Effect of integrated school-based nutrition education on optimal dietary practices and nutritional status of school adolescents in Southwest of Ethiopia: a quasi-experimental study
-
Dessalegn Tamiru
,
Alemayehu Argaw
Abstract
Background:
Malnutrition and infection are major barriers to educational access and achievement in low-income countries and also work in conjunction with each other in deteriorating wellness and productivity of school adolescents.
Methods:
A quasi-experimental design was used to evaluate the effectiveness of school-based nutrition education using a peer-led approach, health promotion through school media and health clubs. Data were collected at baseline, midline and end line from sampled participants. To account for the effect of time trend, the difference was measured using a repeated measure analysis. Variables that have p≤0.25 in the bivariate analyses were entered into multivariables to determine the independent effect of interventions.
Results:
There is a significant difference in food variety between food secure and insecure households (p<0.01). A significant improvement of animal source dietary intake was observed among intervention schools (p<0.001) that was significantly associated with an intervention [adjusted odds ratio (AOR)=0.26, confidence interval (CI): 0.16, 0.42], male gender (AOR=0.48, CI: 0.31, 0.73) and household economic status (AOR=1.69, CI: 1.01, 2.84). The control group had high body mass index (BMI) at baseline, but a significant improvement was observed among the intervention schools, which positively associated with male gender (AOR=4.13, CI: 2.38, 7.15) and having a middle-income family (AOR=2.93, CI: 1.92, 6.15).
Conclusion:
This study showed that by integrating a dietary intervention into school-based activities, there might be significant improvements in dietary intake of primary school adolescents. Therefore, school-based nutrition education programs should be a part of comprehensive school health programs to reach the students and potentially their families.
Acknowledgments
The authors would like to express their sincere gratitude to the World Bank and Jimma University for facilitating the study and study participants for their diligence and dedication in collecting and inputting the high-quality data used for the study.
Conflict of interest statement: The authors declare that they have no competing interests.
Authors’ contributions: The authors’ responsibilities were as follows: DT, AA, MG, TB, GA and AN, participated and supervised the study and made a substantial contribution to the implementation of the study. DT and AA designed the study and had the primary responsibility for the content and finally submitted the paper for publication. We are extremely grateful to school adolescents and their caregivers involved in the study.
References
1. Pollit E. Malnutrition and infection in the classroom. Paris: UNESCO, 1990.Suche in Google Scholar
2. Levinger B. Nutrition, health and learning: current issues and trends. School Nutrition and Health Network Monograph Series #1. School Nutrition and Health Network, USA, 1992.Suche in Google Scholar
3. UNESCO/UNICEF/WHO/The World Bank. Focusing Resources on Effective School Health: A FRESH start to enhancing the quality and equity of education. World Education Forum 2000, Final Report. Dakar, Senegal, 2000.Suche in Google Scholar
4. Kirby D, Short L, Collins J, Rugg D. School based programs to reduce sexual risk behaviors: A review of effectiveness. Public Health Rep 1994;109:339–61.Suche in Google Scholar
5. Rodrigo CP, Aranceta J. Nutrition education in schools: experiences and challenges. Eur J Clin Nutr 2003;57(Suppl 1):S82–5.10.1038/sj.ejcn.1601824Suche in Google Scholar PubMed
6. Rao GMS, Rao DR, Venkaiah K, Dube AK, Sarma KVR. Evaluation of the food and agriculture organization’s global school-based nutrition education initiative, Feeding Minds, Fighting Hunger (FMFH), in schools of Hyderabad. Public Health Nutr 2006;9:991–5.10.1017/PHN2006974Suche in Google Scholar
