School Feeding for Improving the Physical and Psychosocial Health of Disadvantaged Students

The main objective of this systematic review was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils. A comprehensive search was conducted up to May 2006. We included 18 studies. School meals may have some small benefits for disadvantaged children. We recommend further well‐designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio‐economic status, and that researchers gather robust data on both processes and carefully chosen outcomes. Abstract Background Early malnutrition and/or micronutrient deficiencies can adversely affect physical, mental, and social aspects of child health. School feeding programs are designed to improve attendance, achievement, growth, and other health outcomes. Objectives The main objective was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils. Search strategy We searched a number of databases including CENTRAL (2006 Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), PsycINFO (1980 to May 2006) and CINAHL (1982 to May 2006). Grey literature sources were also searched. Reference lists of included studies and key journals were handsearched and we also contacted selected experts in the field. Selection criteria Data from randomized controlled trials (RCTs), non‐randomised controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series studies (ITSs) were included. Feeding had to be done in school; the majority of participants had to be socio‐economically disadvantaged. Data collection height gain was greater for younger children. Attendance in lower income countries was higher in experimental groups than in controls; our results show an average increase of 4 to 6 days a year. Math gains were consistently higher for experimental groups in lower income countries; in CBAs, the Standardized Mean Difference was 0.66 (95% C.I. = 0.13 to 1.18). In short‐term studies, small improvements in some cognitive tasks were found. Reviewers’ conclusions School meals may have some small benefits for disadvantaged children. We recommend further well‐designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio‐economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.