THE NUTRITIONAL QUALITY OF FEEDING PROGRAMS
IN BOTSWANA JUNIOR SECONDARY SCHOOLS AND
THE CONTRIBUTION OF FAMILY AND CONSUMER SCIENCES/
HOME ECONOMICS TEACHERS TO MEAL QUALITY
by
ELSIE MOSIE, B.S.H.E.Ed., M.A.
A DISSERTATION
IN
FAMILY AND CONSUMER SCIENCES EDUCATION
Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of
DOCTOR OF PHILOSOPHY
Approved
'^Chairpéí'son of the Committee
Accepted
Dean of the Graduate School
August, 2004 © 2004, Elsie Mosie All rights reserved. ACKNOWLEDGEMENTS
I would like to start by thanking the American people for the hospitality they have
given me during the course of my stay in their country. The many special friendships I have enjoyed helped create a positive leaming environment for me.
Dr. Virginia "Ginny" Felstehausen, my dissertation committee chairperson, has
stayed the course with me through both interesting and difficult times, and has taught me
lessons that go a long way beyond the classroom door. Her patience, understanding and
unequivocal readiness to help have certainly contributed to my overall development. My
sincere appreciation goes to other members of my committee: Dr. Amia Sue Couch for
helping me understand the essence of research; Dr. Carmen Roman-Shriver for her
numerous invaluable suggestions based on her unquestionable nutrition-dietetic work
experience; and Dr. LesLee Taylor for her invaluable professional guidance that coupled
with her own experience in writing helped to shape my dissertation.
Special thanks and appreciation are extended to Dr. Du Feng and Dr. Pedros
Hardjicostas, my statistics advisors, who provided me with technical knowledge and direction. However, these advisors are not responsible for any mistakes that may be found in this dissertation. Many thanks also go to Dr. Sue Reichelt and Dr. Lynda March who helped on various components despite their busy schedules.
I extend my sincere appreciation to the govemment of Botswana for having provided fmancial assistance throughout my studies. My gratitude is also extended to various colleges/departments at Texas Tech University for generously providing fmancial support during the course of this endeavor. Specifically, I am thankful to the CoUege of
Human Sciences for providing support through the college's graduate student scholarships and Phi Upsilon Omicron, the honor society of this coUege; and the
Intemational Cultural Center.
I also want to thank Sonja Koukel, Sandy and Roy Goodloe, Catherine and Delaine
Crawford and others who supported me morally and emotionally during my studies. My
appreciation also goes to Mabanza Masuka for the technical support he rendered for the
presentation of the docimient.
Most importantly, I want to express my iove and devotion to my husband,
Nephious, who stood by his word to support me from the begirming to the end of my
studies. My love and my admiration also go to my children, Selebogo, Itimieleng, and
Khimibo; step-children, Harvest, Daniel, Elizabeth and Tiyedze; sisters; and all the extended family for sacrificing and allowing me to pursue and achieve my academic goal.
Indeed, I am very grateful for their unconditional support and encouragement despite the distance that separated us over the years. Special thanks are also extended to my nephews
George and lan, and to my fnends Seratwa and Mpaphi Kuswane, who helped my husband with the actual coUection of data.
Hl TABLE OF CONTENTS
ACKNOWLEDGEMENTS ii ABSTRACT vii LISTOFTABLES viii LIST OF FIGURES x CHAPTER L INTRODUCTION 1 Background of theProblem 1 Meal Programs of Schools inBotswana 2 Statement of theProblem 7 Purpose ofthe Study 7 Research Questions 8 Basic Assumptions 8 Scope and Limitations 9 Defínition of Terms 10 Summary 12 n. REVIEW OF THE LITERATURE 14 Overview of the Food and Nutrition Situation in Botswana 14 Availability of FoodinBotswana 16 Nutritional Status of Botswana 19 Communicable Disease and Diet 25 Diet-related Non-communicable Diseases 25 Other Factors Contributing to Malnutrition in Botswana 26 Other Strategies and Programs Used to Combat Malnutrition 29 Nutrition Problems in Schools: A Global Perspective 33 Menu Plaiming Systems Used in Schools 35 Food-Based Menu Plarming Systems 36
IV Nutrient-Based Menu Planning Systems 37 Menu Planning System in Botswana Schools 38 Characteristics of the Four-Food Group Menu Plan/Guide 39 The Four Food Group Proportions in Menus 40 Ways of Analyzing School Menus 42 Nutrient Quality of School Meals 43 Intemational Studies of Students' Nutritional Status 55 Impact of Food Service Personnel and Their SkiUs on Children's Nutrient Litake 80 Teacher Participation in School Feeding Programs 99 Summary 102 m. RESEARCH DESIGN AND PROCEDURE 106 Sample Design and Selection 106 Description of the Sample 108 Design and Development of Instruments 113 PilotStudy 115 Reliability and Validity of Instruments 117 Data Collection 117 Analysis of Data 118 Summary 124 rV. ANALYSIS AND INTERPRETATION OF DATA 126 Research Questions 126 Summary 160 V. CONCLUSION 164 Summary of the Study 164 Summary and Discussion of Findings and Implications 167 Conclusions 174 Limitations 176 Recommendations 177 BIBLIOGRAPHY 179 APPENDICES
A. BOTSWANA EDUCATION REGIONS AND JUNIOR SECONDARY SCHOOL DISTRIBUTIONS 186 B. PROPORTIONAL STRATIFIED SAMPLE OF SCHOOLS SURVEYED 188 C. NUMBER OF SCHOOLS THAT RESPONDED 190 D. LETTER TO THE PRINCIPAL EDUCATION OFFICER 192 E. LETTER TO THE HEADMASTER/HEADMISTRESS 194 F. LETTER TO THE SCHOOL FOOD SERVICE SUPERVISOR 196 G. THE MENU QUALITY SURVEY 198 H. LETTER TO THE FAMILY AND CONSUMER SCIENCES/HOME ECONOMICS TEACHERS 209 L TEACHER PARTICIPATION SURVEY 211 J PERCENTAGES OF FOODS OFFERED IN THE NATIONAL STANDARDS AND THE MINISTRY OF EDUCATION'S STANDARDS FOR BOARDING AND NON-BOARDING SCHOOLS 216 K. TIMES PER WEEK ENERGY GIVING FOODS SERVED IN SCHOOLS COMPARED TO MINISTRY OF EDUCATIONSTANDARDS 218 L. TIMES PER WEEK BODY BUILDING FOODS SERVED IN SCHOOLS COMPARED TO MINISTRY OF EDUCATION STANDARDS 220 M. TIMES PER WEEK PROTECTIVE FOODS SERVED IN SCHOOLS COMPARED TO MINISTRY OF EDUCATION STANDARDS 222
VI ABSTRACT
A review of literature revealed nutritional imbalances in school feeding programs
where students received nutrients in excess of intemational reference standards in
developed countries and below the standards in developing countries. Virtually no
research had been conducted in Botswana schools to analyze the nutritional quality of
meals students receive, nor had there been any research investigating the impact that
participation by FCS/HE teachers in school feeding programs has on the nutritional
quality of school meals.
The purpose of the present study was to investigate the nutritional quality of
feeding programs in junior secondary schools in Botswana, Southem Afiica. In addition,
the study determined if participation by FCS/HE teachers in programs makes a difference
in the quality of these meals. School meals were assessed against the Ministry of
Education (MOE) and food-group national standards.
The study was based on responses from 67 school food service supervisors and
125 FCS/HE teachers, randomly selected from the 206 junior secondary schools in
Botswana. The school food service supervisors responded to a Menu Quality Survey instmment, adapted from a food frequency questionnaire that was designed specifically to assess the food intake of populations. This instnmient was used to obtain data pertinent to the specifíc foods and serving portion sizes offered to students in Botswana junior secondary schools. FCS/HE teachers responded to a Teacher Participation Survey instmment, developed by the researcher, to ascertain teachers' influence and positive attitudes toward school lunch.
vn Results of the study indicated that students in Botswana junior secondary schools receive meals consisting of foods from the three food groups (Energy Giving, Body
Building, and Protective). The majority of the boarding schools met or exceeded the
MOE and the national standards for Energy Giving foods while the majority of the non- boarding schools exceeded these requirements for Body Building and Protective foods.
The nutritional quality of school meals was not significantly changed by teacher participation.
Findings from this study have practical implications for up-dating menu planning
tools to ensure students receive nutritious meals. Findings also indicated that activities
involving FCS/HE teachers in programs should be conducive to impacting the nutritional quality of the meals.
vni LIST OF TABLES
1.1 The Ministry of Education Ration Scale Stipulation 5
2.1 The Botswana' s Food Group National Menu Plan Proportions' Model 40
2.2 Ministry of Education Food Group Menu Plan Model (Boarding) 41
2.3 Ministry of Education Four-Food Group Menu Plan (Non-Boarding) 42
3.1 Regional Distribution of Junior Secondary Schools in Botswana 107
3.2. A Regional Proportional Cross-Section Sample of Junior Secondary Schools in Botswana 108
3.3 Regional Distribution of Junior Secondary Schools in Botswana
that Provided Data 109
3.4 Smnmary of Demographics for School Food Service Supervisors 111
3.5 Siunmary for FCS/HE Teacher Demographics in Botswana Junior Secondary Schools 113 3.6 Siunmary of Research Questions and Statistical Procedures Used in the Menu Quality and Teacher Participation Surveys 122
4.1 Foods Offered on MOE Menu Plan at Botswana Junior Secondary Schools 129
4.2 MOE Menu Plan vs. Food Group National Menu Plan Standards in Botswana 130
4.3 t-test Comparisons of Times per Week Energy Giving Foods were Offered Between Boarding Junior Secondary Schools and the Ministry of Education in Botswana 134
4.4 t-test Comparisons of Times per Week Energy Giving Foods were Offered Between Non-Boarding Junior Secondary Schools and the Ministry of Educafíon in Botswana 134
IX 4.5 t-test Comparison of Times per Week Body Building Foods were Offered Between Boarding Junior Secondary Schools and the Ministry of Education in Botswana 138
4.6 t-test Comparison of Times per Week Body Building Foods were Offered Between Non-Boarding Junior Secondary Schools and the Ministry of Education in Botswana 139
4.7 t-test Comparison of Times per Week Protective Foods were Offered Between Boarding Junior Secondary Schools and the Ministry of Education in Botswana 143
4.8 t-test Comparisons of Times per Week Protective Foods were Offered Between Non-Boarding Junior Secondary Schools and the Ministry of Education in Botswana 143
4.9 Siunmary of Multiple Regression Analysis for Variables Influencing Energy Giving Foods Offered in Junior Secondary School Weekly Meal Plans in Botswana 151
4.10 Summary of Multiple Regression Analysis for Variables Influencing Body Building Foods Offered in Junior Secondary School Weekly Meal Plans in Botswana 152
4.11 Summary of Multiple Regression Analysis for Variables Influencing Protective Foods Offered in Junior Secondary School Weekly Meal Plans in Botswana 152
4.12 Menu Plan Modifícation Decision-Makers at Junior Secondary Schools in Botswana 154
4.13 A Comparison of Food Group Proportion Averages Between Schools' Menu Plans With or Without FCS/HE Teacher Participation and. National Food Group Menu Plan Standards 159 LIST OF FIGURES
Location of schools on the map of the Republic of Botswana in pocket 4.1 Schools Meeting or Exceeding MOE Meal Plan 147
4.2 Schools Meeting or Exceeding National Standards 148
XI CHAPTERI
INTRODUCTION
This chapter presents the background of the problem, the statement of the
problem, the purpose of the study, and the research questions. Assumptions, limitations,
definitions and a summary are provided.
