Impact of School Feeding Programme on Children’s Anthropometry and Learning Outcomes in Chikwawa District-Malawi

Impact of School Feeding Programme on Children’s Anthropometry and Learning Outcomes in Chikwawa District-Malawi

*Kondwani Chavula¹., Beatrice Matafwali²

¹Ministry of Health, Department of Nutrition, HIV and AIDS, Malawi

²University of Zambia, Department of Educational Psychology, Sociology and Special Education

*Correspondence Author

DOI: https://dx.doi.org/10.47772/IJRISS.2025.909000283

Received: 07 September 2025; Accepted: 14 September 2025; Published: 08 October 2025

ABSTRACT

In order to improve school enrolment in Malawi, the government is implementing a School Feeding Programme (SFP) in Chikwawa, one of the worst hit Tropical Cyclone Freddy towns where thousands of people died and others displaced with extensive crops, animals and infrastructure damage in Malawi. Despite well implemented programme, there remains a need to comprehensively assess the impact of the SFP on Children’s Anthropometry and Learning outcome. The study aims to assess the effects of the programme on school children’s Anthropometry and Learning outcome. It is hoped that this study will help establish the impact of School Feeding Programme and its role in improving Anthropometry and Learning outcomes. This will help inform policy makers who make research based policies that benefit children in schools. A quantitative research with a between-subjects cross-sectional quasi-experimental design comparing three SFP and three non-SFP preschools were sampled through multi-staged stratified random sampling technique in Chikwawa District in Malawi. Two hundred and eight preschool children were administered with Zambia Child Assessment tools (ZamCAT). Data variables were analyzed and generated descriptive and inferential statistics using Statistical Package for Social Sciences (SPSS version 20), WHO anthro and STATA version 17 to determine significant differences and relationship between Anthropometry and Learning outcomes. The results revealed a relationship; a marginal positive relationship was found between MUAC and letter naming scores  (R=0.46). The study also found that relationship existed between height for age and letter naming scores (R=0.37). Therefore, policies on SFP in early education should be promoted with a scale up to other districts to ensure that children develop optimally and holistically as they pursue their education. Future research should also be done on a large scale longitudinally to further evaluate the effect of SFP on school trajectories and the modification effect of socio-economic status.

Key: Learning outcomes, Cyclone Freddy disaster, Education, Malawi, School Feeding Programme

INTRODUCTION

Anthropometry in nutrition refers to non-invasive measurements of the human body size, proportion and distribution of fats. It is used to determine nutrition status of an individual through measurements of height, weight and body circumferences. It assesses adequancy of individual nutrition status in clinical settings, schools, recreation areas and sports (National Multi-Sectoral Nutrition Policy, 2018). It uses Z-score charts to calculate stunting (height for age), wasting (weight for height) including underweight (weight for age)  and any Z-score reading of <-2 indicates malnutrition (NSO and ICF Macro, 2020). Malnutrition results from deficiency (macro and micro) nutrients which is key for normal functioning, growth and development (Tosi, 2020).

Malnutrition is the enemy of good health and development. It reduces the resilience to fight infections in children leading to less energy to move about and play resulting in little brain stimulation and development and it also reduces concentration hence poor school performance (Fadilah & Faizah, 2022). Rather, adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of one’s intellectual performance, academic and professional achievement and overall work performance at a later stage (National Multi-Sectoral Nutrition Policy, 2018). When children are exposed to adequate nutrition, their brain development is enhanced, resulting into increased intelligent quotient levels with higher chances of attaining higher education and be productive at work (WHO, 2022).

Globally, malnutrition contributes to about half of all deaths of children under five years old in third world countries (Djoumessi, 2022). Aside from contributing significantly to child mortality, it also causes maternal deaths, decreases resistance to infectious diseases and prolongs episodes of illnesses. It impedes growth and cognitive development, threatens resilience in times of emergencies, and negatively impacts countries human capital and economic growth of countries (Millward, 2017). In Malawi, under-nutrition and illiteracy trends are still persistently high despite the enabling environment. The rates of stunting, wasting and underweight are at from 35.5%, 2.6% and 11.8% respectively (Malawi Multiple Cluster Indicator Survey, 2020). Similarly, the pre-school education status has gone down in the country. Currently, only 59% of 3-4 years children are developmentally on track in at least three of the four domains ((physical (89%), socio-emotional (78%), language domains (74%) and numeracy-literacy rate (17%)) (Malawi Multiple Cluster Indicator Survey, 2020). This is attributed to the poor nutrition status which might have contributed to low numeracy and literacy levels in the country.

School Feeding Programme

The promotion of SFP has increasingly become a strategy adopted by International Organizations and Governments to address food insecurity and illiteracy which is aligned to Sustainable Development Goals (No poverty, Zero hunger, Good health and well-being and Quality education)(Chaves etal., 2023). Amusa et al, (2022) conducted anthropometric measurements in early childhood SFP centres to examine the association between child stunting and academic achievement in South Africa. The results found that being short for age (stuntedness) in early childhood had 29% reduction in the odds of grade completion. Similarly, Amuzu, (2023) study in Ghana on SFP showed that there is causal relationship between school meals and the learner’s academic performance. The anthropometric measurements of the learners also showed quite a tremendous improvement in weight for height, height for age and MUAC measurements. The study further found out that the presence of Ghana SFP in basic schools had a positive effect on pupils‟ academic performance. The examination assessment of school going children before and after during the SFP period had shown a tremendous improvement in the results of learners.

