Perceptions of School Management on the Relationship between School Nutrition and Development of Non-Communicable Diseases in a Rural South African District: A Qualitative Study

Globally, noncommunicable diseases (NCDs) were responsible for 41 million deaths in 2016, with the majority of these occurring in low- and middle-income countries. These diseases are on the rise as a result of unhealthy, low-quality, and unbalanced diets, which have resulted in overweight and obesity. The National School Nutrition Program (NSNP) was created to regulate the foods sold to schoolchildren. The aim of this study was to ascertain school management teams’ perspectives on the relationship between the NSNP and the development of lifestyle diseases. A phenomenological qualitative study using focus group discussions among 16 purposively selected members of the school management teams were conducted in Mt Frere, Eastern Cape in 2016. The narrative data were analyzed using Tesch’s eight-phase thematic analysis approach. The data analysis revealed two themes (NSNP and the vendor system) and six sub-themes. The NSNP was viewed as making a significant contribution to children’s food security, thereby improving academic output. However, reengineering of the NSNP was needed through improved budgeting and inclusion of breakfast in the menu to control NCDs risk factors. The current implementation of the vendor system did not support reduction of NCDs risk factors. Improved implementation of the guide to the vendor system is needed.

Factors Associated with Self-Efficacy Toward Healthy Eating and Physical Activity among Kuwaiti Adolescent Girls

Factors that influence adolescents’ health-related behaviors in Kuwait are unclear. We hypothesized that self-efficacy would be negatively associated with a heavier weight status and positively associated with healthy eating-related behaviors. We aimed to measure healthy eating-related parameters in a sample of Kuwaiti girls and to assess the correlates of self-efficacy. The participants of this cross-sectional study were adolescent schoolgirls. The main outcome measures were self-efficacy, dietary habits, dietary beliefs, nutrition knowledge, physical activity, and weight status per body mass index (BMI) categories. Pearson’s correlation analysis was performed to determine the associations among the healthy behavior-related parameter scores. Independent samples t-test was used to examine the differences in scores between participants’ characteristics and self-efficacy score (SES). Only 19.9% of the participants had high self-efficacy toward healthy eating behaviors, 20.9% had “satisfactory eating habits,” 11.3% had a good comprehension of the meanings of healthy and unhealthy dietary habits and food, 16.3% had good nutrition knowledge, and 29.2% had an active lifestyle. SES is associated negatively with BMI, and positively with all the domains of healthy eating and with physical activity. However, SES was not associated with nutritional knowledge. Adolescent girls in Kuwait demonstrated a high level of self-efficacy toward healthy eating and behaviors with firm nutritional beliefs; however, they failed to practice them. Interventional school nutrition programs could help to improve healthy behaviors among adolescents.

Harnessing Public Food Procurement for Sustainable Rural Livelihoods in South Africa through the National School Nutrition Programme: A Qualitative Assessment of Contributions and Challenges

This paper examines how public food procurements contributes to sustainable rural livelihoods through local sourcing of school food, what has become known as ‘home-grown’ school feeding. Specifically, it draws on in-depth interviews to explore the contributions and challenges of using local farmers as suppliers for South Africa’s National School Nutrition Programme (NSNP) using the case of the Eastern Cape Province, the country’s poorest province. The study found that participating schools in rural areas benefit from local sourcing by way of using fresh vegetables in preparing meals thanks to the utilisation of a decentralised catering model in the Eastern Cape Province. Consequently, there is evidence of farmers participating in NSNP food market earning additional income and growing more vegetables on more land in some cases. However, even though the Eastern Cape Province uses a decentralised procurement model, it has no clear-cut programme to optimise the benefits of local sourcing for NSNP. It only ‘encourages’ schools to buy vegetables grown locally. This calls for pragmatism on the side of government to, through creative procurement and initiatives such as the Agri-Parks, use NSNP as a tool for making the South African food system more inclusive, drive down rural poverty and realise sustainable rural development.

