Indian Pediatrics 1999;36: 1221-1228
Impact of mid day meal program on educational and nutritional status of school children in karnataka
|A. Laxmaiah, K.V. Rameshwar Sarma, D.
Hanumantha Rao, Ch. Gal Reddy, M. Ravindranath, M. Vishnuvardhan Rao and K. Vijayaraghavan
From the National Institute of Nutrition, Indian Council of
Medical Research, Jamai-Osmania, P.O., Hyderabad 500 007, India.
Objective: To assess the effect of the Mid Day Meal (MDM) Program on enrolment, attendance, dropout rate and retention rate in the schools and its impact on nutritional status as well as on school performance. Design: Comparison by multistage random sampling. Subjects: Primary school children, who are attending the school in the MDM and non-MDM areas. Results: A total of 2,694 children (MDM: 1361; Non-MDM : 1333) from 60 schools were covered in the study. Results of the study indicated better enrolment (p <0.05) and attendance (p <0.001), higher retention rate with reduced dropout rate (p <0.001) a marginally higher scholastic performance and marginally higher growth performance of MDM children. Conclusion: MDM program is associated with a better educational and nutritional status of school children in Karnataka.
Key words: Mid Day Meal Program, Nutritional status, Scholastic performance.
Education plays a vital role in the development of human potential. The StateGovernments are spending considerable portion of their limited resources to provide educational facilities all over the country. Inspite of these efforts the goal of cent per cent uni-versalisation of elementary education appears to be far and elusive due to inherent socio-economic factors present in the society. Most of the children from low socio-economic society suffer from undernutrition(1,2); more often they drop out from schools at an early age(3), which directly affects their personality development. Several programs have been launched to combat these problems.
Mid Day Meal (MDM) Program has been one of the earliest supplementary nutrition programs in the country. The program has nutritional as well as educational objectives. It was initiated in 1963 as a part of Applied Nutrition Program in the State of Karnataka for school children, aged 6-11 years with the assistance of the Co-operative for American Relief Everywhere (CARE)(4) as an incentive program for 2 lakh beneficiaries. The coverage gradually increased to more than a million in the State by 1980-81. Under the program each beneficiary is expected to receive a supplement providing 330 calories and 7 to 12 grams of protein(5). The cost of the food was borne by the `CARE' while the overhead charges were borne by the State Government. To start with the CARE provided corn meal and skim milk powder and later switched over to Bulgar wheat and soya oil. The CARE support however, is being withdrawn in a phased manner from 1993-94 onwards.
Since the Central Government is contemplating to participate in phased expansion of the Mid Day Meal Program in lieu of buffer stocks of food grains and also in view of the government's emphasis on primary education, it was felt necessary to evaluate the existing program to understand its strengths and weaknesses. Hence, at the request of the Planning Commission and Government of India, an evaluation of the program was undertaken in the State of Karnataka during the years 1992-93. The objectives of the present study were: (i) to study the effect of food supplementation provided under MDM program on the nutritional status of school going children; and (ii) to assess the effect of the program on the children's enrolment, attendance and their retention rate in schools and the resultant change, if any, in the scholastic performance.
Subjects and Methods
All the districts, where the MDM program is in operation were stratified based on levels of literacy status and developmental criteria. One developmentally backward district with low literacy status was selected (Kolar) and another developmentally improved district with high literacy status was selected (Mysore) for the study. From each district, 3 inspector zones (as defined by the Department of Education) were selected and in each inspector zone, total number of schools were stratified according to the MDM and non-MDM. From each stratified list, 5 schools were selected randomly. Thus, in each district, 3 inspector zones and 5 schools from each inspector zone were chosen on systematic random basis in view of the limited resources and time available [2 (districts) ´ 3 (inspector zones) ´ 5 (schools) = 30 schools].
To assess the impact of any intervention program, a pre and post design with control groups (randomized control trial) would be ideal. Since no baseline information was available, a set of 30 schools without MDM program with comparable socio-economic background were used as controls. Both the sets of schools belonged to same geographical area with essentially similar socio-economic background. In every school, five boys and five girls were randomly selected from each class for anthropometry, clinical examination and scholastic performance. If the number of boys or girls were less than ten in a class, all the available children were included. However, to arrive at drop out and retention rates all the children who were admitted in the schools were taken into account.
