Impact of a school feeding programme on nutritional status of primary school children in Orange Farm

Abstract

Introduction. Most of the children aged between five and 15 around the world live under difficult circumstances, which lead to a high dropout rate from school before the end of the secondary level. Most of them have poor nutrition, are undernourished and are exposed to a large range of harmful, parasitic and infectious diseases (Shariff et al, (2000:265). Purpose. The purpose of this investigation was to analyze the nutritional status of primary school children in Orange Farms informal settlement in terms of their nutritional needs in order to implement a school feeding programme and assess its impact on the nutritional status of these children. Methodology. A cross-sectional baseline survey was conducted two weeks before commencing with the school feeding programme. The measurements taken during this phase were socio-demographic and health by means of a questionnaire, as well as dietary intake and food consumption patterns by means of a quantified food frequency questionnaire and 24-hour recall, weight and height measurements. The anthropometric measurements included height and weight and the biochemical measurements included serum ferritin, C-reactive protein, total protein, albumin, vitamin B 12, folate, glucose, full blood count, haemoglobin, haematocrit, red blood cell count, mean cell volume, white blood cell count, vitamins A, E and zinc. A single matched "placebo" -controlled, parallel group, clinical trial of ten months followed in a randomly selected sample of 100 participants, 50 forming part of the control group receiving a fruit and 50 forming part of the experimental group receiving com-soy blend porridge. After the 10-month period, the same measurements for the baseline survey were repeated, except for the sociodemographic and health measurements. Results. Malnutrition, including under and over nutrition, remains a major problem among primary school children globally. This was also true in both the experimental and control school groups in this study where 18.6 percent, 34.9 percent and 4.7 percent were underweight, stunted and wasted especially in the experimental group compared to 9.1 percent severe underweight, and 9.1 per cent each for severe stunting and wasting in the control group at baseline. A mainly carbohydrate based diet was consumed with limited vegetable and animal protein intakes. The socio-demographic data indicated that household food insecurity contributed to the poor dietary intake of the sample, as the majority of the caregivers were unemployed in both groups. This was further confirmed by the limited monthly household income of less than R 1000 for a relatively large family size of up to 5 members in the control group compared to 5-10 household members in the experimental group. The implementation of a school feeding programme that included a nutritious and acceptable meal in the form of enriched corn-soy blend or a fruit as part of the programme, also proved to be a relatively easy and cost-effective way to address hunger in these primary schools. Furthermore, the dietary intake levels for both groups showed statistically significant improvements for various macro- and micronutrients when compared to DRis. Conclusion Although few statistically significant differences were observed between the groups with regard to dietary intake patterns, biochemical changes and nutritional status indices, positive changes were observed in both groups, indicating that any food provision may have a positive impact on undernourished children. The results of the intervention indicated an improvement in dietary intake which could result in an improved nutritional status, specifically related to micronutrients. However, the anthropometric indices and certain biochemical parameters showed significant improvements in both groups after the intervention. School feeding programmes are a good strategy for addressing malnutrition among primary school children if monitored effectively. However, it does not impact directly on household food security. A long-term clinical intervention trial is recommended to measure the impact of a food-based approach to address specific micronutrient deficiencies prevalent among children in these age groups.