THE IMPACT OF SCHOOL GARDENS ON NUTRITION OUTCOMES IN LOW-INCOME COUNTRIES

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Introduction
Low quality diets have signicant human health risks (Willett et al., 2019). Of
the world’s population of 7.2 billion, more than 2.1 billion people are over-
weight or obese and 2 billion people are micronutrient decient. Hence there is
a growing need to transform current food systems to ensure healthy diets. As part
of this, there is a need for good policies and programmes that promote healthy
eating habits.
This requires a sound understanding of drivers of eating habits. It is known
that taste preferences and food attitudes are important drivers alongside lifestyles,
convenience, aordability, nutrition awareness, and policies (Kearney, 2010;
Traill et al., 2014). Taste preferences and food attitudes are established early in
life and tend to persist through to adulthood (Kelder et al., 1994; Birch, 1999;
Cooke, 2007 ). This understanding has stimulated interest in interventions that
nudge children to adopt healthy eating habits. School garden programmes are
one such type of intervention.
School garden programmes have become popular for improving food, nu-
trition, and health behaviour of schoolchildren in both high- and low-income
countries (FAO, 2005; Ozer, 2007; Parmer et al., 2009; Christian et al., 2014a;
Hutchinson et al., 2015; Triador et al., 2015; Nury et al., 2017). Such programmes
usually bundle hands-on practical education in school gardening with nutrition
education. School gardening training is expected to give children the knowledge
and the ability to produce food, while nutrition education promotes children’s
demand for quality food. This combination of supply- and demand-side inter-
ventions is a key feature of school garden programmes.
The use of school gardens to promote healthy eating behaviour in low-income
countries is conceptually appealing because of high rates of child malnutrition. As
a result, there has been a substantial increase in such programmes in low-income
8
THE IMPACT OF SCHOOL GARDENS
ON NUTRITION OUTCOMES IN
LOW-INCOME COUNTRIES
Pepijn Schreinemachers, Ray-yu Yang,
Dhruba Raj Bhattaraj, Bal Bdr Rai, and
Mamounata Sandaogo Ouedraogo

116 Pepijn Schreinemachers et al.
countries. However, the evidence basis for their impact on food behaviour in low-
income countries is very limited as there are no impact evaluations in the literature.
This chapter describes the results of three recent impact evaluations, each
using a cluster randomised controlled trial design, of school garden programmes
in Bhutan, Nepal, and Burkina Faso with the objective to assess the current
evidence for the impact of school garden programmes in low-income countries.
The three studies that this chapter is based on are the largest evaluation of school
garden programmes to date.
The results show that school garden interventions signicantly improved chil-
dren’s knowledge about food and agriculture in all three countries. For Bhutan
and Nepal, the results showed improvements in children’s awareness of fruit and
vegetables and their stated preferences for eating them. In none of the countries
did these changes translate into clear increases in fruit and vegetable consump-
tion. The results therefore suggest that for school garden programmes to contrib-
ute to healthier food choices a more holistic intervention design may be needed
that addresses the household-level supply of healthy foods and inuences the food
choices of parents, considering aordability and availability factors.
The chapter starts by reviewing the existing evidence for school garden
programmes. It then presents the results of three recent studies from Bhutan,
Burkina Faso, and Nepal. The chapter concludes with some recommendations
on how to better design school garden programmes aimed at inuencing food
choices in low-income countries.
Current evidence for school garden programmes
School garden programmes need to be designed in response to the food environment
and lifestyle of people in the target location. In high-income countries, school gar-
dens often try to promote greater physical activity levels among children, encourage
social interaction, promote healthier eating habits, and give children a better un-
derstanding of food production while trying to instil a love for nature. Such goals
can also be found in lower income countries, but the emphasis is usually more on
building children’s resilience by giving them the ability to grow food in a sustainable
way through the transfer of agricultural knowledge and skills, and increasing the
consumption of healthy foods such as micronutrient-dense fruit and vegetables.
Virtually all the evidence for the impact of school gardens has come from
higher-income countries (Ozer, 2007; Lineberger and Zajicek, 2009; Parmer
et al., 2009; Morgan et al., 2010; Ratclie et al., 2011; Christian et al., 2014b),
while there was no evidence for lower-income countries until this project was
completed. In the following we will describe this evidence based on four review
papers before turning our attention to lower-income countries.
Blair (2009) reviewed 12 quantitative impact studies of school garden pro-
grammes in the United States. All 12 quantitative studies collected pre- and
post-intervention data, but none used an experimental design in which schools
would be randomly assigned to a treatment or control group. These 12 studies
used samples of 1 to 5 schools and no more than 500 schoolchildren. The review

