Influence of school food environment on eating behaviours and nutritional status of primary school children (6-13 years) in Dodoma
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Date
2024-05
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Sokoine University of Agriculture
Abstract
Malnutrition among school-aged children has significant
consequences for their health, cognitive development, and overall
educational achievement. Rapid shifts in the availability and
affordability of less nutritious foods in food environments have
contributed to the dual challenges of malnutrition. There is growing
global interest in understanding how food environments contribute to
this double burden of malnutrition. This study aimed to assess the
impact of the school food environment on the eating habits and
nutritional well-being of primary school children aged 6 to 13 years in
Dodoma region. Specific objectives were first: to evaluate the
nutritional status of school-age children and examine how socio-
economic, demographic, and environmental factors influence their
nutritional well-being; second, to investigate how the school food
environments affect the eating behaviours of primary school children
in both public and private schools in Dodoma region. A cross-
sectional study involving 248 pupils was conducted in eight primary
schools in Dodoma region. Four schools were chosen from
Chamwino district (a rural setting), including two public and two
private schools. The other four schools were located in Dodoma
urban district (an urban setting), comprising of two government
schools and two private schools. The study also involved eight head
teachers and eight health/food teachers, who were purposefully
selected from the eight participating primary schools. Anthropometric
measurements were made following the World Health Organization
(WHO) guidelines to assess stunting, thinness, underweight, and
overweight/obesity. Socio-demographic data were collected from
pupils using structured questionnaires. School administrators,
including head teachers and health/food teachers, provided
information on the physical, political, and socio-cultural aspects of
the school food environment. Data on eating behaviours were
obtained through structured questionnaires and food frequency
questionnaires to assess students' dietary patterns over a period of
seven days. Additionally, an observation checklist was used to gather information on the availability and accessibility of foods
consumed by the school children. Data analysis was performed by
using the WHO AnthroPlus v1.0.4 software and IBM SPSS Statistics
26v. Descriptive statistics, such as frequencies and percentages,
were calculated. Regression models were used to explore the
determinants of nutritional status, reporting both crude (COR) and
adjusted odds ratios (AOR). Multilevel modeling was employed to
assess individual-level variance in eating behaviours and examine
the association between the school food environment and dietary
behaviours of children. Prevalence rates among surveyed pupils
were as follows: stunting (10.5%), underweight (3.6%), thinness
(2.8%), and overweight/obesity (10.1%). Stunting was more
common in boys (13.2%) than in girls (8.2%), and it increased with
age. Underweight was higher in public schools (8.2%) than in private
schools (3.2%). Thinness was more prevalent in public schools
(85.7%) than in private schools (14.3%), particularly in rural areas
(57.1%) and among younger children (aged 6-9 years, 57.1%).
Overweight/obesity was more common among girls (90.1%) than
boys. Urban schools had a higher prevalence of overweight/obesity
(90.3%) compared to rural schools (89.5%), and private schools had
a higher prevalence (95.2%) than public schools (84.7%). Pupils in
urban areas were more likely to be overweight/obese than those in
rural settings. After adjusting for student characteristics, the school
environment accounted for a small proportion of the variance in
eating behaviours, ranging from 11.3% to 11.6% for carbohydrate-
rich foods, 12.6% to 11.4% for protein-rich foods, 20.3% to 19.4%
for vitamins and mineral-rich foods, and 11.0% to 10.1% for lipids
and sugar-rich foods. In model 2, controlling for other factors,
protein-rich and lipid and sugar-rich foods intake were significantly
related to the death of a parent, while vitamins and mineral-rich
foods intake were significantly related to the number of adults in the
household. None of the investigated school food environmental
factors were associated with the children's reported intake of
carbohydrate-rich foods, protein-rich foods, vitamin and mineral-rich
foods, or lipids and sugar-rich foods. These findings suggested that,
Description
MSc Dissertation
Keywords
Anthropometric status, Primary school children, Nutritional status, Socioeconomic Factors and Dodoma, Tanzania