Background: Micronutrient deficiencies and physical inactivity can adversely affect child growth and development. This study assessed the effects of school-based physical activity and multi-micronutrient supplementation on micronutrient status among schoolchildren in Kilombero district, Tanzania. Methods: In a cluster-randomized trial, children aged 6-12 years were allocated to physical activity, multi-micronutrient supplementation, combined physical activity plus supplementation, or placebo control. Anthropometric and biochemical assessments were conducted at baseline, 14 months, and 26 months. Dried blood spot samples were available for 923 children at baseline. Complete-case analyses used biomarker-specific subsamples with valid baseline and 26-month measurements. Results: The primary complete-case sample included 243 children with valid paired measurements for zinc and serum transferrin receptor; vitamin D analyses were restricted to 52 children because of missing or invalid samples. At baseline, iron and vitamin D deficiencies were common, affecting 42.8% and 39.9% of children, respectively, while zinc deficiency affected 11.9%. At 26 months, allocation to the physical activity intervention was associated with lower odds of zinc deficiency, both when delivered alone (OR = 0.16) and when combined with supplementation (OR = 0.57). Supplementation alone was not significantly associated with reduced zinc deficiency. Iron status did not differ between intervention groups. Vitamin D findings should be interpreted with caution because analyses were based on a very small biomarker-specific subsample. Conclusions: School-based physical activity, alone or combined with multi-micronutrient supplementation, was associated with lower odds of zinc deficiency among Tanzanian schoolchildren. Supplementation alone showed no clear benefit for zinc or iron status. Vitamin D findings remain inconclusive because of substantial biomarker-specific missingness. Future trials should strengthen adherence monitoring, biomarker follow-up, and repeated assessment of dietary and contextual factors.

Children in low- and middle-income countries are disproportionately affected by socioeconomic disparities, which might influence access to diverse and nutritious foods, increasing the risk of food insecurity and low dietary quality. Hence, monitoring of these conditions is crucial. This study examined whether children from households with different wealth status vary concerning food insecurity, dietary diversity, consumption of specific food groups, and risk of stunting. Baseline data were utilized from a multi-country randomized intervention trial. Primary school children (Mage= 8.3±1.4 years; 416 girls and 423 boys) from four schools in a marginalized, peri-urban area (government-defined wealth index quintile 3) in Gqeberha, South Africa, participated. Parents/guardians provided information about household socioeconomic factors and completed a 24-hour food item checklist and a food security questionnaire. Stunted children were defined as <-2 SD height-for-age compared to current World Health Organization child growth standards. Analyses of variance and χ2-tests were employed to compare children classified into five wealth quintiles. On average, children consumed food items from 5.8±2.0 healthy food groups. One out of 12 children (8.4

Childhood overweight and obesity are increasing in low- and middle-income countries, including Tanzania, due to changing lifestyles and diets. This study evaluated the effect of a school-based physical activity (PA) programme and multi-micronutrient supplementation (MMNS) on body composition among primary schoolchildren in the Kilombero district, Tanzania. In a cluster-randomized design, children aged 6–12 years were assigned to one of four groups: PA, MMNS, both interventions combined (PA + MMNS), or control. Body composition was assessed at baseline and after 14 months (T2) and 26 months (T3). Among 745 children (396 girls, 349 boys) from 16 clusters assessed at T3, no statistically significant differences in overall body composition (primary outcome) were observed across intervention groups compared to control. However, sex-stratified analyses revealed important differential responses: girls in the PA arm showed significant decreases in both fat mass (FM) and fat-free mass (FFM), while girls in the PA + MMNS arm exhibited significant decreases in FFM and truncal fat-free mass (TrFFM). In contrast, boys in the MMNS arm demonstrated significant increases in FFM and TrFFM, while boys in the PA + MMNS arm showed significant increases in FFM and TrFFM alongside a significant decrease in truncal fat mass (TrFM). The interventions showed gender-specific effects on body composition. Further research is warranted to understand why boys and girls respond differently to similar interventions. The study was registered on 9 August 2018, with ISRCTN. https://doi.org/10.1186/ISRCTN29534081 .

