Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review.

BACKGROUND: Previous evidence suggests that school garden-based programmes (SGBP) may be a promising yet cost-effective intervention to improve children's knowledge, attitudes and practices (KAP) on healthy eating. This review aimed to summarise and evaluate the evidence available on the impacts of SGBP in addressing diet and nutrition-related KAP among school-aged children. METHODS: Five databases including PubMed, Embase, Cochrane, Web of Science and Scopus were searched until February 2021. Randomised, non-randomised controlled and pre-post intervention studies investigating the impacts of SGBP on at least one of the outcomes of interest including diet and nutrition-related knowledge, attitudes towards fruits and vegetables (F&V), food diversity and dietary practice among school-aged children were included. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Quality appraisal for studies included was assessed using American Dietetic Association Quality Criteria Checklist. RESULTS: A total of 10,836 records were identified, and 35 studies that met the inclusion and exclusion criteria were included. This includes 25,726 students from 341 schools and 8 nurseries from 12 countries. Intervention duration ranged from 6 weeks to 4 years with 18 studies involving a varied degree of parental participation. SGBP, which majorly includes school gardening activities, cooking lessons and nutrition education, demonstrated beneficial effects on children's nutritional knowledge, their attitudes and acceptability towards fruits and vegetables and children's dietary practices including the actual F&V consumption and dietary diversity. However, the impacts of SGBP on such outcomes were highly influenced by various social and environmental factors including the activities/components and duration of the intervention, parental involvement, sample size, and the age of children when interventions were first introduced. CONCLUSION: These findings suggest that SGBP may be effective in promoting children's nutritional knowledge, attitudes and acceptability towards vegetables, however, the impacts may vary by the type, the extent, and the length of the programmes, and other factors such as parent involvement. Future SGBP is suggested to implement using a combined multidisciplinary approach targeting the children, parents, and community to effectively promote healthy eating among the children and prevent childhood obesity.

Nutritional and health status of children 15 months after integrated school garden, nutrition, and water, sanitation and hygiene interventions: a cluster-randomised controlled trial in Nepal.

BACKGROUND: It has been suggested that specific interventions delivered through the education sector in low- and middle-income countries might improve children's health and wellbeing. This cluster-randomised controlled trial aimed to evaluate the effects of a school garden programme and complementary nutrition, and water, sanitation and hygiene (WASH) interventions on children's health and nutritional status in two districts of Nepal. METHODS: The trial included 682 children aged 8-17 years from 12 schools. The schools were randomly allocated to one of three interventions: (a) school garden programme (SG; 4 schools, n = 172 children); (b) school garden programme with complementary WASH, health and nutrition interventions (SG+; 4 schools, n = 197 children); and (c) no specific intervention (control; 4 schools, n = 313 children). The same field and laboratory procedures were employed at the baseline (March 2015) and end-line (June 2016) surveys. Questionnaires were administered to evaluate WASH conditions at schools and households. Water quality was assessed using a Delagua kit. Dietary intake was determined using food frequency and 24-h recall questionnaire. Haemoglobin levels were measured using HemoCue digital device and used as a proxy for anaemia. Stool samples were subjected to a suite of copro-microscopic diagnostic methods for detection of intestinal protozoa and helminths. The changes in key indicators between the baseline and end-line surveys were analysed by mixed logistic and linear regression models. RESULTS: Stunting was slightly lowered in SG+ (19.9 to 18.3%; p = 0.92) and in the control (19.7 to 18.9%). Anaemia slightly decreased in SG+ (33.0 to 32.0%; p < 0.01) and markedly increased in the control (22.7 to 41.3%; p < 0.01), a minor decline was found in the control (43.9 to 42.4%). Handwashing with soap before eating strongly increased in SG+ (from 74.1 to 96.9%; p = 0.01, compared to control where only a slight increase was observed from 78.0 to 84.0%). A similar observation was made for handwashing after defecation (increase from 77.2 to 99.0% in SG+ versus 78.0 to 91.9% in control, p = 0.15). CONCLUSIONS: An integrated intervention consisting of school garden, WASH, nutrition and health components (SG+) increased children's fruit and vegetable consumption, decreased intestinal parasitic infections and improved hygiene behaviours. TRIAL REGISTRATION: ISRCTN17968589 (date assigned: 17 July 2015).

