23 Jan 2017

Reducing malnutrition through education actions

Harold Alderman Senior Research Fellow at The International Food Policy Research Institute (IFPRI)

Schools and educators have a role to play in reducing malnutrition around the world.Nutrition-sensitive programs draw upon complementary sectors to affect the underlying determinants of nutrition and child development, which include poverty, food insecurity, and lack of access to adequate care resources and adequate health, water, and sanitation services (Ruel and Alderman 2013). While particular attention has been applied to the potential nutrition sensitivity of agriculture and social protection, education shares in that potential owing to its coverage as well as its ability to serve as a platform for nutrition-specific programs. There are several ways to make school more nutrition-sensitive.

  1. Increase girls’ participation in schooling. Girls’ schooling can reduce adolescent pregnancy—a well documented risk factor for small birth size (Kozuki et al. 2013)—as well as raise the age of marriage (Hahn et al. 2015) and reduce total fertility (Breierova and Duflo 2004). Clearly, however, in the long run what girls learn in school is even more important. This is not just basic literacy and numeracy, but also information on health and nutrition.
  2. Use school as a platform for nutrition education and other nutrition-related services. There is accumulating evidence on school-based modules for nutrition education, particularly in encouraging healthy eating and exercise with the aim of preventing obesity (Waters et al. 2011). There is also some experience with encouraging hygiene and hand-washing as well as with teaching modules addressing risky activities potentially linked to adolescent pregnancies. But there is also one glaring omission: there is little in the nutrition literature that covers low- and middle-income countries on the experience of using classrooms to impart information on caring for children, despite the high expectation that most students will shortly take on the role of caregiver (Tang et al. 2009). Schools can also be a platform for iron supplementation (Luo et al. 2012) as well as for incentives for school leaders to reduce anemia in schools (Miller et al. 2012). Similarly, albeit not without some debate, schools can provide a platform for regular deworming (Ahuja et al. 2015).
  3. Make school meals a nutrition intervention. School meals offer a possibility for exploring diet diversity, but their role in improving nutrition is less straightforward than their proven role in promoting school enrollment. This is illustrated by the example of certain Mexican children who can be classified as both underweight by World Health Organization (WHO) standards and simultaneously overweight in terms of body mass index (Lobstein et al. 2015). This paper offers an apt phrase for the challenge that this phenomenon exemplifies—overweight or underheight?—a challenge that affects the goals and assessment of school feeding programs, including those in preschools. It is no longer clear how to interpret evidence such as the systematic review of randomized trials of school meals that reported an increased weight gain of 0.39 kilograms (Kristjansson et al. 2007) without a greater understanding of context, although the corresponding evidence on school performance in these programs is less ambiguous (Victora and Rivera 2014).
  4. Use school feeding as a potential support to agricultural development. In addition to its nutrition, education, and social protection objectives, school feeding is increasingly asked to support agricultural development through homegrown school feeding programs. Adding a new objective, of course, increases the tradeoffs that must be considered. In the case of homegrown school feeding, decentralization makes fortification—one means by which school meals can effectively reduce micronutrient deficiencies—more challenging, but not impossible. It also increases the challenge of logistics in food-insecure areas in times of drought or seasonal shortages. Over time, however, homegrown school feeding may improve dietary diversity and increase food security among low-income producers, although there is no evidence yet to support this hope.

This excerpt appears in Panel 6.6 of the 2016 Global Nutrition Report.

Photo: © Aisha Faquir/World Bank