Background Africa is undergoing rapid urbanisation and demographic ageing. It is hypothesised that multiple risk factors and chronic conditions are presenting at younger ages, yet evidence on early emergence in African populations is limited. The aim was to characterise the disease burden among young women living in urban Soweto (South Africa) by examining the prevalence of multimorbidity and investigating the association of poverty-related and behavioural risk factors with multimorbidity. Methods We conducted a cross-sectional analysis of baseline data from 7735 women aged 18–29 years (mean (SD): 22.6 years (2.8)) enrolled in the Bukhali trial. Participants completed interviewer-conducted surveys, physical measurements and clinical assessments. Multimorbidity was defined as the co-occurrence of ≥2 of six-specified conditions (anaemia, obesity, hypertension, diabetes, HIV infection and depression). Findings Severe food insecurity affected 18.5% (n = 1209) of participants’ households, and 91.8% (n = 6829) of young women were unemployed. Hazardous alcohol use was reported by 20% (n = 1539), and 55.5% (n = 4264) reported poor sleep quality. The prevalence of women living with obesity and hypertension was 24.5% (n = 1884) and 8.6% (n = 666) respectively. Depression affected 15.8% (n = 1217), and 22.4% (n = 1700) had multimorbidity. Among poverty-related and modifiable behavioural factors, household food insecurity (RRR 1.21, 95% CI 1.04–1.39) and poor sleep quality (RRR 1.53, 95% CI 1.34–1.76) showed the strongest associations with multimorbidity. Interpretation Young women in Soweto face high anaemia and early cardiometabolic risk, with multimorbidity in their early adulthood. Public health interventions addressing nutrition, sleep, and social factors are needed to curb multimorbidity and improve long-term health. Funding South African Medical Research Council and Canadian Institutes of Health Research (ISA-181192).

Mental health disorders affect millions worldwide, with socially vulnerable youth in urban environments disproportionately affected. South Africa (SA) remains one of the most inequitable countries, and specific pathways linking poverty to mental health remains unclear. This cross-sectional study analysed baseline data from the Bukhali trial in Soweto, SA part of the global Healthy Life Trajectories Initiative (HeLTI). Young women (n = 7735) completed surveys with physical assessments covering sociodemographic, household-level and behavioural-level factors, and mental health. Among the women, 12.6% reported anxiety, 15.8% reported depression, and 9.7% experienced both. Hazardous alcohol use (20.0%) and poor sleep (55.5%) were commonly reportedly behavioural factors among these women. Being in a committed relationship reduced the odds of reporting anxiety and depression (OR ≥0.66), while childhood adversity, hazardous alcohol use, and poor sleep increased the odds (OR ≥1.29). Moderate to severe anxiety greatly increased the risk of depression (OR 32.20). In the comorbid model, while being in a committed relationship remained protective (OR 0.67), childhood adversity and poor sleep quality was associated with substantial risk (OR ≥1.31) of this co-morbidity. In a gSEM constructed a priori, significant direct associations were found for poverty (measured by household socioeconomic status) on alcohol use (p = 0.015), childhood adversity on mental health (p < 0.001), and committed relationship on anxiety (p < 0.001). Mediation analysis revealed that poverty affected anxiety partially through poor sleep (54.2%), and fully via depression (86.9%), and affected depression fully via sleep (43.7%). Childhood adversity associated with depression partially via anxiety (79.4%), sleep (31.3%), and alcohol use (14.2%), and anxiety through depression (88.6%) and sleep (42.2%). In conclusion, childhood adversity, poverty and behavioural factors co-occur, and are collectively associated with elevated symptoms of anxiety and depression among young women in urban-poor settings. While tackling structural inequalities is critical, strengthening mental health support networks in these settings could aid women.

