ABSTRACT
This study compared the nutritional status of beneficiaries and non-beneficiaries of school feeding programme in public primary schools in Akwa Ibom State. A cross-sectional descriptive survey design was used for the study and a population of 818,588 public primary school pupils. A multi-stage sampling technique was used to select 400 school children between 3-11 years who were enrolled in ECE (Early child Education) to primary three (3). Eighteen (18) public primary schools were selected from the 3 senatorial districts in the state of which 12 schools adopted school feeding programme (SFP) and 6 did not. Anthropometric measurement of weight and height were taken and nutritional status was assessed using height-for-age, weight-for-age, height-for-weight and BMI-for-age parameters. SPSS version 20.0 was used for data entry and analysis. WHO anthro plus software was used to assess the nutritional status of pupils and the result was interpreted using Z-score (WHO Standard). The result revealed that more than half (58.3%) of the pupils were females while 41.7% were males. Not all the public primary schools in Akwa Ibom state adopted the feeding programme. Majority (60.6%) of the schools adopting the programme reported meal serving time to be between 10-11 am. Foods from the cereal group were served 4 times weekly and foods from root/tuber group, legumes were served once a week respectively, while meat/ fish/poultry groups were served thrice in a week. It was also observed that fruits and vegetable group as well as snacks/beverages were not included in the children’s meal. The result showed that while all the benefiting children from the school feeding program had a normal weight-for-age status, underweight (3.5%) and severe underweight (1.5%) were observed among children not benefiting from the feeding program. The prevalence of stunting (10%) and severe stunting (3.5%) observed among the non-beneficiaries of the feeding program were higher than stunting (5.5%) and severe stunting (0.5%) observed among children benefiting from the school feeding program. The prevalence of wasting and severe wasting (4%) respectively observed among the non-beneficiaries of the feeding program were higher than 2% obtained for wasting among beneficiaries as none of the beneficiaries were severely wasted. The prevalence of overweight (9%) observed among benefiting children was higher than 6.5% observed among non-beneficiaries while obesity (0.5%) for both categories was observed. The weight-for-age (X2 =13.437a, P=0.00), height-for-age (X2 = 7.736a, P= 0.02) and BMI-for-age (X2 = 10.281a, P= 0.04) status of the children benefiting from school feeding program and those that do not benefit were significantly different. In conclusion, school feeding programme has the potential to directly address malnutrition if it is effectively managed. Based on the findings, it was recommended among others that Government should ensure regular monitoring and evaluation of the program to ensure that adequate and nutritious meals are served.
TABLE OF CONTENTS
Tittle page i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
Table of Contents vi
List of Tables viii
Abstract ix
CHAPTER
1: INTRODUCTION
1.1 Background
of the Study 1
1.2 Statement
of the Problem 7
1.3 Objectives
of the study 8
1.4 Research
questions 9
1.5 Hypotheses 9
1.6 Significance
of the study 10
1.7 Scope
of the study 11
CHAPTER 2: LITERATURE REVIEW
2.1 Conceptual
Framework 16
2.11 Concept
of school feeding programme 17
2.1.2 Benefits of school
feeding program on school-aged children
19
2.1.3 Nutritional benefits
of school feeding programmes
24
2.1.4 Drawbacks and challenges to school feeding
programs 25
2.1.5 Nutritional status of children
27
2.1.6 Nutritional related disease at
school-age.
29
2.1.7 Methods to be used in assessing the nutritional
status of pre-school children 33
2.1.8 Causes of malnutrition among children 36
2.1.9 Prevention of malnutrition in children 40
2.2 Theoretical
Framework 43
2.2.1 Theoretical
model for the study of nutritional status 43
2.2.2 Theory
of human motivation 44
2.3 Review
of Related Empirical Studies 45
2.4 Summary
of Related Literature Reviewed 54
CHAPTER
3: METHODOLOGY
3.1 Research
Design 56
3.2 Area of
Study 57
3.3 Population
of the Study 57
3.4 Sample
and Sampling Technique 58
3.5 Instrument
for data Collection 59
3.6 Validation
of the Instrument 60
3.7 Reliability
of the Instrument 60
3.8 Method
of Data Collection 61
3.9 Method
of Data Analysis 63
CHAPTER
4: RESULTS AND DISCUSSION
4.1 Results
and Discussion of Findings 64
CHAPTER 5: CONCLUSION AND
RECOMMENDATIONS
5.1 Conclusion 92
5.2 Recommendations 93
REFERENCES
APPENDICES
LIST OF TABLES
4.1 Background information of the pupils 65
4.2 Adoption
of school feeding program in Akwa Ibom State 67
4.3 Food
group and frequency of consumption by school children 68
4.4 Quality
of good given to the children 70
4.5 School meal feeding time 72
4.6 Mean
anthropometric parameters of the benefiting children 73
4.7 Nutritional
status of benefiting children by gender 75
4.8 Nutritional
status of benefiting children by age 77
4.9 Mean anthropometric parameters of the
non-benefiting children 79
4.10 Nutritional
status of non-benefiting children by gender 80
4.11 Nutritional
status of non-benefiting children by age 82
4.12
Differences between the nutritional status of beneficiaries and 84
non-beneficiaries of the school feeding programme.
