C E Draper,1,2 PhD; S A Tomaz,2 PhD; S H Bassett,3 PhD; J Harbron,4 PhD; H S Kruger,5 PhD; L K Micklesfield,1,2 PhD; A Monyeki,6 PhD; E V Lambert,2,7 PhD; and members of the HAKSA 2018 Scientific Advisory Group

1 SA MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2 Division of Exercise and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
3 Department of Sport, Recreation and Exercise Science, Faculty of Community and Health, University of the Western Cape, Cape Town, South Africa
4 Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
5 Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
6 Physical Activity, Recreation and Sport Sciences Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
7 Health through Physical Activity, Lifestyle and Sport Research Centre, Faculty of Health Sciences, University of Cape Town, South Africa

Corresponding author: C E Draper (catherine.draper@wits.ac.za)

Background. Healthy Active Kids South Africa (HAKSA) Report Cards were produced in 2007, 2010, 2014 and 2016.
Objective. The 2018 Report Card aims to report on the latest available evidence relating to the physical activity (PA), nutrition and body
composition of South African (SA) children and adolescents.
Methods. A review was conducted using the following databases: PubMed; Africa Journals Online; and Africa-Wide (EBSCOhost). Articles
published from January 2016 to September 2018 were included for review by the HAKSA scientific advisory group. Data were extracted,
and a grade for each indicator was assigned based on the available evidence and the consensus of the scientific advisory group. This
included 12 PA indicators, 6 nutrition indicators and 3 body composition indicators.
Results. There was no evidence of a significant change in any of the indicators since the 2016 Report Card. Grades for certain indicators
have been downgraded (from 2016) to bring these to the attention of relevant stakeholders and industry. These include food insecurity and
grades that relate to the implementation of policy on PA and nutrition in the school environment, and on advertising and media relating
to nutrition.
Conclusion. Key priorities for action include: safe opportunities for physical activity; minimising the gap between policy and
implementation (school culture and environment, and government strategies); and the double burden of over- and undernutrition, which
relates to the continuing concern about food insecurity in SA. There is a need for further research, including surveillance, on all indicators,
for future Report Cards.
S Afr J Child Health 2019;13(3):130-136. https://doi.org/:10.7196/SAJCH.2019.v13.i3.1640

Physical activity (PA) is beneficial for the physical and mental health of children and adolescents (0 – 17 years old),[1,2] while higher levels of sedentary behaviour (particularly screen time) are associated with unfavourable health outcomes.[3,4] Nutrition has been recognised as a factor contributing to the development of overweight/obesity in children and adolescents.[5]A nutrient-dense diet and regular PA are beneficial for overall child growth, health and wellbeing.[6] Healthy lifestyle behaviours also play a role in cognitive development and school achievement in children and adolescents.[7] The Healthy Active Kids South Africa (HAKSA) Report Card reviews the most current evidence on the PA, nutrition and body composition of South African (SA) children and adolescents. This evidence provides the basis from which to guide policy, develop interventions and programmes and strengthen advocacy to create healthy environments and support healthy nutrition and PA, and discourage sedentary behaviours in SA children and adolescents. Children and adolescents (0 – 19 years old) make up 39% of the total population of SA (~52 million people in total).[8] Although this proportion of children and adolescents is relatively high, it is lower than those in some other African countries: the proportion of children and adolescents 0 – 14 years old (a narrower age range) is also 39% in Zimbabwe (population ~13.8 million), and in Nigeria the proportion of 0 – 14 year olds is 43% (population ~190.6 million).[9] Results from the HAKSA 2016 Report Card indicated that more than 50% of SA children were meeting PA recommendations, and government policies for the support of sport and PA in children and adolescents were evident. Areas of concern were high amounts of screen time and sedentary behaviour, as well as low fruit and vegetable consumption, and high intake of sugar-sweetened beverages (SSBs) and fast foods. Undernutrition and overweight/obesity were highlighted as a concern, as overweight prevalence was increasing,[10] and the HAKSA 2016 Report Card highlighted the persistence of the double burden of under- and over-nutrition across South Africa.[11] The HAKSA 2018 Report Card is the fifth in the series (since 2007),[10-12] and aims to report on the available evidence relating to PA, sedentary behaviours, nutrition and body composition of SA children and adolescents (3 – 18 years old) published since the 2016 Report Card. In addition, we consider the related environmental and ecological factors that may be barriers to or facilitators…