More than a meal: successes and challenges of several modalities of school meals to improve learning

Group Submission Type: Formal Panel Session

Proposal

Malnutrition and hunger affect children’s ability to learn, develop, play, and study. School-age children face a several nutritional problems including: micronutrient deficiencies such as anemia, iodine or vitamin A deficiency; stunting and underweight; and overweight and obesity. Malnutrition is caused by a poor diet and disease. Malnourished schoolchildren can become tired more easily and get sick more often, causing them to miss school more often and have difficulties concentrating while they’re there.

Globally, an estimated 53% of school-age children suffer from Iron Deficiency Anemia (IDA), the major health consequences of which are impaired physical and cognitive development, as well as increased morbidity from infectious diseases. Many school-age children are anemic due to parasitic infections such as malaria, schistosomiasis or hookworm (WHO 2011a).

It is estimated that in 2011, 30% of the school-age population had insufficient iodine intake (median UI <100 μg/l). Iodine Deficiency Disorders (IDD) is associated with intellectual disability as well as effects on growth and development. (Anderson 2012).

More than 250 million preschool and 85 million school age children (or 7 percent of all school-age children) suffer from Vitamin A Deficiency (VAD), which negatively impacts growth, impairs learning ability, and puts them at risk for blindness, malnutrition (anemia), infections (e.g. parasitic worms, malaria) and death. (Jukes 2001 and WHO nutrition website).

Children’s nutritional needs rise during the adolescent growth spurt for both boys and girls, and the risk of under-nutrition and anemia also increases at this age. The nutritional status of adolescent girls is especially important because many adolescent girls get pregnant early. Girls who menstruate or are pregnant have even greater nutrient needs, especially iron. Girls are more likely to die during childbirth than older women, or to be left nutritionally depleted as a result of childbirth. Their babies are also more likely to die, or be born with nutritional deficits (Save the Children 2015, Waid and Burgess 2015).

Stunting (low height-for-age) is a physical indicator of chronic or long-term undernutrition (lack of calories and protein) and is often linked to poor mental development. It is widely believed to occur mainly in early childhood (mostly by 3 years of age) and through a cumulative process of poor growth. Children stunted at school-age are likely to have been exposed to poor nutrition since early childhood. Underweight (low weight for age) is an indicator of both chronic and acute undernutrition and is also common in school-age children.

Many school-age children experience hunger, which may or may not lead to stunting: 66 million primary students attended classes hungry across the developing world, with 23 million in Africa alone (WFP website). Nearly all countries around the world have a school meals program and about 368 million children from kindergarten to secondary school receive food at school every day (WFP website). However, school meals are a very costly intervention and need careful assessment before implementation.

In countries experiencing the “nutrition transition” or a shift in dietary consumption that coincides with economic and other changes, overweight and obesity are increasing. Worldwide obesity has more than doubled since 1980. In 2013, 42 million children under the age of 5 were overweight or obese. In absolute numbers there are more children who are overweight and obese in low- and middle-income countries than in high-income countries. Many countries are facing the double burden of undernutrition and obesity, and overweight children oftentimes have micronutrient deficiency at the same time. Overweight or obese children are often less active, may be bullied, and are at risk of chronic diseases such as early onset of type 2 diabetes and cardiovascular disease later in life (Kamau-Mbuthia and Hall 2015). Children with obesity are very likely to remain obese as adults (WHO 2015).

Schools offer many opportunities to address malnutrition, to promote healthy diets and physical activity, and are also a potential access point for engaging parents and community members in preventing child malnutrition in all its forms. All types of malnutrition are prevented by eating a healthy diet, by preventing or treating infections, and by exercising regularly. With this in mind, there are several strategies that can be used to improve children’s nutritional status, as well as educational outcomes (UNICEF 2014, Savage King 2015), which can be summarized as follows:

• Improve food which children bring to school
• Improve food which children buy at school
• Improve food or supplements which children get at school
• Improve what children learn about food and nutrition at school
• Improve how children move at school

This panel will present examples of program interventions addressing these key areas.

Sub Unit

• General Pool

Individual Presentations

• A pre-school based integrated agriculture-nutrition package to improve nutrition and education outcomes - Patricia Tibbetts, Save the Children

• Obesity prevention through active play and nutrition education at school - Seung Lee, Save the Children - USA

• Improving post-lunch attendance and nutritional status in Nepal - Sarah Bramley, Save the Children