How do publicly procured school meals programmes in sub-Saharan Africa improve nutritional outcomes for children and adolescents: a mixed-methods systematic review

Résumé En

Objective: This review aimed to (i) synthesise evidence of the impact of publicly procured school meals programmes on nutritional outcomes of children/adolescents (5–18 years) in sub-Saharan Africa and (ii) identify challenges and facilitators to implementing effective school meals programmes. Design: Mixed-methods systematic review ( n 7 databases). Nutritional outcomes assessed were anthropometrics (underweight, stunting, wasting, overweight/obesity), micronutrient deficiencies, food consumed and food environment. Qualitative findings were coded using a nine-step school food system framework: production of food, wholesale and trading, transportation and storage, processing and distribution, food preparation, distribution to students, student stakeholders, community involvement and infrastructure support . Setting: Sub-Saharan Africa. Participants: Children/adolescents (5–18 years), parents, school personnel and government officials. Results: Thirty-three studies (twenty-six qualitative, seven quantitative) from nine sub-Saharan African countries were included. Six studies found a positive impact of publicly procured school meals programmes on nutritional outcomes (wasting ( n 1), stunting ( n 3), underweight ( n 1), vitamin A intake ( n 1) and dietary diversity ( n 1)). Fifty-three implementation challenges were identified, particularly during food preparation (e.g. training, payment), distribution to students (e.g. meal quantity/quality/diversity, utensils) and infrastructure support (e.g. funding, monitoring, coordination). Implementation facilitators were identified ( n 37) across processing and distribution (e.g. programme coordination), student stakeholders (e.g. food preferences, reduced stigma) and community involvement (e.g. engagement, positive perceptions). Included policy recommendations targeted wholesale and trading , food preparation , student stakeholders and infrastructure support in nine, fifteen and twenty-five studies, respectively. Conclusions: As many challenges remain, strengthening implementation (and therefore the nutritional impact) of school meals programmes in sub-Saharan Africa requires bold commitment and improved coordination at multiple levels of governance.