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Meta-Analysis
. 2021 Sep 4:11:04051.
doi: 10.7189/jogh.11.04051. eCollection 2021.

Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis

Dongqing Wang  1 , Sachin Shinde  1 , Tara Young  1 , Wafaie W Fawzi  1   2   3
Affiliations
Meta-Analysis

Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis

Dongqing Wang et al. J Glob Health. .

Abstract

Background: School feeding programs are ubiquitous in low- and middle-income countries (LMICs) and may have critical implications for the health and education of school-age children and adolescents. This systematic review aimed to assess the impacts of school feeding on educational and health outcomes of children and adolescents in LMICs.

Methods: Interventional studies on the effects of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs were included. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and grey literature were searched (through December 2019) to identify eligible studies. We included randomized controlled trials and controlled before-after studies on school feeding conducted in LMICs among children and adolescents aged 6 to 19 who received primary or secondary education. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Meta-analyses were performed for outcomes available in three or more independent studies. Subgroup analyses were conducted by study design and school feeding modality whenever possible.

Results: Fifty-seven articles met the inclusion criteria for the review, including 44 randomized controlled trials and 13 controlled before-after studies; 19 articles were included in the meta-analysis. School feeding resulted in a significant increase in height (mean difference = 0.32 cm; confidence interval (CI) = 0.03, 0.61; P = 0.032) and weight (mean difference: 0.58 kg; 95% 95% CI = 0.22, 0.93; P = 0.001) over 12 months, compared to those in the control groups. School feeding also resulted in a significant increase in the percentage of school days attended (2.6%; 95% CI = 1.2%, 3.9%; P < 0.001).

Conclusions: School feeding is an important approach to improving the health and education outcomes of children and adolescents living in LMICs. More well-designed research is needed to establish further the effectiveness of school feeding for nutritional outcomes and academic achievement.

Registration: PROSPERO ID: CRD42020159003.

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Conflict of interest statement

Competing interests: The authors completed the ICMJE Declaration of Interest Form (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Random-effects meta-analysis of school feeding interventions on 12-month height gain (in centimeters), comparing the group receiving school feeding intervention to the control group. I2 = 82.02%.
Figure 3
Figure 3
Random-effects meta-analysis of school feeding interventions on 12-month change in height-for-age Z-score, comparing the group receiving school feeding intervention to the control group. I2 = 4.85%.
Figure 4
Figure 4
Random-effects meta-analysis of school feeding interventions on 12-month weight gain (in kilograms), comparing the group receiving school feeding intervention to the control group. I2 = 93.20%.
Figure 5
Figure 5
Random-effects meta-analysis of school feeding interventions on 12-month change in weight-for-age Z-score, comparing the group receiving school feeding intervention to the control group. I2 = 25.38%.
Figure 6
Figure 6
Random-effects meta-analysis of school feeding interventions on 12-month change in body mass index-for-age Z-score, comparing the group receiving school feeding intervention to the control group. I2 = 33.92%.
Figure 7
Figure 7
Random-effects meta-analysis of school feeding interventions on 12-month change in hemoglobin concentrations (g/L), comparing the group receiving school feeding intervention to the control group. I2 = 23.87%.
Figure 8
Figure 8
Random-effects meta-analysis of school feeding interventions on 12-month change in plasma or serum ferritin concentrations (μL), comparing the group receiving school feeding intervention to the control group. I2 = 57.62%.
Figure 9
Figure 9
Random-effects meta-analysis of school feeding interventions on 12-month change in mathematical or arithmetic skills, comparing the group receiving school feeding intervention to the control group. I2 = 32.37%.
Figure 10
Figure 10
Random-effects meta-analysis of school feeding interventions on 12-month change in school attendance (percentage of possible school days attended), comparing the group receiving school feeding intervention to the control group. I2 = 0.00%.
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