School gardens in low-income countries 117
showed that 9 out of the 12 studies showed positive outcomes in the area of sci-
ence achievement, but only one study showed a signicant increase in fruit and
vegetable consumption that could be attributed to the school garden programme.
Robinson-O’Brien et al. (2009) reviewed 11 studies for the United States that
examined the impact of garden-based nutrition education programmes on pref-
erences, willingness to taste, and intake of fruit and vegetables. Of these 11 stud-
ies, four reported eects on fruit and vegetable intake and three of these reported
a signicant increase. Six studies reported results on fruit and vegetable prefer-
ences, and two of these reported a signicant increase. Three studies reported
results on willingness to taste fruit or vegetables, and two of these reported a
signicant increase. The authors therefore concluded that, based on the limited
evidence available, garden-based nutrition-education programmes may have the
potential to lead to improvements in fruit and vegetable intake, willingness to
taste, and preferences among students.
Langellotto and Gupta (2012) specically reviewed the evidence of
garden-based nutrition education programmes on student’s nutrition knowledge,
preferences for fruit and vegetables, and consumption of fruit and vegetables.
They reviewed 20 studies from the United States and found that nutrition ed-
ucation programmes that included a gardening component were more eective
at increasing vegetable consumption in children than nutrition education pro-
grammes without such gardening component.
Ohly et al. (2016) conducted a systematic review of quantitative and qualita-
tive evidence of school gardening programmes. The review identied 21 quan-
titative studies, 16 qualitative studies, and 3 mixed methods studies. The 40
studies all came from high-income countries (United States, United Kingdom,
Australia, and Portugal). Thirteen studies reported the eect on healthier food
preferences and eight found a signicant eect. Ten studies reported eects on
food knowledge and attitudes, and seven of these reported a signicant increase.
Thirteen studies reported the eect on fruit and vegetable consumption, and
only two found a signicant increase. Hence, this review shows that school gar-
den programmes are more capable of inuencing children’s food preferences,
knowledge, and attitudes but less able to inuence actual food behaviour in terms
of a signicant increase in children’s fruit and vegetable consumption.
These reviews for high-income countries point out that there is no strong ev-
idence that school garden programmes improve children’s consumption of fruit
and vegetables. School garden programmes are more likely to improve science
scores, food knowledge, and food preferences than they are able to inuence
actual behaviour towards healthier food choices.
Results of three recent experimental studies
forlow-incomecountries
To ll the evidence gap for the impact of school garden programmes in
low-income counties, the Swiss Agency for Development and Cooperation
(SDC) funded the project ‘Vegetables Go to School: Improving Nutrition by