Integrated school based nutrition programme improved the knowledge of mother and schoolchildren.

This study evaluates the effects of nutrition education on improving knowledge, attitude, and practice (KAP) of mothers and the improvement of the nutritional status of their children. A cluster randomized controlled design using multistage sampling was employed. The integrated school-based nutrition programme included gardening, nutrition education for parents, and supplementary feeding for children (GarNESup). KAP of mothers was assessed using pretested questionnaires administered by teachers. The randomly selected schools were randomly allocated into two groups: Both schools provided lunch to targeted children with one-dish indigenous vegetable recipe, but School 1 received iron-fortified rice whereas School 2 was provided ordinary rice. Eighty wasted and/or anaemic children in each school were fed for 120 days. Nutrition education for children's parents was done every school card claim day and during parent-teacher meetings using 10 developed modules. Weight, height, and haemoglobin level of children and KAP of mothers were measured at baseline and endpoint using standard techniques. KAP of mothers who had completed more than six modules had significantly increased from baseline to endpoint: Negative consequence of worm infestation (33.3% to 60.6%, P = 0.035), importance of serving breakfast for children (42.4% to 78.8%, P = 0.004), cooking vegetables (63.6% to 93.9%, P = 0.002), and purchasing fortified foods was recorded (51.5% to 93.9%, P = 0.000). Children in School 1 had significantly higher weight gain (1.33 ± 0.72) and haemoglobin level (0.49 ± 0.99) than children in School 2 (0.84 ± 0.59; 0.12 ± 0.70). Nutrition education resulted to significant increase of mother's KAP and the implementation of the integrated school-based nutrition model significantly improved children's nutritional status.

Integration of Autonomous Wireless Sensor Networks in Academic School Gardens.

In this work, the combination of capabilities provided by Wireless Sensor Networks (WSN) with parameter observation in a school garden is employed in order to provide an environment for school garden integration as a complementary educational activity in primary schools. Wireless transceivers with energy harvesting capabilities are employed in order to provide autonomous system operation, combined with an ad-hoc implemented application called MySchoolGardenApp, based on a modular software architecture. The system enables direct parameter observation, data analysis and processing capabilities, which can be employed by students in a cloud based platform. Providing remote data access allows the adaptation of content to specific classroom/homework needs. The proposed monitoring WSN has been deployed in an orchard located in the schoolyard of a primary school, which has been built with EnOcean's energy harvesting modules, providing an optimized node device as well network layout. For the assessment of the wireless link quality and the deployment of the modules, especially the central module which needs to receive directly the signals of all the sensor modules, simulation results obtained by an in-house developed 3D Ray Launching deterministic method have been used, providing coverage/capacity estimations applicable to the specific school environment case. Preliminary trials with MySchoolGardenApp have been performed, showing the feasibility of the proposed platform as an educational resource in schools, with application in specific natural science course content, development of technological skills and the extension of monitoring capabilities to new context-aware applications.

Determining Barriers to Use of Edible School Gardens in Illinois.

OBJECTIVE: The objective of this study was to gather data regarding the awareness, perceived benefits, interest in, and barriers to establishment of edible school gardens in Illinois public schools. METHOD: Setting/Design: This study used an online survey design. PARTICIPANTS: Participants included Illinois public elementary school principals and superintendents. VARIABLES MEASURED: Region and community population, current edible garden use, perception (Likert scale) of garden benefits, interest in establishment of a school edible garden, and barriers to establishment of a school edible garden were the variables of interest. ANALYSES: Logit regression and Kruskal-Wallis with follow-up where p < 0.05 were performed. RESULTS: Elementary school principals and superintendents are aware of gardens and their potential benefits to students, but many barriers exist that make their use challenging. Funding, staff and volunteer support, and class time were identified as the major barriers. Region affected likelihood of garden use, and community population size also affected the odds of having an edible school garden. CONCLUSION AND IMPLICATIONS: Data suggest that edible garden use would increase with provision of resources and organization of dedicated supporters.