Background of the Problem
Enhancing and maintaining the nutritional status of its people, especially children,
is an important commitment for the Botswana govemment (NDP 8, 1997). To achieve
this goal, the govemment has implemented nutrition intervention programs, including
school meal programs. School meals offer a source of readily available essential nutrients
hkely to be missing in the students' home diets (FAO, 1993). Schools also provide
positive nutrition leaming experiences leading to a lifelong impact on health and
education (Mamapula, 1995).
Historical anecdotes indicated that school meal programs in colonial Botswana were initially approved to combat the widespread malnutrition of children due to continuous drought conditions culminating in crop failures (Bomay, Chengeta, Chotani,
Magole, & Rambukwelle, 1990). The Worid Food Program (WFP) of the United Nations played a key role by assisting in purchasing and supplying food commodifies, providing supervisory and advisory services, and evaluating the project periodically. Evaluations undertaken included the impact the food program had on the nutritional status of the beneficiaries (Bomay et al., 1990).
Information documenting the composition of pre-independence school meals in
Botswana is lacking. However, meal rations were likely composed of donated surplus food provided by developed countries (Florencio, 2001). For instance, primary school children's diets were supplemented with maluti meal, a South Afiican product containing
11% protein, 5% fat, 2% calcium, and 3% phosphoms. One hundred grams of this mixture provided 380 calories a day to primary school children (May & McLelIan, 1971).
After Botswana gained its independence in 1966, the govemment accepted flill responsibility for the school feeding programs and tasked various ministries to contribute to the success of the "national school feeding program" (Bomay et al., 1990). In attempts to ensure that schools offer meals providing adequate nutrients to students, the Botswana govemment utilized the intemational Recommended Dietary Allowances (RDA) guidelines. Because primary schools offered just one meal per day, the rations that were offered provided one-third of children's daily caloric requirements. Students living at school received 100% of the RDAs (Bomay et al., 1990).
Meal Programs of Schools in Botswana
Approximately one-third of Botswana's population, the majority of whom are children, is enrolled in elementary, secondary and post-secondary institutions of leaming
(NDP 8, 1998; CSO, 1998). While some of the student population commutes to and from school on a daily basis, others reside in the institutions' boarding facilities. It is also common practice for students to be provided with meals at school whether or not they live at the school.
School meal programs originated after the unhealthy state of children in native schools was observed (CircuIarNo. 5397, 1932; Circular No. 8446/2, 1936). Colonial education authorities discovered that many children went to school without having had any food to eat. Other children reported having had less than the normal/standard three meals per day at home. Some children's meals consisted of com meal porridge, weak tea, and beef or goat meat only once in a week. Almost 100%» of the children reported not having had any milk in six months. This poor quality diet resulted in a malnourished and unhealthy student population not expected to benefit from education unless the nutritional status and the health status were improved. Because of these discoveries in the early part of the twentieth century, school meal programs in Botswana are part of the nutrition intervention programs created through national policy with presidential endorsement.
Meal programs in public schools currently are funded by govemment resources and funds are based on a per-meal/snack, per-student, per-diem amount directly transferred from the national level to the local level. Govemment anecdotal notes indicate annual allocations ofP 1000.00 (~$200.0) and P400.00 (~ $80.00) to feed a boarding and non-boarding student respectively within an educational institution (Savingram, undated).
At the institutional level, meals are augmented by using produce from school gardens tended by students in Agricultural Science Education, and by seeking contributions from the local community as needed. A guide to student feeding, provided to schools by the Ministry of Education includes seven breakfasts; lunches; suppers; and fíve mid-moming snack meals. The
Ministry of Education (MOE) utilizes a set of dietary guidelines as a basis for the menu plan and advises the schools to incorporate them within the feeding program. These dietary guidelines include:
The food should be appealing
Eat a variety of different foods
Eat the correct amount
Eat food rich in fíber
Eat food with less fat
Eat food with reduced amounts of sugar
Eat food with less amount of salt (Secondary School Menu - Ministry of
Education Draft, Undated)
The ministry clarifíes the "eat the correct amount" dietary guideline by including a ration scale. The daily ration scale of the MOE menu plan indicates amounts of a variety of food choices that provide protein, carbohydrates, vitamins and minerals. The ration scale indicates that nutrients can be obtained daily by offering any one of the listed food choices (Tablel.l). Table 1.1: The Ministry of Education Ration Scale Stipulafíons
Types of food Portion sizes/student
Protein foods 200g meat with bone 1 OOg meat without bones 200g chicken ISOgoffal ISOgfish 250g beans 250ml milk 2eggs
Starch foods 250g bread 250g com meal 250g sorghum meal 250g hominy 250g grits 125grice
Vegetables/fiiiits 125g cooked green vegetable 125g raw green vegetables One finit (apple, orange) twice a week
Beverages 250ml cold drink powders twice a week 250ml hot drinks (milo, tea, coffee) twice a day
Extra ingredients lOmlmayonnaise 25g oil/fat 25ml sugar
Spreads lOgmargarine 25gjam 25g peanut butter
(Ration scale: Ministry of Education, 1992) Because school children are provided food at school, Bandeke (1996), Molefí
(1996) and Murphy, Calloway & Beaton (1995) reported that it is assumed that their nutritional status is comparatively better than that of the out-of-school children. Not without doubt, school feeding programs in theory and practice provide the necessary nutrients to students. AII children in Botswana primary schools are provided with one hot meal daily, except during weekends and holidays (Bomay et al. 1990). The food items in the ration provide one-third of the school children's daily caloric requirements.
Secondary students commuting to and from school daily receive a mid-moming snack and a lunch meal while those living at the school also receive breakfast and an evening meal from school. Assisting schools to improve nutrient provision to students may be a key to improving the nation's health.
A suffícient food supply should be understood to positively correlate with the
required nutritional and/or health status of the people, while an insufficient food supply
and nutritional/health status would be negatively correlated. Meals in public schools are
fiilly fianded by the national govemment. Given this scenario, it would appear that
properly planned menus should enable students to receive nutritious meals necessary for
their proper maintenance and good health. However, adequacy of food does not
necessarily translate to all individuals having access to the available food.
Because Botswana does not produce enough food to feed its people,
macronutrient and micronutrient malnutrition continue to prevail in the country.
hifectious diseases, including a high incidence of HFV-AIDS, further compromise the
people's nutrifíonal status. Botswana also experiences diet related non-communicable diseases such as hypertension and diabetes (Mamapula, 1995). Improving the quality of school meals could enhance the health and well being of the country as a whole.
Statement of the Problem
Previous research conducted in the US (Fox et al., 2001; Wildey et al., 2000;
Hoover et al., 1998; Baker et al, 1997; Burghardt & Devaney, 1993; Ho et al., 1990),
Europe (Colquhoun et al., 2001; Soriano et al., 2000; De Vito et al., 1999), Asia
(Harioka, 2001; Hori et al., 2001), Latin America (Viera da Silva, 1998; Sichieri et al.,
1996; Amigo et al., 1995), North Afiica/Middle East (Hasan et al., 2001; AI Isa &
Moussa, 2000; Al-Othaineen et al., 1999), and continental Afiica (Adiboye, 2000;
Elkhalifa et al., 2000; Ene-Obong, 1993), clearly indicates that meals offered in feeding programs in schools do not provide nutrients and/or food groups in amounts that meet the physiological needs of students. Thus, these programs are failing to fiilfill the overall goal of improving the health and nutritional status of the student recipients. Poor health and/or nutritional status also have been linked to low scholastic achievements. Enhancing scholastic achievement is another goal of school feeding programs. Schools must strive toward utilizing and improving existing feeding programs and personnel in schools to provide meals to meet students' nutritional needs as well as programmatic goals.
Purpose of the Study
The purpose of this study was to investigate the nutritional quality of meals in the feeding program in junior secondary schools in Botswana, and to determine whether participafíon of Family and Consumer Sciences/Home Economics (FCS/HE) teachers in program activities makes a difference in the nutritional quality of the meals.
Research Ouestions
The research questions addressed in this study were:
1. How do the meals included in the Ministry of Educafíon (MOE) menu plan
written for junior secondary schools compare with the national food group menu
planning reference standards?
2. How do the schools feeding program menu plans compare with the MOE menu
plan and with the national food group menu planning standards?
3. What factors contribute to the compliance of school feeding program menu plans
with those written by the MOE and at the national food group plarming standards?
4. What is the nature and extent of FCS/HE teacher participation in the school-
feeding program?
5. Is there a difference in the compliance of menus between junior secondary
schools where FCS/HE teachers are involved in the implementation of school
feeding programs and where they are not?
Basic Assumptions
The following assumptions were made for this study:
1. FCS/HE teachers have background knowledge in food and nutrition.
2. Because all junior secondary schools offer FCS/HE as an optional subject. FCS/HE teachers are available in the schools to be involved in the feeding
programs.
3. Through job designation or volunteerism, the FCS/HE teachers participate in
school feeding programs.
4. Schools that utilize FCS/HE teachers in the feeding program provide meals that
are of an improved/higher/better nutritional quality.
Scope and Limitations
The following limitations of this study were identified.
1. There were limitations to extending the generalizability of the fíndings for
this study. Because a sample of limited size was used to obtain data, fíndings may
be unique to the feeding programs in schools from which data were obtained.
Therefore, fmdings will be generalizable only to schools with similar
characteristics.
2. The study utilized self-reported data, therefore accuracy depended upon the
honesty of the respondents.
3. Results and conclusions of the study were based on information provided by the
respondents.
4. Because schools were unable to provide recipes to be used to compute and
establish thorough nutritional quality of meals included in feeding programs, the
lists of foods offered in menu plans were instead used to generalize on the food
group proportions. Defmifíon of Terms
For the purpose of this study, the following terms were defíned as follows:
Balanced meal is a meal that has a variety of foods with at least one food item
from each of the three major food groups (Bomay et al., 1990).
Batswana or Tswana are natives of Botswana (singular is Motswana). Tswana
also refers to the culture.
Boarding master is a man who supervises male students living in the residence
halls (Merriam-Webster's CoIIege Dictionary, 2000). He also usually works with the
mafron and supervises the preparation, cooking and serving of meals to the students in
Botswana boarding schools.
Boarding school is a school at which meals and lodging are provided (Merriam-
Webster's CoIIege Dictionary, 2000). A school where meals and no lodging are provided
is referred to as a non-boarding school.
Chef, also known as head of the kitchen, is a skilled cook who manages the
kitchen (Merriam-Webster's CoIIege Dictionary, 2000).
Family and Consumer Sciences (FCS) is a multi-dimensional discipline that seeks
to affect positive change among individuals, families and communities through its multi professionals who have practical reasoning and critical thinking abilities. This was
formally known as Home Economics.
Food groups refer to the Energy Giving, Body Building, and Protective food groups used as the major groups to categorize foods in Botswana, as advised by intemational organizations such as the Food and Agricultural Organization (FAO),
10 United Nations Intemational Children's Education Fund (UNICEF), and the Worid
Feeding Program (WFP).
Home economics (HE) is a discipline currently known as Family and Consumer
Sciences in the US that seeks to impart skills useful in the home and in the employment of environment to improve conditions of individuals, families, and communities
(Brandon & Mhango, 1996).
Junior secondarv school is a school that usually includes grades 8-10. Because they are located in most of the communities in Botswana, they also are referred to as
community junior secondary schools (CJSS).
Kitchen hands/cooks refer to personnel that prepare, cook and serve meals to the
students under the guidance of a school food service supervisor.
Matron is a woman who supervises female students living in residence halls and
also usually supervises the preparation, cooking and serving of meals to students in
Botswana boarding schools. The matron and boarding master work together.