118 Pepijn Schreinemachers et al.
Agricultural Diversication’ (2013–2017). Through this project, the World
Vegetable Center worked with national partners in Burkina Faso, Tanzania,
Indonesia, Bhutan, Nepal, and the Philippines to design and implement school
garden programmes. Quantitative evidence for impact was generated for three
of these countries– Bhutan, Nepal, and Burkina Faso. Results have been pub-
lished previously (Schreinemachers et al., 2017a; Schreinemachers et al., 2017b;
Schreinemachers et al., Under review) and the purpose of this chapter is to syn-
thesise and highlight the evidence from these studies.
Research design and data collection
Each study used a cluster randomised controlled trial design. Treatment and con-
trol schools were selected randomly from a larger list of primary schools in a
particular region of the country. For each school, baseline data were collected at
the start of the school year, next the intervention was implemented, and end line
data were collected at the end of the school year for the same students (Table 8.1).
In Nepal and Burkina Faso the study was repeated to increase the robustness of
the results. For these two countries, control schools in year-1 became treatment
schools in year-2. In Bhutan the data collection started only in the second year
of the project.
TABLE 8.1 Data collected for the study
Bhutan Nepal Burkina Faso
C T A C T A C T A
Yea r-1:
# schools – – – 20 10 30 10 10 20
# students,
baseline
––– 904 466 1,370 500 500 1,000
# students, endline – – – 882 454 1,336 499 501 1,000
# students, total1––– 846 429 1,275 491 488 979
Year-2:
# schools 9 9 18 10 10 20 10 10 20
# students,
baseline
265 260 525 433 394 827 400 400 800
# students, endline 258 259 517 385 428 813 400 400 800
# students, total 1235 233 468 416 369 785 389 392 781
Source: (Schreinemachers et al., 2017a; Schreinemachers et al., 2017b; Schreinemachers et al., Under
rev iew).
Notes: C = Control; T = Treatment; A = Sum of Control and Treatment.
1 Students outside an age range were dropped from the sample with the age range being 9–15 years
old for Bhutan, 10–15 years old for Nepal, and 8–14 years old for Burkina Faso.

School gardens in low-income countries 119
Outcome indicators were selected from a review of previous impact stud-
ies of school garden programmes. The selected outcome indicators represented
stepwise changes in the intervention’s impact pathway from increased awareness
about fruit and vegetables to improved knowledge of food, nutrition, and WASH
(water, sanitation, and hygiene) as well as knowledge of sustainable agriculture
and increased preferences for healthy foods and food behaviour in terms of in-
creased fruit and vegetable consumption. Details about variable denitions and
measurement can be found in the published papers. Data were collected using
relatively simple questionnaires with photos and multiple-choice questions to aid
children’s comprehension. The text was brief, and the phrasing was simple. The
questionnaire was designed in English and translated into the local language.
Intervention designs
The school garden programmes in each country were designed in collaboration
between the Ministry of Agriculture and the Ministry of Education. For details
see (Bhattarai et al., 2016; Bhattarai et al., 2017; Ouedraogo et al., 2017; Rai et al.,
2017). This collaboration across ministries was an important aspect of the project.
A nutrition expert from the Ministry of Health in Burkina Faso and Nepal and
from a local university in Bhutan also contributed to the project. Each programme
design included three intervention components that were concurrently imple-
mented in all treatment schools and targeted children in elementary education:
School garden component: School gardens were established in each treatment school
for the cultivation of about eight dierent vegetables. Emphasis was given to
vegetables that were culturally accepted, nutrient-dense, and easy to grow.
The school garden designs generally included raised planting beds, fences to
prevent livestock from entering the garden. Irrigation water tanks were in-
stalled where water availability was a constraint. Other improvements were
made depending on the local situation.
Education component: Complementary education was provided about agriculture,
nutrition, and hygiene. A curriculum was developed for 23 weeks and teach-
ers received training on how to use it. Topics covered were food groups,
the health benets of vegetables, food and body hygiene, and school and
environmental sanitation. The school garden and its products were used by
teachers to illustrate mathematics, biology, moral education, and language.
The agricultural education emphasised learning by doing and was regularly
conducted in the school garden.
Involvement of parents, local farmers and other community members: Parents helped
preparing the school garden and fencing it with locally available materials.
Depending on the local situation, vegetables were supplied to the school
canteen or given to the children to bring home. In many instances, local
farmers helped with making nurseries and preparing seed beds and local
extension ocers visited the schools to provide technical advice as needed.

