A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana
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Food environments can play important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP). Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse.
KeywordsFood environments Food access Dietary quality School meals Children and adolescents
This work was financially supported by the Bill and Melinda Gates Foundation and Dubai Cares. The authors acknowledge the Ghana School Feeding Programme and a number of individuals. The contributions of Lesley Drake, Kwabena Bosompem, Felix Asante, Irene Ayi, Daniel Kojo Arhinful, and Edoardo Masset are acknowledged for leading the overall impact evaluation. Tony Kusi provided field supervision and data analysis support. Rosanna Agble provided guidance on nutrition. Edoardo Masset contributed to the design of the household survey and Eric Ockrah developed the school questionnaire. Daniel Mumuni contributed to the implementation of the survey, liaised with the GSFP and provided feedback on the manuscript at various sages. Individuals at the Ghana School Feeding Programme who were instrumental in the study design and in the provision of valuable technical support include the National Coordinator, Mr. S.P Adamu, Mrs. Susan Torson, Nutrition Programme Manager, and Mrs. Kate Quarshie of the Ghana Health Service. The Partnership for Child Development Ghana team also provided a critical role in the implementation of the impact evaluation and liaising with the Ghana School Feeding Programme. These individuals include Getrude Anase-Baiden, Abigail Bondzie, Fred Amese and Lutuf Abdul-Rahman.
All authors made substantial contributions to the conception and design, data acquisition, data analysis, interpretation of analysis results and the drafting of the manuscript. MF developed the concept and led the quantitative analysis and writing of the manuscript, while EA contributed the use of food environments as a guiding framework and the mixed methods approach as well as significant contributions to the manuscript text. GF provided critical inputs to the conduct of the survey and conducted the qualitative analysis of the focus group transcripts. GF also contributed to the construction of variables, reviewed analysis output for the quantitative analysis and contributed to the writing of the manuscript. AG designed the household questionnaire and identified the sampling approach. In addition, he provided overall guidance on the analytic approach for the quantitative analysis, sample definition and the variable construction.
Compliance with ethical standards
The household and school surveys were conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the University of Ghana Noguchi Memorial Institute for Medical Research (NMIMR) Institutional Review Board. Consent to voluntarily participate in the study was sought from respondents after giving them general information about the study, details of data to be collected, risks and discomforts, benefits, confidentiality and their right to leave the research at any point in time. They were also given contact details of one researcher for further information. Participants signed a consent form to indicate such, or made a cross to indicate consent if they could not sign.
Conflict of interest
The authors report no conflicts of interest.
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