school feeding thesis

• Open access
• Published: 16 March 2020

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

• Dongqing Wang 1 &
• Wafaie W. Fawzi 1 , 2 , 3  

Systematic Reviews volume  9 , Article number:  55 ( 2020 ) Cite this article

137k Accesses

22 Citations

29 Altmetric

Metrics details

School feeding programs are beneficial for the physical, mental, and psychosocial development of school-age children and adolescents, particularly those in low- and middle-income countries (LMICs). While school feeding programs are ubiquitous in LMICs, the specific benefits of school feeding programs are unclear. The aim of this systematic review and meta-analysis is to evaluate the impacts of school feeding programs on the educational and health outcomes of children and adolescents in LMICs.

Rigorously designed interventional studies on the impacts of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs will be included. The following information sources were used to identify relevant published or unpublished studies: MEDLINE, EMBASE, CINAHL, the Cochrane Library, and governmental or organizational websites. The risk of bias of randomized and non-randomized studies will be assessed using the Cochrane Risk of Bias tool and the ROBINS-I tool, respectively. Two reviewers will independently conduct the selection of studies, data extraction, and assessment of the risk of bias. A narrative synthesis of all the included studies will be provided. Meta-analyses will be performed whenever appropriate. Heterogeneity of effects will be assessed by I 2 , subgroup analyses, and meta-regression. The certainty of evidence for each outcome will be assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

The design and implementation of school feeding programs in LMICs should be based on the understanding of the benefits of such programs. This work will provide a crucial evidence base for the educational and health benefits of school feeding on children and adolescents in LMICs.

Systematic review registration

This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on November 18, 2019 (registration number: pending).

Peer Review reports

Nutrition during the school years is crucial for the physical, mental, and psychosocial development of children and adolescents aged 6 to 19 years. It is estimated that, across the developing world, 66 million school-age children go to school every day hungry, with 23 million hungry children in Africa [ 1 ]. Attending classes hungry severely impacts children’s and adolescents’ abilities to learn, to thrive, and to realize their full potentials [ 2 ].

School feeding programs (sometimes referred to as school meal programs) are interventions that regularly provide nutritious foods to children and adolescents attending school [ 3 ]. Benefits of school feeding on children and adolescents include alleviating hunger, reducing micronutrient deficiency and anemia, preventing overweight and obesity, improving school enrollment and attendance, increasing cognitive and academic performance, and contributing to gender equity in access to education [ 4 , 5 , 6 , 7 , 8 ]. Most countries have some forms of school feeding programs in some way and at some scale [ 6 , 8 ]. School feeding programs are widely available in high-income countries but generally have incomplete coverages in low- and middle-income countries (LMICs), where the need is greatest in terms of hunger and poverty [ 5 ]. Most countries in sub-Saharan Africa only have school feeding interventions that are targeted toward the most food-insecure regions instead of being universally available [ 5 ]. It is imperative to expand the coverage of school feeding programs and to improve the quality of existing programs to maximize their benefits on children and adolescents.

Little is known about the impacts of school feeding programs on specific educational and health outcomes of school-age children and adolescents in LMICs. Previous reviews on the potential effects of school feeding are outdated, with the most recent Cochrane review published in 2007 [ 9 ], thus do not reflect all of the currently available evidence. Also, previous work has limited scopes in terms of the age range [ 10 ] or the outcomes examined (e.g., anthropometric and nutritional outcomes but not educational or psychosocial outcomes or vice versa) [ 11 ]. Further, prior reviews have focused on the provision of school meals and did not explicitly evaluate what specific content (types and amounts of foods and nutrients) of the school meals conferred the largest benefits on outcomes [ 9 ]. Therefore, an updated and refined synthesis of evidence on school feeding interventions and a wide range of educational and health outcomes of children and adolescents is warranted and will inform the design and implementation of future programs.

The aim of this systematic review and meta-analysis is to evaluate the impacts of school feeding programs on educational and health outcomes of children and adolescents aged 6 to 19 receiving primary or secondary education in LMICs. We will emphasize findings generated from randomized controlled trials (RCTs). RCTs better account for external factors that may confound the effect of school feeding programs, including background nutritional deficiency levels and inputs from schools and teachers [ 8 , 12 ]. We will also include other rigorously designed interventional studies, including controlled before-after studies (CBAs) and non-randomized controlled trials that were able to account for the baseline differences between intervention arms [ 9 ].

Methods/design

Research question.

We aim to evaluate the impacts of school feeding programs on educational and health outcomes of children and adolescents receiving primary or secondary education in LMICs. We also aim to assess the potentially different impacts of school feeding by characteristics of the program and by composition of the foods provided.

Eligibility criteria

Inclusion criteria.

We will include RCTs, with the intervention randomized individually or in clusters (classes or schools). We will also include CBAs as they are non-randomized studies with a relatively rigorous design and occupy a non-negligible proportion of the relevant literature [ 9 ]. Non-randomized controlled trials are also eligible for inclusion as long as the baseline differences between intervention arms were accounted for in the analysis.

We will include published articles as well as unpublished and grey literature and will include ongoing studies where preliminary findings are available to us.

Studies conducted in LMICs as defined by the World Bank 2020 fiscal year.

Studies involving children and adolescents (boys and girls) aged 6 to 19 who were receiving primary or secondary education (i.e., primary, middle, or high school).

Studies that examined the impacts of the provision of foods, including meals (breakfast, lunch, or dinner) or snacks consumed at school (in-school feeding), and foods distributed to the family and consumed outside of the school setting (take-home ration) [ 5 ]. We will consider the provision of solid foods or beverages (e.g., milk). We will also include studies that examined food stamps or food vouchers distributed at school for the participants to access foods (in the market or food banks).

The comparison (control) group in each included study can be participants who did not receive school feeding or any other interventions, or participants who received alternative interventions instead of school feeding. We will also consider the comparison of school feeding programs with different food compositions, such as the comparison between an updated program with an original one.

We will include educational, nutritional, anthropometric, cognitive, and morbidity outcomes of children and adolescents. Potential outcomes include height, weight, skinfold thickness, mid-upper arm circumference, micronutrient status, hemoglobin level, school enrollment, school attendance, dropout, school achievement (math, reading, spelling), on-task behavior, cognition, and morbidity (e.g., fever, cough, diarrhea, and vomiting). Studies with results for at least one outcome of interest will be included.

No restrictions will be placed on the year, language, sample size of the study, or the duration of the intervention.

Exclusion criteria

Non-randomized controlled trials that did not account for the baseline differences between intervention arms.

Interventional studies without a proper control group, such as uncontrolled before-after studies, uncontrolled interrupted time series studies, and uncontrolled difference-in-difference designs.

Observational studies (e.g., cohort, case-control, and cross-sectional studies).

Editorials, commentaries, opinions, and review articles (these will, however, be used to identify additional original studies).

Studies conducted among preschool children only. Feeding interventions among preschool children are important and of great interest but are beyond the scope of this work, which will focus on the school setting.

Studies that examined the impacts of micronutrient fortification, micronutrient supplementation, or nutrition education; however, if such interventions are complementary to otherwise eligible school feeding interventions, these studies will be included.

Clinical treatment programs targeted toward individuals with specific medical conditions, or programs toward underweight, overweight, or obese individuals.

Studies that only examined aggregate-level economical or agricultural outcomes.

Studies that described school feeding programs without linkage to specific outcomes.

Information sources

The following databases were searched for eligible studies, from the inception of each database through November 2019: MEDLINE (via PubMed), EMBASE, CINAHL, and the Cochrane Library. The selection of the four electronic databases was made in consultation with a health science librarian with expertise in systematic searching. Our search covered the three databases (i.e., MEDLINE, EMBASE, and the Cochrane Library) that are recommended by the Cochrane Handbook for Systematic Reviews of Interventions [ 13 ]. We also searched ClinicalTrials.gov and other governmental or organizational websites (World Food Programme (WFP), World Health Organization, Food and Agriculture Organization (FAO), and World Bank) for studies not identified from the database searching. We will conduct a manual search of references of retained articles and previous reviews. We will also consult with content experts on school feeding to identify any additional studies. Reports written in languages other than English will be translated by colleagues who are native speakers of the corresponding languages whenever possible. Studies that cannot be adequately translated will be excluded.

Search strategy

We consulted with a health science librarian to develop the PubMed search strategy, which is provided in Additional File 1 . The sensitivity of the search strategy was examined by confirming that several sentinel articles were identified. The PubMed strategy will be adapted to the syntax appropriate for other databases. The initial search took place in November 2019, and an updated search will be conducted in early April 2020.

Data management

EndNote X9 (Clarivate Analytics, PA, USA) will be used to store the records retrieved from searches of electronic databases. The records will also be imported into Covidence (Veritas Health Innovation, Melbourne, Australia), an internet-based program that facilitates the streamlined management of the systematic review. Duplicate records will be detected and removed first by EndNote and then by Covidence.

Selection of studies

The results of the searches will be independently assessed by two reviewers based on the inclusion and exclusion criteria. All titles and abstracts will be reviewed first to remove irrelevant studies. For potentially eligible studies and studies with unclear eligibility, the full texts will be obtained and reviewed to confirm eligibility using a form for full text screening, which will be pilot tested on five randomly selected full texts. Disagreements between reviewers will be resolved by discussion or by a third reviewer when necessary. Inter-rater agreement will be quantified by calculating the raw percentage of agreement and Cohen’s κ coefficient. Specific reasons for study exclusions will be documented and summarized using the flow diagram for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 14 ]. Neither of the reviewers will be blind to journal titles or the names of the authors.

Data extraction

Data of the retained studies will be extracted by two reviewers independently and entered into a data extraction form, which will be pilot tested on five randomly selected studies. Disagreements in the extracted information between reviewers will be resolved by discussion or by a third reviewer. When necessary, the corresponding authors of the studies will be contacted to obtain relevant information. We will extract the following information: title, authors (first author and corresponding author), contact information of corresponding author, journal (or source for unpublished reports), calendar year of publication, calendar year of intervention, country, source of funding, study design, sample size (number of clusters for each group and number of participants in each group), sample characteristics (e.g., age, sex, and socioeconomic status), intervention (including timing, duration, food and nutritional content, and co-interventions), measure of adherence, comparator/control, outcomes assessed, main findings with point estimates and measures of variance (standard errors, 95% confidence intervals, or p values), theory to explain success (if available), and theory to explain failure (if available). Multiple reports of a single study will be collated as additional results may be provided in different reports. Whenever there are inconsistent results across reports of a single study, we will contact the corresponding author to obtain more accurate results. The data extraction form is provided in Additional File 2 .

Assessment of risk of bias

The risk of bias will be independently assessed by two reviewers. Any disagreement on the risk of bias between reviewers will be resolved by discussion and by a third reviewer when necessary. The risk of bias assessments will be conducted for each outcome reported in each trial, rather than for the whole study. For RCTs, we will use version 2 of the Cochrane Risk of Bias tool (RoB 2) [ 15 ], which considers the following five domains: bias arising from the randomization process, bias due to deviations from intended interventions, bias due to missing outcome data, bias in measurement of the outcome, and bias in selection of the reported results. For cluster-randomized trials, we will additionally consider bias from the timing of identification and recruitment of individual participants in relation to timing of randomization [ 16 ]. Each domain will be judged as “low risk of bias,” “high risk of bias,” or “some concerns.” We will consider an RCT to be of low risk of bias if it is judged to have low risk of bias for all domains; we will consider an RCT to be of high risk of bias if it is judged to have high risk of bias in at least one domain or have some concerns for multiple domains (≥ 3) in a way that substantially lowers confidence in the result; we will consider an RCT to have some concerns if it raises some concerns in at least one domain but not to be at high risk of bias for any domain [ 15 ]. For CBAs and non-randomized controlled trials, we will use the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool [ 17 ], which considers biases from confounding, bias in selection of participants into the study, bias in classification of interventions, bias due to deviations from intended interventions, bias due to missing data, bias in measurement of outcomes, and bias in selection of the reported results. Each domain will be judged as “low risk of bias,” “moderate risk of bias,” “serious risk of bias,” “critical risk of bias,” or “no information.” We will consider a non-randomized study to be of low risk of bias if it is judged to have low or moderate risk of bias for all domains; we will consider a non-randomized study to be of high risk of bias if it is judged to have serious or critical risk of bias in one or more domains; we will consider a non-randomized study to have some concerns if the assessment is unclear for one or more domains but low or moderate for all other domains. We will contact the corresponding authors of the reports to obtain more information when necessary. We will summarize the results of the assessment of the risk of bias in a table, in which the judgment for each domain will be presented with a justification [ 15 ].

Data synthesis

A systematic and narrative synthesis of all included studies will be presented in the text and also as a table. School feeding will be treated as a dichotomous exposure (i.e., intervention vs. control). Effect estimates for continuous outcomes will be expressed as mean differences (with 95% confidence intervals) comparing the intervention group with the control group; effect estimates for dichotomous outcomes will be expressed as risk ratios, rate ratios, hazard ratios, or odds ratios (all with 95% confidence intervals), comparing the intervention group with the control group. For RCTs, we will extract the results based on intention-to-treat analyses. When more than two intervention groups are present in a study, they will be treated as separate arms. However, when the interventions of the additional arms are not relevant to school feeding, they will not be taken into account. Ideally, cluster-randomized studies should report results from analyses that appropriately account for the study design, such as mixed-effects models or generalized estimating equations. Studies that ignored clustering are overprecise and will receive unduly high weights in the meta-analysis. When cluster-based studies did not use the proper statistical methods to account for clustering, we will extract or apply an intraclass correlation coefficient to modify the standard errors based on the approach described in the Cochrane Handbook for Systematic Reviews of Interventions [ 13 ].

If studies for a given outcome are sufficiently consistent in terms of intervention, comparator, and outcome definition, we will conduct a random-effects, inverse-variance-weighted meta-analysis for the outcome. The random-effects method will be used as the effect of school feeding is presumed to be heterogeneous across time and populations. Heterogeneity of effects across studies will be assessed by computing the I 2 statistic, which represents the percentage of the total variation in the effect estimates that is due to true heterogeneity rather than chance; I 2 > 50% will be considered as substantial heterogeneity [ 18 ].

We will assess the sources of heterogeneity by conducting subgroup analyses with the following prespecified characteristics: unit of allocation (individual, class, or school), modality of intervention (in-school meal, in-school snacks, take-home ration, food stamps/food vouchers), presence of co-interventions (by itself or combined with complementary interventions), timing of intervention (breakfast, lunch, dinner, or snack), duration of intervention (defined as the interval between the initialization of the school feeding intervention, and when the outcomes were assessed), year of study, country or region, level of food insecurity of the region, age group of participants (primary or secondary education), sex of participants, type of report (published or unpublished), and risk of bias (low, high, or some concerns). To assess the potentially differential impacts by the specific content of the meal, we will conduct exploratory subgroup analyses by the type and amount of the foods or nutrients entailed in the program, such as the presence of fruits, vegetables, and animal source foods, or the adequacy of micronutrients and macronutrients (defined in relation to the Recommended Dietary Allowances). To further explain heterogeneity, we will perform meta-regression using the predictors mentioned above. We will use contour-enhanced funnel plots to detect publication bias if there are 10 or more studies available for an outcome [ 19 ]. We will assess the robustness of the results by excluding studies judged to have a high risk of bias, and by repeating the analyses using fixed-effects models. We will compute for each outcome a 95% prediction interval, which provides a predicted range of the effect of the intervention when applied in an individual setting [ 20 ]. Statistical analyses will be conducted using STATA 16 (StataCorp, College Station, Texas). For outcomes with insufficient data or extreme heterogeneity that cannot be assessed in subgroup analyses or meta-regression, we will provide a narrative synthesis without a meta-analysis.

Assessment of certainty of evidence

The overall certainty of evidence for each included outcome will be assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach, which considers risk of bias, publication bias, imprecision, inconsistency, and indirectness [ 21 , 22 , 23 , 24 , 25 , 26 ]. The strength of the overall evidence will be judged as high, moderate, low, or very low [ 21 ].

Registration and reporting

This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on November 18, 2019. However, at the time of this proofing, the protocol has still not been reviewed or assigned a registration number. We reached out to PROSPERO for an update on the registration status and was told that the registration for non-U.K. studies would take a long time (4-5 months with a minimum of 140 days). In the event of protocol amendments, the date of each amendment will be accompanied by a description of each change and the rationale on PROSPERO. We prepared this protocol following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) [ 27 ]. The PRISMA-P checklist can be obtained from Additional File 3 . We will report this systematic review following the Cochrane Handbook for Systematic Reviews of Interventions [ 13 ] and the PRISMA guidelines [ 14 ].