Background/Objectives: Declining physical activity (PA) and cardiorespiratory fitness (CRF) in children are global public health concerns, particularly in populations experiencing urbanization and economic transition. This study investigated the effects of a school-based intervention on PA, CRF, and cardiovascular disease (CVD) risk factors in children aged 6–12 years from marginalized communities in Gqeberha, South Africa. Methods: A cluster randomized controlled trial was conducted in four schools, with participants randomly assigned to one of the following four arms: (i) PA and multi-micronutrient supplementation (MMNS); (ii) PA and placebo; (iii) MMNS; or (iv) placebo (control). A total of 1151 children were assessed at baseline (T1), 1003 at post-intervention (T2), and 549 at follow-up (T3). PA was measured using accelerometers. Secondary outcomes included CRF (20 m shuttle-run) and CVD risk factors (i.e., anthropometry, blood pressure, glycated hemoglobin [HbA1c], and lipid profile). Mixed linear models adjusted for baseline characteristics were used. Results: None of the interventions significantly improved daily PA. From T1 to T2, the MMNS arm significantly increased CRF, while PA + MMNS reduced HbA1c. However, MMNS alone increased triglycerides, and PA + placebo increased low-density lipoprotein (LDL). From post-intervention (T2) to follow-up (T3), the MMNS arms significantly reduced blood pressure. Yet, the PA + MMNS arm increased body fat percentage and decreased high-density lipoprotein (HDL). Conclusions: While MMNS showed promise for improving fitness and blood pressure and PA + MMNS reduced HbA1c, adverse metabolic changes emerged. The results should be interpreted with caution due to the short intervention span and COVID-19 disruptions during the second year of the intervention.

BackgroundStunting and overt malnutrition remain prevalent among school age children in rural areas of Côte d'Ivoire while obesity is increasing in urban areas. Associations of children's nutritional status, Plasmodium infection, physical activity and household characteristics with body composition were analyzed to identify what factors might be contributing to this dual burden of disease.MethodsLongitudinal growth curve models (LGCM) evaluated associations of micronutrient status, household food security, Plasmodium falciparum prevalence and physical activity assessed at three time points with fat free mass and fat mass.ResultsMore severe anaemia was inversely associated with FFM and TrFFM trajectories overall and among girls. P. falciparum infection had an indirect inverse association with FFM trajectories through anaemia among girls and through reductions of vitamin A directly associated with FFM. Changes in zinc concentrations were positively associated with FM trajectories overall and among boys. Food insecurity was inversely associated with FFM among boys from lower socio-economic status (SES) households while increased MVPA was associated with reduced fat mass among girls.ConclusionsThe integration of Malaria control programs with efforts to improve household healthy diet and promote physical activity can lead to improvements in body composition and overall child health and wellbeing.

Background: Physical activity (PA) and adequate micronutrient intake are essential for brain development and may influence cognitive function and academic achievement. However, few large-scale studies have assessed the combined effects of PA and multi-micronutrient supplementation (MMNS) in school-age children. Methods: A cluster-randomized placebo-controlled trial in four peri-urban Tanzanian schools assigned children to one of four groups: (i) PA alone; (ii) MMNS alone; (iii) PA plus MMNS; or (iv) placebo. Children were followed over two school years with assessments at baseline, 14 months, and 26 months. Cognitive function was assessed using computerized Flanker tasks. Academic achievement was evaluated through end-of-year exams in mathematics and Kiswahili subject scores. Anthropometric measures determined nutritional status. Data were analyzed using generalized estimated equations (GEE). Results: Complete data from 559 children (326 girls, 233 boys) aged 6–12 years showed differing characteristics across groups, particularly age and body mass index. No significant intervention effects on cognitive function were found. MMNS groups (alone or combined with PA) showed significantly higher Kiswahili scores, while PA alone had the lowest performance compared to placebo. No intervention effect was found in mathematics. Sex, hemoglobin level, and baseline measures were key predictors for cognition or academic performance. Conclusions: PA and MMNS interventions showed no significant cognitive or academic improvements versus placebo. Further research should optimize school-based nutrition and PA programs for improved learning outcomes.

