School feeding in Ethiopia: a scoping review.

INTRODUCTION: Undernutrition is a major public health problem in developing countries, especially in Sub-Saharan Africa. Undernourished children are smaller and have low weight. To solve this issue, school feeding (corn-soya blend, vegetable oil) started in 1994 in Ethiopia. Thus, this scoping review aims to map the evidence relating to school feeding programs and their potential role in managing children`s nutrition in Ethiopia. METHODS: This scoping review is informed by the methodological framework of Arksey & O'Malley for scoping reviews and recommendations on the framework by Levac and colleagues. The databases searched included the Education Resources Information Centre, International Initiative for Impact Evaluation, Cochrane Library, MEDLINE, and Google Scholar. To ensure its comprehensive search, grey literature sources were searched. The search was undertaken on 26 April 2023. Studies on school feeding, such as coverage, and studies that evaluate the educational and nutritional impacts of school feeding in Ethiopia, regardless of study designs, were included. Reports (publications) about school feeding without scientific methodology were excluded. RESULT: Twenty-seven studies were included in this review. It includes cross-sectional, prospective cohort, laboratory-based analysis, experimental, case study, and qualitative study designs. The school feeding program results were inconclusive, while some indicate a positive effect on body mass index, height, thinness, anemia, weight, dropout rate, class attendance, and enrollment. The others showed that the school feeding program did not affect stunting, thinness, weight, hemoglobin level, enrollment, attendance, dropout rate, and academic achievement. Factors affecting school feeding programs negatively include poor quality food and financial constraints. However, no literature on school feeding program coverage was found. CONCLUSION: School feeding programs improved nutritional status, and academic performance, although some studies show any effect. Poor-quality food provisions and financial constraints affect school feeding programs. There are mixed findings, and further research is required to determine the effect of school feeding programs conclusively. To ensure the program's sustainability, it should be supported by a national policy, and budget allocation is needed. In addition, more evidence should be generated to show the coverage of school feeding programs in Ethiopia.

Corrigendum: Effect of school feeding program on body mass index of primary school adolescents in Addis Ababa, Ethiopia: a prospective cohort study.

[This corrects the article DOI: 10.3389/fnut.2022.1026436.].

Contribution of school meals to the recommended nutrient and energy intake of children enrolled in the National Homegrown School Feeding Program in Zaria, Nigeria.

BACKGROUND: A poor nutritional status in children results in reduced physical and mental health and poor academic performance. The National Homegrown School Feeding Program (NHSFP) was introduced in Nigeria in 2016 to ameliorate short-term hunger and improve the nutritional status of school-aged children (SAC). At least 33% of the recommended nutrient intake (RNI) for the enrolled students should be met by the school meals. However, to our knowledge, the contribution of school meals served through the NHSFP to the RNI of SAC in Zaria, Nigeria, remains to be explored. METHODS: We conducted a school-based cross-sectional study among 276 eligible SAC recruited from public primary schools in the Zaria Local Government Area. Portion sizes of the meals served through the NHSFP were determined using an electronic scale, meal samples were collected for nutrient analysis, and the average daily nutrient intake of the participants from the meals was calculated. The average daily intake of nutrients and energy of the participants was compared with the age- and sex-specific RNI to estimate the percentage contribution of the meals. RESULTS: The portion sizes recorded were 199.3 ± 20.6 g, 263.9 ± 11.5 g, 242.1 ± 16.8 g, 311 ± 17.3 g, and 160.3 ± 1.9 mL, respectively, for moi-moi, jollof rice and beans, bean porridge, jollof rice and boiled egg, and yoghurt. In addition, the meals contained moisture (30.13-66.11%), ash (0.73-7.08%), crude fat (9-32.61%), crude protein (7.25-24.5%), crude fiber (0-2.45%), and total carbohydrate (2.19-29.74%) with an energy content ranging from 183.6 to 330.57 kcal. Similarly, the meals contained calcium (82.58-711 mg), potassium (133-797 mg), sodium (340-1720 mg), iron (0.078-8.60 mg), zinc (1.84-13.4 mg), vitamin A (2.38-100.56 RAE), and vitamin C (0.04-1.57 mg) per 100 g of the school meals. The meals contributed 18.2-19.1%, 102.8-183.7%, 13.04-13.6%, and 26.1%-35.8% of the RNI for carbohydrates, proteins, fiber, and energy, respectively. Furthermore, they contributed 137-175%, 314.3-502.2%, 87.6-142.1%, 21.5-25.1%, 279.2-348.5%, 3.3-5.9%, 24.7-48.8%, and 3.3-5.9% of the RNI for iron, zinc, calcium, potassium, sodium, vitamin A, and vitamin C, respectively. CONCLUSION: The meals served through the NHSFP contributed at least 33% of the RNI for energy, protein, iron, calcium, sodium, vitamin A, and zinc. However, they could not meet the 33% of the RNI for carbohydrates, fiber, potassium, and vitamin C. Increasing the portion sizes and the diversity of the meals can address the suboptimal contribution of the meals to the RNI for carbohydrates, fiber, potassium, and vitamin C.

