Formative assessment of primary school educators in independent schools in Gauteng to advise the need for an intervention for the prevention of non-communicable diseases

Abstract

Background: Non-communicable diseases (NCDs) are a significant contributor to premature mortality in South Africa. The risks for NCDs among educators in higher socio-economic areas of South Africa have not been studied. The aim of this research was to conduct a formative assessment of grade 4 to 7 educators in independent (non-public) schools in Gauteng to advise the need for an intervention for the prevention of NCDs targeted at these educators. Methods: A cross-sectional, descriptive study design was used to assess the educators' dietary risks for NCDs, their weight status and association with select individual and social factors, and the educators' modifiable and intermediate risk factors for NCDs. A self-administered estimated three-day food record was used to assess dietary and alcohol intake. A self-administered questionnaire was used to collect individual (age, gender, socio-economic status (SES), education level, personal weight and weight loss history, weight status of parents, nutrition knowledge, psychological well-being, body image discordance and satisfaction with body areas) and social factors (influence of significant others on body image) that affect weight status. This questionnaire was also used to assess other modifiable NCD risks (tobacco smoking, physical inactivity) in addition to dietary and alcohol intake, and psychological well-being mentioned. Intermediate NCD risk factors were assessed by taking anthropometric measurements and obtaining non-fasting finger prick blood samples to assess blood glucose, total cholesterol, and triglyceride levels. Results: Eighty-one educators participated and 91% were female. They had a high SES and education level. The median (IQR) age of the educators was 42.0 (35.0; 50.0) years. Sixty-four educators submitted completed food records. The percentage of educators that exceeded the World Health Organisation recommendations for particular dietary parameters were as follows: saturated fat: 91%, trans-fats: 31%, free sugars: 27% and sodium: 28%. Almost three quarters of educators (72%) consumed a lower carbohydrate diet (<45%E) and 94% consumed inadequate amounts of dietary fibre. Thirty percent of educators exceeded the recommended intake for alcohol. The percentage of educators that did not meet the Dietary Reference Intakes for certain micronutrients were as follows: potassium: 100%, vitamin D: 97%, folate: 92%, calcium: 70%, vitamin E: 73%, magnesium: 66%, and vitamin C: 50%. None of the educators had a Dietary Diversity Score (DDS) <4 (mean ± SD DDS: 6.1 ± 1.2) and their diets were varied (mean ± SD Food Variety Score: 13.4 ± 4.5). The ten most frequently consumed items were coffee, brown bread, chicken, full fat cheese, full cream milk, salad, beef, sugar, chocolate, and high fibre breakfast cereals in descending order. As a result, 11 of the 13 measured dietary risk factors outlined by the Global 2017 Diet Collaborators (2019) were present among the educators. The median (IQR) BMI of the total group was 23.9 (21.6; 29.2)kg/m2 . Twenty-seven percent of educators were overweight, 14% obese and 75% had a distorted view of their body size. Overweight/obese educators were significantly more likely to see themselves as smaller than they were (p< .001) and also to have higher levels of dissatisfaction with their bodies in general (p< 0.001), and all the body areas assessed. Female educators wanted to weigh median (IQR) 5 (2; 12)kg less than their actual weight. Sixty-five percent of educators had attempted weight loss in the past two years. Forty-six percent of the educators were psychologically stressed. Nutrition knowledge scores were as follows: poor: 8%, fair: 55% and good: 37%. Significant protectors against being overweight/obese were being younger than 30 years (OR=0.18; 95% CI: 0.04-0.88; p=0.034), not having a distorted body image (OR=0.09; 95% CI: 0.03-0.32; p< 0.001) and being satisfied with their waist (OR=0.29; 95% CI: 0.01-0.85; p=0.025), hips (OR=0.21; 95% CI: 0.07- 0.65; p=0.007) and legs (OR=0.29; 95% CI: 0.10-0.83; p=0.02). All studied NCD risk factors were present in the total group. More prominent risks in those <30 years were a diet high in SSBs, excess sedentary behaviour, elevated triglycerides and smoking, and in those ≥30 years were a diet high in total fat, having a high waist circumference, having elevated cholesterol levels, being overweight/obese and having low PA levels. Nine percent of the educators smoked cigarettes and 32% of educators exceeded alcohol recommendations. The top nine risks were dietary factors including low intake of vegetables, legumes, milk, calcium, fruit, nuts/seeds, fibre, polyunsaturated fat and high intake of red meat. Seventeen percent of educators had insufficient PA levels and 39% spent >4 hours sitting/day. In addition to the levels of psychological distress and overweight/obesity already mentioned, 43% had waist circumferences indicating risk. Eleven percent of educators had a high blood pressure (≥140/≥90 mm Hg), 37% a raised glucose level (≥5.6-< 11.0 mmol/L), 43% a raised total cholesterol level (≥5.0 mmol/L) and 72% a high triglyceride level (≥2.0 mmol/L). Conclusions: Considering the limitations indicated for this study, it can be concluded that the educators teaching at independent schools in Gauteng had a high dietary risk for NCDs, despite consuming a diverse and varied diet. The prevalence of overweight and obesity among the female educators requires intervention. Individual and social factors, that could be used to tailor interventions aimed at preventing or controlling overweight and obesity among this group, were identified. This study provides insights into the modifiable and intermediate risk factors for NCDs among educators teaching at independent schools and indicates the need for effective interventions aimed at reducing their risk for NCDs.