Background:Physical activity is pivotal in promoting overall health and wellbeing, improving brain function and cognitive performance, and reducing risk of excessive weight and non-communicable diseases. Despite these benefits, physical inactivity among children and adolescents remains a global concern, particularly in low- and middle-income countries (LMICs). Only few studies have explored the association between physical activity, nutritional status, and cognitive performance in LMICs like Tanzania. This study assessed these associations among school children in a rural setting in southern Tanzania. Methods:Physical activity was assessed using an actigraphy device that assessed 7-day average of physical activity among school children aged 6-13 years. Cognitive performance was assessed via the Flanker task, which assessed the executive domain of cognitive functions, specifically information processing and inhibitory control. Weight was determined using Tanita digital scale, and height was measured using measuring board. A multinomial logistic regression model and a gamma generalized linear model with a log link function were used to examine the association between physical activity, nutritional status, and cognitive performance. Results:Among 678 children who participated in the baseline assessment, 77.9% had normal weight, 14.3% were underweight, 5.5% were overweight, and 2.4% were obese. Most (92.6%) of the children engaged in at least 60 min per day of moderate-to-vigorous physical activity (MVPA) as per WHO recommendations. Children who did not meet the recommended MVPA level were nearly three times more likely to be obese compared to those who did. No statistically significant associations were found between physical activity and cognitive performance, or between nutritional status and cognitive performance. Conclusion:This study highlights a high prevalence of normal weight and adherence to WHO-recommended MVPA levels among school children in southern Tanzania. However, children not meeting MVPA criteria were more likely to be obese, indicating the importance of physical activity in maintaining a healthy weight. The lack of association between physical activity or nutritional status and cognitive performance, indicates that there may be additional factors that influence cognitive outcomes. Further research is needed to explore these interactions, particularly in rural LMIC settings.

Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0-11 months of age and ST-ETEC infections among children 12-23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12-59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children's feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities.

Introduction: Physical activity (PA) promotion combined with multimicronutrient supplementation (MMNS) among school -age children may reduce fat mass accrual and increase muscle mass through different mechanisms and so bene fi t child health. This study determined the ef fi cacy of combined interventions on body composition among South African schoolchildren and determined if micronutrients mediate these effects. Study design: Longitudinal cluster randomized controlled trial of children followed from 2019 to 2021. Statistical analyses carried from 2022 to 2023. Setting/participants: A total of 1,304 children 6 - 12 years of age recruited from public schools in Gqeberha, South Africa. Intervention: Children were randomized by classes to either: (a) a physical activity group (PA); (b) a MMNS group; (c) a physical activity + multimicronutrient supplementation group (PA + MMNS); and (d) a placebo control group. Main outcome measures: Trajectories of overall and truncal fat free mass (FFM) and fat mass (FM) estimates in modeled at 9 and 21 months using latent growth curve models (LGCM). Changes in micronutrient concentrations at 9 months from baseline. Results: An increased FFM trajectory was found among children in the MMNS arm at 9 months (Beta 0.16, 95% CI = 0.12, 0.31). The PA and MMNS arms both had positive indirect effects on this trajectory at 9 months (Beta 0.66, 95% CI = 0.44, 0.88 and Beta 0.32 95% CI = 0.1 0.5, respectively) and similarly at 21 months when mediated by zinc concentration changes. A reduced FM trajectory was found among children in the PA promotion arm at 9 months when using this collection point as the referent intercept. This arm was inversely associated with the FM trajectory at 9 months when mediated by zinc changes. Conclusions: PA and MMNS promotion in school -based interventions directly contributed to reductions in FM and increased FFM among South African children and indirectly through changes in micronutrient status.

