|Title||Public health nutrition intervention to evaluate the nutritional impact of the Ghana School Feeding Programme in Lower Manya Krobo (LMK) district, and enhancing its effectiveness through a nutrition intervention|
School feeding interventions like many other donor dependent nutrition interventions in low-income countries have often been described to be ineffective or unsustainable because they are designed with donor specific nutritional interests, which often do not reflect the indigenous dietary preference and patterns of target populations. In Ghana, over half a million school children depend on the school meals as their main stable source of food for the day however there have been several reports of lack of nutritional impact of the due to the dependence on non-indigenous foods. The aim of this study was to develop school meals (SCm) for the Ghana School Feeding Programme (GSFP) in the Lower Manya Krobo District by employing local agricultural produce as food-to-food fortification. The study is based on the tailored functional food recipe concept that seeks to enhance the effectiveness of nutrition interventions by employing indigenous knowledge of food composition and food processing to improve micronutrients profile of local available foods without compromising palatability. Maize, sweet potatoes, soybeans, Moringa oleifera, palm nut oil, anchovies were processed using traditional methods. Each SCm was formulated using nutrition data from FAO West African-Food-Composition-Table to contain at least 40% DRI for protein. AOAC (2009) methods were used to analyse the nutritional content of the SCm and two sets of sensory tests were performed to determine acceptability. In all, five SCm were developed and per 100g of each SCm, carbohydrate (with crude fibre) and protein content ranged from 68.07g to 49.18g and 16.32g to 27.52g respectively whilst fat content ranged between 4.1g and 19.4g. Calcium content ranged from 284mg to 960mg whilst iron and zinc contents range between 7.17g to 11.17g and 0.97g to 1.59g respectively. In the sensory test, SCm coded FSM123, FSM101 and FSM579 had highest mean overall acceptability scores of 7.58±0.56, 7.74±0.81 and 7.71±0.70 respectively. The efficacy and effectiveness of the SCm were tested in a 6 months pilot nutrition n (180) and 9-month scale-up intervention (n=330) together with a control group and a GSFP group. After initial deworming and malaria screening, the intervention the GSFP group received the normal school meals, the control group received three portions of fruit as incentive the SCm group receive 15g weight bases of SCm meal together with nutritional education. The results showed that participants in the SCm treatment group had an average 3.24% increase in height (p≤0.05) and 13.08% increase in weight (p≤0.0.5) over the intervention periods. There was also a 17% decrease in anaemia prevalence compared 11% decrease in the control and 9% decrease in GSFP. The results illustrate that the application of indigenous knowledge, and innovation in of nutrition could be a plausible tool in enhancing the nutrient content of school meals. The SCm seems to provide some leverage and resilience against further malnutrition and when combined with deworming, malaria treatment buttressed with behaviour change communication provided greater nutritional impact on height and weight relative to the other groups in the study.