School feeding for improving the physical and psychosocial health of disadvantaged students
(Review)
Betsy Kristjansson 1,Mark Petticrew 2, BarbaraMacDonald 3, Julia Krasevec 3, Laura Janzen 4, Trish Greenhalgh 5,George AWells 6, Jessie MacGowan 7 , Anna P Farmer 8, Beverley Shea 7, Alain Mayhew 7, Peter Tugwell 9, Vivian Welch 9
1 School of Psychology, Faculty of Social Sciences,
2 PEHRU,
3 C/O Cochrane Developmental, Psychosocial and Learning Problems Group,
4 Department of Psychology & Division of Haematology/Oncology, The Hospital for Sick Children,
5 Primary Care and Population Sciences,
6 Cardiovascular Research Reference Centre,
7 Institute of PopulationHealth,University ofOttawa,
8 Department of Agricultural, Food and Nutritional Science and The Centre for Health Promotion Studies,
9 Centre for Global Health,
The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. 2009
Available online PDF [76p.] at: http://bit.ly/bPJD8V
Background
Early malnutrition and/or micronutrient deficiencies can adversely affect physical, mental, and social aspects of child health. School feeding programs are designed to improve attendance, achievement, growth, and other health outcomes.
Objectives
The main objective was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils .
Search strategy
We searched a number of databases including CENTRAL (2006 Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), PsycINFO (1980 to May 2006) and CINAHL (1982 to May 2006). Grey literature sources were also searched. Reference lists of included studies and key journals were hand searched and we also contacted selected experts in the field.
Selection criteria
Data from randomized controlled trials (RCTs), non-randomised controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series studies (ITSs) were included. Feeding had to be done in school; the majority of participants had to be socio-economically disadvantaged.
Data collection and analysis
Two reviewers assessed all searches and retrieved studies. Data extraction was done by one of four reviewers and reviewed by a second. Two reviewers independently rated quality. If sufficient data were available, they were synthesized using random effects meta-analysis, adjusting for clustering if needed. Analyses were performed separately for RCTs and CBAs and for higher and lower income countries.
Main results
We included 18 studies. For weight, in the RCTs and CBAs from Lower Income Countries, experimental group children gained an average of 0.39 kg (95% C.I: 0.11 to 0.67) over an average of 19 months and 0.71 kg (95% C.I.: 0.48 to 0.95) over 11.3 months respectively. Results for weight were mixed in higher income countries. For height, results were mixed; height gain was greater for younger children. Attendance in lower income countries was higher in experimental groups than in controls; our results show an average increase of 4 to 6 days a year. Math gains were consistently higher for experimental groups in lower income countries; in CBAs, the Standardized Mean Difference was 0.66 (95% C.I. = 0.13 to 1.18). In short-term studies, small improvements in some cognitive tasks were found.
Authors’ conclusions
School meals may have some small benefits for disadvantaged children. We recommend further rwell-designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio-economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.
Content:
Header
Abstract .
Plain language summary .
Background
Objectives
Methods
Results .
Discussion
Authors’ conclusions
Acknowledgements .
References
Characteristics of studies
Data and history
Contributions of authors
Declarations of interest
Sources of support
Notes
Index terms
“……Health inequalities have been defined as “the virtually universal phenomenon of variation in health indicators ... associated with socio-economic status” (Last 1995); inequalities may also be seen between different sexes or geographic groups.
Health inequalities require three components for calculation: a valid measure of health status, a measure of social position or status, and a statistical method for summarizing the magnitude of the health differences between people in different social positions.
Health inequities ’are unfair and remediable inequalities’ (Tan-Torres 2001; Peter 2001). Thus, health inequalities are measurable, while health inequities require a value judgment……………” page 5
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