Perceptions of School Management on the Relationship between School Nutrition and Development of Non-communicable Diseases in a Rural South African District: A Qualitative Study

Globally, noncommunicable diseases (NCDs) were responsible for 41 million deaths in 2016, with the majority of these occurring in low and middle-income countries. These diseases were on the rise as a result of unhealthy, low-quality, and unbalanced diets, which resulted in overweight and obesity. The National School Nutrition Programme (NSNP) was created to regulate the foods sold to schoolchildren. To ascertain school management teams' perspectives on the relationship between the NSNP and the development of lifestyle diseases. A phenomenological qualitative study using Focus Group Discussions among 16 purposively selected members of the School Management Teams were conducted in Mt Frere, Eastern Cape in 2016. The narrative data was analyzed using Tesch's eight-phase thematic analysis approach. The data analysis revealed two themes (NSNP and the vendor system) and six sub-themes. The NSNP was viewed as making a significant contribution to children's food security, thereby improving academic output. However, reengineering of the NSNP was need through improved budgeting and inclusion of breakfast in the menu to control NCDs risk factors. The current implementation of the vendor system did not support reduction of NCDs risk factors. Improved implementation of the guide to vendor system is needed.

Nutrition of primary school children: world and Ukrainian realities

The aim of the study is to assess the actual nutrition of primary school children in Ukraine and other countries. Material and methods. An analysis of publications in scientific journals and reports of national agencies on the state of nutrition of primary school children. Search depth 10 years. The following search strategy "primary school", "nutrition", "sentinel surveillance" was used. The 15 most relevant publications were selected for further analysis. In addition, a survey of 450 primary school students was conducted on the quality of nutrition during school. Statistical processing was performed using MedCalc software. Results. Most countries in the world have some kind of nutrition program for younger students. At the same time, the diets that these programs offer do not always meet the principles of healthy eating. According to our own data, only 96 (21.3%) of the surveyed schoolchildren aged 6-10 had a full meal at school. For the rest, there was either a qualitative or quantitative discrepancy in the composition of breakfast and lunch at school. The children noted the lack of time for meals, low taste of school lunches. Every second child consumed insufficient volume of fluids during school. Conclusion. The nutritional status of primary school children is affected by lack of time for eating and recreational physical activity, unbalanced diet when using home lunch boxes and low coverage of high school students with organized meals. Unlike other countries, the main problem for Ukraine is not an energy surplus diet, but the popularity of fast food among children of primary school age is undoubtedly unacceptable.

Cost and Cost Effectiveness of a Pilot m-Health Intervention Targeting Parents of School-Aged Children to Improve the Nutritional Quality of Foods Packs in the Lunchbox

The SWAP IT program aims to improve the nutritional quality of school lunchboxes via a multicomponent m-health intervention, involving: weekly support messages to parents; physical resources; school nutrition guidelines and lunchbox lessons. SWAP IT has been reported to be effective. This study aims to determine the cost and cost effectiveness of the SWAP IT m-health intervention. The retrospective trial-based economic evaluation was conducted in 12 Catholic primary schools in New South Wales, Australia. Schools were randomised to intervention or usual care. The costs (AUD, 2019) were evaluated from societal perspectives. The direct cost to uptake the intervention and the incremental cost-effectiveness ratios (ICER) were calculated. ICERS were calculated for two outcomes: reduction in total kJ and reduction in discretionary kJ from the lunchbox. The total cost was calculated to be AUD 55, 467. The mean incremental cost per student to receive the intervention was calculated to be AUD 31/student. The cost per reduction in total lunchbox energy was AUD 0.54. The ICER for the reduction in energy from discretionary foods in the lunchbox was AUD 0.24. These findings suggest that this m-health intervention has potential to be cost effective in reducing the kilojoules from discretionary foods packed in school lunchboxes.

