National School Lunch Nutrition and Cost Profile: A Case Study of the Ghana School Feeding Programme.

Numerous governments in developing countries institute school lunch programs or school feeding programs as a strategy to address high malnutrition and low education rates among children. In 2005, the Ghanaian government launched the Ghana School Feeding Programme (GSFP). The GSFP policy does not document (1) the actual meal and associated nutrient profile received by the student, (2) the cost of the meal ingredients to the caterer who prepares the food, nor (3) the recipe derivations that may supply an enhanced nutritional profile. We address these 3 information gaps by employing a detailed case study of 4 caterers supplying a traditional tomato stew recipe in northern Ghana within GSFP-supported school lunch programs. Specifically, we explore the following propositions: (1) GSFP caterers can deliver a school lunch for under 100 pesewas (1 GH¢ or $0.21 USD) per student; (2) the meal meets the recommended daily allowance for protein; (3) soy can serve as a cost-effective ingredient to fortify the meal in terms of protein level and protein quality; and (4) significant differences exist in the macro- and micronutrient profile due to caterer discretion. We answer the above 4 propositions, and by doing so show the importance of accurately measuring the nutritional content, costs, and quantities of the actual school lunch under study. Second, among our results, we show the economy of locally produced soy flour as an ingredient that can lower costs and raise nutrition when substituting for other locally produced proteins such as ground beef and mackerel.

Ready-to-use supplementary food increases fat mass and BMI in Haitian school-aged children.

BACKGROUND: In Haiti and other countries, large-scale investments in school feeding programs have been made with marginal evidence of nutrition outcomes. OBJECTIVE: We aimed to examine the effectiveness of a fortified ready-to-use supplementary food (RUSF), Mamba, on reduced anemia and improved body composition in school-aged children compared to an unfortified cereal bar, Tablet Yo, and control groups. METHODS: A cluster, randomized trial with children ages 3-13 y (n = 1167) was conducted in the north of Haiti. Six schools were matched and randomized to the control group, Tablet Yo group (42 g, 165 kcal), or Mamba group (50 g, 260 kcal, and >75% of the RDA for critical micronutrients). Children in the supplementation groups received the snack daily for 100 d, and all were followed longitudinally for hemoglobin concentrations, anthropometry, and bioelectrical impedance measures: baseline (December 2012), midline (March 2013), and endline (June 2013). Parent surveys were conducted at baseline and endline to examine secondary outcomes of morbidities and dietary intakes. Longitudinal regression modeling using generalized least squares and logit with random effects tested the main effects. RESULTS: At baseline,14.0% of children were stunted, 14.5% underweight, 9.1% thin, and 73% anemic. Fat mass percentage (mean ± SD) was 8.1% ± 4.3% for boys and 12.5% ± 4.4% for girls. In longitudinal modeling, Mamba supplementation increased body mass index z score (regression coefficient ± SEE) 0.25 ± 0.06, fat mass 0.45 ± 0.14 kg, and percentage fat mass 1.28% ± 0.27% compared with control at each time point (P < 0.001). Among boys, Mamba increased fat mass (regression coefficient ± SEE) 0.73 ± 0.19 kg and fat-free mass 0.62 ± 0.34 kg compared with control (P < 0.001). Mamba reduced the odds of developing anemia by 28% compared to control (adjusted OR: 0.72; 95% CI: 0.57, 0.91; P < 0.001). No treatment effect was found for hemoglobin concentration. CONCLUSION: To our knowledge, this is the first study to give evidence of body composition effects from an RUSF in school-aged children.