Background: Valid, reliable, and easy-to-administer scales are crucial for identifying mental health conditions, especially in LMICs where such scales tend not to be validated. This study aims to address this gap by investigating the psychometric properties and factorial structure of the PHQ-9 and GAD-7 in a sample of young women in Soweto, South Africa. Methods: The PHQ-9 and GAD-7 were administered to 6028 women aged 18-28 years old. Cronbach's alpha, Mokken scale analysis, and Confirmatory Factor Analysis were used to provide support for the internal consistency and construct validity of these scales. Results: Both scales demonstrated good internal consistency (alpha = 0.81 for PHQ-9 and alpha = 0.84 for GAD-7). Internal consistency reliability was further supported by positive inter-item correlations and item-by-scale correlations for all items on both measures. CFA of the PHQ-9 and GAD-7 showed a reasonable fit for the 1-factor model and 2-factor models (depression and anxiety with somatic and cognitive subtypes). Limitations: This study was limited to young African women in urban Soweto who were proficient in English, which may affect generalizability. Differences in language or cultural context may impact the accuracy and applicability of these scales to other African populations. Conclusion: The PHQ-9 and GAD-7 are valid and reliable for identifying psychological distress in the studied population. Despite showing good psychometric properties, further diagnostic assessment is needed to confirm clinical diagnoses. The scales are useful for identifying those at risk but not a substitute for comprehensive diagnostic evaluations.

There is a notable lack of engagement in reproductive and lifecourse research with and from men, with a disproportionate focus on women. While studies investigating the lack of men's engagement with services exist, there is little evidence on their engagement with reproductive and lifecourse research. This article qualitatively examines men's engagement in such research in the Bukhali trial in South Africa. Single, in-depth interviews were conducted with 19 male partners of Bukhali participants, and data were thematically analysed. Results were grouped into three domains: (i) motivators for engagement, (ii) barriers to engagement, and (iii) recommendations to improve engagement. Motivators to engage included partner support, desiring to learn and gain knowledge, and taking the opportunity to access the same perceived trial benefits as their partner. Barriers included having misconceptions around the research, fear and mistrust of hospitals and illness, gendered ideas around 'women's health issues', hesitance around sharing personal details, and lack of time and perceived (financial) benefits. To increase engagement, male partners recommended increasing awareness and creating safe research spaces for men. Each theme was inflected with male partners' sociocultural and contextual realities and provided valuable insights into obstacles and opportunities for improving men's engagement in reproductive research.

Adverse pregnancy and birth outcomes remain significant public health challenges, particularly in low- and middle-income countries (LMICs). Maternal age and parity are recognised as key factors, yet their combined influence on maternal and infant outcomes is less understood, especially in LMICs. We investigated the combined effects of maternal age and parity on maternal health risks, including body mass index (BMI), gestational diabetes mellitus (GDM), and hypertension, as well as infant birth outcomes, namely birth weight, length, and gestational age, in an urban South African cohort. This study used data from 830 pregnant women (aged 18–44) enrolled in the Soweto First 1000 Days (S1000) longitudinal cohort. Group comparisons were conducted using ANOVA, chi-square, or Kruskal-Wallis tests. Multivariable Linear and logistic regression models assessed associations between age-parity and outcomes, adjusting for sociodemographic factors. Analyses were conducted in StataSE 18; p < .05 was considered significant. Mothers > 23 years, ≥ 1 child had higher BMI (28.6 kg/m², p < .001) and increased likelihood of hypertension (44.1

Background: There is extensive evidence that rapid infant weight gain increases the risk of childhood obesity, but this is normally based on childhood body mass index (BMI) only and whether or not this is because infants with rapid weight gain accrue greater fat mass is unknown. Objective: The primary objective of our study was to test whether the proportion of infant weight gain due to concurrent increases in fat mass is greater in infants with rapid weight gain as compared to those with normal growth. Methods: Body composition was assessed by (1) air-displacement plethysmography (ADP) at 0 and 6 months in 342 infants from Australia, India, and South Africa and (2) deuterium dilution (DD) at 3 and 24 months in 555 infants from Brazil, Pakistan, South Africa, and Sri Lanka. Weight gain and length growth were each categorized as slow, normal, or rapid using cut-offs of <-0.67 or >+0.67 Z-scores. Regression was used to estimate and contrast the percentages of weight change due to fat mass change. Results: Approximately 40% of the average weight gain between 0 and 6 months and 20% of the average weight gain between 3 and 24 months was due to increase in fat mass. In both samples, compared to the normal group, the proportion of weight gain due to fat mass was higher on average among infants with rapid weight gain and lower among infants with slow weight gain, with considerable individual variability. Conversely, slow and rapid length growth was not associated with differential gains in fat mass. Conclusions: Pediatricians should monitor infant growth with the understanding that, while crossing upward through the weight centiles generally is accompanied by greater adiposity gains (not just higher BMI), upward crossing through the length centiles is not.

BackgroundThe use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. ObjectiveThis study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. MethodsA convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). ResultsOf the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. ConclusionsRemote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice.