Malawi is implementing SFP in 329 Community Based Child Care Centres (CBCCs) in Chikwawa, one of the Cyclone Freddy worst hit towns. The program started in 2006 with support with support from Malawi Red Cross Society (MRCS), Scotland mission, Mary’s Meal and World Food Programme (WFP).

Despite well implemented SFP, there remains a need to comprehensively assess the impact of the nutrition intervention on children’s anthropometry and learning outcome. Therefore, the study sought to assess the impact of SFP children anthropometry and learning outcomes.

Specific Objectives

1. To assess the impact of SFP on anthropometry of children in SFP and non-SFP Schools in Chikwawa District in Malawi
2. To assess the impact of SFP on learners outcome in SFP and non-SFP schools in Chikwawa District in Malawi
3. To establish the relationship between Children anthropometry and learning out come in SFP and non-SFP schools

Significance of the study

This paper provided an opportunity to assess the impact of the SFP on children’s anthropometry and learning outcome. It will also help the government and stakeholders to realize the crucial role, the SFP play on reducing health and education costs in children since it is more effective and less costly than attempting to address the consequences of early adversity later. This study may also help to generate more evidence for further research on the subject. With enough evidence, the results of this paper may help in providing strategic measures to improve and scale up the SFP to benefit a larger target population of school-aged children, preschoolers, and their households in Malawi. The findings may also help to determine the possibility of using SFP, if well managed and sustained, as a tool for improving nutrition and education indicators in Malawi.

Limitation

This study encountered limitations including time constraints which limited the desirable data collection. Furthermore, socioeconomic factors such as education level, occupation and others including the logistical challenges were the bread of the day as the terrain was not conducive for accessing the venues. However, the data analysis controlled all potential extraneous variables that would affect the study.

Delimitations

The study was limited to Chikwawa-District Council which is one of the districts offering SFP programme in ECE centres. The focus was to assess children’s anthropometry and learning outcomes.

Theoretical frame work

Maslow’s Hierarchy of Needs is a motivational theory comprising a five tier pyramid of human needs. As needs are met, individual graduate from the most basic physiological needs to self-actualization. Food is a basic physiological need, and if this need is met through the school feeding programme, it is envisaged that school enrolment, retention and education achievement will improve significantly. Linkages must exist between school meals and education achievement. School meals as a basic physiological need has to be met in order to attain higher education. According to Bekidusa, (2020), when learners feed at school, they get retained and this in return improves school enrolment, school attendance, school drop-outs reduction and absenteeisms hence increased attention leading to better nutrition status and education achievement. This would achieve Sustainable Development Goal 4, which targets quality equitable lifelong learning for all learners (UNICE, 2021).

LITERATURE REVIEW

Overview

This chapter reviewed the impact of SFP on children’s anthropometry and learning outcomes and relationship between anthropometry and learning outcomes. Among others, it has also highlighted the historical review of SFP in Malawi and world at large including the origin, trends and its categories.

Impact of School Feeding Programme on children’s anthropometry

Many outcomes have reportedly improved with SFP including school performance and nutrition variables across the world. Nutrition variables ranging from improved dietary intake and anthropometric measurements have impressively changed with SFP with the later having a greater impact on the overall health of school children (WHO, 2020). Studies have shown that schools participating in the SFP have impressive outcomes on nutrition status and overall health of learners. The researchers have compared the anthropometry of learners who were in schools that are implementing school meals and compared them with the schools that were not implementing SFP and the results apart from improving pupil retention rate and increased class performance, have also shown tremendous improvement in weight for height and height for age z-scores (Amuzu, 2023). Furthermore, school children’s who access school meals, have developmental milestones that are on track leading to improved overall health well-being.

Hussein etal, (2023) in their comparative study done in North East Ethiopia has also revealed that SFP has more benefits than just retaining children in school as the current SFP objectives entails. The study have found that SFP improves nutrition status, reduces drop-outs and also improves learners performance among others and that is why a SFP was strongly recommended  in all the schools in North East Ethiopia. Similarly, Bekidusa, (2020), concur with Hussein etal, (2023) that SFP leads to learners retention however their exposure to better diet leads to better nutrition status.

Impact of School Feeding Programme on Children Learning Outcome

SFP has significant impact on the learners education outcome. Besides eradicating poverty and malnutrition, studies have shown that SFP leads to improved learning outcomes. School children served with school meals have improved height, weight gain and overall health. Barnabas etal., (2024), in their study found that there is a strong relationship between SFP and education outcomes. The study showed that the underprivileged who come from the low socio-economic profile fail to meet the education needs than those from a well to do background.

