School food, politics and child health

N. Rodrigues EL, Etuge P, Warner Y, Kessler H, Mitchell A. School Meal Programs in Africa: Regional Results From the 2019 Global Survey of School Meal Programs

Introduction

School meal programs operate throughout Africa, serving as a social safety net and aiming to improve children's nutrition, influence their dietary choices, and strengthen the agrifood economy through local procurement. Despite their rapid expansion in the past decade, there has been no systematic effort to comprehensively document school feeding activities across the continent.

Methods

Detailed information on school feeding activities in each country was captured in the Global Survey of School Meal Programs©, which launched in 2019. An invitation to participate was extended to each government, which appointed a national-level respondent to gather information on every large-scale school meal program in the country.

Results

Forty-one countries in Africa (38 in sub-Saharan Africa) responded to the survey in 2019 with information on 68 large-scale programs that together reached 60.1 million children. Across these countries, the aggregate school feeding budget was USD 1.3 billion. Diversity in school meal programs is evident across regions, country income levels, and levels of national commitment. Coverage rates tended to be highest in southern Africa, in countries with school feeding as a line item in the national budget, and in countries with the greatest domestic share of the school feeding budget. Diversity in the school menu tended to be greatest in programs that sourced food through domestic purchase rather than relying on foreign in-kind donations. To address micronutrient malnutrition, about two-thirds of the programs served fortified foods, and one-quarter included micronutrient supplements. Even as rates of overweight/obesity are rising among African school children, just 10% of school meal programs identified its prevention as an objective.

Conclusion

The extent to which school meal programs in Africa are supported with domestic funding reflects a dramatic shift in favor of national ownership and domestic food procurement. At the same time, programs have grappled with inadequate and unpredictable budgets and challenges related to supply chains and logistics—impediments that need to be addressed if these programs are to achieve their objectives. Overall, the survey results underscore the important position of school meal programs within African food systems and their potential (if well-designed) to sustainably improve food security, child health, and nutrition.

Roles of Cities in Creating Healthful Food Systems

Over the past several decades, cities worldwide have attempted to reconfigure their food systems to improve public health, advance social justice, and promote environmental resilience using diverse municipal policies, often with the support of stakeholder-led governance mechanisms such as food policy councils. This article reviews the roles that cities have played in creating healthful urban food systems and the effects of those policies on public health. It explains that despite wide-ranging policy initiatives, disparities in food insecurity and malnourishment persist. It concludes by describing several promising pathways for urban food policy: engaging in food-focused urban planning to create equitable food environments; treating policies to address inequality and social justice as upstream food policies; considering the effects of new business models such as online food retail in urban food policy making; and using food procurement as a lever to influence regional, national, and global food systems. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Agricultural policy and societal factors influence patients' ability to follow a healthy diet

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Cardiovascular and cardiometabolic diseases are largely preventable, and are propagated by a poor diet.

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Poor diet may be due to a lack of supply and access to healthy foods, agricultural subsidies, and marketing.

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Improving national dietary intake starts with enhancing dietary guidelines, enacting legislative changes to optimize agricultural subsidies and food advertising, and incentivizing a plant-forward diet.

Intergenerational nutrition benefits of India's national school feeding program

India has the world's highest number of undernourished children and the largest school feeding program, the Mid-Day Meal (MDM) scheme. As school feeding programs target children outside the highest-return "first 1000-days" window, they have not been included in the global agenda to address stunting. School meals benefit education and nutrition in participants, but no studies have examined whether benefits carry over to their children. Using nationally representative data on mothers and their children spanning 1993 to 2016, we assess whether MDM supports intergenerational improvements in child linear growth. Here we report that height-for-age z-score (HAZ) among children born to mothers with full MDM exposure was greater (+0.40 SD) than that in children born to non-exposed mothers. Associations were stronger in low socioeconomic strata and likely work through women's education, fertility, and health service utilization. MDM was associated with 13-32% of the HAZ improvement in India from 2006 to 2016.

