Contribution of Home and School Environment in Children’s Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment

Figures & data

Table 1 Summary of Evidence on Prevalence of Overweight and Obesity in School Children in Selected African Countries

Author	Year	Country, Region	Age (Years	Study Design	Sample (n)	Prevalence of Overweight/Obesity (%)
Pienaar^Citation3 a	2015	South Africa, North-west	6–9	Longitudinal	574	OB 12.5 baseline; OB 16.6 follow-up
Baard & McKersie^Citation34 a	2014	South Africa, Port Elizabeth	7–10	Cross-sectional	713	OV 20.9, OB 9.8 Boys: OV 18.5, OB 6.9 Girls: OV 23.3, OB 12.9
Negash et al^Citation35 a	2017	South Africa, Western cape	7–18	Cross-sectional	1559	OV 15.6, OB 7.3 Boys: OV 9.4, OB 4.5 Girls: OV 19.7 OB 9.1
Tathiah et al^Citation74 a	2013	South Africa, Nongoma, Ceza	9–12	Secondary data	963	OV 9.0 OB 3.8
Truter et al^Citation94 a	2010	South Africa, Potchefstroom	9–12	Cross-sectional	280	OV 5.5, OB 6.5 Boys: OV 7.2, OB 2.5 Girls: OV 8.3, OB 4.0
Armstrong et al^Citation95 a	2017	South Africa, all 5 provinces	6–13	Cross-sectional	10,285	OV+OB 15.4
Puckree^Citation96 b	2011	S.Africa, Kwazul-Natal	10–12	Cross-sectional	120	OV 5.0
Yusuf et al^Citation36 a	2013	Nigeria, Kano	13–18	Cross-sectional	718	OV 1.98, OB 0.84
Umar et al^Citation37 a	2018	Nigeria, Kano	6–18	Cross-sectional	720	OV 8.9, OB 3.3 Boys: OV 7.0, OB 3.0 Girls: OV 10.8, OB 3.6
Kambonda & Sartorius^Citation4 a	2018	Zimbabwe, Mashonaland	6–12	Cross-sectional	974	OV 6.0, OB 7.7
Kyallo et al^Citation51 b	2013	Kenya, Nairobi	9–14	Cross-sectional	344	OV+OB combined 19.0 Boys: OV+OB 16.8 Girls: OV+OB 21.0
Rapando et al^Citation52 b	2017	Kenya, Langata, Nairobi	14–18	Cross-sectional	292	OV+OB 17.8 Boys: OV+OB 16.96 Girls: OV+OB 20.59
Muthuri et al^Citation53 b	2014	Kenya, Nairobi	9–11	Cross-sectional	563	OV 14.4, OB 6.4
Annan-Asare et al^Citation39 e	2017	Ghana, Accra metropolis	11–15	Cross-sectional	260	Boys: OV 26.1, OB 26.0 Girls: OV 33.3, OB 27.0
Musa et al^Citation5 a	2012	Nigeria, Bene	9–16	Cross-sectional	3240	adolescents: OV 9.7, OB 1.8 children: OV 18.3, OB 3.2
Wamba et al^Citation7 a	2013	Cameroon, Douala	8–15	Cross-sectional	2689	OV 12.4, OB 1.9
Van den Berg et al^Citation40 b	2014	Lesotho, Maseru	16	Cross-sectional	221	Boys: OV 8.3 Girls: OV 27.2
Mohamed & Vuvor^Citation6 b	2012	Ghana, Accra	5–15	Cross-sectional	270	OV 15.8 OB 10.9 Boys: OV 16.7, OB 7.2 Girls: OV 15.0, OB 15.0
Ofakunrin et al^Citation38 a	2018	Nigeria, Jos north central	6–13	Cross-sectional	600	OV 10.3 OB 1.7
Sagbo et al^Citation15 a	2018	Togo, Lomé	8–17	Cross-sectional	634	OV 5.2, OB 1.9 Boys: OV 3.8 Girls: OV 6.4
Nagwa et al^Citation50 b	2011	Sudan, Khartoum	10–18	Cross-sectional	1138	OV 10.8, OB 9.7 Boys: OV 9.9 OB 11.4 Girls: OV 11.6, OB 8.2
Salman et al^Citation49 c	2010	Sudan, Khartoum	6–12	Cross-sectional	304	OV 14.8, OB 10.5 Boys: OV 11.8, OB 5.9 Girls: OV 14.0, OB 11.0
Hussein et al^Citation48 b	2018	Northern Sudan, Argo	6–14	Cross-sectional	1223	OV 6.2, OB 1.5 Boys: OV 5.4, OB 1.6 Girls: OV 7.0, OB 1.5
Hussein^Citation46 c	2018	Libya, Misurata	6–11	Cross-sectional	1000	OV 15.8, OB 12.4 Boys: OV 15.4, OB 12.5 Girls: OV 16.1, OB 12.2
Sheriff^Citation47 e	2016	Libya, Chennai	12–18	Cross-sectional	900	Boys: OV 10.0, OB 2.9 Girls: OV 8.0, OB 1.5
Taha & Marawan^Citation42 c	2015	Egypt, Menoufia	8–12	Cross-sectional	354	OV 19.5, OB 23.7 Boys: OV+OB 46.4 Girls: OV+OB 53.6
Talat & El-Shahat^Citation44 d	2015	Egypt, Sharkia	12–15	Cross-sectional	900	OV 20.0, OB 10.7 Boys: OV 20.1, OB 10.4 Girls: OV 19.9, OB 10.9
Badawi et al^Citation45 d	2013	Egypt, Port Said city	12–15	Cross-sectional	852	OV 17.7, OB 13.5 Boys OV 18.4, OB 13.0 Girls OV 17.1, OB 14.0
Hadhood et al^Citation43 d	2017	Egypt, Sohag	6–14	Cross-sectional	711	OV 16.5, OB 14.6
Mekonnen et al^Citation8 b	2018	Ethiopia, Bahir Dar	6–12	Cross-sectional	616	OV+OB 11.9 OV 8.8, OB 3.1
Desalew et al^Citation41 c	2017	Ethiopia, Dire dawa	11–15	Cross-sectional	448	OV 14.7, OB 5.8 Boys: OV 12.3, OB 8.6 Girls: OV 16.5, OB 3.8
Peltzer & Pengpid^Citation55 a	2011	Ghana & Uganda	13–15	National data survey	5613	Boys: OV+OB 3.2 Girls: OV+OB 10.4
Chebet et al^Citation54 b	2015	Uganda, Kampala	8–12	Cross-sectional	958	OV 32.3, OB 21.7
Mosha & Fungo^Citation56 b	2010	Tanzania, Dar-es salaam and Dodoma	6–12	Cross-sectional	428	OV 5.8, OB 6.4 in 6–9 years OV 4.9, OB 5.4 in 10–12 years
Muhihi et al^Citation58 a	2013	Tanzania, Dar-es salaam	6–17	Cross-sectional	446	OV 9.8 OB 5.2 Boys; OV6.3 OB 3.8 Girls; OV13.1 OB 6.3
Mwaikambo et al^Citation59 a	2015	Tanzania, Dar-es salaam	7–14	Cross-sectional	1722	OV 10.2, OB 4.5 Boys OV+OB comb 14.9 Girls: OV+OB comb 14.5
Pangani et al^Citation61 b	2016	Tanzania, Dar-es salaam	8–13	Cross-sectional	1781	OV 15.9, OB 6.7 Boys: OV 12.1, OB 4.0 Girls: OV 18.7, OB 8.0
Kimario^Citation60 a	2015	Tanzania, Kilimanjaro	10–12	Cross-sectional	140	OV+OB 20
Tluway et al^Citation57 a	2018	Tanzania, Manyara	10–19	Cross-sectional	619	OV+OB 9.2