Ministry of Education is a central govemment office that promotes primary and post primary education, education research, and the progressive development of schools
(Sephuma, 1991). Because the MOE is accountable for the fiinds govemment provides to the schools, it also sets standards, including those to be followed in school feeding programs..
MOE menu plan refers to a prepared plan of meals showing a week's list of foods that the Ministry of Educafíon suggests can be used or adapted by schools when implementing feeding programs.
II Nutritional quality is the ability for food provided or consumed to be measured
against a standard of acceptance such as the Recommended Dietary Allowances (RDA)
or food groups.
School menu plan refers to an operational plan of meals showing a list of foods
the school uses to actually prepare and offer/serve to the students in the feeding program.
This set of menu may or may not be adapted from the MOE menu plan.
Recommended dietarv allowances (RDAs) are average daily dietary intake levels
that are suffícient to meet the nutrient requirements of neariy all (97-98%) healthy
individuals in a particular life stage and gender group (Tmmbo, Yates, Schlicker & Poos,
2001).
School feeding program is a nutrition intervention used to provide meals to children of school age at the educational site in order to prevent short-term hunger and to improve enrollment, attendance, performance, nutritional status, and health (FAO, 1993).
School food service supervisor refers to a person who is charged with the responsibility of overseeing and supervising the activities of the food service in the school, including plarming, purchasing, preparing and serving meals to students.
Summary
This chapter highlighted the research problem of investigating the nutritional quaUty of meals offered to Botswana junior secondary students in light of the following three sets of menu plan standards:
12 • The MOE menu plan that schools are encouraged to use as a guide when
implementing the school-feeding program,
• The operational menu plans that are used at each of the schools and that may or
may not have any bearing on the MOE menu plan,
• The food group menu plan used in national standards.
Whether participation by FCS/HE teachers in food service programs improves the nutritional quality of the meals included in menu plans at the schools where they teach was also examined. Five questions were used to guide procedures aimed at gaining insight into the problem under investigation. Conclusions were drawn based on how the nutritional quality of each menu set favorably compared with intemational reference values, RDAs, which are set for junior secondary students.
13 CHAPTER II
REVIEW OF LITERATURE
Prior studies have neither reported the nutritional quality of school meals nor the nutritional and/or health status of adolescent students in Botswana. Most nutrition-related studies have investigated the nutrition status of younger children in the country. This review of the literature begins with an overview of the food and nutrition situation in
Botswana, highlighfíng prevailing nutrition problems, causes, and intervention strategies.
The review also focuses on the methodologies and findings of previous studies conducted on nutrients provided by school meals, and/or the impact these meals have on the nutritional/health status of students in the United States (US), Europe, Asia, Latin
America, North Afiica/Middle East, and continental Afiica. Contributions teachers make toward activities related to feeding students in schools is also explored. Finally, prior works investigating the factors of preparation and delivery of meals impacting the nutritional quality of school meals are addressed.
Overview of the Food and Nutrition Situation in Botswana
The basic diet of the nation of Botswana is obtained from the crop and livestock sub-sectors of agricultural production. The nation's agriculture supports the nutrition and health status of the country. Whether or not agricultural production provides an adequate food supply to achieve a national goal of the citizen's health in the twenty-first century depends on a number of factors. The following section highlights factors that affect food
14 production in Botswana. Producfíon levels and the country's self-sufficiency of food supply in each of the sub-sectors are greatly impacted by these factors.
Description of the Countrv
The Republic of Botswana (formeriy the British Protectorate of Bechuanaland) is a landlocked country of Southem Afiica with an area of approximately 582,000 square kilometers, roughly equivalent in size to the state of Texas (Montshiwa, 1985). The country is bounded on the southeast and south by the Republic of South Africa, on the northeast by Zimbabwe, on the north by the Caprivi Strip (which separates Botswana from Zambia and Angola) and on the west by Namibia. Much of Botswana is flat with approximately eighty percent (80%)) of its area covered by the Kgalagadi sands and some savannah. The country also is characterized by a few rocky outcrops and hills mostly located in the eastem part (Nafíonal Development Plan [NDP] 8, 1997).
Botswana is situated close to the atmospheric subtropical high-pressure belt of the
Southem Hemisphere. As a result, the country is largely arid or semi-arid. The mean armual rainfall ranges from 650 mm in the extreme northeast to less than 250 mm in the extreme southwest. The poor soil and unreliable rain features contribute to the low potential for food production that impacts the nutritional and health status of the
Batswana. The agricultural sector, however, still remains the backbone of Botswana's economy (NDP 8, 1997; Bandeke, 1996; Montshiwa, 1985).
The 1991 population and housing census hsted the national population at
1,326,796 (Central Statistics Office [CSO] 1998). Based on these figures and on an
15 esfímated populafíon annual average growth rate of 2.5% during the period 1991-2001, the populafíon of Botswana was projected to be about 1,700,000 for the 2001 population and housing census.
Availability of Food in Botswana
The availability of food in Botswana is affected by and dependent on a number of factors. Among the factors impacting the food supply are crops, horticulture and livestock.
Crops
Limited land is available for arable agriculture in Botswana, with the eastem part of the country providing the best potential for arable farming (Bandeke, 1996;
Mamapula, 1995; Montshiwa, 1985). Unreliable and inadequate rainfall makes arable agriculture a risky venture (Bandeke, 1996; Mamapula, 1995). Botswana has experienced a food deficit since gaining independence in 1966. This created a heavy reliance on agricultural food imports to meet the country's needs (Bandeke, 1996; Molefí, 1996;
Mamapula, 1995; May & McLelIan, 1971). Under normal rain conditions, the country is able to meet about half of the nation's food needs (Bandeke, 1996; Mamapula, 1995).
Recurring droughts further impair domestic food production, which exacerbates the food deficit status of the country. Due to drought and other factors, cereal crop fields per hectare planted have decreased (Bandeke, 1996; Molefi, 1996 Mamapula, 1995).
16 Through mechanized farming, subsidy and free seed programs, more land is being ploughed, thus increasing cereal production in tons (Bandeke, 1996).
Sorghum is by far the most important cereal crop in terms of area crop and production figures, followed by maize (com) and then millet (Bandeke, 1996).
Pulses/Iegumes, especially beans, consfítute the most important non-cereal crop. Basic grain needs have been met with commercial imports and donations from the World Food
Program (WFP) (Bandeke, 1996; May et al, 1971). This fortunate effort by nafíonal leadership to recognize the importance of ensuring an adequate food supply has enabled
Botswana to be classified as a self-suffícient country without a need for most foreign aid, including food (ESCAFAN, 1991). As of 1994, Botswana was neither receiving nor expecting aid, including food from the WFP (Bandeke, 1996). Since Botswana is also classified as a hunger-free country because it does not appear to experience a hungry season (WFP/UNESCO/WHO, 1999), the WFP withdrew its food and other monetary aid in the 1990s (Molefi, 1996; Bomay et al. 1990).
Horticulture
The major horticultural crops grown in Botswana are tomatoes, potatoes, onions, cabbages, green mealies (sweet com) and oranges (Bandeke, 1996). Data indicated that over 70%) of the country's vegetable and fruit requirements were met from imports (CSO,
1998, Bandeke, 1996). Poor performance of this sub-sector is thought to be due to a number of factors, including poor soils, erratic rainfall and unavailability of water, lack of appropriate technology, an unproductive labor force (most unskilled), and lack of
17 diversificafíon and crop diseases (Bandeke, 1996; Molefi, 1996; Montshiwa, 1985; May et al., 1971). Limited production of fmits and vegetables could seriously impact the vitamin A and C status of people who depend on imports for their supply.
Livestock
Botswana's economy has long depended on livestock production. Reports made prior to the nation's independence suggested that in some cases livestock would be the only viable economic activity at the national level (Montshiwa, 1985). Rural communifíes depend heavily on livestock for their livelihood. The cattle industry accounts for 80%) of agricultural output and is the second foreign exchange commodity after minerals. The cattle population that exceeded one milhon in the mid 1960's
(Bandeke, 1996; Montshiwa, 1985) has increased dramatically to close to three million
(CSO, 1998). The small stock goat and sheep population has been consistently above one million since the 1980's. Other stocks like poultry and pigs have increased considerably since the 1960's. Although Bandeke and Ministry of Agriculture officials argued that pig production had not yet increased to sufficient levels to meet the country's food needs, poultry production is reported to have increased to levels suffícient to meet the nation's needs (Botswana Daily News No. 132, March, 2002).
When the population of Botswana is compared to the level of livestock production, the consumer market for livestock products is small. Production in excess of native consumer demand provides an opportunity for Botswana to export into the global economy (Montshiwa, 1985; Otzen et al., 1979). The appeal of livestock products export
18 to increase economic stability, coupled with production ebbs due to periodic drought, increases the likelihood for Botswana to suffer the consequences of inadequate protein in the diets. The status of milk and milk products, a major source of protein for a large segment of the Botswana population, is inadequate to meet consumption needs.
Botswana produces only about 30% of the needed milk, and the remaining consumable milk products are imported from the neighboring countries, the Republic of South Africa and Zimbabwe (Bandeke, 1996).
Nutritional Status of Botswana
Botswana, like many other countries in the Sub-Saharan Africa, continues to battle the problem of malnutrition. The malnutrition that prevails in these countries is mainly a consequence of inadequate food consumption due to lack of food (Mamapula,
1995; Latham, 1979). Other causes of malnutrition include lack of knowledge on food processing and preparation; lack of dietary variety, poor dietary habits, and poverty
(Bandeke, 1996; Kiamba, 1996; Mamapula, 1995). Malnutrition is therefore an ultimate manifestation of the interaction of various factors in society. Protein energy malnutrition
(PEM) and micro nutrient inadequacies are types prevalent in Botswana and are fairly well documented. PEM together with infectious diseases are known to be the cause of 9%) of deaths in Botswana children under five years of age (Bandeke, 1996; Mamapula,
1995).
19 Macronutrient Malnutrition
PEM is a condition that describes weight and growth failure due to defícient
intake of energy and protein. With a compromised nutritional status, the younger citizens
are more prone to develop childhood infectious diseases (Bandeke, 1996; Mamapula,
1995). Accompanying the primary issues of lack of food and disease, underiying causes
of PEM include food insecurity, inadequate childcare protection and insuffícient basic
services such as a clean water supply (Bandeke, 1996). Mamapula argued that poverty,
resulting from inadequate employment opportunities and limited access to resources, is
known to be the basic cause of malnutrifíon in the country.
Monthly data from child growth and developmental monitoring provide insight
into the prevalence of PEM in Botswana. Data from the National Nutrition SurveiIIance
System (NNSS) reports indicated that the prevalence of moderate malnutrition was 30%
in the 1980's and declined to 12.5%) in the 1990's (Bandeke, 1996; Mamapula, 1995).
Based on the numbers of reported severely underweight children, the severe form of PEM
has been very low with a high of 2%) in the 1980's and then declining to 1% in the 1990's
(Mamapula, 1995).
A 1993 nationwide malnutrition study confirmed earlier studies and provided
additional information on children's health status and development (Mamapula, 1995).
The overall prevalence of PEM was found to be 14.3% with 15.2% of male and 13.5%) of
female children undemourished. Of the underweight children, 3% were severely
underweight. Furthermore, 25.8%o of the children were stunted (short stature) and 4.5% were wasted. From the results of the study, more boys than girls were both stunted and
20 underweight or underweight. However, giris were more likely than boys to show only
wasting. PEM was observed to take a high toll on the nation's youth.
Information on matemal nutrition has been scanty undl recently. The 1994 micro
nutrient survey indicated that a number of mothers had chronic energy defíciency when
their weight was related to height (Mamapula, 1995). The 13% prevalence of low birth
weight in the country also is indicative of matemal malnutrition (Bandeke, 1996).
