Efficacy of Adding Pre-packaged Ultra Heat Treated Long-Life Cow Milk to School Meals on the Growth Parameters of Learners (6-12 Years old) in Nkhotakota District

This study’s objective was to determine the effect of adding cow milk, which is an animal source food, to school meals on the growth parameters of standard 1 learners aged 6 to 12 years in Nkhotakota. A quasi-experimental design was implemented. A total of 132 learners from two schools were recruited with 67 learners allocated to the intervention group and 65 learners in the control group.  Learners in the intervention group were supplemented with 250 ml of UHT cow milk 3 times a week for 6 months and those in the control group were not provided with milk. Baseline data was collected and analyzed using SPSS version 20.0 at the start of the intervention and after 6 months.  Results from baseline showed no significant differences between the intervention and control group in terms of weight, height and MUAC (P=.15, 0.37, 0.12, respectively). At endline, the intervention group showed improvements in weight, height and MUAC compared to the control group, however MUAC was the only parameter that was significant (P< 0.001). In summary, milk supplementation was associated with improved growth parameters among learners in the selected schools in Nkhotakota.

 

TABLE OF CONTENTS

DECLARATION................................................................................................................ i

CERTIFICATE OF APPROVAL ................................................................................... ii

DEDICATION.................................................................................................................. iii

ACKNOWLEDGEMENTS ............................................................................................ iv

ABSTRACT ........................................................................................................................v

TABLE OF CONTENTS ................................................................................................ vi

LIST OF TABLES .............................................................................................................x

LIST OF FIGURES ......................................................................................................... xi

LIST OF APPENDICES ................................................................................................ xii

LIST OF ABBREVIATIONS AND ACRONYMS ..................................................... xiii

CHAPTER 1 .......................................................................................................................1

INTRODUCTION..............................................................................................................1

1.1 Background ............................................................................................................1

1.2 Problem statement and study justification .............................................................3

1.3 Main Objective ......................................................................................................5

1.3.1 Specific Objectives ....................................................................................... 5

1.4 Hypothesis .............................................................................................................6

CHAPTER 2 .......................................................................................................................7

LITERATURE REVIEW .................................................................................................7

2.1 The Nutritional Status of School Age Children .....................................................7

2.2 Determinants of Nutritional Status of School Age Children .................................8

2.3 The Prevalence of Undernutrition Among School Age Children in Malawi ......11

2.4 Evaluation of The School Feeding Program ........................................................11

2.5 The School Meals Program in Malawi ................................................................13

2.6 Dietary Diversity and Food Consumption among School Age Children ............13

2.7 Complementary School Health interventions ......................................................15

2.8 The importance of Milk Consumption ................................................................16

2.9 Importance of milk supplementation to School going children...........................19

2.10 Scope and Nature of Milk in Schools ..................................................................20

CHAPTER 3 .....................................................................................................................21

MATERIALS AND METHODS ....................................................................................21

3.1 Study site .............................................................................................................21

3.2 Study Design ........................................................................................................22

3.3 Inclusion and Exclusion Criteria .........................................................................23

3.4 Sampling protocol ................................................................................................24

3.5 Data collection methods ......................................................................................25

3.5.1 Training of enumerators .............................................................................. 26

3.5.2 Pretesting of the Data Collection Tools ...................................................... 27

3.5.3 Outcome measurements .............................................................................. 27

3.5.4 Anthropometric data ................................................................................... 27

3.6 Data analysis ........................................................................................................29

3.7 Ethical Consideration ...........................................................................................31

CHAPTER 4 .....................................................................................................................32

RESULTS AND DISCUSSION ......................................................................................32

4.1 Mean age and age frequencies of learners in the intervention and control group

32

4.2 Sex differences between the control and intervention groups .............................32

4.3 Occupational status of caregivers of learners in the intervention and control

group ....................................................................................................................33

4.4 Educational status of caregivers in the intervention and control group ...............34

4.5 Literacy levels of caregivers in the control and intervention groups ...................34

4.6 Social and Economic indicators of the intervention and control group ...............36

4.7 School feeding complementary health programs ................................................37

4.8 Caregivers’ perceptions of the school feeding program ......................................40

4.9 Learners’ period of participation in the School Feeding Program ......................41

4.10 Provision of breakfast to learners before and after school ..................................42

4.11 The types of meals provided at school ................................................................43

4.12 Caregivers’ concerns over School Meal ..............................................................44

4.13 Comparison of baseline growth parameters between the intervention and control

group ....................................................................................................................46

4.14 The nutritional status of learners in the intervention and control groups ............47

4.15 Household Food Consumption Score in the intervention and control groups .....48

4.16 Mean dietary diversity score in the intervention and control group ....................49

4.17 Determinants of weight among learners ..............................................................50

4.18 The effect of factors on MUAC of learners .........................................................52

4.19 The effect of factors on height .............................................................................54

4.20 The relationship between baseline and end-line growth parameters ...................55

4.21 A comparison between baseline and end-line weights of learners in intervention

group ....................................................................................................................56

4.22 A comparison between baseline and end-line heights of learners in intervention

group ....................................................................................................................57

4.23 A comparison between baseline and end-line MUAC of learners in intervention

group ....................................................................................................................57

CHAPTER 5 .....................................................................................................................60

CONCLUSION AND RECOMMENDATIONS ...........................................................60

5.1 Conclusion ...........................................................................................................60

5.2 Recommendations ................................................................................................60

5.3 Limitations of the study .......................................................................................61

REFERENCES .................................................................................................................62

APPENDICES ..................................................................................................................78