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The Impact at Scale of the Ghana School Feeding Programme on Primary School-Age Children's Anthropometry: A Cluster Randomised Trial

51 Pages Posted: 8 Oct 2018

See all articles by Aulo Gelli

Aulo Gelli

International Food Policy Research Institute (IFPRI)

Elisabetta Aurino

Imperial College London

Gloria Folson

University of Ghana

Daniel Kojo Arhinful

University of Ghana - Noguchi Memorial Institute for Medical Research

Clement Adamba

University of Ghana

Isaac Osei-Akoto

University of Ghana - Institute of Statistical, Social and Economic Research (ISSER)

Edoardo Massett

University of Sussex - Institute of Development Studies

Kristie Watkins

Imperial College London

Meena Fernandes

Imperial College London

Lesley Drake

Imperial College London

Harold Alderman

International Food Policy Research Institute (IFPRI)

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Abstract

Background: Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school feeding programmes as platforms to scale-up nutrition interventions is relevant as programmes function in nearly every country in the world. This study is aimed at evaluating the impact of the national school feeding programme in Ghana on school-age children's anthropometry indicators.

Methods: A longitudinal cluster randomized control trial was implemented across the 10 regions of Ghana, covering 2,869 school age children (aged 5-15y). Communities were randomized to 1) control group without intervention; or 2) treatment group providing the reformed national school feeding programme. Primary outcomes included height-for-age (HAZ) and BMI-for-age (BAZ) scores. The analysis followed an intention to treat approach as per the published protocol for the study population and sub-group analysis by age (i.e. mid-childhood for children 5-8y and early adolescence for children 9-15y), gender, poverty and region of residence. We used single difference ANCOVA with mixed-effect regression models to assess programme impacts.

Findings: School feeding had no effect on HAZ and BAZ in children aged 5-15 years. However, in per protocol subgroup analysis, the school feeding intervention improved HAZ in 5-8y old children (effect size 0.12 SDs), in girls (effect size 0.12 SDs), particularly girls aged 5-8y living in the northern regions, and in children aged 5-8 in households living below the poverty line (effect size 0.22 SDs). There was also evidence that the intervention influenced food allocation and sharing at the household level.

Interpretation: Schools feeding can provide a platform to scale-up nutrition interventions in the early primary school years, with important benefits accruing for more disadvantaged children.

Trial Number: Trial registered on the ISRCTN Registry as ISRCTN66918874

Funding Statement: This trial was funded by the Bill and Melinda Gates Foundation and Dubai Cares.

Declaration of Interests: Aulo Gelli received support from the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute.

Ethics Approval Statement: Ethical clearance was obtained from the Institutional Review Board of the Noguchi Memorial Medical Research Institute of the University of Ghana and sought at the Imperial College Research Ethics Committee. Meetings were held from early stages in the study development with relevant government ministries both at central and decentralised levels to discuss the purpose, procedures and risks involved in the study. Informed consent was obtained from parents/guardians of children through written and verbal information provided before interviews.

Keywords: Nutrition, School-Age, School Feeding, Impact Evaluation, Ghana

Suggested Citation

Gelli, Aulo and Aurino, Elisabetta and Folson, Gloria and Arhinful, Daniel Kojo and Adamba, Clement and Osei-Akoto, Isaac and Massett, Edoardo and Watkins, Kristie and Fernandes, Meena and Drake, Lesley and Alderman, Harold, The Impact at Scale of the Ghana School Feeding Programme on Primary School-Age Children's Anthropometry: A Cluster Randomised Trial (September 27, 2018). Available at SSRN: https://ssrn.com/abstract=3258667

Aulo Gelli (Contact Author)

International Food Policy Research Institute (IFPRI) ( email )

1201 Eye St, NW,
Washington, DC 20005
United States

Elisabetta Aurino

Imperial College London

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Gloria Folson

University of Ghana

PO Box 25
Legon, Accra LG
Ghana

Daniel Kojo Arhinful

University of Ghana - Noguchi Memorial Institute for Medical Research ( email )

P. O. Box LG 581
Legon, LG581
Ghana

Clement Adamba

University of Ghana

PO Box 25
Legon, Accra LG
Ghana

Isaac Osei-Akoto

University of Ghana - Institute of Statistical, Social and Economic Research (ISSER) ( email )

P.O BOX LG 74
Legon
Ghana

Edoardo Massett

University of Sussex - Institute of Development Studies ( email )

Brighton
Falmer, Brighton, East Sussex BN1 9RE
United Kingdom

Kristie Watkins

Imperial College London

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Meena Fernandes

Imperial College London

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Lesley Drake

Imperial College London

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Harold Alderman

International Food Policy Research Institute (IFPRI) ( email )

1201 Eye St, NW,
Washington, DC 20005
United States

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