Parent Willingness to Pay for School Feeding Programs in Junior High Schools in Malang Regency, Indonesia.

In Indonesia, school feeding programs have not been established nationally due to the government's limited budget. To examine the possibility of copayment for school feeding programs, parents' intentions to use the school feeding programs and their willingness to pay (WTP) for these programs should be considered. We conducted an online questionnaire survey among the parents of junior high school students in all five public junior high schools in the Kepanjen District of Malang Regency, East Java Province, Indonesia. We used the contingent valuation method to elicit parents' WTP for school feeding and calculated the price elasticity of school feeding. Factors associated with the WTP were examined using logistic regression analysis. Of the 940 participants, 90% intended to use school feeding programs, and 30% were willing to pay Rp 15,000 (USD 1.05) or higher per meal. Of the 944 students (participants' children), all but two students consumed meals or snacks at school, with 74% consuming foods three or more times daily. Higher WTP for school feeding was associated with frequent food consumption at school, higher income, and a better perception of meals at school. In contrast, lower WTP was associated with more household members. Most parents intended to use school feeding programs with certain WTP irrespective of the price of school feeding. Therefore, school feeding in Indonesia might be expanded through copayment.

Effect of school feeding program on academic performance of primary school adolescents: A prospective cohort study.

BACKGROUND: School Feeding Programs (SFPs) in low-income countries help vulnerable children learn better and maintain their health through the provision of nutritious food to school children. Ethiopia scaled up the implementation of SFP in Addis Ababa. AIMS: We aimed at evaluating the effect of the SFP on the school performance of primary school adolescents in Addis Ababa, Central Ethiopia. METHOD: A prospective cohort study design was employed on 322 SFP-beneficiary and equal-size non-beneficiary adolescents. SPSS version 24 and multivariable linear regression models were used. RESULT: In linear regression, unadjusted model (Model 1), compared with the non-school-fed adolescent, the mean difference in difference of average academic scores of school-fed adolescents was higher by 2.11 (ß 2.11, 95% CI 1.39-2.83). The beta coefficient remained positive after adjusted for age and sex (Model 2: ß 2.11, 95% CI 1.39-2.83), sociodemographic variable (Model 3: ß 2.16, 95% CI 1.45-2.88), health and lifestyle variable (Model 4: ß 2.21, 95% CI 1.38-3.04). In the final model, adjusted for model five, school absenteeism, there was a significant difference in favor of school-fed adolescents on GPA-score (Model 5: ß 2.32, 95% CI 1.47-3.17). Furthermore, being adolescents in middle tertile wealth index families decrease GPA by 1.22 (ß -1.22, 95% CI -2.19 to -0.26) as compared to high tertile wealth index. CONCLUSION: School feeding was positively associated with academic performance. However, these changes may not be meaningful to generate a firm conclusion on the utility of school feeding in improving the academic performance of adolescents.

Effect of School Feeding Program on School Absenteeism of Primary School Adolescents in Addis Ababa, Ethiopia: A Prospective Cohort Study.

