BACKGROUND: School feeding interventions are implemented in nearly every country in the world, with the potential to support the education, health and nutrition of school children. In terms of impact on school participation, there is little evidence to show that different school feeding modalities have different effect sizes. OBJECTIVE: To examine the influence of different school feeding modalities on primary school enrollment, particularly for girls, in 32 countries across sub-Saharan Africa. METHODS: An observational study involving a meta-analysis of published data was developed to examine program effect. Schools were divided according to the type and length of the program: those with existing programs, those that had had school feeding for less than 1 year, and a counterfactual including schools without a program but that were going to initiate school feeding within the survey year. The intervention consisted of two different types of school feeding: onsite meals alone or onsite meals plus take-home rations. Changes in enrollment, both total and disaggregated by grade and gender, over a 1-year period, were used to assess effects of school feeding. To control for pre-program characteristics in the beneficiary population, data on covariates were also examined before the school feeding intervention began and after one year of implementation. Using this design a comparison of enrollment levels was made between the types of treatment schools and controls schools during the period school feeding was first introduced. Standard multiple regression models were used to analyze program effect. RESULTS: School feeding programs were found to have statistically significant increases in enrollment, with effect size of about 10%. The changes on enrollment varied by modality of school feeding provision and by gender, with onsite meals appearing to have stronger effects in the first year of treatment in the lower primary grades, and onsite combined with take-home rations also being effective post-year 1, particularly for girls that were receiving the extra take-home rations. CONCLUSION: School feeding programs had a positive impact on school enrollment. The operational nature of the survey data used in the meta-analysis, however, limits the robustness of the design and validity of the findings. Nevertheless, this analysis is the first to study possible links between enrollment and length of program duration using multivariable models, examining whether programs reach a saturation point or steady state beyond which school feeding may in fact have no further benefits on school enrollment. Further research is required to examine this issue in more detail.
Frontiers in Public Health, 3: 76
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