School feeding programs have been and will continue to be essential for the provision of nutrients, improvement of academic performance, and the promotion of a healthy lifestyle in LMICs. Therefore, there is a strong political will to continue to fund new programs and to expand on existing programs [ 28 ]. The design and implementation of school feeding programs in LMICs should be based on the established benefits of such programs on specific educational and health outcomes of children and adolescents, for which an updated evidence base is needed.

The State of School Feeding Worldwide , published by the WFP, summarized the status of school feeding across the world and reported that school feeding programs are ubiquitously present. However, the quality of school feeding programs varies greatly across countries and with national income [ 6 ]. The report also highlighted a need to strengthen the evidence base on the potential benefits of school feeding. Drake et al. reviewed the design and implementation of 14 school feeding programs in LMICs [ 28 ]. They concluded that there is no one-size-fits-all model for school feeding programs, given that different countries approach school feeding programs with different objectives. However, they did identify some good practices that are likely applicable across countries, such as the inclusion of fruits and vegetables, the collaboration with local smallholder farmers, and the incorporation of school feeding programs as the component of a much broader curriculum of nutrition and health education. They noted that there was a lack of quantitative data on the impacts of school feeding, especially those from randomized controlled trials. A recently published report by the FAO-reviewed nutrition guidelines and standards for school meals from 33 LMICs through surveys targeted toward relevant stakeholders and found considerable variation between and within countries in terms of coordination, management, funding, objectives, and modalities of school feeding programs [ 3 ]. For example, the objectives of the identified school feeding programs include addressing short-term hunger, reducing nutrient deficiency, improving attendance and school performance, encouraging healthy eating habits, and supporting local agriculture and economy. Lunch is the most common timing for the identified programs, and the majority of the school lunch programs offer cooked meals that range from single dishes based on staples with added vegetables, legumes, and animal-source foods to menus with a main dish and a side dish; fruits are provided as part of the meal in some programs. Nutrition education and school gardens (often also for educational purposes) are the most common complementary interventions to the feeding programs. However, this report focused on government-owned programs and excluded any pilot projects or scalable programs coordinated by non-governmental entities. None of the reports mentioned above quantitatively linked school feeding programs to specific outcomes of children and adolescents.

Numerous systematic reviews have synthesized the impacts of school-based dietary interventions on various outcomes of children and adolescents [ 9 , 10 , 11 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. However, most of the reviews consist primarily of nutrition education programs that did not provide actual foods. To date, only a few reviews focused on or were able to draw conclusions regarding school feeding programs [ 9 , 10 , 11 , 44 , 45 ]. Kristjansson et al. conducted the first systematic review on this topic with 18 studies (nine from lower-income countries) among socio-economically disadvantaged children and adolescents across the world [ 9 ]. It was reported that, in RCTs from lower-income countries, participants who were fed at school gained an average of 0.39 kg more weight over 19 months and attended school more frequently (4 to 6 more days per year per participant) than those in control groups; school-fed participants in lower-income countries also had better performances in math and short-term cognitive tasks compared to controls. However, results for height and results from higher-income countries are mixed, suggesting that the benefit of school feeding varies by outcome and by socioeconomic status, with disadvantaged participants from lower-income countries likely to benefit more from school feeding. While comprehensive at the time, this first systematic review only included seven RCTs, five of which were conducted in lower-income countries. Jomaa et al. reviewed the impacts of school feeding programs on educational and health outcomes of primary-school-age children in developing countries. They reported relatively consistent positive associations between school feeding and energy intake, micronutrient status, school enrollment, and school attendance, but reported inconclusive results on growth, cognition, and academic achievement [ 10 ]. However, this review did not include children and adolescents at the secondary school level or studies conducted prior to 1990. Krishnaratne et al. reviewed rigorously designed studies among children and adolescents in LMICs. They found significant associations between school feeding and enrollment, dropout, progression, and nonsignificant associations with attendance and learning [ 44 ]. Snilstveit et al. systematically reviewed interventions for improving learning outcomes and access to education for children and adolescents in LMICs and reported positive associations between school feeding and enrollment, attendance, and various learning outcomes [ 45 ]. The reviews by Krishnaratne [ 44 ] and Snilstveit [ 45 ], however, did not specifically focus on school feeding, nor did they consider non-educational endpoints such as nutrition and health. Watkins et al. reviewed the impacts of school feeding on the nutritional status of primary-school-age children and preschool and adolescent girls in LMICs; they reported small and significant effects on weight gain and small and nonsignificant effects on height gain among school-age children [ 11 ]. Nevertheless, this review focused on anthropometric outcomes and nutritional status and had limited coverage on educational or psychosocial outcomes. None of the previous reviews examined in detail whether different content (e.g., types and amounts of foods and nutrients) of the provided meals had differential impacts on children and adolescents, which is crucial information for the design and improvement of future programs.

School years represent a critical period not only for physical and mental development but also for the formation of long-term dietary and lifestyle habits. This systematic review and meta-analysis will provide a comprehensive evidence base for the development and refinement of future school feeding programs targeted toward children and adolescents in LMICs.

Availability of data and materials

All data that will be generated and analyzed during this study will be included in the published article or its supplementary information files.

Abbreviations

Controlled before-after study

Food and Agriculture Organization

Grading of Recommendation, Assessment, Development, and Evaluation

Low- and middle-income country

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols

International Prospective Register of Systematic Reviews

Randomized controlled trial

Risk of Bias in Non-randomized Studies of Interventions

World Food Programme

Bundy D, Silva Nd, Horton S, Jamison DT, Patton GC, Schultz L, et al. Re-imagining school feeding: a high-return investment in human capital and local economies. 2018.

Plaut D, Thomas M, Hill T, Worthington J, Fernandes M, Burnett N. Getting to education outcomes: reviewing evidence from health and education interventions. Child and Adolescent Health and Development 3rd edition: The International Bank for Reconstruction and Development/The World Bank; 2017.

Food and Agriculture Organization (FAO). Nutrition guidelines and standards for school meals: a report from 33 low and middle-income countries. Rome: FAO; 2019.

Adelman S, Gilligan D, Lehrer K. How effective are food for education programs?: a critical assessment of the evidence from developing countries: Intl Food Policy Res Inst; 2008.

Bundy D, Burbano C, Grosh ME, Gelli A, Juke M, Drake L. Rethinking school feeding: social safety nets, child development, and the education sector: The World Bank; 2009.

WFP (World Food Programme). State of school feeding worldwide. Rome, Italy: WFP; 2013.

Google Scholar  

Aliyar R, Gelli A, Hamdani SH. A review of nutritional guidelines and menu compositions for school feeding programs in 12 countries. Front Public Health. 2015;3:148.

Article   Google Scholar  

Drake L, Fernandes M, Aurino E, Kiamba J, Giyose B, Burbano C, et al. School feeding programs in middle childhood and adolescence. Child and Adolescent Health and Development 3rd edition: The International Bank for Reconstruction and Development/The World Bank; 2017.

Kristjansson B, Petticrew M, MacDonald B, Krasevec J, Janzen L, Greenhalgh T, et al. School feeding for improving the physical and psychosocial health of disadvantaged students. Cochrane Database Syst Rev. 2007;1.

Jomaa LH, McDonnell E, Probart C. School feeding programs in developing countries: impacts on children's health and educational outcomes. Nutr Rev. 2011;69(2):83–98.

Watkins K, Gelli A, Hamdani S, Masset E, Mersch C, Nadazdin N, et al. Sensitive to nutrition? A literature review of school feeding effects in the child development lifecycle. Working Paper Series; 2015.

Greenhalgh T, Kristjansson E, Robinson V. Realist review to understand the efficacy of school feeding programmes. Bmj. 2007;335(7625):858–61.

Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons; 2019.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals Int Med. 2009;151(4):264–9.

Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. bmj. 2019;366:l4898.

Eldridge S, Campbell M, Campbell M, Dahota A, Giraudeau B, Higgins J, et al. Revised Cochrane risk of bias tool for randomized trials (RoB 2.0): additional considerations for cluster-randomized trials. Cochrane Methods Cochrane Database Syst Rev. 2016:10.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. bmj. 2016;355:i4919.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557–60.

Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol. 2008;61(10):991–6.

Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. Bmj. 2011;342:d549.

Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.

Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias). J Clin Epidemiol. 2011;64(4):407–15.

Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J, et al. GRADE guidelines: 5. Rating the quality of evidence—publication bias. J Clin Epidemiol. 2011;64(12):1277–82.

Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence—imprecision. J Clin Epidemiol. 2011;64(12):1283–93.

Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol. 2011;64(12):1294–302.

Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 8. Rating the quality of evidence—indirectness. J Clin Epidemiol. 2011;64(12):1303–10.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.

Drake L, Woolnough A, Burbano C, Bundy D. Global school feeding sourcebook: lessons from 14 countries: World Scientific; 2016.

Story M. School-based approaches for preventing and treating obesity. Int J Obesity. 1999;23(S2):S43.

Summerbell CD, Waters E, Edmunds L, Kelly SA, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane database of systematic reviews. 2005(3).

Katz DL, O’Connell M, Yeh M-C, Nawaz H, Njike V, Anderson LM, et al. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. 2005;54(10):1–12.

PubMed   Google Scholar  

Doak C, Visscher T, Renders C, Seidell J. The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obesity Rev. 2006;7(1):111–36.

Article   CAS   Google Scholar  

Flynn M, McNeil D, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’recommendations. Obesity Rev. 2006;7:7–66.

Sharma M. School-based interventions for childhood and adolescent obesity. Obesity Rev. 2006;7(3):261–9.

Cole K, Waldrop J, D’Auria J, Garner H. An integrative research review: effective school-based childhood overweight interventions. J Specialists Pediatr Nurs. 2006;11(3):166–77.

Budd GM, Volpe SL. School-based obesity prevention: research, challenges, and recommendations. J School Health. 2006;76(10):485–95.

Katz DL, O'Connell M, Njike VY, Yeh M-C, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obesity. 2008;32(12):1780.

Li M, Li S, Baur LA, Huxley RR. A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents. Obesity Rev. 2008;9(6):548–59.

Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Rev. 2009;10(1):110–41.

De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, Oppert JM, Rostami C, Brug J, et al. School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obesity Rev. 2011;12(3):205–16.

Khambalia A, Dickinson S, Hardy L. Gill Ta, Baur L. A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obesity Rev. 2012;13(3):214–33.

Verstraeten R, Roberfroid D, Lachat C, Leroy JL, Holdsworth M, Maes L, et al. Effectiveness of preventive school-based obesity interventions in low-and middle-income countries: a systematic review. Am J Clin Nutr. 2012;96(2):415–38.

Petrosino A, Morgan C, Fronius TA, Tanner-Smith EE, Boruch RF. Interventions in developing nations for improving primary and secondary school enrollment of children: a systematic review. Campbell Syst Rev. 2012;8(1):i–192.

Krishnaratne S, White H, Carpenter E. Quality education for all children? What works in education in developing countries, vol. 20. New Delhi: International Initiative for Impact Evaluation (3ie), Working Paper; 2013. p. 155.

Snilstveit B, Stevenson J, Phillips D, Vojtkova M, Gallagher E, Schmidt T, et al. Interventions for improving learning outcomes and access to education in low-and middle-income countries: a systematic review. Campbell Collaboration. 2015.

Download references

Acknowledgements

We thank Jacqueline Cellini at Francis A. Countway Library of Medicine at Harvard University for conceptual consultation and assistance with developing the search strategy.

This work will not receive financial support.

Author information

Authors and affiliations.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 90 Smith Street, 310 WS-5, Boston, MA, 02120, USA

Dongqing Wang & Wafaie W. Fawzi

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

Wafaie W. Fawzi

Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

You can also search for this author in PubMed   Google Scholar

Contributions

DW is the guarantor. DW and WWF contributed to the development of the selection criteria, the search strategy, the risk of bias assessment strategy, and the data extraction form. DW drafted the manuscript. Both authors read, provided feedback, and approved the final manuscript.

Corresponding author

Correspondence to Dongqing Wang .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Additional file 1..

PubMed search strategy.

Additional File 2.

Data extraction form.

Additional File 3.

PRISMA-P 2015 Checklist.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Wang, D., Fawzi, W.W. Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: protocol for a systematic review and meta-analysis. Syst Rev 9 , 55 (2020). https://doi.org/10.1186/s13643-020-01317-6

Download citation

Received : 19 November 2019

Accepted : 01 March 2020

Published : 16 March 2020

DOI : https://doi.org/10.1186/s13643-020-01317-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• School feeding
• School meal
• Low- and middle-income countries
• Adolescents
• Systematic review
• Meta-analysis
• Randomized controlled trials
• Controlled before-after studies

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

School Feeding Programs: What Happens Globally?

Alessandra cupertino.

1 Department of Nutrition, College of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil

Veronica Ginani

2 Master’s Programs Public Health, Department of Nutrition, College of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; moc.liamg@inanigcv

Ana Paula Cupertino

3 Medical Center Wilmot Cancer, Wilmot Cancer Institute, University of Rochester, Rochester, NY 14627, USA; ude.retsehcor.cmru@onitrepuc_aluap

Raquel Braz Assunção Botelho

4 Master’s Programs Nutrition, Department of Nutrition, College of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; moc.liamg@ohletobableuqar

Associated Data

World Health Organization (WHO). Alphabetical List of WHO Member States; WHO: Geneva, Switzerland, 2019.

School feeding programs (SFPs) are an important effort to address food insecurity, improve nutritional education, and ultimately improve health outcomes. The objective of this research was to describe the nutritional, cultural, food safety, and agro-family participation of SFPs in different countries and observe the SFP in low-middle and high-income countries to establish disparities. The study followed documentary research of SFP official online resources complemented by a literature review. The programs were assessed in four criteria: (1) nutritional aspects, (2) cultural aspects, (3) food safety, and (4) agro-family participation. Out of 192 countries registered, 117 countries (60.93%) have an SFP, and only 8 (4.16%) do not have SFPs. A total of 67 countries (34.89%) did not have an official online resource and did not respond to follow-up emails. Out of the 117 countries with SFP, all of them had a detailed description of their nutritional aspects, cultural aspects (11.96%), food safety (16.23%), and agro-family participation (23.93%). Europe and Central Asia were the continents with the most comprehensive SFP. While most countries incorporate nutritional aspects and healthy food, cultural, food safety, and agro-family participation must be incorporated in their SPF to optimize children and adolescent development. Moreover, the study identified disparities across countries where the SFPs were identified in low-middle countries compared to middle- and high-income countries.

1. Introduction

The biopsychosocial development of children (5 to 19 years old) is directly linked to adequate and healthy nutrition [ 1 , 2 ]. Unlike adults, healthy nutrition for children consists of understanding the differences existing in each stage of life, highlighting the first 1000 days. At his stage, nutritional requirements meet a rapid evolution of the nervous and immune system, and are essential in the formation of good eating habits. Thereafter, good nutrition will meet the child’s intellectual and physical development demands which accelerates again during adolescence [ 3 ].

Food and nutrition security for children is defined as the guaranteed right to access quality food, in a sufficient quantity, without compromising the access to order essential needs [ 4 ]. Despite the world economic development and established guidelines, more than 802 million people worldwide face food insecurity of which, 34.7 million were located in Latin America. Among children, the data show that at least one in three children do not have access to the food necessary for their health and physical and cognitive development [ 3 ]. Hence, it must be a priority for the government of different countries and a joint effort of all nations to guarantee its population’s food and nutritional security.

In addition, hunger is part of the modern world. More than 820 million people worldwide face food insecurity of which, 34.7 million are in Latin America. Eliminating hunger by 2030 is the United Nations goal linked to sustainable development (SDG) [ 5 ]. Food insecurity and suboptimal nutrition are also linked to obesity, an emerging trend in low-middle income countries [ 6 ]. About 40 million children under five years old are overweight in these countries, and about 120 million children and adolescents are obese [ 7 ].

Specifically, in Latin America and the Caribbean (LAC) countries, an epidemiological and nutritional transition is rapidly taking place with different changing patterns of obesity compared to developed countries [ 8 ]. In Brazil, the prevalence of obesity is around 20% in men and 20–30% in women. An urban population-based study in Argentina, Chile, and Uruguay ( n = 7524) determined that the prevalence of obesity was 35.7%, and central obesity was 52.9% [ 9 ].

