Introduction: Mid-Day Meal Scheme (MDMS) was introduced in India with a view to enhancing enrolment, retention and attendance and simultaneously improving nutritional levels among children. The impact of MDMS on nutritional and educational outcomes have been studied extensively. But attempts at synthesizing the findings from these primary studies have been sparse and challenging. To address this gap, we conducted a systematic review to assess the effects of MDM programs, on the nutritional and academic outcomes of school children in India.
Methods: A comprehensive literature search was conducted, and relevant studies published between 1997 and 2022 were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. A qualitative synthesis of the included studies was undertaken. Meta-analysis, though planned, was not performed due to considerable clinical and methodological heterogeneity. The protocol was registered in PROSPERO (ID: CRD42023391776).
Results: Among the 31 studies included for qualitative synthesis, 16 studies focused on academic outcomes, while 18 studies reported children's nutritional status. Several studies showed improvements in stunting and underweight but did not show much favorable outcomes on wasting, weight, and Mid Upper Arm Circumference. While some studies reported marginal improvements in height and weight measurements, others showed no significant improvement. Regular MDMS access improved enrollment, attendance, retention rates, and lower dropout rates. However, its impact on academic performance remains unclear due to conflicting results. The study also found that the nutritional outcomes were better in private schools compared to government-run schools.
Conclusion: Studies on MDMS reported contrasting results on nutritional outcomes. Additionally, the review also noted favorable effects of MDMS on school enrollment, attendance, retention, and dropout rates.