Dietary intake and nutritional status of primary school children participating in the Botswana school feeding programme, South-east District, Botswana.
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Introduction: Optimal nutrition is essential for the growth and development of primary school children. School-based nutrition interventions, especially in resource limited settings, are important for addressing health problems and the improvement of health, as well as nutritional and educational outcomes. The majority of African countries such as Botswana, are currently experiencing nutrition transition. This concept contributes to the double burden of malnutrition (undernutrition and overnutrition) among children. A change in dietary habits, the adopotion of a sedentary lifestyle, and limited dietary diversity are the some of the outcomes linked to the nutrition transition. . Aim: To determine the effect of the Botswana School Feeding Programme (SFP) (all government schools) on the nutritional status of primary school children in the South-east District when compared to non-beneficiaries of the SFP (private schools). Study design: A school-based, comparative cross-sectional study was conducted among primary school children during the school term and immediately after the school holiday (period of no SFP). Setting: This study was conducted in 13 public and private schools located in urban and peri-urban areas in the South-east District, Botswana. Subjects: 392 sampled primary school learners from public and private schools aged 8 – 13 years of age were sampled. Outcome measures: SFP impact was assessed using household food insecurity status (HFIAS), dietary diversity score (DDS) and anthropometric indices such as weight-for-age (WAZ z-scores), height-for-age (HAZ z-scores) and Body Mass Index-for-age (BAZ z-scores). For the calculation of WAZ, the Centre for Disease Control (CDC) tables were used to interpret weight-for-age of learners older than ten years, as WAZ is only available for children up ten years of age on the World Health Organization (WHO) growth standards. Results: Significant differences (p<0.000) were documented for SFP beneficiaries (intervention) versus non-beneficiaries of the SFP (control) for mode of transport to school, HFIAS and DDS. Significant differences (p<0.000) were also found when comparing urban to peri-urban learners for mode of transport to school, HFIAS and DDS. However, a significant difference between beneficiaries of the SFP (intervention) versus non-beneficiaries of the SFP (control) was not documented for Physical Activity Level (PAL), whereas the PAL of peri-urban learners was significantly higher than that of urban learners (p<0.001). Learners participating in the SFP were receiving inadequate energy, macro- and micronutrient from the food rations provided, as they only received 60% of the Dietary Reference Intake (DRI) for energy, 90% of the Recommended Dietary Allowance (RDA) for protein, 46% of the Estimated Average Requiremment (EAR) for vitamin A and 28% of the Adequate Intake (AI) for calcium when comparing the ration scale to 33% of the DRIs. Discussion: The low DDS of learners participating in the SFP indicated that school meals did not make a significant contribution to the DDS of its beneficiaries. When comparing SFP beneficiaries to SFP non-beneficiaries, despite the fact that the majority of learners in both groups had a normal BAZ, the disparity became more evident for those being at risk for becoming overweight. Nearly a third (29.0%) of non-beneficiaries were at risk for become overweight, whereas the same held true for 18.8% of beneficiaries. A similar trend was echoed when comparing the WAZ between the two groups, as the difference was significant. When comparing the WAZ between urban and peri-urban learners, a significant difference was documented, with learners from urban areas having a lower prevalence of normal weight and a higher risk of becoming overweight than their peri-urban counterparts. In addition, recipients of the SFP had a higher prevalence of underweight when compared to non-beneficiaries. A nutrient analysis of the SFP ration scale indicated that it supplied inadequate levels of energy, protein, vitamin A and calcium. Conclusion and Recommendations: The study findings emphasise the need for targeted school feeding and community-based nutrition interventions and public health awareness campaigns to create an awareness of the importance of eating a diverse diet and being aware of the importance of being physically active for the promotion of health and wellbeing, as well as for the prevention of overweight and obesity among primary school learners. Although learners attending public schools in urban and peri-urban areas as well as private schools may face diverse nutritional challenges as a result of differences in socio-economic status and available resources, it is evident that the dietary diversity and prevalence of overweight and obesity among primary school learners attending both public and private schools in the South-east District, Botswana, requires special attention. Participation in the SFP and resultant food security, may have a positive impact on learner anthropometric status as indicated by the low prevalence of undernutrition and stunting documented in this study sample. In addition, as the BAZ categories did not differ significantly.