Background Given the importance of infancy for establishing growth trajectories, with later-life health consequences, we investigated longitudinal body composition among infants from six economically and ethnically diverse countries. Methods We recruited mother-infant dyads using the WHO Multicenter Growth Reference Study criteria. We measured fat-free mass (FFM) in 1393 (49% female) infants from birth to 6 months of age (Australia, India, and South Africa; n = 468), 3–24 months of age (Brazil, Pakistan, South Africa, and Sri Lanka; n = 925), and derived fat mass (FM), fat mass index (FMI), and fat-free mass index (FFMI). Height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WHZ) Z-scores were computed. Sex differences were assessed using a t-test, and country differences using a one-way analysis of covariance. We further compared subsamples of children with average (−0.25 > HAZ < +0.25), below-average (≤−0.25) and above-average (≥+0.25) HAZ. Results HAZ performed well between 0 and 6 months, but less so between 3 and 24 months. The stunting prevalence peaked at 10.3% for boys and 7.8% for girls, at 24 months. By 24 months, girls had greater FMI (10%) than boys. There were significant differences in FFM (both sexes in all countries) and FM (Brazilian boys, Pakistani and South African girls) by 24 months of age between infants with average, above-average, and below-average HAZ. Conclusion In a multi-country sample representing more ideal maternal conditions, body composition was heterogeneous even among infants who exhibited ideal length. Having a mean HAZ close to the median of the WHO standard for length reduced FFM between-country heterogeneity but not FM, suggesting that other factors may influence adiposity.

BackgroundAccurate assessment of body composition during infancy is an important marker of early growth. This study aimed to develop anthropometric models to predict body composition in 3-24-month-old infants from diverse socioeconomic settings and ethnic groups.MethodsAn observational, longitudinal, prospective, multi-country study of infants from 3 to 24 months with body composition assessed at three monthly intervals using deuterium dilution (DD) and anthropometry. Linear mixed modelling was utilized to generate sex-specific fat mass (FM) and fat-free mass (FFM) prediction equations, using length(m), weight-for-length (kg/m), triceps and subscapular skinfolds and South Asian ethnicity as variables. The study sample consisted of 1896 (942 measurements from 310 girls) training data sets, 941 (441 measurements from 154 girls) validation data sets of 3-24 months from Brazil, Pakistan, South Africa and Sri Lanka. The external validation group (test) comprised 349 measurements from 250 (185 from 124 girls) infants 3-6 months of age from South Africa, Australia and India.ResultsSex-specific equations for three age categories (3-9 months; 10-18 months; 19-24 months) were developed, validated on same population and externally validated. Root mean squared error (RMSE) was similar between training, validation and test data for assessment of FM and FFM in boys and in girls. RMSPE and mean absolute percentage error (MAPE) were higher in validation compared to test data for predicting FM, however, in the assessment of FFM, both measures were lower in validation data. RMSE for test data from South Africa (M/F-0.46/0.45 kg) showed good agreement with validation data for assessment of FFM compared to Australia (M/F-0.51/0.33 kg) and India(M/F-0.77/0.80 kg).ConclusionsAnthropometry-based FFM prediction equations provide acceptable results. Assessments based on equations developed on similar populations are more applicable than those developed from a different population.

Background Accurate assessment of body composition during infancy is important, especially for understanding the effects of early growth on later health. This study aimed to develop an anthropometry-based approach to predict body composition in 3–24 month old infants from diverse socioeconomic settings and ethnic groups. Methods An observational, longitudinal, prospective, multinational study of infants from birth to 24 months. Body composition was assessed at 3, 6, 9, 12, 18, and 24 months using deuterium dilution (DD) and anthropometry. Linear mixed modelling was utilized to generate sex-specific fat mass(FM) and fat-free mass(FFM) prediction equations. Length(m), weight-for-length(kg/m), triceps and subscapular skinfolds and Asian ethnicity were used as predictor variables. The study sample consisted of 1896(942 measurements from 310 girls) training data sets, 941(441 measurements from 154 girls) validation data sets from Brazil, Pakistan, South Africa and Sri Lanka, and 349(185 measurements from 124 girls) data sets of infants at 6 months from South Africa, Australia and India of external validation group. Results Sex-specific equations for three age categories (3-9 months; 10-18 months; 19-24 months) were developed and validated and an external validation was performed on the test group. The root mean squared error(RMSE) was similar between validation and test data for assessment of FM and FFM. Root mean squared percentage error(RMSPE) and mean absolute percentage error(MAPE) in validation data were higher for predicting FM but lower for FFM compared to test data. Conclusions Anthropometry-based FFM prediction equations provide acceptable results which have the potential to be developed as a field tool.

