School Feeding Programmes and Physical Nutrition Outcomes of Primary School Children in Developing Countries

Context School feeding programmes have been widely implemented and particularly in developing countries with the aim to improve school enrolment and attendance especially of girls and to reduce short term hunger to improve childrens performance in school. Beyond the first 1000 days of the lives of children, school feeding programmes remain one of the critical interventions that have used schools as a platform to contribute to the fulfilment of their nutritional needs though the evidence to this effect is little and mixed. Objective This review focused on assessing the impact of school feeding programmes on reduction in underweight, thinness, and stunting among primary school children in developing countries. Data sources Electronic searches were carried out in PUBMED, SCORPUS and Cochrane library. The WHO clinical trials registry as well as reference lists of relevant articles were also hand searched. Data Extraction Data was extracted from included studies which have been published in the past 10 years (2010 - August 2021) from original research where the main intervention was the provision of school based meals. Data analysis Meta-analysis was conducted to determine changes in height-for-age (HAZ), weight-for-age (WAZ) and BMI-for-age (BAZ) z scores. A random effects model was applied to determine the mean difference in all outcomes of interest which were evaluated as continuous variables. Results Children aged 3 - 16 years were enrolled in the included studies and the number of participants ranged between 321 and 2,869 across studies. Of the included studies, the feeding intervention provided for a minimum of 30% RDA for the age group with the intervention lasting up to a maximum of 34 weeks. The impact of school feeding intervention on HAZ, BAZ and WAZ showed statistically non-significant (p>0.05) mean differences of 0.02 (95% CI, -0.06 to 0.10), 0.11 (95% CI, -0.01 to 0.23) and 0.06 (95% CI, -0.04 to 0.16) respectively Conclusion School feeding interventions have not shown any significant positive effect on the physical nutrition outcomes of primary school children. Short duration of intervention of studies, poor compliance to feeding and substitution of school meals could have accounted for the weak effect sizes.