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Healthy eating behaviours among
school-aged children play a key role in their mental and physical development
and also promote growth and reduce many risks associated with both immediate
and long-term health problems (Bordi et
al., 2002). The improvement of children’s lifestyle relies on actions
carried out in the school settings as children spend most of their hours in
school. Today’s children are tomorrow’s leaders, that is why nutritional
assessment at this level is crucial for accurate planning and implementation of
intervention program to reduce morbidity and mortality associated with
undernutrition.
Anthropometry index can be sensitive
indicators of health, growth and development in children (Medhi et al., 2006). Anthropometric is universally applicable and inexpensive
method of assessing the size, proportion and composition of human body.
Adequate diets are vital for proper growth and physical development to ensure
optimal reactions and resistance to infections. Reversely, inadequate diets
lead to severe forms of malnutrition in children including vitamin A deficiency
and iodine deficiency disorders. (Amuta and Houmsou 2009). The school setting
has been considered as a condusive environment to tackle the issue of
malnutrition among preschool children as research has shown that some of the
children attending public primary school attend school in an empty stomach and
most of the children consume food with low nutrient composition. Many
intervention programmes have been lunched to tackle the issue of malnutrition
among children, in 2004 the federal Government lunched the school feeding
programme.
School feeding programme are meals
served to pupils in schools, as well as take-home rations subjected to pupil’s
school attendance, to serve as a common way of enhancing school participation
and also promoting learning and complementing the insufficient diets of
school-aged children (Adelman et al.,
2008). Children from different socio-economic groups get their meals at the
respective schools every day. According to Aliyar et al., (2015), School meals provide high-energy food with high
nutritional values to tackle the issue of malnutrition. This programme is not
only an initiative to help poor children’s food insecurity, but also to provide
healthy and nutritious food to all children in public primary school and to
educate children on nutritional benefits and understanding of food. School
feeding have the potential to directly address nutrition by improving the
quality of diets.
School
feeding programme has been implemented in many parts of the world with
variation in design and evaluation where they are often implemented by National
Government Organization or non-governmental organizations (NGOs). The Nigerian
Home-Grown School feeding (NHGSF) program aims to deliver a government-led, cost-effective
school feeding programme using food that is locally grown by small holder’s
farmers. School children benefit from a nutritious adequate school meal which
reduces hunger and improves education outcomes. The first implementation of Nigerian
Home-grown school feeding programme was in 2004 beginning with 12 States
selected from the six geopolitical zones. The programme stopped shortly after
commencement in 10 states due to insufficient funds. In 2016, the Federal
Government of Nigeria reaffirmed its commitment to the Home-grown school
feeding programme by setting a target of 12.8 million primary school- aged
children to benefit from the programme (UNICEF 2006).
Globally, an estimated 60 million
children go to school hungry everyday with about 40% in Africa (Buhl, 2012),
whereas 65 million children suffer from severe undernutrition globally due to
inadequate food intake, frequent infection or both. In addition, 75 million
school-aged children (55% of them girls) do not attend school with 47% of them
living in sub-Saharan Africa (World bank, 2013). Thus, the need to reduce
hunger while increasing school enrolment in these children is relevant, and
school feeding programme have been adopted to tackle this multifaceted problem.
Schools have become a natural and conducive setting for the implementation of
health and education interventions. School feedings is just one facet of school
health initiatives as other programmes may include de-worming, HIV/AIDS
prevention and education, and health skills education.
