THE IMPACT OF THE SCHOOL LUNCH PROGRAMME ON THE ALL ROUND DEVELOPMENT OF CHILDREN
The school lunch programme in Sri Avinashilingam. Primary School is an educational programme. Along with providing nutritious meals, it aims at providing nutrition education to the children and their parents. Children help in the various activities of the programme like serving foods, washing utensils, cleaning the lunch room and gardening. The impact of the school lunch programme on the pupils of Sri Avinashilingam. Primary School is discussed in this chapter.
The staff and post-graduate students of the nutrition department of the college help in running the programme in a satisfactory nutritional, hygienic and educational environment and the school lunch programme is evaluated periodically using a proforma given in Appendix G.
The school lunch is a medium for improving the nutritional knowledge, nutritional status and food habits of children. It helps to improve the attendance and class performance of children. Several studies have been carried out to assess the impact of school lunch programme on the nutritional status of children. The findings of these studies are discussed under the following heads:
1. School lunch programme and all round development of children
2. Role of green leafy vegetables in school lunch pro- gramme and
3. Supplementation studies.
1. School lunch programme and all round development of children The studies on the impact of the school lunch programme on the nutritional status of children and development used body height, weight, blood haemoglobin level, school attendance, performance and nutritional knowledge as criteria. The results show that the children participating in school lunch programme
98
99
are better than their counterparts (control) who are not participating in the school lunch programme. In order to find out whether or not the good organisation of the feeding programme in Sri Avainashilingam Primary School leaves any special impact on the nutritional status of the children, the effects were compared with those of two other selected schools in the neighbourhood, all operating under the Tamil Nadu Midday Meals Scheme. The results revealed that the provision of lunches in the primary schools even when not nutritionally adequate did help to some extent in improving the nutritional status, attendance, performance and social development of children, besides supplementing their home diets. However, only good organisation of the school lunch programme, brought the full impact on the development of children.
Longitudinal records on heights and weights of children par- ticipating in the school lunch programme over a period of five years, showed that children participating in the well organised lunch programme recorded significantly greater heights and weights over the control group, as can be seen in Table XIII and figures 22 and 23.
100
TABLE XIII
Mean Six Monthly Heights and Weights of Children Over a Period of Five Years (No. 73 in each group)
Six monthly intervals Diff-
Groups erence Groups
(Mean + compared
1 2 3 4 5 6 7 8 9 10 11 S.D) `t'
value
Height (cm)
School 106.3 108.8 111.9 114.7 116.7 119.5 121.4 123.9 125.2 127.9 129.4 23.1 + School
lunch 2.12 lunch 7.97**
Non-school
lunch 105.9 108.2 110.9 113.3 114.8 117.2 119.1 121.3 122.6 124.2 126.1 20.1 +
2.38
Weight (kg)
School
lunch 16.8 18.7 18.9 20.1 21.7 23.2 25.2 26.2 27.2 29.2 30.7 13.9 + School
2.44 lunch
Vs 7.48**
Non-
school
lunch
Non-
school 16.0 17.0 18.3 18.7 19.9 21.1 21.8 23.1 24.6 25.8 26.9 10.9 +
lunch 2.38
**Significant at one per cent level.
101
The mean blood haemoglobin levels of children who participated in the programme continuously for periods of five years, four years, three years, two years and one year was compared with that of comparable groups of children not participating in school lunch. The results are presented in Table XIV.
TABLE XIV
Mean Blood Haemoglobin Levels of Children After Different Periods of Participation
(No. 25 in each group)
Years of participation
S.No. Group 5 4 3 2 1
(Haemoglobin level g/100 ml)
1. School lunch 10.32+ 10.26+ 9.96+ 9.42+ 9.29+
0.43 0.89 0.90 0.91 0.49
2. Non-school 9.83 + 9.78 + 9.38+ 8.83 + 8.59+
lunch 0.74 0.61 0.48 0.62 0.48
102
The blood haemoglobin levels in the five groups of school lunch children ranged from 9.29 to 10.32 g/100 ml whereas in the non-school lunch children it ranged from 8.59 to 9.83 g/100 ml blood.
The clinical symptoms observed in children who participated in the programme for five consecutive years is presented in Table XV.
TABLE XV
Clinical Picture of Children Participating and not Participating in the School Lunch Programme
(No. 25 in each group)
Percentage of children in the
five years study
Clinical symptoms
School Non school
lunch group lunch group
Angular stomatitis - 8
Bleeding gums - 12
Anaemia 4 12
Dry and rough skin - 8
The children in non-school lunch groups were suffering from more deficiency symptoms than their counterparts in school lunch groups.
