Mid-day Meal Programme Research Articles

Benchmarking the Determinants of Nutritional Status among Community Schools’ Children in Nepal

The government of Nepal initiated the Mid Day Meal Program (MDMP) to reduce hunger and increase educational outcomes, including health status. However, limited studies have been conducted on these issues covering the nutritional status of students at the lower basic level at community schools in Nepal. The main objective of the study is to determine the factors associated with malnutrition among children from community schools in Nepal. A school-based cross-sectional study was conducted in 98 (46 basic and 52 secondary) community schools from 44 municipalities in Nepal. Altogether, 2727 students participated in the questionnaire survey and anthropometric measurement. Data collection was performed on May 10-31, 2023. WHO Anthro plus and LMS (Lambda Mu and Sigma) parameters were used: weight for age for national health and nutrition survey recommended by CDC/National Center for Health Statistics for ages older than ten years to analyze nutritional status, including z scores. Descriptive analysis, including inferential analyses such as the chi-square test and logistic regression, was performed using IBM SPSS Statistics v25. The prevalence of weight-for-age Z-score[WAZ], height-for-age Z-score [HAZ], and body mass index-for-age Z-score [BAZ] were 72%, 75%, and 82%, respectively. Students with z-scores outside the range of ±2 were classified as malnourished. Of them, 27.3%, 23% and 16.6% were assessed as underweight, stunted and thin, respectively. Students' sociodemographic characteristics such as age, asex, family size and type, source of income, wealth status were significantly associated with malnutrition, while age group, gender, wealth status, residence setting, and geographical location were noted as significant predictors of nutritional status. The study found no statistical relationship between school feeding and good nutrition, questioning the quality of the midday meal program. The study concludes that existing school-based nutritional interventions need to be re-evaluated and re-designed since it is less potent to minimize malnutrition among students substantially. Policymakers could consider these findings when planning and implementing nutrition-related policies and programs.

Strategies to build stronger bones in Indian children: Challenges for implementation.

Background & objectives Globally, vitamin D deficiency has been incriminated in poor bone health and growth retardation in children, impaired adult musculoskeletal health (classically described), increased risk of cardiovascular events, immune dysfunction, neurologic disorders, insulin resistance and its multiple sequelae, polycystic ovary syndrome (PCOS) and certain cancers. This review intends to holistically highlight the burden of vitamin D deficiency among children in India, the public health importance, and potential therapeutic and preventive options, utilizing the concept of implementation research. Methods A systematic search was carried out on PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Cochrane database, clinicaltrials.gov, Google Scholar, and ctri.nic.in with the keywords or MeSH terms namely 'vitamin D', 'cholecalciferol', 'ergocalciferol', 'children', connected with appropriate boolean operators. Results Vitamin D deficiency/insufficiency prevalence varies from 70-90 per cent in Indian children. Rickets, stunting, impaired bone mineral health, and dental health are common problems in these children. Serum 25-hydroxy vitamin D (25(OH)D) should be maintained >20 ng/ml in children. Oral vitamin D supplementation has a high therapeutic window (1200-10,000 IU/d well tolerated). Fortification of grains, cereal, milk, bread, fruit juice, yogurt, and cheese with vitamin D has been tried in different countries across the globe. From Indian perspective, fortification of food items which is virtually used by everyone would be ideal like fortified milk or cooking oil. Fortification of "laddus" made from "Bengal gram" with vitamin D as a part of a mid-day meal programme for children can be an option. Interpretation & conclusions There is enough evidence from India to suggest the importance and utility of food fortification with vitamin D to address the epidemic of vitamin D deficiency/insufficiency in children.

Midday Meal Programs in Institutional and Community Schools of Nepal: A Comparative Analysis of Students’ Meal Choices

Midday meals play a crucial role in satisfying and motivating students during teaching-learning activities, ensuring that they receive their basic education rights. As food and nutrition are fundamental for every living being, and since students spend a significant portion of their day in school, they require snacks to sustain their energy levels. The study aimed to recognize modalities related to parents' education and evaluate school physical facilities associated with midday meals in institutional and community schools. The research, conducted with the participation of school principals and fifth-grade students, revealed significant disparities in providing midday meals and the quality of school facilities. The study employed an explanatory sequential design. Ten headteachers and 240 students were the samples for this research. The interview schedule and observing rating scale were used as data collection tools. The study explored how parents' education levels influence their choices regarding where to enroll their children. It also discovered that parents with lower qualifications prefer community schools, while those with graduate qualifications lean towards institutional schools. Additionally, snack consumption habits differ between institutional and community schools, reflecting potential socio-economic influences. It was found that over half of students in institutional schools brought homemade lunches, while community schools offered meals in canteens. The findings underscore the need for targeted interventions to enhance school facilities, particularly addressing identified shortcomings to ensure the well-being and safety of students participating in the midday meal program.

