Also, previous work has limited scopes in terms of the age range [ 10 ] or the outcomes examined e. 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 ].
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.
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We will include published articles as well as unpublished and grey literature and will include ongoing studies where preliminary findings are available to us.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 involving children and adolescents boys and girls aged 6 to 19 who were receiving primary or secondary education i. 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. 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.
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. 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.
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.
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. We also searched ClinicalTrials. 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. 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 , and an updated search will be conducted in early April 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. 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.
Neither of the reviewers will be blind to journal titles or the names of the authors. 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.
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. 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 ].
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. 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 ]. 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. 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.
When school feeding programmes are linked to local smallholder farm production , they benefit local economies as well. In certain contexts, they can help build trust in national education systems and foster social inclusion.
Currently 73 million children living in extreme poverty in 60 countries need urgent nutritional assistance. WFP works with partners to ensure that meals are accompanied by a broader package of health and nutrition services, such as deworming, health screenings, vaccinations and WASH water, hygiene and sanitation training. WFP works with governments to tailor its responses: in emergency settings where countries do not have the capacity to meet the nutritional and educational needs of all vulnerable children, WFP will scale up its coverage and operations; within more stable contexts, WFP helps to strengthen systems and provides technical assistance, improving the scale and quality of national programmes and supporting governments in innovating and testing new approaches.
In this strategy — , WFP lays out its vision of working with governments and partners to jointly ensure that all primary schoolchildren have access to good quality meals in school, accompanied by a broader integrated package of health and nutrition services.
Read more. Today with hundreds and thousands of pupils out of the classroom, WFP and partners are working to mitigate the effects of the COVID pandemic on school children through frameworks for reopening schools. This is a school Lunch at a pre-school in Japan where the kids range in age from yrs old.
On the left: mushroom and minced pork, in the middle: Chinese chives stir fry with tempura, on the right: eggplant probably stirfry , soup with radish and pork, and steamed white rice. Photo source. Lunch usually consists of soup and a main course. Usually, there is a salad or some sort of fruit along with something sweet for dessert.
There is always tea and water with sweet syrup on tap and cacao if sweet buns are for lunch. Most of the kids eat at the school canteen cafeteria. This meal of avocados may look measly but it is very nutritious.
The fats from the avocado are invaluable, especially in a country where malnutrition is so widespread. And yes, kids in India eat with their hands. Reduce the Cost of Education Several African countries have abolished their school fees.
Each time, the move has triggered a large increase in primary school enrollment. For example, enrollment increased by 12 percent in Ghana, 18 percent in Kenya, 23 percent in Ethiopia and 51 percent in Malawi after the abolition of school fees. However, according to the World Food Programme in , 66 million school children are hungry.
School lunch programs have been shown to increase math scores, student concentration and general achievement. For example, providing iron-fortified vitamin pills to children in rural China, many of whom have anemia, had an immediate positive impact on learning.
0コメント