Childhood undernutrition is a major issue in low- and middle-income countries, affecting the health, well-being, and educational outcomes of schoolchildren. This study aimed to assess the prevalence and associated factors of stunting, wasting, and underweight among schoolchildren in peri-urban areas in the south-eastern part of Tanzania. A cross-sectional study was conducted involving 930 children aged 6–12 years from four primary schools from July to August 2019. The WHO Anthro Survey Analyzer was employed to estimate the prevalence of stunting, wasting, and underweight, while logistic regression analyses examined sociodemographic background, malaria infection, anaemia, anthropometric measures, and dietary diversity score as potential factors. The prevalence of stunting, wasting, underweight, overweight, and obesity was 11.8%, 4.3%, 3.9%, 11.1%, and 2.0%, respectively. Overall, 1.5% of the children had malaria, as determined by rapid diagnostic tests, and 0.4% had severe anaemia. Univariate analysis indicated higher odds of undernutrition among children aged 9–12 compared to their younger peers. Stunting was more common among children with low and medium dietary diversity. Anaemia was found in 11.2% of schoolchildren, and severe anaemia was associated with wasting. Multivariate analysis revealed that age and low dietary diversity were significantly associated with undernutrition. These findings emphasise the need for school-based health and nutrition programmes targeting children beyond the age of 5 to improve their nutritional status and mitigate potential adverse effects on health, cognition, and academic achievement. Regular assessment of the nutritional status of schoolchildren is warranted.

Background/aimSchool-aged children in low- and middle-income countries carry the highest burden of intestinal helminth infections, such as soil-transmitted helminths (STH). STH infections have been associated with negative consequences for child physical and cognitive development and wellbeing. With the epidemiological transition and rise in cardiovascular disease (CVD), studies have shown that helminth infections may influence glucose metabolism by preventing obesity. Thus, the aim of this study was to determine the association of STH infections in schoolchildren from Gqeberha, focusing on physical activity, physical fitness, and clustered CVD risk score.MethodsThis cross-sectional study involved 680 schoolchildren (356 girls and 324 boys; mean age 8.19 years, SD±1.4) from disadvantaged communities in Gqeberha (formerly, Port Elizabeth), South Africa. Stool samples were collected and examined for STH infections using the Kato-Katz method. Physical activity (accelerometer) and physical fitness (grip strength, 20 m shuttle run) were measured using standard procedures. Furthermore, anthropometry, blood pressure, as well as glycated haemoglobin and lipid profile from capillary blood samples were assessed. We employed one-way ANOVAs to identify the associations of STH infections in terms of species and infection intensity with physical activity, physical fitness, and clustered CVD risk score.ResultsWe found a low STH infection prevalence (7.2%) in our study, with participants infected with at least one intestinal helminth species. In comparison to their non-infected peers, children infected with STH had lower mean grip strength scores, but higher mean VO2max estimation and higher levels of MVPA (p < .001). When considering type and intensity of infection, a positive association of A. lumbricoides infection and MVPA was found. In contrast, light T. trichiura-infected children had significantly lower grip strength scores compared to non and heavily-infected children. VO2max and MVPA were positively associated with light T. trichiura infection. No significant association between the clustered CVD risk score and infection with any STH species was evident.ConclusionsSTH-infected children had lower grip strength scores than their non-infected peers, yet, achieved higher VO2max and MVPA scores. Our study highlights that the type and intensity of STH infection is relevant in understanding the disease burden of STH infections on children's health. The findings of our study must be interpreted cautiously due to the low infection rate, and more research is needed in samples with higher prevalence rates or case-control designs.

