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Impact of National Egyptian school feeding program on growth, development, and school achievement of school children



School feeding program (SFP) increases access to education and to better health. This study aims to evaluate the effects of SFP on physical growth, cognitive development, psychosocial behavior, and learning achievement of school children.


A quasi-experimental study was conducted. The intervention group included 903 pupils in the fifth grade receiving the school meal, while the control group included 886 pupils, matched for age and sex, without meal. The meal consisted of a pie made of flour fortified with vitamins A, B6, B12, C, thiamin, riboflavin, niacin, folate, calcium, iron, zinc, and phosphorus. Socioeconomic position, nutritional status, and dietary behavior were evaluated. Neuropsychological tests were done. Psychosocial behavior was rated and educational achievement was recorded. Post hoc and independent sample t tests were used to detect the association of the studied parameters with the intake of school snack.


Children who took the meal had better scores on visual memory, auditory vigilance tests (9.71 ± 2.80 vs. 7.45 ± 3.25; 25.02 ± 3.36 vs. 10.82 ± 8.92, respectively, P < 0.001), the afternoon attention and working memory test (8.20 ± 2.21vs. 7.75 ± 3.05) (P < 0.001), but less score of externalizing behavior (P < 0.001) than the control group. No significant changes of children’s nutritional status were detected between the two groups. School meal was the main predictor of visual memory and auditory vigilance (P < 0.001), and was the strongest predictor of academic achievements when combined with family size and meals’ frequency (P < 0.001).


School meal improves academic achievements of school children.

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  1. 1.

    WHO (World Health Organization). The WHO Child Growth Standards. WHO. 2016. https://who.int/childgrowth. Accessed 15 April 2016

  2. 2.

    Ministry of Health and Population, El-Zanaty and Associates, ICF International. Egypt demographic and health survey 2014. Cairo, Maryland: Ministry of Health and Population, ICF International; 2015. https://dhsprogram.com/pubs/pdf/FR302/FR302.pdf. Accessed 28 Aug 2018.

  3. 3.

    UNICEF. Children in Egypt: a statistical digest. UNICEF (United Nations Children’s Fund) Children in Egypt; 2015. https://www.unicef.org/egypt/sites/unicef.org.egypt/files/2017-12/EGY-UNICEF-2015-Children-in-Egypt-Statistical-Digest.pdf. Accessed 15 July 2018.

  4. 4.

    Abdelaziz SB, Youssef MRL, Sedrak AS, Labib JR. Nutritional status and dietary habits of school children in Beni-Suef Governorate, Egypt. Food Nutr Sci. 2015;6:54–63.

  5. 5.

    Ali G, Habib N, Ismail LG. Nutritional status among primary governmental school student’s, Cairo Governorate. Med J Cairo Univ. 2016;84:157–65.

  6. 6.

    UNICEF (United Nations Children’s Fund). Nutrition—Micronutrients. 2018. https://www.unicef.org/nutrition/index_iodine.html. Accessed 25 Apr 2019.

  7. 7.

    WFP (World Food Programme). Saving lives. Changing lives. The impact of school feeding programmes. 2019. https://docs.wfp.org/api/documents/WFP-0000102338/download/?_ga=2.211543701.1247978500.1567068185-1481948825.1530783556. Accessed 29 Aug 2019.

  8. 8.

    WFP (World Food Programme). How school meals contribute to the sustainable development goals. 2017. https://documents.wfp.org/stellent/groups/public/documents/communications/wfp290718.pdf. Accessed 29 Aug 2019.

  9. 9.

    Trochim WM. Research methods knowledge base. 2006. https://trochim.human.cornell.edu/kb/index.htm. Accessed 25 Apr 2016.

  10. 10.

    WFP (World Food Programme).Egyptian Government to Expand National School Feeding Programme To Reach All Public Schools. United Nations World Food Programme 2016. https://www.wfp.org/news/egyptian-government-expand-national-school-feeding-programme-reach-all-public-scho. Accessed 14 Sep 2019.

  11. 11.

    Horwitz W, Latimer GW. Official methods of analysis of the association of official analytical chemists international. 18th ed. Washington DC: Gaithersburg; 2005.

  12. 12.

    James CS. General food studies. In: analytical chemistry of foods, blachie academic and professional, London, New York, Tokyo. 1995; 6:135.

  13. 13.

    Food and Nutrition Board, Institute of Medicine, National Academies. Dietary reference intakes: the essential guide to nutrient requirements. 2011. http://www.nap.edu/catalog/11537.html. Accessed 9 May 2019.

  14. 14.

    Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 3rd ed. New York: John Wiley & Sons; 2003.

  15. 15.

    Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Publishers; 1988.

  16. 16.

    .WHO, AnthroPlus for Personal Computers. Manual Software for Assessing Growth of the World's Children and Adolescents. 2009. Geneva. https://www.who.int/growthref/tools/en/. Accessed 5 Jul 2018.

  17. 17.