Explore The Mid-day Meal Policy in the Context of Retention in School Education

Explore The Mid-day Meal Policy in the Context of Retention in School Education: A Teacher's Perspective from Lalitpur District. Nepal's midday meal policy, aimed at improving children's health and educational access, is a critical component of its national education system. However, limited research has explored this policy from the viewpoint of community school teachers. This study addresses three pivotal research questions: The funding for midday meals is adequate. The allocated funding is fully utilized. The program enhances education quality and reduces dropout rates due to midday meals. In-depth interviews with Lalitpur district teachers, where the midday meal policy is active, provided qualitative data. Ethical considerations safeguarded participants' identities and opinions. Teachers expressed concerns about insufficient funds for midday meals, requiring additional local contributions. Nevertheless, they reported that the granted funds were fully utilized, supporting students' nutrition and local farmers. The program positively impacted education quality and reduced dropout rates. This study underscores the midday meal policy's challenges and successes, highlighting the importance of supplementary financial support for student nutrition. It also emphasizes the program's multiple advantages, including improved education quality and lower dropout rates, especially among disadvantaged students. The provision of a midday meal program in schools can have a positive impact on student retention This research offers vital insights into Nepal's midday meal policy's impact on the education system. It emphasizes the ongoing need for financial support to sustain and enhance the program, ultimately benefiting children's comprehensive development.

IJCM_258A: Perceptions regarding mid-day meal programme among parents of government school children in rural field practice area of a government medical college a cross sectional study.

Background: Mid - Day Meal Scheme (MDMS) renamed as PM POSHAN in 2021 is aiding 11.80 crore children studying in 11.20 lakhs schools across the country making it the largest school feeding programme in the world. This study was intended to know the opinion of parents of children going to government schools regarding mid - day meal. Objectives: 1. To study the perceptions of parents regarding Mid -Day Meal Scheme. 2. To identify the barriers for non-consumption of Mid - day meals. Methodology: Study Design Cross - sectional study Sampling Systematic Random Sampling Study setting “Rural Field Practice Area of a Government medical college. Study Period November - December 2023 Inclusion criteria Parents and Guardians who gave written informed consent. Exclusion criteria Parents who could not respond due to mental problems. Ethical Prior ethical approval was taken from Institutional Ethics Committee. Data collection and analysis data collection was done using pre-designed semi structured questionnaire and analyzed using Excel and SPSS software. Results: Mean age of the respondents (parent) was 33±7SD. Majority (72.9%) of the respondents were mothers. 59.4% of parents perceived that quality of MDM was good. It was found that overall satisfaction among parents regarding MDM was 65%. More than two thirds (67.5%) of parents felt that MDM has improved their childs school performance. Conclusion: Most of the parents were satisfied about the quality of mid - day meal and few parents agreed that MDM has encouraged parents to send their children to school. Most of the parents agreed that MDM is beneficial and should be continued

Transformative effects of mid-day school meal program in Nuwakot district through Homegrown model: A case study of Nepal

This study aims to explore the roles of various actors in school meal programs in the Nuwakot district, particularly those following homegrown models. A mixed-method research approach was employed, involving 16 government schools (with 64 interviews) from two local governments to understand the program's impact. The school meal program in Nepal has heightened awareness among various stakeholders. Hot meals are prepared and served, with a collaborative effort in line with homegrown models involving parents who play a significant role. Schools, too, contribute significantly to the success of the program. The utilization of locally produced foods has increased, albeit with seasonal variations, and involves farmers and cooperatives. This shift has resulted in changes in dietary practices. The cooperative's role is pivotal in ensuring an ongoing supply of limited school and food items. Local markets play a crucial role in meeting demands for these programs. The local governments' role is vital, requiring a multi-sectoral approach to effectively support and sustain the program.

The effect of the Mid-Day Meal programme on the longitudinal physical growth from childhood to adolescence in India.