Background In utero exposure to human immunodeficiency virus (HIV) and antiretroviral (ART) is associated with adverse birth outcomes, which are often attributed to alterations in placental morphology. This study used structural equation models (SEMs) to examine the impact of HIV and ART exposure on fetal growth outcomes and whether these associations are mediated by placental morphology in urban-dwelling Black South African women. Methods This prospective cohort study included pregnant women living with HIV (WLWH, n = 122) and not living with HIV (WNLWH, n = 250) that underwent repeated ultrasonography during pregnancy, and at delivery, to determine fetal growth parameters in Soweto, South Africa. The size and the velocity of fetal growth measures (i.e., head and abdominal circumference, biparietal diameter, and femur length) were calculated using the Superimposition by Translation and Rotation. Placenta digital photographs taken at delivery were used to estimate morphometric parameters and trimmed placental weight was measured. All WLWH were receiving ART for the prevention of vertical transmission of HIV. Results A trend towards a lower placental weight and significantly shorter umbilical cord length was reported in WLWH compared to their counterparts. After sex stratification, umbilical cord length was significantly shorter in males born to WLWH than in male fetuses born to WNLWH (27.3 (21.6–32.8) vs. 31.4 (25.0–37.0) cm, p = 0.015). In contrast, female fetuses born to WLWH had lower placental weight, birth weight (2.9 (2.3–3.1) vs. 3.0 (2.7–3.2) kg), and head circumference (33 (32–34) vs. 34 (33–35) cm) than their counterparts (all p ≤ 0.05). The SEM models showed an inverse association between HIV and head circumference size and velocity in female fetuses. In contrast, HIV and ART exposure was positively associated with femur length growth (both size and velocity) and abdominal circumference velocity in male fetuses. None of these associations appeared to be mediated via placental morphology. Conclusion Our findings suggest that HIV and ART exposure directly affects head circumference growth in females and abdominal circumference velocity in male fetuses; but may improve femur length growth in male fetuses only.

Objectives There’s paucity of longitudinal studies assessing the role of adolescent growth on adult body composition in developing countries. The aims of this study were to assess the association between adolescent change in height, weight and BMI and early adult height, weight, body fat and lean mass. Methods Magnitude, timing and intensity of height, weight and BMI growth were modelled for participants from the Birth to Thirty (Bt30) cohort (7–23 years). Early adult height, weight, BMI and DXA-derived body composition were obtained 1881 black participants (21–24 years). Linear regression analyses were used to assess associations. Results Adolescents with an earlier onset of puberty were heavier in childhood and had an earlier timing and faster weight gain velocity in late adolescence. The intensity of adolescent weight gain was positively associated with adult BMI and fat mass index (FMI) in females. Early timing of adolescent BMI gain was associated with increased weight and BMI in adult females and FMI in adult males. Achieving peak weight velocity around age at peak height velocity was associated with lower BMI and fat mass in both sexes. Conclusion This study confirms the adverse consequences of excessive weight gain prior to puberty, which is associated with an earlier and faster resurgence in weight gain velocity in early adulthood. Factors that contribute to an asynchronous timing of ages of peak weight and peak height velocities may accentuate the risk of adult obesity.

BACKGROUND:Body composition assessment in the first 2 y of life provides important insights into child nutrition and health. The application and interpretation of body composition data in infants and young children have been challenged by a lack of global reference data.OBJECTIVES:We aimed to develop body composition reference charts of infants aged 0-6 mo based on air displacement plethysmography (ADP) and those aged 3-24 mo based on total body water (TBW) by deuterium dilution (DD).METHODS:Body composition was assessed by ADP in infants aged 0-6 mo from Australia, India, and South Africa. TBW using DD was assessed for infants aged 3-24 mo from Brazil, Pakistan, South Africa, and Sri Lanka. Reference charts and centiles were constructed for body composition using the lambda-mu-sigma method.RESULTS:Sex-specific reference charts were produced for FM index (FMI), FFM index (FFMI), and percent FM (%FM) for infants aged 0-6 mo (n = 470 infants; 1899 observations) and 3-24 mo (n = 1026 infants; 3690 observations). When compared with other available references, there were observable differences but similar patterns in the trajectories of FMI, FFMI, and %FM.CONCLUSIONS:These reference charts will strengthen the interpretation and understanding of body composition in infants across the first 24 mo of life.

