الفهرس 
Growth and Development of Primary School ChildrenOnly 14 pages are availabe for public view
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Abstract
School meal program started to be applied in Egypt since 1981 under the supervision of the Ministry of Education. The number of students involved in the school meal program in Egypt increased from 3 019 130 in 1991/1992 to 11 210 258 in 2004/2005. The magnitude of benefits of SFP realized are probably dependent on the design of the program, amount of energy and other nutrients provided by the meal/snack, baseline nutritional status, timing of meal/snack , age of the child, and not surprisingly, on compliance. However, it is unrealistic to expect that school meals or any other single intervention can be a panacea for all of the deprivation of children living in poverty.
The general aim of the present study was to evaluate the impact of offering a school meal on the nutritional status and cognitive functions of primary school children. Also to estimate the energy value and nutrients components of the offered meal, evaluate the impact of offering a school meal on scholastic achievement and absenteeism, and finally to assess the effect of summer vacation on the nutritional status of primary school children.
During a period of one year, a Cross sectional study followed by experimental design was conducted in the in El-Dekhela mixed primary school (school with feeding program), and Amar Ebn Yaser mixed primary school (without feeding program) in Al-Amria district, Alexandria governorate. 2083 students from the first to fifth grades were included for the study, 1042 student from intervention school and 1041 from the control school. The study was conducted during the year 2007/2008 and 2008/2009.
All participants were interviewed to answer a pre-designed questionnaire. It included demographic and socioeconomic characteristics, eating habits, family data, and house hold data. Clinical examination was conducted to exclude any child with chronic disease or drug intake that may affect the health status of the student. Height and weight was recorded before and after intervention. Then body mass index was calculated. The school meal was introduced to all students of the experimental school from the beginning of the study year (2007/2008) till its end. Meal was served before the start of classes. It was started from 23rd of October 2007 till the 1st of April 2008. At the end of school year school records of each student were also reviewed to collect data about attendance and scholastic achievement.
A sub sample of 300 students, 150 from the experimental school plus 150 from the control one, was taken to test Hb levels, cognitive functions before and after intervention, and parasitic infections screening to exclude students with heavy infection. Stratification of the sample according to educational grades was done. One class was selected randomly from each educational grade to fulfill a subsample of 150 students of each school.
The school meal was available four days a week and all children were consuming their meals. The provided meal was consisted of one cooked cheese slice
(15 g), 30 g jam and bread in two days (first meal menu), or two cooked cheese slices
(30 g), sweet (50 g) and bread in the other two days (second meal menu). School meal was analyzed using the Egyptian food composition tables.
Finally, the studied sample of both schools was assessed as regards their nutritional status at the beginning of the next school year 2008/ 2009 using anthropometric measurements.
The study revealed the following results:
Sample characteristics:
• In the intervention school 50.1% were boys and 49.9% were girls, while in the control school 50.3% were boys and 49.7% were girls
• Regarding the level of father education the highest percent of in the intervention and control schools students (25.7% and 26.5% respectively) their fathers were with secondary education and the lowest percent their fathers were with university education (7.6%, 7.9% respectively).
• The highest percent of the studied sample (40.9% and 45.7% in intervention and control school respectively) their fathers work was skilled and unskilled workers.
• As regard birth order, the second child constituted the highest percent among the studied sample (26.4% in intervention and 34.2% in the control school), while the lowest percent was the single child (2.3, 3.4% respectively).
• Among intervention school 46.7% of families considered family income sufficient with no saving, while 45.8% considered it insufficient with dept. In the control group 51.7% considered family income sufficient with no saving, while 41.8% found it insufficient with dept.
• There was sewage disposal mean in (87.9% and 82.1) in the two schools respectively. At the same time 98.8% of students of intervention group have electricity in their houses, and 97.1% of control group likewise. Finally 92.9% and 86.8% of students in intervention and control groups respectively have clean water in their houses.