    Yunis FA, Khalifa AG, Monir ZM, Ayad AA, Gabr SA. physical growth, nutritional status and intellectual performance among school children of a rural village. Med J Cairo Univ. 1995;63:971–80.

  18. 18.

    Wahba SA, Khalifa AG. Breakfast skipping and cognitive functions of primary school children, relation to nutritional status. Gaz Egypt Paed. 1998;46:203–16.

  19. 19.

    Khalifa AG, Hasaballa F, Tawfik S, Mansour M. Nutritional status and cognitive performance of primary school children, relationship to social status and academic achievement. JAC. 2001;12:31–54.

  20. 20.

    Wechsler D. Manual for the Wechsler Intelligence Scale for Children - Revised (WISC-R). New York: The Psychological Corporation; 1977.

  21. 21.

    Babikian T, Boone K, Lu P, Arnold G. Sensitivity and specificity of various digit span scores in the detection of suspect effort. Clin Neuropsychol. 2006;20:145–59.

  22. 22.

    De Paula JJ, Malloy-Diniz LF, Romano-Silva MA. Reliability of working memory assessment in neurocognitive disorders: a study of the digit span and corsi block-tapping tasks. Br J Psychiatry. 2016;38:262–3.

  23. 23.

    Conway ARA, Kane MJ, Bunting MF, Hambrick DZ, Wilhelm O, Engle RW. Working Memory span tasks: a methodological review and user’s guide. Psychon Bull Rev. 2005;12:769–86.

  24. 24.

    Ismaiel E, Kamel M. Wechsler intelligence scale for children revised, Arabic version. Cairo: El-Nahda El Massryia; 1993.

  25. 25.

    Sattler JM. Assessment of children. 3rd ed. San Diego: Jerome M. Sattler, Publisher, Inc.; 1992.

  26. 26.

    Pollit E (1984) Methods for the Behavioral Assessment of the Consequences of Malnutrition. In: Lockwood ER, Scrimshaw NS (eds) Methods of the evaluation of the impact of food and nutrition programs. UNU, Tokyo

  27. 27.

    Jellinek MS, Little M, Murphy JM, Pagano M. The pediatric symptom checklist: support for a role in a managed care environment. Arch Pediatr Adolesc Med. 1995;149:740–6.

  28. 28.

    Gardner W, Murphy M, Childs G, Kelleher K, Pagano M, Jellinek MS, et al. The PSC-17: A brief pediatric symptom checklist including psychosocial problem subscales: a report from PROS and ASPN. Ambulatory Child Health. 1999;5:225–36.

  29. 29.

    WHO (World Health Organization). Nutrition in WHO news 2018. http://www.who.int/news-room/facts-in-pictures/detail/nutrition. Accessed 25 May 2019.

  30. 30.

    Mwaniki EW, Makokha AN. Nutrition status and associated factors among children in public primary schools in Dagoretti, Nairobi, Kenya. Afr Health Sci. 2013;13:39–46.

  31. 31.

    Kandeel WA, Rabah TM, Zeid DA, El-Din EMS, Metwally AM, Shaalan A, et al. Determinants of exclusive breastfeeding in a sample of Egyptian infants. Open Access Maced J Med Sci. 2018;6:1818–23.

  32. 32.

    Boraey NF, El-Sonbaty MM. Behavioral problems in children with nephrotic syndrome. J Appl Sci Res. 2011;7:2001–7.

  33. 33.

    Salem S, Salah H, El-Sonbaty MM, Fathy A. The impact of chronic chest trouble on cognitive functions, psychosocial behavior and academic achievement among Egyptian children. J Appl Sci Res. 2012;8:3459–68.

  34. 34.

    Salah El-Din EM, Elabd MA, Nassar MS, Metwally AM, Abdellatif GA, Rabah TM, et al. The interaction of social, physical and nutritive factors in triggering early developmental language delay in a sample of Egyptian children. Open Access Maced J Med Sci. 2019;7:2767–74.

  35. 35.

    El Din EMS, Rabah TM, Metwally AM, Nassar MS, Elabd MA, Shaalan A, et al. Potential risk factors of developmental cognitive delay in the first two years of life. Open Access Maced J Med Sci. 2019;7:2024–30.

  36. 36.

    Chakraborty T, Jayaraman R. School feeding and learning achievement : evidence from india ’ s midday meal program. J Dev Econ. 2019;139:249–65.

  37. 37.

    Adolphus K, Lawton CL, Dye L, Oddy WH. The effects of breakfast on behavior and academic performance in children and adolescents. Front Hum Neurosci. 2013;7:1–28.

  38. 38.

    Adolphus K, Lawton CL, Champ CL, Dye L. The effects of breakfast and breakfast composition on cognition in children and adolescents : a systematic review. Adv Nutr. 2016;7:10–2.

  39. 39.

    Anderson GH, Hunschede S, Akilen R, Kubant R. Physiology of food intake control in children. Adv Nutr. 2016;7:232S–40S.