Generally, school feeding programmes have been
shown to directly increase the educational and nutritional status of recipient
children and indirectly impact the economic and social lives of themselves and
their families. Subsequently, school feeding directly addresses the Sustainable
development goals (SDGs) of reducing hunger by one-half, achieving universal
primary education and achieving gender parity in education. School meal must
provide one third of the dietary reference intakes for the age/grade of
children being served for energy, protein, calcium, iron, Vitamin A and C.
(Aliyar et al., 2015). Special
emphasis is placed on serving a variety of foods and having menus that contain
a variety of fruits and vegetables, low fat dairy products and lean meats. In
addition, food vendors employed by school feeding committee must make food
safety a priority as unhygienic handling of food leads to contamination which
exposes children to diseases. According to Bundy et al., (2009), nutritional adequate school meals along with
complementary nutrition education and health measures, support child
development and hunger reduction through improved nutrition and enhanced
learning ability, with short and long-term effects. Many school feeding programs
supplement the food provided by care-givers to children as well as enhance
school children food consumption and dietary diversification by exposing
children to healthy foods and providing macro and micronutrients often missing
from the diets of children in middle and low-income countries (Alderman, 2016).
Furthermore, school feeding programs have a vital role to play in eliminating
hunger and malnutrition. When properly designed, they have the ability to
improve the diets, nutritional status, nutrition knowledge and practices of
millions of school- aged children.
School-aged children are those
between the ages of 5-12years, it typically comes after pre-school age of 2-5
years which most public primary school have accommodated pre-schoolers into
what is named ‘Early Child Education’ (ECE). Preschool
children are one of the most vulnerable groups that are at greater risk of
malnutrition in the society. It is also during this period, the pre-school age
that most undernutrition in form of Kwashiorkor, Marasmus and anaemia are
common (Ene-Obong, 2001). Thus, Nutrition has a direct impact on their growth
and development as well as their nutritional status. Good nutrition during this
period is very important since it is the cornerstone for survival, good health
and development for current and succeeding generations (UNICEF, 2006). Primary school age is a period of dynamic physical growth and
mental development. Research has shown that poor nutritional status results in
low school enrolment, high absenteeism, early dropout and unsatisfactory
classroom performance. Well-nourished children are poised to perform better in
school and are able to achieve their full physical and mental potential (WHO, 2003). They are at risk of being
malnourished because they have very high energy and nutrients needs for their
body size in comparism to adults. It is at this stage that they are more
vulnerable to infections, so it is therefore important that these children eat
the right foods to enable them to build up immunity while at the same time
allowing their body to grow and develop normally (Anozie, 2014).
School age is a dynamic period of physical growth as
well as of mental development of the child. Health problems due to low
nutritional status in school-age children are among the most common causes of
low school enrolment, high absenteeism, early dropout and unsatisfactory classroom
performance. Chronic undernutrition in childhood is linked to slower cognitive
development and serious health impairments later in life that reduce the
quality of life of individuals. Adequate nutrition continues to play a vital role during
the school-age years in assuring that children reach their full potentials for
growth, development, and health. Nutrition problems such as iron deficiency anaemia,
and dental caries can still occur during this stage, therefore, adequate
nutrition and the establishment of healthy eating habits can help prevent
immediate health problems as well as promote a healthy lifestyle, which in turn
may reduce the risk of the child developing a chronic condition, such as
obesity, type 2 diabetes, and/or cardiovascular diseases later in life (Meyer et al., 2004). Well-nourished children perform better in school, grow
into healthy adults, and in turn give their children a better start in life.
Childhood undernutrition has a negative influence on growth and cognitive development.
Poorly nourished children have more problems fighting infection. Moderate
undernutrition can have lasting effects and compromise cognitive development and
school performance. Every year it is estimated that undernutrition contributes
to the death of about 5.6million children under the age of five. One out of
every four under five children in the developing world is under weight for his
or her age and at increased risk of an early death (UNICEF, 2001). The basic dietary recommendation for
school-age children is to eat a diet rich in varieties which is why it remains
so important throughout their school years for children to have a variety of
food available to them. In this respect,
understanding the nutritional status of children is very crucial for the better
development of future generations.
