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Weekly menu for midday meal in Bangladeshi schools: Caregivers’ choices

By Abu Ahmed Shamim, Jannaty Mayna, Ishrat Jahan, Syed Muntasir Ridwan and Rudaba Khondker

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Abu Ahmed Shamim is the Nutrition Advisor (Consultant) at the Research and Evaluation Division of BRAC. He has previously managed nutrition programmes and research projects at the Bangladesh National Nutrition Council, CARE, Johns Hopkins University, FHI 360 and Helen Keller International. 

Jannati Mayna has a Master’s degree in Nutrition and Food Science from the Institute of Nutrition and Food Science, Dhaka University and is currently serving as a lecturer at the Khulna City Corporation (KCC) Women’s College, Khulna, Bangladesh.

Dr. Ishrat Jahan studied dental surgery (BDS) and public health (MPH) form James Pitter Grant School of Public Health, BRAC University and is currently working as a researcher at the ARK Foundation, Dhaka, Bangladesh.

Syed Muntasir Ridwan works at the Global Alliance for Improved Nutrition (GAIN), conducting research in health economics, econometrics and behavioral economics.

Dr Rudaba Khondkar is the Country Director of GAIN, Bangladesh. She is a Medical Doctor with expertise in pediatrics and over 15 years’ experience in humanitarian and development with Concern Worldwide, Save the Children, UNICEF and BRAC in Asia, Africa and the Pacific.

The authors wish to acknowledge the financial and technical support of GAIN, Bangladesh. However, the views expressed are the responsibility of the authors and do not necessarily reflect the view of GAIN.

The writers also acknowledge the insights provided by Dr. Mahbubur Rashed, Ex Head of Programme, GAIN, Bangladesh, and the support of the District Coordinator (Sherina Akther), Shushilan Barguna and the field-team of the School Meal Programme Bamna Barguna.

Background

Early-life malnutrition is reported to have long-term consequences. Improvements in height-for-age in pre-schoolers are linked with increased height as young adults and increased number of school grades completed (Alderman et al, 2006). A recent review commissioned by the World Bank and World Food Programme (WFP) reported that school feeding programmes increase school attendance, cognition and educational achievement, particularly if supported by complementary actions such as deworming and micronutrient fortification or supplementation (Bundy et al, 2009).

In response to such evidence and prevalent undernutrition, the Government of Bangladesh (GoB) and WFP launched a school feeding programme (SFP) in 2002, through which fortified biscuits were distributed to primary schoolchildren in poverty prone areas of Bangladesh to improve child nutrition status. To complement this initiative, a partnership was formed in between GoB, Global Alliance for Improved Nutrition (GAIN) and Dubai Cares in 2011 to implement a pilot School Nutrition Project (SNP) in both rural and urban areas of Bangladesh to provide cooked midday meals (MDM) in primary schools.

A ‘cluster kitchen model’ was used whereby one basic kitchen provided a meal (often ‘khichuri’, made from rice, lentils or other pulses with added vegetables) to 1,500 to 2,500 students from five to six schools, using domestically produced and locally available ingredients cooked on traditional stoves. This model reduced dependence on electricity and ensured quicker delivery of food (within 40 to 60 minutes) compared to a large, centralised kitchen; avoided the need to build kitchen extensions in schools; reduced costs per school of kitchen workers; and avoided disturbing schoolteachers from their primary duty of teaching. Research showed that the nutrition status of children in participating schools, as well as school enrolment and attendance rates, improved significantly (Afroze & Tukun, 2014). The WFP supported programme continues to run in selected areas of Bangladesh and the GoB is now formulating a national school feeding policy and a plan for scale-up. To inform this process, GAIN conducted the current study to develop an acceptable and cost-effective MDM menu, taking into consideration the menus from the pre-existing programme.

Methods

A literature review was conducted to investigate the prevalence of undernutrition and micronutrient deficiencies of Bangladeshi primary school-age children. A pilot study that included a cross-sectional survey was then carried out among 111 mothers and caregivers in 71 pilot MDM households (of randomly selected students from a primary school in Bamna, sub-district of Borguna district, with the MDM programme) and 40 non-pilot households (of students from the nearest school from the adjacent sub-district with no MDM programme) to estimate energy, calcium and vitamin A intakes using the 24 hour-recall method¹. Three focus group discussions (FGDs) (with 22 participants in total) were conducted with groups of mothers and caregivers of students attending MDM schools and local female vegetable suppliers of the MDM programme to gather their opinions on alternative MDM menus within the same budget.

