Table 7: Summary table of included studies: Observational studies.

Study (year), and Location

Sample Size (n), age of participants

Duration of intervention

Measurement of exposure and outcomes of interest

Summary of key findings

Direction of results

Remarks

Neervoort, et al. [28]

 

Kenya

Intervention group = 67

 

Control group = 81

 

 

 

1 year

 

Exposure Measurement: school based lunch provided on each school day with health education

Outcome measurement: Haemoglobin concentration was measured and adjusted for age and altitude

Anaemia was 19% among the intervention group and 42% anaemia prevalence was recorded among the control group (difference is significant at p = 0.01)

*Positive

 

Intervention is associated with lower anemia levels

 

The following confounders were adjusted for; family size, age and education of mother, adoption status, amount of food consumed at home.

All children were dewormed

Abizari, et al. [41]

 

Ghana

N (total) = 383

SFP participants =

Non-SFP participants =

 

School children aged 5-13 years

 

 

children aged 6-15 years

 

Exposure measurement: School based lunch was provided each school day except on holidays

 

Outcome measurement:

- 24 Hr recalls, weighed food records and biochemical analysis to determine concentrations of Hb, serum ferritin and soluble transferrin receptor

Mean probability of adequacy of micronutrient intake was significantly higher among SFP participants (0.61 vrs 0.18) p < 0.001

SFP participants had 6 g/l higher Hb concentration (p < 0.001) and about 10% points lower anaemia prevalence (p = 0.06)

Concentration of soluble transferrin receptor was lower in intervention group (p = 0.004)

There was no significant difference in iron and iron deficiency anaemia.

 

*Positive

SFP participants had a higher Haemoglobin concentration and lower prevalence of anaemia.

Iron intake was higher SFP participants

 

*Negative

There is no significant difference in Iron deficiency and iron deficiency anaemia among SFP and Non SFP participants

Adjustment was done for background differences.

Study area is hyper endermic for malaria

Corn soy blend which is given is multiple micronutrient fortified and orange was given twice a week

Afridi Farzana [46]

 

India

N (total) = 226

School meal participants = 143

Non school meal participants = 93

 

Children aged children

 

Exposure measurement: Provision of school lunch each school day

 

Outcome measurement:

24 Hr recalls for school day and non school day

Daily iron deficiency was reduced by 10% associated with school feeding during school days

 

Increased iron intake during school days by 3.85 mg (p < 0.001)

 

*Positive

 

School feeding during school days is associated with increased dietary iron intake

 

Walker, et al. [49]

 

Jamaica

N (total) = 147

School meal group = 73

 

Non school meal group = 74

Children aged 7-10 years

 

Exposure Measurement: Children offered lunch in school prepared by school (paid for) during school days

 

Outcome Measurement: -Repeated 24 Hr recalls of dietary nutrient intake

Dietary iron intake was significantly higher in the school meal group (3.4 mg ± 1.8 vrs 0.5 mg ± 0.9)

 

*Positive

School feeding was associated with increase dietary iron intake

 

School meals were relative expensive ($6-10) compared to other cooked meals and lunch items available from shops and street vendors

Harding, et al. [42]

 

Ghana

N (Total) = 193

School feeding participants = 104

School feeding Non participants = 89

 

School children aged 2-5 years

7 months

Exposure measurement: SFP participants received one meal at lunch for each school day. Meals vary

 

Outcome measurement: 24 Hr dietary recalls on two non consecutive days. Blood samples were analyzed for haemoglobin levels

SFP participants had a higher intake of iron compared to non participants but after controlling for confounders SFP participants had a reduced iron intake compared to non participants.

 

There was no significant difference in haemoglobin levels between the two groups.

*Negative

School feeding was associated with decreased dietary iron intake and haemoglobin levels were not significantly different between participants and non participants

Foods used for the feeding programme were contributed by parents, cooked and shared among pupils. Foods were from local sources and not fortified.