The study aims to examine the effect of the world's largest school-feeding programme, the Mid-Day Meal (MDM) programme, on the changes in the underweight prevalence among school-children in India. Data from the Indian Human Development Survey (IHDS) Rounds 1 (2004-05) and 2 (2011-12) were utilized. The sample included individual-level information of children aged 6 to 9 years in IHDS-1 who then turned 13 to 16 years in IHDS-2. The sample was categorised into four groups based on their MDM consumption history (Group 1: no MDM support in IHDS-1 and IHDS-2, Group 2: MDM support in IHDS-1, Group 3: MDM support in IHDS-2, Group 4: persistent MDM support in IHDS-1 and IHDS-2). The dependent variable was underweight status as defined by the World Health Organisation Child Growth Standards Body Mass Index for age (BMI Z-score) < -2 SD of the median. Bivariate analysis was used to examine the prevalence of underweight and establish associations between underweight status and socio-demographic characteristics. Logistic regression was performed to assess the strength of the association of socio-demographic characteristics and MDM consumption patterns with underweight across poor and non-poor asset groups. The findings suggest that early and persistent MDM support among respondents reduced the likelihood of low BMI Z-scores compared to those without MDM support. Respondents from the poor asset group who received MDM support in at least one of the two survey rounds had higher odds of being underweight in comparison with those who did not receive MDM support at all. Girls and adolescents residing in the Eastern region of India were less likely to be underweight. The study shows that the MDM programme was effective in reducing the rate of underweight among school children. However, continuous programme upscaling with a special focus on children from poor households will significantly benefit India's school-aged children.

Mid-Day Meal Scheme in India: Current Status, Critical Issues and Challenges

This piece of work examines the impact of the midday meal program on body mass index using secondary data on several Indian states. India has implemented the Mid-day Meal Program to improve the enrolment, attendance, retention, and academic success of school-aged children. A significant portion of schoolchildren from lower socioeconomic categories rely on cooked midday meals. This policy change will require the states to prepare against three key parameters—Mid-day-meal ground infrastructure, financial inclusion, and beneficiary identification—to target the beneficiaries. Using secondary govt data, this paper explores the digital readiness of various states and the challenges they face. Also, research highlights the urgent need for the government to intensify its focus on improving Mid-day-meal at various levels in order to reduce the inequality in India effectively. To meet the goals of the Mid-day Meal Scheme, it is important to avoid repetition of the roughly same sort of meal menu

Large-scale Fortification of Rice in India and Its Distribution in Public Distribution System

Rice fortification with micronutrients is getting popularity in supplementation programmes as it provides cost-effective, easy and public-health-solution to treat anaemia and protein-energy-malnutrition. In India, A pilot scheme for rice- fortification and its distribution under Public Distribution System in fifteen districts was started for a period of 3 years (2019–2022). To examine effect of fortified rice on nutritional status of population, its supplementation studies in Indian government’s social safety programmes were reviewed. The reviewed studies showed that supplementation of fortified rice was significantly effective in reducing prevalence of anaemia, increase in haemoglobin level, and improvement in cognitive scores. However, all the reviewed studies were limited only to supplementation of fortified rice at mid-day meal programme. Thus, it can be inferred that fortification of rice can be a cost-effective tool to combat anaemia at community level but more conclusive evidences are still required.

Involvement of Panchayats in the Development of Primary Schools Located in the Tribal Areas of Wayanad, Kerala

The paper explores the role of Grama Panchayats in advancing the development of primary schools situated in the tribal regions of Wayanad, Kerala. This includes their participation in matters such as student enrollment, reducing dropout rates, teacher training, enhancing infrastructure, managing the midday meal program, and monitoring school activities. The paper's conclusion highlights that the Panchayats' contributions in these areas have been limited and underscores the urgent necessity for their more proactive engagement to enhance the quality of primary school education.

Review of blood donor deferral with emphasis on donor and patient safety.

Blood donor deferral is a part and parcel of the commitment of the blood transfusion services to assure the safety and health of the blood donor as well as the recipient. Periodic review of blood donor deferral is to incorporate or revoke deferral reasons based on the evidence generated in the process of review. Therefore, emphasis must be laid on preparing strategies to only judiciously defer blood donors, recruit and retain first time blood donors, which needs critical appraisal of the existing deferral policies, so that the evidence based changes can be done. A retrospective analysis of deferral in blood donors who presented at the blood donation centre of an institute of national importance over a span of nine years (2011-2019). Donors were screened as per the Drugs and Cosmetics Act 1940 and Rules 1945 given by the Ministry of Health and Family Welfare, Govt of India. There were 1,37,935 donors attempts, out of which 20,167 (14.6%) donors were deferred from donating blood. Most of the deferred donors were male (88.5%), first time (86.1%) and temporarily deferred (87.6%). Almost comparable number of donors (49.1 % & 48.5%) were deferred for donor safety and patient safety reasons respectively. Overall the three most common reasons for deferral were low hemoglobin (21.6%), hypertension (11.4%) and history of jaundice (9%). In donor safety reasons, low hemoglobin (43.4%), hypertension (22.9%) and low blood pressure (4.5%), and in patient safety, a history of jaundice (18.6%), common cold (15.8%), and high-risk behavior (8.8%) emerged as the three most common reasons for deferral respectively. Blood donor deferral is an essential quality indicator of the blood donor selection process. Initiatives like fortification of dietary ingredients with iron, optimizing protein in diet served in schools under mid-day meal program, screening for iron deficiency, hypertension and education about high-risk behavior in schools and colleges may have long term effects of promotion of better health.

