United Nations System
Standing Committee on Nutrition

Working Group on the Nutrition of School-Age Children Contribution to Millennium Development Goals

held during the ACC/SCN's 31st Session in New York,  United States, 25 March 2004

Co-Chairs: Arlene Mitchell, WFP (unable to attend), Joy Miller Del Rosso, Save the Children/US
Rapporteur: Celia Maier, Partnership for Child Development

Part I: Actions taken in 2003

The Working Group on the Nutrition of School-Age Children has primarily taken advantage of the Standing Committee on Nutrition’s (SCN’s) annual session as an opportunity to bring attention to the important nutrition issues among the school-age population. Although the working group was unsuccessful in convening meetings or holding other events during the year 2003 under the specific auspices of the working group, the promotion of this work through the SCN contributes to the expansion of activities in this area. During the previous year:

• The "Alliance for Action on School Feeding, Health and Basic Education for the Sahel" was launched in September of 2003. A similar multi-country approach was initiated for the countries of Southern Africa also in 2003. In March 2004, the Latin America School Feeding Network was launched in Santiago, Chile. All of these efforts have involved a wide variety of partners including national governments and local and international health, nutrition and education institutions.
• The WFP Working Group Co-Chair participated actively in the millennium development goal (MDG) Task Force on Education and Gender and coordinated closely with the Hunger Task Force. The work included meetings in New York, Washington, DC, and Bangalore as well as a Millennium Project team mission to Ethiopia. One key recommendation from the Ethiopia visit was to substantially increase school feeding activities there.
• Work has been undertaken on the issue of the sustainability of school feeding operations, by the World Food Programme, The U.S. Department of Agriculture, and by Catholic Relief Services.
• UNICEF has announced its support of school feeding and the "minimum package" approach as described in the 2003 Working Group discussion and the agency has expanded its cooperation with school feeding programs worldwide.
• De-worming linked to school feeding has expanded significantly over the past year, and gained support from a wider variety of donors and governments.
• Several studies and large-scale initiatives have been undertaken related to nutrition, food, and school-based interventions for children affected by HIV/AIDS. In December, WFP implemented an all-Africa HIV/AIDS and School Feeding workshop with representatives from UNAIDS, UNICEF, FAO to share lessons learned and to encourage more attention and action on these issues in Africa.

Part II: Recommendations for SCN Action in 2004

In accordance with the main objective of the 31st session, the working group session discussed the most important linkages between the MDGs and this group’s work, and presented recent program and intervention results and experiences related to scaling up key nutrition interventions for this age-group.

Linkages between the MDGs and School Nutrition

The working group identified three key linkages between its work and the MDGs:

1. The link between nutrition, children’s ability to learn and their education achievement means that adequate nutrition is essential for achieving MDG 2 – Achieving Universal Primary Education.
2. Since ‘school-age children’ encompasses adolescents, the health and nutrition of this age group is essential for achieving MDG 5 – Improving maternal health.
3. Adequate nutrition is essential for a healthy immune system and can reduce the severity of HIV infection. School can also provide a forum for health and nutrition education, including HIV/AIDS prevention education, and for caring for orphans and vulnerable children. This links with MDG 6 – Combating HIV/AIDS, malaria and other diseases.

Discussion on this point focused on the relationship between MDG 1 – eradicate extreme poverty and hunger and one element of this group’s work, school feeding. School feeding has a role to play in the alleviation of hunger among school-age children with possible spin off benefits for families. The significance of this intervention relative to other nutrition interventions aimed at achieving MDG 1 requires additional analysis.

Scaling up Programs to Achieve the MDGs

The presentations focused on recent success stories in nutrition programming for school-age children. The highlights are summarized below.

Deworming
Results from a national deworming program in Nepal which should achieve full national coverage by April 2004 were shared. A study taking place in connection with the programme demonstrated a 77% reduction in the percent of children who are anaemic, together with a reduction in the mean intensity of hookworm infection, following just 2 rounds of deworming treatment.

This study, together with others, has confirmed that deworming is extremely cost effective (in Nepal, 2 cents per child per year) and can have enormous benefits for children, with reduction in worm load and subsequent improvement in iron status leading to reduced morbidity, improved growth and improved development. Deworming of school-age children has also been shown to reduce the prevalence of worm infection in the local community, even for those who have not been treated themselves.