Dietary characteristics:
• As regards number of usual daily meals, more than two thirds of the studied sample reported having three meals daily and those constituted 68.9% of intervention and 69.1% of control school. While 27.9%, and 28% of the intervention and control groups respectively reported having two meals daily. Only 0.4 of studied sample reported having one meal daily, and 2.7% reported having 4 and more daily.
• 20.8% versus 17.7 for control group stated that they did not take breakfast. While the highest percentage of the sample was keen to have breakfast always (more in the control group 44.2% than intervention (37.1%).
• More than two thirds of the studied sample take foods with them to school, with higher percentage among control school students (69%) than intervention school students (61.1%). While the lowest percentage stated that they did not take food to school. The highest percent of the intervention (51.6%) and control (61.6) school students preferred to take sandwiches to school than other foods.
Effects of school meal:
• School meal provides substantially more than the breakfast goal of 20- 25% of RDA for energy.
• School meal provides substantially more than the breakfast goal of 25% of RDA for most nutrients, but fall short of that goal for some nutrients. For the age range from 4-8 years, the percent satisfaction of RDA’s for Niacin, Vitamin C, Vitamin A and Calcium was lower than one fourth of the recommended daily need in the first meal menu while only vitamin C in the second meal menu . With regard to the age range 9-13 years, percent of RDA for total Niacin, Vitamin C, Vitamin A, and Calcium was lower than the goal in the first and second meal menu for male and females.
• School meal has a positive effect on the nutritional status, as seen in increased weight change. Children who were fed at school gained an average of 0.6 kg in weight more than those who were not supplemented.
• Results showed significant gains in height; children in the intervention groups gained an average of 0.48 cm more than children in the control groups.
• With respect to underweight prevalence, a statistically significant improvement in underweight from pre to post intervention was observed for the intervention group from 4.2% to 2.1% on contrary, no significant change observed from pre to post intervention for the control group from 1.6% to 0.7%.
• About 90.6, and 88 % % of the examined students in the intervention and control schools respectively were below the WHO cut off points (< 12 g/dl)
• The study reported a greater increase in hemoglobin in the experimental groups of 0.23 g/dl at the end of intervention.
• The group of children who received school meal, percent of school days lost decreased from 18.2 % to 16.8% per year while in the control group, percent of school days lost increased from 10.2% to 11.04% per year. The increase in attendance in intervention school, and the decrease in attendance in control school were statistically significant.
• One third (30.9%) of students in the intervention group improved in their scores from the year before intervention to the current year, while there was improvement only in 12.5 % of students in the control group. This is from one hand, and from the other hand 24.4% of intervention group deteriorated compared to 28.7 % of the control group.
• The present work indicated a significant improvement in Quantitative subtest, short term memory, and total IQ in intervention versus control school.
Subgroup analyses:
• Significant better improvement on height as a result of school meal in lower socioeconomic levels than on moderate one; also there was a better improvement in achievement in lower socioeconomic levels.
• The present study showed a significant higher gain in weight and height in the adequately nourished group than undernourished group.
• School meal significantly improved short term memory in undernourished group.
• Younger children realize greater height, weight, and achievement benefits than older children.
• There was a significant improvement in weight, height and WAZ for girls than boys as a result of school feeding.
• Our study has shown that sex differences in cognition in children are evident; girls are more proficient than boys in short term memory as a result of school feeding.
Results of after summer holiday assessment:
• Students after summer vocation have a significantly increased weight, height and BMI in response to normal growth over this period, while there was no statistically significant difference between intervention and control school in weight change in response to summer vacation. Concerning height change from post intervention to the after summer vacation, there was a statistically significant better increase in height in intervention than control school
• A statistically significant improvement in the prevalence of stunting from post intervention to after summer holiday phase observed from (7.2%) to (5.9%) in the intervention group,
from the present study we came to the following recommendations:
• Ministry of education should implement school meals in all public schools especially in underprivileged areas all over the country.
• The quality of the offered meal should be revised continuously with continuous supervision.
• Ministry of education should provide adequate funding for program implementation for school meals to ensure increase attendance and nutritional status.
• Coordination between different ministry of Health, Education, and Finance Ministry to ensure safety of the meal.