Impact of school meals on educational outcomes in Addis Ababa, Ethiopia.

OBJECTIVE: This study evaluated the impact of the Addis Ababa School Feeding Program (SFP) on educational outcomes. DESIGN: Single-group repeated measurement/longitudinal study design and multistage stratified sampling design were followed. Effect sizes estimates, repeated measures ANOVA, Chi-square, Generalised Additive Mixed Model and mixed effects negative binomial regression were used. Academic scores, attendance and dropout and height and weight of schoolchildren were collected. SETTING: School Feeding Programs in Addis Ababa, Ethiopia. PARTICIPANTS: Schoolchildren in primary schools and school directors and teachers in fifteen randomly selected schools for Key Informant Interview (KII). RESULTS: Anthropometric measurements of 4500 schoolchildren were taken from 50 schools. Academic scores of 3924 schoolchildren from 46 schools, class attendance records of 1584 schoolchildren from 18 schools and annual enrolment records of 50 schools were gathered. School meals achieved a minimum to large scale effects on educational outcomes with effect sizes (η2) of academic scores (boys = 0·023, girls = 0·04), enrolment (girls = 0·001, boys = 0·05) and attendance (Cramer's V = 0·2). The average scores of girls were significantly higher than that of boys (P < 0·0001). Height-for-age in all schoolchildren (P < 0·01) and BMI-for-age Z-scores in adolescent girls of 15-19 years (P < 0·0001) never had a significant positive relationship with average scores. Significant relation was observed between nutritional status and attendance (P = 0·021). KII showed that SFP created convenient teaching-learning environment and reduced hunger in schools, while boosting enrolment, attendance and academic performance among the schoolchildren. CONCLUSION: The Addis Ababa SFP has positively contributed to educational outcomes. Strengthening the program would enhance nutritional outcomes and diminish educational inequalities.

School feeding contributed valuable dietary energy and nutrients despite suboptimal supply to school-age children and adolescents at primary schools in Addis Ababa, Ethiopia.

OBJECTIVES: This study investigated the nutritional quality and adequacy of school meals served to school-age children and adolescents. METHODS: A total of 55 food samples were collected from 11 food types served for breakfast and lunch at 15 selected school kitchens. Each meal was weighed using a digital scale. The initial sample weights were recorded and dried in an oven at a temperature of 60°C to constant weight. The nutrient content and dietary energy of the meals were calculated using a conversion factor with reference to the national food composition table. RESULTS: School meals supplied 883 calories of average energy, representing 48% and 34% of the daily recommended nutrient intake (RNI) for early adolescents (ages 7-12 y) or late adolescents (ages 13-17 y), respectively. Late-adolescent boys acquired the least RNI (31%). The meals contributed protein (44%-66%; 31%-47%), carbohydrate (50%-68%; 35%-48%), fat (15%-26%; 10%-20%), and fiber (44%-110%; 31%-78%) for early and late adolescents, respectively. Micronutrients, such as ß-carotene (36%-51%; 26%-37%), thiamine (47%-78%; 33%-54%), riboflavin (35%-55%; 26%-38%), niacin (16%-27%; 12%-19%), phosphorous (27%-41%; 20%-29%), calcium (64%-103%; 46%-73%), and iron (188%; 133%) were served for early and late adolescents, respectively. The caloric and nutritional contributions were generally less than two-thirds of the daily RNIs required from school meals, except that of fiber, thiamine, and calcium (for early adolescents), and iron. CONCLUSIONS: Despite their benefit to alleviate hunger in schools, school meals contributed suboptimal energy and nutrients to deprived school-age children and adolescents. Inclusion of animal products, fruits, and vegetables may improve energy and nutritional values.