It is believed that the SFP provides a reasonable accommodation by ensuring that every child has access to food regardless of socio-economic status thereby putting every child at an opportunity to optimally develop in all the four developmental domains namely; language, physical socio-emotional and cognitive development. Besides that, SFP has also shown increasing cognition capacity for learners. Amuzu (2023), in Ghana also found that SFP had profound cognitive development leading to significant improved learner’s academic performance. The examination assessment of school going children before and after during the SFP period had shown a tremendous improvement in the learners outcome. In addition, Aotedu, (2020) study in Nigeria found that SFP increased the enrolment and improved the performance of elementary school pupils in the state. Children who have been served school meals, their milestones improve and they develop good cognitive functioning.

Gibson‐Moore etal., (2023), also looked into factors beyond achieving education outcome in SFP. The findings of the study concluded that good health is far more economical than under-nutrition as the latter risks children to infection. Children become frequently sick requiring hospital admission putting more strain on the already depleted medical resources and long term costs to the government and the society at large. They also argued that under-nutrition deters societal integration and potential full personal development (Bundy et al, 2021).

In contexts of emergency, economic shock, vulnerability and protracted crisis such as tropical cyclones, SFP has also shown to be the most reliable cushion for hunger and under-nutrition. Apart from being an incentives, it is a social safety nets for the vulnerables in the community (Orunbon and Adeleke, 2024).

Therefore, with this evidence, government agencies and development partners should be encouraged to pump more resources in the operation of SFP.

Relationship between anthropometry and Children Learning Outcome

Historically, Studies on cognitive skills positive impact evidence has shown that many school going children in developing countries hardly access diversified food necessary for the provision of macro-nutrients to afford them with adequate learning conditions. As a result, they fail to maintain alertness, attention and concentration needed for classroom performance (Sharif etal., 2023).  Study by Gooderham, (2024) showed that nutrition status is associated with meta-cognition. Although, the development of cognitive processes is governed by age and nutrition status, children with normal nutrition perform better in class than children who are undernourished.

Tete et al. (2020), in their study found that apart from SFP alleviating hunger, the programme also improves nutrition status through providing energy enhancing diet and kilo-calories. Not only did they found that it brings energy gain, but also it enhances education outcomes and equity among primary school going children. Similarly, Leshabana (2022) in a study conducted at university of Free state in RSA concluded that height for age (stunting), weight for age (underweight), weight for height (wasting) including micro-nutrient deficiency (iodine deficiency) drastically affect the academic performance of elementary school children. Among others, the study found a strong association between academic performance and malnutrition. Likewise, Beckmann et al, (2021) in a study conducted in South Africa, established that there is a positive and a strong relationship between under-nutrition and academic performance.

Summary

In a nutshell, SFP has increasingly become a strategy adopted by International Organizations and Governments to address food insecurity and improve learner’s outcomes, hence it is widely implemented across the world. Despite the somewhat mixed research results, the present study demonstrates promising SFP positive impact on the nutrition status and learners outcome of school-aged children. However, most of the reviewed literature which had negative impact shows that studies were conducted on older children which its impact might have been jeopardized by age as their brain had already lost the neuroplasticity. According to a series of assembled evidence by Black et al (2021) and Britto et al. (2019) reveal that the foundations of the brain and mental development occur in the first few years of life failure which after five years, the brain rarely responds to any intervention that addresses the lost milestones. Children below five years of age have increased neuro-growth and increased synaptogenesis.

METHODOLOGY

The study used quantitative research approach and cross-sectional Quasi-experimental research design where one group of children who are beneficiaries of school meals in schools implementing SFP and another group of children in non-SFP was studied. The researcher collected data on children anthropometry and learning outcomes by administering Zambia Child Assessment Tool (ZamCAT) which has learning outcome assessment and nutrition assessment components. The quantitative approach was used to draw statistical perspectives about SFP through descriptive and inferential statistical analysis because it emphasizes on the production of precise generalized statistical findings (Staller, 2021).

Study Period

The study was conducted during the lean period from 27^th January, 2024 to 25^th February, 2024. The lean period (time of the year when households do not have inadequate or surplus food) was chosen as means of controlling other extraneous factors such as occupation, education level, age and others which might impact the variabilities between subjects and within subjects.

Study Site

The study was conducted in Chikwawa district in selected Traditional Authorities (TA) where the SFP is implemented. The district was chosen because it is one of the few districts implementing SFP and affected by disasters hence providing SFP a midst the shocks helped to control some variabilities in the social economic statuses.

Study population

The study comprised learners aged 4-6, Early Childhood Education instructors and learners parents. Children with known health problems and those above six years or below 4 years were excluded from the study including those previously attending schools participating in the SFP.

Sample size

A sample size of 217 determined by finite population correction factor formula was targeted however 208 participants comprising of 4-6 years old pupils in six ECE schools were enrolled for both participating and non-participating schools. This was because some respondents did not consent to participate in the study, others were absent during the time the study was conducted

The sample size has been determined by finite population correction factor formula (Qian, 2020).