When the five groups were put together, the school lunch children attended the school for 93.78 per cent days while the non-school lunch children attended for 91.39 per cent days.
The percentage of failures were more in each non-school lunch group when compared with the corresponding experimental group. The percentage of failures ranged from 1.3 to 2.7 in school lunch groups whereas it ranged from 2.5 to 5.4 per cent in the non-school lunch groups.
One of the benefits of the school lunch programme is its `carry home' effect on nutritional information. Children carry
103
home the knowledge they gain in the school and introduce some desirable changes in the food habits of the family. This is evident from a study on the impact of the school lunch programme on the dietary habits of 160 selected families in Coimbatore city. Among the two schools selected, nutrition education had been conducted only in one school. Parents of the school lunch group where nutrition education was conducted had a greater knowledge of nutrition than the parents of the school where no nutrition education was given.
In another study which was longitudinal a questionnaire was administered to parents of the school lunch children, who were classified into five groups, according to the number of years of participation of their children in the school lunch programme. It was administered also to 25 parents from non-school lunch group to compare against the school lunch group. The data are presented in Table XVI.
TABLE XVI
Nutritional Knowledge of Parents of School Lunch and Non School Lunch Children
(No. 25 in each group)
Years of participation Non
Questions Answers 5 4 3 2 1 school
lunch
1 2 3 4
number stating
Why should we 1. For good
consume green health 20 12 18 10 10 3
leafy vegeta-
bles? 2. For health 11 12 - 2 - -
3. To purify
the blood 7 6 8 10 7 4
4. To avoid
constipation 3 - - - 2 -
Which foods are
to be consumed 1. Cereal pre-
daily? parations 12 14 8 5 6 6
2. Fruits and vegeta-
bles including green
leafy vegetables 15 10 10 8 5 6
3. Milk and milk
products 11 11 8 7 5 6
4. Non vegeta-
rian foods 2 4 2 1 - -
104
1 2 3 4
How do you
cook rice? 1. Absorption
method 22 20 20 15 14 10
2. Draining
the water 3 5 5 10 9 15
This revealed that the participation of children in the school lunch programme with nutrition education had influenced the nutritional knowledge and practices of their parents favourably.
The Municipal schools in the Coimbatore city receive cooked lunch from the central kitchen and distribute the food to children during the lunch hour. The effect of that programme was evaluated. Five hundred children were randomly selected from four Municipal schools and their heights, weights, hygienic practices, nutrient intake, nutritional knowledge, attendance, class performance, and parents' opinion about the school lunch programme were studied in comparison with a group of children participating in a well organised school lunch programme in the privately managed Sri Avinashilingam Primary School. The results of this study revealed that the private school was practising all the hygienic practices whereas they were absent in the Municipal schools. The supply of nutrients by the Municipal schools was deficient in calories, protein, calcium, vitamins A and C. The mean height and weight increments of children in the private school were greater than those in the Municipal schools. In all the schools, parents expressed positive opinions regarding the school lunch programme.
Apart from measuring the physical development of children research has also been carried out to find out the mental ability and certain behavioural aspects of school children who participate in the school lunch programme. The proforma used is given in Appendix H. To further evaluate the long standing benefits of the school lunch programme, the same tests were conducted on a group of 47 children in the high school who had earlier participated in the lunch programme when they were in the primary school and a comparable group of children who had never participated in any school lunch programme served as control. The changes in habits observed in children by the parents because of their children's participation in the lunch programme were also assessed and the results are presented in Table XVII.
105
TABLE XVII
Changes in Habits as Observed by the Parents Due to the Parti- cipation of the Children in the School Lunch Programme
(No. studied-150)
S.No. Change in habits Percentage of
parents
1. Increased consumption of greens and vegetables 92
2. Better habits of selection of foods 88
3. Increased willingness to share responsibilities at home 78
4. Avoids waste in eating 76
5. Takes meals punctually 72
6. Is punctual, regular and systematic in work 66
7. Has improved sociability 64
8. Tolerance and cooperativeness 60
9. Cleaning plates and tumblers 46
The school lunch programme resulted not only in significant physical development but also in greater mental ability and better behavioural aspects such as tolerance, obedience and general Cleanliness. A well organised school lunch programme has the potential to bring out the best in the growing generation. Its effects are long standing as evidenced long after the children had left the primary school.
2. Role of green leafy vegetables in school lunch programme Green leafy vegetables furnish liberal quantities of iron in the diets. They are easily available throughout the year, at low cost. The beneficial effect of supplementing diets with green leafy vegetables have been demonstrated by Devadas and coworkers through the investigations carried out on the utilisation of iron from leafy vegetables in the school lunch programme.