BACKGROUND: School feeding programs (SFP) in low-income countries are designed to provide food to vulnerable school children to create optimal educational and health conditions for learners. Ethiopia scaled up the implementation of SFP in Addis Ababa. Yet, the utility of this program in terms of school absenteeism has not been monitored thus far. Hence, we aimed at evaluating the effect of the SFP on school performance of primary school adolescents in Addis Ababa, Central Ethiopia. METHODS: A prospective cohort study was carried out from 2020 to 2021 on SFP-beneficiary (n = 322) and non-SFP beneficiary (n = 322). Logistic regression models were done using SPSS version 24. RESULTS: In logistic regression, unadjusted model (model 1), the school absenteeism of non-school-fed adolescents was higher by 1.84 (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 1.28-2.64) as compared to school-fed adolescents. The odds ratio remained positive after adjusting for age and sex (model 2: aOR 1.84, 95% CI 1.27-2.65), and sociodemographic (model 3: aOR 1.84, 95% CI 1.27-2.67). In the final model, adjusted model 4, health and lifestyle, there was a significant increase in absenteeism of non-school-fed adolescents (model 4: aOR 2.37, 95% CI 1.54-3.64). The likelihood of absenteeism in female increase by 2.03 (aOR 2.03, 95% CI 1.35-3.05), whereas being in a low tertile wealth index family decreases absenteeism by (aOR 0.51, 95% CI 0.32-0.82). School feeding was negatively associated with school absenteeism. CONCLUSIONS: The findings imply the need for strengthening school feeding programs.

A call to readjust the Israeli school feeding program.

The COVID-19 pandemic challenged the food and nutrition security status of thousands of children in Israel. This commentary argues that policymakers should urgently readjust the Israeli school feeding program based on experts' advice. Children should have the right to select food items, grow the items, prepare the meals, and clean and care for the waste together. They should eat as a community in suitable school dining rooms. Access to the school feeding program should also be ensured during emergencies, school closures, isolation and quarantine, treatment, and rehabilitation of children. The food provided through the program should be integrated into the food baskets of their families, aimed at improving their households' food and nutrition security. It is important to activate a universal school feeding program that does not differentiate, separate, and stigmatize children, their households, their communities, and their schools. The United States National School Lunch Program is briefly reviewed, highlighting the importance of the program's routine monitoring, evaluation, and improvement. Engaging the children in planning the meals and in the production, preparedness, provision, and waste management processes are key to improving their involvement, health literacy and promotion, and their families' resilience. Implementing a holistic Food System Approach, including school gardening and "Farm to School," is suggested. It is recommended to urgently formulate a modern, universal, and comprehensive Israeli Food and Nutrition Security Plan, with a dedicated chapter for the upgraded School Feeding Programe with a section on its implementation in emergency preparedness, response, and Resilience. It should be anchored in the Food Systems framework and the One Health Approach.

Successes and challenges of the Home-grown School Feeding Program in Sidama Region, Southern Ethiopia: a qualitative study.

The Home-grown School Feeding Program (HG-SFP) is a model designed to provide school meals to students using foods sourced from local markets. HG-SFP recently has been incorporated as one of the strategies of educational development in Ethiopia aiming to address hunger and food insecurity problems of school children. Yet, evaluation of the successes and challenges of the program has been limited evaluated. The purpose of the present study was to explore the successes and challenges of the SFP in Sidama Region, Southern Ethiopia. This exploratory qualitative study collected data from eight schools targeted for HG-SFP through key informant interviews and focus group discussions (FGDs). A total of sixteen FGDs and twenty-one in-depth interviews were conducted. Purposive sampling was used to include study participants based on their potential relevance in delivering in-depth information. The findings of the present study showed that HG-SFP was successful in improving class attendance and academic performance of school children. In addition, the program had a contribution in saving the parents' money and time as a result of the food provided. With regard to SFP challenges, lack of permanent clean water provision, delay in ration delivery, poor-quality food provision, inadequate amount of food allocated for the academic year, lack of necessary infrastructure for the program, and lack of training in sanitation and hygiene for cooks were among the major challenges identified. Therefore, program challenges need high-level attention in order to make the school feeding program more successful in Sidama Region, Ethiopia.

Effect of school feeding program on the anthropometric and haemoglobin status of school children in Sidama region, Southern Ethiopia: a prospective study.

