable intake, but not milk intake among the children.

Depressive Symptoms Among Adolescents in Bangladesh

Adolescent mental well-being hardly took precedence in Bangladesh, which is reflected in both policies and literature. This study assessed the common symptoms of depression among school-going adolescents (aged 10–19 years) in Bangladesh. Primary data were collected during October–November 2019 from 289 participants in four schools using a questionnaire based on the WHO global school-based student health survey and WHO stepwise approach to NCD (Tools version 9.5). Sadness (45.3%) and aggression (40.5%) were the most common depressive symptoms found in the study, followed by confusion (27.7%), worthlessness (21.8%), fatigue (21.5%), and insomnia (18.0%). The sex of the student, grade of study, and duration of daily sleep showed differential associations with these symptoms. These findings indicate a crucial stage of adolescence, where the different societal pressures often ignored by primary carers, could have detrimental effect on children. There is an urgent need to address the growing adolescent mental health issue in Bangladesh and a need for health system to recognize its precedence.

Boys should not be overlooked: Sexual violence victimization and associated factors among school-going adolescents in urban Ghana

BackgroundAdolescent sexual violence victimization is still less researched in countries within sub-Saharan Africa, including Ghana. ObjectivesTo estimate the 12-month prevalence of sexual violence victimization and describe the differences and commonalities in the associated factors between school-going boys and girls in urban Ghana. Participants and settingStudents (n = 1692) aged 13–19 years attending Second Cycle Schools in the Greater Accra Region of Ghana participated in this study. MethodsThis is a cross-sectional survey involving the use of a self-report anonymous questionnaire. Items measuring sexual violence victimization and correlates were adopted from the 2012 WHO–Global School-based Student Health Survey. Data analysis involved bivariable and multivariable approaches. ResultsOverall, 17.6% (95% confidence interval [CI] 15.7, 19.4) adolescents (males = 10.4% [95% CI 8.3, 13.6]; females = 24.3% [95% CI 21.5, 27.3]) reported sexual violence victimization during the previous 12 months. Girls (compared to boys) were nearly three times more likely to report sexual violence victimization (aOR = 2.74, 95% CI 2.01, 3.74, p < 0.001). Breakup, sexual minority status, and conflict with parents were uniquely associated with sexual violence victimization among females. Regardless of gender, adolescents who were in a romantic relationship (aOR = 1.63, 95% CI 1.19, 2.24, p = 0.002) and reported physical abuse victimization (aOR = 1.84, 95% CI 1.36, 2.49, p < 0.001) were more likely to report sexual violence victimization. ConclusionsThe prevalence of sexual violence victimization among school-going adolescents in urban Ghana compares with estimates from sub-Saharan Africa, but also warrants the need for universal and targeted prevention regimes against the offence in both boys and girls.

Self-Harm Among School-Going Adolescent Survivors of Sexual Violence Victimisation: A Cross-Sectional Study.

Background: A growing body of evidence from high-income contexts suggests a strong association between sexual violence victimisation and self-harm and eventual suicide. However, both sexual violence and self-harm among adolescents are still less researched in sub-Saharan African countries, including Ghana.Objectives: To estimate the 12-month prevalence of self-harm, and to describe the associated factors and reported reasons for self-harm among school-going adolescent survivors of sexual violence victimisation during the previous 12 months in urban Ghana.Methods: Analytic data came from a regional-based representative cross-sectional survey including in-school youth (N = 1,723) conducted in 2017 within the Greater Accra Region of Ghana. Of these, 297 (17.2%) self-reported sexual violence victimisation in the previous 12 months; this proportion of the participants (n = 297) was the focus of the current study. Items measuring sexual violence victimisation, self-harm, and correlates were adopted from the 2012 Ghana WHO–Global School-based Student Health Survey and the Child and Adolescent Self-harm in Europe Study. Data analysis involved multivariable logistic regression models.Results: The estimate of self-harm ideation during the previous 12 months was 45.8% (95% CI: 40–52), whereas the estimate of self-harm behaviour was 38.7% (95% CI: 33–44). About two in five of the participants who reported self-harm wanted to die by their last episode of the behaviour. While bullying victimisation was associated with increased odds of self-harm ideation (aOR = 1.97, 95% CI 1.17, 3.31, p = 0.010) and behaviour (aOR = 2.76, 95% CI 1.59, 4.80, p < 0.001), weekly alcohol use (aOR = 2.56, 95% CI 1.32, 4.93, p = 0.005), conflict with parents (aOR = 2.30, 95% CI 1.28, 4.12, p = 0.005), and physical abuse victimisation (aOR = 1.80, 95% CI 1.03, 3.15, p = 0.037) showed strong associations with increased odds of self-harm behaviour in the past 12 months.Conclusions: The evidence underscores the need for both universal and targeted multi-level intervention and prevention programmes to mitigate the offence of sexual violence and reduce the chances of self-harm among adolescent survivors of sexual violence in urban Ghana.