In one of the earlier studies, the effect of incorporation of leafy and non-leafy vegetables in the school lunch was studied on two groups of children. The children in the school lunch group were divided into two groups of 16 children each. One group was supplied with 42 g of leafy vegetables daily while the other group was supplied with 42 g of non leafy vegetables every day. There was a comparable group of children to serve as control, who were not participating in the lunch programme.
106
After six months, the nutritional status of the pupils receiving leafy vegetables in the school lunch was significantly higher than that of the pupils who received non leafy vegetables in the school lunch. The former had registered significantly higher increases in weight and haemoglobin levels. In another study in two villages, the children of Pannimadai village school were given daily 25 g of the green leafy vegetables namely drumstick leaves on two days and amaranthus on three days obtained from their school garden in the form of 'kootu' to supplement the school lunch whereas the programme in Thaliyur village did not supply green leafy vegetables in the diet. The programme was evaluated after a period of six months. It showed that the nutritional status of children receiving the green leafy vegetables had registered significantly greater heights, weights and mean blood haemoglobin levels over the group which was not receiving the green leafy vegetables. These studies emphasise the need for the daily in- clusion of green leafy vegetables in the school lunch programme.
The iron content of amaranthus cooked in an iron utensil was found to be greater than that in a sample cooked in aluminium or brass utensils. Hence a study was attempted to evaluate the availability to children of iron from amaranthus cooked in iron and aluminium utensils when supplemented to a school lunch over a period of six months. Children participating in the school lunch programme at Sri Avinashilingam primary school were divided into three groups of 35 children each. A comparable group of control was also selected and designated as follows:
Group I - Control group
Group II - Basal diet
Group III - Basal diet and 37.5 g amaranthus cooked in
aluminium utensil
Group IV - Basal diet + 37.5g. amaranthus cooked in iron
utensil
At the end of six months, the evaluation showed that children receiving amaranthus cooked in iron utensil had improved their nutritional status significantly better than the other groups, parti- cularly with regard to haemoglobin levels (p< 0.01). Inclusion of greens, whether cooked in aluminium. or iron utensil had definitely a beneficial effect.
In a three year study, the availability of iron from amaranthus was compared to that from an iron tablet 'fersolate' and an iron tonic 'colliron' in the school lunch programme. The basal school lunch provided seven milligrams of iron which is one third of a
107
day's requirement. The supplements, namely, amaranthus, iron tonic and iron tablets were introduced to provide 13 mg of iron thus making a total of 20 mg which is a day's requirement for children. All the three experimental groups were evaluated for their physical measurements, blood picture and clinical assessment. The contribution of the other nutrient components namely calcium and ascorbic acid present in amaranthus were also studied.
These studies revealed greater beneficial effects from amaran- thus, an inexpensive supplement over the iron salts in the form of tablets and tonic as iron supplements. When calcium and ascorbic acid were given in the form of tablets along with iron tonic, the haemoglobin level increased to a greater extent although not to the same extent as that of amaranthus supplementation.
3. Supplementation studies India has been receiving a great deal of food for the school lunch programme from CARE. However, it will not be wise to depend for ever upon food gifts from CARE to conduct the national feeding programmes. The challenge is therefore to produce and evaluate the efficiency of indigenous foods in promoting the nutritional status of school children. The studies conducted along this line are described in the following pages.
(a) Indian Multipurpose Food (MPF) The effects of the Indian Multipurpose Food, skim milk and their combination (1:1) on the nutritional status of children participating in the school lunch programme were studied. Out of the 20 g of protein supplied by the school lunch, 8 g were supplied by each of these supplements. The study revealed that the children receiving the combination of the Indian MPF and skimmed milk registered the greatest increase in weight, height and haemoglobin level evidencing the possible biological complementation of protein. The differences between the children on Indian MPF and skim milk were not significant with regard to weight, height and haemoglobin content. The effects of incorporating skim milk alone and in combination with MPF or roasted red gram flour in a school lunch were also studied. A combination of red gram dhal and skim milk in the protein ratio of 1:1 was found to be an efficient substitute for an equal quantity by protein content from skim milk or from the combination of Indian MPF and skim milk in the same proportion.
108
(b) Neera (Palm juice) The effect of Neera (Palm juice) as a supplement to the school lunch was studied in two primary schools. One hundred ml of Neera contain 9.6 g total sugars, 2.2 mg calcium, 0.2 mg iron, 0.1 mg thiamine, 18.5 mg riboflavin and 12 mg ascorbic acid. A group of 70 children was given 225 ml of Neera supplement along with school lunch while a comparable group of 70 children did not receive the Neera supplement. These groups were compared against a non school lunch control, at the end of six months. The physical measurements, blood picture and clinical scores were found to be the highest for the group receiving Neera.