  40. 40.

    Edefonti V, Bravi F, Ferraroni M. Breakfast and behavior in morning tasks: facts or fads? J Affect Disord. 2017;224:16–26.

  41. 41.

    Taylor AD, Ogbogu CO. The effects of school feeding programme on enrolment and performance of public elementary school pupils in Osun State, Nigeria. World J Educ. 2016;6:39–47.

  42. 42.

    Whaley SE, Sigman M, Neumann C, Bwibo N, Guthrie D, Weiss RE, et al. The impact of dietary intervention on the cognitive development of Kenyan school children. J Nutr. 2003;133:3965S–71S.

  43. 43.

    Metwally AM, El-Din SEM, Shehata MA, Shaalan A, El Etreby LA, Kandeel WA, et al. Early life predictors of socio-emotional development in a sample of Egyptian infants. PLoS ONE. 2016;11:86.

  44. 44.

    Alim F, Khalil S, Mirz I, Khan Z. Impact of one day meal scheme on nuritional status and academic achievement of school children in Aligarh City. Indian J Sci Res. 2012;3:85–90.

  45. 45.

    Zenebe M, Gebremedhin S, Henry CJ, Regassa N. School feeding program has resulted in improved dietary diversity, nutritional status and class attendance of school children. Ital J Pediatr. 2018;44:1–7.

  46. 46.

    Bundy DAP, De’ Silva N, Horton S, Jamison DT, Patton GC, Optimizing education outcomes: high-return investments in school health for increased participation and learning disease control priorities, vol. 1. Wahington DC: World Bank Group; 2018.

  47. 47.

    Best C, Neufingerl N, Del Rosso JM, Transler C, Van den Briel T, Osendarp S. Can multi-micronutrient food fortification improve the micronutrient status, growth, health and cognition of schoolchildren? A systematic review. Nutr Rev. 2011;69:186–204.

  48. 48.

    Gelli A, Aurino E, Folson G, Arhinful D, Adamba C, Osei-Akoto I, et al. A School meals program implemented at scale in Ghana increases height-for-age during midchildhood in girls and in children from poor households: a cluster randomized trial. J Nutr. 2019;149:1434–42.

  49. 49.

    FAO (Food and Agriculture Organization of the United Nations). Nutrition guidelines and Standards for School Meals: a Report from 33 Low and Middle-Income Countries. Rome. 2019; p. 106. Licence: CC BY-NC-SA 3.0 IGO.

  50. 50.

    Salah EM, Khalifa AG, Metwally AM, Hamid NA, Hussien HA, Moneer ZM. The impact of school snacks on cognitive function of primary school children in Egypt. J Appl Sci Res. 2012;8:5639–50.

  51. 51.

    Metwally AM, Ibrahim NA, Saad A, Abu El-Ela MH. Improving rural women role in health and environmental issues. Int J Environ Health Res. 2006;16:44–133.

  52. 52.

    Metwally AM, Saad A, Ibrahim NA, Emam HM, El-Etreby LA. Monitoring progress of the role of integration of environmental health education with water and sanitation services in changing community behaviours. Int J Environ Health Res. 2007;17:61–74.

  53. 53.

    Shiha G, Metwally AM, Soliman R, Elbasiony M, Mikhail NNH, Easterbrook P. An educate, test, and treat programme to reduce hepatitis C in Egypt: results from a community-based demonstration project. Lancet Gastroenterol Hepatol. 2018;11:778–89.

  54. 54.

    Metwally AM, Saleh RM, El-Etreby LA, Salama SI, Aboulghate A, Amer HA, et al. Enhancing the value of women’s reproductive rights through community based interventions in upper Egypt Governorates: a randomized interventional study. Int J Equity Health. 2019;18:146.

  55. 55.

    Salama II, Sami SM, Said ZNA, Salama SI, Rabah TM, Abdel-Latif GA, et al. Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy. Vaccine. 2018;36:2005–111.

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Author information

AMM designed the study and the approach, and reviewed the manuscript. MMS wrote the manuscript. AMM, LAE, and EMS reviewed and revised the manuscript. EMS, HAH, AH, and ZMM shared in data collection. HAH and AH did the statistical analyses. NH supervised the data collection process. AMM, MMS, LAE, and EMS interpreted the data. AMM and MMS shared in putting the final format. All authors provided input into the manuscript and approved the final manuscript.

Correspondence to Marwa M. El-Sonbaty.

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Ethical approval

The study was approved by the Medical Research Ethics Committee of the National Research Centre with the ethical approval number of 19068. Permission to conduct the research was obtained from the Ministry of Education. Competing interest for all authors “No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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We declare no competing interests.

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Metwally, A.M., El-Sonbaty, M.M., El Etreby, L.A. et al. Impact of National Egyptian school feeding program on growth, development, and school achievement of school children. World J Pediatr (2020). https://doi.org/10.1007/s12519-020-00342-8

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  • Cognition
  • Growth
  • Performance
  • School feeding