Where n is the sample size, z is a standard deviation, p is the prevalence of stunting, d is the degree of accuracy and q is 1.0-p (Ryan, 2013). With the current district ECE numeracy-literacy prevalence rate of 17% (Micro-nutrient Cluster Indicator Survey, 2020), which is the highest among all the indicators, the sample calculation was based on the prevalence rate with confidence level of 95%.

Therefore, sample size 1.96² X (0.17) (0.83)/ 0.05²   =217

Sampling techniques

Sampling methodology

Pupils aged 4-6 were selected using a multi-stage stratified sampling method. Considering the list of schools as a population frame. Six ECE schools were selected by stratified sampling method and each three represented schools participating in SFP or non-SFP in their zone. School going children in selected schools were incorporated in the study by using simple random sampling technique after obtaining a sampling frame from the class attendance registers. Out of 217 sample size, 208 learners were available for the study and participated in the study.

Research instruments

The study targeted only five tests of the ZamCAT which were relevant with the topic namely; Tactile pattern completion, Pencil tapping, Peabody picture Vocabulary test, Expressive language, Letter naming and anthropometric measurements. ZamCAT also assesses nutrition status and it uses anthropometry. Data was collected using the anthropometric measurements such as Weight, Height and Mid Upper Arm Circumference (MUAC) to ascertain childhood malnutrition (wasting, stunting and under-weight levels) in school going children both in SFP and non-SFP schools.

Data analysis

Because of the nature of data, the researcher analyzed data to show data variability using different analysis methods SPSS, WHO anthro and stata. SPSS was used to generate descriptive and inferential statistics to determine mean differences for children learning outcome and childrens anthropometric measurements between the children in SFP and non-SFP schools and compare how demographic variables may affect children’s anthropometry and the learning outcomes for research question number one and two. While regression analysis was applied to answer research question number three and all data was presented in graphs, tables and percentages. WHO anthro plus statistical package was used to develop z-scores where as stata was used to analyse and produce graphical visualization of data. Out of 217 targeted sample size, 208 children participated in the study and all the 208 samples were analyzed using SPSS and stata. However, for WHO anthro plus analysis, only 126 children met the WHO anthro plus standards for analysis. 82 samples did not because they were above 60 months therefore they were excluded for analysis.

Validity and Reliability of data

Validity refers to the extent to which a research instrument measure what it is supposed to be measured, while reliability is defined as the degree of consistency of the research instrument in measuring whatever it is measuring (Ary, Jacob & Sorensen, 2010). This study used ZamCAT as a tool for data collection. It is one of the standardized tools for data collection having been tested several times in Zambia. However, the tool was again tested on weekly basis for 3 weeks prior to the actual data collection. The consistency on the results with reliability of 0.8 was found. Furthermore, reliability was also achieved through conducting a pre-testing of the questionnaire developed with all effect of necessary corrections observed during the pre-testing. Data validity was also assured through data triangulation.

Ethical considerations

Ethical approval was obtained from the University of Zambia, Directorate of Research and Graduate Studies. Permission to conduct the study was sought from the District Council Research Committee and District Social Welfare Officer at Chikwawa District Council in Malawi. Furthermore, the head masters of schools were informed and consent obtained from parents of the participating learners including verbal assert from the participating learners. Confidentiality of information and anonymity of respondents was done by using research codes instead of names of respondents. However, learners whose parents declined the consent were replaced.

RESULTS

Objective 1: To assess the impact of SFP on Children’s Anthropometry in Schools implementing SFP and non SFP.

Objective one focused on assessing the impact of SFP on children’s anthropometry by comparing data from SFP and non SFP school. This involved analyzing child background information and anthropometric measurements to understand differences between the two groups.

Anthropometric measurements of children

Figure 2 Overall distribution of childrens nutrition status

Figure 2 presents is a comparison between children normal nutrition status and those who are malnourished, specifically those who are stunted and or wasted. To analyse that, WHO anthro plus was used and out of 208 children who participated in the study, only126 children met the WHO anthro standards for analysis as the software does not allow participants whose age is above 60 months to be included. In this regard, 82 children were excluded in the analysis for Z-score analysis.

Among the 126 children eligible children, approximately 57% (n = 72) of the children are classified as having normal nutritional status, while about 43% (n = 54) are classified as either stunted (short for age) or wasted (low Weight for Height) indicating poor nutritional status below the WHO growth standards. Descriptive analysis was conducted using Height for Age (HAZ) and Weight for Height z-scores generated through WHO Anthro plus to assess the impact of SFP on children’s nutritional status.

Figure 3: Height-for-age

Figure 3, is the height-for-age graph comparing 126 children (left shift curve) to WHO standards (normal distributed curve).

The curve with significant leftward shift shows that the children enrolled in the study were generally shorter for their age than global normal z-scores of below -2. The wider spread of the red curve suggests more variability in height among these children, with some cases of severe stunting (z-scores below -3).

