Factors Affecting The Uptake Of Healthy Meals

Published Date: 02 Nov 2017

Abstract

School feeding is one of the widely used interventions programs and Ghana has spent huge sums of money running into millions of dollars in her school feeding programs with the aim of improving school attendance, nutritional status and the and to increase local production and to boost the economic situations of local farmers who produce the raw materials for the preparation of school meals. Not participating in the program to take up school meals can lead to hunger during school hours which has an overall effect on education especially in a developing country like Ghana. Healthy children grow up into healthy adults and healthy communities. Healthy people become productive people who can contribute meaningfully towards the development of communities. The main purpose of school meals is to provide nutritious food to school children in order to stay healthy. Other reasons may include increasing school enrollment and provide a cushion for vulnerable children. A total of 200 primary school level 4-6 pupils will be covered in the study. Analysis of the data will be done using simple statistical test.

The main objective of this study is to identify the factors contributing to the low uptake of school meals in local authority school in the Asante Akim North district of Ashanti of Ghana.

Background to the problem /Literature review

introduction

The Ghana School Feeding Programme (GSFP) commenced in 2005 with the intermediate objective of reducing hunger and malnutrition; increasing school enrollment, retention and attendance and to boost local food production1. The Ghana School Feeding Program was designed and implemented to provide hot, nutritious meal (lunch) per day to children in public primary schools and kindergartens in the poorest communities of the country using locally grown food stuffs2.

Good nutrition is needed for proper physical and mental growth and development of children. There is evidence to suggest that school meals can help improve nutrition and in some cases may also be associated with improvements in school attendance, academic performance and behaviour3. However, combined outcomes of health care and food security promote improved nutrition4.

School feeding programs are said to have three major impacts5 6 that include:

improvement of the nutritional status of school-going children and the reduction of malnutrition rate

improvement of school enrolment, school attendance and cognitive performance

Finally the effect of school feeding on the demand for locally produced foods.

A review of the programme in Ghana in mid-2006 outlined a number of achievements and challenges. Enrolment has increased by 20.3 percent in the pilot beneficiary schools, compared with 2.8 percent in nonbeneficiary schools; school retention went up by an average of 10 percent in the beneficiary schools while declines were observed in non-beneficiary schools4

Challenges outlined in the 2010 annual operating plan of the GSFP2. included:

Linking the program with local farmers is a major challenge.

De-worming of pupils is still a major challenge and will need the collaboration of all Stakeholders to deal with.

Another area of concern is sensitization of sub district actors by the district actors on the programme.

Delay in the release of funds.

Resources and logistics for effective monitoring.

Inadequate training for caterers on health and nutrition related issues.

Competition with unhealthy food products and practices

Caterers of the GSFP are very important actors in the implementation of the program1. The caterers are usually tasked with the handling, production, service and administration of school meals to the pupils in receipt of free school meals.

Vermeersch and Kremer also found that the school meal program in primary schools in rural areas in kenya led to an increase in scores on written and oral tests of performance, relative to the school curriculum, after two years participation in school7. Vermeersch and Kremer again found out that While the school meal program improved performance this was only noted in schools where the teachers had greater than average experience7

School meal programs can also be a vehicle for improved micronutrient status if the meals or rations are fortified or if they contribute to an increase of diet diversity8.

Statement of problem / area of study

In developing countries, school attendance and literacy rates are significantly lower for rural people, particularly among women and girls9

The Ghana school feeding program which started in 2005 on a pilot scale in one school in each of the ten regions is an excellent initiative but lots of factors affect its smooth operation2. Caterers are usually selected from within the communities by the district assembly in consultation with the district education office to deliver catering services to the selected schools. Food stuff is usually bought from local farmers within the district. Some of the beneficiary schools have kitchens where the school meals are prepared whilst a few lack kitchens hence the food is normally delivered from the homes of the caterers to the schools which can pose food safety and hygiene problems. Lack of constant supply of portable drinking water for the preparation of school meals has always been a problem.

The positive results from the GSFP seem to be posing new challenges that must be addressed for the sustainability of the programme. The large increases in school enrolment have put pressure on facilities within the beneficiary schools. Schools have inadequate classrooms, teachers, dining halls, etc. to handle the larger numbers of children attending school4

There is no system designed to check the quality and safety of foods being fed to the children enrolled in school feeding programmes in Ghana4. The health status of the schools’ cooks and the health status of the caterers’ employees have not been established. This is critical, in view of the programme’s objective to improve the health status of school children4

Protein energy malnutrition (PEM) is the most serious nutritional disorder among children under age 5 in Ghana, with its devastating effects of severe stunting, wasting and underweight4.

There exist little information on this topic hence; this study is aimed to provide information on factors that might influence the uptake of the healthier school meals by children in the Asante Akim North district of the Ashanti region of Ghana.

Research questions

What are the individual, socio-cultural, economic and health related factors affecting uptake of school meals?

Aim of study

To determine the factors affecting the uptake of school meals in the Asante Akim North District of the Ashanti region of Ghana.

Objectives

To consult with the various stakeholders (Ghana education service staff, catering staff, chiefs/opinion leaders, parents etc.) to collect information on why they think uptake of school meals is low

To design, pretest and implement a semi structured questionnaire to assess the individual, socio-cultural, economic and health related factors affecting uptake of school meals

To assess the health factors affecting the uptake of school meals.

