Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis

Abstract

Background School feeding programs are ubiquitous in low- and middle-income countries (LMICs) and may have critical implications for the health and education of school-age children and adolescents. This systematic review aimed to assess the impacts of school feeding on educational and health outcomes of children and adolescents in LMICs. Methods Interventional studies on the effects of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs were included. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and grey literature were searched (through December 2019) to identify eligible studies. We included randomized controlled trials and controlled before-after studies on school feeding conducted in LMICs among children and adolescents aged 6 to 19 who received primary or secondary education. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Meta-analyses were performed for outcomes available in three or more independent studies. Subgroup analyses were conducted by study design and school feeding modality whenever possible. Results Fifty-seven articles met the inclusion criteria for the review, including 44 randomized controlled trials and 13 controlled before-after studies; 19 articles were included in the meta-analysis. School feeding resulted in a significant increase in height (mean difference = 0.32 cm; confidence interval (CI) = 0.03, 0.61; P = 0.032) and weight (mean difference: 0.58 kg; 95% 95% CI = 0.22, 0.93; P = 0.001) over 12 months, compared to those in the control groups. School feeding also resulted in a significant increase in the percentage of school days attended (2.6%; 95% CI = 1.2%, 3.9%; P < 0.001). Conclusions School feeding is an important approach to improving the health and education outcomes of children and adolescents living in LMICs. More well-designed research is needed to establish further the effectiveness of school feeding for nutritional outcomes and academic achievement. Registration PROSPERO ID: CRD42020159003.

Food Insecurity among Adolescent Students from 95 Countries Is Associated with Diet, Behavior, and Health, and Associations Differ by Student Age and Sex

“…Food insecurity was prevalent among adolescent students in this global sample, with 25%–30% of students, depending on age group and sex, reporting going hungry because there was not enough food at some point in the last 30 d. Hunger is an experience associated with very low food security and is relatively infrequent compared with food-related worries or cutbacks in food quality ( 31 ), so the actual prevalence of less severe food insecurity is likely higher than was assessed with the 1 question available in the GSHS. This finding highlights the importance of monitoring and intervention to promote food security, including among students who are generally at lower risk of food insecurity in part owing to the food they receive while in school ( 32 ).…”

Urban Public Food Procurement in Kiambu and Machakos Counties as a Driver of Food and Nutrition Security and Sustainability: A Literature Review and Case Studies

“…A recent systematic review of randomised control trials in LMICs found that school feeding was positively associated with height and weight; although, they did not find significant changes in height-for-age, weight-for-age, or body mass index-for-age. This indicates a need for further long-term studies to fully measure anthropometric changes [93].…”

“…At the intersection of education and SDG5 (Gender Equality), school feeding has been linked to improved school attendance and performance, especially for girls [93,98,99]. Food procurement can also economically empower female food producers, which is why the FAO recommends giving women producers preferential access to public food procurement markets [88,100].…”

Stronger efforts are needed to safeguard the nutrition of school aged children

“…9 In addition, several studies in low-and middle-income countries have shown that school meal programmes have positive effects in correcting nutritional deficiencies and improving children's growth as measured by weight and height. 10 Including locally produced food in school meals could also provide structured institutional demand and a predictable market for smallholder farmers, benefitting child nutrition as well as food security more broadly. 11 However, we reiterate that current global inequalities resulting from the negative effects of climate change point to the urgent need to transform and adapt food systems from the global to the local level to ensure nutritious diets for children in all parts of the world.…”

“…Such measures can contribute to positive health and nutrition outcomes for school aged children, for example, weekly iron supplementation for adolescents has been shown to reduce the risk of anaemia, and nutritional education through school gardens has improved school children’s nutritional agency 9. In addition, several studies in low- and middle-income countries have shown that school meal programmes have positive effects in correcting nutritional deficiencies and improving children’s growth as measured by weight and height 10. Including locally produced food in school meals could also provide structured institutional demand and a predictable market for smallholder farmers, benefitting child nutrition as well as food security more broadly 11.…”