title: Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review.
abstract: BACKGROUND
  Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.
  
  
  OBJECTIVE
  This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.
  
  
  METHODS
  Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.
  
  
  RESULTS
  A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.
  
  
  CONCLUSIONS
  This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.
  CRD42013004399.
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Stella K
authors.initials: SK
authors.lastname: Muthuri
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Francis
authors.affiliation: Kenyatta University, Nairobi, Kenya.
authors.forename: Lucy-Joy M
authors.initials: LJ
authors.lastname: Wachira
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Allana G
authors.initials: AG
authors.lastname: Leblanc
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Sampson
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Kenyatta University, Nairobi, Kenya.
authors.forename: Vincent O
authors.initials: VO
authors.lastname: Onywera
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Kenyatta University, Nairobi, Kenya.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Tremblay
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D000367:Age Factors; D001823:Body Composition; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000453:epidemiology*; D012737:Sex Factors; D012959:Socioeconomic Factors