7. Fahlman MM, Dake JA, Mccaughtry N, Martin J. A pilot study to examine the effects of a nutrition intervention on nutrition knowledge, behaviors, and efficacy expectations in middle school children. J School Health 2008;78:216–22.10.1111/j.1746-1561.2008.00289.xSuche in Google Scholar PubMed
8. Rutter M. Pathways from childhood to adult life. J Child Psychol Psychiatry 1989;30:25–51.10.1111/j.1469-7610.1989.tb00768.xSuche in Google Scholar PubMed
9. Peters L, Kok G, Ten Dam G. Effective elements of school health promotion across behavioral domains: a systematic review of reviews. BMC Public Health 2009;12:182–96.10.1186/1471-2458-9-182Suche in Google Scholar PubMed PubMed Central
10. Bundy AP, Shaeffer S, Jukes M. Disease control priorities in developing countries: school-based health and nutrition programs. Wallingford, Oxford Shire: CABI Publishing, 2008.Suche in Google Scholar
11. Aldinger C, Jones J. Healthy nutrition: an essential element of a health-promoting school. WHO Information Series on School Health. Document four. Geneva: WHO, 1998.Suche in Google Scholar
12. Hall A, Kassa T, Demissie T. National survey of the health and nutrition of schoolchildren in Ethiopia. Trop Med Int Health 2008;13:1518–26.10.1111/j.1365-3156.2008.02168.xSuche in Google Scholar PubMed
13. Aweke KA, Habtamu F, Akalu G. Nutritional status of children in food insecure households in two districts of North Showa Zone, Ethiopia. Afr J Food Agric Nutr Dev 2012;12:5915–27.10.18697/ajfand.50.11240Suche in Google Scholar
14. Demissie F, Petros B, Kebede A. Hookworm species distribution among schoolchildren in Asendabo town, Jimma zone, southwest Ethiopia. Ethiop J Health Sci 2008;18.Suche in Google Scholar
15. Alemu A, Atnafu A, Addis Z. Soil transmitted helminthes and schistosomamansoni infections among schoolchildren in Zarima town, northwest Ethiopia. BMC Infect Dis 2011;11:189.10.1186/1471-2334-11-189Suche in Google Scholar PubMed PubMed Central
16. Legesse M, Erko B. Prevalence of intestinal parasites among schoolchildren in a rural area close to the southeast of Lake Langano, Ethiopia. Ethiop J Health Dev 2004;18:116–20.10.4314/ejhd.v18i2.9947Suche in Google Scholar
17. Pollitt E, Golub M, Gorman K. A reconceptualization of the effects of undernutrition on children’s biological, psychosocial and behavioral development. Soc Policy Rep Soc Res Child Dev 1996;10:1–24.10.1002/j.2379-3988.1996.tb00003.xSuche in Google Scholar
18. Black M. Micronutrient deficiencies and cognitive functioning. J Nutr 2003;133:3927S–31S.10.1093/jn/133.11.3927SSuche in Google Scholar PubMed PubMed Central
19. Fernandez PS, Torres-Barahona R, Muela-Martínez JA. Intelligence quotient and iodine intake: a cross-sectional study in children. J Clin Endocr Metab 2004;89:3851–7.10.1210/jc.2003-031652Suche in Google Scholar PubMed
20. Pollit E. Iron deficiency and educational deficiency. Nutr Rev 1997;55:133–41.10.1111/j.1753-4887.1997.tb06464.xSuche in Google Scholar PubMed
21. Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 2001;131:649S–68S.10.1093/jn/131.2.649SSuche in Google Scholar PubMed
22. Sanstead HH, Frederickson CJ, Penland JG. Zinc nutriture as related to brain. J Nutr 2000;130:140S–6S.10.1093/jn/130.2.496SSuche in Google Scholar PubMed
23. Black MM. The evidence linking zinc deficiency with children’s cognitive and motor functioning. J Nutr 2003;133:1473S–6S.10.1093/jn/133.5.1473SSuche in Google Scholar PubMed PubMed Central
24. Pollitt E, Mathews R. Breakfast and cognition: an integrative summary. Am J Clin Nutr 1998;67:804S–13S.10.1093/ajcn/67.4.804SSuche in Google Scholar PubMed
25. Wilson A. Longitudinal analysis of diet, physical growth, verbal development and school performance. In: Balderston J, Wilson A, Freire M, Simonen M, editors. Malnourished children of the rural poor. Boston: Auburn House Publishing Company, 1983:39–79.Suche in Google Scholar
