Do school-based nutrition interventions improve the eating behavior of school-age children?

BACKGROUND/OBJECTIVES: Filipino children aged 6-10 yrs are consuming poor quantities and quality of food based on the 2013 Philippine National Nutrition Survey. During these years healthy eating habits must be formed through family influence. Within this background, a complete package of nutrition intervention-feeding and nutrition classes, was pilot tested in selected schools to determine 1) changes in nutrition attitude and behavior and 2) food intake of schoolchildren after the intervention. SUBJECTS/METHODS: A quasi-experimental design was used in the study. School children aged 7-9 yrs enrolled in selected Philippine public elementary schools and their mothers/caregivers were the study participants. Profile and socio-demographic data were collected from each participant at baseline. The nutrition behavior and food intake of children were determined using the modified Child and Diet Evaluation Tool (CADET) and the 24-h food recall form, respectively. Data were analyzed using Stata version 15. RESULTS: No significant differences in characteristics were found among the 339 child-mother pairs in the 4 study groups. The modified CADET recorded improved mean attitude scores of children ranging from 22 to 24 points at endline in the group receiving both lunch feeding and nutrition education classes (group 3). The perceived better behavior of children was reported by their mothers in terms of increased intake of milk and vegetables and decreased consumption of sugar. These improvements were supported by the actual food intake of children obtained from the 24-h food recall. CONCLUSIONS: Family involvement, particularly of mothers/caregivers, appeared to be an important factor in shaping the children's eating behavior. An intervention package with lunch feeding and nutrition classes resulted in a substantial improvement in children's behavior and actual food intake with increased levels of vegetables and milk while lowering sugar consumption. The adoption of the intervention package in public elementary schools should therefore be pursued.

Monitoring the implementation of nutrition intervention at the local level.

Implementing nutrition intervention program requires monitoring to assess the accomplishments of targets, and eventually the program's goals. The nutrition intervention strategy under the Malnutrition Reduction Program [MRP] has the components of complementary feeding among children six months to below three years old and nutrition education among mothers/caregivers. This intervention was monitored and determined the facilitating and hindering factors in implementation. A total of 32 cities/municipalities were included in the monitoring using qualitative and quantitative methods, specifically, in-depth interviews among implementers. Results showed that the implementation of the intervention strategy at the local level was primarily facilitated by the commitment of local chief executives (LCEs) who gave full support to the intervention, presence of local resolution on its adoption, and accessibility of complementary food production facility which provided the complementary food supplies for the intervention. Other facilitating factors to implementation were the presence of manpower and other resources like the active involvement of local nutrition implementers. However, the multiple workload of key implementers and with nutrition program as least priority in the local agenda were challenges in program implementation. From this monitoring study, the commitment of LCEs, consideration of nutrition as a priority program, and active participation of both implementers and participants contributed in effective program implementation.

Assessing school-lunch feeding and nutrition education strategy for healthier kids in selected Philippine public schools.

BACKGROUND: Nutrition interventions during the early years of a child's life are anchored on the need to provide good nutrition and proper health care to optimize their growth potential as adults. In the Philippines, undernutrition is a persistent problem among 0-10 year old Filipino children. In this age group, children consume a diet poor in quantity and quality. AIM: This study aimed to assess the effects of a school-lunch and nutrition education intervention among schoolchildren in terms of attaining good nutrition. METHOD: Using a quasi-experimental design, children aged 7-9 years from public elementary schools in the province of Laguna, Philippines were categorized into three intervention groups and one non-intervention group. Anthropometric measurements; nutrition knowledge, attitude and behavior; and food intake among children and households were collected at baseline and endline periods. SPSS for Windows version 16 and Stata version 15 were utilized for data analysis. RESULTS: Mean scores on knowledge, attitude and behavior of schoolchildren in intervention groups increased significantly at endline (p<0.05). Protein requirement was met by more children and households than the energy requirement. Most children with normal nutritional status after the interventions (25.3%) belonged to the group with the complete intervention of school-lunch and nutrition education. CONCLUSIONS: The provision of both school-lunch feeding and nutrition education is effective in improving the knowledge, attitude and behavior scores and nutritional status of schoolchildren. The adoption and institutionalization of complete intervention with school-lunch and nutrition education in elementary public schools should be pursued.

Process Evaluation of Nutrition Intervention Strategy in a Local Philippine Setting.

Aims: Undernutrition among 0 to 5 years old children remains a public health problem in the Philippines. This process evaluation study documented and examined the implementation of an intervention strategy for young children. Methods: Complementary feeding of 6-month to 2-year-old children was implemented for 120 days by the municipalities of Plaridel and Pulilan in Bulacan, Philippines utilizing local-based food made of rice and mung bean along with nutrition education classes among mothers/caregivers using the developed nutrition modules. A total of 121 mother-/caregiver-child pairs were the program participants of the intervention. Pre-post design were used in the analysis of quantitative data. Qualitative data were encoded verbatim manually using emerging themes. Key informant interviews among community workers and municipal officials and focus group discussions among mothers/caregivers and community workers were conducted to gather the needed data. Results: The municipalities adhered to the program phases of planning, organizing, implementation, monitoring, and evaluation. At end-line, the weight of children participants increased in both municipalities and the mean nutrition knowledge scores of mothers/caregivers increased significantly (P < .05). Conclusions: This process evaluation confirmed that the proposed nutrition intervention strategy for young children can be implemented at the local level. The strong support and active cooperation of the local program implementers and mothers/caregivers and adherence to program requirements were the key factors in the efficient implementation of the intervention. For sustainability, the passing of local ordinance for the adoption of intervention and budget support for implementation of the intervention is recommended.