Nutritional status is the health condition of an
individual influenced by the intake and utilization of food nutrients. According
to Goon,
et al., (2011), nutritional
status is an integral component of the overall health of an individual and
provides an indicator of the well-being of children living in a particular
area. The nutritional status of school-aged children impacts their health,
cognition, and subsequently their educational achievement (Buttenheim, et al., 2011). The 2013 Nigeria Demographic and Health
Survey(NDHs) report showed that although the rate of stunting among children
had declined slightly from 41% in 2008 to 37% in 2013, the prevalence of
underweight had worsened from 23% in 2008 to 29% in 2013 and that of wasting
also worsened from 14% in 2008 to 18% in 2013 (National population commission,
2014). Studies among school children from various parts of Nigeria gave varying
figures with stunting ranging from 11.1 to 52.7% and underweight between 10.3
and 43.4% (Akor et
al., 2010; Fetuga et al., 2011).
The World Health Organization (WHO) in 2007 developed
a WHO growth reference for school-aged children and adolescents, which was in
tandem with the 2006 WHO child Growth Standards for under-five children and the
body mass index (BMI) cut-offs for adults. This provides an appropriate tool
for screening and monitoring of the nutritional status of school- aged children
and adolescents internationally (De Onis et al., 2007). The WHO 2007 growth reference provides
BMI-for-age to complement height-for-age in the assessment of thinness (low
BMI-for-age), overweight and obesity (high BMI-for-age), and stunting (low
height-for-age) in school children (De Onis et al., 2007).
Several studies in Nigeria and outside Nigeria have
been conducted on nutritional status of children of all ages and majority of
states in Nigeria have embarked on school feeding program as an intervention to
fight against malnutrition. The aim of this study was to determine the
nutritional status of beneficiaries and non-beneficiaries of school feeding
programme in public primary schools in Akwa Ibom State. This was done in order
to gain information for proper planning and operation of the programme as poor
implementation can hinder the programme from achieving its aims.
1.2 STATEMENT OF PROBLEM
School feeding programme have been established
in Nigeria to reduce malnutrition and improve child nutrition to lessen the
negative effect of malnutrition on the nutritional status and learning capacity
of school aged children (World Food Program, 2015). According to world bank
(2013), Malnutrition disorders affect more than 42% of school children in
Nigeria and are responsible for about 49% absenteeism of primary school-age
children. The common causes of malnutrition are frequent and lack of access to
adequate meals. Among the poor, there is often not enough food at home and a
child that is hungry does not see going to school has been important. School
feeding programme encourages school-aged children to be in school daily and as
such helps in reducing malnutrition as the meal in schools provides macro and
micro-nutrients that are often missing in diets of children from low-income
background. Children are the building blocks of the future generation and their
health, physical growth and intellectual development fundamentally depends on
adequate provision of nutrients and healthy nutrition during childhood lays a
foundation for early adulthood.
Due to poverty, many children have poor
nutritional and health status, which affects learning outcomes, and the school
feeding programme aims to address this. Following the implementation of the
programme in Akwa Ibom State, some challenges emerged including delay in the
release of funds, insufficient fund, and insufficient food products and inadequate
training of food vendors on health and nutrition related issues, these could
hinder the successful implementation of the programme. Children who go to
school hungry may have diminished attentiveness, a greater likelihood of
becoming distracted and a lack of interest in learning resulting in failure,
low achievement and repetition. With school feeding programme, a child is
assured of one nutritious meal per day at school at such helps in mental and
intellectual development which improves the learning outcome of the children.
Whilst some studies found the school feeding programme to impact positively on
the nutritional status of public primary school children, others have not
witnessed any significant difference on the nutritional status of children in
schools operating feeding programme compared with those in schools that do not
implement the school feeding program (Danquah et al., 2012). Inspite of the various research study on school
feeding programme and upon reviews in literature, no empirical study seems to
be identified in Akwa Ibom State School Feeding programme. This study therefore
seeks to examine the nutritional status of beneficiaries and
non-beneficiaries of school feeding programme in public primary schools in Akwa
Ibom State.
1.3 OBJECTIVES OF THE STUDY
The main objective of the study was
to compare the nutritional status of beneficiaries and non-beneficiary of
school feeding program in public primary schools in Akwa Ibom State.
Specifically, the study aimed to:
1. Identify the public primary schools
adopting school feeding programme in Akwa Ibom State.
2. Identify the type of food and
frequency of serving the meals to the children in public primary schools
3. Assess the quality of food given and
time when meals are served to the children in public primary schools in Akwa Ibom
State.