Figure 4: Weight for Height

Figure 4 compares the weight-for-height distribution of 208 children (with left shift) to WHO standards (normal distributed curve). The children’s distribution is shifted left, indicating they are wasted. Their peak is around -1 z-scores, while WHO’s is at 0, with more variability in the studied group. Many fall below -2 z-scores, and few exceed the WHO median.

This suggests a high prevalence of wasting among the children in both SFP and non-SFP schools, potentially due to nutritional or health issues.

Table 1: Anthropometric measurement of the children

The anthropometric measurements of the children, as presented in Table 1, were compared between SFP and non-SFP schools using an independent T-test. Overall, Weight for Height z-score scored better in feeding schools (-0.99±1.62) than non-feeding schools (-1.56±1.58) with Weight for Height z-score statistical significance (P<0.05). Similarly, the significant association was noted between SFP and children playing with siblings (81.2%) compared to 58.1% in non-SFP schools (P=0.000).

Table 2: The association between childrens socioeconomic status and anthropometry

Key *=0.1,**=0.05, ***=0.01

In table 2, the results reveal that children from schools with SFP have a 44% lower risk of being stunted compared to non-SFP schools, significant at the 0.05 alpha level. Furthermore, secondary school education level was associated with 30% lower odds of shorter height for age (stunting) compared to unemployment but was significant at 0.1 alpha level.

However, no significant statistical association was found between subsistence farming and the risk of stunting, relative to unemployment. Additionally, the age of the child and education level of household were not significantly associated with the risk of stunting.

Objective 2: To assess the impact of School Feeding Program on Learning outcomes in Schools implementing SFP and non SFP.

This study had two categories of schools; schools offering school meals and those that did not offer school meals to school children. The study used Zambian Child Assessment Tool (ZamCAT) which comprised child learning outcomes and Nutrition Status Assessments. The assessment included components such as letter naming, pencil tapping, expressive language, tactile pattern completion and Pea-body vocabulary test. The tools were administered to both categories of children in order to assess the impact of SFP on learning outcome. The table 3 demonstrates the effects of SFP on total pencil tapping score, overall pea body picture vocabulary test and expressive language scores.

Table 3 Total pencil tapping, Pea body picture Vocabulary Test and Expressive Language scores

Key *=0.1,**=0.05, ***=0.01

As presented in the table 3, The results show that on average, Children from schools with feeding programs scored 5.3 points higher on Peabody Picture Vocabulary Test than those from schools without feeding programs (P=0.008). Children with Household Heads having secondary and tertiary education scored 6.3 and 10.5 points higher, respectively, compared to those with Household Heads having no education (P=0.0224 and P=0.0055, respectively). In contrast, children with Household Heads having preschool education scored 10 points lower than those with household heads having no education (P=0.054).

However, no significant relationship was found between household head occupation and overall Pea-body total scores (P>0.05). The result in table shows that parents who had primary education as their highest level had 11.7 more score on total expressive language compared to children from parents with no education with significant level (p<0.05). Similarly, children from Household Head whose education level was secondary school had 14.8 more score on expressive arts compared to children from parents no education with significant level (p<0.05). Interestingly, tertiary education had no statistical significant effect on total expressive language when compared with parents with no education. No significant association was found between occupation of the household head with children total score on expressive language. Nevertheless, children from schools with feeding programs scored 1.04 points higher on the total pencil tapping score compared to those from schools without feeding programs, and this difference was statistically significant (P=0.0382).

Additionally, at an alpha level of 0.1, children from households with secondary and tertiary education scored 2.10 and 3.5 points higher, respectively, on the total pencil tapping score compared to those with household heads having no education. However, no significant effect was observed for children with parents having primary or preschool education compared to those with parents having no education (P>0.1). Similarly, no significant relationship was found between household head occupation and children’s performance on the total pencil tapping score.

Table 4 Letters Naming and Tactile Pattern Completion scores

Key *=0.1,**=0.05

Table 4 presents the effect of school feeding on letter naming within two minutes and tactile pattern completion patterns. The analysis revealed that school feeding, occupation of the household head, and the child’s age had no statistically significant impact on either Letter Naming  or Tactile Completion patterns. However, the education level of the household head shown a significant association. Children from households with secondary education qualification were 90% less likely to have poor cognitive function resulting in poor learning outcomes in letter naming and tactile pattern completion tasks than those from households without formal education.

Conversely, the education level of household heads did not significantly influence cognitive ability in letter naming patterns and tactile pattern completion tasks.

Objective 3: To establish whether there is a relationship between Children’s Anthropometry and Learning Out come in SFP and non-SFP schools

Learning outcomes and non- verbal cognitive abilities were assessed to establish their relationship with children’s anthropometry using the sub-tests from the ZamCAT. Specifically, measures of learning outcomes included: receptive language abilities as assessed by the Pea-body Picture Vocabulary test; expressive language; and alphabet knowledge. Whereas cognitive abilities were assessed using tactile pattern reasoning and pencil tapping test.