26. Ezeamama AE, Friedman JF, Acosta LP. Helminthes infection and cognitive impairment among Filipino children. Am J Trop Med Hyg 2005;72:540–8.10.4269/ajtmh.2005.72.540Suche in Google Scholar
27. Crompton DW, Nesheim MC. Nutritional impact of intestinal helminthiasis during the human life cycle. Annu Rev Nutr 2002;22:35–59.10.1146/annurev.nutr.22.120501.134539Suche in Google Scholar PubMed
28. World Bank. World development report: investing in health. Oxford, United Kingdom: Oxford University Press, 1993.Suche in Google Scholar
29. Tefera B, David L, Abebe G, Dennis H, Carl L, et al. Food insecurity, food based coping strategies and suboptimal dietary practices of adolescents in Jimma zone southwest Ethiopia. PLoS One 2013;8:e57643.10.1371/journal.pone.0057643Suche in Google Scholar PubMed PubMed Central
30. Steyn N, Nel J, Nantel G. Food Variety and dietary diversity scores in children: are they good indicators of dietary adequacy. Public Health Nutr 2005;9:644–50.10.1079/PHN2005912Suche in Google Scholar
31. Ethiopian Federal Ministry of Health. National nutrition programme. Addis Ababa, Ethiopia, 2013.Suche in Google Scholar
32. Sunguya BF, Poudel KC, Mlunde LB, Shakya P, Urassa DP, et al. Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutr J 2013;12:66.10.1186/1475-2891-12-66Suche in Google Scholar PubMed PubMed Central
33. Kabahenda M, Mullis RM, Erhardt JG, Northrop-Clewes C, Nickols SY. Nutrition education to improve dietary intake and micronutrient nutriture among children in less-resourced areas: a randomised controlled intervention in Kabarole district, western Uganda. SAfr J ClinNutr 2011;24:83–8.10.1080/16070658.2011.11734355Suche in Google Scholar
34. FAO. Food security and nutrition in the context of the global nutrition transition. Rome: Food and Agriculture Organization of the United Nations, 2014.Suche in Google Scholar
35. Kubik MY, Lytle LA, Hannan PJ, Perry CL, Story M. The association of the school food environment with dietary behaviors of young adolescents. Am J Public Health 2003;93:1168–73.10.2105/AJPH.93.7.1168Suche in Google Scholar
36. FAO. Agricultural censuses and gender considerations. Rome, Italy, 2001. http://www.fao.org/docrep/003/x2919e/x2919e04.htm.Suche in Google Scholar
37. Thang NM, Popkin BM. Patterns of food consumption in Vietnam: effects on socioeconomic groups during an era of economic growth. Eur J Clin Nutr 2004;58:145–53.10.1038/sj.ejcn.1601761Suche in Google Scholar PubMed
38. World Health Organization. WHO global database on child growth and malnutrition. WHO/NUT/97.4, 1997.Suche in Google Scholar
39. Kristen D, Chery S. Food-related attitudes and behaviors at home, school, and restaurants: perspectives from racially diverse, Urban, low-income 9 to 13-year-old children in Minnesota. J NutrEduc Behav 2010;42:389–97.10.1016/j.jneb.2009.09.003Suche in Google Scholar
40. Chisa S, Masaki M, Mohamed K, Junichi T, Mwatasa C, et al. Factors associated with stunting among children according to the level of food insecurity in the household: a cross-sectional study in a rural community of South-eastern Kenya. BMC Public Health 2015;15:441.10.1186/s12889-015-1802-6Suche in Google Scholar PubMed PubMed Central
41. Chau D, Takehito T, Masashi K, Keiko N, Kaoruko S. Consumption of animal source foods and dietary diversity reduce stunting in children in Cambodia. Int Arch Med 2013;6:29.10.1186/1755-7682-6-29Suche in Google Scholar PubMed PubMed Central
42. Lisa C, Marie T, Aida N. Why is child malnutrition lower in Urban Than in rural areas? Evidence from 36 developing countries. World Dev 2005;33:1285–305.10.1016/j.worlddev.2005.03.002Suche in Google Scholar
43. Omigbodun O, Adediran k, Akinyemi J, Omigbodun A, Adedokun B. Gender and rural urban differences in nutritional status of in-school adolescents in south-western Nigeria. J Biosoc Sci 2010;42:653–76.10.1017/S0021932010000234Suche in Google Scholar PubMed
