Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review

AbstractObjective:To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour.Design:A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school’s physical and social environments, to the school’s nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community.Setting:Schools in SSA.Participants:School-aged children and adolescents, aged 5–19 years.Results:Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities.Conclusions:There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.

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School-Based Nutrition Programs for Adolescents in Dodoma, Tanzania: A Situation Analysis

Food and Nutrition Bulletin ◽

10.1177/03795721211020715 ◽

2021 ◽

pp. 037957212110207

Author(s):

Colette Rector ◽

Nadhira Nuraini Afifa ◽

Varun Gupta ◽

Abbas Ismail ◽

Dominic Mosha ◽

...

Keyword(s):

Nutrition Education ◽

Ad Hoc ◽

School Administrators ◽

School Nutrition ◽

Overweight And Obesity ◽

School Meals ◽

Nutrition Interventions ◽

Double Burden ◽

School Based ◽

Sanitation And Hygiene

Background: Tanzania has a double burden of malnutrition, including a high prevalence of undernutrition and an increasing prevalence of overweight and obesity among adolescents. Schools present a valuable opportunity to reach a large section of the country’s adolescent population with nutrition-oriented interventions. Objective: The objective of this study was to assess the current state of adolescent school nutrition interventions in Dodoma, Tanzania, with emphases on 3 potential school-based nutrition interventions, school vegetable gardens, school meals, and education (on nutrition, agriculture, and water, sanitation, and hygiene). Methods: Focus group discussions were conducted with several regional and district-level governmental stakeholders, including health, education, and agricultural officers. Ten public secondary schools were visited, and interviews with school administrators, teachers, students, and parents were conducted. Results: All stakeholders interviewed supported interventions to improve school-based nutrition, including school gardens, school feeding, and nutrition education. All 10 schools visited had some experience providing school meals, but parents’ contributions were essential for the program’s sustainability. Most schools visited had land available for a school garden program, but water availability could be challenging during certain times of the year. The teachers interviewed expressed that the curriculum on nutrition education was highly theoretical and did not allow students to practice the knowledge and skills they learned in the classroom. Conclusions: The current school-based approach to tackling the double burden of adolescent malnutrition in Dodoma is localized and ad hoc. To leverage the potential of schools as a platform for nutrition interventions, integrated and policy-mandated interventions are needed.

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Nutrition Education Impact on Nutrition Knowledge, Attitude and Practice of Schoolchildren: A Pilot Study in Ghana

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_004 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1287-1287

Author(s):

Janet Antwi

Keyword(s):

Nutrition Education ◽

Dietary Diversity ◽

Intervention Group ◽

Nutrition Knowledge ◽

Sub Saharan Africa ◽

Health Concern ◽

Nutrition Status ◽

Control Group ◽

Positive Effects ◽

The Impact

Abstract Objectives Malnutrition among children, and adolescents remains a crucial public health concern in sub-Saharan Africa. Nutrition education contributes to acquisition of nutrition knowledge, attitude, and practices (KAP) which may lead to improved nutrition status and health, and brings greatest benefits to the poor and the most vulnerable particularly school-age children (SAC). We evaluated the impact of a 6-week nutrition education intervention on nutrition KAP, and nutrition status of SAC. The effect of nutrition education training on the knowledge of teachers and caregivers was also evaluated. Methods Pretest-posttest controlled design was used in elementary schools in Ghana. A total of 325 SAC 6–12 years old, 6 teachers and 99 caregivers completed the study. Nutrition KAP were estimated using a standardized questionnaire. Nutrition status was calculated using height and weight measurements. Results Schoolchildren in the intervention group had significantly higher knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in lower elementary level. The attitude of children in learning about food and nutrition issues was a higher proportion in the intervention group as compared to control group (88% vs. 77%, P = 0.031). Dietary diversity score did not differ significantly between intervention and control groups (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184). Intervention group had a marginally lower proportion of stunted SAC at the end of the study period as compared to control group (3.6% vs. 8.2%, P = 0.080). The nutrition knowledge of teachers, and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.85 ± 0.73 to 6.29 ± 1.02, P = 0.009), respectively. Conclusions Nutrition education could have positive effects for passing on nutrition knowledge, and attitudes to elementary school children which are essential to developing healthy behaviors, and managing nutrition status. Funding Sources This study was funded by the Institute of International Education with award of the Carnegie African Diaspora Fellowship Program.