Note: ^aIOTF, ^bWHO, ^cCDC, ^dEGC and NRC, ^eunspecified.

Abbreviations: CDC, Centre for Disease Control; EGC and NRC, Egyptian Growth Charts and National Research Centre; IOTF, International Obesity Task Force; OV, overweight; OB, obesity; WHO, World Health Organization.

Table 2 Summary of Studies on Influence of School and Home Environment on Children Food Choice in Selected African Countries

Study	Country	Environment	Study Design	Description of Findings
Kalimbira & Gondwe, 2015^Citation62	Malawi	School & Home	Cross- sectional	Many school children (>80%) consume sugar-sweetened beverages regularly, carbohydrate-rich foods, before going to school, at school and after school.
Brown et al, 2015^Citation63	Botswana	School & Home	Qualitative	Parental control dictates what a child eats; eating out exposes a child to junk foods; peer pressure influence on food choice; energy-dense foods are readily available in school shops.
Itatiro, 2014^Citation64	Tanzania	School	Cross-sectional	Food vendors around school environments formed the main food suppliers, followed by school shops, canteens. Main foods supplied were snacks and soft drinks, while fruits, vegetables and dairy products were less available.
Sedibe et al, 2014^Citation65	South Africa	School & Home	Qualitative	Role of caregivers in preparing healthy foods through the availability of home gardens; adolescent perception on healthy foods; barriers to access healthy foods.
Bekker et al, 2017^Citation66	South Africa	School	Mixed method	The presence of healthy food varieties in the school tuck shop influenced a positive attitude and perceptions towards healthy eating although unhealthy options should also be available.
Abrahams et al, 2011^Citation67	South Africa	School	Quasi-experiment	Children who brought lunch boxes to school comprised of healthy food options had lower BMI compared to children who bought food items from school shops.
Kupolati et al, 2017^Citation20	South Africa	School	Qualitative	Teachers perceived that nutrition education can influence positive healthy eating habits in the school environment.
Feeley & Norris, 2014^Citation69	South Africa	School & Home	Cross-sectional	Consumption of fast foods such as fried chips and sweetened beverages at school, at home and around the community was higher among adolescents (17years old) compared to consumption of confectionary and salty snacks in the urban environment
Faber et al, 2013^Citation68	South Africa	School	Cohort	School environment provides less options of health foods like fruits and vegetables but more of unhealthy food items like chips, sweets, chocolates and biscuits which are preferred by children.
Chan Sun et al, 2009^Citation27	Mauritius	School	Cross-sectional	Confectionaries and deep-fried foods, soft drinks and desserts were most commonly sold (by more than 75%) followed by main meals from canteens and food vendors; healthy foods like dairy products and fruits were also available

Abbreviation: BMI, body mass index.

Figure 1 Flow chart of the selection process for inclusion of eligible studies.

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