Table 5: Relationship between children’s Anthropometry (MUAC, HAZ and WHZ) and learning outcomes in SFP and non SFP schools

The Line Regression analysis results in table 5, reveal a significant relationship between anthropometric measurements and learning outcome. At an alpha level of 0.05, a significant relationship was found between anthropometry (MUAC) and learning outcomes as follows; – At an alpha level of 0.05, a strong relationship was found between letter naming scores and MUAC. Similarly, a strong relationship was also found between Height for age and Letter naming scores total pencil tapping scores and Height-for-Age z-scores. However, the study results revealed no relationship between Weight-for-height with any of the learning scores tested.

DISCUSSION OF THE FINDINGS

Objective 1: To assess the impact of SFP on Children’s anthropometry in SFP schools and non-SFP schools.

In regards to the first objective, the study findings suggest that SFP had an impact  on the children’s anthropometry as seen in the overall nutrition status of learners benefiting from SFP meals. The study findings demonstrated a diverse difference in anthropometric measurements outcomes of children between schools implementing SFP and non-SFP.

anthropometric measurements

Overall,  children in SFP registered better anthropometric measurements. Weight for Height z-score improved in SFP schools than non-feeding schools with Weight for Height z-score statistical significance. This is in tandem with what Locke etal., (2024) in their review in Netherlands found. The findings show that SFP meals have improved the anthropometry and overall nutrition status in learners.

Furthermore, The results also indicates a significant association between participation in SFP and children playing with siblings with higher level of sibling play observed in SFP schools compared to non-feeding schools. According to Mweru, (2017) study, children tend to play with older siblings in homes and it is usually common during feeding. Often when this happens, it brings about brain stimulation improving overall cognitive functioning. Playing is very important in initiating neuroconnectivity in the brain. Siblings in the family need to engage the children in a play every time as this helps to stimulate their brain leading to improved developmental milestones.

Similarly, Onyango etal, (2023) found a largest effect size for language stimulation (ES = 0.15) and overall maternal stimulation was most strongly associated with gross motor development. This entails that children need friends to play with for them to get stimulated. It could be a father, neighbors, siblings or mothers as Onyango and his friends had rightly found in their study. According to WHO growth standards (Height-for-Age and Weight-for-Height z-scores results found that, 43% of the children enrolled had poor nutrition status below the WHO growth standards. Further analysis shows that WHZ is shifted to the left, indicating wasting. Their peak is around -1 z-scores, while WHO’s is at 0, with more variability in the studied group. Many fall below -2 z-scores, and few exceed the WHO median. This suggests a high prevalence of wasting among the children enrolled. HAZ is also shifted leftward showing that the children enrolled in the study were generally shorter for their age than global normal z-scores of below -2, the sample data indicates stunting. The short stature may be due to chronic malnutrition as these children literally do not have diversified food to eat hence might have drastic effects on the growth of children due to lack of essential nutrients needed for the body growth (Quamme, 2022).

Yaya etal., (2022) study findings on short stature among children in Sub-Saharan region concurs with this study, the study found that more than one-third of children in Sub-Saharan African countries were reportedly stunted. The percentage of stuntedness was higher among males than females and among rural children than their urban counterparts in Sub-Saharan countries. The prevalence of chronic malnutrition is widespread affecting one third of the under five children due to the increased prevalence of micro-nutrient deficiencies specifically the long term deficiency of iron and iodine which is usually irreversible when the child reaches two years (Sawadogo etal., 2022). Nevertheless, the wasting rate was more pronounced in schools without SFP than SFP schools meaning there was an impact observed from the school meals. This is in tandem with studies done in Ethiopia by Demilew & Nigussie, (2020) where the magnitude of stunting and thinness in school fed students was found to be lower, but over-nutrition is higher than non-school fed. In addition, the study also found that the MUAC measurements were normal in both schools.

However, it concluded that SFP has the great potential to improve the nutrition status among the targeted beneficiaries. Results of regression analysis indicated that there is a significance interaction between nutrition status and education outcomes (p<0.05). Similarly, studies done by Mideksa et al (2024) found that school feeding programs in Ethiopia showed mixed findings on nutritional status and academic performance. Besides that, poor-quality food provisions and financial or funding constraints affect SFP. Similarly, Abebe, and Ashenafi (2022) in their study done in Nigeria in the city of Kano revealed that there is a causal relationship between SFP, anthropometry and education outcomes. The results showed that children who benefited from SFP performed better in class and they had improved anthropometry and overall nutrition status as compared to the children in non-SFP.

Objective 2: To assess the impact of SFP on Learning outcomes

To realize this objective, the study assessed the impact of SFP on learning outcomes through comparing two categories of schools; schools offering school meals and those that did not offer school meals to school children. The study used ZamCAT which comprised child learning outcomes. The tools were administered to both categories of children in order to assess the impact of SFP on learning outcome. Selected components of ZamCAT such as Pea-body Picture Vocabulary Test, Naming letters, Pencil tapping, Tactile Completion task and Expressive languages were used. However, when the learners were attested with pea-body picture vocabulary learning assessments, SFP schools showed a 5.3 points higher than those from schools without feeding programs (P=0.008). Similarly, the expressive language assessments in learners also showed that School feeding had negligible effect on expressive language total score with children from parents with primary and secondary education having the highest scoring of 11.7 and 14.8 score respectively compared to children from parents with no education (p<0.05). Learners also performed better in pencil tapping however with a weak association.