Ethiopia recently scaled up the implementation of a school feeding program (SFP) as a targeted intervention for protecting disadvantaged school children from hunger and food insecurity. However, the contribution of the program to advancing the nutritional status of children has not been adequately explored. We assessed the effect of SFP on the anthropometric and haemoglobin status of school children in Sidama Region, Southern Ethiopia. Our prospective cohort study compared the height-for-age z-score (HAZ), BMI-for-age z-score (BAZ) and haemoglobin concentration of SFP beneficiary (n 240) and non-beneficiary (n 240) children, 10-14 years of age. The children were recruited from 8 SFP implementing and 8 control schools using a multistage sampling procedure and were followed for an academic year. The SFP intervention and control schools were matched one-to-one based on agro ecological features and geographical proximity. Exposure, outcome and pertinent extraneous variables were collected through baseline and end-line surveys. Multilevel difference-in-differences (DID) analysis was used to measure the net effect on the outcomes of interest. In the multivariable DID model adjusted for potential confounders including maternal and paternal literacy, household monthly income, wealth index and household food insecurity, the SFP did not show significant effects on the haemoglobin concentration (ß = 0⋅251, 95 % confidence interval (CI): -0⋅238, 0⋅739), BAZ (ß = 0⋅121, 95 % CI: -0⋅163, 0⋅405) and HAZ (ß = -0⋅291, 95 % CI: -0⋅640, 0⋅588) of children.

The Impact of School Meal Programs on Educational Outcomes in African Schoolchildren: A Systematic Review.

Malnutrition and hunger can lower a child's ability to learn effectively. Many countries in Africa experience high rates of childhood undernutrition, and school feeding programs are a common tool used to address this challenge. A systematic review was conducted to evaluate the effect of school-provided meals on educational outcomes in preschool and primary school children. Specific outcomes of interest in this review included test scores, attendance, and enrollment rates. PubMed and Scopus were used for an electronic search of relevant studies. Studies included in this review were randomized and non-randomized controlled trials, prospective cohort studies, controlled before-after studies, and pre/post-test design studies published in the past 10 years in English in sub-Sahara Africa. Findings from the nine studies included in this review suggest a positive correlation between school feeding programs and educational outcomes. Although mealtime may reduce classroom time, the benefits of providing a meal outweigh the potential loss of learning time because hungry children may not learn as effectively. In conclusion, it is recommended that school meal programs be implemented and expanded. To improve general wellbeing and learning capabilities of children, school meals should be employed starting at a young age. More research on school feeding programs is needed concerning the preschool age group (2-5 years), as there is a limited amount of information in this area.

Effect of school feeding program on body mass index of primary school adolescents in Addis Ababa, Ethiopia: A prospective cohort study.

Background: Governments and developmental organizations are encouraged to devote adequate resources to the establishment of free school meals to low-income children in developing countries. In Ethiopia, the school feeding program (SFP) is implemented in a few regions including the capital, Addis Ababa. However, the nutritional benefit of the program was not monitored and reported thus far. In this study, we evaluated the effect of the SFP on the body mass index (BMI) of primary school adolescents in Addis Ababa, Central Ethiopia. Method: A prospective cohort study was employed to collect data from 644 SFP-beneficiary adolescents (n = 322) and non-SFP (n = 322). Nutritional outcomes were measured following 6 months of follow-up. WHO Anthroplus were used to convert anthropometric data into body-mass-index-for-age Z scores. The independent effect of school feeding is analyzed through a multivariable linear regression model. Result: In linear regression, unadjusted model (Model 1), compared with the non-school-fed adolescents, the mean difference in difference of BAZ-score of school-fed adolescent was higher by 0.36 (ß 0.36, 95% CI 0.17, 0.55). The beta coefficient remained positive after adjusted for age and sex (Model 2: ß 0.35, 95% CI 0.16, 0.54) and sociodemographic variable (Model 3: ß 0.35, 95% CI 0.16, 0.54). In the final model, adjusted for model four, lifestyle and health status there was a significant difference in favor of school-fed adolescents on BAZ-score indices (Model 4: ß 0.4, 95% CI 0.18-0.62). On the contrary, for a unit increase in family size, the BAZ score will decrease by 0.06 (ß 0.06, 95% CI -0.12--0.01). Similarly, adolescents with a middle tertile wealth index decreased their BAZ score by 0.30 (ß 0.30, 95% CI -0.55--0.05) as compared to the higher tertile wealth index. Conclusion: School feeding was positively associated with a change in BAZ score whereas family size and middle tertile wealth index were negatively associated. This implies that school feeding can serve as an optimal strategy for addressing the nutrition needs of adolescents.

