A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana

Abstract

Food environments can play important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP). Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse

Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review

“…agreed that fortyfour studies were potentially eligible for full-text analysis. Subsequently, only fourteen studies (34,(36)(37)(38)(39)(42)(43)(44)(45)(46)(47)(48)(49)(50) met our pre-specified inclusion criteria; thirty of the potentially eligible articles were excluded as those studies were either 'companion' reports of studies already included (n 7); school nutrition surveys/case studies (n 14) which mainly involved assessments of anthropometry and/or nutrition KAB (51)(52)(53) ; analyses of perception and practice of healthy eating among teachers and parents, and development of school food gardens as nutrition tools (54)(55)(56) ; RCT of government school feeding initiatives (n 4) (28,57,58) ; or SBNI on pre-schoolers aged <5 years (n 5), these consisted mainly of school-and-community nutrition interventions with parental involvement (59)(60)(61)(62) . Figure 1 presents a flow chart of the review process.…”

Youth and Food Systems Transformation

“…They may consume a greater proportion of food outside the home (e.g., street food and fast food, or meals in institutional canteens). Sites such as schools, gyms and workplaces may exert an influence over young people's food choices, whether through providing food or exposing the young people to guidance on nutrition and healthy eating (Fernandes et al, 2017;Hossain et al, 2019). Participating in activities and employment away from home will also expose young people to positive and negative influences via peer pressure and other social and cultural signals, including food marketing, which typically promotes highly processed, energy dense, "empty calorie" foods (WHO, 2006;Popkin et al, 2012;Marcus, 2013; Save the Children, 2015; Development Initiatives, 2018).…”

“…The economics of food markets have an important, structuring influence on consumption. Young people's food choices and behaviors are shaped by the food environments in which they move (Cullen et al, 2015;Herforth and Ahmed, 2015;Fernandes et al, 2017;Turner et al, 2018;Holdsworth and Landais, 2019). As indicated above, food marketers routinely target youth.…”

Basic school pupils’ food purchases during mid-morning break in urban Ghanaian schools

“…Conversely, vending unhealthy food can expose children to malnutrition and other diet-related non-communicable diseases (NCDs). In Ghana, there is limited evidence on the school food environment and pupil purchasing behaviour [3,4]. More scarce is evidence on pupil food purchases at school in the presence or absence of school provided meals or regulation.…”

“…There is also reported concentration of unhealthy foods and beverages in formal establishments in urban Ghana [24] with high evidence of the dominance of unhealthy foods in commercial advertisements in higher education [25]. Literature on how pupils interact with the prevailing food retail environment at schools in Ghana is limited [3,4].…”