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Effect of Adding Milk to a Micronutrient-Fortified High-Energy Biscuit School Feeding Programme in Yemen: A
Lilia Bliznashka1, Monica George Michail2, Dalia Elsabbagh2
1International Food Policy Research Institute, Washington, DC 20001, USA; Global Academy of Agriculture and Food Systems, University of Edinburgh, UK.
Insights
Adding milk to school feeding programs in Yemen improved children's cognition and reduced conduct problems. Caregivers experienced less anxiety and food insecurity, demonstrating the program's broad family benefits.
Area of Science:
- Global Health
- Nutrition Science
- Developmental Psychology
Background:
- Two billion children live in conflict zones, necessitating robust support systems.
- School feeding programs (SFPs) are critical safety nets for children in crisis-affected regions.
- Evaluating supplementary nutrition within SFPs is vital for optimizing child welfare.
Purpose of the Study:
- To assess the impact of adding milk to a high-energy biscuit (HEB) SFP in Yemen.
- To determine effects on children's dietary diversity, cognition, learning, attendance, nutritional status, health, and mental well-being.
- To evaluate caregiver mental health and household food security.
Main Methods:
- A 2-arm cluster-randomized controlled trial involving 42 schools in Yemen.
- Children aged 6-18 years received either HEBs alone or HEBs plus 120 mL of ultra-high temperature milk daily for 5 months.
- Intent-to-treat analysis using linear mixed-effects models accounted for clustering.
Main Results:
- Milk supplementation increased milk consumption but did not affect dietary diversity.
- Significant improvements were observed in children's cognition, literacy, and numeracy scores.
- Reductions in children's cough symptoms and conduct problems were noted, alongside decreased caregiver anxiety and household food insecurity.
Conclusions:
- Integrating daily milk into HEB-based SFPs in Yemen yields substantial benefits for children and families.
- Hybrid SFP models enhancing meal quality are feasible and effective.
- Further research is recommended to understand the long-term impacts of such interventions.
Background:
Two billion children globally are estimated to live in conflict-affected areas. School feeding programs (SFPs) are a widely implemented safety net that supports children during and after conflict.
Objectives:
We evaluated the effectiveness of providing milk alongside a high-energy biscuit (HEB) SFP in Yemen on children's and caregivers' outcomes.
Methods:
We implemented a 2-arm longitudinal cluster-randomized controlled trial from December 2023 to May 2024. Forty-two schools in Al Mukha district were randomly assigned (1:1) to control, where children received HEBs (2 packets [100 g] daily), or milk, where children received HEBs plus a 120 mL carton of ultra-high temperature milk. Children aged 6-18 y were randomly selected for enrolment. The primary outcomes were children's dietary diversity and milk consumption. Secondary outcomes were children's cognition, learning, attendance, nutritional status, and health. Tertiary outcomes were child and caregiver mental health and household food security. We conducted intent-to-treat analysis using linear mixed-effects models accounting for clustering.
Results:
One thousand two hundred ninety-nine children were enrolled. After 5 mo, the intervention increased milk consumption but had no effect on dietary diversity. Children's cognition [mean difference (MD): 1.00 (95% CI: 0.40, 1.61)], literacy [MD: 1.14 (95% CI: 0.36, 1.92)], and numeracy [MD: 1.06 (95% CI: 0.46, 1.67)] scores improved. Cough symptoms declined: MD: -0.12 (95% CI: -0.2, -0.03). There were no changes in school attendance or nutritional status. The intervention reduced conduct problems in children [MD: -0.52 (95% CI: -0.97, -0.08)], severe anxiety in caregivers [MD: -0.03 (95% CI: -0.06, -0.001)], and household severe food insecurity [MD: -0.09 (95% CI: - 0.17, -0.001)].
Conclusions:
Adding a daily milk drink to an HEB SFP in Yemen resulted in numerous benefits for children and their families. Hybrid models to incrementally improve meal quality are feasible, acceptable, and lead to meaningful impacts. More research is needed on medium- and long-term benefits.
Registration:
The trial was registered with ISRCTN (ISRCTN12225603).
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