Growth patterns may be indicative of underlying changes in body composition. However, few studies have assessed the association of growth and body composition in poorly resourced regions experiencing the double-burden of malnutrition exists. Thus, the aims of this study were to investigate the association of intrauterine and postnatal growth patterns with infant body composition at 2 years in a middle-income country. Participants were from the International Atomic Energy Agency Multicentre Body Composition Reference study. Fat mass (FM), fat free mass (FFM), Fat mass index (FMI), fat free mass index (FFMI), and percentage fat mass (

Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the 'quality' of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts.

Background/Objective Available evidence on infant body composition is limited. This study aimed to investigate factors associated with body composition at 6 and 24 months. Subjects/Methods Multicenter study with data from a 0 to 6-mo cohort (Australia, India and South Africa) and a 3 to 24-mo cohort (Brazil, Pakistan, South Africa, and Sri Lanka). For the 0–6-mo cohort, body composition was assessed by air-displacement plethysmography (ADP) and for the 3–24-month cohort by the deuterium dilution (DD) technique. Fat mass (FM), fat-free mass (FFM), FM index (FMI), and FFM index (FFMI) were calculated. Independent variables comprised the Gini index of the country, maternal and infant characteristics, and breastfeeding pattern at 3 months. For the 3–24-mo cohort, breastfeeding, and minimum dietary diversity (MDD) at 12 months were also included. Crude and adjusted analyses stratified by sex were conducted by multilevel modelling using mixed models. Results At 6 months, every 1 kg increase in birth weight was associated with an increase of 0.716 kg in FFM and 0.582 kg/m 2 in FFMI in girls, whereas in boys, the increase was of 0.277 kg in FFM. At 24 months, compared to those weaned before 12 months, girls still breastfed at 12 months presented a decrease of 0.225 kg in FM, 0.645 kg in FFM and 0.459 kg/m 2 in FFMI, and in boys the decreases were of 0.467 kg in FM, 0.603 kg in FFM and 0.628 kg/m 2 in FFMI. Conclusion Birth weight and breastfeeding are independent predictors of body composition in early life, irrespective of sex.

Objective We examined associations among serial measures of linear growth and relative weight with adult body composition. Design Secondary data analysis of prospective birth cohort studies. Settings Six birth cohorts from Brazil, Guatemala, India, the Philippines and South Africa. Participants 4173 individuals followed from birth to ages 22-46 years with complete and valid weight and height at birth, infancy, childhood and adolescence, and body composition in adult life. Exposures Birth weight and conditional size (standardised residuals of height representing linear growth and of relative weight representing weight increments independent of linear size) in infancy, childhood and adolescence. Primary outcome measures Body mass index, fat mass index (FMI), fat-free mass index (FFMI), fat mass/fat-free mass ratio (FM/FFM), and waist circumference in young and mid-adulthood. Results In pooled analyses, a higher birth weight and relative weight gains in infancy, childhood and adolescence were positively associated with all adult outcomes. Relative weight gains in childhood and adolescence were the strongest predictors of adult body composition (beta (95%CI) among men: FMI (childhood: 0.41 (0.26 to 0.55); adolescence: 0.39 (0.27 to 0.50)), FFMI (childhood: 0.50 (0.34 to 0.66); adolescence: 0.43 (0.32 to 0.55)), FM/FFM (childhood: 0.31 (0.16 to 0.47); adolescence: 0.31 (0.19 to 0.43))). Among women, similar patterns were observed, but, effect sizes in adolescence were slightly stronger than in childhood. Conditional height in infancy was positively associated with FMI (men: 0.08 (0.03 to 0.14); women: 0.11 (0.07 to 0.16)). Conditional height in childhood was positively but weakly associated with women's adiposity. Site-specific and sex-stratified analyses showed consistency in the direction of estimates, although there were differences in their magnitude. Conclusions Prenatal and postnatal relative weight gains were positive predictors of larger body size and increased adiposity in adulthood. A faster linear growth in infancy was a significant but weak predictor of higher adult adiposity.