In each of the selected schools, the following were evaluated:
(i) School enrolment (per cent enrolled to the total number of 6-11 years children in each village or catchment area of the school), attendance (children attended ³60% working days in the previous year), retention (number of students continued on the rolls for 5 years) and dropout rates (number of children discontinued during previous 5 years).
(ii) Nutritional status of children by anthropometry (height and weight) and clinical examination (sub sample of children).
(iii) Scholastic performance based on marks obtained by the children in annual examination in the preceding year (sub sample of children).
(iv) Supplement provided and its consumption (sub sample of children).
Ten children, with atleast one girl and one boy from each class I-V (6-11 years) were observed from each MDM program school, while they were receiving and consuming the supplement. The amount of food received was measured at the time of serving. In addition the amount of ration drawn per day, the way it was cooked and stored were closely observed. The energy and protein intake per child from the supplementary foods was computed(6).
The nutritional status was assessed on 1361 children in MDM schools and 1333 in non-MDM schools. These were the children who were randomly selected for anthropometry and clinical examination satisfying the numbers required in each age and sex groups (Table I).
Table I__Coverage Particulars
* The feeding was not in operation in other 15 schools at the time of visit ,** NA: Not Applicable
Preparation of Supplementary Food and its Consumption
The recipe was based on bulgar wheat and soya oil. Each child was entitled to receive 80 g of bulgar wheat and 5 g of oil. The food was prepared in the form of upma (uppittu) at central kitchens located in the block/taluk headquarters. The cooked upma was served to the beneficiaries usually at 1.00 p.m. From central kitchen the supplement was distributed among the children (6000 beneficiaries) of 15-20 schools, which are situated within a radius of 3 to 4 km. In about half of the central kitchens visited, it was observed that the quantities of raw foods drawn for the preparation of recipe, were marginally short of the stipulated amounts.
In each school, the number of target beneficiaries were fixed and they were selected on the basis of community and income of their fathers. However, in half of the schools, the number of children who actually partook the meals was always more than the number listed. The average energy and protein supplied to a child by the supplement was 303 Kcal and 7.2 g, respectively as against 330 Kcal of energy and 7-12 g of protein.
The proportion of schools with feeding for more than 100 days (50% of targeted feeding days) during the previous year was 55%. Interruption in feeding (not serving the food continuously for more than one week) was observed in 19 of 30 schools. The main reason was shortage of food stocks (79%).
The total number of children (6-11 years) who were eligible for school enrolment was estimated at the rate of 14% of total population of the particular village(7). The actual number of children who were enrolled in school, from the same area were assessed by making use of the school records. On an average, the number of children enrolled in schools with the MDM program was higher (72%) as compared to schools in non-MDM areas (68%) (p <0.05).
The percentage of children with better attendace (> 60% of working days) was higher (97.8%) in MDM schools than in non-MDM schools (95%) (p <0.001).
The retention rates were calculated based on a four year follow-up of the students of 1st standard (cohort of students, 1988) promoted to class V (1992). The proportion of students who were on roll to the number enrolled into first standard in 1988 for the next 4 years was better in MDM schools (80.2%) than in non-MDM schools (77%) (p <0.05). It was sur-prising to note that the retention was higher among girls in MDM areas while the proportion was higher among boys (78.3%) than girls (75.6%) in non-MDM areas.
The year-wise dropout rates were sig-nificantly lower in MDM schools than in non-MDM schools in every corresponding year. When all the primary classes were considered together the dropout rates varied from 14% to 18% in MDM schools, as against 27 to 36% in non-MDM schools (p <0.001) (Table II).