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Do Nutrition Education Approaches With Preschoolers and Their Caregivers Influence Retention of Biofortified Orange-Fleshed Sweetpotato on Farms?: Evidence From Homa Bay County, Kenya

Food and Nutrition Bulletin ◽

10.1177/03795721211025445 ◽

2021 ◽

pp. 037957212110254

Author(s):

Sylvester O. Ojwang ◽

David J. Otieno ◽

Julius J. Okello ◽

Penina Muoki ◽

Rose A. Nyikal

Keyword(s):

Nutrition Education ◽

Early Childhood Development ◽

Controlled Trial ◽

Text Messages ◽

Sub Saharan Africa ◽

Childhood Development ◽

Control Group ◽

Micronutrient Deficiencies ◽

Household Level ◽

Intention To Treat

Background: Biofortified staples have been promoted widely in sub-Saharan Africa to combat micronutrient deficiencies. Contemporary projects are increasingly using elementary schools to target households with these foods. Objective: This study assessed the effects of integrated nutrition education approaches, targeting preschoolers and their caregivers, on retention of orange-fleshed sweetpotato (OFSP) on farms in the second season after lapse of free vine dissemination initiatives. Methods: Rural farming households, with preschoolers and no prior engagement with OFSP, were targeted. A multistage sample of 431 preschooler–caregiver pairs was recruited for a cluster-randomized controlled trial. After issuing routine OFSP promotion activities, 15 village-level clusters of the pairs were randomized into 1 control group (3 villages) and 3 treatment arms (4 villages each) for the interventions. Baseline and follow-up household-level survey data were collected from the caregivers. The interventions included: (1) OFSP-branded exercise books, posters, and a poem to preschoolers only; (2) OFSP-oriented mobile phone-mediated text messages to caregivers only; and (3) both 1 and 2 provided to individual households concurrently. Interventions 1 and 2 were single-channeled, while 3 was multichanneled. We estimated the intention-to-treat (ITT) and treatment-on-the-treated (TOT) effects using a binary logit model and a special regressor method, respectively. Results: Only the multichanneled nutrition education approach had significant effects (ITT = 0.167, P = .001; TOT = .243, P = .007) on the caregivers’ likelihood to retain OFSP on their farms. Conclusions: The finding implies that multichanneled agriculture-nutrition education interventions through Early Childhood Development institutions can be effective in ensuring sustainable adoption of OFSP.

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The effects of a group nutrition education program on nutrition knowledge, nutrition status, and quality of life in hemodialysis patients

Journal of Renal Nutrition ◽

10.1016/s1051-2276(97)90017-0 ◽

1997 ◽

Vol 7 (4) ◽

pp. 187-193 ◽

Cited By ~ 13

Author(s):

Norma A. Wiser ◽

Jan M. Shane ◽

Ann T. McGuigan ◽

Jean A. Memken ◽

Phillip J. Olsson

Keyword(s):

Quality Of Life ◽

Nutrition Education ◽

Education Program ◽

Hemodialysis Patients ◽

Nutrition Knowledge ◽

Nutrition Status ◽

Nutrition Education Program

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Evaluation of a computer-based nutrition education tool

Public Health Nutrition ◽

10.1079/phn2003525 ◽

2004 ◽

Vol 7 (2) ◽

pp. 271-277 ◽

Cited By ~ 25

Author(s):

Katrin Kreisel

Keyword(s):

Student Teachers ◽

Nutrition Education ◽

Repeated Measures ◽

Nutrition Knowledge ◽

Primary School Children ◽

Teaching Tool ◽

School Based ◽

Computer Based ◽

Dependent Samples

AbstractObjective:To evaluate the efficacy and feasibility of using a computer-based teaching tool (http://www.coolfoodplanet.org) for nutrition and lifestyle education developed for primary school children.Design:This was a 2-week school-based intervention in third and fourth grades. The study design was multi-factorial with repeated measures of nutrition knowledge, at three points in time, of dependent samples from control and intervention groups. Control schools (n=7) used ‘traditional’ nutrition education materials and intervention schools (n=8) additionally used the computer-based educational tool. Qualitative information was collected in focus group discussions with student teachers and pupils, and by observing the nutrition lessons.Setting/subjects:Pupils aged 8–11 years (n=271) from participating schools in Vienna, Austria.Results:Nutrition knowledge increased significantly in both intervention and control schools, irrespective of the teaching tool used (P<0.001). The significant effect was maintained at 3 months' follow-up. There was no detectable difference in nutrition knowledge post intervention or at follow-up between the two study groups. In intervention schools, younger pupils (8–9 years) had better nutrition knowledge than older pupils (10–11 years) (P=0.011).Conclusion:This computer-based tool increases the possibilities of school-based nutrition education. If the tool's weaknesses identified during the formative evaluation are eliminated, it has the potential to make learning about nutrition more enjoyable, exciting and effective. This is of great importance considering that ‘healthy’ nutrition is not necessarily a topic that easily attracts pupils' attention and in view of the potential long-term health benefits of early and effective nutrition education.