Field-friendly MUNNG® optima simple test kit for quick qualitative assessment of iodine and iron presence in double-fortified salt.

Data from several efficacy studies and a long-term effectiveness study have encouraged the governments to adopt a policy of providing double-fortified salt (DFS) in the Mid-Day Meal (MDM) programs in government schools across India. These envisaged food security events are likely to boost the manufacturing of DFS in a big way. Thus, it becomes pertinent to come up with a robust monitoring system involving community and field workers for quality checks. It is imperative to equip these field workers with simple testing kits (STKs) capable of qualitative detection of iron and iodine in DFS. As the consumer acceptance of foods is based on several factors including sensory characteristics, performance, convenience, cost, nutrition, and product image, a variety of iron compounds are in use for fortification. However, it becomes challenging to provide a kit that can overcome the chemical masking of iodine detection by iron compounds. We aimed at (1) the development of a field-friendly STK for quick qualitative assessment of iodine and various forms of iron present in DFS, (2) to check its validity under field conditions. We put in place reagents combined using known chemical reactions and balanced use of oxidants to overcome the problems of encapsulation and to maximize the use, by enabling reagent combination to react with all forms of iron. The kit reagents successfully detect iodine as well as three commonly used iron fortificants in DFS. Published field trials confirmed the specificity and sensitivity of the developed kit. The simplicity and use of the kit by a field worker can be seen in the enclosed video. The combination of improvised kit reagents allows early detection of iron and iodine in DFS. Iron is detected in a variety of iron-containing fortifications. The provision of diluted H2O2 ensures the presence of oxygen-free radicals that enhances iodine release captured by concentrated KI making iodine detection an easy task.

Implementation Paper on Web Based Mid-Day-Meal Analysis

Abstract: The Mid Day Meal Programme (MDMP) is a welfare programme that is being operated through the country and involves millions of children, crores of public funds, and thousands of officials manning the programme. While there can no denying that the programme needs to be monitored with an eagle’s eye for lacunae, discrepancies and malpractices, it is equally imperative that each and every well-intentioned effort, however miniscule, needs to be appreciated, rewarded and publicized for the simple reason that man motivation is a simple but a highly effective tool that can rev up the gargantuan lumbering machinery involved in the implementation of MDMP to generate unprecedented results, as expected of this populist programme. Keywords: Mid-Meal, Government schemes, School, Children, Database connection

Health profile and nutritional status of rural primary school children in Western Maharashtra. Is school absenteeism associated with undernutrition?

Background: Healthy adulthood thrives on the foundation of a healthy childhood. Earlier studies show different morbidity patterns and prevalence of under-nutrition in children studying in Government primary schools. The present study was undertaken to explore the morbidity pattern and nutritional status of children studying in a government primary school in the field practice area of Rural Health Training Centre of a medical college in Pune, Western Maharashtra. Methodology: A cross-sectional study was done in a Government Primary School during January–February 2019. A total of 134 school children studying in classes 1st to 7th underwent anthropometric measurements, medical examination, dental examination, and haemoglobin estimation to bring out the common morbidities present in children of school-going age. School records of the past 6 months of the academic year 2018–19 were used to know the prevalence of absenteeism among the subjects studied, and an attempt was made to find any association between absenteeism and under-nutrition among school children. Results: Out of 134 children, 26 (19.4%) were stunted, 51 (38.64%) were underweight, and 2 (1.49%) were found to be obese. Dental caries was found in 73 (54.48%) pupils, and it was the commonest morbidity found. Eighty-six (64.18%) of the examined school children were anemic. Thirty-five (26.12%) had ear problems, skin problems were found in 35 (26.12%), 6 (4.48%) had refractive errors, and 2 (1.49%) were having Tachycardia. An association was found between abesentism and underweight (P = 0.02). Conclusions: The present study found that under-nutrition is present among children studying in a rural Government school despite the mid-day meal programme being implemented in the school. Targeted interventions may be planned for undernourished children to improve their nutritional status, and more studies are required to assess their health needs and problems.

