Does a subsidized school meal program reduce absenteeism and improve academic performance of Palestinian Refugee School Children?

Abstract

Background: Palestinian refugees are one of the most marginalized populations in the Middle East. High rates of poverty, food insecurity, low diet quality, increasing NCD burden, poor control of school food and high rates of dropout after brevet have been reported in this population, and are negatively associated with educational accomplishment. There is evidence in the literature that a healthy diet is necessary for adequate cognitive development and educational achievement, and school feeding interventions have led to improvements in attendance and academic achievement in low income countries. In the context of Palestinian refugees in Lebanon, an intervention aiming to improve child diets at school was implemented in schools run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Aim: The aim of the present analysis was to study the impact of a subsidized school nutrition intervention on school absenteeism and academic performance (Arabic and English languages and Mathematics grades) in school children attending UNRWA schools in Lebanon. Methods: This school-based intervention study ran for the duration of the school year (8-months period). Two UNRWA schools were selected to receive a subsidized healthy school meal program in addition to nutrition education, whereas two control schools received nutrition education only. Data were collected from parents and children at the four schools at base line and at the 8-month end line using questionnaires focusing on socio-demographic and economic status, anthropometric measurements and anemia. School attendance records were collected by teachers on a daily basis and were returned to the study team at the end of each month. Official grades were obtained from the school at the end of the school year for Arabic and English languages and Mathematics. Descriptive statistics were generated for the dependent and independent variables and were expressed as means and standard deviations (SD) for the continuous variables and as frequ