Article type
Year
Abstract
Background:
We have completed two complex systematic reviews on food supplementation: one for young children and one for school children, which was recently updated. In addition to rigorous Cochrane methodology, we used process evaluation to understand which implementation factors were important for the outcomes.
Objectives:
To present results of the reviews and process evaluations, and from this, to identify policy and program implications for those who develop and implement supplemental food programs for children.
Methods:
We carefully followed Cochrane procedures, developing a logic model, standardized searching and involving at least two authors in reviewing searches, inclusion/exclusion and conducting data extraction, analyses and bias assessment. We also conducted relevant subgroup analyses in order to assess key implementation and participant factors.
Results:
Thirty studies were in the preschool review, 27 from low and middle income (LMIC). Eighteen studies were originally in the school meals review with 8 more in the update; 17 from LMIC. We will focus on findings from LMIC. Both reviews showed small effects on weight (preschool: .12 to .25 kg per year, school: .25 to .75 kg per year) and height (preschool: .48 to .67 cm. per year, school .25 to 1.47 cm/year). The preschool review showed significant, moderate effectiveness for psychomotor development in 4 out of 5 studies and both reviews demonstrated significant effects on mental development; school meals showed consistent effectiveness for attendance and performance in math.
Factors that impacted on the effectiveness included the child’s nutritional need, broken supply chains, redistribution of the supplement within the family, amount of energy given in the supplements, parental or school capacity to give food, location and level of staff supervision of the supplementation.
Policy/progam implications:
Food supplementation programs for young children have unexpectedly small benefits for growth; the effects for psychomotor development are somewhat larger in the School feeding programs and have small benefits for growth, and also for attendance and academic performance.
We have completed two complex systematic reviews on food supplementation: one for young children and one for school children, which was recently updated. In addition to rigorous Cochrane methodology, we used process evaluation to understand which implementation factors were important for the outcomes.
Objectives:
To present results of the reviews and process evaluations, and from this, to identify policy and program implications for those who develop and implement supplemental food programs for children.
Methods:
We carefully followed Cochrane procedures, developing a logic model, standardized searching and involving at least two authors in reviewing searches, inclusion/exclusion and conducting data extraction, analyses and bias assessment. We also conducted relevant subgroup analyses in order to assess key implementation and participant factors.
Results:
Thirty studies were in the preschool review, 27 from low and middle income (LMIC). Eighteen studies were originally in the school meals review with 8 more in the update; 17 from LMIC. We will focus on findings from LMIC. Both reviews showed small effects on weight (preschool: .12 to .25 kg per year, school: .25 to .75 kg per year) and height (preschool: .48 to .67 cm. per year, school .25 to 1.47 cm/year). The preschool review showed significant, moderate effectiveness for psychomotor development in 4 out of 5 studies and both reviews demonstrated significant effects on mental development; school meals showed consistent effectiveness for attendance and performance in math.
Factors that impacted on the effectiveness included the child’s nutritional need, broken supply chains, redistribution of the supplement within the family, amount of energy given in the supplements, parental or school capacity to give food, location and level of staff supervision of the supplementation.
Policy/progam implications:
Food supplementation programs for young children have unexpectedly small benefits for growth; the effects for psychomotor development are somewhat larger in the School feeding programs and have small benefits for growth, and also for attendance and academic performance.