Part of the alleviation of malnutrition can be attributed to the supplementation of
food raUons to women and children, and to the provision of income through labor-based
relief that is believed to have had positive effects on the nutritional status. PEM rates do
vary by area and by section in Botswana. The rates are higher in mral than in urban areas.
A higher prevalence of under-nutrition is recorded in November to Febmary, the plowing
season, and the lowest in June/July, the harvest season (Bandeke, 1996).
Micro Nutrient Malnutrition
Kiamba (1995) defíned micronutrient malnutrition as mild-to-moderate vitamin
and mineral defíciencies evidenced by marginal intake and clinical symptoms such as
night blindness. Vitamin A defíciency, nutritional iron deficiency anemia, and iodine
defíciency disorders continue to ravage the developing world, especially in vulnerable groups (Bandeke, 1996; Mamapula, 1995). Although Del Rosso (1999) and Florencio
(2001) understood all nutritionally disadvantaged persons to be vulnerable, infants and younger children in the developing world, particularly in Afiica, are prone to nutritional
21 vulnerability (Murphy et al, 1995). However, vulnerability in Botswana begins after
intentional growth monitoring ceases, at the 60^*' month of life (Mamapula, 1995).
Vitamin A Deficiency
Vitamin A defíciency is likely connected to cases of blindness that occur in some
areas of Botswana (Bandeke, 1996; Mamapula, 1995). Data from the Worid Health
Organization (WHO) and the United Nations Children's Fund (UNICEF) estimate that at
least 251 million children are at risk of a biochemical vitamin A defíciency, and 2.8
million children are clinically affected with evidence of associated deficiency symptoms
(FAO, 1997). Africa alone is estimated to have 52 million children with approximately
1.04 miUion evidencing clinical signs. On an annual basis, between 250,000 and 500,000
children become partially or totally blind from vitamin A deficiency with two-thirds
dying shortly after going blind. Many other children (approximately 10-20 times more)
are at risk in terms of health and survival because vitamin A deficiency impairs their resistance to infection (FAO, 1997; Mamapula, 1995; Pinstmp-Andersen, Pellitier &
Alderman, 1995). Impaired resistance to infection increases the risk of severe iUness, elevates mother-to-child HFV transmission, and may eventually lead to death (Mamapula,
1995).
Vitamin A deficiency has been attributed to several factors in developing countries, including Botswana. The primary cause is persistent inadequate intake of vitamin A (Mamapula, 1995; Molefí, 1996; Ncube, Malaba, Greiner & Gebre-Mendhin,
2001). Other dietary circumstances such as cultural food taboos forbidding consumption
22 of certain foods, mainly of protein origin, further exacerbate the defíciency situation
(FAO, 1997). The low levels of animal product consumption increases the defíciency
status in most fropical countries by leaving populations heavily dependent on pro-vitamin
A caretonoids as the main sources of vitamin A in the diet (West, 2000). The use of beta-
carotene as a food additive also is still quite limited in developing countries. Molefi
(1996) also noted that protective foods tend to be lacking in the diet of Botswana.
A high frequency of infections such as diarrhea also exacerbates nutritional
deficiencies such as that of vitamin A (FAO, 1997). A total of 166 children died from
diarrhea in Botswana between January 1995 and September 1997 (CSO, 1998). The 1994
micronutrient survey revealed that 32.5%) of children below five years of age had low
vitamin A status, and of these, 2.9%) had severe vitamin A deficiency (Mamapula, 1995).
Although WHO/UNICEF classifíes Botswana under the moderate sub-clinical prevalence
category, vitamin A deficiency continues to be a public health problem of significance.
Nutritional fron Defíciency Anemia
Anemia resulting from an iron defíciency is a global problem affecting mostly
young children and pregnant women. Limited or no good sources of dietary iron such as
meat, meat products or green leafy vegetables, and the incidence of diseases such as
malaria, intestinal parasites and diarrhea are among the causes of nutritional anemia in
Botswana (Bandeke, 1996; Mamapula, 1995). fll-defíned intesfínal infectíons and malaria
account for 6.1%) and 3% of the major causes of morbidity in all age groups excluding neonatal conditíons countrywide (NDP 8, 1997). Protective foods, which contain
23 nitrogenous material and vitamins, are lacking in the Botswana diet and thus a large portion of the population suffers from undemourishment and defíciencies (Molefí, 1996).
The 1996 epidemiological study and the 1994 micronutrient survey cited by
Mamapula (1995) reported the prevalence and seriousness of iron deficiency anemia in
Botswana. While 17%) of the populatíon was anemic in 1986, 29.4%) of the children and
32.6% of the women were anemic in 1994. The health status of school children examined countrywide had not improved or declined between a 1930s study and the 1994 study
(Molefi, 1996). The much higher figures obtained in the epidemiological survey depict the seriousness of a lack of progress in addressing this problem for women and children.
lodine Deficiency Disorders
The main physical manifestation of iodine defíciency is goiter. Other various disorders resulting from iodine deficiency include stillbirths, low birth weights, deaf- mutism, cretinism, and mental and physical retardation (Maraapula, 1995). Not many people are observed with goiters in Botswana. However, the 1989 iodine defíciency disorders study and the 1994 micronutrient survey indicated that about 18%) of the
Botswana population had a prevalence of mild-to moderate iodine defíciency disorders
(Bandeke, 1996; Maraaplua, 1995). Consumptíon of iodized salt can easily remedy this condition. Less iodine defíciency may be observed in Botswana due to the country being a major salt producer and exporter in the southem Afiican region. Botswana also took the initiative to iodize salt for human and animal consumption as a means to control iodine deficiency disorders, a program started by the WHO (WHO, 1996). A lower incidence of
24 iodine defíciency may also be observed because cassava is not a staple food in Botswana.
Endemic goiter is prevalent in countries such as Tanzania and Cameroon where cassava is used as a staple tuber, and the goitrogens contained in them are suspected to aggravate the condition (FAO, 1997; WHO, 1996).
Communicable Disease and Diet
HFV/AIDS has become one of the most serious and urgent social problems facing
Botswana. Since the detection of the fírst HlV-related illness in the 1980s, Botswana has experienced a rapid spread of the disease in urban, peri-urban, and mral areas (NDP 8,
1997). With a prevalence rate of about 23%) among the sexually actíve, 180,000 people or
12.8% of the general populatíon were projected to be infected by the mid-1990s.
However, as of 1996, 14,396 persons (about l%o) of the populatíon had developed AIDS and HFV-related illnesses. Approximately 25%) of all reported HIV/AIDS cases (3,621) conformed to the Bangui classifícatíon of fiill-blown AIDS (NDP 8, 1997). Although not as high as originally predicted, these numbers imply a tremendous burden of health care and social services costs for assisting nutritionally compromised patients.
Diet-related Non-communicable Diseases
Protein energy malnutrition and micronutrient malnutrition are not the only existing problems of nutrient deficiencies in Botswana. The country also experiences diet-related non-communicable diseases or diseases of affluence. According to
Mamapula (1995), the older generatíon has begun to develop hypertension and diabetes.
25 Overall, information on these diseases is scanty and more work is needed to determine their prevalence and magnitude. However, 1993 health statístics indicated that hypertension in Botswana accounted for 2.4%) of all instítutíonal deaths and 2.6% of inpatíent discharges. To stem the continued increase of these types of nutritional problems, young people will need to be educated to make wise nutritíonal choices as imbalances of nutrient provision in the nation's food supply contínues to be rectífied in the fiiture.
Other Factors Contributing to Malnutrition in Botswana
Several other factors contribute to malnutrition in Botswana. Among these factors are the growth of the population, the continuing process of urbanization, and the population's level of education.
Population Growth
Botswana's population is small relative to the size of the country. However, it is growing rapidly as a resuU of high fertility (4.2%o) and a declining mortality rate (NDP 8,
1997). Rapid population growth increases food production needs, and contributes greatly to the problems of food insecurity (Maraapula, 1995). If the country under normal circumstance is only able to meet half of its cereal requirements, then population growth increases the diffículty of providing food for the populatíon. The majority of Botswana's population (56%o) lives below the poverty datum line (Maraapula, 1995). Since more natives of Botswana are poor, the problem of food insecurity is probably extensive.
26 although there is a lack of information on food security at the household level.
Populatíon growth not only affects the need for food, but also the consumption of natural resources, including an increased demand for land for different uses, including food productíon (Maraapula, 1995). Issues of concem associated with population growth are the implications of the balance of family size and family resources to provide enough food for family members, matemal child health especially in relatíon to the birth interval and age at fírst pregnancy, and consequences of populatíon migration and urbanization.
Urbanization
The rapid growth in population has impacted the pattem of settlement in
Botswana. At independence, Botswana's population was chiefly raral. With economic expansion, a trend of raral-urban migration concentrated the population in and around the major metropolitan areas in the country (NDP 8, 1997). While only 9% of citízens hved in urban areas in the early 1970s, projectíons were that 52% of the country's residents would live in urban areas by 2003.
Such a large urban-based proportion population leads to heightened concem for unemployment (Maraapula, 1995). The majority of the urban poor usually live in communities of temporary houses or shanties that are over crowded, and they lack adequate sanitation facilities. Poor drainage problems result in disease due to unsanitary conditions. Diarrhea and other infectious disease, in tum, cause malnutrition by reducing food intake, decreasing nutrient absorption, increasing metabolic requirements, and increasing nutrient losses. These diseases negatively impact growth. Rapid urbanization.
27 therefore, not only exerts pressure on the provision of food and/or food production, but also limits the adequate provision of health and social services (Mamapula, 1995). In a rapidly growing population concentratíon shift, the services cannot be provided quickly enough. These conditions predispose urban dwellers to disease outbreaks due to poor sanitation and inadequate health and social amenities, fiirther perpetuating the cyclical relationship of disease and malnutrition.
Education
An individual's educatíon influences his or her quality of life. An educated person is more likely than the uneducated one to be employed if jobs are available. Raising the educatíon level of parents and especially of the mother reduces childhood mortality rates
(Maraapula, 1995). A report by the World Bank indicated that increasing the educatíon level of mothers by one year decreased mortality by 2%). Fertility rates also decrease in a more educated populatíon (Maraapula, 1995). Reduced fertility has implicatíons for childcare and nutritional status.
Education positively impacts nutritional status. This is probably because it promotes the adoption of positive behaviors like good sanitation and appropriate food choices. Because women/mothers in developing countries are the main providers of nutritíon and informal health care to other members of the household, increasing their educational level would assist them to better care for their families and provide them with nutritious meals. An educated mother tends to use the increase in income to buy a variety of foods needed to diversify the diet (Mamapula, 1995). Maraapula argued that women
28 with even primary education were better placed to understand nutrition messages.
Combining the provision of good nutrition and educatíon in the national education system could impact the overall health status of the nation into the ftiture.
Other Strategies and Programs Used to Combat Malnutrition
The complexity of nutritíonal problems and their underlying causes means that there is no single strategy that will achieve the ultímate goal to reduce malnutrition.
Consequently, many strategies have to be employed (Maraapula, 1995). The Botswana govemment has developed several strategies to tackle the malnutrition problem in women and children. The sfrategies include empowering individuals, families, and communities to improve their health and nutritional status. Programs to alleviate nutrition problems have been developed through the Food and Nutrition Unit, Matemal Child/Family
Planning Unit, Health Education Unit, the Expanded Program on Immunization and the
Control of Diarrheal Disease (Mamapula, 1995; NDP 8, 1997). Other sectors engaged in combating nutrition problems include those involved in mral development and agriculture (NDP 8, 1997). Overall, the components of the strategies include improved feeding practices, growth monitoring/promotion, and immunization and control of diarrheal diseases.