120 Pepijn Schreinemachers et al.
The three intervention components are jointly expected to raise children’s awareness
about vegetables and increase their knowledge. This increased knowledge is then ex-
pected to stimulate their preferences for healthier food choices including vegetables,
which should then lead to better food choices and improved nutrition status.
Results
Table 8.2 shows the average treatment eects, which is the dierence in mean
outcomes between students assigned to the treatment and students assigned to the
control. For means and standard errors we refer to the original papers.
TABLE 8.2 Impact of the school garden intervention on nutrition outcomes in Bhutan,
Nepal, and Burkina Faso, average treatment eects showing marginal eects
as means
Outcome variable Bhutan Nepal Burkina Faso
Year-2 Ye ar-1 Year-2 Year -1 Year-2
Awareness:
% of fruit and vegetables
correctly named
17.9 29.4 12.8 3.3 2.5
*** *** ***
Knowledge:
% of correct answers on
sustainable agriculture
15.2 21.7 16.7 4.5 5.7
** *** ***
% of correct answers on food,
nutrition, and WASH
−5.2 13.8 14.6 6.1 7.7
*** *** ** **
Preferences:
% of fruit and vegetables liked 9.5 15.8 19.1 −1.4 12.3
** *** ***
Behaviour:
% of children that ate
vegetables
11.7 2.35 0.91 20.2 2.7
** *
% of children that ate fruit −3.6 −0.75 7.11 −6.5 −3.9
# of dierent vegetables eaten 0.19 0.09 −0.04 0.3 0.2
# of dierent fruits eaten −0.09 0.07 0.08 NA 0.1
Students (n) 468 1,275 785 979 781
Source: (Schreinemachers et al., 2017a; Schreinemachers et al., 2017b; Schreinemachers et al., Under
rev iew).
Notes: ***p < 0.01, **p < 0.05, * p < 0.10. NA = Not available (the average treatment eect could
not be estimated as the number of dierent fruits eaten in the sample of students in Burkina Faso
in year-1 was near zero).

School gardens in low-income countries 121
The results show that the school garden programme, which was similarly
designed and implemented in each country, had more signicant eects on nutri-
tion outcomes in Bhutan and Nepal than in Burkina Faso. For the latter country,
only one of the eight outcome variables showed a signicant increase.
For Bhutan and Nepal, the school garden programme increased students’
awareness of fruit and vegetables. For Nepal and Burkina Faso, the school garden
programme increased students’ knowledge of food, nutrition, and WASH. For
Bhutan and Nepal, but not for Burkina Faso, the school garden programme also
enhanced students’ knowledge of sustainable agriculture. It is, however, noted
that for Burkina Faso, when pooling the two years together, the eect on agri-
cultural knowledge was also signicant ( p < 0.05).
For Bhutan and Nepal, but not for Burkina Faso, the school garden pro-
gramme promoted children’s preferences for eating fruit and vegetables. Only in
Bhutan, did the school garden programme increase the percentage of children
eating vegetables. The eect of the school garden programme on fruit consump-
tion or the number of dierent fruits or vegetables consumed was insignicant
for all years and all countries.
These studies therefore broadly show that school garden programmes in
low-income countries can be eective in increasing students’ awareness of fruit
and vegetables, their knowledge of food and agriculture, and their preferences for
eating fruit and vegetables, but school garden programmes appear less eective in
changing students’ actual food behaviour towards the increased consumption of
fruit and vegetables, at least in the short-term.
Discussion
The nding that school garden programmes in low-income countries are more
eective in increasing students’ awareness, knowledge, and preferences and less ef-
fective in increasing students’ actual consumption of fruit and vegetables conrms
the ndings of two major reviews on the eect of school garden programmes on
nutrition outcomes in high-income countries (Blair, 2009; Ohly et al., 2016).
In explaining the reasons for this lack of impact, it is important to bear in
mind that school gardens themselves cannot supply students with a daily serving
of vegetables. The size of a school garden is just too small for this and trying to do
this would seriously distract students and teachers from the school curriculum.
Hence, the purpose of a school garden is usually purely educational while vegeta-
ble harvests are small and irregular. Therefore, school gardens can only make an
indirect impact on nutrition outcomes through stimulating students’ awareness
of fruit and vegetables and enhancing their knowledge about the importance of
eating a diverse range of fruit and vegetables for good health. The combination
of these eects is assumed to nudge students to adjust their food behaviour and
eat more fruit and vegetables.
The problem in this assumed impact pathway is that the school garden inter-
vention does not adequately address the supply of fruit and vegetables to students.
This is likely the main reason why none of the three impact studies showed