According to Onyango etal., (2023), development of the domains in expressive language is associated with cognitive capacities in children which is due to good development coupled with good nutrition status and consistent class attendance. Interestingly, household head higher education level (tertiary) had no association with the learning outcomes. Neither was the occupation of the household head. Much as higher parental education is associated with better school achievements through parenting practices (Tamayo et al, 2022), research has shown that higher parent education may unlikely effect on the child development because of inadequate care towards the child. Educated parents are most of the times and tend to work for more hours and they likely leave their children unfed and unstimulated and unsupervised than their less-educated parents (Davis-Kean, Tighe & Waters, 2021).

Overall, the study findings leans towards SFP scoring negligibly better than those in schools without SFP with a weak association in pencil tapping, expressive language scores and Pea-body Picture Vocabulary Test Scores. This indicates that SFP is associated with better learning scores and overall improved learners performance than non-SFP schools. This also correlates with the prospective cohort study findings by Mohammed etal.,(2023) on effect of SFP on academic performance of primary school learners in Ethiopia where learners class performance improved drastically on SFP.

Similarly, Mostert, (2021), found that SFP has an impact on learning outcome. The results shows that the SFP has a significant effect, improving wellness, school attendance, and academic achievement because the meals improves concentration in class as such learners are able to grasp lessons leading to better performance. This also concurs with the quasi experimental study done by Metwally etal.,(2020) in which they found that Children who took the meal had better scores on visual memory, auditory vigilance tests than those that did not (9.71 ± 2.80 vs. 7.45 ± 3.25; 25.02 ± 3.36 vs. 10.82 ± 8.92, respectively (P<0.001). The study concluded that SFP is a strong predictor of education outcomes in school children. Ayele et al. (2022) study in Ethiopia concurs with Belachew etal (2023) and Metwalley et al (2020). The study concluded that malnutrition in the form of stunting, underweight, and micro-nutrient deficiency (iodine deficiency) affects the academic performance of elementary school children. The study confirmed that there was a strong association between academic performance and malnutrition. Kamnyung, (2019), a study conducted in Tanzania also found that school feeding is a catalyst for improving students’ attendance and academic performance.  The study recommended that SFP should be enhanced in schools and to be established in schools which do not have such program to ensure learners enrolment, attendance and eventually good academic performance.

Contrary to the positive findings on effect of nutrition status on learning outcomes, a few scores of the child learning assessments did not do well. For instance, Letter Naming and Tactile Pattern Completion task scores, had showed no improvement despite the exposure to school meals and good nutrition status of learners and they had also no any significant association between them. However, both SFP and non SFP schools had high “Incorrect” responses on the Letter naming and Tactile Pattern Completion task assessments. This is because the class room behaviors are complex and are affected by so many factors including the disasters such as tropical cyclones such as Cyclone Freddy which had also disturbed classes big time in the district. The quality of school itself can also affect learning outcomes. Other factors include education level of teachers as most instructors in these early learning are untrained volunteers in the communities.

While some children in these early childhood centres are handled by trained ECD caregivers, most of the children are being managed by untrained caregivers since only 17,101 caregivers out of  35,361 had received formal training by 2021 (Malawi Government, 2021). In addition, there are no incentives for them and they are not paid. In a review of other studies on learning outcomes, Beisly, etal., (2022), reported that despite school meals and better nutrition status of learners is more important in improving learning outcomes. However, it may be at a certain threshold level, otherwise education of teachers and socio-economic status (SES) of learners become critically important in achieving learning outcomes. The poor the SES of the child, the more ability to grasps concepts in class because executive function and learning behaviour are significantly correlated with children’s literacy outcomes. Learning behaviour moderates the association between family SES and child learning outcomes. Teachers may support learning behaviour by teaching active listening and frustration management techniques, thus motivating children to actively participate in learning. This also serves to buffer the negative impacts of family SES on children’s academic outcomes.

The school meals would most likely facilitate learning  and improve learners concentration in class, even for the undernourished learners. However, in the non-SFP schools, it is uncertain whether good nutrition status would have led to an improved learning outcomes without the availability or access to meals (Aino, 2020).The findings suggest that, if we desire maximum benefits from school feeding programs, we should link them with educational improvements where necessary. There is currently a reasonable amount of evidence that children’s cognitive functions are enhanced if they eat breakfast, especially if they are undernourished. However, we cannot be certain that this will lead to better attainment levels.

Objective 3:To establish whether there is a relationship between Children anthropometry and Learning Out come in SFP and non-SFP schools

Learning outcomes and non- verbal cognitive abilities were assessed using the sub-tests from the ZamCAT. Specifically, measures of learning outcomes included: receptive language abilities as assessed by the Pea-body Picture Vocabulary test; expressive language; alphabet knowledge, tactile pattern reasoning and pencil tapping test. The findings of the study which aimed at establishing the relationship between school children anthropometry and the learning outcomes was run using the Linear regression analysis. The results, reveal a significant relationships between anthropometry and learning outcomes. As the results read, at an alpha level of 0.05, a positive relationship was found between anthropometry and learning outcomes as follows;- a marginal positive relationship was found between MUAC and letter naming scores  (R=0.46).

