BackgroundSouth African studies have suggested that differences in obesity prevalence between groups may be partly related to differences in body image and body size dissatisfaction. However, there has never been a national study that measured body image and its relationship to weight control in the country. Hence, the main aim of the study was to examine body image in relation to body mass index and weight control in South Africa.MethodsA cross-sectional survey and a secondary analyses of data were undertaken for 6 411 South Africans (15+ years) participating in the first South African National Health and Nutrition Examination Survey. Body image was investigated in relation to weight status and attempts to lose or gain weight. Data were analysed using STATA version 11.0. Descriptive statistics are presented as counts (numbers), percentages, means, standard error of means, and 95 % confidence intervals. Any differences in values were considered to be significantly different if the confidence intervals did not overlap.ResultsOverall, 84.5 % participants had a largely distorted body image and 45.3 % were highly dissatisfied about their body size. Overweight and obese participants under estimated their body size and desired to be thinner. On the other hand, normal- and under-weight participants over estimated their body size and desired to be fatter. Only 12.1 and 10.1 % of participants attempted to lose or gain weight, respectively, mainly by adjusting dietary intake and physical activity.DiscussionBody mass index appears to influence body image and weight adjustment in South Africa.ConclusionsSouth Africans at the extreme ends of the body mass index range have a largely distorted body image and are highly dissatisfied by it. This suggests a need for health education and beneficial weight control strategies to halt the obesity epidemic in the country.

Introduction: In the context of poverty and HIV and AIDS, peer education is thought to be capable of providing vulnerable youth with psychosocial support as well as information and decision-making skills otherwise limited by scarce social and material resources. As a preventative education intervention method, peer education is a strategy aimed at norms and peer group influences that affect health behaviours and attitudes. However, too few evaluations of peer-led programmes are available, and they frequently fail to reflect real differences between those who have been recipients of peer education and those who have not. This article reports on an evaluation of a pilot peer-led intervention, entitled Vhutshilo, implemented on principles agreed upon through a collaborative effort in South Africa by the Harvard School of Public Health and the Centre for the Support of Peer Education (the Rutanang collaboration). Vhutshilo targeted vulnerable adolescents aged 14 -16 years living in some of South Africa's under-resourced communities. Methodology: The research design was a mixed-method (qualitative and quantitative), longitudinal, quasi-experimental evaluation. Tools used included a quantitative survey questionnaire (n ¼ 183) and semi-structured interviews (n ¼ 32) with beneficiaries of peer education. Surveys were administered twice for beneficiaries of peer education (n ¼ 73), immediately after completion of the programme (post-test) and 4 months later (delayed post-test), and once for control group members (n ¼ 110). The three main methodological limitations in this study were the use of a once-off control group assessment as the baseline for comparison, without a pre-test, due to timing and resource constraints; a small sample size (n ¼ 183), which reduced the statistical power of the evaluation; and the unavailability of existing tested survey questions to measure the impact of peer education and its role in behaviour change. Findings: This article reports on the difficulties of designing a comprehensive evaluation within time and financial constraints, critically evaluates survey design with multi-item indicators, and discusses six statistically significant changes observed in Vhutshilo participants out of a 92-point survey. Youth struggling with poor quality education and living in economically fraught contexts with little social support, nonetheless, showed evidence of having greater knowledge of support networks and an expanded emotional repertoire by the end of the Vhutshilo programme, and 4 months later. At both individual and group level, many with low socio-economic status showed great improvement with regard to programme indicator scores. Conclusion: For the poorest adolescents, especially those living in the rural parts of South Africa, peer education has the potential to change future orientation, attitudes and knowledge regarding HIV and AIDS, including an intolerance for multiple concurrent partnerships. When well organised and properly supported, peer education programmes (and the Vhutshilo ...