44. Barker M, Chorghade G, Crozier S, Leary S, Fall C. Socio-economic factors, lifestyle and gender differences in body mass index in rural India. J Nutr 2006;136:3062–8.10.1093/jn/136.12.3062Suche in Google Scholar PubMed PubMed Central
45. Ndiku M, Jaceldo-Sieg K, Singh P, Sabate J. Gender inequality in food intake and nutritional status of children under 5 years old in rural Eastern Kenya. Eur J Clin Nutr 2011;65:26–31.10.1038/ejcn.2010.197Suche in Google Scholar PubMed
46. Fernando C, Cesar G, Robert S, Davidson G. Socioeconomic inequities in the health and nutrition of children in low/middle income countries. Rev SaúdePública 2010;44:1–16.10.1590/S0034-89102010000100001Suche in Google Scholar
47. Mandefro A, Mekitie W, Mohammed T, Lamessa D. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in BuleHora district, South Ethiopia. BMC Public Health 2015;15:41.10.1186/s12889-015-1370-9Suche in Google Scholar PubMed PubMed Central
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Artikel in diesem Heft
- Gastrointestinal dysfunction and autism: caution with misdiagnoses as many mysteries remain to be unraveled!
- Effect of integrated school-based nutrition education on optimal dietary practices and nutritional status of school adolescents in Southwest of Ethiopia: a quasi-experimental study
- Promoting the sexual and reproductive health of adolescent females in Ijebu-Ode, southwest, Nigeria: a study of sexual risk-taking
- Characterization of physical activity in undergraduate students in Israel
- Immediate drop-out rate in adolescent substance abusers: an out-patient chart review from North India
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- External criticism by parents and obsessive beliefs in adolescents in Iran: the mediating role of emotional self-regulation
- Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria
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Artikel in diesem Heft
- Gastrointestinal dysfunction and autism: caution with misdiagnoses as many mysteries remain to be unraveled!
- Effect of integrated school-based nutrition education on optimal dietary practices and nutritional status of school adolescents in Southwest of Ethiopia: a quasi-experimental study
- Promoting the sexual and reproductive health of adolescent females in Ijebu-Ode, southwest, Nigeria: a study of sexual risk-taking
- Characterization of physical activity in undergraduate students in Israel
- Immediate drop-out rate in adolescent substance abusers: an out-patient chart review from North India
- Dysmenorrhea and self-care strategies in Iranian female students: a regression modeling of pain severity and underlying factors
- Hookah addiction among adolescents of five major cities in Central India
- Characteristics of sleep habits among adolescents living in the city of Ribeirão Preto (SP)
- Pathways between BMI and adherence to weight management in adolescence
- Barriers to disclosure of child maltreatment among school-going adolescent girls of a semi-urban area of Delhi, India
- Long-term positive and negative psychosocial outcomes in young childhood cancer survivors, type 1 diabetics and their healthy peers
- External criticism by parents and obsessive beliefs in adolescents in Iran: the mediating role of emotional self-regulation
- Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria
- The nurse-patient communication: voices from nursing students
- The Tarunya Project’s efforts to improve the quality of adolescent reproductive and sexual health services in Jharkhand state, India: a post-hoc evaluation
- Abdominal lymphadenopathy in an adolescent with Kawasaki disease: a major sign?
- Electric wire in the urinary bladder in an adolescent boy
- Optimizing enrollment in pediatric obese patients: reflections on recruitment characteristics