Percepções sobre a implementação do programa nacional de alimentação escolar (PNAE) na perspectiva do direito humano à alimentação adequada / Perceptions about the implementation the national school feeding program (PNAE) from the perspective of the human right to adequate food / Percepciones sobre la implementación del programa nacional de alimentación escolar (PNAE) en la perspectiva del derecho humano a la alimentación adecuada

O artigo tem por objetivo analisar, diante das condições de implementação do PNAE em escolas públicas de educação básica do Oeste catarinense, percepções quanto à efetivação do acesso de forma igualitária e ao respeito às diferenças biológicas e condições de saúde dos estudantes, na perspectiva do direito humano à alimentação adequada. Toma por base resultados de pesquisa com nutricionistas e diretores de escola da região, realizada por meio de questionários, com enfoque na leitura que fazem acerca da ação do Estado na perspectiva do direito humano à alimentação adequada e, nesse contexto, da efetividade do Programa Nacional de Alimentação Escolar (PNAE). Conclui que, quanto ao respeito às diferenças biológicas e condições de saúde dos estudantes, são parciais as condições de implementação do PNAE em escolas públicas de educação básica da mesorregião, embora afirmada a efetivação do acesso de forma igualitária à alimentação viabilizada pelo Programa.(AU)

The article aims to analyze, according to the conditions for implementation of the PNAE in public schools of basic education in the West of Santa Catarina, perceptions regarding the effectiveness of equal access and to the respect for biological differences and health conditions of the students, from the perspective of the human right to adequate food. It is based on the results of research with nutritionists and school principals from the region, carried out through questionnaires, focusing on the reading they make about the State's action in the perspective of the human right to adequate food and, in this context, the effectiveness of the National School Feeding Program (PNAE). It concludes that, regarding the biological differences and health conditions of the students, the conditions for implementation of the PNAE in public schools of basic education on the microregion are partial, although the effectiveness of equal access to food enabled by the program is affirmed.(AU)

El artículo tiene por objetivo analizar, en vista de las condiciones de implementación del Programa Nacional de Alimentación Escolar (PNAE) en escuelas públicas de educación básica del Oeste de Santa Catarina, percepciones cuanto a la efectividad del acceso de manera igualitaria y al respeto a las distinciones biológicas y condiciones de salud de los estudiantes, en la perspectiva del derecho humano a la alimentación adecuada. Tiene como base resultados de investigación con nutricionistas y directores de escuela de la región, realizada por medio de cuestionarios, con enfoque en la lectura que hacen sobre la acción del Estado en la perspectiva del derecho humano a la alimentación adecuada y, en ese contexto, de la efectividad del PNAE. Se concluye que, en relación al respeto a las distinciones biológicas y condiciones de salud de los estudiantes, son parciales las condiciones de implementación del PNAE en escuelas públicas de educación básica de la mesorregión, sin embargo, afirmada la efectividad del acceso de manera igualitaria a la alimentación viabilizada por el Programa.(AU)

Programas de alimentación escolar en Costa Rica y Guatemala: Percepciones de la comunidad escolar acerca de su funcionamiento en escuelas urbanas públicas

RESUMEN El objetivo de esta investigación fue comparar las principales características que influyen en el funcionamiento de los Programas de Alimentación Escolar (PAE) en escuelas urbanas y públicas de Costa Rica y Guatemala y la percepción de la comunidad escolar sobre dicho funcionamiento. Se realizó una revisión documental de informes y normativas vigentes relacionadas con los PAE de cada país para comparar características principales. Se realizaron 32 entrevistas y 43 grupos focales con la comunidad escolar para captar sus percepciones sobre el funcionamiento. Se realizó un análisis temático de transcripciones aplicando teoría fundamentada. Como principales hallazgos, se destaca que los PAE en Costa Rica y Guatemala han sido una estrategia para luchar contra el hambre y malnutrición infantil, contando ambos países con un gran respaldo normativo y político que le da sostenibilidad. Sin embargo, existen barreras como recursos limitados, problemas administrativos y falta de fiscalización de las normas. En conclusión, apesar de que en ambos países existe una normativa robusta para hacer cumplir el derecho a una alimentación saludable, se encontraron algunas barreras que dificultan una correcta implementación del PAE.