Protocol design

sampling

The study will be cross sectional involving mixed methods. The mixed methods will be used to collect in-depth knowledge and understanding of the possible factors affecting uptake The Ghana education service (GES) will be asked for the names and locations of the schools enrolled in the Ghana school feeding program within the district. Primary schools benefitting from the school feeding program will be selected through a simple random sampling technique. Children will be randomly selected to form the study subjects. The randomization sequence will be adequately protected or concealed by masking from the investigators, schools and pupils so as to eliminate bias and to add validity to the research.

The table 1 below shows the inclusion and exclusion criteria for the selection of participating schools

Inclusion criteria

Exclusion criteria

agreement of headmaster following consultation with staff

Unwillingness to participate in the study by the school administration

public school

Private schools because not part of the program

Agreement of parents and wards to sign the consent form

Sample size calculation

Using a 5% (0.05) significance level and a power of 80%, assume the probability of the outcome of the control group (schools with kitchen) to be 0.5 and the probability of the outcome of the experimental group (schools without kitchens) to be 0.3. Using a ratio of control case to be 1 a sample size of 93 is needed. This means 93 subjects from schools with kitchens (school based model) and 93 subjects from schools without kitchens (caterer based model). A total of 200 study subjects will be used in the study to compensate for any fall out of study subjects. Pupils (from primary level 4-6) will be randomly selected from beneficiary schools that will take part in the study. A similar case study done in the Bawku west district of the upper east region of Ghana by Andrea Havenkort in 2008 involved two primary schools. Hence a total of four schools will be selected thus, two schools with kitchens on site (school based model) and two schools without kitchens on site (caterer model). Selection of schools will be based on uptake levels of the school meals in the last three years.

** school based model and caterer model are described in annex 3.

Study location

The Asante- Akim North district is one of the 27 districts in the Ashanti Region of Ghana. The district covers about 5.6% of the total land area of the Ashanti Region and has a population of 182,699. Annexes 1 and 2 show the map of Ghana and the Asante Akim North District respectively

The table 2 below shows a snapshot of schools under the GSFP

schools

No

Primary schools

87

Beneficiary schools

32

Schools with kitchen

17

Schools without kitchens

5

Source: Ghana Education Service-Asante Akim north, 2012

Total number of primary school pupils in the district=20,880

Data collection Methods

At the school level a focus group discussion and in-depth interviews will be held with school and catering staff on school menu, source of ingredients/composition of meals, eating environment, sanitation, source of water and possible factors affecting uptake of school meals. A topic guide will be developed with probing questions and will be pretested in eligible schools that will be taking part in the study. The focus group and in-depth interviews be transcribed. The transcribed texts will be verified using the audio tape recorder and the field notebook to ensure that texts are accurately transcribed. The transcribed text will be coded based on the themes of the research to reflect the various categories above.

There will be an observational study to observe the operations of the catering services, handling and production/preparation of meals using a simple designed checklist which will highlight on good hygienic and sanitation practices.

Semi-structured questionnaires designed and administered to the children and their parents and will include areas such as demographic characteristics (age, gender, ethnicity etc), socio-economic factors (customs/taboos, religious beliefs/considerations etc) and economic (income and poverty levels) issues which may have effect on uptake of meals.

Enumerators to be used for questionnaire administration will be selected through an interview process. Their selection will be based on previous data collection experience, ability to speak a local language as well as English. Training will be organized for all enumerators after which teams will be constituted and field practice in two non-participating schools near the training centre completed. Eight teams will be formed and each team will be made up two enumerators.

The completed questionnaires will be cross checked on the field by both enumerators for completeness and accuracy before submitted for processing..

Research Governance

Permission will be sort from the Ghana Education Service authority at the regional, district and school levels. Also teachers, parents and wards who will take part in the study will be informed through letters and will be asked to sign a consent form indicating their willingness in taking part in the study. Respondent will be advised that they can withdraw at any point in time during the study and they will not suffer any consequence if they so wish to withdraw.

Data processing and analysis

Data collected will be double entered by data entry clerks using SPSS version 16. Data collected will be stored in an archive. Using 95% confidence level and a p value of 0.05 the data will be graphically illustrated presented in percentages, frequencies, and bar charts.

Chi square or fischers exact test will be used for the analysis since the data has a binary outcome. Because of the multiple factors that affect the uptake of school meals and the categorical nature of the outcome multiple logistic regressions will be used to compare associations.

Implication for study

Findings of the study will be presented in 3 reports. One report will be a detailed report given to the local educational authority, another will be an executive summary with recommendations the third one will be published and copies sent to the district assembly and district library. A stakeholder’s seminar will be organized to present findings. Findings will be used to inform and advise the local authority and other stakeholders on how to improve the activities and operations of the school feeding program and the uptake of school meals by children in the district.

Time Course

months

activity

Jan

feb

march

april

may

june

july

aug

sep

oct

nov

Funding approved

Secure ethical permit

Recruitment of staff

Training of staff and Team formation

Develop tools/pretest

Selection of schools

and Data collection

Data cleaning/entry

Data analysis

Report writing

Report submission

Seminar presentation