Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;21 Suppl 1(Suppl 1):e13614.
doi: 10.1111/mcn.13614. Epub 2024 Aug 1.

School health and nutrition environments: A multicountry survey in five countries of sub-Saharan Africa region-Burkina Faso, Ethiopia, South Africa, Sudan, and Tanzania

Ramadhani A Noor  1 , Heavenlight A Paulo  2   3 , Sachin Shinde  4 , Amare W Tadesse  5   6 , Amani Tinkasimile  7 , Yemisrach Hussen  1 , Joyce Ngeba  8 , Huda Sherfi  9 , Roisin Drysdale  10 , Mary Mwanyika-Sando  7 , Patrick Codjia  8 , Stanley Chitekwe  1 , Till Bärnighausen  4   11 , Deepika Sharma  12 , Wafaie W Fawzi  4
Affiliations

School health and nutrition environments: A multicountry survey in five countries of sub-Saharan Africa region-Burkina Faso, Ethiopia, South Africa, Sudan, and Tanzania

Ramadhani A Noor et al. Matern Child Nutr. 2025 Jul.

Abstract

Schools are increasingly regarded as a key setting for promoting the health, well-being, and development of children and adolescents. In this multicountry cross-sectional survey, we describe the health, nutrition, and food environments of public primary schools in five urban settings in Africa region: Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Durban; South Africa, Khartoum, Sudan; and, Dar es Salaam, Tanzania. We evaluated the school health and nutrition (SHN) environments in three main areas: (1) the availability of health-related policies, guidelines, and school curricula, (2) the provision of health, nutrition, and water, sanitation, and hygiene (WASH) services in schools, and (3) the school food environments and eating habits of adolescents. We used stratified random sampling to recruit 79 schools from five countries. Trained fieldworkers collected standardized questionnaire data from 79 school administrators, 765 food vendors, and 4999 in-school adolescents aged 10-15 years. In our study, 24 out of 79 school administrators were aware of their school's health-related policies and guidelines while 30 schools had a specific SHN curriculum. In general, health, nutrition, and WASH services were inadequate. Possibly due to a lack of school kitchens, 14.4% of students bought snacks and unhealthy foods from food vendors. Our study indicates that schools' food and nutrition environments are insufficient to improve adolescent health and nutrition in the African region, including limited coverage of SHN policies, suboptimal facilities and nutrition services, and unregulated food environments. Schools in sub-Saharan Africa need to improve their health and nutrition environments.

Keywords: Africa; WASH; adolescents; environment; health; nutrition; policy; schools.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Foods reported to be consumed by students over the previous 24 h (N = 4999).
Figure 2
Figure 2
Student reports on the proportion of meals prepared by different sources (N = 4999).
See this image and copyright information in PMC

References

    1. Afshin, A. , Sur, P. J. , Fay, K. A. , Cornaby, L. , Ferrara, G. , Salama, J. S. , Mullany, E. C. , Abate, K. H. , Abbafati, C. , Abebe, Z. , Afarideh, M. , Aggarwal, A. , Agrawal, S. , Akinyemiju, T. , Alahdab, F. , Bacha, U. , Bachman, V. F. , Badali, H. , Badawi, A. , … Murray, C. J. L. (2019). Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393, 1958–1972. - PMC - PubMed
    1. Berezowitz, C. K. , Bontrager Yoder, A. B. , & Schoeller, D. A. (2015). School gardens enhance academic performance and dietary outcomes in children. Journal of School Health, 85, 508–518. - PubMed
    1. Bundy, D. A. P. , Silva, N. d , & Horton, S. (Eds.). (2017). Child and adolescent health and development (3rd ed.). The International Bank for Reconstruction and Development/The World Bank. - PubMed
    1. Cowley, E. S. , Watson, P. M. , Foweather, L. , Belton, S. , Thompson, A. , Thijssen, D. , & Wagenmakers, A. J. M. (2021). “Girls aren't meant to exercise”: Perceived influences on physical activity among adolescent girls—The HERizon project. Children, 8(1), 31. - PMC - PubMed
    1. Danquah, F. I. , Ansu‐Mensah, M. , Bawontuo, V. , Yeboah, M. , & Kuupiel, D. (2020). Prevalence, incidence, and trends of childhood overweight/obesity in Sub‐Saharan Africa: A systematic scoping review. Archives of Public Health, 78(1), 109. - PMC - PubMed

Grants and funding