ABSTRACT The aim of this study was to compare the functioning of School Feeding Programs (SFP) in Costa Rica and Guatemala and the perceptions about operationalization among the public school community. We conducted a comparative review of government reports and existing regulations related to SFP in each country to compare key characteristics. We conducted 32 individual interviews and 43 focus group discussions with actors at different levels of the school community to capture their perceptions about SFP functioning. We conducted thematic analysis applying grounded theory. SFP in both countries have been used as a strategy to address hunger and child malnutrition. Both countries have an important body of regulations and policies that support program sustainability. However, the research revealed some barriers to effective implementation including: limited resources, administrative problems, and a lack of oversight of regulations. In conclusion, while SFP are important instruments of social protection for the right to nutrition in both countries, there are a number of barriers to optimal SFP implementation.

Status of Intestinal Helminth Infection in Schools Implementing the Home-Grown School Feeding Program and the Impact of the Program on Pupils in Anambra State, Nigeria.

PURPOSE: Intestinal helminthiasis among pupils is a major impediment to their well-being and development. This 2-year study determined how home-grown school feeding programme (HGSFP) impacted on pupils' school attendance and created opportunity for more children to assess interventions geared towards the prevention and possible elimination of intestinal helminthiasis. METHODS: Faecal samples were collected from 1677 consented pupils and examined for helminths using Kato-Katz technique. Pupils were treated with 40 mg Levamisole (anti-helminthic) and re-examined. Structured questionnaires and focus group discussions were used to determine anthropometric indices and risk factors. RESULTS: A 6% prevalence rate which was not significant with respect to sex or age was observed. Helminth parasites observed were Ascaris lumbricoides (4.4%), Trichuris trichiura (0.8%), Hookworm spp. (0.2%), and Taenia spp. (0.5%). Two pupils (1.98%) recorded high intensity of infection (epg) while 98.02% had light infection. Ascaris lumbricoides voided following treatment were 290. The Body Mass Index (BMI) indicated that infected pupils had lower values (14.6317) compared to uninfected pupils (19.2003). The HGSFP significantly improved school attendance by 30%. Lack of knowledge about transmission (P = 0.0004), hand hygiene (P = 0.01) and usage of toilet (P = 0.01) were risk factors observed. CONCLUSION/SIGNIFICANCE: Intestinal helminthiasis remains a public health problem among pupils because environmental and behavioural risk factors persist. HGSFP improved school attendance and created opportunity for more inclusive participation of school-aged children for deworming. This has great potential in fast-tracking the elimination of intestinal helminthiasis. The present study consequently advocates the need to sustain HGSFP in schools.

A Comparative Interrupted Times Series on the Health Impact of Probiotic Yogurt Consumption Among School Children From Three to Six Years Old in Southwest Uganda.

Introduction: Following a school milk feeding program in Southwest Uganda, we initiated a probiotic yogurt school feeding program in the same region in 2018. In order to investigate the potential health benefits from probiotic yogurt we conducted an observational study, where we compared the effect of the consumption of locally produced probiotic yogurt containing Lactobacillus rhamnosus yoba 2012 to milk in pre-primary schoolchildren from different schools on the occurrence of respiratory tract infections (common cold) and skin infections (e.g., tinea capitis). Method: A comparative interrupted time series over a period of 3 weeks of baseline followed by 9 weeks of 100 ml of probiotic yogurt or milk consumption for 5 days per week. In total 584 children attending five different schools were followed during consumption of probiotic yogurt and 532 children attending five other schools during consumption of milk. Incidences of respiratory tract infection symptoms and skin infection symptoms, changes in anthropometric indicators and absenteeism were recorded. Results: Over the course of the study period the incidence rate for common cold symptoms decreased faster in the yogurt group than in the milk group (p = 0.09) resulting in a final RR of 0.85 (95% CI: 0.5-1.4) at the end of the observational period. The incidence rate of skin infection related symptoms also reduced faster in the yogurt group compared to the milk group (p < 0.0001) resulting in a relative risk factor (RR) of 0.6 (CI: 0.4-0.9) at the end of the observational period. Anthropometric indicators and level of absenteeism did not show significant differences between yogurt and milk. Conclusion: Notwithstanding the observed positive trend and effect of probiotic yogurt on the incidences of common cold and skin infections, respectively, we consider the results of this comparative interrupted time series inconclusive due to differences in the recorded health parameters between the probiotic yogurt and milk control groups at base line, and fluctuations over the course of the intervention period. An improved study design, with more uniform study groups, a longer intervention period and a third control group without yogurt or milk is required to draw definitive conclusions.

