The Effect Of In School Feeding Programs Health Essay

A school feeding programme was first implemented in Uganda after the 1979 war, covering all schools. Recognizing that Karamoja had the worst social indicators of any district in Uganda, Government and the World Food Programme started a school feeding Project 2417 in 1983, to be followed by Project 2642 between 1993 and 1998 (Global child Nutrition Forum, 2006).

fHunger is most destructive and very persistent with an effect on growth of a country and her people .Brain development in infants and chances of learning well in class are mostly affected by hunger. The following depend on each other namely Hunger ,low levels of education and poverty(Averett,2007).According to the study which was done by World Food programme,joining school ,concentrating and behavior in class are affected by Chronic and acute Hunger(WFP2006)

School feeding leads to increased time spent in school, through increased enrolment and attendance and decreased drop-out rates (Ahmed, 2004). WFP data from Lao PDR show that attendance increases by 5.5 percent per year, enrolment by 16 percent, and drop-out declines by 9 percent. School feeding also leads to increased cognition: learning is improved. For instance, in Lao PDR, one additional year of school feeding leads to an increase in cognition of 0.09 SD in test scores. An increase of 1 SD leads to an increase of 11 percent in wages over a productive life (Jukes, Drake and Bundy, 2008). In comparatively higher-income countries of Latin America, school feeding programs are just as common, and more likely to be funded and operated on a large scale by domestic agencies (Bundy et al., 2009). In the United States, the National School Lunch Program subsidizes meal provision in 99 percent of public schools, with participation of more than half of students (Caldes, 2004). As a conditional in-kind transfer, feeding programs have the explicit objective of increasing child enrollment and attendance. By increasing time in school and, perhaps, improving child nutrition, meal programs further aspire to improve child learning and attainment. However, the empirical evidence on whether this occurs is limited, especially in countries with well-established feeding programs. Quasi-experimental studies from India and Sri Lanka identified mixed effects on enrollment and attendance, but could not examine other student outcomes.

With the introduction of UPE, the Ugandan government expects parents and caretakers to take on the responsibility of feeding their children. A number of the UPE schools have private feeding programs but many parents particularly in the rural areas cannot afford to pay even the minimal cost of the simple meal of maize meal porridge. A recent study carried out shows that 26% of Day schools provide at least one meal at school. Pupils attending day schools in urban settings often take a packed lunch according to what is available in their homes or may buy snacks from vendors within the school compound. This cannot be said of schools in the rural areas. Both primary and secondary schools provide all meals at school. Parents pay for the meals through the school fees every term. The diet in boarding schools commonly consists of maize meal porridge for breakfast and maize meal pap with beans for the other meals of the day.

The School Health Section in the Ministry of Health was established in 1999 and has been endeavoring to carry out advocacy for improvement of school health services in general. A School Health Policy under which feeding in schools is highlighted has also been drafted but is still under discussion. Under this policy, the Ministry of Education and Sports as well as the Ministry of Health are expected to provide guidelines on feeding in schools, encourage parents and schools to provide at least one hot meal a day, provide micro nutrient supplements for pre-primary schoolchildren.

Though significant gains have been achieved throughout the country in terms of educational expansion and accessibility, rural Ugandans continue to lag far behind their urban counterparts. (Finan, 2010). Though school-feeding programs have increased student enrollment rates, attendance, and exam scores, rural districts have exhibited only modest gains in completion rates and advancement. Additionally, schools are not always equipped with suitable bathrooms and kitchens to ensure that food is prepared in a hygienic and safe environment.

This study will assess the impact of school feeding programmes on school participation (attendance, academic achievement and dropout) in Kisoro district

1.2 Problem statement

Children in primary schools are more susceptible to short-term hunger, particularly where there shortage of food and poor diets. Factors like staying far from school and pupils have to move very many Kilometers to school, have to first do work at home before going to school, contribute to hunger in primary school pupils. Pupils who report to school with empty stomachs have reduced attention, high chance of being diverted to other things , less concentration in class and end up performing poorly in class(DoH 2005:32).By giving a child what to eat may improve her/his ability to study well in class hence facilitating learning(Kremer;2007).