Combating the triple burden of malnutrition–undernutrition, hidden, hunger, and obesity that plagues children, especially in developing countries, depends partly on the balanced meals provided at school [ 10 ]. Children spend at least five hours at school, especially in low-middle income countries, and take their main meals [ 6 ]. According to the World Food Program (WFP) guidelines, a comprehensive school feeding program (SFP) is linked to a country’s financial allocation of public food and nutrition [ 5 ]. In Brazil, for example, public school meals are free, 100% subsidized by the government [ 11 ]. On the other hand, in the United States of America (USA), the meal is not charged depending on the family income to which the student belongs [ 6 ]. In Canada, in contrast, there is no national SFP. Only a few provincial programs are spread across the country [ 12 ].

Since 2006, the WHO has been providing a framework to ensure integrated school programs based on some initiatives in the school environment. The aim is to address the burden of nutrition-related health problems, overweight, obesity, and malnutrition. The initiative is focused on 26 criteria divided into five blocks: (1) school nutrition policy, (2) awareness and training of the school community, (3) curriculum base and health promotion, (4) favorable school environment for good nutrition, and (5) supportive school nutrition and health service [ 2 ]. Since then, this initiative has been used worldwide as a self-assessment tool for existing programs and as part of projects and research.

A recent study in Brazil sought to identify the main criteria used in preparing school menus. They are habits, food culture, acceptance; nutritional characteristics; food availability; management and execution. Promoting a healthy environment, including food systems that promote a diverse, balanced and healthy diet, requires the involvement of multiple sectors and stakeholders, including the government and public and private sectors.

In a global setting, it is expected that almost every country provides food for their students on some scale, reaching around 368 million children [ 13 ]. Nevertheless, nutrition disparities across countries are complex underlying suboptimal school-based feeding programs that impact school performance and poor health outcomes [ 1 , 14 , 15 ]. These nutrition disparities within and across countries reinforce food insecurity and obesity classified as a global health priority. Consequently, it becomes essential that school feeding programs offer healthy and nutritionally adequate meals [ 16 ], and thus knowing what each program prioritizes and how it is organized is fundamental to aligning overall decisions on the issue in question.

This study is justified by the need to understand how school feeding programs are presented worldwide, having as a research question: What is the scenario of school feeding programs in the world to meet the premises of the World Health Organization for healthy eating? Therefore, the present documentary research aims to describe the presence of cultural and nutritional aspects, food safety, and the presence of agro-family in school-based feeding programs globally. We also aimed to observe the SFP in low-middle and high-income countries to establish disparities. Results will inform the nutrition disparities delivered in schools and guide future interventions designed to eliminate food insecurity and hunger globally.

2. Materials and Methods

The present study consists of a documentary analysis conducted through the consultation of the official websites followed by email and literature reviews. It refers to the analysis of documents containing information about the phenomenon studied [ 17 ]. Thus, it was elaborated to identify, verify, and assess documents relating to the School Feeding Program (SFP) in several countries to contextualize the facts and enable a global vision of the different realities experienced by peoples. The documents found were objectively analyzed in their original source, allowing the location, identification, organization, and evaluation of the information found. The research systematically took place concerning the capture of documents, processing, and analysis of their content [ 17 , 18 ]. Thus, we sought to reach a greater number of research sources to describe the presence or absence of SFP and information about them as the present characteristics. Data were collected to complement the SFP panorama in the world, identifying which countries have programs, and how they contribute to nutritional and food security.

All 192 countries registered by World Health Organization [ 19 ] until September 2019 were included when searching for information. To conduct the study, all official websites in the countries were visited by the Google platform from September 2019 to January 2020. For each country, we sought to identify the presence or absence of an SFP based on the visit to the website. Website search utilized “School feeding program” keyword. When the country’s official website did not present any information, an email was sent with a cover letter for the research and a request for information about public relations, the country’s ministry of education, or a specific body. The letter asked the following question: Does this country have a school feeding program? Is it possible to receive information on it or a website?

When building the database, data were collected through the Google search to respond to the following question: “Does the country have a school feeding program”? For countries with an official language other than English, the search was performed in the country idiom relying on google translate. Two emails were sent to inquire about September 2019 over January 2020 to complete the database. Finally, the results from the website search and emails were classified dichotomically in “YES” or “NOT” for the presence of a school-based feeding program.

To complement the school-based feeding program database, a literature review was carried out in the following databases: PUBMED, LILACS, Scielo, Google academic, and Science Direct. The following descriptors were used to search for articles: “School feeding program”, “public policy”, “guideline” and “world” and their combination. The inclusion criteria for selecting articles were articles in English, Portuguese and Spanish, article in full that portrayed the theme of this research with open access, and articles published and indexed in these databases in the last five years.

To identify the structural characteristics of each program, we identified four aspects that add up to conceptualizing food security. In this way, we transcend the definition of healthy food, including, in addition to nutritional aspects, access, safety, and origin. For that, a search was also carried out on the websites of the agencies responsible for managing the program in each country to learn about the program and the official regulations. The programs were characterized according to the four criteria described by the World Health Organization in the concept of food security [ 7 ]:

(1) presence of nutritional aspects: understanding that the nutritional aspects of food enable the child’s growth and development according to previously defined parameters; (2) presence of cultural aspects: valuing cultural aspects based on the presence of basic foods from the local food tradition and also considering the social and cultural aspects of the target population; (3) food safety: all procedures adopted throughout the food chain to ensure its safety; and (4) presence agro-family: comprising the participation of the agro-family in school menus, with food products supplied by local farmers. It was also noted, as a fifth item, the government´s participation, whether it is 100% or partially subsidized. The presence of any of these aspects in the SPF document justified their inclusion as a feature of the program.

Data on the presence or absence of the criteria were captured by information from official websites, email responses, or by searching for articles found about SFP. Figure 1 presents a flowchart of the steps developed.

The flowchart of the steps developed for the documentary research.

The countries were grouped according to the World Food Program [ 12 ] which determined the distribution of the programs in the following regions: America/Caribbean; Africa/Middle East; Europe/Central Africa; and Southeast Asia/Pacific. In this way, the number of countries per region that presented each of the criteria in their respective program was registered [ 12 ]. Human development data from each country provided in the Human Development Report [ 20 ] were used to recognize existing disparities.

Descriptive statistics were used to analyze the results, determining the frequency of the characteristics of the programs related to their respective countries.

In the present study, out of 192 countries registered in the WFP, 117 countries (60.93%) have a school-based feeding program (SPF), and only 8 (4.16%) did not have a program ( Figure 2 ). A total of 67 countries (34.89%) did not have an official online resource, scientific manuscripts do not respond to follow-up emails.

Distribution of school-based feeding programs by regions and their respective countries. America/Caribbean ( n = 28; 23.91%): Argentina, Bahamas, Barbados, Bolívia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Equatorial Guinea, Guatemala, Guyana, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, USA, Uruguay, and Venezuela. Africa/Middle East ( n = 38; 32.5%): Bhutan, Burkina, Burundi, Faso, Cape Verde, Chad, Congo, Côte d’Ívoire, Djibouti, Egypt, Eritrea, Essuatíni, Ethiopia, Gambia, Ghana, Guinea Bissau, Jordan, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Morocco, Mozambique, Republic of Niger, Rwanda, São Tomé and Príncipe, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Togo, Uganda, United Arab Emirates, and Zambia. Europe/Central Asia ( n = 41; 35%): Afghanistan, Albania, Andorra, Armenia, Austria, Azerbaijan, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, Italy, Kazakhstan, Kyrgyzstan, Latvia, Luxembourg, Netherlands, Macedonia, Poland, Portugal, Moldova, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Thailand, Tunisia, Turkey, Ukraine, United Kingdom, and Uzbekistan. Southeast Asia/Pacific ( n = 11; 9.4%): Australia, Bangladesh, Cambodia, China, India, Indonesia, Japan, Nepal, New Zealand, Sri Lanka, and East Timor.

The countries without a SFP were Angola, Cameroon, Greece, Iran, Iraq, Pakistan, Tuvalu, and Yemen. These countries are located explicitly in the following regions: Africa/Orient ( n = 04); Southeast Asia/Pacific ( n = 03); and Europe ( n = 01).

It is noteworthy here that only the countries that presented information or that information was found were quantified. Thus, the percentage was made according to the complete information.

Out of the 117 countries with SPFs, all of them had a detailed description of their nutritional aspects (100%). However, 11.96% presented cultural aspects, 16.23% food safety, and 23.93% agro-family participation ( Table 1 ). Europe and Central Asia had the most comprehensive school-based feeding programs.

Information provided by countries on the presence of a school feeding program (SFP), local government participation in its funding (partial or total subsidy for school feeding), and the presence of nutritional, cultural, food safety, and agro-family aspects in accordance with local human development.

Most countries did not report whether or not the government subsidizes school meals. However, among the countries that reported ( n = 54), 87.0% subsidize 100% of food, and 13.0% partially subsidize. It is important to note that of the countries that subsidized 100%, 57.1% are classified by the United Nations as “high human development” countries.

4. Discussion

The results point to a worldwide trend of using SFPs as a strategy to guarantee food and nutrition security. However, there is still a large disparity among developed and developing countries. Even in the poorest countries where SFPs exist, the issues addressed are limited. It is observed that coverage is concentrated in countries with higher incomes, reinforcing the recent study “The Global Child Nutrition Foundation” [ 21 ]. The programs in these countries aim to meet nutritional goals, ensure food and nutritional security, promote an environment for students to work as a team, and strengthen social interaction. Specifically in Europe, the School Feeding Council discusses ways and means to provide healthy food in schools and all stakeholders’ involvement. For this, it promotes a discussion forum with representatives from all countries. The following aspects are discussed in these forums: nutrition and health of food at school, respect for eating habits, partnerships with private companies and NGOs (non-governmental organizations), and community involvement.

On the other hand, some countries in poverty do not benefit from the SFP. In low-income countries, the expectation is a large percentage of food insecurity in the population. According to the World Bank, 55 countries (28.64%) distributed in the world regions are considered low-middle income, and according to the present study, five of these low-income countries do not have SFPs ( Figure 2 ) [ 22 ]. Most of them are regions of major political and economic conflicts, low-middle income countries where malnutrition is present and recognized as a challenge for public health [ 23 ]. It is known that the contexts of economic crisis, fluctuations in food prices, wars, political conflicts, and natural disasters deprive millions of people of accessing adequate food. Thus, there is a suboptimal investment in the health and nutrition of school-age children and adolescents, which is an obstacle to their development [ 5 , 14 ].

Another factor that enhances the situation of poverty and hunger, specifically in Africa, is the underreporting of malnutrition cases. School-age children are not commonly included in health and nutrition surveys. Therefore, an up-to-date overview of their nutritional status is not available [ 12 , 24 ]. According to WFP (2013) data [ 12 ], coverage of school feeding programs is still low in the regions with greater demand, similar to low-income countries [ 12 , 23 ]. Thus, the importance of a school feeding program in these regions may be catalyst for development [ 12 ]. On the other hand, middle-income countries represent 52% ( n = 100) and high-income countries 19% ( n = 37), being the countries that concentrate on school feeding programs. Therefore, school feeding programs are common in developed and developing countries with different scenarios. Furthermore, the aspects of food security analyzed in this research were present in a different way in the investigated countries. Next, each of the aspects and the possible implications of their presence or absence in SFPs will be addressed.

4.1. Nutritional Aspects

The nutritional aspect was covered by all the countries that reported having SFP. This characteristic of the programs highlights the relationship between food and health in a more direct way. Malnutrition, obesity, and chronic non-communicable diseases are important public health problems and should be highlighted. Nutritional aspects define the essential nutrients for a healthy diet and its nutritional balance. Therefore, the SFPs describe the nutritional characteristics of their meals, which should be based on WHO recommendations, respond to programs objectives, and align with national food guidelines if available [ 25 ]. Among the WHO recommendations, the following were mentioned in the analyzed SFP: insert vegetables in large meals, eat fresh fruit and raw vegetables in small meals, eat fruit and vegetables in varieties and in season; limit saturated fat intake to 10% of total daily and trans-fat intake to 1% of total daily energy; limit free sugar intake to less than 10% of total daily energy and further reduce free sugar to less than 5% of total daily energy for additional health benefits. Additionally, keep salt intake to less than 5 g/day [ 2 ]. Thus, the SFPs seek to ensure that all meals at school meet the children´s daily needs regarding the quality and quantity of energy and nutrients. Although, the SFPs identified in the present study focus on nutritional aspects they did not establish a professional nutrition program as a requirement. In Brazil, some studies have assessed the importance of the nutritionist in the management and implementation of their program “PNAE” [ 26 , 27 ], but few studies have evaluated the role of the nutritionist in planning school meals [ 28 ].

4.2. Cultural Aspects

In the present study, as seen in Table 1 , only 37 countries (31.6%) present the cultural aspect as an important basis for school feeding in the characteristics of their programs. Considering the other characteristics analyzed in the programs, according to Botelho [ 28 ], healthy and adequate food must be based on eating practices that also consider the social and cultural aspects of the target population. Ginani [ 29 , 30 ] described the importance of regional foods and ingredients in the Brazilian territory. The author identified that menus need to be adequate according to regional and national guidelines that recommended the consumption of culinary preparations based on local foods. Cultural elements are associated with the acceptability of food and can preserve agricultural habits of sustainable systems, maintenance of biodiversity, and sustainability [ 30 ]. Enhancing the cultural aspects is important to encourage children to develop cooking skills in the school environment, thus presenting their culture and eating habits [ 2 ]. A study identified that the acceptability of school menus is related to regional products, that is, “local products” [ 31 ]. In this study, only one country presented a description of the school feeding program’s cultural characteristics and five countries presented agro-family characteristics. Especially in countries with large numbers of malnourished people and countries in poorer regions, locally produced food is crucial for economic development in the region. However, Table 1 shows that most countries that address the cultural aspect of menus in their programs are those with very high or high HDI. This fact can increase public health disparities, further distancing the most vulnerable populations from ideal situations.

4.3. Food Safety

Similar to the cultural aspects, only 41 countries (35.0%) address food safety in their SFPs. Worldwide, foodborne illnesses affect about 30% of the population every year [ 32 ]. In addition to the risk of death, foodborne illnesses can cause diarrhea, vomiting, abdominal pain, fever, and weakness in school-age children. These reactions can increase students’ absences from classes in the school environment affecting concentration and, consequently, school performance [ 33 ]. It is estimated that 600 million people worldwide get sick after eating contaminated food, 1 in 10 people. In addition, 420,000 die each year, resulting in the loss of 33 million years of healthy life. Epidemiological data reflect the importance of adopting strategies capable of mitigating this problem, especially in the production of meals for vulnerable communities, such as children, who are normally the most affected [ 33 , 34 ]. Few countries with medium or low HDI have contemplated these aspects. Outbreaks of foodborne illnesses can be fatal for populations with nutritional deficiencies or other comorbidities. For the child population, the neglect of this aspect is a generator of important social problems. Therefore, urgent strategies must be considered to modify this scenario.

4.4. Agro-Family

Finally, the inclusion of agro-family in the supply of schools is an important alternative to guarantee food security. Once again, less than half (41.8%; n = 49) of the schools that reported having SFPs mentioned privileging agro-family products ( Table 1 ). Among countries, 79.6% are countries with very high or high HID. Food systems are processes that include agriculture, livestock, production processing, distribution, supply, marketing, preparation, and consumption of food and beverages [ 35 ]. The foods system needs to guarantee the integrity and maintenance of the planet’s biodiversity. That is, ensuring that the present natural resources are available in a way that enhance the right of future generations to also use them, meeting their needs and enabling a healthy quality of life. It is understood that an unsustainable environment is not capable of producing healthy food. The hegemonic development in the field based on agribusiness, on monoculture, and the use of pesticides has brought irreversible damage to the environment [ 36 ]. This described scenario has been causing negative impacts on health and the environment. Thus, this is the subject of one of the discussions in the world for the guarantee of the Sustainable Development Goals (SDGs) [ 37 ].

The environmental sustainability of food systems must be associated with the actions of individuals or groups about their food choices and the orientation of national food so that there are improvements in the population’s nutritional health [ 37 ]. The participation of family farming in the school feeding program creates market opportunities for small producers. In Brazil, there is a specific law [ 38 ], that requires that 30% of the amount transferred by the national school feeding program must be invested in the direct purchase of family farming products. This measure encourages economic development and the sustainable development of communities [ 39 ].

Thus, it contributes to ensuring food and nutritional security in the school environment and ensures better meals and healthier and more sustainable eating practices [ 2 , 7 ].