Adolescent Problem Gambling in Rural Ghana: Prevalence and Gender Differentiation

Problem gambling among young people is now a public health challenge in sub-Saharan Africa. However, the behaviour remains understudied, particularly, among rural-dwelling young people in countries within the subregion. We aimed to estimate the 12 months prevalence of problem gambling and to describe the overall and gender differences and commonalities in personal factors and social adversities associated with problem gambling among adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana; we used the DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) questionnaire to assess problem gambling during the previous 12 months. Personal lifestyle and psychosocial variables were assessed using adopted items from the 2012 WHO–Global School-based Student Health Survey. Overall, three in 10 adolescents (3 in 10 females; 4 in 10 males) in rural Ghana reported problem gambling in the previous 12 months. Female adolescents who experienced problem gambling were more likely to report family-related social adversities, while adolescent male problem gambling was associated with school-related factors and interpersonal factors outside the family context. Regardless of gender, sexual abuse victimisation was associated with three times increase in the odds of experiencing problem gambling. Relative to the prevalence of gambling among adolescents in urban contexts in other countries within sub-Saharan Africa, the estimates of problem gambling among in-school rural adolescents in Ghana are higher. Although further studies are needed to understand the nuances of the behaviour, the evidence of this study underscores the need for general and targeted health promotion, intervention and prevention efforts to mitigate the family, school, and interpersonal social adversities associated with adolescent problem gambling in rural Ghana.

Marijuana use and repeated attempted suicide among senior high school students in Ghana: Evidence from the WHO Global School-Based Student Health Survey, 2012

BackgroundThe association between substance use including marijuana use and attempted suicide has been well documented. However, little is known about marijuana use and its association with attempted suicide repetition among...

The age of opportunity: prevalence of key risk factors among adolescents 10-19years of age in nine communities in sub-Saharan Africa.

To measure health-related behaviours and risk factors among sub-Saharan African adolescents. Cross-sectional study in nine communities in Burkina Faso, Ethiopia, Eswatini, Ghana, Nigeria, Tanzania and Uganda between 2015 and 2017. Community-representative samples of males and females 10-19years of age were selected. All communities used a uniform questionnaire that was adapted from the WHO Global School-based Student Health Survey. Weighted prevalence estimates and 95% confidence intervals were calculated for each indicator and stratified by age and sex using SAS version 9.4. All prevalence estimates were pooled across communities through random-effects meta-analyses in Stata version 14. A total of 8075 adolescents participated in the study. We observed a high prevalence of inadequate fruit consumption (57-63%) and low physical activity (82-90%); a moderate prevalence of inadequate vegetable consumption (21-31%), unprotected last sex (38-45%), age at first sex <15years (21-28%) and bullying and physical fighting (12-35%); and a low prevalence of mental health risk factors (1-11%) and alcohol and substance use risk factors (0-6%). We observed a moderate to high prevalence of daily soft drink consumption (21-31%) for all adolescents. Among sexually active adolescents 15-19years, 37% of females reported ever being pregnant and 8% of males reported to have ever made someone pregnant. Bullying (23%) and physical fighting (35%) were more common among younger male adolescents . The prevalence of low mood was generally higher among older (15-19years) than younger adolescents (10-14years). The proportion of adolescents reporting alcohol, drug or cigarette use was very small, with the exception of khat use in Ethiopia. Overall, diet and physical activity, violence, sexual and reproductive health, and depression are important risk factors for these sub-Saharan African communities. These findings suggest that more evidence is needed including novel efforts for the collection of sensitive information, as well as a need to move towards community-tailored interventions to reach adolescent populations with varying needs.

Joint association of screen time and physical activity on self-rated health and life satisfaction in children and adolescents: the CASPIAN-IV study.

Self-rated health and life satisfaction are two subjective measures for assessing overall health status. This study aims to investigate the association of self-rated health and life satisfaction with physical activity and screen time. As part of the fourth survey of a national surveillance program in Iran (CASPIAN-IV study), 14 880 students aged 6 to 18 years were selected via multi-stage cluster sampling from 30 provinces. Data were obtained from the WHO Global School-Based Student Health Survey questionnaire. A total of 13 486 students with mean age of 12.47 (SD 3.36) completed the study. In crude model both prolonged screen time and physical activity were associated with favorable life satisfaction and self-rated health. However, in multivariate analysis only high physical activity was associated with good self-rated health (OR 1.37) and life satisfaction (OR 1.39), while prolonged screen time was not associated with good self-rated health (OR 1.02) and life satisfaction (OR 0.94). For combined screen time-physical activity variable, low screen time-high physical activity combination had the highest OR for both good self-rated health (OR 1.37) and life satisfaction (OR 1.43) in multivariate analysis. Our findings suggest that increasing physical activity is more crucial than emphasizing reducing screen time in improving the well-being of children and adolescents.

