United Nations System
Standing Committee on Nutrition

Report of the Sub-Committee on Nutrition at its Twenty-Fifth Session

II.  Work in Progress:  Summary of Discussion and Conclusions

C. Reports of decisions taken in Working Groups

C.5  Nutrition of School Age Children -- Summary Report of the Working Group

44.  The objectives of the Working Group on School Age Children (aged 6-18 years) are advocacy, briefing of agency activities, and, if necessary, bringing issues to the attention of ACC. The Group meets every two years and this year a technical NGO presented recent findings and a summary of agency activities in this area.

45.  It was noted that malnutrition (stunting, anaemia) in schoolchildren is serious, sometimes worse than in preschool children, and gets worse over the school years. Boys may be more affected than girls during this period. Reasons for this gender difference were not clear; one possible reason is that only better-nourished girls are enrolled and stay in school. There are clusters of activities aimed at improving the nutritional status of school-aged children, including school feeding, school health and nutrition (micronutrients, deworming, nutrition education and first aid), programmes aimed at preventing HIV infection, and water and sanitation projects. There are also programmes aimed at those children not enrolled in school, particularly deworming.

46.  Recommendations from the Group:

• more and better data on nutrition status of school aged children are needed;
• the growth reference curves and criteria for anaemia need to be reviewed, however WHO stated that they were more likely to focus first on the adolescent age group;
• there is a need to identify good practices (pointing out gaps).

Full Report of the Meeting of the Working Group on the Nutrition of School-Age Children

Saturday 28 March 1998, Oslo, Norway

Chair: Judith McGuire, World Bank
Rapporteur: Andrew Hall, Partnership for Child Development

In her opening statement Dr. McGuire noted that since the last meeting of the Working Group two years ago there was a growing consensus on the need for school health and nutrition programmes, there was growing clarity on what services could be provided, and a large number of countries had started activities in the area.

Presentation by the Partnership for Child Development

Data were presented by Andrew Hall on the anthropometric and haemoglobin status of school children in several countries of the Partnership. Cross-sectional anthropometric data from large samples of schoolchildren in Ghana, Tanzania, India, Indonesia and Viet Nam (PCD, Proc.Nutr.Soc, in press) showed that:

• about 50% of children in all countries were stunted;
• in all countries height-for-age increasingly departed from reference values, especially among boys, indicating that children were becoming more stunted with age;
• in all countries more boys were classified as underweight than girls but this may be confounded by female drop-out from school;
• children in Tanzania and Ghana who enrolled late in school were more stunted than children who enrolled closer to the right age;
• there was little evidence for an adolescent growth spurt.

A survey of anaemia in 8 - 9 year old school children in Ghana, Tanzania, India and Viet Nam showed a wide range in the prevalence of anaemia from around 12% in Viet Nam to about 60% in Tanzania.

These data show that the nutritional problems of school age children may be greater and more widespread that previously thought, and indicate that school health and nutrition programmes have a clear potential to improve the nutrition and growth of school-age children.

A wide-ranging review was presented by Don Bundy of activities by international, bilateral and non-governmental agencies in the field of school health and nutrition. The range of activities was very broad, for example covering health education, water and sanitation programmes, school health services, adolescent life-skills training, and school feeding, but all agencies were active in the of school nutrition and health. Within UN organizations such activities were covered by a very wide range of groups: 22 in WHO headquarters, for example, as well as separate activities at regional and country levels. The information on activities was, because of this, hard to piece together and somewhat fragmentary, but there was growing coordination between UN agencies and evidence of convergence in activities and programmes. The school health education materials developed by UNAIDS was a good example of materials developed by collaboration between UN agencies.

The World Bank was developing partnerships with UN agencies, international NGOs and bilateral agencies to promote the dissemination and flow of technical information. Many bilateral agencies were also active in the health and nutrition of school-age children, including CIDA, DFID, GTZ, NORAD, DANIDA, USAID and SIDA, but only USAID and GTZ had specific policies that referred to this age group.

The experiences of agencies and general discussion

The meeting was then opened for statements of the experiences of agencies working on school-age children and for a general discussion of issues and concerns. The main points raised were:

• There was a need for more data on the health and nutrition of school-age children to assess the scale of the problem which may, until now, have been greatly underestimated; to provide guidance to develop programmes; and to provide information for advocacy purposes.
• There was a need for more examples of good practices and successful school health and nutrition programmes.
• There was a need for good instruments to monitor and evaluate both the processes of school health and nutrition programmes and to assess their impact on nutrition, health and education.
• There was concern for the health of adolescent girls and a recognition that, if they were to be easily provided with health services, then they needed to be retained in school.
• There was concern for the health of non-enrolled children although there was growing experience of using schools to reach such children.
• The fact that all the First Ladies of Latin American countries had endorsed school health and nutrition initiatives was greatly welcomed.
• There was concern, particularly in Latin America rather than in Africa and Asia, for the rising prevalence of obesity among school children, and there was a need for health education which focused on healthy eating.
• The need was stressed for children, both in developing and developed countries, to come to school having had breakfast.

Future of the Working Group

Dr McGuire canvassed opinions on the future of the Working Group. There was general agreement that it should continue in order to advocate the need for programmes and research on school health and nutrition, to share information and assess the current status of programmes and knowledge, and to make recommendations to the SCN. Dr. McGuire agreed to continue as Chair of the Working Group and proposed Prof. Don Bundy as the new Secretary. The Partnership for Child Development at Oxford University was proposed as a focal point for communications and discussion on the health and nutrition of school age children (Fax: + 44 - 1865 - 281245; E-mail: child.development@zoo.ox.ac.uk).

Recommendations to the SCN

The following recommendations were made:

• There is growing evidence that the health status of school-age children may be worse than previously thought and there is a clear need for more data about their health and nutritional status. This information is needed both to develop or strengthen school health and nutrition programmes and for the purposes of advocacy. In this context it was proposed that a report on the nutrition of school-age children should be considered for the next Report on the World Nutrition Situation.
• The development of new growth reference values was confined to children less than 6 years old, hence neglecting school-age children, and the revised reference cut-offs for anaemia were complicated to apply to school-age children. These issues should be reviewed by the SCN for discussion with the WHO.
• There is a need to identify good practices for school health and nutrition programmes, to develop coordinated and unified nutrition education messages, and to develop a coherent school health and nutrition policy. The SCN should promote these developments.