The quality of school feeding must be evaluated based on environmental and sustainability issues. Sustainability being one of the recommendations for school feeding in the world [ 40 ]. Thus, school feeding programs must support sustainable development by encouraging the purchase of local food produced by producers in the region [ 41 ]. Furthermore, good sustainability practices aim to solve part of the ecological impact caused by food production in food services [ 42 ].

In Ghana, the school feeding program has been redesigned since 2011. While the program’s goal was to boost local food production, farmers are not linked to the market created by the program. However, countries such as Ethiopia, Malawi, Mozambique, Nigeria, and Senegal have benefited from FAO and WFP implementation programs to link local agriculture with school feeding through specific food procurement tools [ 5 , 6 , 25 , 26 , 43 ].

4.5. Specific Characteristics of Some SFP

4.5.1. africa.

In general, although it ranks second in the school feeding programs on the African continent, it is difficult to obtain information and details about them. Another relevant fact is the high incidence of malnutrition and food insecurity among school-age children. Therefore, the effectiveness of programs in achieving adequate and healthy school nutrition is questioned. Consequently, despite the existence of the programs, there are few references and documents that guide public policies. In other words, officially, some countries have programs, but paradoxically, “they do not exist”, since they are not instructed [ 12 , 44 ].

4.5.2. Southeast Asia and Pacific

In Southeast Asia and the Pacific, 160 million children [ 6 ] in several countries receive school meals. All states and territories have implemented region-specific school food service policies in Australia. The first was developed in New South Wales (NSW) in 2005, while the most recent was implemented in Tasmania in 2014. The policies are mandatory for all government schools in every jurisdiction except Tasmania. A curiosity of the SFPs in this region is the use of educational tools to encourage healthy eating. Most regions use traffic light systems that categorize food and beverages into three groups: green, amber, and red. The green foods group is based on the five main food groups, fruits, vegetables, grains, meat, and dairy products, and they need to be consumed daily. The amber group has nutritional value with a moderate amount of energy and saturated fat, salt, and sugars. Finally, the red group has no favorable nutritional value and contributes to an excessive amount of energy, total fat, sodium, and sugars [ 6 , 45 ].

The eleven programs in this region only have nutritional characteristics in their description. The other characteristics were not found, even in Australia, which has implemented school feeding policies. The other features need to be incorporated into programs to better link local food production and the school.

4.6. School Feeding Programs’ Challenges

It is understood that the world faces somewhat opposite problems: (1) an increase in obesity in developed countries [ 46 ] and (2) food shortages and malnutrition in developing countries. Hunger is an ongoing problem that affects more than 1.2 billion people who do not have enough to eat in the world today [ 47 ]. Reducing obesity and malnutrition are complex challenges that can be better managed by school feeding programs [ 6 , 47 ].

In this sense, worldwide attempts to direct the consumption of healthy foods occur regularly. An example is that WHO has been encouraging countries to implement nutrition policies that specify what foods and beverages can and cannot be offered in schools. Although some programs have been in existence for more than fifty years, such as the PNAE in Brazil and the NSLP in the USA, it was only from the 2000s that school feeding attracted the interest of government agencies at international, national, and regional levels. The government interest is justified by considering school feeding as a way to combat nutritional inadequacy in adulthood, ecological threats (excessive consumption waste), social challenges (food crisis, scarcity), and cultural issues (debates and conflicts around beliefs and values and cultural issues) [ 48 ].

5. Conclusions

With this study, an overview of the school feeding programs in the world was identified. The region with the greatest coverage of programs was Europe/Central Asia. Although these programs contemplate the nutritional aspects for healthy school feeding, other criteria such as culture, food safety, and agro-family need to be revised to comply with the FAO and WHO recommendations. The America/Caribbean regions stand out here. Despite encompassing the largest and oldest program globally, the NSLP in the US and PNAE in Brazil need to be further explored to meet the objectives of adequate school feeding.

The results obtained from the study did not take into account aspects such as the size of the country, population, and the number of countries in the analyzed regions. It is concluded that there are still many countries without information, either because of the difficulty in finding them on the official site, without updating at the time of the search or because of the lack of scope of the bibliographic search.

Author Contributions

Conceptualization, A.C. and R.B.A.B.; Methodology, A.C., V.G. and R.B.A.B.; Validation: A.P.C. and R.B.A.B.; Formal Analysis, A.P.C. and R.B.A.B.; Investigation, A.C.; Resources, A.C.; Data Curation, A.C.; Visualization, A.C.; Supervision, R.B.A.B.; Project Administration, A.C. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Search Menu
• Sign in through your institution
• Advance articles
• Editor's Choice
• Supplement Archive
• Article Collection Archive
• Author Guidelines
• Submission Site
• Open Access
• Call for Papers
• Why Publish?
• About Nutrition Reviews
• About International Life Sciences Institute
• Editorial Board
• Early Career Editorial Board
• Advertising and Corporate Services
• Journals Career Network
• Self-Archiving Policy
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction, methodology and criteria for selection of empirical evidence included in the review, impact of school feeding on nutrition and health of school-aged children, impact of school feeding on education and learning, evaluating the evidence, research and evaluation gaps, challenges and future directions, acknowledgments.

• < Previous

School feeding programs in developing countries: impacts on children's health and educational outcomes

• Article contents
• Figures & tables
• Supplementary Data

Lamis H Jomaa, Elaine McDonnell, Claudia Probart, School feeding programs in developing countries: impacts on children's health and educational outcomes, Nutrition Reviews , Volume 69, Issue 2, 1 February 2011, Pages 83–98, https://doi.org/10.1111/j.1753-4887.2010.00369.x

• Permissions Icon Permissions

School feeding programs (SFPs) are intended to alleviate short-term hunger, improve nutrition and cognition of children, and transfer income to families. The present review explores the impact of SFPs on nutritional, health, and educational outcomes of school-aged children in developing countries. Peer-reviewed journal articles and reviews published in the past 20 years were identified and screened for inclusion. Analysis of the articles revealed relatively consistent positive effects of school feeding in its different modalities on energy intake, micronutrient status, school enrollment, and attendance of the children participating in SFPs compared to non-participants. However, the positive impact of school feeding on growth, cognition, and academic achievement of school-aged children receiving SFPs compared to non-school-fed children was less conclusive. This review identifies research gaps and challenges that need to be addressed in the design and implementation of SFPs and calls for theory-based impact evaluations to strengthen the scientific evidence behind designing, funding, and implementing SFPs.

Hunger is an ongoing problem that affects more than 1.2 billion people who do not have enough to eat in the world today. 1 The recent global economic crisis, fluctuations in food prices in 2006–2008, wars and political conflicts, and devastating natural disasters have deprived millions of people of access to adequate food. Most of the individuals affected are in the most impoverished regions of the world. Previous efforts by heads of states, international organizations, and local agencies to address poverty and hunger-related issues resulted in the UN Millennium Declaration (2000). The goals outlined in the declaration were established to eradicate poverty, alleviate hunger, reduce gender inequalities, improve health and longevity, overcome environmental degradation, and most importantly, develop global partnerships to achieve the goals. 2

Education and health were central components of the roadmap towards implementing the stated goals. The first millennium development goal (MDG) emphasized the eradication of extreme poverty and hunger, whereas the second and third MDGs focused on “achieving universal primary education” and overcoming gender disparities in primary and secondary education. The UN declaration and its roadmap have set the platform for global trends and national efforts to meet the MDGs within a reasonable timeframe (mostly by 2015) and the World Bank (WB) and its development partners, including the World Food Program (WFP), took more rapid steps to meet these goals and launched the Education for All (EFA) Fast Track Initiative (FTI) in 2002. The main objective of EFA FTI was to help low-income countries meet the MDGs, particularly the “education for all” goal. 3 Despite the major efforts exerted, the progress towards universal primary education (2 nd MDG) has been slow and uneven. More than 121 million school-aged children are still out of school, and two-thirds of them are girls living in rural areas in the most vulnerable regions of the world. One of the major reasons for this lag in progress toward universal primary education is the persistence of poverty, hunger, and malnutrition. 4 Infants and children are among the most vulnerable population groups subject to the adverse, and when very young, irreversible, short- and long-term cognitive, physical, and psychosocial consequences of hunger and undernourishment. 5 , 6 There is also increased evidence that childhood undernutrition imposes significant economic costs on individuals and nations, and that improving children's diets and nutrition can have positive effects on their academic performance and behaviors at school as well as their long-term productivity as adults. 7 , 8

School feeding programs (SFPs) have been continuously gaining popularity in developing countries, mostly among those affected severely by childhood hunger and malnourishment. These programs aim to enhance the concentration span and learning capacity of school children by providing meals in schools to reduce short-term hunger that may otherwise impair children's performance. 9 Currently, SFPs exist in 70 of the 108 low- and lower-middle income countries, and most of them have been initiated and funded by the WFP. 10 Some of these SFPs have evolved and been adopted nationally while others still rely on the assistance, funding, and/or expertise of the WFP and its development partners in varying degrees. The WFP and its development partners have been promoting school feeding in its different modalities for years as effective interventions that help alleviate hunger and improve the cognitive and educational abilities of children. When children are provided with food at school, not only do parents receive an incentive to send their children to school, particularly girls, children are also encouraged to attend and complete a school day. Thus, SFPs can help developing countries and their development partners meet a number of MDGs, including the eradication of hunger, achieving universal primary education, and closing the gender gap by giving boys and girls equal opportunities for completion of primary schooling. 11 , 12

According to Belgeron and Del Rosso's conceptual framework for Food for Education (FFE), 13 also known as SFPs, FFE programs provide food transfer to children at school, income transfer to their families, and resource transfer to the schools operating these programs. In 2009, the World Bank and the WFP published a joint review on SFPs 14 re-emphasizing the rationale and objectives of these programs. The three main objectives identified were to provide safety nets for families to absorb social and economic shocks, improve the education and scholastic performance of school-aged children, and enhance children's nutrition and health status. To parallel the three main pillars or objectives of SFPs (safety nets, nutrition, and education), a logical framework for SFPs was developed mapping the inputs, outputs, outcomes, and impacts for each of the objectives and rationales of the programs. 15 Resources or inputs include micronutrient fortified meals, snacks, and take-home rations, as well as anthelmentic treatments; outputs include the numbers of children fed, schools reached, and food rations/deworming tablets distributed. If nutrition is the objective of the program, the outcomes identified are the alleviation of hunger and improvement of the micronutrient status of school-aged children; the intended impacts are to improve the nutrition and health of beneficiary children and improve their learning capacities. The main impacts of SFPs with regard to meeting educational objectives are to improve learning, increase lifetime earnings of targeted children, and increase access to education for girls, orphans, and vulnerable children. In addition, educating families and future generations about family planning, HIV/AIDs prevention, and other health topics are among the intended impacts of SFPs.

Although the benefits of school feeding are well-documented, controversy remains over the effectiveness of SFPs. According to Kristjansson et al., 16 “experts at a School Feeding/Food for Education Stakeholders meeting in 2000 concluded that there is little evidence for nutritional benefits of school feeding and that school feeding only enhances learning when other improvements in school quality are made (World Bank, n.d)”. The present review was conducted to summarize the nutrition literature on the impact of school feeding, focusing primarily on the relationship between school feeding and changes in the nutritional and health outcomes of targeted school-aged children and secondarily on more established cognitive and educational outcomes. The review sheds light on gaps in the literature regarding school feeding in developing countries and other challenges faced by those implementing SFPs. Furthermore, it highlights the need for theory-based impact evaluation studies to strengthen the design and implementation of existing and future SFPs.

Articles and manuscripts included in this review were identified using primarily PubMed and Web of Science databases, as well as the World Food Program headquarters online database and library. Research articles addressing this topic and published in peer-reviewed journals in the past 20 years (1990–2009) were screened and those that did not meet the inclusion criteria of our review were excluded (see Table 1 ). Variations of terms were used in the search process to find studies of different designs and interventions conducted in developing countries. Randomized controlled trials (RCTs), which are experiments in which investigators allocate eligible people randomly into treatment and control groups to receive or not to receive one or more of the interventions being compared, are regarded as the gold standard of research. However, non-randomized trials are seen as important complimentary studies when randomization or blinding is inappropriate, unethical, or sometimes not feasible. Thus, our review included RCTs, intervention/control studies, crossover design studies, and effectiveness reports of existing SFPs. Table 2 includes a summarized description of the studies included in the review, outlining their research designs, study participants, duration of observations/interventions, outcomes measured, and the main findings.

Inclusion and exclusion criteria for studies and publications included in this review.

Summary of reviewed papers on the impact of school feeding on nutrition, health, education, and learning of school-aged children in developing countries (13 studies).

Conclusive: consistent findings that support the link SFP provisions and intended outcomes.

Inconclusive: mixed results from the literature, weaker evidence on link between SFP provisions and intended outcomes.

Unexplored: no empirical evidence to explore the relationship between SFP provisions and intended outcomes.

Abbreviations: BMI, body mass index; Ca, calcium; CBA, controlled before and after trials; Cu, copper; E, energy; Fe, iron; HAZ, height-for-age z-score; Hb, hemoglobin; kcal, kilocalories; RCT, randomized controlled trial; RDA, recommended dietary allowance; SFP, school feeding program; Vit B 2 , riboflavin; Vit B 12 , cobalamin; WAZ, weight-for-age z-score; WHZ, weight-for-height z-scores; WRAT, wide range achievement test; Zn, zinc.

Growth and body composition

Evidence of the impact of SFPs on children's growth and body composition remains inconclusive due to the mixed results reported from different studies. A few studies found a positive effect of school feeding on children's growth and anthropometric indices, while others showed no effect. In 2006, Kristjansson et al. 16 conducted the first systematic review and meta-analysis to explore the impact of school feeding on a number of physical and psychosocial variables in school-aged children. A total of 18 studies were included in the review, nine of which were conducted in developing/lower income countries (Kenya, Jamaica, India, Indonesia, and China), five of which were RCTs, and four of which were controlled before and after (CBA) trials. The meta-analysis showed an overall small, non-significant change in height between children who did or did not receive meals at school in RCTs, 17 , – 19 whereas a significant increase in height was observed in CBA trials. 16 , – 22 On average, school-fed children gained 1.43 cm in height more than controls. The meta-analysis of two RCTs within the same review showed a small, yet significant effect of school feeding on height-for-age (z-score change = 0.04 [95%CI: 0.02–0.06]). However, authors found a stronger and more consistent effect of school feeding on weight gain from the three RCTs and three CBA trials that were analyzed; a gain that ranged between 0.25 to 0.75 kg a year.

Similar positive effects of school feeding were reported by Powell et al. 18 Researchers reported positive nutritional outcomes from their RCT in which they provided 395 primary school-aged children (2 nd to 5 th graders), from 16 rural Jamaican schools, breakfast meals every day for one school year (8 months). Children in the control group ( n  = 396 children) were given one-quarter of an orange as a placebo. Researchers found that children in the breakfast group gained significantly more weight (β = 0.42), height (β = 0.25), and BMI (β = 0.16) than children in the control group ( P  < 0.05). A slight substitution effect was observed among breakfast consumers over lunchtime, as they consumed 54 calories less on average than the control group. Substitution is a reduction in home diet for students who are receiving food at school. However, the decrease in energy intake did not offset the total energy consumed from the school breakfast meal and a net increase in dietary (energy) intake was observed among breakfast consumers. Children receiving breakfast gained, on average, an additional 0.25 cm during the 8-month intervention, a gain which, when extrapolated by researchers, was found to be equivalent to 0.4 cm increase in height per year or approximately 1 month of growth in the National Center for Health Statistics (NCHS) reference population. The increase in weight among intervention group members was found to be even greater than the increase in height, an equivalent of 2–3 months of weight gain in the reference population. Analyzing the effect of breakfast based on the nutritional status of children, researchers observed more significant gains in height and BMI among adequately nourished children compared to undernourished children, β = 0.77 and β = 0.18 ( P  < 0.005), respectively. 18 The significantly greater increase in the height and BMI of adequately nourished children compared to undernourished children was somewhat unexpected. Powell et al. 18 argued that the “undernourished” group of children recruited in this study was only moderately undernourished, whereas children in previous studies were more severely undernourished. The undernourished children may have greater dietary needs than their well-nourished counterparts and these dietary requirements were either not met through the school breakfast meals or were offset by reduced dietary intakes at home. This study had some limitations as it lacked data on the micronutrient status of children and their health conditions and possible infections that may interfere with the absorption of nutrients from school meals. In addition, the sample of undernourished children may have been suffering from subclinical infections that could have impeded their absorption of nutrients, such as iron and zinc, that are needed for adequate growth and development. It is also possible that energy and nutrient utilization were better in the adequately nourished group of children compared to the malnourished children.