4. Determine the nutritional status of the
children benefiting from school feeding programme in public primary schools in Akwa
Ibom State using anthropometric measurements of weight-for-age, height- for-age
and BMI- for-age. (Underweight, Stunting and Wasting)
5. Determine the nutritional status of
the children not benefiting from school feeding program in public primary
schools in Akwa Ibom State using anthropometric measurements of weight-for-age,
height- for-age and BMI- for-age. (Underweight, Stunting and Wasting)
6. Compare the nutritional status of the
children benefiting from school feeding programme and those not benefiting in
Akwa Ibom State.
1.4
RESEARCH QUESTIONS:
The
following are the research questions guiding the study.
1 How many public primary schools have
adopted school feeding programme in Akwa Ibom State?
2 What type of food and how frequent
do children receive school meals in public primary schools in Akwa Ibom State?
3 How is the quality of food given and
what time are meals served to children in public primary schools in Akwa Ibom State?
4 What are the nutritional status of Children
benefiting from School feeding programme in Akwa Ibom State using
anthropometric measurement of weight-for-age, height- for-age and BMI- for-age?
(Underweight, Stunting and Wasting)
5 What are the nutritional status of children
not benefiting from school feeding program in Akwa Ibom State using
anthropometric of weight-for-age, height- for-age and BMI- for-age?
(Underweight, Stunting and Wasting)
6 What are the differences between the
nutritional status of children benefiting from school feeding programme and
those not benefiting in Akwa Ibom State?
1.5
HYPOTHESIS: (P = ≤ 0.05)
This research hypothesis guided the study
Ø There is no significant difference
between the mean scores of nutritional status of children benefiting from
school feeding programme and those that do not benefit.
1.6 SIGNIFICANCE OF THE STUDY
This study is unique and significant
in that the study brings forward the nutritional status of pupils benefiting
from school feeding programme in Akwa Ibom State in other to ascertain that the
programme has achieved its aim. Findings of the study will be significant to
the Government, School feeding program committee members, Community at large,
Parents of primary school children, Home Economics teachers, Nutritionists and other
Researchers.
The study will provide data on the
nutritional status of children benefiting from school feeding programme and the
type of food they consume. The data could be used by Government to improve
program implementation thereby meeting the intended goal of good nutrition and
health status of children. Findings will be made accessible through
publication.
The information acquired from the
research will propel the school feeding program committee to enact good food
and nutrition policy that will contribute to improving the health status of
school-aged children. Findings will be made accessible through journal.
The study will be beneficial to the
community at large as findings from the study will identify problems that could
hinder proper operation of the feeding programme which policies towards
remedying the identified problems will go a long way in making the feeding
programme better in various senatorial districts. This will be made accessible
through town hall meetings.
The findings from the study will educate
parents of primary school pupils on the benefits of school feeding programme on
the nutritional status and educational achievements of their children as such
encouraging their children to attend school daily to partake in the meal. This
will be made accessible through women’s meeting and PTA meeting.
Findings from the study will add to
existing knowledge to Home Economics teachers. It will aid Home Economics Extension
workers to sensitized the rural communities on the role of school feeding
programme on the nutritional and learning outcome of the children as well as
its relevant to the community at large. This will be made accessible through
seminars.
The study will expand the knowledge
of nutritionist toward what constitute an adequate meal to meet the nutritional
requirements of school-aged children to promote a healthy lifestyle. This will be
made accessible through seminars and health advocacy.
Researchers will benefit from the
study as it is expected to add to existing literature on school feeding
programme, this will serve as a reference material for them. Research findings
from the study will be made available in the library.
1.6
SCOPE
OF THE STUDY
The research is limited to assessing the nutritional status
of pupils benefiting from school feeding programme and pupils that do not
benefit from the programme in primary schools in Akwa Ibom State. Pupils from
ECE (Early Child Education) to primary three (3) were used for the study as
there are the primary target of the programme. Anthropometric measurements of
weight and height were taken from both categories of pupils to assess their
nutritional status. Selected public primary schools from the three (3)
senatorial districts in the state participated in the study. The study was
conducted in Akwa Ibom state and it cut across the 3 senatorial district in the
state which are Uyo senatorial district, Ikot Ekpene senatorial district and
Eket senatorial district.
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