School feeding for improving the physical and psychosocial health of disadvantaged students

University of Ottawa, Ottawa, Ontario, Canada
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2007; 1(1):CD004676. DOI: 10.1002/14651858.CD004676.pub2
Source: PubMed


Early malnutrition and/or micronutrient deficiencies can adversely affect physical, mental, and social aspects of child health. School feeding programs are designed to improve attendance, achievement, growth, and other health outcomes.
The main objective was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school children.
We searched a number of databases including CENTRAL (2006 Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), PsycINFO (1980 to May 2006) and CINAHL (1982 to May 2006). Grey literature sources were also searched. Reference lists of included studies and key journals were handsearched and we also contacted selected experts in the field.
Data from randomized controlled trials (RCTs), non-randomised controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series studies (ITSs) were included. Feeding had to be done in school; the majority of participants had to be socio-economically disadvantaged.
Two reviewers assessed all searches and retrieved studies. Data extraction was done by one of four reviewers and reviewed by a second. Two reviewers independently rated quality. If sufficient data were available, they were synthesized using random effects meta-analysis, adjusting for clustering if needed. Analyses were performed separately for RCTs and CBAs and for higher and lower income countries.
We included 18 studies. For weight, in the RCTs and CBAs from Lower Income Countries, experimental group children gained an average of 0.39 kg (95% C.I: 0.11 to 0.67) over an average of 19 months and 0.71 kg (95% C.I.: 0.48 to 0.95) over 11.3 months respectively. Results for weight were mixed in higher income countries. For height, results were mixed; height gain was greater for younger children. Attendance in lower income countries was higher in experimental groups than in controls; our results show an average increase of 4 to 6 days a year. Math gains were consistently higher for experimental groups in lower income countries; in CBAs, the Standardized Mean Difference was 0.66 (95% C.I. = 0.13 to 1.18). In short-term studies, small improvements in some cognitive tasks were found.
School meals may have some small benefits for disadvantaged children. We recommend further well-designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio-economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.

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    • "The scale-up has often been accompanied with the mainstreaming of school feeding within national education sector policies and plans. The programme theory on the educational effects of school feeding is generally well established and underpinned by an increasingly robust evidence base (see Alderman and Bundy, 2011; Kristjansson et al., 2007; Adelman et al., 2008, for recent reviews). School feeding programmes can support enrolment and attendance; and once children are in school, the programmes can contribute to their learning, through avoiding short-term hunger, enhancing attention and cognition, though the evidence on the latter point is mixed. "
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    ABSTRACT: This cross-sectional study examines the status and the determinants of primary education in food insecure areas of Mali. Net and gross enrolment ratios in primary school were between 0.3 and 0.4 for both girls and boys and well below national levels, highlighting a critical gap in terms of access to primary education. Schooling was found to respond to a broad range of determinants, including child's age and nutrition status, as well as on household consumption, on farm labour, teacher availability, and village level remoteness. Interestingly, no significant gender differences were found in terms of primary education. School meals were found to be associated with increased enrolment, attendance and attainment. The scale of the problem in Mali strongly suggests the need for investments in education and social protection to be prioritised and funded as part of national education policy and development strategies.
    International Journal of Educational Development 07/2014; 39. DOI:10.1016/j.ijedudev.2014.07.003 · 0.95 Impact Factor
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    • "At the time we conducted this synthesis, (2009–2011), few examples of realist reviews had been published. Most examples looked at sets of similar or related interventions working on similar program goals to better understand the causes of their successes and challenges (Kristjansson et al., 2007; Wong et al., 2010). Similar to our review, these reviews handled significant complexity and heterogeneity in their respective research areas. "
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    ABSTRACT: Realist review has increased in popularity as a methodology for complex intervention assessment. Our experience suggests that the process of designing a realist review requires its customization to areas under investigation. To elaborate on this idea, we first describe the logic underpinning realist review and then present critical reflections on our application experience, organized in seven areas. These are the following: (1) the challenge of identifying middle range theory; (2) addressing heterogeneity and lack of conceptual clarity; (3) the challenge of appraising the quality of complex evidence; (4) the relevance of capturing unintended outcomes; (5) understanding the process of context, mechanism, and outcome (CMO) configuring; (6) incorporating middle-range theory in the CMO configuration process; and (7) using middle range theory to advance the conceptualization of outcomes - both visible and seemingly 'hidden'. One conclusion from our experience is that the degree of heterogeneity of the evidence base will determine whether theory can drive the development of review protocols from the outset, or will follow only after an intense period of data immersion. We hope that presenting a critical reflection on customizing realist review will convey how the methodology can be tailored to the often complex and idiosyncratic features of health research, leading to innovative evidence syntheses. Copyright © 2013 John Wiley & Sons, Ltd. Copyright © 2013 John Wiley & Sons, Ltd.
    06/2014; 5(2). DOI:10.1002/jrsm.1099
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    • "This would also lessen the risk of increasing stigmatization. Regarding poverty, research has demonstrated improvements in child educational outcomes as a result of school feeding schemes , social grants, and other poverty-alleviation measures (Kristjansson et al., 2007). Regarding the psycho-social consequences, for instance addressing internalising problems to improve Pathways to poor educational outcomes for HIV/AIDS-affected youth 12 classroom concentration, the literature is more limited, though there are indications of the benefits of support groups (Kumakech, Cantor-Graae, & Maling, 2009), and indeed of measures to diminish poverty (Cluver & Orkin, 2009). "
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    ABSTRACT: A recent systematic review of studies in the developing world has critically examined linkages from familial HIV/AIDS and associated factors such as poverty and child mental health to negative child educational outcomes. In line with several recommendations in the review, the current study modelled relationships between familial HIV/AIDS, poverty, child internalising problems, gender and four educational outcomes: non-enrolment at school, non-attendance, deficits in grade progression and concentration problems. Path analyses reveal no direct associations between familial HIV/AIDS and any of the educational outcomes. Instead, HIV/AIDS-orphanhood or caregiver HIV/AIDS-sickness impacted indirectly on educational outcomes via the poverty and internalising problems that they occasioned. This has implications for evidence-based policy inferences. For instance, by addressing such intervening variables generally, rather than by seeking to target families affected by HIV/AIDS, interventions could avoid exacerbating stigmatisation, while having a more direct and stronger impact on children's educational outcomes. This analytic approach also suggests that future research should seek to identify causal paths, and may include other intervening variables related to poverty (such as child housework and caring responsibilities) or to child mental health (such as stigma and abuse), that are linked to both familial HIV/AIDS and educational outcomes.
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