Simeon's review of a study conducted in a rural school in Jamaica did not show remarkable changes in the weight gain of children following consumption of a morning meal each school day for two semesters. 23 A total of 115 students in grade 7 (12–13 years old) were recruited; one class ( n  = 44 students) received the school meal (100 mL milk and either a slice of cake or a meat-filled pastry providing a total of 500 kcal on average) and two classes served as controls. Weight for age was measured before the school feeding intervention started (1 st semester) and at the beginning and end of the second semester (during which intervention took place). Students in both the intervention and the control groups gained weight after the 2 nd semester; however, there was no significant difference in weight gain between both groups. The lack of impact of school feeding on the weight gain of these children may be attributed to several limitations of this study. Data on the height of children at baseline was not collected due to time constraints; thus, researchers could not measure the change in height after the intervention was completed and observe whether there were significant differences in height change between the intervention and control groups. In addition, total dietary intake of participants was not assessed to learn if the school meal provided additional calories and nutrients to the child's dietary intake or if it was compensated for with diminished energy and food consumption outside of school hours.

A large study that was conducted in Bangladesh by Ahmed Akhter and the International Food Policy Research Institute provided evidence regarding the positive impact of SFPs on dietary intakes and educational outcomes of school-aged children. The SFP was implemented by the WFP and the Government of Bangladesh in approximately 6,000 primary schools located in highly food-insecure rural areas and four slum areas in Dhaka city, Bangladesh. Ahmed 24 reported that the BMI of children receiving a midmorning snack at school increased by 4.3% compared to children in control schools who were not receiving these snacks. The midmorning snack consisted of a packet of fortified wheat biscuits providing a total of 300 calories and 75% of the recommended daily allowances of vitamins and minerals for school-aged children; it was given to students for each day of school attendance. The average energy intakes of participants were 11% and 19% higher in rural and urban slum areas, respectively, than the energy intakes of sex- and age-matched students in control schools who did not participate in the SFP. Energy intake consumed from biscuits was 97% additional to the child's normal diet; thus, the SFP improved net food consumption of the participating children, and the extra energy from the biscuits was not compensated for by a decrease in food consumption at home. Using household food consumption surveys, researchers observed that the majority of students receiving SF shared fortified biscuits with other members of their families on a regular or intermittent basis. These spillover effects of SF biscuits on food consumption of the participants' siblings (ages 2–5 years) led to a 7% increase in total calories consumed, on average, by these preschoolers.

In terms of body composition, studies have also shown promising results. Grillenberger et al. 25 , 26 conducted an RCT in 12 primary schools from a rural malaria-endemic area in Kenya (Embu District). Schools were assigned to one of three food supplement groups: 1) energy, 2) milk, or 3) meat supplement. In larger schools with more than one grade 1, classes were randomly assigned to one of the three isocaloric supplement groups. A total of 544 students participated in the study and, depending on the group to which their school or classroom was assigned, they were further randomly assigned to a food supplement group (treatment) or no supplement group (control). The number of children in each group was relatively equal, approximately 140 children per group. Children in the treatment groups (receiving food supplements) were fed Githeri, a local vegetable stew, with meat, milk, or extra oil added, depending on the treatment group to which they were assigned, i.e., meat, milk, or energy. The control groups did not receive food. Researchers observed that children in each of the supplementation groups gained approximately 0.4 kg (10%) more weight than children in the control groups. In addition, children in the three treatment groups showed increases in mean upper-arm area circumference (MUAC), a measure that is usually used as an indicator of protein-energy malnutrition. They also gained more mid-upper arm muscle circumference (MUAMC), which is a fine indicator for the total body muscle mass, than the control groups; this was mainly observed in members of the meat group, whose gain reached up to 90%. The significant gain in MUAMC among children in the meat group highlights the importance of providing children with a good source of high-quality protein that is also rich in multiple micronutrients and can increase the bioavailability of iron and zinc. This is important, especially among children living in rural communities where the staple plant-based foods are low in iron and zinc content and people are susceptible to micronutrient deficiencies. The overall effects of supplementation on height, height for age, weight for height z-scores, and measures of body fat were insignificant in this study; however, researchers observed a positive effect of milk supplements on height gain in a subgroup of children (stunted children with height for age z scores ≤  - 1.4).

In another study conducted in South Africa, 27 the fortification of soup powders with iron and vitamin C, when combined with deworming within a SFP, led to significant improvements in height, height-for-age, and weight-for-height z scores of primary school children aged 6–8 years; the improvements were mainly among those with low baseline iron stores. Furthermore, combined food fortification and deworming led to improvements in weight and weight for age z scores of children who had adequate iron stores at baseline. One important finding of this study is that the combined positive effects of iron fortification and deworming on children's anthropometric status surpassed the individual effects of each treatment alone.

Dietary and micronutrient status

The nutritional benefits of school breakfast programs were further documented in studies conducted in Peru. 28 , 29 In 1993, the government of Peru launched a school breakfast program in one of the poorest provinces of the country, the Andes region. An evaluation of the school breakfast program implemented in the outskirts of two Peruvian cities (Matahuasi and Huaraz) showed significant improvements in the energy, protein, and micronutrient intakes of a subsample of children receiving the school breakfast. A total of 120 children were recruited from the 3 rd and 4 th grades and were divided equally between the experimental and control groups. After implementation of the school breakfast program, significant differences were seen between the experimental group and the control group with respect to total energy intake (2,182 versus 1,731 kcal/day), protein intake (56.1 versus 43.6 g/day), and iron intake (21.6 versus 12.5 mg), P  < 0.001. 28 The energy intake of children receiving the school breakfast increased by 15.2%, their protein intake increased by 16.1%, and their dietary iron intake increased by 60%. One of the strengths of this study is that the observed increase in the dietary intake of children within the experimental group was not compensated for by lower food consumption at home. Instead, children consuming a breakfast meal at school had significantly higher overall dietary intakes compared to their control counterparts. In addition, the study controlled for a number of variables, including children's stature (height-for-age) and nutritional status (weight-for-age) in their regression analyses in an attempt to measure the independent effect of school breakfast consumption on dietary intake and a number of educational and cognitive markers. Using data from a nationally mandated school meal program in India, Afridi 30 conducted an empirical analysis of 24-hour food consumption recalls for children (age range, 4–14 years; n  = 976) on school and non-school days to estimate the extent to which children benefit from the targeted school meal program. Afridi's study showed that the meal program provided children with a significant proportion of their daily intake of five nutrients (energy/calories, proteins, carbohydrates, calcium, and iron). Furthermore, 49–100% of the food transfers were reflected in the total daily intakes of children, indicating that the program succeeded in improving dietary intake for the five essential nutrients for which the diets of children in India were found to be highly deficient.

In Bogota, Colombia, Arsenault et al. 31 conducted a longitudinal observation of 3,202 children aged 5–12 years in public schools to examine whether a state-launched snack program (initiated in 2004 in all public primary schools) had any impact on the nutritional status of children. The snack consisted of a beverage, a cereal and/or a protein component, was well as a “sweet” component that included peanuts and Petit Suisse cheese, as well as fruits on most days. The snack was designed to provide children with a certain percentage of recommended daily intakes (30% of energy, 50% of iron, and 40% of calcium). Only 3 months after the program was pilot-tested, researchers observed greater increases in serum vitamin B 12 levels among children receiving the snacks compared to the controls. However, significant changes were not observed in the hemoglobin, serum ferritin, or folate levels of children. This can be explained by the low prevalence of iron deficiency at baseline and the fact that children in both the schools receiving the snack and the controls were receiving iron supplements prior to this program's initiation.

Food fortification with micronutrients or the supplementation of children with multiple nutrients are among the strategies used in certain SFPs to reduce multiple micronutrient deficiencies and improve the nutritional status and cognitive and learning capacities of school-aged children. Van Stuijvenberg et al. 32 were interested in determining the effects of providing schoolchildren with mineral-fortified biscuits on their micronutrient status. The researchers conducted their study in a rural school in South Africa located in an area with a high prevalence of micronutrient deficiencies. They recruited 115 children (6–11 years old) to serve as the treatment group and 113 children served as controls. The treatment group received biscuits fortified with iron, beta-carotene, and iodine (at 50% of the RDA) whereas the control group consumed non-fortified biscuits. Significant improvements were observed in the vitamin A, iron, and iodine status of children who received the fortified biscuits. In addition, anemia, vitamin A, and iodine deficiencies were reduced by 13%, 28%, and 67%, respectively, in this sample. However, improvements seen in the vitamin A and iron status of children were not sustained after consumption of the fortified biscuits was interrupted during the school's summer break. The researchers concluded that since the biscuits provided only 50% of the RDA for vitamin A in the form of carotene, this may have been only sufficient to maintain the day-to-day vitamin A levels but not sufficient for replenishing very low or depleted vitamin A stores. Also, the dietary intake of vitamin A from meals consumed at home during the summer months, were assessed to be approximately 10% of the RDA per day; thus, during the period in which the fortified biscuit were not offered to students, retinol values reverted to the baseline level. All these findings indicate that the diets of these children contained very low amounts of micronutrients and the children's body stores were depleted rapidly during the summer months. According to the same authors, resolving iron deficiency through food fortification can be very challenging due to the low bioavailability and high reactivity of the iron compounds used in food fortification. 33 However, the provision of vitamin C-fortified drinks (rich in ascorbic acid) along with fortified food has been shown to improve iron status and is thus encouraged in SFPs targeting children with high levels of iron deficiency and iron-deficiency anemia, when feasible. 34 Only iodine did not return to the levels measured prior to the intervention, and that was probably because iodization of salt was mandated in South Africa 6 months after the intervention was in place.

This study provides promising results in terms of food fortification and its impact on children's micronutrient status. The fortification of food proved successful in alleviating highly prevalent micronutrient deficiencies, such as iron and vitamin A, which can lead to serious consequences for the health and cognition of children. However, the amount and duration of fortification were insufficient to maintain these changes. Thus, the challenge remains for researchers and policy planners to design SFPs that not only provide the targeted children with adequate types and amounts of micronutrients, depending on their deficiencies, but also ensure that the duration of fortification or micronutrient supplementation is sufficient to replenish depleted body stores.

In another intervention-control study conducted in South Africa by Kruger et al., 27 the fortification of soup powder with iron and vitamin C, when combined with the use of anthelmintic treatment (deworming) as part of a school feeding scheme, resulted in significant, positive changes in the hemoglobin, mean corpuscular volume (MCV), and serum ferritin levels of children receiving fortified soups compared to controls. These positive effects were observed mainly among children with low baseline iron stores. Furthermore, fortification of biscuits with bovine-hemoglobin as part of a nationwide SFP in Chile led to significant improvements in the iron status of children (aged 6–11 years) who received fortified biscuits compared to children consuming non-fortified biscuits. 35 These positive findings were observed despite the low rates of iron-deficiency anemia found among the recruited samples of school children. In addition, increases in hemoglobin concentrations and iron stores (serum ferritin) were observed among boys across all ages and among girls, mainly after menarche. These findings highlight the importance of providing micronutrients to school-aged children, particularly during growth phases with high micronutrient demands.

The use of food supplements to overcome multiple micronutrient deficiencies among school-aged children in developing countries is another area of interest to some researchers and program planners. Neumann et al. 17 assessed the micronutrient status of children before intervention using 24-hour recalls and biochemical measures. They found that children had low micronutrient intakes of vitamins A, B 12 , B 2 , zinc, and iron. Furthermore, at baseline, approximately 30% of children were found to be stunted and underweight. The same research group later analyzed the effect of providing three different food supplements (meat, milk, and energy) on the micronutrient status of these primary school children. In their 1-year intervention, researchers succeeded in reducing the prevalence of vitamin B 12 deficiency by 17% for the meat supplement group and by 27% for the milk group. The fact that a similar effect was not observed in the energy group can be explained by the higher level of vitamin B 12 in animal-source foods such as meats and dairy products. 36 The prevalence of infection among children participating in this study decreased after 1 year of receiving school food supplementations (lower prevalence of elevated C-reactive protein levels and enlarged spleens with a decrease in plasma ferritin and copper levels). However, the researchers did not observe any significant improvements in the levels of other micronutrients, such as iron, zinc, copper, or vitamin A and could not find any diet-related explanation for the lack of significant effects of meat and milk supplementation on these micronutrients. Researchers attributed the lack of significant increases in vitamin A, iron, zinc, and copper levels to the confounding effect of malaria and the high rate of infection among this population. In a follow-up study, Murphy et al. 37 reported changes in the children's micronutrient intakes after comparing three 24-hour recalls collected before school feeding started with three 24-hour recalls collected after feeding was initiated. The researchers observed that the intakes of vitamin B 12 , vitamin A, riboflavin, and calcium of children in the milk group were greater than those of children in the control group. Also, children in the meat group had higher intakes of vitamin B 12 , vitamin A, and available iron and zinc than the control group. The total energy intake of children in the meat group was also higher than that found in either the milk or the energy groups. Although the energy intake of children at home decreased upon consuming one of the fortified snacks, the decrease in energy intake was lowest in the meat group. Thus, consumption of the meat snacks in this study improved the dietary quality (micronutrient status) and dietary quantity (total energy intake) of participant children, whereas the milk snacks had a positive impact solely on dietary quality.

In addition to the promising nutritional outcomes, studies highlight the importance and benefits of offering school-aged children school meals and/or snacks to improve certain cognitive functions and scholastic achievement, especially among disadvantaged malnourished children. Thus, school feeding is once again of particular significance in developing countries with the highest percentages of malnourished children, low school enrollment, and high dropout rates. Almost all types of SFPs reported in the literature demonstrate a positive impact on school enrollment and attendance. 23 , – 39 The impact of school feeding on academic achievement shows consistent positive effects on arithmetic tests, but lower effects on reading, writing, and spelling tests. 16 , – 26 School feeding helps improve school progress by reducing the dropout rate. This applies to both school meals and take-home rations, with greater benefits to girls, in particular, when both modalities of school feedings are offered together at school. 38

Findings from the nutrition literature may be mixed and equivocal at times, thus weakening the evidence on how effective SFPs are for improving various markers of nutrition status, growth, and health. Mixed findings may be attributed to a multitude of factors, mainly differences in the objectives and methodologies used in SFPs. Differences lie in the design of household and school surveys, the quality and quantity of food served to children, available school resources, durations of the interventions (ranging from 1-month to 2- or 3-year interventions), and the modalities of school feeding (school meals, fortified snacks, take-home rations) in various settings and studies. In addition, findings from various studies and national programs are difficult to compare as outcome variables and indicators vary, and the age groups, degree of malnourishment, and severity of worm infections and illnesses in targeted school-aged children differ from one program to another. Since study designs, sample populations, and outcome variables vary considerably, meta-analyses of studies become more difficult to perform. Despite the somewhat mixed results, the present review demonstrates that SFPs have promising, positive impacts on the nutrition and health status of school-aged children. Providing food to children in the form of school meals, snacks, or take-home rations can help alleviate hunger, address the nutrition needs of children, improve children's micronutrient status (if food is fortified with essential micronutrients or if micronutrient supplements are provided), and reduce the susceptibility of children to infectious diseases and illnesses (as summarized in Table 3 ). However, the school feeding studies and programs in developing countries published to date lack an in-depth investigation of whether children are receiving culturally and developmentally appropriate nutrition and health education lessons to complement the nutritious foods and snacks being offered during a regular school day. According to Powell et al., 18 in order for the achievement levels of children to improve and for children in developing countries to fully benefit from the school feeding and supplemental services offered at their schools, integrated interventions that include nutrition, health, and educational components are needed. Successful school nutrition and feeding programs in developed countries have learned the importance of integrating nutrition education into these programs. 40 , 41

Summary of the scientific evidence on the impact of school feeding activities and provisions on intended nutrition, health, and educational outcomes in school-aged children and their households.

Conclusive: consistent findings that support the link between SFP provisions and intended outcomes.