Research has shown that hunger leads to mental retardation in children, especially making them have violent behavior and anxiety when hungry rendering them non productive in class (WFP2006:4).

Poor performance in schoolas is worldwide problem and is predominantly in Low income countries.Uganda has perfomed well in education since when Education for all started in 1997 as per the indicators of education. However, educational outcomes remain below this is due to low attention by the policy makers on Universal Primary education and schools not having feeding programmes . Instead, as a national policy,the care givers are expected to provide food although many families who live in rural areas cannot afford to provide it. In order to achieve quality education for all, school feeding is an essential component. The country still has the challenge of passing the policy and developing guidelines and minimum standards for implementation. Additionally, a number of studies have been done on the cost effectiveness of school feeding programmes in Uganda but few have been done to assess the effect of the programmes on school attendance and academic achievement among primary school pupils especially in the rural areas like Kisoro district.

1.3 Purpose of the Study

The purpose of the study will be to investigate the effect of school feeding program on school attendance, academic achievement and dropouts in primary school pupils in Kisoro district-Uganda.

1.4 Research Objectives

1.4.1 Broad objective

The broad objective of the study is to assess the effect of school feeding program on school attendance, academic achievement and dropouts in primary school pupils in Kisoro district

To determine the effect of the school feeding programme on school attendance among primary school pupils in Kisoro district

To establish the relationship between child nutrition status and school participation

To determine the effect school feeding programs on school drop outs in primary schools in Kisoro district

To determine the effect of school feeding programmes on academic achievement among primary school pupils

1.5 Research Questions

The study will be guided by the following questions:-

What is the effect of the school feeding programme on school attendance among primary school pupils in Kisoro District?

Is there a relationship between nutrition status and school participation?

What is the effect school feeding program on school drop outs in primary schools in Kisoro Districts?

What is the effect of school feeding programmes on academic achievement among primary school pupils?

1.6 Hypotheses of the study

H0: There is no significant relationship between school feeding programs and school participation among pupils in Kisoro district

H1: There is a significant relationship between school feeding programs and school participation among pupils in Kisoro district

1.7 Scope of the Study

The study will be conducted in sampled primary schools in Kisoro district. The study will target a population of 200 pupils and the administration of the schools in Kisoro district. The research is limited to analyzing the impacts of School Feeding Program on school participation among primary school children. Although the impacts of SFP are studied in various ways such as the impacts on nutrition, cognitive development, learning achievement, agricultural production, and so on, these aspects are beyond the scope of this research and hence are not covered here. In terms of geography, the study will be conducted in Kisoro district, Kirundo Sub County.

1.8 Significance of the Study

The study results will first and foremost point out the school feeding programme situation in Kisoro district which will in turn provide valuable information for both the local authorities like the Local council, District Education Officers and the government at large as regards areas which require improvement and / or reinforcement. The results will also enable school administrators especially those of schools without school feeding programmes to appreciate the importance of the programmes as regards school participation and thus general school progress

CHAPTER TWO; LITERATURE REVIEW

2.0 Introduction

This chapter reviews literature related to the main research theme and also reviews the literature on the impact of school feeding programs on school enrollment, attendance, and dropout rates; dietary intake; nutritional status; and academic performance of participating children.

2.1 History of school feeding

School feeding programme began in Germany in 1790 this was followed by France in 1867.As years go by countries like Norway also adapted the same mechanism of school feeding by introducing breakfast of milk , bread , some fruits and in addition to this was cod-liver oil (FAO 2005:15). In as early as 1853,countries like USA started school feeding programme by giving lunch to their children. (Gunderson 2007). The law to start serving lunches was first launched in Holland in 1900.This involved the provision of lunch to about 80% of the primary school pupils motivating them to attend school and used to travel long distances to school .as a way (FAO 2005:15, Gunderson 2007). According to Dr Huber due to the support which was rendered by teachers, there was an improvement in school performance and attendance. His recommendations led to a national order that schools in urban centres should provide lunch for their children and the government provided funds for this(Gunderson 2007).England passed an education provision of meals act in 1905 which lead to the coming up of 365 nongovernmental organizations to support school feeding programs. Programmes of feeding school children spread to other countries like Italy and United Kingdom by 1930 with an aim of improving growth of children (Gunderson 2007).

