Diet Diversity and Food Security in a Biodiverse Region of Madagascar

Abstract

component in the development of healthy eating practices and behaviors as it enhances children's knowledge and skills that they need to perform desired behaviors which may track to adulthood. Objective: To identify factors associated with successful nutrition education interventions among children in promoting healthy behaviors. Study Design, Setting, Participants, Intervention: A systematic review of nutrition education interventions among children was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies published between 2009 and 2016 were identified through Pubmed, Medline, Web of Science, Science Direct, and Educational Resources Information Center (ERIC) database. Forty-eight studies met the inclusion criteria and were screened and determined the quality of the studies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A total of 41 studies were included in the final analysis. Outcome Measures and Analysis: The data from 41 studies were extracted. The studies were grouped and reviewed according to their target age groups: preschoolers, elementary and secondary school children. The primary analytic goal was to determine the overall effectiveness of nutrition education interventions according to their stated objective. Results: Out of the 41 studies, 26 targeted elementary school children, eight targeted secondary school children, and seven studies targeted preschoolers. Seven overarching factors emerged as critical to successful nutrition education among children as follows: a multicomponent (involving teachers and parents) and multilevel intervention (including the schools and home) approach; adequate duration and frequency of exposure; level of parental engagement; age-appropriate and handson experiences; fidelity as ensured by trained implementers and standardized protocol; environmental change for upstream and midstream outcome; and proper alignment between stated objectives, intervention, and desired outcome. Conclusions and Implications:The critical components for effectiveness of children education interventions included strategies that were age appropriate, involved parents and environmental change, ensured fidelity, and had adequate duration. Funding: None.