A meta-analysis that explores school feeding and its impact on the nutrition and cognition of school-aged children showed mixed, yet promising, results on changes in the nutritional status of school-fed children compared to non-school-fed children in developing countries. 16 Numerous studies in the nutrition literature, which were discussed in this review, show that school feeding can enhance children's diets by increasing the total energy intake of children consuming meals and/or snacks at school. Although a substitution effect does occur, studies have shown that the increase in total dietary intake from school feeding offsets any diminished intake at home. The substitution effect varies depending on the modality of school feeding (e.g., snacks/biscuits result in lower substitution effects than meals), as well as the timing and composition of meals (e.g., breakfast or mid-morning meals result in lower substitution effects than lunches). 16 , – 44

A growing body of literature supports micronutrient fortification (fortifying commonly eaten foods) and supplementation (providing nutrients through micronutrient pills or suspensions) as part of the SFPs in communities with high levels of micronutrient deficiencies. Studies highlight the importance of school deworming (anthelmintic treatments) in regions where high rates of worm infections prevail. As a result, the WFP has been strongly recommending that multiple nutrient fortification and meal supplementation, as well as deworming, be complementary services to school feeding and included in the “essential package.” 45 In addition, research shows that the effect of school feeding on the dietary intake and growth of school-aged children is greater among those that are malnourished compared to adequately nourished children. 25 , 27 Furthermore, greater benefits are observed among younger school-aged children. 16 These findings have very important implications regarding the design and targeting criteria that are set for SFPs. Thus, program designers and planners are encouraged to target children from highly food-insecure areas with high infection rates in their populations in order to provide food to those who are most susceptible to hunger and malnutrition and to overcome the burdens of illness and diseases that may otherwise impair the children's growth and nutrition.

Evidence on the positive impact of school feeding on education outcomes seems to be even stronger than that observed and reported with nutritional outcomes. The present review of the literature shows that SFPs have a positive impact on children's school enrollment and attendance. 23 , – 39 The impact of school feeding on school-aged children's academic achievement is consistently positive for arithmetic tests, yet inconclusive for reading, writing, and spelling tests. 16 , – 26 Although there is reasonable evidence for school feeding and its positive effects on short-term cognitive functions and various dimensions of children's school performance, randomized controlled trials and well-designed evaluation studies are needed to demonstrate the long-term impact of these programs on children's school completion and productivity as adults. Table 3 includes a summary of the scientific evidence that justifies the link between school feeding provisions and activities and intended positive outcomes on the nutrition, health, and academic performance of school-aged children. The evidence was considered conclusive if consistent findings were reported across studies reviewed in this paper; they were considered inconclusive if findings were mixed, and unexplored if there is a lack of scientific measurement of the link between the SFP provision or activity and the intended outcome.

The school feeding literature is rich with well-designed trials and country reports; however, rigorous theory-based impact evaluations are required in this area. Experimental and quasi-experimental studies on the nutritional benefits of school feeding may target and evaluate specific outcomes and biomarkers of children's nutrition and health status; however, these studies mostly fall short of identifying the causal chain or theory behind the implemented programs. Furthermore, many of these studies lack a detailed description of the political, social, and economic context of a SFP, thereby limiting the possibility of replicating the program in similar contexts or the generalizability of the findings.

The International Initiative for Impact Evaluation (3ie) 46 highlights the importance of theory-based impact evaluations of programs in developing countries designed to improve the livelihood of populations. Numerous principles are needed for a theory-based impact evaluation including the existence of a program theory (causal chain), understanding the context of the program, anticipating heterogeneity, conducting rigorous factual analysis, and using mixed methods to validate the outcomes and impact of a program. 47 In the case of school feeding, there are insufficient rigorous theory-based evaluations of the nutritional and health impact of these programs on school-aged children in developing countries. The theory and context of SFPs that are funded and managed by the WFP or transitioning to become nationally owned are well-defined. However, the design of these programs falls short from fulfilling other principles needed for theory-based impact evaluations, including the use or reporting of mixed methods (qualitative and quantitative data), and the availability of factual and counterfactual analyses (experimental versus control or pre- and post-intervention results) in some of these programs. On the other hand, experimental and quasi-experimental studies assessing school feeding, such as those reviewed in this paper, meet the scientific caliber needed in impact evaluations yet often lack a clear definition of the logical framework of the SFP being implemented; moreover, their inconclusive findings, at times, limit them from validating the links between resources, outputs, and outcomes within a causal chain of a school feeding framework.

Furthermore, several questions were raised from the literature on school feeding and should be addressed when future programs and trials are designed to test the effectiveness of SFPs. Some of these research gaps were pointed out throughout this review, while others are summarized as follows. 1) Studies on the SFPs vary in design and some lack scientific rigor. Thus, efforts need to be exerted to provide guidance to researchers on what standardized methods, designs, and outcomes would be best implemented and measured to improve the quality of evidence on school feeding. 2) The benefits of school feeding on nutrition, health, and education of school-aged children are identified in the literature; however, the scale of these benefits requires further exploration. 3) Independent and combined effects of SFPs with supplemental health and educational interventions, including school-based health and nutrition education, on the nutritional knowledge and eating behavior of targeted children and their households are areas of needed study. 4) Studies that explore or control for the substitution effect of SFPs based on various factors including modality, timing, and composition of snacks or meals, age of child, and other household characteristics are still limited, yet necessary. 5) Long-term studies and program evaluations are needed to track the impact of school feeding on nutritional/health status, educational attainment, and productivity of children as they reach adulthood. 6) Research on the cost-drivers, cost-effectiveness, and benefit-to-cost ratio of various feeding programs, including cross-sectional and randomized trials, is needed to better advise governments on how to best allocate their limited resources

School feeding programs face numerous and continuous challenges, some of which are context-specific; however others are more universal and apply to all SFPs implemented in developing countries. The sustainability of these programs, procurement of food in light of food price fluctuations and environmental and agricultural changes, as well as questions of a program's cost-effectiveness are common challenges faced by SFP planners and designers. Despite their importance, these issues are beyond the scope of this review and were discussed in depth in the most recent joint WB and WFP publication on school feeding. 48 , 49

Based on the most recent “transition process” theories and modules developed by the WFP and the WB with the collaboration of national governments, the trend for SFPs is to become government-driven and owned, more cost-contained and cost-efficient, and linked with wider school health and nutrition services such as water sanitation, supplementation, and deworming, among other services. The aim is for these SFPs to become embedded into national policies and frameworks. Questions remain about the feasibility and effectiveness of nationally owned, funded, and managed SFPs. Thus, a working database of success stories, country and program evaluation reports that can be publicly accessible and updated not only by the international agencies and funders but also by national governments can help advance research in this area. This would be an invaluable database and a reference document that could be used by various stakeholders involved in designing, funding, implementing, and evaluating SFPs.

Local procurement of food is yet another area that seems to be the focus of international non-governmental and governmental organizations and that will be expanding to provide full coverage to the growing number of SFPs, especially in response to the financial and food crises. In addition, home-grown school feeding (HGSF) is a new framework that is suggested to link school feeding with local agricultural production. 50 HGSF seems to be the next revolution in school feeding. Therefore, more interest and funding might be channeled to expand on this new framework. Furthermore, SFPs that offer more nutritious food fortified or supplemented with required micronutrients will also be sought in order to increase the effectiveness of SFPs and their impact on the nutrition, cognition, and health of children.

Researchers design rigorous randomized controlled trials to examine the efficacy of SFPs and to establish cause and effect relationships, when possible, between school feeding in its different modalities and positive nutrition and educational outcomes. However, ethical issues arise as researchers deny or delay the provision of foods and complimentary services, such as anthelmentic treatment and micronutrient supplements, to children in control groups that may otherwise benefit from the treatment.

Global efforts were exerted to set the MDGs, yet we are still far from achieving those highly aspired goals. Millions of children are still deprived of some of their basic human rights to be fed and taken care of, to receive the necessary medical and health care, to go to school and get a formal education that prepares the child for a productive adult life. The present review of the literature shows a relatively consistent positive effect of SFPs on the energy intake and micronutrient status of school-aged children, and a decline in infections and morbidities, particularly in programs in which micronutrient fortification and deworming are provided to school-aged children in regions with multiple micronutrient deficiencies and heavy loads of worm infections. Mixed findings were reported from various studies in terms of the impact of school feeding on weight, height, and BMI gains among school-aged children. Long-term studies that assess the benefits of school meals, snacks, and take-home rations on children's growth and household food consumption patterns are still lacking. Furthermore, as SFPs shift from emergency and post-crisis strategies to stable and long-term development projects and safety nets, complementary nutrition and health education curricula will need to be further emphasized with provision of school meals and food rations to address long-term sustainable improvements in nutrition.

In conclusion, the success and almost universality of SFPs highlights the important yet challenging task of sustaining these programs and ensuring that they expand and benefit a larger target population of school-aged children, preschoolers, and their households. Collaborative efforts are required to ensure that SFPs not only expand, but become increasingly cost-effective and efficient and achieve intended outcomes in the short and long terms. Health professionals, educators, researchers, and community workers need to work together when developing national and regional SFPs and designing trials to evaluate their impact on various intended outcomes.

This review was conducted in part at the World Food Programme (WFP) headquarters in Rome, Italy. The authors thank Mr. Andreas Psoroulas, the head of the WFP library, Ms. Nancy Walter, the Chief of the School Feeding Policy at the WFP, and Ms. Carmen Burbano, co-author of the joint WFP and WB publication “Rethinking School Feeding: Social Safety Net, Child Development, and the Education Sector,” as well as all members of the School Feeding Division for providing helpful information and sharing their expertise in this area.

Declaration of interest . The authors have no relevant interests to declare.

Food and Agriculture Organization . The State of Food Insecurity in the World 2009 . Rome: FAO ; 2009 .

Google Scholar

United Nations . Declaration of Millenium Development Goals: United Nations Resolution . 2000 :Available at: http://www.un.org/millennium/declaration/ares552e.pdf . Accessed 8 March 2010.

World Bank . Education for All Fast Track Initiative . 2002 :Available at: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/0,contentMDK:20278663~menuPK:617564~pagePK:148956~piPK:216618~theSitePK:282386,00.html . Accessed 5 August 2009.

United Nations Children's Fund, World Food Programme . The Essential Package: Twelve Interventions to Improve the Health and Nutrition of School-Age Children . Rome: World Food Programme ; 2005 .

World Hunger Education Service . World Hunger Poverty Facts and Statistics 2010 . 2010 :Available at: http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm . Accessed January 1, 2011.

Weinreb L Wehler C Perloff J , et al . Hunger: its impact on children's health and mental health . Pediatrics . 2002 ; 110 : e41 .

Broca S Stamoulis K . Micro- and macroevidence on the impact of undernourishment . Nutrition Intake and Economic Growth . Economic and Social Development Department. Food and Agriculture Organization of the United Nations. 2003 . http://www.fao.org/docrep/006/y4850e/y4850e03.htm . Accessed January 5, 2010.

Victora CG Adair L Fall C , et al . Maternal and child undernutrition: consequences for adult health and human capital . Lancet . 2008 ; 371 : 340 – 357 .

Food and Agriculture Organization . The State of Food Insecurity in the World: Eradicating World Hunger – Key to Achieving the Millenium Development Goals . Rome: FAO ; 2005 .

World Food Programme . Figures on WFP School Feeding Programmes . 2008 :Available at: http://home.wfp.org/stellent/groups/public/documents/communications/wfp205343.pdf . Accessed 26 January 2010.

United Nations . Road Map toward the Implementation of the United Nations Millenium Declaration . 2000 :Available at: http://www.un.org/News/Press/docs/2001/pi1380.doc.htm . Accessed January 2, 2010.

Bundy D Burbano C Grosh M Gelli A Jukes M Drake L . Why implement school feeding? Rethinking School Feeding: Social Safety Nets, Child Development, and the Education Sector . Washington, DC: World Bank ; 2009 : 15 – 34 .

Bergeron G Del Rosso JM . Food for Education Indicator Guide. Food and Nutrition Assistance Project . 2001 :Available at: http://www.fantaproject.org/downloads/pdfs/FFE.pdf . Accessed 28 June 2010.

Bundy D Burbano C Grosh M Gelli A Jukes M Drake L . Rethinking School Feeding: Social Safety Nets, Child Development, and the Education Sector . Washington, DC: World Bank ; 2009 .

World Food Programme . School Feeding Policy: Informal Consultation . 2009 :Available at: http://home.wfp.org/stellent/groups/public/documents/resources/wfp205242.pdf . Accessed 26 June 2010.

Kristjansson E Robinson V Petticrew M , et al . School feeding for improving the physical and psychosocial health of disadvantaged students . Cochrane Database Syst Rev . 2006 ; 1 . doi:10.4073/csr.2006

Neumann CG Bwibo NO Murphy SP , et al . Animal source foods improve micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings . J Nutr . 2003 ; 133 (Suppl): S3941 – S3949 .

Powell C Walker SP Chang SM Grantham-McGregor SM . Nutrition and education: a randomized trial of the effects of breakfast in rural primary school children . Am J Clin Nutr . 1998 ; 68 : 873 – 879 .

Du X Zhu K Trube A , et al . School-milk intervention trial enhances growth and bone mineral accretion in Chinese girls aged 10–12 years in Beijing . Br J Nutr . 2004 ; 92 : 159 – 168 .

Agarwal DK Agarwal KN Upadhyay SK . Effect of mid-day meal programme on physical growth & mental function . Indian J Med Res . 1989 ; 90 : 163 – 174 .

Bailey KV . Rural nutrition studies in Indonesia IX: feeding trial on school boys . Trop Geogr Med . 1962 ; 14 : 129 – 139 .

Devadas RP Jamala S Surabhi A Murthy NK . Evaluation of a food supplement to school children . Indian J Nutr Diet . 1979 ; 16 : 335 – 341 .

Simeon D . School feeding in Jamaica: a review of its evaluation . Am J Clin Nutr . 1998 ; 67 (Suppl): S790 – S794 .

Ahmed AU . The Impact of Feeding Children in School: Evidence from Bangladesh . Washington, DC: International Food Policy Research Institute ; 2004 .

Grillenberger M Neumann CG Murphy SP , et al . Food supplements have a positive impact on weight gain and the addition of animal source foods increases lean body mass of Kenyan schoolchildren . J Nutr . 2003 ; 133 (Suppl): S3957 – S3964 .

Neumann CG Murphy SP Gewa C Grillenberger M Bwibo NO . Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children . J Nutr . 2007 ; 137 : 1119 – 1123 .

Kruger M Badenhorst CJ Laubscher JA Spinnler Benade AJ . Effects of iron fortification in a school feeding scheme and anthelmintic therapy on the iron status and growth of six- to eight year-old schoolchildren . Food Nutr Bull . 1996 ; 17 : 11 – 21 .

Jacoby E Cueto S Pollitt E . Benefits of a school breakfast programme among Andean children in Huaraz . Bull Nutr Food . 1996 ; 17 : 54 – 64 .

Jacoby E Cueto S Pollitt E . When science and politics listen to each other: good prospects from a new school breakfast program in Peru . Am J Clin Nutr . 1998 ; 67 :(Suppl): S795 – S797 .

Afridi F . Child welfare programs and child nutrition: evidence from a mandated school meal program in India . J Dev Econ . 2010 ; 92 : 152 – 165 .

Arsenault JE Mora-Plazas M Forero Y , et al . Provision of a school snack is associated with vitamin B-12 status, linear growth, and morbidity in children from Bogota', Colombia . J Nutr . 2009 ; 139 : 1744 – 1750 .

Van Stuijvenberg ME Kvalsvig JD Faber M Kruger M Kenoyer DG Benade AJS . Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial . Am J Clin Nutr . 1999 ; 69 : 497 – 503 .

Van Stuijvenberg ME . Using the school feeding system as a vehicle for micronutrient fortification: experience from South Africa . Food Nutr Bull . 2005 ; 26 (Suppl 2 ): S213 – S219 .

Hurrell RF . Preventing iron deficiency through food fortification . Nutr Rev . 1997 ; 55 : 210 – 222 .

Walter T Hertrampf E Pizarro F , et al . Effect of bovine-hemoglobin-fortified cookies on iron status of school children: a nationwide program in Chile . Am J Clin Nutr . 1993 ; 57 : 190 – 194 .

Seikmann J Allen LH Bwibo NO Demment MW Murphy SP Neumann CG . Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B12 is the only detectable micronutrient response to meat or milk supplementation . J Nutr . 2003 ; 133 (Suppl): S3972 – S3980 .

Murphy SP Gewa C Lliang LJ Grillenberger M Bwibo NO Neumann CG . School snacks containing animal source foods improve dietary quality for children in rural Kenya . J Nutr . 2003 ; 133 (Suppl): S3950 – S3956 .

Gelli A Meir U Espejo F . Does provision of food in school increase girls' enrollment? evidence from schools in sub-saharan Africa . Food Nutr Bull . 2007 ; 28 : 149 – 155 .

Ahmed AU del Ninno C . The Food for Education Program in Bangladesh: An Evaluation of Its Impact on Educational Attainment and Food Security . Washington, DC: International Food Policy Research Institute ; 2002 .