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial.

BACKGROUND: Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data. METHODS: The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student's weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling. RESULTS: Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed. CONCLUSIONS: The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

The Association Between Duration of School Garden Exposure and Self-Reported Learning and School Connectedness.

When students feel connected to their school, they experience positive health and academic outcomes. In contrast, school disengagement is a predictor of dropout, delinquency, and substance use. School garden programming has the potential to help children achieve academic outcomes and feel connected to their school. Unfortunately, most school garden research has been conducted with white, affluent study participants. We describe the results of a secondary analysis utilizing data from an evaluation of a university-supported community school garden program (CSGP). Using a cross-sectional survey study design, we examined the impact of school garden programming in Title I schools on primarily Latino/a (Hispanic) elementary student self-reported learning and feelings of school connectedness by comparing students with ≤1 year exposure to those with >1 year. Social cognitive theory formed the conceptual basis for the analysis. Duration of school garden exposure did not have a significant association with self-reported learning or feelings of school connectedness. Regardless of past exposure, fifth-grade students, females, and those who identify as Latino/a (Hispanic) felt that school garden programming improved their learning. Latino/a (Hispanic) students who participate in school garden programming may also feel a greater sense of connection to their teachers and peers at school. Qualitative results demonstrated that most students enjoyed spending time in the garden and indicated that participating in the program helped them learn new things and feel connected to their school. If individuals who may be disadvantaged because of systemic racism, such as Latino/a (Hispanic) students, can benefit from school garden programming, such interventions should be further investigated and prioritized.

School-based intervention impacts availability of vegetables and beverages in participants' homes.

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.

School Garden Prevalence Before and After the Implementation of the Healthy Hunger-Free Kids Act.

BACKGROUND: The Healthy Hunger-Free Kids Act (HHFKA) of 2010 supported implementation of school gardens for promoting fruit and vegetable consumption. We examined school garden prevalence over time by school-level factors during the period before and after the implementation of HHFKA. METHODS: Using data from the New Jersey Child Health Study, conducted in 4 low-income New Jersey cities, prevalence of school gardens among K-12 schools (n = 148) was assessed between school year 2010-2011 and 2017-2018. Multivariable analysis estimated changes in garden prevalence over time adjusting for school-level factors. RESULTS: Overall, the sample included 97 elementary and 51 middle/high schools. Multivariable logistic regression showed that compared to 2010-2011 (19%) a higher proportion of schools reported having a garden in 2013-2014 (32%, p = 0.025). Over the entire study period, schools with majority Hispanic student enrollment had approximately half the odds of having a garden compared to schools with majority Black students (p = 0.036). CONCLUSION: School garden prevalence increased in the year immediately following the implementation of the HHFKA but this increase was not sustained over time. Future research should investigate the reasons for this decline and potential disparities by race/ethnicity.

School Garden Benefits: Health Promotion and Environmental Conservation.

Garden-based learning promotes environmental awareness, health, and wellness across the school community and beyond. In this article, we review the literature on the benefits of school gardening and describe firsthand experiences for garden success. By sharing lessons learned, our aim is to inspire school nurses to join forces with like-minded teachers and staff or take the lead to build capacity in their school for gardening and a green culture dedicated to the conservation of natural resources.

The School Garden: A Social and Emotional Place.

