Data was collected by means of the following research instruments.
Socio-demographic questionnaire
The questionnaire, developed for the purpose of the study, determined the socio-demographic characteristics of the study sample including learner age, gender and socio-demographic background (Annexure J).
129 Household Dietary Diversity Score (HDDS)
The household dietary diversity score (HDDS) is defined as the quantitative measure of food groups consumed, usually within the previous 24 hours by an individual inside and outside the home (Meng, Wang, Li, van Loo-Bouwman, Zhang, Szeto 2018; Ogechi & Chilezie 2017; Nair, Augustine, Konapur 2016). High dietary diversity scores are associated with diets that contain acceptable macronutrient and micronutrient levels and are also related to a reduced risk for developing obesity (Hooshmand & Marhamati 2018). The measurement of dietary diversity, when used in isolation, has the advantage of being less time consuming with minimal respondent burden (Kennedy, Ballard, Dop, 2010). Limitations include not generating quantitative data regarding actual food consumption and not taking seasonal variation of certain foods into consideration (Nithya & Bhavani, 2018). This tool has been used to collect data in rural as well as urban areas Botswana (Kasimba et. al, 2018). The HDDS that was used in this present study (Annexure L), was intended to represent household food access.
The HDDS (including the 24-hour recall) was administered by trained field workers as described in the study conducted by Rankin, Hanekom, Write & Macintyre (2010). In the current study, food models were used to assist learner recall of foods eaten in the previous 24 hours. This was followed by classifying the foods into food groups containing foods frequently consumed in Botswana such as letlhodi, dinawa tsa Setswana and phane. The response categories in the DDS questionnaire included “Yes” if consumed and “No” if not consumed within the previous 24 hours. This was followed by adding up the number of “Yes” responses from of each learner that was interviewed to determine the DDS of each learner. Although there are 16 food groups in the HDDS, similar foods (for example cereals were combined with white tubers and roots) as recommended by Kennedy et. al. (2010). This resulted in the HDDS food group range being 0 to 12. Due to a lack of national and international DDS cut-offs (Assenga & Kayunze, 2016; McDonald, McLean, Kroeun, Talukder, Lynd & Green 2015), the DDS of participating learners where classified as being low (≤ 4 food groups), medium (5 to 8 food groups) and high (9 to 12 food groups) as was classified by Ogechi & Chilezie, (2017), in addition to mean scores being calculated for each food group.
130 Household Food Insecurity Access Scale (HFIAS)
The HFIAS has been used to determine learner food security status at household level in studies conducted by Ijarotimi & Erota (2018) among school going learners aged 10 – 19 years of age from both private and public schools. The association between participant HFIAS and nutritional status was significantly and positively associated with household food security status (OR=1.03, p=0.004). HFIAS has been validated by several studies (Mohammadi, Omidvar, Houshiar-Rad, Khoshfetrat, Abdollahi & Mehrabi, 2012; Salarkia, Abdollahi, Amini & Neyestani, 2014;
Knueppel, Demment & Kaiser, 2010). It was also found to be a valid tool for measuring household food insecurity in both urban and rural settings, similar to the study conducted by Gebreyesus, Lunde, Mariam, Woldehanna & Lindtjorn (2015) in nine rural and one urban area in Ethiopia.
This tool has also been used by Kasimba et. al, (2018) in both urban and rural settings in Botswana in order to assess the HFIAS of women.
The HFIAS that was administered by a trained field worker, consisted of a set of questions where learners had to answer occurrence questions based on a recall period of the past month. If the answer was “Yes”, to an occurrence question, a follow-up question was asked on the frequency of the occurrence. Responses were coded as follows: rarely = 1 (once or twice in the past four weeks), sometimes = 2 (three to ten times in the past four weeks), and often = 3 (more than ten times in the past four weeks).
The HFIAS occurrence questions relate to three different domains of food insecurity (access) found to be common to the cultures examined in a cross-country literature review (FANTA 2004, Coates, 2004). The generic occurrence questions, grouped by domain, are:
1. Anxiety and uncertainty about the household food supply,
2. Insufficient quality (includes variety and preferences of the type of food), and 3. Insufficient food intake and its physical consequences.
Based on participant response, the HFIAS was calculated as a continuous variable to document the degree of food insecurity for each individual study participant. Hence learners were categorised as: Food secure (score 0 – 6.75), mildly food secure (score 6.75 – 13.5), moderately food insecure (score 13.5 – 20.5) and severely food insecure (score 20.5 – 27).
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Physical Activity Questionnaire for Older Children (PAQ-C)
For healthy children between five to seven years of age, the WHO (2011) recommends that they should accumulate at least one hour of moderate to vigorous-intensity physical activity on a daily basis that includes playing games, sports, conducting chores and other activities that improve cardiorespiratory fitness.
The PAQ-C developed by Crocker, Bailey, Faulkner, Kowalski & McGrath (1997) was deemed suitable for use in the current study as it was developed for primary school children aged 8 to 14 years which is similar to that of the study sample. The PAQ-C was administered in a classroom setting and within a time-related reference frame of seven days as per the questionnaire protocol (Kolwalski, Crocker & Donen 2004). This research instrument has been validated by various authors in different populations (Wang, Baranowski, Lau, Chen & Pitkethly, 2016; Zaki, Sahril, Omar, Ahmad, Baharudin & Nor, 2016; Manchola-Gounzalez, Bagur-Calafat & Girabent-Fareès, 2015). The questionnaire manual (Kowalski et. al, 2004) was used to guide the methodology used for data collection and analysis. The instrument consists of nine structured questions. Each question was given a value of one (lowest) to five (highest). Once the value for each question was recorded, the mean value was calculated, thus generating the final PAQ-C activity summary score.
Other researchers (Zaki et. al, 2016) have categorized the level of physical activity into three categories, namely: 1.2 – 3.3 = low, 2.34 – 3.66 = moderate, and 3.67 – 5.00 = high. For the purpose of this study, similar categories were used.