School feeding is key to the removal of today-to day hunger .As per the research from WFP ,feeding the children on breakfast can improve school performance.(WFP, 2007). Studies show that breakfast contributes a lot to a child’s nutrient intake and a child who misses it has high chances of suffering from nutrient deficiency diseases (Kazianga, 2009).Studies fro south Africa indicate that one among five rural and Urban black and white primary schools pupils miss breakfast before going to school (Labadarios, 1997:91) .Children get one-third their daily from breakfast and other nutritional requirements.Low income countries experience challenges in trying to manage school feeding programmes because of their low income per capita and cultural differences to support the programme. School feeding programmes are also faced with challenges like supply, distribution and storage.

2.2 Benefits of school feeding programmes

For one to tackle hunger school feeding programme is the most commonly used tool to address it world wide. This program is directly linked to the Millennium development Goals ( MDG 2000).

The first Mellenium development Goal is concerned with the addressing Poverty and hunger where it is expected that by 2015, the proportion of people living below one dollar per day will have reduced by a half counting from 1990.While the second is for achieving universal primary education.it is expected that by 2015 children are able to complete a full course of primary but hunger reduces the chances of these children by reducing their leaning capabilities.As for the case of Gender disparities among boys and girls ,hunger reduces the chances of girls attending school as they are at home working in fields and end up getting married early and the cycle continues(FAAO,2005)

Good feeding in schools with enough and nutrient foods would cattail the problems of children’s undernutrition such as wasting and mineral deffeciency like Iron.Therefore when children are properly feed it improves their cognitive and effectiveness..It is believed that school feeding increases the time the child spends in school.It also improves factors such as the number of children attending school,reaching school in time and starting school at the correct age.In areas where poverty and hunger are at its highest peak,school feeding reduces the amount of money spent when sending children to school and thus enrollment in schools is increased. Giving children food to take home is a big motivation mostly in poor communities (Grantham-McGregor 2005:S145).

The following figure summarizes the benefits of the programmes

Source: (Adelman, Gilligan et al. 2008:10)

2.3 Nutrition and academic performance

The association between Nutrition and academic performance has been documented world-wide most especially the negative effect of under nutrition. Among others, Averett and Stifel (2007) did a study on childhood over and underweight on cognitive functioning and conclude that undernourished children tend to have lower cognitive capabilities when he compared with well fed children. Furthermore, Alaimo et al. (2001) in their study, they concluded that children ranging from 6 to 11who come from households which are food insecure perform poorly in arithmetic tests, were likely to repeat a class many times and had difficulty in getting along with other children Kaestner and Grossman (2009) found out that children who lie in the bottom and top of weight distribution scored less in tests than those in the middle position of the weight distribution.

Published Research reviewed by Taras (2005) shows that there is a relationship between nutrition among school-aged children and their academic achievement in school and on their cognitive functioning. From his findings also it shows clearly that children with iron deficiencies were likely to perform poorly in school unless they received iron supplementation. Food shortage is a serious problem affecting children’s ability to learn. By giving children breakfast is the most effective way of eliminating this problem and thereby increasing their academic performance.

2.4 School feeding globally

The following International organizations are the biggest players in the current school feeding programmes globally.

2.4.1 World Food Programme (WFP)

World Food Programme is the leading world-wide organization the deals with the provision of food with an objective ‘Building Stronger partnership to End Hunger” It works with both National and international both private and public organizations with an aim if ending hunger. By 2005 WFP was already working with around 2200 Nongovernmental Organizations and 74 countries (WFP, 2006).

WFP works with educational institutions through flexible process. The educational institutions it works with are those in emergency areas which are food insecure. And their educational needs are unmet. These institutions have a high dropout rate, few children attend school and have big gender disparities. The aim of WFP is to make sure that food aid is given to schools where it is efficiently and well utilized. To make sure this is fulfilled it works with partner organizations both at national and international level in the area where it oprearates.It ensures that food is properly stored, prepared and proper hygiene is maintained (WFP 2006).

