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Project Ntshembo (Hope)

Health and wellbeing of female adolescents and young adults, and their infants: limiting the inter-generational risk of metabolic disease in South Africa


Adolescents have previously been considered a low risk group for poor health, and thus receive few healthcare resources and attention. However, adolescent girls in sub-Saharan Africa are now recognised to be at particularly high risk for several negative health outcomes, including anaemia, unplanned pregnancy, HIV, burgeoning obesity risk, poor access to health care, and delivery complications.

While these risks impact the health and quality of life of the women themselves, they also affect their offspring, setting up transgenerational cycles of risk, such as mother-to-child transmission of HIV, poor infant development, and increased risk of non-communicable disease in later life among their infants.

Persisting low birth weight and stunting among infants in sub-Saharan Africa, coupled with emerging female adolescent obesity in some settings, establishes another cycle that can result in increased risk for gestational diabetes, and obstructive labour complications. Given that healthy mothers raise healthier children through better nutrition and education, interventions that target young women can lead to improved health, and stronger families and communities.

Extensive formative work has been done to characterise rural and urban adolescent female metabolic risk in rural Agincourt (MRC/Wits Rural Public Health and Heath Transitions Research Unit) and urban Soweto. Investigations include detailed anthropometry and body composition, dietary and physical activity patterns, health service access, mental health and cardiometabolic risk markers. The planned cluster randomised trial is scheduled to begin in 2015.


The formative work for the intervention has been funded by: