Micronutrient deficiency status in school feeding schemes: a case study of 5-9 year olds in Driefontein and Kleinfontein.

Abstract

Malnutrition, particularly micronutrient deficiencies, remains a significant public health issue affecting millions of children worldwide, including those in South Africa. This study addresses the persistent problem of micronutrient deficiencies among Foundation Phase school children in Driefontein and Kleinfontein, Ladysmith, KwaZulu-Natal, despite the implementation of the National School Nutrition Programme (NSNP). The study was guided by two critical research questions: (i) What is the current state of micronutrient deficiencies among Foundation Phase school children in Driefontein and Kleinfontein areas? (ii) What are the factors influencing the nutritional micronutrient status of these children? To answer these questions, a cross-sectional case study design using mixed methods was employed. Quantitative data was gathered through dietary surveys and nutritional assessments to determine the prevalence and severity of deficiencies in key micronutrients such as iron, zinc, and vitamin A. Concurrently, qualitative data was collected through in-depth focus group interviews with various stakeholders, including cooks, suppliers, principals, and foundation phase teachers. The investigation was grounded in three pivotal frameworks developed by UNICEF: the UNICEF Conceptual Framework for Malnutrition (1990), the UNICEF Conceptual Framework for Malnutrition (1992), and the UNICEF Conceptual Framework on the Determinants of Maternal and Child Nutrition (2020). Findings for Research Question 1 revealed that inadequate dietary intake and poor dietary diversity are prevalent among the children in Driefontein and Kleinfontein. Despite the NSNP’s efforts, many children continue to suffer from deficiencies in essential micronutrients. Physical examinations showed that while most learners in School A were well-nourished with only mild deficiencies, School B exhibited more frequent signs of deficiencies, particularly in hair and skin health. The nutritional value of the meals provided by the schools lacked sufficient vegetables and fruits, essential for vitamins and minerals, and had limited sources of omega-3 fatty acids, indicating a need for more diverse protein sources. Findings for Research Question 2 highlighted the significant impact of socioeconomic constraints, lack of nutritional balance, limited nutritional education, and the absence of food gardens on malnutrition. The school-feeding program is widely supported and plays a crucial role in addressing food insecurity and supporting children’s health and academic performance. However, concerns about the adequacy and balance of the meals provided suggest a need for targeted improvements. The study also identified budget constraints, timely payments, and the need for increased funding and policy development as critical themes for the long-term sustainability of school meal programmes. Recommendations included the development and implementation of school nutrition policies, standards for healthy meals and snacks, and fostering public-private partnerships to enhance the overall effectiveness of the NSNP program. The findings underscore the multifaceted nature of malnutrition, highlighting the need for nuanced theoretical models that consider local contexts. Practically, the study identifies critical areas for intervention, such as ensuring consistent funding and comprehensive nutritional education. Policy implications include the necessity for increased funding, robust school nutrition policies, and addressing logistical challenges. Methodologically, the mixed methods approach provided a holistic understanding, but future longitudinal studies are needed to establish causality. Overall, the study calls for improvements in meal quality, variety, and financial management to enhance the feeding scheme’s effectiveness.