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Evaluating survey designs for targeting preventive chemotherapy against Schistosoma haematobium and Schistosoma mansoni across Sub-Saharan Africa: a geostatistical analysis and modelling study

10.21203/rs.3.rs-36950/v3 ◽

2020 ◽

Author(s):

Kimberly Fornace ◽

Claudio Fronterrè ◽

Fiona M Fleming ◽

Hope Simpson ◽

Honorat Zoure ◽

...

Keyword(s):

Cost Effectiveness ◽

Schistosoma Haematobium ◽

Sampling Strategy ◽

Sub Saharan Africa ◽

Spatial Distributions ◽

Preventive Chemotherapy ◽

School Based ◽

Control Programmes ◽

Sub Saharan ◽

Survey Designs

Abstract Background: Schistosomiasis control programmes primarily use school-based surveys to identify areas for mass drug administration of preventive chemotherapy. However, as the spatial distribution of schistosomiasis can be highly focal, transmission may not be detected by surveys implemented at districts or larger spatial units. Improved mapping strategies are required to accurately and cost-effectively target preventive chemotherapy to remaining foci across all possible spatial distributions of schistosomiasis. Methods: Here, we use geostatistical models to quantify the spatial heterogeneity of Schistosoma haematobium and S. mansoni across sub-Saharan Africa using the most comprehensive dataset available on school-based surveys. Applying this information to parameterise simulations, we assess the accuracy and cost of targeting alternative implementation unit sizes across the range of plausible schistosomiasis distributions. We evaluate the consequences of decisions based on survey designs implemented at district and subdistrict levels sampling different numbers of schools. Cost data were obtained from field surveys conducted across multiple countries and years, with cost effectiveness evaluated as the cost per correctly identified school. Results: Models identified marked differences in prevalence and spatial distributions between countries and species; however, results suggest implementing surveys at subdistrict level increase the accuracy of treatment classifications across most scenarios. While sampling intensively at the subdistrict level resulted in the highest classification accuracy, this sampling strategy resulted in the highest costs. Alternatively, sampling the same numbers of schools currently recommended at the district level but stratifying by subdistrict increased cost effectiveness.Conclusions: This study provides a new tool to evaluate schistosomiasis survey designs across a range of transmission settings. Results highlight the importance of considering spatial structure when designing sampling strategies, illustrating that a substantial proportion of children may be undertreated even when an implementation unit is correctly classified. Control programmes need to weigh the increased accuracy of more detailed mapping strategies against the survey costs and treatment priorities.

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Association of high-sensitivity C-reactive protein with cardiometabolic risk factors and micronutrient deficiencies in adults of Ouagadougou, Burkina Faso

British Journal Of Nutrition ◽

10.1017/s0007114512003182 ◽

2012 ◽

Vol 109 (7) ◽

pp. 1266-1275 ◽

Cited By ~ 5

Author(s):

Augustin N. Zeba ◽

Hélène F. Delisle ◽

Clémentine Rossier ◽

Genevieve Renier

Keyword(s):

Risk Factors ◽

Burkina Faso ◽

Cardiometabolic Risk ◽

High Sensitivity ◽

Sub Saharan Africa ◽

Micronutrient Deficiencies ◽

C Reactive Protein ◽

Reactive Protein ◽

Sub Saharan ◽

Hs Crp

Increasing evidence suggests that high-sensitivity C-reactive protein (hs-CRP) is associated with cardiometabolic risk factors (CMRF) while being also related to micronutrient deficiencies. As part of a project on the double burden of under- and overnutrition in sub-Saharan Africa, we assessed the relationship between hs-CRP and both CMRF and micronutrient deficiencies in a population-based cross-sectional study carried out in the Northern district of Ouagadougou, the capital city of Burkina Faso. We randomly selected 330 households stratified by income tertile. In each income stratum, 110 individuals aged 25–60 years and having lived in Ouagadougou for at least 6 months were randomly selected, and underwent anthropometric measurements and blood sample collection. The prevalence of high hs-CRP was 39·4 %, with no sex difference. Vitamin A-deficient subjects (12·7 %) exhibited significant risk of elevated hs-CRP (OR 2·5;P= 0·015). Serum ferritin was positively correlated with log hs-CRP (r0·194;P= 0·002). The risk of elevated hs-CRP was significant in subjects with BMI ≥ 25 kg/m2(OR 6·9; 95 % CI 3·6, 13·3), abdominal obesity (OR 4·6; 95 % CI 2·2, 7·3) and high body fat (OR 10·2; 95 % CI 5·1, 20·3) (P< 0·001, respectively). Independent predictors of hs-CRP in linear regression models were waist circumference (β = 0·306;P= 0·018) and serum TAG (β = 0·158;P= 0·027). In this sub-Saharan population, hs-CRP was consistently associated with adiposity. Assuming that plasma hs-CRP reflects future risk of cardiovascular events, intervention which reduces CRP, or chronic and acute nutrition conditions associated with it, could be effective in preventing their occurrence particularly in sub-Saharan Africa.

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