Malnutrition and parasitic infections are often interconnected in a vicious cycle. Malnutrition can lead to changes in immune response, which may affect cytokine concentrations and potentially increase susceptibility to infections. In turn, parasitic infections can exacerbate malnutrition by impairing nutrient absorption. This cross-sectional study aimed to explore this interplay. Schoolchildren aged 6–12 years living in rural Tanzania (n = 120) provided blood, stool and urine samples to determine the relationship between cytokine concentrations (interleukin 4 (IL-4), interferon gamma (IFNγ) and interleukin 17A (IL-17A)), parasitic infections, undernutrition and micronutrient deficiency adjusting for sex, age, inflammatory markers, socioeconomic status and school categories. All schoolchildren had a normal blood cell count. The concentration of IL-4 was significantly higher in schoolchildren diagnosed with stunting, Schistosoma mansoni infection, a high C-reactive protein concentration, nausea, poor housing and increasing age. The concentration of IFNγ was associated with Plasmodium falciparum and Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii infections, vitamin A deficiency, attending the most remote schools and low socioeconomic status. Our study confirms a potential relationship between cytokine concentrations and parasitic infections, malnutrition and low socioeconomic status. A better understanding of long-term effects of parasitic infections and malnutrition on the immune function could help in designing tailored and effective interventions.

ObjectivesMuscular strength represents a specific component of health-related fitness. Hand grip strength (HGS) is used as an indicator for musculoskeletal fitness in children. HGS can also be used as a marker of cardiometabolic risk, but most available HGS data are derived from Western high-income countries. Therefore, this study examines whether HGS is associated with body composition and markers of cardiovascular risk in children from three sub-Saharan African countries.DesignCross-sectional study.SettingPublic primary schools (grade 1–4) in Taabo (Côte d’Ivoire), Gqeberha (South Africa) and Ifakara (Tanzania).ParticipantsData from 467 children from Côte d’Ivoire (210 boys, 257 girls), 864 children from South Africa (429 boys, 435 girls) and 695 children from Tanzania (334 boys, 361 girls) were analysed.Primary and secondary outcome measuresBody composition (assessed via bioelectrical impedance analysis) was the primary outcome. Cardiovascular risk markers were considered as secondary outcome. Blood pressure was measured with an oscillometric monitor, and blood markers (cholesterol, triglycerides, glycated haemoglobin) via Afinion point-of-care testing. HGS (independent variable) was assessed with a hydraulic hand dynamometer. Inferential statistics are based on mixed linear regressions and analyses of covariance.ResultsAcross all study sites, higher HGS was associated with lower body fat, higher muscle mass and higher fat-free mass (p<0.001, 3.9%–10.0% explained variance), both in boys and girls. No consistent association was found between HGS and cardiovascular risk markers.ConclusionsHGS assessment is popular due to its simplicity, feasibility, practical utility and high reliability of measurements. This is one of the first HGS studies with children from sub-Saharan Africa. There is a great need for further studies to examine whether our findings can be replicated, to develop reference values for African children, to establish links to other health outcomes, and to explore whether HGS is associated with later development of cardiovascular risk markers.Trial registration numberISRCTN29534081.

The 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. Children 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). A 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. Our 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. ISRCTN, 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)

Background Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries. However, not enough data concerning this issue is available. The aim of this study was to assess the distribution of nutritional indicators, anemia and micronutrient deficiency and their underlying risk factors among schoolchildren in south-eastern Tanzania. Methodology/Principal findings This cross-sectional study enrolled primary schoolchildren aged 6–12 years from Kikwawila and Kiberege wards, Tanzania. In total, 471 schoolchildren underwent a physical examination and provided blood, stool and urine samples for an assessment of the levels of different micronutrients, nutritional and anemia status, and parasitic infection status. We employed bivariate and multivariate logistic regression to determine the association between nutritional statuses, anemia, micronutrient deficiency and parasitic infections. We found that 23.90%, 12.60% and 16.20% of schoolchildren were stunted, underweight and wasted, respectively. About 14.0% of schoolchildren were found to be anemic. Children diagnosed with Plasmodium falciparum infection were more likely to have low levels of ferritin (aOR: 10.40, 95% CI: 2.88-40.53) and elevated levels of serum soluble transferrin receptor (aOR: 3.59, 95% CI: 1.27-11.23), respectively. Vitamin A (34.71%) and vitamin B12 (8.79%) were the most prevalent micronutrients found to be deficient in diagnosed children. Finally, we found that schoolchildren attending the most rural schools were five times more likely to be diagnosed with at least one micronutrient deficiency (aOR: 5.04, 95% CI: 2.38–11.44). Conclusions/Significance Malnutrition, anemia and micronutrient deficiency still pose a significant health burden among schoolchildren living in rural Tanzania. To effectively tackle this burden, health interventions such as deworming, micronutrient supplementation, vector control, health education and access to clean water and improved sanitation should be strengthened and made sustainable.