Breast Feeding Promotion and Protection
Breast-feeding is integral to child survival and development (Rolfes, DeBrayne &
Whitney, 1998). Exclusive breast-feeding for the first four to six months provides
29 adequate nutrients for an infant. Breast-feeding is further associated with reduced morbidity and mortality common from childhood diseases (Rolfes et al, 1998). The
Botswana govemment has formulated guidelines on the marketing of breast milk substitutes in all health facilitíes. To enable mothers to successfially breast-feed, women in the civil service are given fiall pay during matemity leave up to a maximum of three children, and thereafter, half pay for each matemity leave. After delivery, working mothers are given an hour to breast-feed until the child is 12 months old (Maraapula,
1995). Although the govemment facilitates breast feeding, Maraapula argued that continued support is needed to train health workers and other community members on lactation management, especially enhancing expertise in sensitizing mothers on needed information for successful breast feeding.
Vulnerable Group Feeding
The Botswana govemment has developed a sorghum-soya weaning food called tsabana for the four- to 36-month old age groups (NDP 8, 1997; Maraapula, 1995). This vitamin-mineral fortifíed weaning food is used widely for the benefíciaries during drought periods. During non-drought periods, tsabana is distributed only to those at medical risk (NDP 8, 1997). A nutritíonal risk is considered if children are below 80%) standard weight for age, and/or have multiple births within the same age group. The children receive vegetable oil to increase the energy density of the food (Maraapula,
1995).
30 Maize-milk composed of maize meal and dry skim milk (6:1) is given to medically select pregnant and lactating mothers, and children aged 37-60 months during normal years, and provided to all during drought periods (Maraapula, 1995). The maize- milk benefíciaries also receive vegetable oil. The govemment considers medical risk above lack of economic resources ultimately to determine supplement recipients
(Maraapula, 1995). Vulnerable group feeding has been extended to older children in schools.
Growth Monitoring/promotion and Nutrition SurveiIIance
AII children under five years of age are monitored monthly in health facilities in
Botswana through the growth monitoring/promotion program (Maraapula, 1995; NDP 8,
1997). This program operates concurrently with the National SurveiIIance and
Supplementary feeding. The growth monitoring promotion and nutrition surveillance programs use the same growth indicators such as underweight and growth failure to determine children who are at nutritional risk. Policy makers and program managers use data from the Nutrition SurveiIIance for planning and implementing nutrition strategies for continued improvement of the nutritional status of the younger population in
Botswana (Maraapula, 1995).
Immunization and Control of Diarrheal Diseases
The govemment of Botswana has an expanded program on immunization (EPI) and control of diarrheal diseases (CDD) to infectíous diseases (NDP 8, 1997; Maraapula,
31 1995). EPI and CDD programs curb the problem of malnutrition and increase the populatíon's awareness on the control of infectíous disease. The immunization program covered approximately 70%) of the citízens by the mid-1990s (Maraapula, 1995).
Family Planning
The country's family planning strategy empowers women and families to make conscious decisions on initiating and ceasing childbearing, planning the number of offspring and maintaining a birth interval of 45 months (NDP 8, 1997). Family planning also encourages the mother to rest between pregnancies, improve her nutritional status, and to provide the best care for her child (Maraapula, 1995; NDP 8, 1997).
Safe Motherhood
Pregnancy and childbirth stresses a woman. It is estimated that 70%) of the matemal deaths could be prevented in Botswana (Maraapula, 1995). The increased rate of teenage pregnancy increases survival risks for both the child and the mother. Hence the safe mother program aims to reduce matemal mortality and to ensure child survival by improving the screening of pregnant women at risk, improving care during pregnancy, promoting family planning, and preventíng teenage pregnancy (Maraapula, 1995).
School Health
The Food and Nutritíon Unit of the Ministry of Health participates in curriculum development to guide the teaching of nutritíon components at different levels of the
32 educatíon system in Botswana. The ministry developed the nutrition component of the
Home Economics training, and the procedure manual for use in the primary school
feeding programs (NDP 8, 1997). Molefí (1996) suggested that the reduction of the
prevalence of defíciencies should entail encouraging the growing of fresh vegetables in
school gardens and educating the public on the value of including them in the diet. Since
agriculture is a required primary and secondary subject, students can leam practical
knowledge from using the produce from school gardens and preparing nutritious meals.
Nutrition Problems in Schools: A Global Perspective
School feeding programs (SFPs) in both developed and developing countries
target vulnerable groups lacking adequate food (Del Rosso, 1999; Florencio, 2001;
Murphy, Calloway & Beaton, 1995). The SFPs have traditionally focused on improving
recipients' food intake, health, and nutrition status. Foods provided alleviated short-term
hunger and increased food intake. Feeding programs also provided nutrition education,
enhanced values formation, and increased academic performance (Florencio, 2001).
The SFPs exist globally by many names basically for the purpose of delivering
better nutrition to children. Schools or govemments then modify or broaden the
programs' nutrition objectives upon identification of specifíc nutritional deficiencies or
problems. While protein-energy malnutrition and micronutrient deficiencies, particularly
of iron, iodine, and vitamin A, remain as the dominant problem in many countries, others already have eradicated under-nutrition and addressed obesity and diet-related chronic
33 degenerative diseases (Florencio, 2001). Some countries face the coexistence of both
over- and under- nutrition.
The SFPs also educate children about food, nutrition, and health practices. The
Japanese lunch program encourages sociability and interaction among students and
teachers; promotes fraditional food and food pattems; and cooking and eating practices
such as the use of chopstícks (Florencio, 2001). The Philippines school milk project
promotes environmental awareness by reusing empty milk cartons as art materials.
India's mid-day meal program increases school enrollment and attendance and provides
nutrition, thus boosting the universalizatíon of primary educatíon. The provision of free
food at school has improved Chilean children's academic performance. Ghana's school
feeding program favors female enrollment by providing them with a take-home snack in
addition to the meal at school. The Indonesian Makan Tambahan Amak Sekolah program
must serve locally produced foods to feed children. This mandate provides incentive for
intensified local production, thus contributing to the viUage economy and to the
amehoration of poverty.
Many developing countries undertook supplementary feeding programs mainly because of "free" food donations provided by developed countries with surpluses.
Discontinuation of "free" food donations led to individual countries' govemments assuming program management. The heavy reliance on donated commodities and problematic developmental management has limited developing nations' progress toward program growth and effectiveness (Florencio, 2001).
34 The nutritíonal adequacy of meals provided at school is critícal to meeting health and educational objectives. Providing healthy meals in schools requires that continuous assessment be done to insure nutritional adequacy (Del Rosso, 1999; Murphy et al.,
1995). Societies generally desire to avoid nutritionally-related problems of underweight, stunted growth, muscle wasting anemia, obesity, dental problems, hypertension, cancers, and diabetes (Baker, CarroII & Champagne, 1997; Ho, Gould, Jensen, Kiser, Mozar &
Jensen, 1990; Hoover, Martin, Fox, Lan & Ahmad, 1998; Seaman, Bower & Fleming,
1997; Seaman & Young, 1996).
Menu Planning Systems Used in Schools
There are several guidelines used to plan menus to meet nutritional requirements
of individuals. Because individuals require nutrients in specific amounts, some countries
such as the US have developed menu-planning systems that assist in providing nutrient
requirements targeted for specific needs of school children. While the Traditional Menu
Planning approach continues to be employed as an option, the US govemment through
the USDA, developed Food-Based and Nutrient-Based Menu Planning systems to be
used by menu plaimers as altemative approaches to planning menus that meet the
nutrition goals established by School Meals Initiative for Healthy Children for American
school children. Nutrition goals are based on RDAs, children's calorie (energy)
requirements, and recommendations of the Dietary Guidelines for Americans (DGA).
Since the Traditional Food-Based Menu Planning system was established before the
DGA became part of school meal requirements, the meal plans do not have built-in
35 features that assist meal planners in serving meals that comply with these guidelines.
Therefore, the Nutrient-Based Menu Planning system has been specially designed to
provide optional ways to use and create menus consistent with the nutrition goals and
school children's nutrient requirements (USDA, 1998).
Food-Based Menu Planning Svstems
Food-Based Menu Planning systems use the traditional food group pattems that
are commonly used globally to assist in planning balanced meals. Schools in the US use
these systems in the form of Traditíonal Menu Planning, Traditional Food-Based Menu
Planning, and Enhanced Food-Based Menu Planning approaches. These approaches have
similarities and differences (USDA, 1998).
Traditional Menu Planning
The Traditional Menu Plarming system requires that menus be planned using specific food components in specific amounts for specific age/grade groups. It is the plarming system that schools have used since the National School Lunch Program was established in 1946 and the School Breakfast Program in 1966. Meal pattems utilizing this system were designed to provide over-time, 1/3 and 1/4 of the RDA for key nutrients for specific age/grade groups for lunch and breakfast respectively. Difficulty in using this system to plan menus that were in compliance with nutrition goals was experienced, hence altematíve systems were sought (USDA, 1998).
36 Enhanced Food-Based Menu Planning
Enhanced Food-Based Menu Planning is similar to the Traditional system-it requires specifíc food group components in specifíc amounts. Different from the
Traditíonal system, this system uses different established age/grade groups. Additíonally,
Enhanced Food-Based Menu Planning requires increased servings of vegetables/fraits and grains/breads. When appropriately followed, this system assists in maintaining consistency with the Dietary Guidelines. Meal pattems utilizing this system were designed to provide 1/3 of the RDA for specific nutrients as well as 1/3 of calorie needs for specific age/grade groups for lunch, and 1/4 each of the RDAs and calorie needs for breakfast (USDA, 1998).
Nutrient-Based Menu Planning Svstems
Instead of food components, Nutrient-Based Menu Planning Systems approach menu plaiming by using menu items. This system requires a nutritional analysis of foods used in school meals. Use of USDA-approved computer software to conduct nutrient analysis is a mandatory requirement for schools. Nutrient-Based approaches used in schools include Nutrient Standard Menu Planning (NSMP) and Assisted Nutrient
Standard Menu Planning (Assisted NSMP). These Nutrient-Based Menu Planning approaches have similarities and differences (USDA, 1998).
37 Nutrient Standard Menu Planning (NSMP)
NSMP takes a nutrient-based approach to plan menus. Instead of specifíc food components, the menu planner utílizes an unlimited number of menu items. AIso required by this system is a nutritional analysis of foods used in school meals. Nutritíonal analysis is achieved by using USDA-approved computer software and must be done by school meal planners. When averaged over a school week (defmed as a 3-7 day period), menu nutrient analysis must be consistent with the DGA and must conform to lunch, providing
1/3 of the RDA for specific nutrients as well as 1/3 of calorie needs for each age or grade group, and 1/4 each for breakfast weekly averages (USDA, 1998).
Assisted NSMP
Similar to NSMP, Assisted NSMP takes a nutrient-based approach and uses an imlimited number of menu items to plan school menus that are in compliance (or are consistent) with nutrition goals and DGA. Compliance of menu nutrient analysis is set at providing 1/3 of the RDA for specifíc nutrients as well as 1/3 of calorie needs for each age or grade group for lunch and 1/4 each for breakfast when averaged over a school week. This system requires that an outside consultant or other contracted agency conducts actívitíes of menu planning and nutrient analysis (USDA, 1998).
Menu Planning Svstem in Botswana Schools
Botswana mainly uses the Four-Food Group system to plan menus for individuals, including school children. The four-food group model is widely used to teach nationals.
38 who in tum use the model to provide balanced meals for their families (Bomay et al,
1990; Chengeta et al, 1999; FAO, 1997).
Characteristics of the Four-Food Group Menu Plan/Guide
Categorizing foods into four groups is based on four overlapping characteristícs.
