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01.12.2015 | Study protocol | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Disease, activity and schoolchildren’s health (DASH) in Port Elizabeth, South Africa: a study protocol

BMC Public Health > Ausgabe 1/2015
Peiling Yap, Ivan Müller, Cheryl Walter, Harald Seelig, Markus Gerber, Peter Steinmann, Bruce P. Damons, Danielle Smith, Stefanie Gall, Dominique Bänninger, Thomas Hager, Nan S. N. Htun, Liana Steenkamp, Annelie Gresse, Nicole Probst-Hensch, Jürg Utzinger, Rosa Du Randt, Uwe Pühse
Wichtige Hinweise
Peiling Yap and Ivan Müller contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

PY, IM, PS and JU designed the study, established the methods and wrote the original study protocol. All other authors contributed to the development of the study protocol. UP is the principal investigator. CW, IM, PY and DS were the main coordinators of the study. IM, PY, DS, NSNH, LS, AG, BPD, MG, SG, TH, DB, RDR, UP and CW conducted the study. CW is responsible for community sensitization; IM is liable for drug administration. IM managed data entry, cleaning and preparation of the database for statistical analysis, supported by HS. PY, IM and JU wrote the first draft of the manuscript. All authors read and provided comments on the drafts and approved the final version of the paper prior to submission.



An in-depth epidemiological investigation on intestinal parasite infections in an impoverished area of Port Elizabeth, South Africa provides a unique opportunity for research on its impact on children’s physical fitness, cognitive performance and psychosocial health. Additionally, we will screen risk factors for the development of diabetes and hypertension in adulthood.


A 2-year longitudinal cohort study will be conducted, consisting of three cross-sectional surveys (baseline and two follow-ups), in eight historically black and coloured (mixed race) primary schools located in different townships in Port Elizabeth, South Africa. Approximately 1000 Grade 4 primary schoolchildren, aged 8 to 12 years, will be enrolled and followed. At each survey, disease status, anthropometry and levels of physical fitness, cognitive performance and psychosocial health will be assessed. After each survey, individuals diagnosed with parasitic worm infections will be treated with anthelminthic drugs, while children with other infections will be referred to local clinics. Based on baseline results, interventions will be tailored to the local settings, embedded within the study and implemented in half of the schools, while the remaining schools will serve as controls. Implementation of the interventions will take place over two 8-week periods. The effect of interventions will be determined with predefined health parameters.


This study will shed new light on the health burden incurred by children in deprived urban settings of South Africa and provide guidance for specific health interventions. Challenges foreseen in the conduct of this study include: (i) difficulty in obtaining written informed consent from parents/guardians; (ii) administration of questionnaires in schools where three languages are spoken (Afrikaans, Xhosa and English); (iii) challenges in grasping concepts of psychosocial health among schoolchildren using a questionnaire; and (iv) loss to follow-up due to the study setting where illiteracy, mobility and violence are common. Finally, designing the health interventions together with local principals and teachers will allow all concerned with the research to bolster a sense of community ownership and sustained use of the interventions after the study has ceased.

Trial registration; identifier: ISRCTN68411960 (date assigned: 14 February 2014).
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