Health Kick was a randomized control trial school-based nutrition and physical activity intervention programme
for the prevention of non-communicable diseases (NCDs) which took place in disadvantaged primary schools in South Africa
over four years. This paper reports on the impact of the intervention on the dietary adequacy of learners after 18 months of
Sixteen primary schools were selected from a total of 232 and randomly allocated to intervention (n=8) and control
schools (n=8). At baseline (February, 2009), 613 learners were selected and 784 at follow-up (October, 2010). The school
intervention comprised an action planning process with provision of a curriculum, manuals, and resource toolkit for educators.
At 18 months learner?s nutrition knowledge, attitudes and behaviour, dietary intake and anthropometric measurements (height
and weight) were assessed. The data were used to generate a dietary diversity score (DDS), and meal score. Dietary adequacy was
defined as having a DDS ≥4. Multiple correspondence analyses were used to develop a score for nutrition knowledge and self-
efficacy. The determinants of dietary adequacy were identified using multiple logistic regression analysis.
At baseline, the intervention schools had a higher median knowledge score (2.27 vs. 1.83), than the control schools.
Follow-up at the intervention schools showed a decrease in median scores for knowledge (2.27 to 2.04), self-efficacy (2.68 to
2.44), BMI z-scores (2.75 to 2.21), an increase in the percentage of learners eating school food shop purchases (44.3% to 52.9%);
and having an adequate diet (77.1% to 88.8%). Follow-up at the control schools found an increase in the percentage learners
eating food shop purchases (48.7% to 64.9%) and having an adequate diet (77.2% to 86.9%). Multivariate analysis found that the
predictors of dietary adequacy were meal score, having a school feeding programme, urban area and male gender.
Although positive behaviour changes were seen, the percentage learners having an adequate diet increased in
both the intervention and control schools. Dietary adequacy appeared to be largely reliant on socio-economic determinants.
Successful interventions in low income settings need to take into account that schools have many serious immediate priorities
which rate higher than education on NCDs.
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