Improved Effect of School Meals with Micronutrient Supplementation and Deworming

Abstract

A mid-day meal or school lunch program commenced in Gujarat, India from the sixties. In 1994, it was serving approximately 3 million schoolchildren. In 1994, the program was improved with the addition of a "package" of health inputs, including anthelmintics and micronutrient supplementation of iron and vitamin A, and iodine fortified salt. Tara Consultancy Services (TCS), India, a member of the Partnership of Child Development, Oxford University, evaluated Gujarat's improved midday meal program from 1993 to 1996. The program was implemented by the Commissionerate of the mid-day meal program, part of the government of Gujarat. The cost of the 'health package' in 1994, per child per year was 35 U.S. cents (1 U.S. dollars = Rs.30). The study to evaluate the improved program included the following components: FOCUS GROUP DISCUSSIONS: Government officials, teachers, students, parents, and community members participated in focus groups to elicit opinions on the proposed program which were predominantly positive. PROCESS EVALUATION: Logistical delivery defined as the adequacy, timeliness and cost of procurement of the anthelmintic drugs and micronutrients and the cost of this 'health package' per schooler per school year by the pharmaceutical companies was 100%. Efficiency of logistics to the schools, defined as the efficiency and cost of logistical delivery of the 'Health Package' from the State Head Quarters to the District to the Taluka to the School was 100%. Coverage defined as consumption of the 'Health Package' by schooler at least once in the 6-9 months of the school year, as stated by the implementing agency was 94%-100% (urban) and 42%-94% (rural); coverage as stated by the schoolchildren was 71%-79% (urban) and 50%-67% (rural). IMPACT EVALUATION: On average, students who received supplements were 1.1 kg heavier and 1.1 cm taller than those who did not; hemoglobin (Hb) levels were >12 g/dL intestinal parasite prevalence rates dropped from 71% to 39%; prevalence of night blindness and vitamin A deficiency were reduced from 67% to 34%. Since 2003, 4 states in India, namely, Gujarat, Andhra Pradesh, Karnataka, and Tamil Nadu covering approximately 30 million schoolers have adopted the "Gujarat Model."