Nourishing the next generation with school feeding programs
Talking Nutrition Editors
Nutritional interventions in schools
- Worldwide, approximately 149 million children under five are cognitively and physically stunted and more than 49 million suffer from wasting, indicating the global prevalence of malnutrition.
- One way of reaching malnourished children is through school feeding programs (SFPs). But to ensure these programs are successful and meet their objectives, they need to be nourishing.
- In this article we look at how DSM provides its partners with innovative, affordable and accessible nutritional solutions that help them implement SFPs, which make a proven public health imprint.
Reporting from the 21st Global Child Nutrition Forum
Just recently, the Global Child Nutrition Forum (GCNF) held its 21st annual meeting in Cambodia, bringing together policymakers, nutrition leaders and influencers from across the private and public sectors. Below are our key takeaways from the event.
Facts on the increasing burden of hidden hunger
Inadequate nutrition, seen in individuals who experience hidden hunger, can have a major, long-lasting impact on human physical and cognitive health and development, with deficiencies related to a wide range of issues. For young infants, children of school age and adolescents, where significant growth occurs, hidden hunger can negatively affect overall health, learning and cognitive function, as well as productivity and performance later in life. Local studies in Ethiopia indicate that 31% of school children are undernourished, out of which 19.6% are stunted, 15.9% underweight and 14.0% considered wasted.1,2 Further studies report that 47.4% of preschool-aged children and 25.4% of school-aged children suffer from anemia, or vitamin B12 deficiency, as a result of inadequate micronutrient intake.3 Anemia in children can contribute to higher risk of disease and infection, poor cognitive development, impaired physical growth, poor school performance and work capacity, which, in turn, can limit social and economic development.4,5
Empowering brighter futures for the next generation with SFPs
A healthy, balanced diet is always recommended to improve nutritional status in children, but, in many cases, this is not easily achievable, particularly in countries with limited access to affordable, nutritious foods or where availability of food is low. In addition, some key nutrients are more expensive than others or difficult to attain from diet, such as calcium and vitamin A. Whereas previous nutritional approaches have mainly focused on children consuming enough calories and not going to school hungry, there is an increasing focus on strategies that provide improved nourishment to children, i.e. more vitamins and minerals, to help communities and nations thrive.
Evidence suggests that well-designed SFPs can promote macro and micronutrient adequacy in childrens’ diets, leading to enhanced nutrition and health, decreased morbidity and increased learning capacities.6 Furthermore, a World Bank report indicates that fortified school meals or snacks consistently reduce anemia prevalence and improve micronutrient status.7 These reports are in line with key findings from the 2019 GCNF conference, which indicated that SFPs should be designed to meet the needs of children from early childhood and beyond; SFPs should be included in the national development agenda; multi-sectoral partnerships are essential for successful, transformative SFPs and communities, civil society, academia and the media must continue to be empowered and educated.8
How fortification enables long-lasting benefits
Arnold Kawuba, Partner Engagement and Management for Nutrition Improvement, DSM, says: “Industrial and point-of-use fortification have long been implemented in food-based strategies to alleviate micronutrient deficiencies. As such, they are considered one of the most safe, effective and affordable tools to enhance the nutritional value of food products. In children of school age, fortification is proven to reduce incidence of chronic illness and support better cognitive and physical development, contributing to improved overall academic performance and productivity, as well as positively impacting quality of life and wellbeing in adulthood. Similarly, point-of-use fortification has been successfully used in school interventions to improve nutritional status and overall health of children. Yet, despite the scientifically proven benefits of fortification, there are still misunderstandings about what it is and how it can benefit young people.”
The primary methods of fortification include:
1. Staple food fortification
Staple foods such as wheat, maize (corn), rice, vegetables, oils and sugars can be fortified on a commercial scale by adding or replacing essential vitamins and minerals at the processing stage. This cost-effective, safe method to provide additional nutrients in the diet has proven effective in reducing micronutrient deficiencies, as well as yielding significant return on investment. As a result, staple food fortification is now mandatory in many countries across the world.
2. Point-of-use fortification
Powdered vitamins and minerals, also known as micronutrient powders (MNPs), are scientifically proven to provide the nutrients that children need to ensure their best possible growth and development. Mixed directly into ready-to-eat, semi-solid foods, MNPs are typically supplied in single-dose sachets, or as multiple servings for use in school feeding or home programs. As MNPs come in a convenient format, and are easy to integrate into meals with minimal changes to taste and appearance of food or eating habits, they are already used as an effective and safe food-based intervention in numerous populations globally. In one study, in children aged 2-12 years, those that received point-of-use fortification were significantly less likely to develop anemia or iron-deficiency and also less likely to have diarrhea compared to children receiving no intervention.9
For maximum effectiveness, education and awareness of the health benefits fortification can provide is crucial to allow people to understand the product and how it is used, as well as the importance of good hygiene practices.
Connecting the dots for success
Population-level strategies, home interventions and other public health approaches that utilize food fortification, or educate individuals on the benefits of consuming a nutritious diet, can significantly benefit children of school age who live in vulnerable communities, helping them to meet their full potential. It also produces high returns in education, health and nutrition, local economies and agriculture.
Already, there has been significant global investment into developing effective, affordable and accessible nutritious feeding programs or fortified foods that can be scaled-up to meet nutritional gaps and improve the micronutrition status of vulnerable populations worldwide. However, further collaboration is essential. Governments, NGOs, donors and those across the supply chain, including food manufacturers, farmers, schools and nutrition experts, must lead the way and work together to identify and implement nutrition-sensitive, sustainable school feeding strategies that will meet specific country goals and support regional and global economies. Countries that do not engage with food-based interventions risk a significant missed opportunity, with children in need not receiving the benefits that food fortification and biofortification can provide.
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- Degarege D, Degarege A, Animut A. Undernutrition and associated risk factors among school age children in Addis Ababa, Ethiopia. BMC Public Health. 2015;15:375. https://doi.org/10.1186/s12889-015-1714-5.
- Wolde M, Birihan Y, Chala A. Determinants of underweight, stunting and wasting among schoolchildren. BMC Public Health. 2015;15:8. https://doi. org/10.1186/s12889-014-1337-2.
- WHO, ‘Global anemia prevalence and number of individuals affected’, [website], https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en/ (accessed 25 April 2019).
- Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr. 2001;131(2):649–666.
- Nokes C, van den Bosch C, Bundy DAP. The Effects of Iron Deficiency and Anemia on Mental and Motor Performance, Educational Achievement, and Behaviors in Children. An Annotated Bibliography. Washington, DC: INACG and ILSI Press; 1998.
- Jomaa et al. (2011) School feeding programs in developing countries: impacts on children's health and educational outcomes. Nutrition reviews, 69(2), 83-98.
- Bundy et al. (2018) Optimizing Education Outcomes: High-Return Investments in School Health for Increased Participation and Learning. Disease Control Priorities, Vol 1. World Bank Group.
- The 20th Global Child Nutrition Forum 2018, ‘National School Meal Programs for Food and Nutrition Security and Multiple Social Benefits’.
- WHO, ‘WHO Guideline: Use of Multiple Micronutrient Powders for Point-of-Use Fortification of Foods Consumed by Infants and Young Children Aged 6–23 Months and Children Aged 2–12 Years’, 2016.
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