As per WFP standard formula, children aged between 3 to 5 years (pre-school) receive 6720KJ with 32g of protein where as those from 6 to 12 years(primary school) receive 8400KJ with 40g of protein (WFP 2005).

The documented amount of protein is based on the standard consumed locally, assuming 85% digestibility rating. Studies have shown that school breakfast can enhance student energy levels and their attention to studies. It also clearly shows that school feeding and take home food when combined raises the attendance by at least 30%.

By supporting FFE programmes that provide school feeding and/or take-home rations, the WFP intends to support efforts aimed at achieving universal primary education and reducing gender disparities in education (WFP 2006, Gelli, Meir & Espejo 2007:149).

Over the past 40 years the FFE programmes have been handed over to host governments in more than 30 countries, enabling WFP to focus its efforts on a growing number of children and schools most in need (WFP 2006).

2.5 Products used in school feeding globally

Children across the world have different tastes and customs. The World Food Programme (WFP) delivers fortified corn soya blend (CSB) for school feeding projects across the world. In the Lao People’s Democratic Republic, villagers follow some unique recipes to prepare it. The cooks, who are usually the mothers of the schoolchildren involved, steam the CSB in a wok over a stove or open fire. Local ingredients such as pumpkin or bananas are added, creating different flavours. Adding coconut, or wrapping the CSB in a parcel of banana leaves before cooking, adds to the taste and nutritional value and is a creative food preparation method (WFP 2006). It is evident from the above literature that similar products are used worldwide for inclusion in school feeding programmes. Easy preparation is the key factor and therefore most of the products used are instant or dry ingredients mixed with water. Where possible, cooking is limited and if necessary, done by mothers or caregivers from the local community.

In Uganda the major materials used for preparing the foods are maize flour and beans in almost all schools in the country.

2.6 Problems in school feeding programmes

2.6.1 Common problems globally

It is well known that school feeding is expensive and logistically complicated. Problems of school feeding programmes across the world include the following:

Irregular delivery of supplies;

Food lost through theft and spoilage;

Culturally unacceptable food being served;

Inadequate rations in kilojoules and nutrients;

Disruption of teaching to prepare meals if community workers are not available;

Burdensome monitoring and reporting of the programme;

Costs of school feeding will generally be high, but will depend substantially on the mechanisms for food preparation and delivery. An important consideration is the extent to which the rest of the family benefits from the programme because of children taking food home to give to younger brothers and sisters (Jamison & Leslie 1990:209).

2.7 A review of the impacts of school meals programs

Food for education is a programme that is meant to serve food at school and children go home with some. This programme has been used to design a policy which would help In the achievement of the millennium development Goals of universal primary education for all and alleviation of poverty and Hunger among the population of low income countries.

Research has showed that school feeding programmes has a big change on a child’s his/her educational achievement as it improves the performance in test scores and reducing dropout (Ahmed, 2004). Tan, Lane, and Lassibille (1999) “evaluated the impact of the school feeding program in the Philippines, and they found that the impacts of the school feeding program were not significant at the school level”.

A study conducted in Malawi by WFP showed that a small, pilot, school feeding program over a three-month period led to a 5 percent increase in enrollment and up to 36 percent improvement in attendance (WFP 1996). An evaluation of a school meal program in Jamaica found that after the first semester, the treatment class showed improved school attendance compared to the control classes (Powell, and Grantham-McGregor 1983). Another evaluation of a school feeding program in Burkina Faso found that school canteens were associated with increased school enrollment, regular attendance, consistently lower repeater rates, lower dropout rates, and higher success rates on national exams, especially among girls (Moore, and Kunze 1994). However, in a schools with and without the school feeding program (Meme et al.1998).

School feeding programs have also proven effective in reducing the education gap between girls and boys. For example, program evaluation results from Pakistan, Morocco, Niger and Cameroon show that while food is the initial motivation for sending girls to school, parents of participating girls develop an interest in the education of their daughters. This change in attitudes is an important factor in enhancing parents’ commitment to education beyond the duration of food assistance (WFP 2002a).