(c) Corn Soya Milk (CSM) CARE introduced a new high protein product, namely, Corn Soya Milk in 1968 in the place of skim milk. How far the CSM. supplied can replace skim milk was a pertinent question. A. study on the comparison of the newly introduced CSM against skim milk was undertaken through the school lunch. Six experimental groups of 25 children each were selected. Groups B and B, received 30 g CSM which provided 6 g protein. In order to provide the same amount of protein 15 g skim milk were given to groups A and A,. Enhanced allowances of 60 g of CSM and 30 g of skim milk respectively were given to groups B2 and A2 There were controls, one receiving the normal school lunch without supplement and the other non school lunch group. In order to study the supplementary effects of green leafy vegetable, 15 of drumstick leaves were supplied to groups A1 and B1.
The findings revealed that the children who had received skim milk (A) had shown higher increases in height, and lower increases in weight than the group B who had received CSM. Children who had received double the quantity of CSM showed higher increases in height and weight than their counterparts, who had received double the quantity of skim milk. The addition of greens to skim milk had stimulated further increase in the heights and weights and addition of greens to CSM stimulated greater increase in weight but not in height.
(d) Low Cost Indigenous Mixture-I Effort was directed also towards the formulation of new low cost indigenous food mixture to supplement the school lunch in the place of the American gift CSM. Among the several combinations formulated, two selected mixtures were good for school
109
lunch. (1) Corn-Green gram-Soyabean-Mixture in the proportion 50:25:25 and (2) Corn-Horse gram-Soyabean-Sesame mixture in the proportion 35:40:20:5. The protein contents of mixtures were similar to that of CSM. At the end of six months of feeding, it was encouraging to note that there was no significant difference between the mixtures and CSM.
(e) Sunflower meat Combinations were also evolved based on a novel source of protein, namely, sun flower meal. Out of the mixtures computed, the one having sun flower meal, maize, roasted Bengal gram flour and sesame meal in the proportion 65:15:10:10, which had the highest chemical score, was tested in the school feeding programme. At the end of six months, the group receiving sun flower meal showed greater potential to improve their heights, weights and haemoglobin levels than the group receiving the normal school lunch diet.
(f) Low Cost Indigenous Mixture-II A nutritious supplement made of low cost indigenous foods such as rice (20 g), cow pea (20 g), horse gram (10 g), amaranthus (30 g) and ground nut oil (15 g) was fed to 200 rural primary school children in the form of three preparations, namely, uppuma, sundal and payasam (a sweet beverage) for a period of 10 months. The improvement in the nutritional status of the children was studied through the physical measurements, blood picture and clinical assessment. The results were so encouraging, that snacks can be made out of local foods to improve the nutriture of children.
The feasibility of incorporating inexpensive food items, namely maize, green gram whole and palm jaggery, in the place of rice, red gram dhal and cane jaggery was investigated in a school lunch programme. This study was undertaken mainly to reduce the cost of the school lunch which is the most felt need. The low cost meal thus planned brought down the cost to 27.7 paise/meal from 43.3 paise. The study showed that there was no significant difference in the increases in heights, weights and haemoglobin level of the children who received the newly formulated menu and the normal basal menu. Further efforts are needed to popularise such low cost menu to suit both the urban and rural areas.
That the school lunch improves the nutritional status, growth rate and intellectual performance of its beneficiaries offers great
110
scope for research. The inclusion of green leafy vegetables improves definitely the blood picture and reduces the incidence of anaemia. This should be an eye opener to all involved in carrying out the school lunch programme in the country. Research on several low cost indigenous food combinations is of global interest.
References : 1. Amudhasurabi, V. Evaluation of a nutritious supplement to school children. A thesis submitted to the University of Madras in partial fulfilment of the requirement for the degree of Master of Science, 1974 (Unpublished).
2. Anandam, K., Susheela, A. and Devadas, Rajammal, P. Effect of incorporation of leafy and non-leafy vegetables in the school lunch on the growth and nutritional status of children. J. Nutr. Dietet., 1965, 2, p. 202.
3. Chandrasekhar, U and Amirthaveni, M. The impact of school lunch programme on physical development, mental ability and certain behavioural aspects of selected primary school children. Ind. .J. Nutr. Dietet., 1976, 14, pp. 237- 243.