Integrated school-based interventions
The experience of the Zambian Government programme implementing a collection of interventions, including: deworming, iron supplementation and vitamin A supplementation, and skills-based health education (including for HIV/AIDS prevention and malaria prevention and treatment) was shared. A three year longitudinal study demonstrated a significant reduction in the prevalence of both hookworm and urinary schistosomiasis, after two annual rounds of deworming (e.g. from 60% to 1% for schistosomiasis). Although the impact of the interventions on children’s nutritional status has yet to be shown – probably due to the programme coinciding with a widespread drought in Zambia – the interventions had a significant impact on children’s educational ability. The programme has been successful in building capacity in the areas of policy, training and training materials, targeting and delivery, partnerships, monitoring and evaluation. The Zambian Ministry of Education have now committed funds to extend the programme to a further four provinces by 2005, with the aim of full national coverage by 2008.

Recommendations of the Working Group

The Working Group on the Nutrition of School-Age Children continues to play an important role in bringing attention to the nutrition problems of school-age children and encouraging support for their resolution among international, national and local institutions working in this area. The Working Group has two specific recommendations regarding taking effective nutrition programming for school-age children to scale so as to maximize the contribution to achieving the MDGs.

1. School feeding programs have been around for decades and continue to be one of the mainstay interventions aimed at school-age children. In the past decade we have learned that food in combination with other interventions that address important school-age child health and nutrition deficits is more effective in achieving both education and nutrition objectives than feeding alone. These interventions include deworming, micronutrient supplementation, or improvements in the water and sanitation environment among others. The integration of other interventions with feeding programs also offers efficiencies in the delivery of these services. It is recommended that every effort possible be made to design and implement school feeding programs as food plus other school-age health and nutrition interventions.
2. Deworming has proven itself many times over to be one of the least costly and most effective interventions available for addressing both health and nutrition needs of school-age children. It is recommended that every opportunity possible be identified for providing deworming services to school-age children.

The third recommendation pertains to actions that the Working Group should undertake over the next year. Notwithstanding the first recommendation regarding “school feeding plus,” there appears to be a lack of awareness among many elements of the international development community of the current state-of-the-art of school feeding as well as a reoccurring set of questions related to a school feeding that never seem to get answered.

3. To address this gap it is recommended that the SCN support and facilitate the Working Group on the Nutrition of School Age Children to produce a “state of school feeding” paper. The specific content of this documentation remains to be elaborated, but it is anticipated that it would be a combination review and meta-analysis drawing on current practice and research in school feeding and school nutrition over the last decade. The recommended approach toward producing this paper would be to draw on experts across a number of institutions involved in school feeding and school nutrition. Some of the topics and individuals who might be involved in this work include:

• De-worming: Lorenzo Savioli, David Crompton or others at WHO
• School feeding plus other interventions/best practice in school feeding: Flora Sibanda-Mulder of UNICEF and/or Joy Miller Del Rosso of Save the Children
• Local agricultural production and school feeding: Pedro Sanchez of Earth Institute/MDG Hunger Task Force and/or Prof. Mkandawire of NEPAD
• Costs and impact of school feeding programs: Akter Ahmed of IFPRI
• The private sector and school feeding: Arlene Mitchell of WFP, and/or someone from TetraPak or Unilever Health Institute
• Sustainability: Mike Posniak (or other) of CRS and/or WFP--Arlene Mitchell
• Obesity in school-age children: Unilever Health Institute, British Department of Health, Chilean school feeding agency, JUNAEB
• School feeding and health/nutrition education (especially HIV/AIDS prevention): ?

Part III: Organization of the Working Group for 2004

The working group is currently chaired by three members (two co-chairs, and a secretary). These three members represent a UN Agency/WFP, an NGO/Save the Children and an academic institution/Imperial College closely associated with the World Bank. These members have served for the past two years. They could conceivably continue to lead this working group, however the organization of the working group going forward was not discussed given the short time of the session (1 hr 15 min) and the fact that one of the co-chairs was absent. The session was well attended and several individuals came up at the end and expressed interest in being actively involved in the group. The current co-chairs will need to work with the Secretariat to determine how to organize this group for 2004 and also how the Secretariat might be able to support the Working Group in implementing the actions outlined in the final recommendation.