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Young adolescence (10-14 years) is considered a crucial stage of development. Characterised neither as children nor entirely adolescent, this age group grapples with the many changes that social, sexual, reproductive and cognitive maturation brings. To navigate these transitions and achieve positive sexual and reproductive health (SRH) outcomes, young people require a supportive environment that relies on a responsive health system. [1] While many young adolescents are not sexually active, when sexual activity does occur, it is more frequently associated with unequal power relationships than in older adolescents. As a result, young adolescents experience higher rates of sexual coercion, more frequent instances of agedisparate sex and more infrequent or inconsistent condom use than their older peers. [2,3] Studies reveal that when developing children have access to quality sexuality education they are better equipped to manage and sustain their own health. [4,5] However, the effectiveness of school-based sexuality education is hampered by the use of strict teacher-oriented approaches, a lack of practical or experiential learning methods and a strong emphasis on 'danger and disease' messaging, at the expense of addressing aspects such as dating, relationships and a positive view of sexuality. [6] Despite increasing recognition of the importance of quality sexuality education in improving SRH outcomes for young adolescents, this age group has received little research and programmatic attention, particularly so in low-and middle-income countries, with most current literature focusing on older teens. Where research with younger adolescents does exist, findings indicate that while this age group is aware of SRH topics (such as avoiding HIV and other sexually transmitted infections (STIs), sexual violence and unwanted or unsupportable pregnancy), in-depth knowledge of these topics reflecting their everyday experiences remains low. [7] In the absence of relatable sexuality education, young adolescents often struggle to make sense of potentially contradictory information without adult guidance. This is especially pertinent in African contexts, where there are often social taboos surrounding puberty and intergenerational communication about sexual issues, [8] with young adolescents turning to informal sources of sexuality education. [9] This article aims to respond to existing knowledge gaps to provide insight into how very young adolescents in South Africa (SA) receive and perceive information related to SRH and the implications of this in their lives. Methods Research design The study took the form of qualitative participatory research, drawing on a conceptual framework of critical sexual and reproductive citizenship. [10] This framework includes a focus on sexual agency, positioning adolescents as active agents in their SRH and engagement with the sociocultural context in which sexuality education occurs. Research setting Mpumalanga is a rural SA province. In addition to major health system challenges, youth in the Gert...

Background: Peer-education programmes aim to bring about attitudinal and behavioural changes in their target audience. In the South African educational context, peer education is a favoured approach in dealing with issues such as HIV and AIDS, sexual decision-making and substance misuse. Given the reliance on peer-education programmes in the educational system, it is important to establish how well they are working. This study aims to assess the effect of an extensive, structured, time-limited, curriculum-based, peer-led educational programme on first-year high school learners in public schools in the Western Cape Province of South Africa. Method: The curriculum called ‘Listen Up’ addresses issues such as supporting peers, sexual decision-making, healthy relationships, HIV risk, alcohol misuse and unwanted pregnancy in seven structured sessions. The programme targeted adolescents in Grade 8 growing up in what are considered to be risky environments in public schools in the Western Cape during 2012 and 2013. The intervention was evaluated based on 10 scales sourced from published literature related to the outcome indicators of future orientation, sensation-seeking, self-efficacy in sexual relations, HIV transmission knowledge, HIV prevention knowledge, HIV attitudes, sexual attitudes, decision-making, healthy relationships and social support. Descriptive statistics were used to analyse demographic and community characteristics and analyses of variance were used to detect differences between groups. The surveys were administered to a total of 7709 learners across three waves of the study in 27 peer intervention schools and eight control schools. Results: Immediately post intervention, statistically significant differences were noted for the intervention schools when compared to their baseline levels on measures of future orientation, self-efficacy in sexual relations, knowledge regarding HIV transmission, knowledge regarding HIV prevention and knowledge in terms of healthy relationships. Comparing baseline values with results collected between five and seven months post intervention, statistically significant results were noted for self-efficacy in sexual relations and knowledge regarding HIV transmission. Conclusion: The findings of this study suggest that peer-education can improve adolescents’ self-efficacy in sexual relations as well as knowledge regarding the transmission of HIV and therefore can contribute to the prevention of HIV transmission among adolescents.

Highlights• South Africa has an enabling, comprehensive and progressive legislative and policy framework for the provision of adolescent and youth friendly services in South Africa is laudable.• However various provider, health facility, and programme design characteristics continue to hamper effective provision and delivery of adolescent and youth friendly health services.• The need to consider the amendment of some health facility regulations such as operating hours and/or days to ensure that service provision is convenient for young people.• The provision of all cadres of primary health service providers with on-going professional development and attitudinal training is imperative to break down prejudices that may limit the success of the adolescent and youth friendly programming in the country.• There is need for more youth involvement in programme design and service provision. AbstractAgainst the background of increasing international calls for the development and implementation of age-appropriate programmes that address both quality and access issues to improve adolescent and youth health, this paper explores the extent to which public health facilities are available and accessible to adolescents and youth in South Africa. The impetus for the study was the current evidence that there was generally poor utilisation of services offered at public health facilities by young people in the country. The overall findings are that despite the country"s comprehensive legal and policy framework and commitment to improve the health of young people, there continues to be some structural and systemic factors that hamper effective provision and programming of adolescent and youth friendly services. The paper concludes with recommendations for policy and practice.