The FAO (1997, p. 229) identifíed these characteristics: "the major nutrient content (e.g. fatty foods, starchy foods, protective foods, protein foods); the role of foodstuffs in human nutrition (e.g. energy foods, protective foods, body building foods); individual nutrients (e.g. carbohydrates, fats, vitamins, minerals, protein); or commercial value (e.g. cereals, roots and tubers, nuts and seeds, fhiits, leafy vegetables)" as the overlapping characteristics of the four food groups.
However, the four-food group guide tends to rely heavily on the characteristic of the role that foodstuffs have in human nutrition. The specific examples of foods listed under each food group indicate the use of one or more of the other characteristícs.
Examples of body building foods (such as meat, físh, eggs, milk, beans); energy giving
(such as cereals, potatoes); protectíve foods (such as fhiits and vegetables); and energy supplements (such as fats, oils, sugars) indicate that all the four characteristics are used when grouping foods using the four food group plan (Bomay et al, 1990; Chengeta et al,
1999; FAO, 1997; MOE, 1996).
39 The Four-Food Group Proportions in Menus
Using four food groups to plan balanced meals requires utilizing them in a nutíitíonally proportional balance. An approximate proportion that should be utilized when teaching menu planning in Botswana schools indicates a larger proportion (about
2/3 or 67%)) of meals is catered by cereal/starchy/carbohydrate/ energy giving foods, while approximately 1/6 or \7% each is provided by foods from body building and protective food groups (Chengeta et al., 1999). Because energy supplements contribute a very low proportion to the meals, this food group is often considered together with an energy giving food group. Latham (1979) observed that incorporating energy supplements into energy giving foods results in "most African diets comprising by far the greatest portion, up to 80%o in some cases, of carbohydrates and less of other nutrients"
(p. 59). Based on these views, proportions of each of the food groups in a typical balanced diet can be represented in an ideal model as shown in Table 2.1.
Table 2:1: The Botswana Food Group National Menu Plan Proportions' Model
Food Group Approximate Proportions
Energy Giving + Energy Supplements 2/3 (0.67 or 67%))
Body Building 1/6 (0.17 or 17%)
Protectíve 1 /6 (0.17 or 17%)
40 The menu plan/guide written by the Ministry of Education for schools is another model this govenmient authority encourages schools to use. This menu plan/guide provides boarding schools with a total of 28 meals (i.e., seven each of breakfasts, mid- moming snacks, lunches and suppers) over a period of one week. The same menu plan/guide provides 10 "meals" or 25%o of the menus for non-boarding schools (i.e., fíve each of Iimches and mid-moming snacks). Modeled on a four-food group pattem, the
Ministry of Educatíon menu plan/guide is illustrated in Table 2.2 for boarding schools and Table 2.3 for non-boarding schools. This was done by counting how many times each food item appeared on the plan and placing it under the appropriate food group.
Proportions were obtained by dividing the total number of foods appearing on the 28- and the ten-meal plans for boarding and non-boarding schools respectively.
Table 2.2: Ministí^ of Educatíon Food Group Menu Plan Model (Boarding)
Food Group Approximate Proportions
Food Frequency (%)
Energy Giving 31 55
Body Building 13 23
Protective 12 21
Total 56 100
41 Table 2.3: Minisfry of Education Four-Food Group Menu Plan (Non-Boarding)
Food Group Approximate Proportions
Frequency (%)
Energy Giving 10 56
Body Building 5 28
Protective 3 17
Total 18 100
Ways of Analyzing School Menus
Because menus in US schools are required to meet certain standards, they are analyzed to validate their compliance with the required standards. In the US, breakfasts and lunches must provide over time, one-fourth and one-third of RDAs, respectively for protein, vitamins A and C, iron and calcium, and energy. Limits on total fat (á0%o of total kilocalories) and saturated fats (^0% of total kilocalories) address dietary guidelines to mitígate development of chronic health problems (Baker et al., 1997;
Burghardt & Devaney, 1993; Gregoire & Sneed, 1994; Ho et al., 1991; Hoover et al.,
1998).
42 To ensure that schools meet these nutrient requirements, that utilize Nutrient-Based Menu
Planning system approaches, USDA-approved computer software is used to do nutrient analysis.
Provision of nutrients is based on the needs of children in individual schools
(WFP/UNESCO/WHO, 1999). Boarding schools are recommended to provide 100% of
RDAs to the resident students. Filipino school meals are planned to meet, over time, one third of the RDAs at least for energy and protein (Florencio, 2001).
Global use of food guides assists in the plarming of nutritionally adequate meals.
Nations such as China, the US, the Philippines, Australia and Puerto Rico report the ability to tailor intemational recommendations to culturally specific foods (Cronin, 1998;
Hertzler, 1996). Many nations still are unable to achieve and maintain the integrity of their meals based only on guidelines (Cronin, 1998; Hencock et al., 1995).
Nutrient Quality of School Meals
The primary global focus of school-based nutrition programs is to augment children's health by increasing the consistency of food intake (Florencio, 2001).
Developed countries such as the United States have conducted several studies to document the nutritional impact school meals have had on student intake, as well as to evaluate the overall nutritional status of children (March, 2001). Large-scale studies conducted in the US include the Bogalusa Heart Study (Nicklas, 1995); and the fírst and the second School Nutrition Dietary Assessments (SNDA-I) (Burghardt & Devaney,
1993); (SNDA-II) (Fox, Crepinsek, Connor & Battaglia, 2001). Smaller scale studies
43 under review included those investigated by Baker, CarroII and Champagne (1997); Ho et
al. (1991); Hoover, Martin, Fox, Lan and Ahmad (1998); and Wildey et al. (2000).
Burghardt and Devaney (1993) and Fox et al. (2001) documented the nutritíonal
quality of school meals in the fírst and second Student Nutrition Dietary Assessment
Studies (SNDA-I and SNDA-II). Burghardt and Devaney (1993) used the 24-hour diet
recall format to interview 3,350 students randomly selected from a natíon-wide sample of
545 schools. Reference standards of nutrient intake evaluated in the study included the
requirement of school meal programs to provide one-fourth and one-third respectively of
the Recommended Dietary Allowances (RDA) for students' breakfast and lunch meals.
Fat limitations were based on recommendations of the Dietary Guidelines for Americans
to limit fat intake to not more than 30%o calories and to 10% or less of saturated fat.
Sodiimi level evaluation was based on the National Research Council's (NRC)
recommendations of daily sodium intake of 2,400 mg or less, daily cholesterol intake to
300 mg or less, and daily carbohydrate intake of at least 55%.
Lunch meals provided most nutrients in excess of one-third of the recommended
daily allowances for the age group at the schools. Lunches were below the recommended
levels of supplying iron for 11-13 year old females, zinc for 11-18 year old males, and
calories and vitamin B6 for 15-18 year old males. Total fat and sattirated fat levels were
found to be 38%o and 15%o, respectively, and exceeded the goal of 30% or less and 10% or
less. School lunches also exceeded the NRC sodium recommendations. Cholesterol was provided in amounts within the recommended range, while carbohydrate
44 recommendatíons were not met. Almost no schools provided lunch meals meeting all the
ideal requirements (Burghardt & Devaney, 1993).
School breakfasts provided one-fourth or more of the daily RDA except for
calories and zinc. Fat in breakfast meals contributed 31% of kilocalories lower than the
expected levels of over 35%. Lower fat content was attributed to the lack of meats and/or
meat altemates in the meals. While school breakfasts met the recommendations for
cholesterol and carbohydrate levels, recommended sodium levels were exceeded
(Burghardt & Devaney, 1993).
Students' dietary intake was confírmed through a 24-hour recall. Of the 98%o
students eating at least three times a day, 58%) ate at least fíve times, 30%) ate four times,
and only 10%o ate a traditional three-meal pattem. On average, students consumed foods
that exceeded the RDA for kilocalories, protein, vitamins A, C, and B6, calcium, iron,
and zinc. Adolescent female intakes of most nutrients were beneath the RDAs. Students'
daily intake of total fat and saturated fat exceeded the recommended levels. While
sodium intake of students based on 24-hoiu- diet recall reports provided almost twice the recommended levels, cholesterol and carbohydrate intakes were within the recommended
amounts (Burghardt & Devaney, 1993). Students consumed most nutrients in excess of
RDAs from both meals offered at school and over a 24-hour period.
The SNDA-I study also compared nutrient intake between participants and non- participants (Burghardt & Devaney, 1993). School lunches contributed notably to the participants' nutritional intake. Lunches provided approximately one-third of the RDA for calories, vitamins A and B6, iron, and zinc. The average lunchtime intake for protein
45 (86%), vitamin C (60%o), and calcium (43%)) exceeded the recommended level of one- third of the RDA. While participants of different ages and genders were determined to eat generally one-third of the RDA for most nutrients, adolescent female participants' (ages
11-14) intake of iron, magnesium, zinc, and vitamins A and B6 was lower than one-third
RDA. School Iimches as offered were similar in nutrient content to what the students actually selected and consumed, and augmented the nutrient imbalances discovered in the nutrient analysis of the lunch meals. Foods that enhanced nutrient intake of NSLP participants included milk and milk products, meats and meat mixtures, complex carbohydrates, and vegetables.
Students not obtaining NSLP school lunches purchased foods from in-school snack bars, from food outlets off campus, or brought lunch from home. The nutrient intake of those bringing lunches from home exceeded that of students purchasing from in-school snack bars, with lunches brought from home providing more kilocalories, vitamins A and B6, calcium and iron than foods bought at the snack bars away. Total fat,
saturated fat, sodium, and cholesterol from a la carte items and foods brought from home were lower than for foods obtained off campus. NSLP lunches purchased from campus provided somewhat similar amounts of sodium and total fat. However, off-campus
lunches provided lower vitamin and mineral levels than NSLP lunches (Burghardt &
Devaney, 1993). Overall, NSLP lunches were of a better nutrient quality when compared to lunches brought from home, and those purchased from in-school snack bars and from
food outlets off-campus.
46 Breakfast participants consumed more than one-fourth of RDA for vitamins (A,
B6, and C), minerals (calcium and iron), and protein. Zinc was provided at a level below the recommended levels and saturated fat, cholesterol, and sodium levels exceeded the recommended ceilings. Total fat and calories were provided at recommended levels.
Breakfast participants received more calories, protein, and calcium than non-participants.
Non-participants consumed less than one-fourth of the RDA for calories and nutrients.
Foods enhancing nutrient intake included milk and milk products, meats, and meat altemates. Breakfast participants received more nutritional benefit than non-participants
(Burghardt & Devaney, 1993) did.
Fox, Crespinsek, Connor and Battaglia (2001) re-evaluated the nutritional quality of school meals in SNDA-II and gathered data from 430 public school food authorities
that included at least 1,000 public schools. Reference standards of nutrient intake were
the same as SNDA-I. Students limited their nutritional intake when selecting foods from
what was offered for both breakfast and lunch. Lunches satisfíed nutrient requirements
except for fat which slightly exceeded targeted goals by 3-4%. Secondary school lunches
were more likely to be deficient in kilocalories than elementary school lunches due to
new lower fat limitations. Lunches also were limited in cholesterol, but were stiU
providing excess sodium and not enough kilocalories from carbohydrates. Overall,
breakfasts met nutrient standards of 25% of the RDA but straggled to meet caloric
requirements for both elementary and secondary schools. These differences were
attributable to students' food selection pattems and to older students' increased nutrient
needs. Jn general, schools made substantial improvements in the nutritional quality of the
47 lunches. School breakfasts met and lunches progressed toward meeting the School Meals
Initiative for Healthy Children standards.
