Aulo Gelli1, Elisabetta Aurino2, Gloria Folson3, Daniel Arhinful3, Clement Adamba4, Isaac Osei-Akoto4, Edoardo Masset5, Kristie Watkins2, Meena Fernandes2, Lesley Drake2, Harold Alderman1. 1. International Food Policy Research Institute, Washington, DC. 2. Partnership for Child Development, Department of Infectious Disease Epidemiology, Imperial College, London, London, United Kingdom. 3. Noguchi Memorial Institute for Medical Research, College of Health Sciences. 4. Institute of Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana. 5. Institute of Development Studies, University of Sussex, Brighton, United Kingdom.
Abstract
BACKGROUND: Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school meals programs as platforms to scale-up nutrition interventions is relevant as programs function in nearly every country in the world. OBJECTIVE: The aim of this study was to evaluate the impact of a large-scale school meals program in Ghana on school-age children's anthropometry indicators. METHODS: A longitudinal cluster randomized control trial was implemented across the 10 regions of Ghana, covering 2869 school-age children (aged 5-15 y). Communities were randomly assigned to 1) control group without intervention or 2) treatment group providing the reformed national school feeding program, providing 1 hot meal/d in public primary schools. Primary outcomes included height-for-age (HAZ) and BMI-for-age (BAZ) z scores. The analysis followed an intention-to-treat approach as per the published protocol for the study population and subgroup analysis by age (i.e., midchildhood for children 5-8 y and early adolescence for children 9-15 y), gender, poverty, and region of residence. We used single-difference ANCOVA with mixed-effect regression models to assess program impacts. RESULTS: School meals had no effect on HAZ and BAZ in children aged 5-15 y. However, in per-protocol subgroup analysis, the school feeding intervention improved HAZ in 5- to 8-y-old children (effect size: 0.12 SDs), in girls (effect size: 0.12 SDs)-particularly girls aged 5-8 y living in the northern regions, and in children aged 5-8 y in households living below the poverty line (effect size: 0.22 SDs). There was also evidence that the intervention influenced food allocation and sharing at the household level. CONCLUSION: School meals can provide a platform to scale-up nutrition interventions in the early primary school years, with important benefits accruing for more disadvantaged children. This trial was registered at www.isrctn.com as ISRCTN66918874.
RCT Entities:
BACKGROUND: Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school meals programs as platforms to scale-up nutrition interventions is relevant as programs function in nearly every country in the world. OBJECTIVE: The aim of this study was to evaluate the impact of a large-scale school meals program in Ghana on school-age children's anthropometry indicators. METHODS: A longitudinal cluster randomized control trial was implemented across the 10 regions of Ghana, covering 2869 school-age children (aged 5-15 y). Communities were randomly assigned to 1) control group without intervention or 2) treatment group providing the reformed national school feeding program, providing 1 hot meal/d in public primary schools. Primary outcomes included height-for-age (HAZ) and BMI-for-age (BAZ) z scores. The analysis followed an intention-to-treat approach as per the published protocol for the study population and subgroup analysis by age (i.e., midchildhood for children 5-8 y and early adolescence for children 9-15 y), gender, poverty, and region of residence. We used single-difference ANCOVA with mixed-effect regression models to assess program impacts. RESULTS: School meals had no effect on HAZ and BAZ in children aged 5-15 y. However, in per-protocol subgroup analysis, the school feeding intervention improved HAZ in 5- to 8-y-old children (effect size: 0.12 SDs), in girls (effect size: 0.12 SDs)-particularly girls aged 5-8 y living in the northern regions, and in children aged 5-8 y in households living below the poverty line (effect size: 0.22 SDs). There was also evidence that the intervention influenced food allocation and sharing at the household level. CONCLUSION: School meals can provide a platform to scale-up nutrition interventions in the early primary school years, with important benefits accruing for more disadvantaged children. This trial was registered at www.isrctn.com as ISRCTN66918874.
Authors: Gina Kennedy; Andrea Berardo; Cinzia Papavero; Peter Horjus; Terri Ballard; MarieClaude Dop; Jan Delbaere; Inge D Brouwer Journal: Public Health Nutr Date: 2010-07-06 Impact factor: 4.022
Authors: E A Kristjansson; V Robinson; M Petticrew; B MacDonald; J Krasevec; L Janzen; T Greenhalgh; G Wells; J MacGowan; A Farmer; B J Shea; A Mayhew; P Tugwell Journal: Cochrane Database Syst Rev Date: 2007-01-24
Authors: Robert E Black; Cesar G Victora; Susan P Walker; Zulfiqar A Bhutta; Parul Christian; Mercedes de Onis; Majid Ezzati; Sally Grantham-McGregor; Joanne Katz; Reynaldo Martorell; Ricardo Uauy Journal: Lancet Date: 2013-06-06 Impact factor: 79.321
Authors: Mercedes de Onis; Adelheid W Onyango; Elaine Borghi; Amani Siyam; Chizuru Nishida; Jonathan Siekmann Journal: Bull World Health Organ Date: 2007-09 Impact factor: 9.408