4. Devadas, Rajammal P., Anandam, K. and Lakshmi Banumathi. Effects of school lunch with Indian Multi Purpose Food, skim milk powder or their combination on the nutritional status of children. J. Nutr. Dietet., 1967, 4, p. 51.
5 . Devadas, Rajammal, P., Chandrasekhar, U, and Kusumlatha Dhody. Evaluation of a low-cost indigenous food supplement to the school lunch. Ind. J. Nutr. Dietet., 1974, 11, P. 127.
6. Devadas, Rajammal, P., Chandrasekhar, U. and Kumari, K.S. Availability to school children of iron from amaranthus cooked in two different utensils. Ind. g. Nutr. Dietet., 1973, 10, pp. 223-229.
7. Devadas, Rajammal, P., Chandrasekhar, U. and Premakumari, S. Availability of iron from green leafy vegetables as compared to iron salts for school children. Ind. J. Med. Res., 1973, 61, pp. 270-277.
8. Devadas, Rajammal, P., Chandrasekhar, U. and Suchetha, P. Availability of iron from green leafy vegetables as compared to iron tonic with calcium and ascorbic acid for school children. ICMR report, 1971, (Unpublished).
9. Devadas, Rajammal, P. and Kasipandya Devi. Nutritional comparison between CSM and skim milk in a school lunch. Ind. J. Nutri. Dietet., 1970, 7, p. 228.
10. Devadas, Rajammal, P., Eapen Mary and Susheela, A. Effect of supplementation of skim milk and its combination with Multi Purpose Food or redgram dhal on the nutritional status of children. J. NW. Dietet., 1968, 5,p. 206.
111
11. Devadas, Rajammal, P. Mangala Babtiwala and Chandrasekhar, K.N. Iron content and organoleptic acceptability of amaranth leaves cooked in iron, aluminium and brass vessels. J. Nutr. Dietet., 1965, 1, pp. 88-90.
12. Devadas, Rajammal, P., Premakumari, S. and Chellammal, S. Nutritional benefits of an indigenous mixture in a school lunch. Ind. J. Nutr. Dietet., 1975, 12, P. 161.
13. Devadas, Rajammal, P., Premakumari, S. and Vasantha Devi, K.P. Evaluation of a low cost meal in a school lunch programme. Ind. J. Nutr. Dietet., 1975, 13, pp. 347-353.
14. Devadas, Rajammal, P. and Radha Rukmani, A. The effect of nutritionally balanced school lunch 'on the growth and nutritional status of school children. J. Nutr. Dietet., 1964, 1, P. 28.
15. Devadas, Rajammal, P., Suchetha, P. and Sundari, K. The effect of supplementation of a rural school lunch programme with green leafy vegetables on the nutritional status of children. Ind. J. Nutr. Dietet., 1971, 8, p. 198.
16. Devadas, Rajammal, P., Susheela, A, and Sundari, K. Effects of supplementation of two school lunch programmes with Neera, on the nutritional status of children, J. Nutr. Dietet., 1969, 6, p. 29.
17. Devadas, Rajammal, P., Usha, T.M. and Radharukmani, A. Effect of an experimental school lunch on the growth and nutritional status of children. J. Nutr. Dietet., 1964, 1, P. 297.
18. Dhanalakshmi, M. Evaluation of the school lunch programme in four selected primary schools in Coimbatore city. A thesis submitted to the University of Madras in partial fulfilment of the requirement for the degree of Master of Science, 1973 (Unpublished).
19. Gayatri, V. Evaluation of mixture based on sun flower meal on school children. A thesis submitted to the University of Madras in partial fulfilment of the requirement for the degree of Master of Science, 1976 (Unpublished).
20. Kamalanathan, Godavari, Premakumari, S. and Devadas Rajammal, P. Nutritional evaluation of school lunch programme in the selected villages. J. Nutr. Dietet., 1969, 6, pp. 308-315.
21. Gopalan, C. and Vijayaraghavan, K. Nutrition Atlas of India, NIN, ICMR, 1969, p. 80.
22. Krishnakumari, V.K. Nutritional contribution of two rural school lunch programmes. A thesis submitted to the University of Madras in partial fulfilment of the requirement for the degree of Master of Science. 1969 (Unpublished).
23. Nirmala, P.S., jayalakshmi, V.A. and Devadas, Rajammal, P. Nutritional evaluation of supplementation of iron from amaranth to anaemic adolescent school girls. J. Nutr. New., 1968, 5, pp. 301-305.
24. Rehuma Begum, Impact of the school lunch programmes on the dietary habits of selected families in Coimbatore city. A thesis submitted to the University of Madras in partial fulfilment of the requirement for the degree of Master of Science, 1968 (Unpublished).