(P06-007-23) Magnitude of Nutritional Effect of the Addis Ababa School Feeding Program on School-Age Children and Adolescents: Evidence From a Longitudinal Study

Objectives: To measure the magnitude of the effect of school meals on nutritional status of schoolchildren.

Methods: A longitudinal study was employed with a multi-stage stratified sampling from 50 schools located in the ten sub cities of Addis Ababa yielded 4500 children of ages five to 19 years. Baseline and follow up data were collected on age, height, weight and MUAC of the school children. The nutritional status of the children was evaluated using conventional anthropometric indicators, modified Composite Index of Anthropometric Failure (mCIAF), and MUAC-for-age. Receiver operating characteristic (ROC) regression was used to examine classification of malnourishment by MUAC-for-age versus BMI-for-age and mCIAF versus MUAC-for-age. Multilevel mixed effects model was applied to investigate variations in the prevalence of malnutrition across sub cities. Repeated measures ANOVA was employed to assess differences in the outcomes over time, and the magnitude of the contribution of school meals on physical growth of the subjects was evaluated using a measure of effect size, η2.

Results: Robust evidence was established that the school feeding intervention has achieved medium to large scale effects on nutritional status (effect size, η2, of 0.02–0.12). ANOVA adjusted for the effects of age, sex, and time showed significant growth change in the mean height-for-age Z-scores (F_{3, 13463} = 507.4, p< 0.0001) overtime with large effect size of 0.123 (0.104, 0.142). Similarly, significant growth changes were observed in mean weight-for-age Z-scores (F_{3, 3803}= 74.1, p< 0.0001) with a medium effect size of 0.06 (0.042, 0.07); that in mean BMI-for-age Z-scores (F_3, 13458 = 66.9, p< 0.0001) with medium effect size of 0.015 (0.01, 0.02); and that in mean MUAC-for-age Z-scores (F_{3, 13482} = 123.7, p< 0.0001) with a minimum of small effect size of 0.03 (0.022, 0.032).

Conclusions: The Addis Ababa school meals were associated with substantial improvement in the nutritional status of school-age children and adolescents.

Funding Sources: Addis Ababa Health Bureau, Ethiopia; Ministry of Health, Ethiopia