McConnell PE Shaw JB . Position of the American Dietetic Association: child and adolescent food and nutrition programs . J Am Diet Assoc . 1996 ; 96 : 913 – 917 .

Centers for Disease Control and Prevention . Guidelines for school health programs to promote lifelong healthy eating . Morb Mortal Wkly Rep . 1996 ; 45 ( RR-9 ): 1 – 33 .

Orphans and Vulnerable Children (OVC) Toolkit . Education Sector Programs . World Bank. 2009 :Available at: http://info.worldbank.org/etools/docs/library/248484/toolkiten/sector/education4.htm . Accessed 26 February 2010.

The Caroline Walker Trust and the National Heart Forum . Eating Well at School: Nutritional and Practical Guidelines . 2005 :Available at: http://www.cwt.org.uk/pdfs/EatingWellatSchool.pdf . Accessed 29 July 2010.

Centers for Disease Control and Prevention , Division of Adolescent and School Health . Coordinated School Health Program . 2008 :Available at: http://www.cdc.gov/healthyyouth/CSHP/ . Accessed 29 July 2010.

Bundy D Burbano C Grosh M Gelli A Jukes M Drake L . What is school feeding? Rethinking School Feeding: Social Safety Nets, Child Development, and the Education Sector . Washington, DC: The World Bank ; 2009 : 9 – 14 .

International Initiative for Impact Evaluation (3ie) . Global Development Network . 2007 :Available at: http://www.3ieimpact.org/ . Accessed 9 July 2010.

White H . Theory-Based Impact Evaluation: Principles and Practice (Working Paper 3) . 2009 :Available at: http://www.3ieimpact.org/admin/pdfs_papers/51.pdf . Accessed 23 July 2010.

Bundy D Burbano C Grosh M Gelli A Jukes M Drake L . Institutional and procurement arrangements . Rethinking School Feeding: Social Safety Nets, Child Development, and the Education Sector . Washington, DC: The World Bank ; 2009 : 69 – 81 .

Espejo F Burbano C Galliano E . Home-Grown School Feeding: A Framework to Link School Feeding with Local Agricultural Production . Rome: World Food Programme (WFP) ; 2009 .

• developing countries
• energy intake
• micronutrients
• knowledge acquisition
• science of nutrition
• child health
• school-age child
• academic achievement

Email alerts

Citing articles via.

• Recommend to your Library

Affiliations

• Online ISSN 1753-4887
• Print ISSN 0029-6643
• Copyright © 2024 International Life Sciences Institute
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

PRACTICE AND CHALLENGES FOR IMPLEMENTATION OF SCHOOL FEEDING AT ADDIS ABABA PUBLIC PRIMARY SCHOOLS

ABSTRACT School feeding is simply providing of food to children by using in-school meals or take-home rations in both developed and developing countries for achieving the sustainable development goal of universal primary education. The objective of the study was to assess the current practice and challenges for implementation of school feeding program at Addis Ababa public primary schools. Institutional based descriptive cross-sectional study of mixed method was implemented. The data collected from teachers, school directors, food handlers and regional coordinators with sample size of 383 by using structured and non-structured questionnaire. Descriptive statistics were used to summarize categorical and continuous variables. For qualitative content analysis was used. Based on the study community participation and involvement is not as expected, Infrastructures in the schools is not standardized and good enough. The fund is not enough and considers the current market. Decision-making process related to the program is not participatory and inclusive. Monitoring and Evaluation is not adequate and capable. Related to challenges lack of effective monitoring and evaluation system, absence of organizational structure and community involvement, legal framework and policy, absence of infrastructure and training, effective communication, manager and management team are challenges. To summarize and conclude; the practice of the school feeding program is not as a standard and expected. So concerned body should give attention and focused to standardize the program. Key words: School feeding program, Practice, Challenge

Related Papers

International Journal of Scientific Research in Science and Technology IJSRST , John Mensah

This study sought to assess the relevance and challenges of the Ghana School Feeding Programme (GSFP) in some Basic schools in the Mpohor-Wassa East District. The study employed the descriptive survey research design. The purposive sampling procedure was used to select 21 respondents made up of one (1) coordinator of the GSFP; five (5) head teachers; five (5) caterers and ten (10) Basic school teachers (2 teachers each) from five (5) Basic schools where GSFP have been implemented for more than the past two (2) decades. Data was analysed using descriptive statistics mainly frequency and percentages. The study revealed that since the inception of the GSFP in the District there have been significant improvements in pupils " enrolment and attendance rates, leading to reduction in absenteeism and drop-out rates. It was also found out that GSFP did not cover all the Basic schools in the District but covers only few selected schools. It was also observed that the feeding cost per pupil per day was insufficient and also not released on time. Finally, it was observed that caterers did not have suitable kitchen for cooking and pupils " also did not have proper canteens and that they eat the food in open spaces. It was recommended that Ghana government should extend the GSFP to cover all the Basic schools so as to reduce short-term hunger of pupils during classes " hours; and also stakeholders should provide suitable kitchen for cooking and proper canteens for the pupils so as to avoid eating in unhygienic open spaces.

IOSR Journals

This study was attempted to explore the sustainability of school feeding program in Ethiopia Somali Regional State. Practices, challenges, contributions and sustainability of school feeding program in the region was captured. Different zones such as Gode, Jigjiga, Deghabour and KebriDehar were selected for the study. Different participants such as teachers, directors, parents, students, Woreda education offices, Region education bureau and WFP focal person were participated in the study. To select participants, primary schools of the respective zone were included in the study. All teachers and directors existed in the selected primary school were purposely selected. In the same vein, purposive sampling technique was employed to select students and parent feeding committee who are jointly working with the schools as well as purposive sampling technique was used to select region heads, woreda education bureau heads and WFP focal person. Percentage and thematic analysis were used to analyze quantitative and qualitative data respectively. The main finding of the study revealed that imbalance or clash between demands of SFP (School Feeding Program) which was expressed in terms of expected and unexpected demand and the supply side of the SFP were found. Region education bureau, schools (directors) and parents were not jointly working to generate new way to sustain the SFP in the region though community and the regional government were committed to support the program. The process of SFP in terms of distribution of food service and the actual distribution was not properly managed. In spite of the fact that there were gaps in SFP practices, SFP has contributed lot for student’s education. It tried to enhance student’s moral and vision to education, increase enrolment and attendance, enhance pastoral parent’s awareness and value to education, enhance quality of education since students motivation to education, concentration and attention in learning were increased after the commencement of food service in the respective schools. Besides, implementation of SFP in the schools change pastoral community’s view towards modern education, shape pastoral parents knowledge to education and increased student’s academic achievement. Despite the fact that there were benefits reported different challenges such as increasing number of students from year to year, lack of government and community commitment to support the program, lack of sectorial engagement, lack of financial and institutional capacity as well as lack of independent SFP structure at different levels affect the implementation of SFP and Future sustainability of the program. To sustain the program opportunities were identified in the study such as the existence of enough land at each school, surplus production, enough rivers, committed (in terms of readiness and perspective) government, parents and community to support the program. On the bases of the identified findings, the regional government is expected to establish new independent structure to run SFP, redesign SFP so as to accommodate the interest different sectors in the program, use the existed opportunity effectively and mobilize pastoral community resource for the program.

School Feeding Program and its Contribution to Quality Education in First Cycle Government Primary Schools of Yeka Sub City, Addis Ababa

mulat abebel

ABSTRACT School Feeding Program (SFP) is one of the components of education sector development program (ESDPIV) and School health and nutrition strategy that implemented by Ministry of Education with collaboration of Ministry of Health. This research aimed at assessing the appropriateness of SFP and contribution of it to quality education particularly, for the indicators of academic achievement, completion rate (minimize school dropout rates) and create good psychological makeup for learning (create child-friendly school environments, readiness to learn (attendance, concentration or class room ethics and initiation to continue their education to the higher level). The research was employed mixed research approach and the design different according to the natures of research objectives i.e., to achieved the objective contribution of SFP to academic performance, psychological makeup and completion rate across groups (beneficiaries and non-beneficiaries but needy) students quasi (nonequivalent groups posttest-only (two or more groups) design, and to assessed the practice of school feeding program non-experimental (descriptive) were employed. For this study, 118 SFP beneficiary and 133 non-beneficiary but needy totally 251 students were participated in the research. The data collection instruments were student roster card analysis, questionnaire and interview. The study conducted two statistical tests; inferential (independent sample T-test, correlation and linear regression) and descriptive statistics by using SPSS version 21. The main findings of the study were that, the contribution of School Feeding Program to academic achievement of student was positive and significant; the program had contribution to develop both negative and positive psychological makeup of students; the implementation process also both appropriate and inappropriate and the program contribute positively to the target of decreasing dropouts. Based on the findings the study recommended that, stakeholders should give due consideration for practical interventions to enhance the program effectiveness. Key Words: School Feeding, Quality Education

FATAWU ALHASSAN

Journal of social development in Africa

MAHAMA SAAKA

This paper seeks to generate debate on the theme of factors that are critical in school feeding programmes for better results. The information used in developing the paper is derived from data that were collected from the evaluation of the CRS/Ghana Development Assistants Project (DAP Title II programme FY2004-08). The findings show that school feeding programmes have the potential to stimulate enrolment and retention of children, particularly the girl child, and to improve the academic outcomes of children depending on how the programme blends feeding with nutritional and other health needs of children on the one hand, and the nature of targeting mechanisms in order to reach deprived families and needy school children, on the other. The findings also show that the institutionalisation of structures for partner participation and capacity building enhances programme effectiveness. However, in order to sustain the benefits of improved enrolment and attendance, especially of the girl c...

Asian Journal of Education and Social Studies

Issah Iddrisu

The study focused on whether there is any involvement and the need for the Ghana Education Service (GES) in the operations of the school feeding programme in Ghana. The Ghana Education Service has supervised similar programmes as the main agency in charge to improve efficiency in delivery. The purpose and intent of the Ghana education service will better be served if they are in control of the school feeding programme. The study sampled 350 teachers as the target group and other stakeholders which included directors of education, school feeding programme, parents and students. With a mixed method and the use of questionnaire and interviews, the study analyzed responses based on percentages and themes respectively. The study concluded that the Ghana Education Service (GES) is not involve in the operations of the school feeding programme. They are stated as partners in its operations but are not consulted in the recruiting of schools and caterers as part of the programme operations. B...

Samuel H. Nyarko

Sani Yakubu

The study assessed the implementation of Home Grown-School Feeding Programme in UBE Schools in South-West Nigeria. The study was guided by two research questions with corresponding two objectives and hypotheses. The research design used for this study was the crosssectional survey research design. The population of the study consisted of 38, 423 (154 Local Government Educational secretaries 2814 principals and 35455 teachers). The sample size of this study consisted of 379 using Krejcie and Morgan (1970) Table and simple random technique respectively. The researcher developed a questionnaire for data collection from the respondents. The questionnaire is tagged ‘‘Implementation of Home Grown School Feeding Programme in UBE Schools Questionnaire’ (IHGSFPUBESQ). The instrument was duly validated and it yielded 0.80 as logical validity index. The coefficient of internal consistency of 0.75 was obtained after pilot testing the instrument. Descriptive statistics of mean and standard devia...

ADAM BAWA YUSSIF

International Journal of Nursing, Midwife and Health Related Cases

Olawale Stephen .G.

The importance of School feeding Programme is well documented. However, it was discovered that just a few studies have been carried out that involve pupils, parents and teachers on their opinions on school feeding programme. Therefore, this research was aimed at identifying the opinion of pupils, parents and teachers on the benefits of school feeding programme in Osun- State, Nigeria. The research adopted a quantitative cross-sectional research design. The sample size for the pupils was determined by Taro Yamane, which was 296. Random sampling technique was used to select 296 parents that represents each primary four pupils during the Parents, Teachers association meeting. Self-structured questionnaires were used to collect data. Cronbach’s Alpha reliability coefficient for the constructs ranged from 0.72 to 0.85. The research achieved a response rate of 80%. Data collected were analyzed using descriptive and inferential statistics. The results showed that majority of the pupils, te...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

RELATED PAPERS

Michael Fiadzigbey

Eric H Yeboah

International Journal of Advanced Research (IJAR)

IJAR Indexing

International Journal of Education

mark amponsah

Directorate Research & Innovation

Asmamaw Guta

International Journal of Advanced Research

Bismark Asante

Brenda alemura

John Adanse

Advance Knowledge for Executives

Advance Knowledge for Executives (AKE)

Frontiers in Sustainable Food Systems

Hosea Mpogole

michael chaula

International Journal of Child Health and Nutrition

Joan Vaccaro

Scientific Research Journal

susan chepkonga

Jeph Ighodaro

Professor Dr. Emmanuel Ohene Afoakwa

Benzies Isaac Adu-Okoree

Ennie Chima

Journal of Research in Health and Sports Science, 20(1): 17-30

Obasuyi Osato

Priya Pandey

International Journal of Innovation and Applied Studies

Abayomi Oloruntoba

IOSR Journal of Humanities and Social Science

john orodho

International Journal of Innovative Research and Development

Dr. Evanson M Muriithi (PhD)

European Journal of Education Studies

Margaret Mwangi

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Theses and Dissertations Collection

Open Access Repository of University of Idaho Graduate ETD

Prescribed Streamflow to Improve Juvenile Steelhead Habitat

Treasure, Jonathan Michael. (2013). Prescribed Streamflow to Improve Juvenile Steelhead Habitat. Theses and Dissertations Collection, University of Idaho Library Digital Collections. https://www.lib.uidaho.edu/digital/etd/items/etd_407.html

Contact us about this record

Virtual Tour

Experience University of Idaho with a virtual tour. Explore now

• Discover a Career
• Find a Major
• Experience U of I Life

More Resources

• Admitted Students
• International Students

Take Action

• Find Financial Aid
• View Deadlines
• Find Your Rep

Helping to ensure U of I is a safe and engaging place for students to learn and be successful. Read about Title IX.

Get Involved

• Clubs & Volunteer Opportunities
• Recreation and Wellbeing
• Student Government
• Student Sustainability Cooperative
• Academic Assistance
• Safety & Security
• Career Services
• Health & Wellness Services
• Register for Classes
• Dates & Deadlines
• Financial Aid
• Sustainable Solutions
• U of I Library

• Upcoming Events

Review the events calendar.

Stay Connected

• Vandal Family Newsletter
• Here We Have Idaho Magazine
• Living on Campus
• Campus Safety
• About Moscow

The largest Vandal Family reunion of the year. Check dates.

Benefits and Services

• Vandal Voyagers Program
• Vandal License Plate
• Submit Class Notes
• Make a Gift
• View Events
• Alumni Chapters
• University Magazine
• Alumni Newsletter

U of I's web-based retention and advising tool provides an efficient way to guide and support students on their road to graduation. Login to VandalStar.

Common Tools

• Administrative Procedures Manual (APM)
• Class Schedule
• OIT Tech Support
• Academic Dates & Deadlines
• U of I Retirees Association
• Faculty Senate
• Staff Council

College of Graduate Studies

Physical Address: Morrill Hall Room 104

Mailing Address: College of Graduate Studies University of Idaho 875 Perimeter Drive MS 3017 Moscow, ID 83844-3017

Phone: 208-885-2647

Email: [email protected]

Thesis and Dissertation Resources

You will find all you need to know about starting and completing your thesis or dissertation right here using ETD (Electronic submission of Dissertations and Theses).