Body Mass Index and Associated Factors of School Absenteeism by School Feeding Program at Selected Primary Schools in Addis Ababa, Ethiopia: A Comparative Study

BACKGROUND

Quality of education plays a crucial role in the social, economic, and political development of a nation. Primary school is a vital stage in developing the personality and consciousness of school children.

OBJECTIVE

The study assessed the Body Mass Index and factors associated with School Absenteeism at selected primary schools in Addis Ababa, 2018.

METHODS

A comparative cross-sectional study was undertaken on 324 (162 each group) from selected primary schools of Addis Ababa from May 02 to July 30, 2018. All participants and their families provided written informed consent and assent. A systematic random sampling technique was used to select participants, where the list of students was once identified from the selected schools. An independent t-test was undertaken at p value <0.05 as the statistically significant level. And, binary logistics regression was used for the identification of factors statistically associated with school absenteeism, with its respective 95% confidence interval (CI) and p value of <0.05 significant level. Findings. There was a statistically significant difference between feeding and nonfeeding participants on average weight, school absenteeism, and BMI for age, at p < 0.05. Participants who enrolled in the school feeding program had a higher average weight than nonfeeding participants (p < 0.05). Participants from the feeding group had lower average school absenteeism than their counter participants (p < 0.05). The average BMI for age was significantly higher among feeding participants than nonfeeding participants (p < 0.05). The odds of having school absenteeism were 1.796 times higher among feeding participants than among nonfeeding participants (AOR: 1.796; 95CI:1.061-3.042, p < 0.05). The odds of sustaining absenteeism from the school were 2.257 times higher among feeding participants than among nonfeeding participants (AOR: 2.257; 95%CI: 1.291-3.948; p < 0.05).

CONCLUSION

A higher number of school absenteeism, average weight, and BMI for age were observed in participants enrolled in the school feeding program than those who did not get enrolled in the feeding program. Large-scale studies were recommended to testify the impacts of school feeding on absenteeism.

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.

Community participation in rural Ecuador’s school feeding programme

Purpose

The purpose of this paper is to contribute to the debate concerning community participation in school-based health education and health promotion, with regard to food and nutrition.

Design/methodology/approach

Based on empirical data generated over the course of one year of fieldwork in three rural communities and schools in Ecuador, the study examines community participation related to the implementation of the school feeding programme (SFP) in rural schools in Ecuador. The conceptual framework for the study is shaped by the concepts of student and community participation within the health promoting school (HPS) paradigm.

Findings

The findings help identify and portray different forms of community participation, ranging from a total absence of meaningful participation, though very limited, to consequential participation determined as community influence on the SFP practices to meet the community needs, priorities and systems of meanings.

Research limitations/implications

The study shows that the meaningful participation of the parents and community members in small rural schools in a low- to middle-income country such as Ecuador can be linked to an empowered stance towards the SFP so that it is better tuned to local conditions, priorities and systems of meaning. School leadership, geographical characteristics and internal community organization seem to influence how participation is valued and enacted. Challenges remain in the interpretations of community participation, including counter- and non-participation of members.

Originality/value

The study contributes to an understanding of policy implementation and the implications of a HPS approach to health education and health promotion in small rural schools.

The perception of parents and teachers about intermittent preventive treatment for malaria in school children in a semi-rural area of Kinshasa, in the Democratic Republic of Congo

BACKGROUND

Intermittent preventive treatment (IPT) is likely to be the most promising therapeutic strategy to prevent malaria and its related adverse outcomes in schoolchildren. However, its successful implementation will depend on acceptability to key stakeholders such as parents and teachers.

METHODS

A qualitative research was conducted, following a clinical trial assessing the effectiveness of IPT in schoolchildren (IPTsc), to understand the perceptions and experiences of parents and teachers with IPTsc, in two schools of Mokali, in Kinshasa, Democratic Republic of the Congo. Eighty parents participated in 8 focus group discussions and 6 school staff were involved in 6 semi-structured interviews.