School gardens are part of many schools. Especially in primary schools, but also in secondary schools, they are used as a learning space and experience space for the pupils. Their importance for the development of cognitive and emotional-affective abilities of pupils is empirically well proven. It is also empirically well proven that exposure to nature has an influence on the prosocial behavior of children and adults. However, there is a lack of studies investigating the effect of the stay in the school garden on the social behavior of pupils in secondary class. To investigate whether a school garden is a good environment for social learning, a self-report study and standardized observations with sixth-grade pupils were carried out. Thus, the socially competent behavior of the pupils (communication and cooperation) and their emotions could be analyzed. In order to provide emotional access to the scientific content of biology lessons and to strengthen social learning, each pupil was responsible for their own plant and the group bed over a period of 10 weeks. The design of the lessons followed the principles of basic needs-competence, autonomy, and relatedness-of the Self Determination Theory. The observations were made during a 90-min class, in the school garden as well in the classroom. The 31 girls and 22 boys, aged 11-12 years, changed weekly between the garden and the classroom. Over 150 observations were made in the school garden (82) and in the classroom (68). In summary, pupils showed more socially competent behavior in school garden lessons than in classroom lessons. The school garden lessons, designed according to the basic needs, seem to create favorable incentives for social learning. Due to frequent social interactions, it can be assumed that learning activities in school gardens can promote emotional and social competence.

Nudging children toward healthier food choices: An experiment combining school and home gardens.

School gardens have become a widely used approach to influence children's food knowledge, preferences and choices in low- and high-income countries alike. However, evidence indicates that such programs are more effective at influencing food knowledge and preferences than actual food choices. Such finding may occur because school gardens insufficiently influence the food behavior of parents and because healthy food items are not always available in children's homes. We tested this hypothesis using a one-year cluster randomized controlled trial in Nepal with 15 treatment and 15 control schools and a matched sample of 779 schoolchildren (aged 8-12) and their caregivers. Data were collected before and after the intervention during the 2018-2019 school year. In addition, children's food consumption was monitored using a monthly food logbook. Average treatment effects were quantified with a double-difference estimator. For caregivers, the intervention led to a 26% increase in their food and nutrition knowledge (p < 0.001), a 5% increase in their agricultural knowledge (p = 0.022), a 10% increase in their liking for vegetables (p < 0.001), and a 15% increase in home garden productivity (p = 0.073). For children, the intervention had no discernible effect on food and nutrition knowledge (p = 0.666) but led to a 6% increase in their liking for vegetables (p = 0.070), healthy food practices (p < 0.001), and vegetable consumption (October-December +15%; p = 0.084; January-March +26%; p = 0.017; April-June +26%; p = 0.088). The results therefore indicate both schools and parents matter for nudging children toward healthier food choices.

The Influence of Food Production Experience on Dietary Knowledge, Awareness, Behaviors, and Health among Japanese: A Systematic Review.

This study aimed to reveal the influence of food production experience on dietary knowledge, dietary awareness, dietary behaviors, and health among Japanese populations. We conducted a systematic review of articles published between January 2000 and September 2018 (PROSPERO registration number: CRD42019117163) using the following four databases: PubMed, Web of Science, CiNii, and ICHUSHI. The search formulas were created by combining search terms "agricultural experience," "garden," "diet," "food," "physical activity," "health," and "well-being." The articles were identified by titles, abstracts, and whole texts. We evaluated the content of the articles that met the adoption criteria. We included original articles from peer-reviewed scientific journals, articles written in Japanese or English, observational or interventional studies with statistical analyses, and articles targeting general Japanese people (except for those targeting patients or disabled) to examine the relationship according to the purpose of this review. Nineteen articles met the study criteria, including 10 cross-sectional studies, one retrospective study, seven pre-post studies, and three non-randomized controlled trials. Two studies combined multiple research designs. Thus, food production experiences were suggested to have a positive influence on dietary knowledge, dietary awareness, food preference, dietary behaviors, and mental health among the Japanese. However, the overall quality of the included studies was low. Further verification with randomized controlled trials and prospective cohort studies is required.