• Create your ETD account
• General ETD Help from Proquest
• Theses and Dissertations template  (Word)
• Example of a thesis
• Note: COGS at this time is unable to provide any troubleshooting support or tutorials on LaTeX. Please use only if you are knowledgeable and familiar with the program.
• Writing Assistance Services
• Format Review Services
• Survey of Earned Doctorates  (for Ph.D. students only)
• University Repository Agreement Form  (PDF)
• Dates and Deadlines
• Sign up with ORCID (take 5 minutes to establish your academic identity)
• U of I Theses and Dissertations , 2013-present
• Data and Digital Services Workshops
• Open Access, Scholarly Communication, and Copyright LibGuide
• Quick Guide - Committee Electronic Review/Authorization - Student View pdf
• Quick Guide - Committee Electronic Review/Authorization - Faculty View pdf
• ETD Checklist jpg
• T/D Format/Component Checklist pdf
• Handbook - reference pdf
• Handbook - example docx

• Election 2024
• Entertainment
• Newsletters
• Photography
• Personal Finance
• AP Investigations
• AP Buyline Personal Finance
• AP Buyline Shopping
• Press Releases
• Israel-Hamas War
• Russia-Ukraine War
• Global elections
• Asia Pacific
• Latin America
• Middle East
• Election Results
• Delegate Tracker
• AP & Elections
• Auto Racing
• 2024 Paris Olympic Games
• Movie reviews
• Book reviews
• Financial Markets
• Business Highlights
• Financial wellness
• Artificial Intelligence
• Social Media

Feds charge 5, including man acquitted at trial, with conspiring to bribe Minnesota juror with $120K

FILE - This photo, supplied by the U.S. Attorney’s Office for Minnesota, shows $120,000 in cash, taken from a bag that was left at the home of a juror in one of the country’s largest pandemic aid fraud cases, June 2, 2024, outside Minneapolis, Minn. The U.S. Attorney’s Office and the FBI announced charges in the case Wednesday, June 26, 2024. (U.S. Attorney’s Office for Minnesota via AP, File)

United States Attorney, Andrew Luger holds a news conference on Wednesday, June 26, 2024 in Minneapolis, Minn. The U.S. Attorney’s Office and the FBI has announced that five people, including a man acquitted at trial, have been charged with trying to bribe a juror in one of the country’s largest COVID-19-related fraud cases with a bag of $120,000 in cash. (Jerry Holt/Star Tribune via AP)

FILE - Assistant U.S. Attorney Joe Thompson, surrounded by the prosecution’s trial team, speaks during a news conference after the verdict was read in the first Feeding Our Future case at the federal courthouse in Minneapolis, June 7, 2024. A jury convicted five Minnesota residents and acquitted two others June 7 for their roles in a scheme to steal more than $40 million that was supposed to feed children during the coronavirus pandemic. The U.S. Attorney’s Office and the FBI announced charges in the case Wednesday, June 26, 2024. (Leila Navadi/Star Tribune via AP, File)

• Copy Link copied

MINNEAPOLIS (AP) — Five people were charged Wednesday with conspiring to bribe a Minnesota juror with a bag of $120,000 in cash in exchange for the acquittal of defendants in one of the country’s largest COVID-19-related fraud cases, the U.S. Attorney’s Office and the FBI announced Wednesday.

Court documents made public reveal an extravagant scheme in which the accused researched the juror’s personal information on social media, surveilled her, tracked her daily habits and bought a GPS device to install on her car. Authorities believe the defendants targeted the woman, known as “Juror 52,” because she was the youngest and they believed her to be the only person of color on the panel.

According to court documents, the group came up with a “blueprint” of arguments for the juror to help persuade other jurors to acquit, injecting the idea that prosecutors were motivated by racial animus: “(w)e are immigrants, they don’t respect us,” the list of proposed arguments read.

The juror reported the bribery attempt and was removed from the case before deliberations began.

The bribe attempt brought renewed attention to the trial of seven Minnesota defendants accused of coordinating to steal more than $40 million from a federal program that was supposed to feed children during the coronavirus pandemic. More than $250 million in federal funds were taken overall in the scheme and only about $50 million has been recovered, authorities say.

Abdiaziz Shafii Farah, Abdimajid Mohamed Nur, Said Shafii Farah, Abdulkarim Shafii Farah and Ladan Mohamed Ali are each charged with one count of conspiracy to bribe a juror, one count of bribery of a juror and one count of corruptly influencing a juror, according to the indictment.

Abdiaziz Shafii Farah is also charged with one count of obstruction of justice.

Abdiaziz Shafii Farah and Abdimajid Mohamed Nur were among five convicted in the fraud trial earlier this month while Said Shafii Farah was acquitted. Abdulkarim Shafii Farah and Ladan Mohamed Ali were not involved.

‘Something out of a mob movie’

Investigators spent three weeks reviewing mountains of evidence to uncover the plot, which U.S. Attorney Andrew Luger, described as “something out of a mob movie.”

The five people charged attempted to win an acquittal not on the evidence, but “through an elaborate scheme to infiltrate this jury,” he said.

According to the indictment, the plan was hatched in mid-May. Ali, who is accused of delivering the bribe money to the juror’s home , flew from Seattle to Minneapolis on May 17 to meet with Nur and allegedly agreed to deliver the bribe money to the home of “Juror #52” in exchange for $150,000.

She returned to Minneapolis two weeks later on May 30 and a day later attempted to follow the woman home as she left a parking ramp near the courthouse.

On June 2, Abdiaziz Farah instructed Nur to meet at Said Farah’s business to pick up the bribe money, the indictment says. When Nur arrived at the business, Said Farah gave him a cardboard box containing the money and told Nur to “be safe.” Nur gave the money to Ali after picking her up in a parking lot later in the day. Hours later, Ali and Abdulkarim Farah drove to a Target store and purchased a screwdriver, which they used to remove the license plates from Ali’s rental car before driving to the juror’s home.

As Farah stayed in the car and filmed the encounter, Ali knocked on the door and was greeted by a relative of the juror. Ali handed the gift bag to her and explained there would be more money if the juror voted to acquit.

The juror called police after she got home and gave them the bag, according to an FBI affidavit. The affidavit noted that the woman who left the bag knew the juror’s first name. Names of the jurors have not been made public, but the list of people with access to them included prosecutors, defense lawyers and the seven defendants.

On June 3, after the bribe attempt was reported, U.S. District Judge Nancy Brasel ordered all seven defendants to surrender their phones. Abdiaziz Farah conducted a factory reset of his iPhone to delete all the messages and photos detailing the plot, according to court records.

Two days later, FBI agents executed a search warrant on Abdiaziz Farah’s home and found a typed list of the jurors hidden inside a plastic water bottle.

Abdiaziz Farah, Said Farah and Abdulkarim Farah made their initial appearances in federal court Wednesday afternoon. A defense attorney who represented them at the hearing declined to comment afterward.

All three men requested representation from the Office of the Federal Defender, a request prosecutors objected to, citing the defendants’ alleged access to money parked abroad. Abdiaziz Farah sent millions in stolen money to Kenya and elsewhere in East Africa, prosecutors said. That money was used to purchase and construct a 12-story apartment building in Nairobi, they added.

Magistrate Judge Douglas L. Micko temporarily allowed the defendants their requested representation and scheduled an arraignment and detention hearing for July 1. Prosecutors said Ali would make her initial court appearance on Thursday.

Other trials in pandemic-related fraud scheme still pending

Seventy people have been charged in federal court for their alleged roles in the pandemic-related fraud scheme that prosecutors say centered on a nonprofit called Feeding Our Future. In addition to the five convictions in early June, eighteen other defendants have already pleaded guilty. Trials are still pending for the others.

Federal prosecutors say the conspiracy exploited rules that were kept lax so the economy wouldn’t crash during the pandemic. The FBI began digging into it in the spring of 2021. The defendants allegedly produced invoices for meals never served, ran shell companies, laundered money, indulged in passport fraud and accepted kickbacks.

The money came from the U.S. Department of Agriculture and was administered by the state, which funneled the funds through partners including Feeding Our Future. The Minnesota Legislature’s watchdog arm found that the state education department provided inadequate oversight of the federal program, which opened the door to the theft.

Luger, who formerly worked as a federal prosecutor in Brooklyn when the U.S. Attorney’s Office was trying to dismantle the Mafia’s “Five Families,” said that form of corruption had made its way to Minnesota. The episode could change the way federal prosecutors approach jury trials as they examine new ways to guard against legal interference, he added.

Medical Scientist Training Program

Congratulations to the mstp students who recently completed their thesis defenses.

Posted by fettigma on Tuesday, June 25, 2024 in Honors and Awards .

Comments are closed

• About the School
• Quick Facts
• Administration
• Basic Sciences
• A-Z Directory
• Contact Information
• Campus Maps & Parking

• Current Students
• Basic Sciences Faculty Affairs
• Clinical Faculty Affairs
• Eskind Biomedical Library
• People Finder

More From Forbes

Harvard business school announces 3 new application essays.

• Share to Facebook
• Share to Twitter
• Share to Linkedin

Harvard Business School.

Harvard Business School announced a surprising departure from its single, open-ended application essay to three short essays with specific prompts. The HBS website sums up the kind of applicant the school is seeking: “We are looking for future leaders who are passionate about business, leadership, and growth.”

The prompts for the class that will begin in fall 2025 instruct applicants to address each topic in turn.

• Business-Minded Essay : Please reflect on how your experiences have influenced your career choices and aspirations and the impact you will have on the businesses, organizations, and communities you plan to serve. (up to 300 words)
• Leadership-Focused Essay : What experiences have shaped who you are, how you invest in others, and what kind of leader you want to become? (up to 250 words)
• Growth-Oriented Essay : Curiosity can be seen in many ways. Please share an example of how you have demonstrated curiosity and how that has influenced your growth. (up to 250 words)

The prompts ask applicants to go beyond simply asserting their allegiance to the ideals of business, leadership and growth. Each of the three questions asks for evidence: “experiences,” “experiences” and “an example,” respectively.

The prompts do not expect a straightforward list of what happened in the past. Rather, they encourage reflection on how these experiences affected present realities and future goals.

Applicants are asked to reflect on past, present and future as an ongoing process of becoming who they are now and who they wish to become. Even the “Business-Minded Essay” is about past choices and future impact; it also assumes you “plan to serve.” The “Leadership-Focused Essay” does not ask applicants to recite a list of titles, but to discuss who they are and how they relate to others; not what title they aspire to, but “what kind of leader you wish to become.”

Perhaps the most surprising essay prompt is No. 3, which asks about curiosity. It opens the door for applicants to discuss a more personal aspect of their candidacies. The prompt asks not about end result, but about the process of change. Once again, the emphasis is on “growth.”

Best High-Yield Savings Accounts Of 2024

Best 5% interest savings accounts of 2024.

In short, the prompts ask about person and process.

How The 3 New Prompts Differ From Last Year’s Single Question

This year’s prompts give applicants more direction than the previous open-ended instruction, which was: “As we review your application, what more would you like us to know as we consider your candidacy for the Harvard Business School MBA program?”

Applicants may find it easier to follow these more detailed instructions and to stay on topic. They no longer need to face an open question and a blank page.

Another aid is the shorter word limit. The essay on being business-minded has a limit of 300 words, and the essays on leadership and growth through curiosity are limited to 250 words each.

A third difference is the specific inquiry about business. Last year’s prompt allowed candidates to choose anything they thought would be important for HBS to consider. Some applicants struggled to decide whether to focus on business or something beyond work. While the “Business-Minded Essay” is still personal, it does ask applicants to reflect on their careers.

One might also speculate that the new, more directive prompts makes it easier for the admissions committee to compare essays across applications, while still leaving room for considerable variation in how applicants choose to address the essay prompts.

• Editorial Standards
• Reprints & Permissions

Join The Conversation

One Community. Many Voices. Create a free account to share your thoughts. 

Forbes Community Guidelines

Our community is about connecting people through open and thoughtful conversations. We want our readers to share their views and exchange ideas and facts in a safe space.

In order to do so, please follow the posting rules in our site's  Terms of Service.   We've summarized some of those key rules below. Simply put, keep it civil.

Your post will be rejected if we notice that it seems to contain:

• False or intentionally out-of-context or misleading information
• Insults, profanity, incoherent, obscene or inflammatory language or threats of any kind
• Attacks on the identity of other commenters or the article's author
• Content that otherwise violates our site's  terms.

User accounts will be blocked if we notice or believe that users are engaged in:

• Continuous attempts to re-post comments that have been previously moderated/rejected
• Racist, sexist, homophobic or other discriminatory comments
• Attempts or tactics that put the site security at risk
• Actions that otherwise violate our site's  terms.

So, how can you be a power user?

• Stay on topic and share your insights
• Feel free to be clear and thoughtful to get your point across
• ‘Like’ or ‘Dislike’ to show your point of view.
• Protect your community.
• Use the report tool to alert us when someone breaks the rules.

Thanks for reading our community guidelines. Please read the full list of posting rules found in our site's  Terms of Service.

SUBMIT A STORY IDEA

In Memoriam: Elizabeth Bernays

Elizabeth Bernays , Regents Professor Emerita of entomology, whose research career focused on the evolution of plant-feeding insects, died on March 5. Bernays is remembered by her colleagues for her numerous contributions to entomology.

Elizabeth Bernays, Regents Professor Emerita of entomology

"She was world-renowned for her research and played a key role in building our Department of Entomology," Bruce Tabashnik , professor and head of the Department of Entomology, wrote in a message to department faculty and staff. "She was a brilliant scientist and a wonderful supporter of our department and community."

Born and raised in Australia, Bernays developed an early fascination with insects and plants. She earned degrees from the University of Queensland and the University of London. She began her career as a British government scientist, working in Africa and India on the biology and control of agricultural pests. In 1983, Bernays joined the faculty at the University of California, Berkeley, where she began more theoretical research on the evolution of plant-feeding insects. She received the Vatican's highest honor for scientists, the Pius XI Medal, in 1986.

In 1989, Bernays and her husband, insect physiologist Reg Chapman, were recruited to the University of Arizona. Two years later, she became head of the University's Department of Entomology.

Her interdisciplinary approach to studying plant-insect interactions and her dedication to research and education left a lasting impact. She supervised 38 graduate students and postdocs, who continue her legacy worldwide. 

"Liz Bernays was nothing if not practical," said Goggy Davidowitz , a professor of entomology at the University who met her while he was a doctoral student. "The best advice I ever received during my dissertation was from Liz, who served on my Ph.D. committee. 'You need to think it through, but don't overthink it. Just do it, see what you get and take it from there.' This is the same advice I now give to my own graduate students."

Bernays had a particular interest in fostering a love of science in children. She worked with Tucson Unified School District over several years to provide hands-on experiments for fourth, fifth and sixth graders to learn about the feeding habits of the differential grasshopper. One experiment, "The Marvelous Munching Melanoplus," involved building "Hopper Hotels," or test chambers, where students observed the behavior of grasshoppers fed with different diets and then used computer analysis on the data they gathered. 

"It's no good being told about science only," Bernays said in a 1991 article about the project published by what was then known as the College of Agriculture and Life Sciences. "You have to do something you can ask questions about. You have to get results and keep an open mind in order to learn."

Bernays was an active supporter of the University's  Arizona Insect Festival . 

After her retirement in 1996, Bernays pursued her passion for writing, earning a Master of Fine Arts in creative writing from the University. She published more than 200 scientific papers, poems, essays and children's books. Her memoir, "Six Legs Walking: Notes from an Entomological Life," won a 2020 New Mexico-Arizona Book Award in the autobiography/memoir category. Her latest book, "Across the Divide: The Strangest Love Affair," was released in 2023.

Bernays is survived by her wife, Linda Hitchcock. Memorial contributions in Bernays' honor can be made to the Humane Society of Southern Arizona or Compassion & Choices, an end-of-life health care nonprofit organization. No services are currently planned.

Resources for the Media

• Share full article

For an Aquatic Veterinarian, It’s Never ‘Just a Fish’

Stress, ovarian cancer, buoyancy disorders: Every pet has its troubles, and needs a good doctor who makes house calls.

Dr. Jessie Sanders analyzing the movement of a Fisher’s wood catfish at a home in Martinez, Calif., in January. Credit...

Supported by

By Emily Anthes

Photographs by Nic Coury

• June 28, 2024

This article is part of our Pets special section on scientists’ growing interest in our animal companions.

Many students begin veterinary school with career aspirations that date back to childhood, when they fell in love with the idea of ministering to cats and dogs, or horses, or the exotic animals at the zoo. Jessie Sanders arrived at veterinary school with a more particular passion. “I was the one weird fish kid,” she said.

It was an interest that had surprised even her. In college, Dr. Sanders had started volunteering at an aquarium, hoping to work with the whales. Instead, she found herself assigned to the fish team — and falling hard for her finned charges.

“I just love fish,” she said. “I love the way they’re built. I love the way they interact with the environment. And there’s still so much that we just don’t know about all the little internal workings.”

Today, Dr. Sanders runs Aquatic Veterinary Services , with patients that include carnival goldfish, pet store bettas and prizewinning koi worth tens of thousands of dollars. Last year, she became one of the first 10 veterinarians to receive a board certification in fish practice, a wholly new accreditation.

Dr. Sanders spoke with The New York Times about life as a fish veterinarian. Her story was based on two conversations, and her responses were edited and condensed.

I’ve done nothing but pet fish for 10 years, and it’s been awesome and challenging. I like the challenge of setting everything in an underwater environment. And the amount of personalities that you get in fish — they have so many little quirks. Some of them are super chill and nice, and some of them are complete terrors.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .

Advertisement