Association of socioeconomic status with psychiatric problems and violent behaviours in a nationally representative sample of Iranian children and adolescents: the CASPIAN-IV study

ObjectivesThe aim of the present study was to evaluate the association between socioeconomic status (SES) and psychiatric problems and violent behaviours in a nationally representative sample of Iranian children and...

Regional disparities in psychiatric distress, violent behavior, and life satisfaction in Iranian adolescents: the CASPIAN-III study.

The purpose of this study was to assess the prevalence of violence behaviors, psychiatric distress, and life satisfaction among 10- to 18-year-old Iranian adolescents at national and regional disparities. In this national survey, 5570 students of age 10 to 18 years from urban and rural regions of 27 provinces of Iran were selected through stratified multistage sampling method. Violence behaviors, psychiatric distress, and life satisfaction were assessed by a questionnaire that was prepared based on WHO global school-based student health survey and the WHO-stepwise approach to noncommunicable diseases (Tools version 9.5). The country classification into 4 subnational regions was done based on combination of geography and socioeconomic status (SES). The data were analyzed by the SPSS software. The prevalence of emotional, depressive, and anxiety problem among Iranian students was 17.7%, 16.3%, and 5.7%, respectively. The percentage of emotional and depressive problem differed significantly between different SES distress (p value <.001). The prevalence of bullying, victim, and physical fight was 27.1%, 32.7%, and 50.6% among students aged 10 to 18 years, respectively. Bullying and victim experience were linearly associated with regions' SES. Students who were living in the north-northeast region had maximum self-rated health and life satisfaction in Iran. The results declared that psychiatric distress was more frequent in high SES distress, whereas violence behavior was more frequent in the lowest SES distress. Therefore, in communities with large variations in health and SES in regional level, health policies for primordial and primary prevention of mental and behavioral distress have to be made at regional levels.

Alcohol and other psychoactive substances in Africa and the Americas: results from the WHO Global School-based Student Health Survey

Objective: The objective of this study was to estimate the prevalence of current alcohol use and its association with cigarette and drug use among 13–15-year-olds in Africa and the Americas.Method: Cross-sectional data of the WHO Global School-based Student Health Survey from nine countries in the WHO African Region and seven countries/territories in the WHO Region of the Americas were analysed. Single and joint prevalence rates, and prevalence odds ratios were computed.Results: In the majority of countries, alcohol was the most often consumed psychoactive substance, with the prevalence of current alcohol use outweighing the prevalence of current cigarette and lifetime drug use. Gender differences for alcohol were not marked. The use of alcohol was strongly associated with cigarette or drug use, indicating clustering.Conclusions: For the bulk of countries in the Americas and for single countries in Africa, current alcohol use is as high as prevalence rates occurring in other parts of the world. It is imperative to monitor psychoactive substance use among adolescents in these countries to be able to prevent future health and social harm with the information gained.

Prophylactic thiamine in liquor

<h3>Objectives</h3> The aim of the present study was to evaluate the association between socioeconomic status (SES) and psychiatric problems and violent behaviours in a nationally representative sample of Iranian children and adolescents, based on nationwide surveillance programme data, 2011–2012. <h3>Methods</h3> Overall, 14 880 students, aged 6–18 years, were selected using a multistage cluster sampling method from rural and urban areas of 30 provinces in Iran. SES was estimated based on a main summarised component, extracted from principle component analysis of family assets and parents9 jobs and education. For statistical analysis, SES was classified as ‘low’, ‘middle’ and ‘high’. The WHO-Global School Based Student Health Survey (WHO-GSHS) questionnaire was used to assess psychiatric problems and violent behaviours. <h3>Results</h3> In total, 13 486 students (participation rate 90.6%) completed the study: 50.8% were boys and 75.6% were urban residents, with a mean age of 12.47±3.36 years. In the multivariate model, the ORs of depression, anxiety, feeling worthless, anger, insomnia, confusion and physical fights were lower in students with high SES compared with those with low SES (p&lt;0.05) but physical fights was lower in the high SES group than in the low SES group (p&lt;0.05). No significant relationship was documented between SES and other variables, including getting worried, history of bullying and being victimised. <h3>Conclusions</h3> Children and adolescents with low SES were at higher risk for psychiatric problems and violent behaviours. Mental health policies and public interventional strategies should be considered at the public level, notably for low SES families.