Using the visual plate method, Ho et al. (1991) evaluated the nutrient content of
140 reimbursable and a la carte, 84 sack, and 30 vending lunches as consumed by 11-14 year-old Utahan junior high students over a four-day period. Reference standards of nutrient intake to be evaluated in the study were set at one-third of the 1989 RDAs and
Estimated Safe and Adequate Daily Dietary Intakes (ESADDI) recommendations for kilocalories, protein, vitamins A and C, iron, and sodium. Standards of percent of calories from carbohydrates, protein, and total fats were set at 55, 15, and 30 respectively, and not more than 10% from saturated fat (SAF), monounsaturated fat (MUF), and polyunsaturated fat (PUF). Evaluation of dietary fiber was based on one-third of the daily recommendatíon of the National Cancer histitute (NCI) (6.7g dietary fiber) and the
cholesterol level of lOOmg was based on one-third of the National Cholesterol Education
Program's daily reconmiendatíons.
School and sack lunches contained more of all nutrients except for vitamins A and
C than in vending lunches. However, school lunches as consumed contained significantly
more amounts of kilocalories (735.3 vs. 601.8), protein (26.3g vs. 15.4g), total fats (32g
vs. 24.5g), SAF (14% vs. 9%), MUF (14% vs. 11%), cholesterol (73.9mg vs. 28.8mg),
and sodium (l,208.9mg vs. 862.7mg) than sack lunches. School lunches as consumed
also were found to be very high in protein content, a finding attributed to the standard
portions for meat or meat altematives and milk components required in the school lunch
meal pattem. The total percent SAF, MUF, and PUF was inconsistent with the percentage
48 of total fats. This fínding was attributed to the incomplete nutrient database used for the three types of fats (Ho et al., 1991).
The nutrient contents of school, sack, and vending lunches also were compared with dietary recommendations. A greater percentage of students consuming vending lunches met recommendations for cholesterol (100%), sodium (100%) and for percent calories from total fats (36.7%)) than those who consumed school or sack lunches. No students consuming vending lunches met recommendations for dietary fíber, vitamin A, and iron. Few sttidents met the kilocalorie (3.3%o), protein (13.1%), and vitamin C (30%) recommendations. More than 90% of the students consuming reimbursable lunches met protein recommendatíons (90.7%), and percent calories from PUF (93.6%). Few sttidents consuming school lunches met standards for percent of calories from carbohydrates
(10%), total fats (5.7%), SAF (1.4%), and MUF (5%). A lower percentage of students consuming school lunches met vitamin C (45.7%o vs. 67.9%o), and sodium recommendations (20%) vs. 44%o), while a higher percentage met kilocalorie (72.1% vs.
26.2%), protein (90.7% vs. 48.8%), dietary fiber (38.6% vs. 13.1%), vitamin A (20% vs.
9.5%), percent calories from protein (43.6%o vs. 13.1%), and PUF (93.6% vs. 56%) than students who consumed sack lunches. Overall, very few students consumed the recommended levels for vitamins A and C from school, sack, and vending lunches (Ho et al., 1991).
Students eating school lunches ate more than the recommended fat levels. This study indicated that more students consuming school lunches met the RDAs for energy,
49 protein, and vitamin A for 11-14 year old male and female students as compared to the number of students consuming altematíve lunches (Ho et al., 1991).
Nicklas (1995) reported nutritional intakes of children participating in the
Bogalusa Heart Study, a longitudinal dietary survey of a Louisiana biracial community.
Results of 24-hour dietary recalls indicated that the general composition of macro- nutrients of children and adolescents were similar, with reported intakes of 13%o protein,
49%) carbohydrate, and 38% fat. Positive dietary changes over time included a lowering of saturated to polyunsaturated fat ratio. Decrease in polyunsaturated fat intake was attributed to decreased egg consumption. However, most of the children's and adolescents' diets were high in total fat, saturated fat and cholesterol as compared to the recommended amounts. School meals augmented the nutrition intake of children participating in the programs. School breakfasts and lunches together contributed approximately 50%o of the children's total daily intake of energy, protein, cholesterol, carbohydrate, and sodium. School breakfasts contributed 26%o of kilocalories, 30% protein, 30%) carbohydrate, 18%) saturated fat, 18%) total fat, 25%) cholesterol, and 27%) sodium to these respective nutrients' recommended intakes. School lunches contributed
25% of kilocalories, 31% protein, 21% carbohydrate, 31% total fat, 26% saturated fat,
34%) cholesterol, and 31% sodium of their recommended intakes. In general, school meals improved the nutritional intake of the Bogalusa school children.
Continued monitoring of nutrient quality of Louisiana school meals ensured better nutrient intake by students. Baker et al. (1997) analyzed characteristícs and nutrient content of five days or one week of lunch menus from seven Louisiana school food
50 service facilitíes. Schools voluntarily participated in Project 2001, a nutritíon initiatíve designed to guide schools in providing more healthful meals in the 21^' century.
Characteristics examined in school Project 2001 criteria reflected nutritíon standards designed to improve American health and included:
- Menu planning, procurement, and food preparation methods to reduce fat,
sugar, and sodium and sodium content,
Daily offering of a bread, bread aUemate, or dessert containing whole grain
flour or meal, and fresh frait or vegetable,
Offering processed meats/meat altemates not modifíed for fat and/or sodium
content once a week; if choices are not offered, and dry beans or peas,
- Availability saltshakers and butter only upon request by students,
Offering of unflavored skim milk or unflavored 1%) (or less) low fat milk.
(p. 93).
Most lunches met the criteria to include fresh firuits or vegetables, dry beans or peas, low fat milk and the limitation of salt and butter on cafeteria tables. The addition of whole grain products to the breads, bread altemates, and desserts were necessary to meet the bread criterion. Preparing more entrees from scratch reduces the frequency of offering processed meats.
A nutritional analysis of lunches was compared over a period of one week to recommendations to limit fat, sodium, and cholesterol, and to provide fiber. On average, lunches provided 33% of fat kilocalories and 13% of saturated fat kilocalories, 7.9g dietary fiber, l,229mg sodium, and 85mg cholesterol. Lunches exceeded fat and sodium
51 content goals but were low in dietary fiber. Lunches, however, provided cholesterol within the recommended levels. Analyses were based on 2% milk, due to students' preference over the 1%) stipulated for the milk criterion (Baker et al., 1997).
Nutrient values of seven school food service menus also were compared to one- third of the RDA for 7-10 year olds, and the RDA for males and females aged 11-14 years. Lunches provided 747 kilocalories, 33g protein, 491mg calcium, 5.3mg iron, 470
RE vitamin A, and 31mg vitamin C. Overall, school lunches appeared to be nutritíonally adequate for the younger children (7-10 year olds), but were insufficient for adolescent males and females (aged 11-14). Not all schools met the kilocalories and vitamin A provisions for adolescent males, and the iron provision for adolescent females. However, all schools provided lunches that met protein, calcium, and vitamin C requirements for both age groups and genders. The observed proximity to providing nutrients near recommended levels was a major achievement. Further improvements will be evident as long as students are encouraged to eat the provided meals (Baker et al., 1997).
Hoover et al. (1998) assessed one-week menus from eighty-four randomly selected Texas school food service facilitíes for compliance with the United States
Department of Agriculture (USDA) meal pattems. Compliance of menus with USDA meal pattems was determined by appropriate inclusion criteria of meat/meat altemate, vegetable/frait, bread^read altemate, milk, and weekly bread requirement food components stipulated for USDA school lunches and breakfasts.
Lunches and breakfasts were found to be highly compliant with USDA meal pattems. School lunches were assessed to have the highest compliance score (100 %) for
52 the meat/meat altemate standard while the bread^read altemate standard had the lowest compliance score (90%)). The bread/bread altemate standard also was found to have the most variability. Overall compliance scores were 95%o for lunches and 96% for breakfasts
(Hoover et al., 1998).
Texas school food service menus also were assessed for compliance with Dietary
Guidelines for Americans (DGA). Compliance of menus with DGA recommendations
was determined by assessing menus against characteristic criteria stipulated for Project
2001 (Baker et al., 1997). Offering unflavored skim milk or 1% low fat milk (99%o) and
the daily offering of the fresh fi^it or vegetable (98%o) criteria yielded the two highest
compliance scores. The bread/bread altemate (40%), and reduction of fat, sugar, and
sodium content in meals (53%o) criteria demonstrated the two lowest compliance scores
with DGA compliance standards. A weekly offering of dry beans or peas, the third lowest
DGA compliance score (60%o), also was found to have the most variability. The higher
compliance of Texas school menus and high degree of variability were partly attributed
to cultural influences on menu planning and general cultural acceptance of dry beans.
Only two out of eight criteria were found to be in total compliance with DGA
recommendations. Overall DGA comphance for all criteria was 64% (Hoover et al.,
1998).
Texas school food service menus were fiirther assessed for compliance with
specific health recommendations of NRC for sodium and DGA recommendations for fat
limitation. Lunches and breakfasts exceeded standards for percentage of kilocalorie needs
from saturated fat and total fat, and sodium. While the percentage of calories from
53 saturated fat was 13%) for breakfast and 12% for lunch, the percentage of calories from total fat was 32%) for breakfast and 38%o for lunch. Texas school lunch and breakfast sodium values were reported at 753mg and l,357mg respectively (Hoover et al., 1998).
The results from the Texas study were compared favorably to the earlier SNDA-I study. Calories from total and saturated fats, and for sodium between Texas and SNDA-I studies were similar. The SNDA-I and Texas studies reported higher values for calories from saturated and total fats, and sodium than DGA recommendations (Hoover et al.,
1998).
Texas school food service meal plarmers exhibited an overall high compliance with USDA meal pattems. However, a high compliance did not equate with meeting the
DGA or NRC recorrmiendations. The high compliance level of school menus with USDA mandated meal pattems should be commended as evidenced by small differences between the goal standard and what is actually offered (particularly in relation to fat).
Snacks consumed by school children contribute nutrients in addition to meals.
Wildey et al. (2000) assessed accessibihty and nutrient content of snacks purchased by
11-13 year olds sold in 15 middle school-based stores. Accessibility was measured by the time stores were opened to students to buy snacks. Nutrient content was derived from fat and sugar content provided by nutrition labeling. Reference criteria included maximums of three grams to be determined for low fat and 20 grams for a threshold of high sugar content in snack food items.
Within the fíve-day assessment period, 80%o of the stores were open for 86 minutes per day, and 54%o of the stores were open during the lunch period. Of the total
54 10,219 snack items sold, 58%o were high in fat; 21% were nonfat; and 15% were of low to moderate fat content. Sugar content in snacks ranged from zero to 75 grams. An average
student purchase included 9 grams of fat and 23 grams of sugar. No school stores sold
fi-uits or vegetables. These snacks provided 14% of the students' recommended daily
intake of fat with chocolate contributing to the fat and sugar content.
Students also were surveyed about their meal selection habits. Students were
asked to report sources of their noon meal. Almost half of the students (47.2%) reported
purchasing food items from student stores at least once every week. The presence of a
school store decreased the likelihood of students purchasing food from the school food
service.
The recent nutritional guidelines implemented in the local districts have improved
quality of nutrient intake of reimbursable meals, with the intention of ultimately
improving sttidents' health. However, children in the US have plenty of food choices in
schools. Students may choose from a la carte menu items offered in school cafeterias,
foods sold in vending facilities, or may bring sack lunches from home in addition to or
instead of a reimbursable meal. The plentitude of choices ultimately can contribute to
nutrient intake imbalance.
Tntemational Studies of Students' Nutritional Status
While school children in the US are typically well or over nourished, school
children in other countries experience varying levels of nutritional status. The following
section discusses nutrient intake and growth pattems of school children in countries
55 outside of the US. Studies are discussed according to geographic regions of Europe, Asia,
Latín America, North Africa and the Middle East, and contínental Africa.