A Content Analysis of Implementation Strategies Chosen by Virginia School Nutrition Directors

Objective: School-based interventions are common approaches to address childhood obesity; however, there is little understanding of strategies that can foster their implementation into schools. In this study, we aimed to identify goals and the specific strategies selected by school nutrition directors (SNDs) in Virginia to execute school-based interventions. Methods: Between 2018 and 2019, SNDs in Virginia participated in Team Nutrition workshops through which they created action plans. We carried out a content analysis of 132 action plans collected from 100 school divisions. We developed codes deductively and inductively. The codes captured plan completion, goals, and strategies. Each plan was independently coded by 2 coders. Results: Action plans included 1.2 goals (SD = 0.54) and 3.9 strategies per goal (SD = 2.1). Goals were most commonly related to improving menus or increasing participation in the school meal programs. The strategies varied based on the goals. However, obtaining buy-in from school personnel and students was the most commonly included goal (64.4%) across plans. The level of action plan completion decreased with each subsequent section of the worksheet. Conclusions: Emerging patterns identified in this study suggest SNDs’ strategy selection is based on goals and that trainings should be tailored to promote the development of skills required to execute optimal strategies.

Development of an energy-dense biscuit suitable for primary school learners for the South African National School Nutrition Programme

South Africa has a well established National School Nutrition Programme (NSNP). Despite rescheduling the mealtime to two hours after the start of the school day to accommodate learners who come to school on an empty stomach, a gap still exists as many children start their learning day with low energy and concentration levels. A cost-effective, energy-dense snack served at the start of the school day can be a solution to sustain learners until the main meal is served. Cross-sectional surveys were used to determine the snack preferences of children and the product development process was used to develop a suitable snack. An energy-dense peanut butter biscuit was developed based on those surveys as well as a scoping review of previous snack studies. The energy-dense developed product provided 1388kJ (61.0%) of energy from fat, 688kJ (30.2%) of energy from carbohydrates and 201kJ (8.8%) of energy from protein per 100g. The biscuit conformed to microbial testing standards. Shelf-life analysis projected a shelf-life of five weeks fresh and five months in food grade packaging. Sensory results showed that there was no significant difference in sensory scores across gender (p=0.691) and age (p=0.706). More of the learners (n=56, 69.1%) found the biscuit to be ‘Super good’ than the other ratings (p<.0005). When compared with similar biscuit products currently on the market, it was found that the developed biscuit was the most reasonably priced. The developed biscuit has the potential to serve as a solution to hidden hunger for children that come to school on an empty stomach. This versatile snack solution has potential for continuity of use even during periods of national crisis as with COVID-19, when learners’ nutritional needs may be most vulnerable.

Governance of food and nutrition security in Eswatini: an analysis of government policies and reports

Background Governance of food and nutrition security is vital in achieving sustainable development goals. Yet, the role of governance in shaping and preventing malnutrition risk is complex and poorly understood. This paper examined the governance of food and nutrition security in Eswatini. Methods Policy documents, annual reports, and minutes of board meetings from five government ministries were the documents that were used for this study. The data analysis focused on the strength of nutrition governance, actors involved in policymaking, nutrition-specific and sensitive-programs, and multisectoral coordination of programs. Results The findings show that Eswatini has medium strength, nutrition governance. The nutrition-specific programs included: micronutrient supplementation and deworming programs, breastfeeding campaigns, and treatment of acute malnutrition. The nutrition-sensitive initiatives included programs on school nutrition, sanitation and hygiene, agriculture production, and healthcare. However, multisectoral coordination was ineffective, as collaborative efforts are not structured, during implementation. Conclusion This study examined the governance of food and nutrition security in Eswatini using documents from government ministries. Diverse actors were involved in policy formation and implementation. The strength of nutrition governance was medium and multisectoral coordination was usually ad-hoc. The multiple actors involved in nutrition governance in Eswatini need to intentionally plan to improve multisectoral coordination to achieve higher impact.