Table II__Distribution (%) of 6-11 Years Children by Drop Out Rate-Year Wise
*** p <0.001.
Marks obtained by each child in the preceding annual examination were collected from the school records, and were distributed as per the grades normally adopted in schools for the purpose of analysis. A majority of the children (76-80%) in both the areas obtained marks between 40-70% that is grades `B' and `C'. In general, the scholastic performance of children in the MDM and non-MDM schools was comparable. However, the proportion of students, who secured grade `A' was marginally higher in MDM schools (13.1%) as compared to non-MDM schools (10.3%) (p >0.05) (Table III).
Table III__Distribution (%) of 6-11 Years Children by Scholastic Performance
*** p <0.005.
About 9.5% of children in MDM schools and 9.1% in non-MDM schools had one or more signs of deficiency, either B-complex and vitamin A or clinical anemia (pallor). There were no significant differences between the groups (Table IV).
Table IV__Distribution (%) of 6-11 Years Children by Nutritional Deficiency Signs
Table V__Anthropometric Measurements (Mean ± SD)
Table VI__Distribution (%) of 6-11 Years Children by Weight for Age Status
The mean measurements of heights and weights of the children in different age and sex groups in both MDM and non-MDM areas were similar (Table IV). The mean measurements of heights and weights of the children in different age and sex groups in both MDM and non-MDM areas were similar (Table V). However, the proportion of children with <70% of weight for age(8) was marginally lower in MDM schools than their counterparts in non-MDM schools (Table VI). The per cent of normals was also marginally higher in MDM areas (3.0%) as compared to non-MDM areas (1.3%) (p <0.05). According to Waterlow's classification(9) the percentage of children in the three groups, wasted (current malnutrition), stunted (long duration malnutrition) and wasted and stunted (current and chronic malnutrition), was lower in MDM schools (3.6, 50.8 and 4.4) as compared to non-MDM schools (4.8, 54.1 and 4.6).
The Mid Day Meal Program, otherwise known as school lunch program, is aimed at providing one meal out of the three meals for a child in the school, atleast one third of the calories and half of the protein RDA per child per day. In low socio-economic communities, the meal should be able to fill the nutrient gap that exists in the diets of children. Thus, the school meal, "in principle" should ensure a supply of atleast 750 Kcals of energy to every child partaking the meal. In the present study, it was observed that only 303 Kcals are provided to each child per day through the MDM program. The extent of energy deficit in the diets of school age children as revealed by NNMB Surveys(1) 1991-92, is about 767 Kcal per day. There was, thus, still a considerable energy-deficit (45%) in the diets of the school children.
Therefore, the benefits in terms of nutritional status were probably not that pereceptible. Improvement if any, was only marginal as seen in the distribution of weight for age and Waterlow's classification in the children of MDM schools compared to non-MDM schools. The National Evaluation of School Nutrition Programs (NESNP)(10) in USA showed that the school lunch programs exceed most reasonable expectations for its nutritional effectiveness. The anthropometric analysis in the NESNP(11), suggested that long term participation in the school lunch program had no relationship to height but a marginal impact with respect to weight of the beneficiaries. The MDM program in the state of Karnataka in fact seems to have achieved educational rather than nutritional benefits as evidenced by lower drop out rate and higher retention rates as compared to the data of United Nations International Child Emergency Fund (UNICEF)(2) and National Council for Educational, Research and Training (NCERT)(12). The retention rate in Karnataka as reported by NCERT in 1978 was about 27%. Earlier workers had also observed a significant nutritional and educational impact of noon meal program(13).
The MDM program needs to be strengthened in its operational supervision. Also the quantity and quality of the supplement needs to be further improved to fill the nutrient gap.
The authors are grateful to the Director, National Institute of Nutrition, Hyderabad for the keen interest and encouragement in carrying out the above study. Smt. Jalaja Sundaram, Joint Director (Nutrition), Directorate of Health and Family Welfare Services, Bangalore deserves mention for her support and co-operation in conducting the study. The authors wish to express their gratitude to Smt. D. Chandra-prabha, Nutritionist and Smt. Girija Bai, Field Assistant of NNMB, Karnataka unit for their unstinted support in the field. The authors are grateful to the concerned authorities running the program (Education Department) in the State of Karnataka and CARE authorities for their cooperation.
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