School feeding programs are likely to improve the nutrient intake of participating children. A study in Huaraz, Peru shows that children who received breakfast at schools, dietary intake of energy increased by 2 percent, protein by 28 percent, and iron by 4 percent compared to the control group (Jacoby et al. 1996). An evaluation of a school feeding program in Jamaica assessed the dietary impact of school breakfast consisting of a bun and half pint of milk. Results showed that the program provided 32 percent and 45 percent of daily energy and protein requirements, respectively (Chambers 1991). In Brazil, a study of a large school lunch program examined the impact of the program on consumption of calories and protein by school children in Sao Paulo. Participation in the program was associated with an increased availability of 357 calories and 8.5 grams of protein (Dall’Acqua 1991).

CHAPTER THREE; STUDY METHODOLOGY

3.0 Introduction

This chapter describes the research design and methodology of the study that is research design, target population, sampling design and sample size, research instruments, data collection procedures, validity and reliability of the research instruments and data analysis techniques.

3.2 Research Design

The study will be a comparative cross-sectional study design children in primary four attending 2 schools selected using a simple random sampling (involving only schools with more than 700 participants as primary sampling units) in Kisoro district. The overall design of this study will be comparative as it will entail studying two contrasting cases (beneficiaries and non beneficiaries), using identical methods. The evaluation method employed in this study will be comparing the outcomes of feeding program and non program schools using what is known as the “with-without” approach (Geda 1999). Thus the method will compare schools/household with the program and those without, as a way to measure the impacts of the school feeding programme on the various scholastic aspects. This approach assumes that both schools with and without school feeding programs and corresponding households have similar characteristics (in terms of, for example, income, household head age and education level distribution), and any observed differences between them are attributed to the effect of program.

3.3 Description of study area

Kisoro District is a district in Western Uganda. Like most other Ugandan districts, it is named after its ‘chief town’, Kisoro, where the district headquarters are located. Kisoro District is bordered by Kanungu District to the north, Kabale District to the east, the Republic of Rwanda to the south and the Democratic Republic of the Congo to the west. The district headquarters at Kisoro are located approximately 42 kilometers (26 miles), by road, northwest of Kabale, the largest town in the sub-region. Kisoro District is inhabited by primarily by the Fumbira, comprising Hutu, Tutsi, and Twa tribes. Fumbira dialect, which is similar to Kinyarwanda, is spoken in the district. Iryaruvumba and Kirundo primary schools are Government-Owned Primary Schools in found in Kirundo Sub-County-Kisoro District.

3.4 Study population

The study population will be participants in the sampled schools, school headmasters and house hold representatives.

3.5 Sampling technique and Sample Size determination

There are a number of schools in Kisoro district both government and privately supported schools with and without school feeding programmes. This study is however conducted in any two schools selected from Kirundo Sub County with a population of more than 700 participants.The sample size is calculated using the following formula:

equation M1

Where n is the required sample size. For Zα, Z is a constant (set by convention according to the accepted α error and whether it is a one-sided or two-sided effect) .This will be performed at a level of significancy of p =5% and it will depend on the following;

Power of the study

Expected effect size

Underlying event rate in the population

Standard deviation in the population.

The household sample consists of households located within 5 kilometers of distance from the schools and at the same time those who have got at least one child in any of the two primary schools. These households will be stratified based on whether they have children in program or non program schools. A list of all such households will be obtained from administrative units and within the district with the help of local field assistants.

3.6 Method of data collection

The study will use questionnaires, interviews and observation. The questionnaires are preferred tools for this study because they will enable the researcher to get views from a larger number of respondents within a short time, thus making it easier to collect relevant information. It also saves a lot of time hence respondents would have time to go through each item. The questionnaires are developed based on the objectives of the study and the research questions. The questionnaires will contain both open-ended and closed-ended questions. The close-ended questions will be designed to get the exact information while the open-ended items will be used to get opinions and views of respondents. The interviews will be conducted with the administration of the questionnaires and will be conducted in a manner that the respondents are free to speak and give their views. Questionnaires will be administered to households to collect demographic and socio-economic data; and school records together with classroom registers will be used to collect information on school variables and attendance respectively. 