A Community-Based School Nutrition Intervention Improves Diet Diversity and School Attendance in Palestinian Refugee Schoolchildren in Lebanon.

BACKGROUND: School feeding programs have the potential to supply children with healthy school food, alleviate short-term hunger, and improve children's educational outcomes. OBJECTIVES: We linked community kitchens to a subsidized school snack intervention and assessed the impact of this intervention on nutritional (diet diversity, hemoglobin, and anthropometry) and educational (attendance and academic performance) outcomes of Palestinian refugee schoolchildren. METHODS: We collected data from 1362 students (aged 5-15 y) and their parents at baseline, and at an 8-mo follow-up in 2 control and 2 intervention schools. We conducted linear, logistic, and negative binomial regression analyses to assess changes in outcomes of children participating in the intervention schools compared with children in control schools (intention-to-treat). We also assessed the impact of the snack intervention in children who participated ≥50% of the time (HP, high-participation) compared with those who participated <50% (LP, low-participation), or who only received nutrition education (control) (per protocol). All the analyses were adjusted for child age and gender, maternal education, household expenditure, and school-level clustering effect. RESULTS: At endline, there were 648 children in the control group, and within the intervention group, 260 children were LP and 454 were HP. There was a significantly greater increase in overall diet diversity score and dairy consumption in the HP group compared with controls. Both LP and HP groups were more likely to consume proteins, and less likely to consume desserts than controls. Furthermore, the HP group had a significant increase in hemoglobin, and both LP and HP groups had a significant decrease in school absenteeism compared with controls. CONCLUSIONS: This community-based school nutrition intervention had a positive impact on diet diversity, hemoglobin, and school attendance of children.

The relationship between school meals with thinness and stunting among primary school students, in Meket Wereda, Ethiopia: comparing schools with feeding and non-feeding program.

BACKGROUND: Though undernutrition affects academic performance, significant number of Ethiopian school children have undernutrition. To avert nutritional problems the government in collaboration with the world food program has implemented a school feeding program. However, data on the nutritional status of primary school students were scarce in the country. Therefore, this study aimed to assess the relationship between school meals with thinness and stunting among primary school students in Meket Woreda and to identify associated factors. METHODS: A school-based comparative cross-sectional study was conducted among 1091 students, from April 1-27, 2015. The study participants were selected using a multi-stage stratified sampling method. A structured questionnaire was used to collect data. Data entry and analysis were done using Statistical Package for the Social Sciences (SPSS) version 20 software. Descriptive statistics and logistic regression analyses were done. Anthropometric data were analyzed using Anthro-plus software. RESULTS: In univariate analysis, thinness was commoner in nonschool feeding program schools (37.5%) compared to school feeding program schools (27.8%) but stunting was less common (48.3% versus 58.5%). However, after adjustment for confounding, there was no difference in stunting levels, but the adjusted odds ratio for thinness in nonschool feeding program schools was 2.6 (95% CI: (1.8, 3.8)) times higher than in school feeding program schools. Other independent risk factors for thinness were: having uneducated mother, being a male and taking meal once daily. Independent risk factors for stunting were ethnicity, having uneducated mother, un-piped water supply, taking meal once daily, type of diet and being a male. CONCLUSION: The provision of meals seems to offer considerable protection against thinness, though not against stunting. Thus, school meal program should be scaling up into schools in food insecure areas.

Snack Development for School Feeding Programs in Africa: A Scoping Review.

The benefits of school feeding have been well documented. As such, school feeding programs have continuously gained popularity in developing countries. However, challenges and potential opportunities persist, calling for a review of school feeding for long-term sustainability. South Africa has an opportunity to improve their National School Nutrition Program (NSNP) by including an energy-dense snack that would increase the recommended dietary allowance (RDA) of school children to meet at least 25% of their energy requirements. The objective of this scoping review was to conduct a review and an appraisal of studies on snack food development for school feeding programs in Africa. Eligible studies had to report snack development for school feeding programs in Africa. We conducted an electronic search in National Research Foundation (NRF) NEXUS, Elton B. Stephens Company (EBSCO), International Food Information Service (IFIS), Nutrition and Food Sciences Center for Agriculture and Bioscience International (CABI.ORG), and Google Scholar. Of the 429 articles identified, nine studies were included in the final review-five from within South Africa and four from elsewhere in Africa. Data extracted included the study design, intervention, outcomes, relevant findings, and limitations. Results were presented in a narrative summary. The review findings showed that energy-rich staple foods and food fortification were commonly used in snack development. The popular snack products developed included porridges and biscuits. While most studies reported nutritional outcomes, few studies reported on sensory acceptability tests and only two studies conducted a cost analysis. This review of previous snack development initiatives for school feeding programs in Africa underscores the importance of establishing the sustainability of any food product developed. The findings of this review have the potential to inform future snack product development for school feeding programs.

