Could breakfast and lunch at schools reduce stunted growth?

Could breakfast and lunch at schools reduce stunted growth?

South Africa continues to have a high prevalence of stunting. This is despite the fact that it's a middle income country, which should put it on a par with countries like Brazil, which has a stunting prevalence rate of just seven percent. In South Africa nearly a fifth of children under the age of 14 are stunted, showing persistently high levels of food insecurity in households, wrote.

The traditional dominant thinking about stunting suggested that it's an issue set in early childhood and that after the age of two there is limited opportunity to correct it. But research has started to disrupt this conventional wisdom, suggesting that there are opportunities to ‘catch up’ in middle childhood  ― that is around the age of seven years  and later again in puberty.

The research built on this new thinking. It suggested that the physical effects of stunting can be reduced up until the age of 14 and that there is an association between lower stunting levels and serving children a combination of a breakfast and lunch meals at school.

The findings are only preliminary and require further verification in different settings. But the study laid the ground for a possible solution to consistently high rates of stunting among children in South Africa.

All children attending 60 percent of the poorest schools in South Africa receive a lunch meal as part of the National School Nutrition Program. The meal consists of a protein, starch and vegetables.

Schools in South Africa are classified into five quintiles (categories): Quintile one and two schools are the poorest while quintile five are the wealthiest. The nutrition program targets schools in quintiles one to three.

Children at some quintile one and two schools are also being given breakfast when they arrive at school through partnerships that the education department enters into with corporates and foundations.

The study assessed the effects of children between the ages of six and 14 receiving a combination of breakfast and lunch against those who only received lunch. The researchers looked at 39 schools. At eight of them, children received breakfast and lunch while at the other 31 they only got lunch. The schools were in the Lady Frere district of the Eastern Cape, the country's poorest province. Lady Frere is a largely rural area.

They measured the childrens' height and weight and found that the stunting rate among children who received lunch was 14 percent. This compared with a rate of 19 percent for the province. The lower stunting rate could be explained by the age range of the children in the study. While the provincial average is for children from the age of 0 to 15 the sample does not include pre-school children who are more vulnerable to stunting. Stunting rates in Lady Frere may also be lower than in other parts of the Eastern Cape.

But more significantly, among the pupils who received two meals the stunting rates was even lower ― at nine percent. This is despite these children being from arguably poorer households. Similar results were found in the urban leg of the study.

The findings counteracted conventional wisdom about stunting but they are not without precedent. Research in Brazil, Guatemala, India, Philippines, and the Gambia showed that there are opportunities for height-for-age catch up after the first 1000 days of a child's life.

The findings suggested that for the sample of children between the ages of six and 14, there are opportunities for catch up and that there is an association between providing an additional meal at school and lower stunting rates, although this does not mean that the programs cause these effects.