3.7 Data collection procedures

3.7.1 Academic achievement

Academic achievement will be assessed using unstandardized tests in English (ELA) and mathematics (MA), which were tailored to record what the children had learnt in class. Use of unstandardized methods will attempt to accommodate the unique differences reported among children, a few of which include learning environments, socio-economic backgrounds and gender. I shall also consider the fact that this kind of testing can bring all the children to the same level of knowledge, having been taught the same content by the same teacher and under more-or-less similar learning conditions; unless otherwise stated, ELA and MA will be assessed by testing the children after they have been given lessons in these subjects, following the curriculum objectives designed by the MOES. The selected children will be taken out of their original classroom and taught in a separate room, which will have adequate space to ensure comfort in both sitting and writing the tests, as well as teacher’s movement in class to attend to the students.

The outcomes of achievement will be measured as scores of written and verbal responses, subsequently awarded out of a maximum of 100 points per subject and 200 points for all subjects (traditionally used by the Ugandan education system).

The two concepts taught and assessed in each subject were ‘place values’ and ‘measures’ in Mathematics; and ‘tenses’ and ‘grammar’ in English; the teaching and assessment being guided by the national curriculum.

3.7.2 School attendance

Data on school attendance (obtained from school registers) will be used to calculate attendance rates. From the total number of school open-days (n=175), a proportion of days attended by the child will be calculated and multiplied by 100, to obtain the attendance rate.

3.7.3 Food intake and feeding patterns

Data on food intake and feeding patterns will be obtained from both the household questionnaire and children’s questionnaire. A section on the household questionnaire concerning child characteristics will ask for information on whether the child consumed breakfast/ lunch, where from and the type of meal. The pupil’s questionnaire will contain questions requiring similar responses as above, but directed to the pupil, in order to corroborate information given by the parent or guardian.

3.7.4 Child level data

Anthropometric measurements of all selected children will be taken height rods, MUAC tapes and weighing scales. Weight and height of each pupil will be determined according to standardized methods (UN, 1986), using a calibrated weighing scale with a precision of 0.5 kg and a height rod with a precision of 0.1 cm. The Seca 150 weighing scale which will be used for measuring the children will been calibrated with a 25 kg water-filled jerry-can every day in the first week and once in the second school. The nutrient intake from the school meals of the children enrolled in the SFP School will be determined using one-day weighed dietary records.

3.8 Pretesting the Questionnaires

The questionnaires will be pre-tested in the two sampled primary schools in the district after which the same will be repeated after two weeks. The purpose of pilot – testing will be; to establish whether they could be used to collect the relevant data.

Identify any problems likely to be encountered by the respondents in completing the questionnaires.

To check whether instructions in the questionnaires will be clear and understandable to the respondents.

3.9 Data Analysis Techniques

Data will be entered using the Statistical Package for Social Sciences (SPSS version 16.0, SPSS Inc; Chicago, USA). Univariate analyses will be conducted to obtain summary statistics (frequencies, means and standard deviations) of the variables investigated. Bivariate associations (correlation tests) will be calculated to test for associations between subjects. Multivariate analysis (Logistic regressions) will be carried out to model academic achievement as a function of covariates (including household size, proportion of school days attended, gender of head of household, feeding habits, child’s age category and household wealth etc). A p-value of 0.05 or less will be used as the probability level at which differences will be considered significant.

3.10 Ethical considerations

For purposes of ethical considerations, participants will be assured of confidentiality and their consent will be sought before the commencement of the discussions. As a result the names of the participants will not be included in the report. Ethical approval will be obtained from the higher degrees, research and ethical committees of Gent University. In addition, permission to conduct the study will be obtained from the District Education Officer, who is the representative of Ministry of Education, local authorities that govern the communities in which the schools are situated. Written informed consent from the mothers will be sought from respondents before interviews begin. Participants will be informed that there will be minimal or no risk to their participation in the study, that participation is voluntary, confidential and that they could withdraw their participation anytime during the interview. They will also be informed that refusing to participate will not affect the usual services they normally access at the hospital. Written informed consent was obtained from the parents and guardians or caretakers of all the children in the target class before their selection, following a meeting where the purpose of the study was thoroughly explained.