Similarly, a relationship was also observed between Height for age and Letter naming scores (R=0.37). However, the study results revealed no relationship between Weight for height with any of the learning scores tested. A study by Ayalew etal.,(2020) comparing nutrition status and education performance revealed an association between the two variables. The study found that low height-for-age children had 75% decreased odds of achieving high average semester score compared to normal height-for-age children. Furthermore, moderate low weight for age children have 68%, 64% and 66% decreased odds of achieving high Science, Mathematics, Amharic, and English course scores compared to normal weighted children, respectively. Similarly, Bassuoni etal., (2020) studied the association of under-nutrition (micro-nutrients deficiencies of zinc, iodine and iron) and cognitive functioning in preschool in Egypt. The study concluded that inadequate diet is associated with reduction in IQ and overall poor cognitive functioning. This is because nutrients such as zinc, iodine and iron are co-factors for more than 200 enzymes that regulate different metabolic activities in the body. Specifically, Zinc is found in high concentrations in synaptic vesicles of hippocampal neurons, which are centrally involved in education and memorial status (Nyaradi etal., 2021).  This study findings also concurs with what Gansaonre etal., (2022) found on stunting and academic achievements in developing countries. The results concluded that children with low height for age (stunted) were more likely to repeat a grade than non-stunted [OR = 1.59 (95% CI, 1.18–2.14)].

Therefore, the Linear regression analysis findings demonstrate that anthropometry (Height-for-age (stunting) and MUAC) could serve as predictors of learning outcomes progress in preschool children.

CONCLUSION AND RECOMMENDATIONS

Conclusion

Evidence has shown that SFP improves anthropometric measurements with opportunities for better nutrition and health well-being contributing to better child development hence better learning outcomes. The basic principles of building a better education performance is through ensuring adequate nutrition for children in preschool among others. It is more effective and less costly than addressing the consequences of early adversity later. The balanced approach to children nutrition through SFP should be taken into consideration for preparation of children’s success in school and later in workplace and community. The study findings showed that there is currently a reasonable amount of evidence that children’s learning outcomes could be enhanced by nutrition. The study points to what could be the potential impact of SFP on anthropometry and overall nutrition status and learning outcome in Malawi. The comparison of SFP schools and non SFP schools would grant more confidence to generalize the findings however more research in Malawian setting or a longitudinal study on the same participants should be conducted to back up the findings. On the other hand, the results are based on entry level early childhood education learners and we do not know whether the benefits would be the same with older children. Furthermore, WHO Anthro Plus 2007 might have some limitations as it automatically excludes participants with an older age especially females were excluded due to the fact that their weight increases in spite of nutritional status hence the need to recruit other statistical packages in the next study.

Nevertheless, based on the findings, the SFP in Early Childhood Education can not be understated. Its has a great potential to improve nutrition status and learning outcomes hence the need to consider scaling up the interventions to other schools which are not implementing the programmes. It is double sworded as it improves both nutrition and health of children and also their academic performance.

Recommendation

The findings of the study indicates that SFP enhances learning outcomes and anthropometry.  Therefore;-

1. The SFP should be considered in all early learning platforms and it should be scaled up in all schools in Malawi.
2. SFP should also be established in schools which do not have such program to ensure learners enrolment, attendance and eventually good academic performance.
3. A wide range of policies, including those directed toward SFP in early education and or primary education should be promoted to ensure that children attain good nutrition status and develop optimally and holistically as they pursue there
4. Future research should be done on a large scale longitudinally to further evaluate the effect of SFP on school trajectories and the modification effect of socioeconomic status.
5. Furthermore, elements of hygiene and sanitation should also be studied as malnutrition are caused in two folds; diseases and inadequate food intake.
6. However, there is need for the government and developmental partner to support for effective running of the programme

ACKNOWLEDGEMENT

Special thanks to my research supervisor Professor Beatrice Matafwali, my family and colleagues for their continued encouragement, and unconditional support. Finally, I thank the University of Zambia for providing me with the opportunity to pursue this research.

Disclaimer

This paper is an excerpt from a master’s thesis on Impact of SFP on children’s anthropometry and Learning outcomes in Chikwawa District-Malawi. The authors wish to declare that they have no conflict of interest.

About the authors

Kondwani Chavula is a Masters’graduate at the University of Zambia. He is a holder of  Bachelor of Science in Peadiatric and Child Health (honours), Bachelor of Science in Human Nutrition and Food Science all from University of Malawi, College of Medicine and Bunda College of Agriculture respectively. Kondwani has worked as Principal Nutrition and Programmes Officer and Clinical Associate  in the Ministry of Health for over 15 years.

Beatrice Matafwali is an Associate Professor at the University of Zambia, Department of Educational Psychology, Sociology and Special Education.

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