RESULTS

Parents experiences with IPTsc divided them into two groups (owning positive experiences and owning negative experiences with IPTsc). Three major themes emerged as key factors associated with reluctance of parents to IPT use in schoolchildren. These included wrong malaria-related knowledge, bad experience with IPTsc administered during the trial and misunderstanding of IPTsc. The school staff were generally willing to be trained to give medicine to schoolchildren within the scope of IPT. However, most parents were more comfortable with the use of health workers than teachers for drug administration. More importantly, all parents accepting IPT suggested to diagnose malaria infection before any administration of IPT, which is not in line with IPT principal.

CONCLUSION

These results suggest that more efforts are needed to improve overall malaria-related knowledge in the community, specifically chemo-prevention strategies and the safety of the drugs used, to ensure the success of health interventions.

Implementation conditions for diet and physical activity interventions and policies: an umbrella review

BACKGROUND

This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life.

METHODS

A systematic review of reviews and stakeholder documents was conducted. Data from nine scientific literature databases were analyzed (95 documents met the inclusion criteria). Additionally, published documentation of eight major stakeholders (e.g., World Health Organization) were systematically searched (17 documents met the inclusion criteria). The RE-AIM framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support.

RESULTS

We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions (87.9 %; 73 of 83) were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians' collaboration in implementation.

CONCLUSIONS

The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB.

Effects of a post-deworming health hygiene education intervention on absenteeism in school-age children of the Peruvian Amazon

Soil-transmitted helminth (STH) infections are a leading cause of disability and disease burden in school-age children of worm-endemic regions. Their effect on school absenteeism, however, remains unclear. The World Health Organization currently recommends delivering mass deworming and health hygiene education through school-based programs, in an effort to control STH-related morbidity. In this cluster-RCT, the impact of a health hygiene education intervention on absenteeism was measured. From April to June 2010, all Grade 5 students at 18 schools in a worm-endemic region of the Peruvian Amazon were dewormed. Immediately following deworming, nine schools were randomly assigned to the intervention arm of the trial using a matched-pair design. The Grade 5 students attending intervention schools (N = 517) received four months of health hygiene education aimed at increasing knowledge of STH prevention. Grade 5 students from the other nine schools (N = 571) served as controls. Absenteeism was measured daily through teachers' attendance logs. After four months of follow-up, overall absenteeism rates at intervention and control schools were not statistically significantly different. However, post-trial non-randomized analyses have shown that students with moderate-to-heavy Ascaris infections and light hookworm infections four months after deworming had, respectively, missed 2.4% (95% CI: 0.1%, 4.7%) and 4.6% (95% CI: 1.9%, 7.4%) more schooldays during the follow-up period than their uninfected counterparts. These results provide empirical evidence of a direct effect of STH infections on absenteeism in school-age children.

The history of ecoimmunology and its integration with disease ecology

Ecoimmunology is an example of how fruitful integrative approaches to biology can be. Since its emergence, ecoimmunology has sparked constructive debate on a wide range of topics, from the molecular mechanics of immune responses to the role of immunity in shaping the evolution of life histories. To complement the symposium Methods and Mechanisms in Ecoimmunology and commemorate the inception of the Division of Ecoimmunology and Disease Ecology within the Society for Integrative and Comparative Biology, we appraise the origins of ecoimmunology, with a focus on its continuing and valuable integration with disease ecology. Arguably, the greatest contribution of ecoimmunology to wider biology has been the establishment of immunity as an integral part of organismal biology, one that may be regulated to maximize fitness in the context of costs, constraints, and complex interactions. We discuss historical impediments and ongoing progress in ecoimmunology, in particular the thorny issue of what ecoimmunologists should, should not, or cannot measure, and what novel contributions ecoimmunologists have made to the understanding of host-parasite interactions. Finally, we highlight some areas to which ecoimmunology is likely to contribute in the near future.