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.

Background: Over the past decades, childhood overweight has increased in many African countries. We examined the relationship between sedentary behaviour, moderate-to-vigorous physical activity (MVPA), and body composition in South African primary schoolchildren living in peri-urban settings. Methods: MVPA was measured via 7-day accelerometry and body composition via bioelectrical impedance analysis in 1090 learners (49.2% girls, Mage = 8.3 ± 1.4 years). The relationships between MVPA and sedentary behaviour with the various body composition indicators (body fat and fat-free mass [total, truncal, arms, and legs], bone mass, muscle mass, and body water) were tested with mixed linear regressions. Results: The prevalence of overweight and obesity was 9.8% and 6.6%, respectively; 77.1% of the children engaged in ≥60 min of MVPA/day. Girls were more likely to be overweight/obese, to accumulate less than 60 min of MVPA/day, and had significantly higher relative body fat than boys (ps < 0.001). Lower MVPA was associated with a higher likelihood of being overweight/obese, higher relative body fat, and lower relative fat-free mass, bone mass, muscle mass, and body water (ps < 0.001). For lower sedentary behaviour, the associations with body composition pointed in the opposite direction. Conclusions: In this South African setting, girls are a particularly relevant target group for future physical activity interventions to prevent overweight/obesity-related non-communicable diseases in later life.

Background A balanced nutrition is important for children’s physical and cognitive development; yet, remains a challenge in many parts of low- and middle-income countries (LMICs). Early detection of nutritional deficiency and metabolic syndrome in school-aged children is necessary to prevent non-communicable diseases (NCDs) in later life. This study aimed at obtaining baseline data on health, nutritional status, and metabolic markers of NCDs among primary schoolchildren in Côte d’Ivoire. Methods A cross-sectional survey was conducted among 620 children from 8 public primary schools located in the south-central part of Côte d’Ivoire. Underweight and overweight were defined as a body mass index (BMI; kg/m2) < 5th and 85th up to 95th percentile for sex and age, respectively. Dietary diversity of children was calculated based on a 24-hour recall conducted with the primary caretaker according to the guideline of Food and Agriculture Organization. Anaemia, malaria, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood glucose levels (HbA1c) were assessed, using capillary blood samples. Logistic models were performed to identify risk factors associated with overweight, HDL-C, LDL-C, and HbA1c. Results Among the 620 children (330 girls, 290 boys; M age 8.0 (± 1.7) years), 530 children attended school in a semi-urban and 90 in a rural area. Around 60% of children had a medium dietary diversity score (DDS). Children in peri-urban areas consumed more cereals (80.2% vs. 63.3%, p < 0.05). Most children were normal weight (n = 496), whereas 3.9% of children classified as prediabetic, 5% were underweight, and 15% overweight. LDL-C and HDL-C levels of children were associated with age, high DDS, and moderate anaemia. A significant association was found between prediabetes and malaria infection, as well as medium and high DDS. Overweight was associated with malaria infection and moderate anaemia. Conclusion Overweight, prediabetes, low HDL-C, malaria, and anaemia are the main concerns of children’s health in Taabo. Our findings highlight interactions between infectious diseases, particularly malaria, and NCD risk factors. Monitoring NCD risk and infectious disease comorbidity in LMIC paediatric populations simultaneously is essential to better understand the dual diseases burden and apply early prevention measures.