Healthy eating promoting in a Brazilian sports-oriented school: a pilot study.

BACKGROUND: Adolescents, particularly athletes, have high exposure to ultra-processed foods, which could be harmful to their health and physical performance. School environments are capable of improving eating patterns. Our study is aimed at capturing changes in students' food consumption three years after they enrolled at an experimental school, considered a model of health promotion in Rio de Janeiro city. We also aimed to depict the promising nature of the healthy eating promotion program implemented in the school and share the learnings from its implementation. METHODS: Our pilot study was a follow-up on the implementation of a school garden, experimental kitchen activities, and health promotion classes. We evaluated 83 adolescent athletes' food consumption twice during the study: at its beginning (2013) and end (2016), by administering a food frequency questionnaire (FFQ) that inquired about the frequency of foods consumed in the past week. To evaluate how effectively the activities were established, integrated, and sustained in schools, the Garden Resources, Education, and Environment Nexus (GREEN) tool was used, and the school's adherence to the school garden program was classified as high (scored 47 points out of 57). RESULTS: In 2013, 89 adolescents (mean ± SD 11.9 ± 0.4 years, 54% male) participated in the study, of which 83 continued until 2016 (14.8 ± 0.5 years, 55% male). In 2013, the mean frequency of raw salad and fruits consumption was 1.4 (CI [1.0-1.9]) and 4.3 (CI [3.8-4.9]) days per week, respectively. Three years later, the frequency of raw salad and fruits consumption was 2.2 (CI [1.6-2.7]) and 5.0 (4.5-5.5), respectively. Considering that five meals were offered at school (five days/week), it may be possible to assume that the program raised awareness on the importance of healthy eating. CONCLUSION: Our results suggest that such integrated healthy eating promotion programs may improve adolescent athletes' eating habits, by increasing the frequency of their consumption of unprocessed foods. This pilot study's results inspired us to implement an expanded project at the municipal level. Since 2018, teachers who participated in this program are working with Rio de Janeiro's Municipal Secretary of Education for Coordination of Curricular Projects. Some learnings from this pilot study on implementing the garden/experimental kitchen project in this school are being applied in 65 schools of the municipal network: joint activities must be fostered among students, teachers, and parents; healthy eating needs to be a respected value among adolescent athletes and become an example for parents and teachers.

Development of the GREEN (Garden Resources, Education, and Environment Nexus) Tool: An Evidence-Based Model for School Garden Integration.

BACKGROUND: Researchers have established the benefits of school gardens on students' academic achievement, dietary outcomes, physical activity, and psychosocial skills, yet limited research has been conducted about how school gardens become institutionalized and sustained. OBJECTIVE: Our aim was to develop a tool that captures how gardens are effectively established, integrated, and sustained in schools. DESIGN: We conducted a sequential, exploratory, mixed-methods study. Participants were identified with the help of Grow To Learn, the organization coordinating the New York City school garden initiative, and recruited via e-mail. PARTICIPANTS/SETTING: A stratified, purposeful sample of 21 New York City elementary and middle schools participated in this study throughout the 2013/2014 school year. The sample was stratified in their garden budgets and purposeful in that each of the schools' gardens were determined to be well integrated and sustained. MAIN OUTCOME MEASURES: The processes and strategies used by school gardeners to establish well-integrated school gardens were assessed via data collected from surveys, interviews, observations, and concept mapping. STATISTICAL ANALYSES PERFORMED: Descriptive statistics as well as multidimensional scaling and hierarchical cluster analysis were used to examine the survey and concept mapping data. Qualitative data analysis consisted of thematic coding, pattern matching, explanation building and cross-case synthesis. RESULTS: Nineteen components within four domains of school garden integration were found through the mixed-methods concept mapping analysis. When the analyses of other data were combined, relationships between domains and components emerged. These data resulted in the development of the GREEN (Garden Resources, Education, and Environment Nexus) Tool. CONCLUSIONS: When schools with integrated and sustained gardens were studied, patterns emerged about how gardeners achieve institutionalization through different combinations of critical components. These patterns are best described by the GREEN Tool, the first framework to identify how to operationalize school gardening components and describe an evidence-based strategy of successful school garden integration.

