Effects of initial nutritional status on the responses to a school feeding programme among school children aged 6 to 13 years in the Millennium Villages Project, Siaya, Kenya

[摘要] ENGLISH ABSTRACT: Aim: To assess the effects of initial nutritional status on the responses to a school feedingprogramme (SFP) among school children in the Millennium Villages Project (MVP), Siaya District,Kenya.Objectives: To establish baseline data on the dietary intake, prevalence of undernutrition, bodycomposition, prevalence of anaemia, body iron stores and vitamin A status in order to assess theimpact of the SFP over a 30-month period on the same outcomes. Further, the study assessed theeffect of initial nutritional status on the responses to the SFP on growth, the prevalence of anaemia,body iron stores and vitamin A status.Methods: In the MVP, a school meal additional to the children's usual daily food intake wasprovided consisting of locally available foods (containing whole fish omena and beef). The mealscontributed approximately 25% of the Estimated Energy Requirement (EER), 70% of the EstimatedAverage Requirement (EAR) for protein, and 18% of EAR for fat. A school meal, additional to thechildren's usual daily food intake, was introduced to the control group 6 months into the study as aproject scale up initiative. The meal provided 15% EER, 49 % EAR for protein and 10% EAR for fat.A total of 235 children participated in the study and were followed up for 30 months, with 118 in theMVP and 117 in the control group. Statistical analysis included descriptive, Pearson's chi-square test,repeated measures ANOVA and multivariate logistic regression models.Results: The mean subject age was 7.9 years (2.0 SD) at baseline, and half (51.4%) were boys. Morethan half of the children (66%) had energy intakes less than the EER. At baseline, the prevalence ofstunting, wasting and underweight was 16.9%, 6.0% and 3.6% respectively. Prevalence of lineargrowth deficit based on height-for-age z-score ≤-1 standard deviation was 48%. Anaemia was higherin the MVP group (82.2%; P < 0.0001) compared to controls (58.1%) while depleted body iron storeswas observed in 10.7% of the children. Half of the children in the control group and 30% in theMVP group had an inadequate vitamin A status while 11% of the children hadinfection/inflammation. At six months after initiation of the intervention, anaemia prevalence wasreduced to 41.2% among the controls and 9.3% in the intervention group (P < 0.001). Among theMVP group, children with initial inadequate nutritional status based on weight-for-age z-score WAZ≤ -1 SD had a higher (P < 0.01) height velocity (2.3 cm/six months) by the 24th month study intervalcompared to those who had an initial adequate nutritional status based on weight-for-age z-scoreWAZ > -1 SD. Conclusion: SPF menus were associated with potential for improved growth, gain in lean body massand reduced anaemia prevalence when inadequate nutritional status was present at baseline.

[发布机构] Stellenbosch University