Avaliação da adequação nutricional de cardápios escolares em uma instituição da rede pública de ensino na região Sudeste de Minas Gerais / Evaluation of the nutritional adequacy of school menus in a public school in the Southeast region of Minas Gerais

Este estudo teve como objetivo verificar a adequação dos cardápios da alimentação escolar com a legislação do Programa Nacional de Alimentação Escolar (PNAE), quanto ao valor calórico, quantidade de macronutrientes, vitaminas A e C, cálcio, ferro, magnésio, zinco e fibras dietéticas. Foram avaliados 20 cardápios destinados a uma escola da rede pública que atende às faixas etárias de 6 a 10 anos e 11 a 15 anos, localizada no sudeste de Minas Gerais. Os cardápios analisados não contemplaram todas as recomendações de nutrientes e de energia para ambas faixas etárias, sendo a maior inadequação para o cálcio. Foi verificado que os mesmos cardápios e per capita eram utilizados para ambas faixas etárias, apesar do PNAE determinar necessidades nutricionais diferentes. Desta forma, as necessidades da faixa etária de 6 a 10 anos foi melhor atendida, com maior percentual de cardápios adequados em relação a carboidrato, proteína, lipídios, vitamina C, ferro, magnésio e zinco, quando comparado aos escolares de idade igual ou maior a 11 anos (p<0,05). Com os resultados obtidos, concluímos que ações corretivas em relação ao planejamento de refeições do cardápio da escola avaliada precisam ser realizadas respeitando a diferença entre as faixas etárias.

This study aimed to verify the adequacy of school feeding menus with the legislation of the National School Feeding Program (PNAE), regarding caloric value, quantity of macronutrients, vitamins A and C, calcium, iron, magnesium, zinc and dietary fibers. We evaluated 20 menus destined to a public school that serves the age groups of 6 to 10 years and 11 to 15 years at Southeast of Minas Gerais. The menus analyzed did not contemplate all the nutrient and energy recommendations for both age groups being the greatest inadequacy for calcium. It was verified that the same menus and per capita were used for both age groups although the PNAE determined different nutritional needs. Thus, the needs of the 6 to 10 years old age group were better met, with a higher percentage of adequate menus in relation to carbohydrates, protein, lipids, vitamin C, iron, magnesium and zinc, when compared to children with aged 11 years or older (p<0.05). We conclude that corrective actions in relation to the meal planning of the menu of the school evaluated must be carried out respecting the difference between age groups.

Acceptance and Impact of Millet-Based Mid-Day Meal on the Nutritional Status of Adolescent School Going Children in a Peri Urban Region of Karnataka State in India.

The study assessed the potential for use of millets in mid-day school meal programs for better nutritional outcomes of children in a peri-urban region of Karnataka, India, where children conventionally consumed a fortified rice-based mid-day meal. For a three-month period, millet-based mid-day meals were fed to 1500 adolescent children at two schools, of which 136 were studied as the intervention group and were compared with 107 other children in two other schools that did not receive the intervention. The intervention design was equivalent to the parallel group, two-arm, superiority trial with a 1:1 allocation ratio. The end line allocation ratio was 1.27:1 due to attrition. It was found that there was statistically significant improvement in stunting (p = 0.000) and the body mass index (p = 0.003) in the intervention group and not in the control group (p = 0.351 and p = 0.511, respectively). The sensory evaluation revealed that all the millet-based menu items had high acceptability, with the highest scores for the following three items: finger millet idli, a steam cooked fermented savory cake; little and pearl millet bisi belle bath, a millet-lentil hot meal; and upma, a pearl and little millet-vegetable meal. These results suggest significant potential for millets to replace or supplement rice in school feeding programs for improved nutritional outcomes of children.