Prevalence and risk factors of undernutrition among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso.

BACKGROUND: Multiple factors determine children's nutritional status, including energy and nutrient intake, recurrent infectious diseases, access (or lack thereof) to clean water and improved sanitation, and hygiene practices, among others. The "Vegetables go to School: improving nutrition through agricultural diversification" (VgtS) project implements an integrated school garden programme in five countries, including Burkina Faso. The aim of this study was to determine the prevalence of undernutrition and its risk factors among schoolchildren in Burkina Faso before the start of the project. METHODS: In February 2015, a cross-sectional survey was carried out among 455 randomly selected children, aged 8-14 years, in eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso. Nutritional status was determined by anthropometric assessment. Helminth and intestinal protozoa infections were assessed using the Kato-Katz and a formalin-ether concentration method. A urine filtration technique was used to identify Schistosoma haematobium eggs. Prevalence of anaemia was determined by measuring haemoglobin levels in finger-prick blood samples. Questionnaires were administered to children to determine their knowledge of nutrition and health and their related attitudes and practices (KAP). Questionnaires were also administered to the children's caregivers to identify basic household socio-demographic and economic characteristics, and water, sanitation and hygiene (WASH) conditions. To determine the factors associated with schoolchildren's nutritional status, mixed logistic regression models were used. Differences and associations were considered statistically significant if P-values were below 0.05. RESULTS: Complete datasets were available for 385 children. The prevalence of undernutrition, stunting and thinness were 35.1%, 29.4% and 11.2%, respectively. The multivariable analysis revealed that undernutrition was associated with older age (i.e. 12-14 years compared to <12 years; adjusted odds ratio (aOR) = 3.45, 95% confidence interval (CI) 2.12-5.62, P < 0.001), multiple pathogenic parasitic infections (aOR = 1.87, 95% CI 1.02-3.43, P = 0.044) and with moderate and severe anaemia in children (aOR = 2.52, 95% CI 1.25-5.08, P = 0.010). CONCLUSIONS: We found high prevalence of undernutrition among the children surveyed in the two study regions of Burkina Faso. We further observed that undernutrition, anaemia and parasitic infections were strongly associated. In view of these findings, concerted efforts are needed to address undernutrition and associated risk factors among school-aged children. As part of the VgtS project, WASH, health education and nutritional interventions will be implemented with the goal to improve children's health. TRIAL REGISTRATION: ISRCTN17968589 (date assigned: 17 July 2015).

Increasing Prevalence of US Elementary School Gardens, but Disparities Reduce Opportunities for Disadvantaged Students.

BACKGROUND: We examined the prevalence of school garden programs at US public elementary schools. The study examined time trends, demographic and regional disparities, and associations with related programs such as farm-to-school. METHODS: Annual surveys were gathered from nationally representative samples of elementary schools between 2006-2007 and 2013-2014. Annual samples ranged from 553 to 748 schools. RESULTS: The prevalence of gardens increased steadily from 11.9% in 2006-2007 to 31.2% in 2013-2014 (p < .001). In multivariate logistic regressions the prevalence of garden programs varied significantly by school characteristics. Gardens were more prevalent in the west than in other regions. Gardens were less prevalent at schools serving higher proportions of lower-income students, and were more prevalent at urban schools than in suburbs, towns, or rural areas. Gardens were more common at schools with farm-to-school programs. Gardens also were associated with offering formal classroom-based nutrition education. CONCLUSIONS: Garden programs in elementary schools have increased over time, but there is room for wider implementation, particularly at schools serving lower-income students. Given the role of childhood in establishing food preferences and dietary consumption habits, such programs are important and can reinforce the messages imparted through nutrition education.