Akshaya Patra: A Leader in Battling Classroom Hunger

Akshaya Patra, the world’s largest mid-day meal program run by a not-for-profit organization, was started in 2000 by serving approximately 1500 school going children in Bangalore, India. In 2009, the organization achieved a milestone of serving one million lunches to the school children. By 2021, it had been feeding more than 1.8 million children and aimed at feeding five million children by 2025. Akshaya Patra also offered its services to people affected during natural calamities like floods and earthquakes, and for the homeless living in shelter homes[2]. It was also the first NGO managed food programme in the world to receive the FSMS ISO 22000:2005 certification. The project received an entry in the Limca Book of Records and India Book of Records[3]. The organisation was able to successfully create a partnership model that included governmental funding, contribution from individuals and support from for-profit companies and not-for-profit organisations.

Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka

BackgroundHigh rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children.MethodsThe study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples.ResultsThe dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort.ConclusionsMidday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.

Crowd-out in school-based health interventions: Evidence from India’s midday meals program

Governments often rely on schools to implement multiple programs targeting child outcomes. How to improve the implementation of these programs is an important, open question. As part of a randomized controlled trial in Odisha, India, we measured the impacts of a nutrition program and a monitoring intervention on the implementation of a pre-existing school-based nutrition program, specifically the Indian government’s iron and folic acid supplementation (IFA) program. The new nutrition intervention distributed a micronutrient mix (MNM) to be added to school meals while the monitoring intervention varied the intensity of monitoring activities. We find that high intensity monitoring improved implementation of the government’s IFA program, while the MNM intervention crowded it out. The net effect is that high intensity monitoring improved child health, while the MNM intervention did not. Both crowd-out of the IFA program and sensitivity to monitoring were predominantly found among schools that were resource or capacity constrained.

Nutritional status of mid-day meal program on government and private school students: a comparative study

Background: Mid-day meal scheme is a school meal programme of the Government of India, designed to improve the nutritional status of school-age children. Malnourished children will not attain optimum potential for growth and development and this affects their physical capacity to work and physiological changes in the later phase of life. The food that we eat affects the nutritional status; hence the study was evaluated to find the nutritional status of the mid-day meal program in school going children.Methods: Total of 100 subjects were selected into 2 groups, 50 students from government schools and another 50 from private schools. Government school groups received mid-day meal scheme and private school students brought their personal lunch. Anthropometric and haemoglobin evaluation was done.Results: The study showed that mid-day meal effects on nutritional status and one meal gives a calorific value of 357.6 and there was a significant difference between the distribution of MUAC (CM) during pre and post nutritious period in government school students. There was no significant difference between the other anthropometric measurements like height, weight and TSFT and hemoglobin values.Conclusions: Study showed that mid-day meal affects nutritional status. A balanced freshly cooked meal in the noon is healthier and nutritious impacting the school children’s academic performance.

Estimating the impact of school feeding programs: Evidence from mid day meal scheme of India

This paper studies the impact of the world's largest free school lunch program (Mid Day Meal Scheme) on school enrollment in India. While the program was launched nationally, its implementation has been scattered within and across states. Using an instrumental variable approach, this paper estimates local average treatment effect of receiving free meals in school on children's enrollment in primary school. The findings of this paper suggest that the mid-day meal scheme increased the probability of enrollment in primary school and on-time enrollment in first grade. An analysis of heterogeneity in results shows that the program had larger effect on socially disadvantaged groups and on girls. Specifically, the analysis found the effect of the mid-day meal program on girls to be almost twice its effect on boys for primary school enrollment, suggesting that the program had a positive impact on reducing the gender gap in school participation.

A Comparative Study of the Nutritional Status of Adolescents in Residential and Non-Residential Tribal Secondary Schools

Background: Tribal populations lack access to health services and proper educational opportunities due togeographical, social and economic reasons. Among tribal population, malnutrition is prevalent resulting invicious cycle of morbidities and mortalities. To tackle these issues, various interventions are being done atall levels. Establishment of residential schools along with structured meals and Mid-Day Meal program fornon-residential schools are few of many such strategies. This study was undertaken to study the effect ofthese interventions in a tribal district.Materials and Methods: It is a record based retrospective cross-sectional study. Health records of classVIII students from a residential and a non-residential (40 each) were analysed for desired variables. Datawas compiled using Microsoft Excel 2016 and analysed using SPSS version 22.Results: More proportion of adolescent tribal students in non-residential schools had history of worminfestation and diarrhoea in the last six months. Similar pattern was observed for signs of deficiencies ofVitamin B and Vitamin C. Significant difference was observed between food consumption and food diversitypattern being followed.Conclusion: The findings of the study reiterate the need of strengthening of nutrition and hygiene centricschool health program for tribal adolescents.