122 Pepijn Schreinemachers et al.
convincing evidence for increased fruit and vegetable consumption. This con-
straint was also identied by the country implementation teams when reviewing
the results of the programme.
The availability of vegetables in students’ homes may be very limited in many
countries, while schools may not serve a school meal that includes vegetables. If
school meals are served at all, then this is usually a combination of staple food
grain and pulses with very small quantities of fresh vegetables. However, if veg-
etables are unavailable in the home or in the school then students do not have a
real choice of eating fruit and vegetables, even if they wanted to.
To accomplish this and give children a healthy food choice, school garden
programmes may need to be coupled to a school meals programme that serves
fruit and vegetables as part of a mid-day meal, or to an intervention that pro-
motes the availability of fruit and vegetables within the household or within the
community. It is also important that primary caregivers understand the impor-
tance of serving vegetables to their children, which may not always be the case,
especially in low-income countries.
Home gardens are an intervention that address both the household-level de-
mand and supply of vegetables (World Vegetable Center, 2016). Home garden
interventions typically couple training in garden management with nutrition
education of mothers. There is evidence that home garden interventions have a
signicant eect on increasing household production and consumption of veg-
etables (Olney et al., 2009; Galhena et al., 2013; Schreinemachers et al., 2016).
However, there is no evidence to date that such interventions inuence the food
attitudes, knowledge, or food behaviour of children 8-15 years old. It therefore
appears ideal to couple a school garden programme – which has a proven eect
on children’s interest in vegetables, to a home garden programme – which has a
proven eect on household production and consumption of vegetables.
The impact of such coupled intervention is currently unknown. Several of
this paper’s authors are involved in an ongoing project in Nepal (2018–2020),
titled ‘Nudging children toward healthier food choices: An experiment combin-
ing school and home gardens’, that pilots such coupled intervention in 15 schools.
This project is part of the Drivers of Food Choice Competitive Grants Program
funded by the UK Government’s Department for International Development
and the Bill & Melinda Gates Foundation.
The ‘Vegetables Go to School’ project was successful in raising the interest of
the governments of Bhutan and Nepal in school-based programmes combining
agriculture, nutrition, and health. As a result of this project, Bhutan has adopted
an integrated approach of tackling child malnutrition through a holistic approach
combining school feeding, WASH, and school gardening. Also, as a result of this
project, the government of Nepal launched the ‘Green School Program’ to roll
out school gardens to public schools across the country and the Department of
Education has meanwhile designed a school garden curriculum that integrates
nutrition, agriculture, and health. There is a need to closely study these initi-
atives to gain a better understanding for how these programmes can optimally

School gardens in low-income countries 123
inuence the healthy eating behaviour of children and parents and to draw les-
sons that can be applied to other countries considering similar programmes.
Conclusion
The evidence for high-income countries suggests that school garden programmes
are more eective in improving knowledge and attitudes about healthy eating
than at changing short-term actual food behaviour. The ndings of three impact
studies of school garden programmes in Bhutan, Burkina Faso, and Nepal, as
presented in this chapter, conrm that school garden programmes are more ef-
fective in changing knowledge and attitudes than in changing actual food behav-
iour. Improvements in knowledge and attitudes can, of course, have long-term
positive eects on food behaviour, which are dicult to measure. Yet, to achieve
also short-term eects in terms of increased vegetable consumption, it may be
necessary to couple school garden programmes to other interventions that raise
the nutrition awareness among parents and increase the availability of vegetables
in students’ homes and the community. Coupling school gardens with home
gardens appears as one suitable combination to accomplish this.
Acknowledgements
Funding for this research was provided by the Swiss Agency for Development
and Cooperation (SDC) under grant number 81017189 and the Drivers of Food
Choice Competitive Grants Programs, which is funded by the UK Government’s
Department for International Development (DFID) and the Bill & Melinda
Gates Foundation, and managed by the University of South Carolina, Arnold
School of Public Health, United States. Funding was also provided by core do-
nors to the World Vegetable Center: Republic of China (Taiwan), DFID, United
States Agency for International Development (USAID), Australian Centre for
International Agricultural Research (ACIAR), Germany, Thailand, Philippines,
Korea, and Japan.
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