Assessment of Dietary Intakes and Nutritional Status of School Age Children Participating in School Feeding Programmes at Otinibi and Danfa

Abstract

Background: School age children (SAC) are vulnerable to malnutrition which can negatively influence their growth and maturity, health and academic attainment. School feeding programmes (SFP) have the potential to improve dietary intakes and nutrition of SAC. However there is limited information on the nutritional impact of school feeding programmes in Ghana. Objective: The aim of this study was to determine the dietary intakes and nutritional status of SAC participating in an NGO-sponsored (NSFP) and a Government-sponsored (GSFP) school feeding programme in two semi-rural communities in Ghana. Methodology: A cross sectional survey was used to obtain data from 182 school age children (SAC) and caregiver pairs. Structured questionnaires were used to interview the SAC and caregivers on their socio-demographic characteristics and dietary practices. The 24hour dietary recall method was used to collect data of the children’s dietary intakes on 2 non-consecutive days. Children’s weight and height measurements were taken and anthropometric indices (stunting, BMI for age) were computed. The hemocue method was used to assess haemoglobin levels on a sub-sample of children. Predictors of nutritional status of SAC were assessed using linear and logistic regression models. T-test was used to test the differences in school performance and attendance of children who have normal nutritional status and those with at least one nutritional deficit. Results: The mean dietary diversity scores for all the SAC was 5±1 out of 9 food groups. Diets of SAC were low in organ meats, dairy products, eggs and dark green leafy vegetables. SAC met all the DRI for energy and nutrients (protein, iron, zinc, vitamin C and A) intake except for calcium intake. Portion sizes of GSFP meals served to SAC were significantly lower (243 ± 50g vs. 416 ± 96g; p=0.012) than NSFP. Meals provided by the NSFP met recommendations for energy and macronutrient content of school meals whiles those provided by the GSFP did not. Dietary intakes of NSFP participants were higher than GSFP. NSFP contributed significantly higher energy (28 ± 10% vs. 16.2 ± 7%; p=<0.001), protein (24.6 ± 9% vs. 13.3 ± 7%; p=<0.001) and micronutrients (p≤0.042) to the children’s total energy intakes compared to meals provided through the GSFP. 67.0% of SAC were either anaemic, stunted or had low BMI for age. Haemoglobin level was lower among SAC who have received any micronutrient supplement in the past 6 months (β=-0.900; p=0.009)and SAC whose caregivers education was lower than JHS (β=-1.050; p=0.002). Younger age (<10yrs) was associated with high BMI for age (β=0.342, p=0.10) .BMI for age and height for age of SAC were not affected by energy intake (β=0.000; p=≤0.046).Also, younger age (<10yrs), caregivers not working or engaged in occupation (trader and vocational occupation) and educational level higher than JHS were associated with HAZ of SAC (p<0.05). The significant predictors for having at least one nutritional deficit among SAC wereyounger age (odds ratio=0.485; CI=0.243-0.969; P=0.040) and caregivers engaged in other occupationsuch as farmers, stone winnowers and professional workers (odds ratio=3.499; CI=1.065-11.491; p=0.039). None of the nutritional indices that SAC were assessed on was significantly associated with school attendance and performance in the past term. However, there was significant association between having at leastone nutritional deficit and school performance in Mathematics (Mean difference=-4.62; p=0.037) and English (Mean difference=-4.49; p=0.027) but not Science in the past term. Conclusion: Malnutrition was prevalent among the SAC. Both GSFP and NSFP were contributing to daily intakes of SAC. However, the quantity of food served by GSFP need to be reviewed to increase its contribution to daily nutrient intakes.