Results

Literature review findings

In Bangladesh prevalence of malnutrition is high; it is estimated that around 42% of school girls aged 5 to 10 years are underweight, 31% are stunted; and 28% are wasted, with a similar prevalence among boys (Akhtaruzzaman et al, 2013). Bangladesh has a high prevalence of iodine deficiency among school age children (40%) and vitamin A deficiency (19%). Although anaemia is prevalent in this age group (19.1% and 17.1 % in children aged 6-11 and 12-14 years respectively), prevalence of iron deficiency is not considered high (3.9% and 9.5 % in children aged 6-11 and 12-14 years respectively) (UNICEF, 2013). Daily intake of vitamin A, iron, calcium and zinc fall far short of daily recommended allowances for children (RDAs) at 20-47%, 35-48%, 50-77% and 36-60% respectively (Jahan & Hossain, 1998; UNICEF, 2013).

Survey findings

Intakes of energy, calcium and vitamin A among schoolchildren in pilot MDM households were higher than in non-pilot households, although the differences were small (hence figures are not presented) and the result should be interpreted with caution due to the small number of children included in the study. Field findings also suggested that a typical home breakfast and lunch of a child provides about 28-32% of dietary energy in both pilot-MDM and non-MDM households.  

When the mothers or caregivers of schoolchildren were asked about their opinion regarding the school meal currently being provided, 52% expressed dissatisfaction with the taste of the meal, while being satisfied with the amount of food served and its nutritional quality. When asked about the benefits of the MDM, 44% of caregivers mentioned that it helped to reduce child hunger; 27% mentioned that it helped to reduce family costs; and 22% mentioned that it improved child health. Results revealed that 66 % of schoolchildren ate most of the meal provided, but 34% did not consume the meal regularly as they felt it was monotonous (100%) and not tasty (28%).

Endnotes

¹Iodine, zinc and iron intake from iodized salt and iron- and zinc-fortified rice were not estimated.

²Shaheen, 20013

³Bangladeshi Taka (BDT); $1= BDT 8 (Department of Agricultural Marketing (www.dam.gov.bd/); accessed 15 June 2017)

⁴Locally and seasonally available mixed vegetables (including 50% leafy vegetables)

⁵Reconstituted from whole milk power/locally collected cow’s milk

⁶Calculated from Food and Agriculture Organization & World Health Organization, 2005; WHO, 2007; and Otten et al, 2006

⁷Upper values were used for calculation.

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References

Afroze R & Tukun AB. (2014). Evaluation of school nutrition programme of BRAC and Banchte Shekha: Learning from a pilot project. BRAC Education.

Akhtaruzzaman M, Khan MNI & Islam SN. (2013). Nutrition, health and demographic survey of Bangladesh 2011. Dhaka: Institute of Nutrition and Food Science University of Dhaka.

Alderman H, Hoddinott J & Kinsey B. (2006). Long-term consequences of early childhood malnutrition. Oxford economic papers, 58(3), 450-474.

Bundy D, Burbano C, Grosh ME, Gelli A, Juke M and Lesley D. Rethinking school feeding: social safety nets, child development, and the education sector. World Bank, 2009.

Food and Agriculture Organization & World Health Organization. (2005). Vitamin and mineral requirements in human nutrition.

Jahan K & Hossain M (1998). Nature and Extent of Malnutrition in Bangladesh. Bangladesh National Nutrition Survey 1995-1996, Dhaka, Bangladesh. Dhaka: Institute of Nutrition and Food Science, University of Dhaka.

Otten JJ, Hellwig JP & Meyers LD (Eds). (2006). Dietary reference intakes: the essential guide to nutrient requirements. National Academies Press.

Shaheen N. (2013). Food composition tables for Bangladesh. Final Research Results, 187.

UNICEF (2013). National Micronutrient Status Survey.

World Health Organization (WHO) & United Nations University. (2007). Protein and amino acid requirements in human nutrition (Vol. 935). World Health Organization.

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Abu Ahmed Shamim, Jannaty Mayna, Ishrat Jahan, Syed Muntasir Ridwan and Rudaba Khondker (). Weekly menu for midday meal in Bangladeshi schools: Caregivers’ choices. Field Exchange 58, September 2018. p27. www.ennonline.net/fex/58/weeklymenubangladeshischools

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