European Studies
The following studies discuss the nutritional status of school children in Britain,
haly, Spain, and Switzeriand. It is noted that multiple standards were used to assess and
draw conclusions on students' nutrient intake.
Colquhoun, Lyon and Alexander (2001) provided an overview of the initíatíon of
providing meals for British school children. Based on historical anecdotes, school meals
in the UK were initiated primarily to alleviate poverty and eventually to enhance the
leaming capabilitíes of children from poor families. Prior to govemment intervention,
voluntary organizations implemented basic strategies to arrest the situation of hunger.
The observation of widespread malnutrition in young military recmits increased the
awareness of the British govemment that large-scale intervention was needed.
Meaningful govemmental interventions were sought to improve the nutritional and health
status of children identifíed as educationally disadvantaged. These interventions included
subsidies, increased nutrition knowledge, and food preparatíon skills. With the
observations of the benefit of the acquisition of knowledge and skills in food and
nutrition, school authorities, parents, and govemment offícials supported the
govemment's role. The nutritíon status of Britísh children is no longer considered critícal.
De Vito, La Torre, Langiano, Berardi and Ricciardi (1999) reported family factors influencing the nutritional status of overweight and obesity among 1,357 11-19 year old
56 Italian students from 12 schools. Parents completed a questionnaire conceming the influence of parents' nutritional status on their off-springs' nutritional status. Overweight and obesity status were measured using the standardized intemational defínitions and the
WHO recommendations of BMI cut-off values for normal (11.50-24.99), overweight
(25.00-29.99), and obese (>30.00).
Approximately eight percent of students were reported obese and 2\% were at risk of overweight. More male students (9.8%) were obese than female students (6.5%).
Male students aged 12 years were more likely to be obese than other age groups. Male and female students, however, were observed to be equally at risk of overweight.
Students assessed to be overweight and obese were likely to have parents with similar nutritional conditions. Students' overweight and/or obese status, also was directly influenced by their mothers' educational level. A high risk of overweight and/or obesity was attributed to physical inactivity. Highly educated students also were observed to be more actively involved in physical activities, and hence achieved a better nutritional status.
In general, family factors influenced Italian students' nutritional status, especially the mothers. Intervention programs to reduce the prevalence of overweight and/or obesity may be intensifíed at the family level and at school. Programs should be targeted toward women/mothers who appear to be pivotal in improving the nutritional status of their children.
Soriano, Moho and Manes (2000) evaluated and reported the dietary intake of 918 university students in Spain. Validated 24-hour diet recalls and the Spanish food tables
57 evaluated students' dietary intakes. The students' intakes were compared to the 1994
Spanish Recommended Intakes (SRI) defíned by gender.
Students consumed protein, calcium, iodine, vitamin A, thiamin, riboflavin, vitamin B12, vitamin C, vitamin D, and folate in amounts exceeding the SRI levels. Male students also consumed excess levels of iron and zinc, while female students consumed megajoules and magnesium below the SRI recommendatíons.
Food intake was evaluated according to the Spanish food groups. Food groups included milk, meat, cereal, fioiit, vegetables, and fat. Female students consumed more milk, fi-uits,vegetables , and cereals while male students consumed more meats and fats.
Male and female students consumed cereals and milk most often for breakfast.
Spanish students consumed fewer megajoules than the SRI standards but higher than intakes for students of the same age in France and New Zealand. Student meals also did not meet the Spanish nutritional objectives regarding percentage of energy
(megajoules) from protein, fat, and carbohydrates. Protein and fat megajoules were consumed in excess while carbohydrate megajoule consumption fell below the Spanish recommended standards. In general, Spanish students consumed most nutrients in excess of the recommended standards.
Decarh et al. (2000) described the nutrient intake of 246 adolescent Swiss students aged 11-16 years. The authors used three-day food records and compared results to the French food composition tables containing data on Swiss food products to determine the nutritional profile of the students' food intake. Adolescents' nutrient intake was compared to the French recommended dietary intakes.
58 Male adolescent students consumed more kilocalories and nutrients than females.
While there were no differences between the kilocalorie intakes of younger versus older female students, the older males tended to consume more kilocalories than the younger males. The tendency for female adolescents to maintain a lower kilocalorie intake was linked to the norm for girls to keep their weight and shape within a range compatible with the slim image societal expectatíon of the female body. In general, adolescents' nutrient intakes were below the French recommended dietary intakes with the largest differences observed for vitamins A, Bl, B6, C, E and folates, and for magnesium, calcium, and iron.
The nutrient intakes of adolescents also were described in terms of food groups by the authors. The authors used milk/milk products, fat, farinaceous, pulses/nuts, vegetables, fraits, sugar/sweet products, and beverages as main categories to describe the adolescents' food intake. Adolescent males consumed more protein products, total fat, farinaceous products, biscuits/cakes, pulses/nuts, vegetables, and sweet products than females. Females consumed more fresh fiiiit and beverages than males. Milk and farinaceous were products often consumed by both genders. The mean daily food intake of Swiss students included two to three portions of milk products, one-meat portion, two shces of bread, and one portion each of vegetables and finaits.Beverag e intake corresponded to three-quarters of a liter of hquid and a glass of juice (Decarii et al.,
2000). Based on the Swiss/French traditional diet plan, the teenagers' diets were fairly balanced. However, the high consumptíon levels of visible fat, high sugar foods, and a very low consumption of fi^iits and vegetables were identified as areas for improvement.
59 Asian Studies
The nutritional status of school children in studies from Japan, Korea and
Thailand are discussed. Although limited in number, the following studies highlight the
importance of teachers' positive attítudes toward meals offered to children in school
feeding programs.
Hiraoka (2001) investigated the nutritional status of 150 21-22-year-old female
Japanese students. Three-day weighted food records and Japanese standard tables of food
composition enabled calculation of student nutrient intakes. The students' dietary intakes
were then compared to the Japanese RDA defined by gender, age, and level of activity.
The students consumed vitamins A, Bl, B2, B6, niacin, B12, and C in amounts exceeding
the Japanese recommended levels. Vitamin E, folate, and protein were consumed in
amounts lower than the recommendations. While kilocalorie intake met Japanese
recommendations for the students at the lowest physical actívity level, the intake was
below the requirement for higher physical activity levels, although the students' higher
activity level was considered a more appropriate level on which to base energy
requirements. Japanese females consumed an adequate diet but a higher activity level
would not have been supported by the current nutrient intake.
Hori et al. (2001) compared attitudes toward school lunches among 1,615
Japanese, Korean, and Thai elementary school children. Questionnaires asked about the
school children's attitudes toward their teachers and their peers from two Japanese, two
Korean, and three Thai elementary schools.
60 School children had positive attitudes about school lunches and attributed their attitudes to the taste, appearance, and nutritional value they perceived the meals contained. Some children also indicated that lunches included foods they preferred.
Japanese children were more likely to consume school meals in their entirety.
Less than half of the children overall indicated that their teachers advised them to eat and fmish their lunches. While teachers in Korea advised the children to eat as much as possible of their lunch meals, Thai teachers advised their children to the contrary.
However, Japanese and Thai children were more likely to enjoy their lunches than the
Korean children. The Japanese and Thai children attributed their meal enjoyment to the
participation they were allowed in the school feeding program (Hori et al., 2001).
Overall, school children in Japan, Korea, and Thailand benefíted somewhat from
the advice teachers provided conceming eating lunch at school. However, the feeding
program could still be improved for the children's health and development. For teachers
to impact positively school feeding programs, basic information about food and nutrition
needs to be provided.
Latin American Studies
Studies from Chile and Brazil highlight the general nutritíonal status of school
children in this region. Instead of quantifying nutrients obtained from meals consumed,
the foUowing studies document the impact of meal consumption on growth pattems
and/or the health status of children in these Latin American schools. Conclusions of
growth and health status were based on comparisons to American standards.
61 Amigo, Bustos, Radrigan and Ureta (1995) compared the nutritional status of
1,842 school aged children of low socioeconomic status and 2,770 of high socioeconomic
status from eight Chilean communitíes. Criteria for determining nutritional status
included height, weight, mid arm muscular circumference (MAMC), and tricipital skin-
fold thickness (TSF) measurements. Students from the high socioeconomic class were
determined to be of a better nutritíonal status than that of students from the low
socioeconomic class, based on a higher mean weight, height, and MAMC. More students
from the low socioeconomic class showed a stunted growth pattem and were more likely
to be obese than those from the high socioeconomic class. Chilean students appeared to
exhibit similar nutritional problems observed of students from other countries.
Ivanovic, Olivares, Castro and Ivanovic (1995) reported the interrelatíonship
between the scholastic achievement and nutritional status of 4,059 Chilean students from
13 schools in eight counties. A survey instmment obtained data on nutritional status using
anthropometric measurements, and socioeconomic and scholastic achievement levels.
Consistent with fíndings of Amigo et al (1995), undemourished students and
students from lower socioeconomic status obtained lower scholastic achievement scores
than well-nourished students from higher socioeconomic status. Undemourished students
of high socioeconomic status, however, outperformed the well-nourished students of low
socioeconomic status. Well-nourished students had higher scholastic achievement test
scores than the under-nourished students from low socioeconomic status. School children assessed to have a sub-optimal head circumference/age (HC/A) statías generally scored poorly on the scholastic achievement test. However, students of high socioeconomic
62 status were more likely to outperform other students irrespective of their nutritional status. Overall, Chilean students from high socioeconomic status, and well-nourished students performed well scholastically. Because well-nourished students of low socioeconomic status also performed well in the scholastíc achievement test, proper nutrition appeared to be an important element in school performance (Ivanovic et al.,
1995).
Socioeconomic status also was used as a factor contributing to nutritional defíciencies of children in Brazilian schools. Sichieri, Mathias and Moura (1996) reported the prevalence of anemia and the relationship to indices of nutritional status among 168 school children aged six to 12 years living in a mral, low income Brazilian community. Anemia was defíned as a hemoglobin value <11.5g/dl. An acceptable nutritional status was defíned as those at or above the lO"" percentile of height-by-age, weight-by-age, and weight-to-height of the NCHS distributíons.
Anemia prevailed among 31.5%) of the male and 20.9% of the female student study participants. Six and seven year olds experienced a higher incidence of anemia than did the 8-12 year-old students. There also were no differences between genders of the students' hematocrit, mean weight, height, weight/height and arm circumference values.
The female students were more likely to have higher levels of subcutaneous fat than male students were, as expected in normal growth and development.
Compared to the NCHS percentile distribution, Brazilian children were shorter and lighter. However, students were heavier for their height-79%o had weight-for-height values in the highest percentile distributions. The oldest students were more likely to be
63 heavier for thefr height. Approximately 61%) of the 10-12 year olds were in the top 20% of the NCHS weight-for-height distributíon.
The authors also used a 24-hour diet recall to evaluate kilocalorie, protein, iron,
and vitamin C intake of 142 Brazilian students. Standards of reference used were the
1989 RDA of the National Academy of Sciences defíned by age. On average, students
consumed 20%o RDA for kilocalories, protein, and iron, and 40% RDA for vitamin C per
day from school meals. Generally, the nutrient intake was below the RDA recommended
levels.
Vieira da Silva (1998) studied factors impacting the nutritional status of 257
students in Brazilian public schools. Criterion for determining nutritional status was
height-for-age defíned by Z-scores. A weight-for-age Z score of < -2 denoted a chronic
malnutrition status. About \6% of the participating students were determined to be
chronically malnourished. Inadequate income levels and day care center attendance
negatively impacted students' nutritional status.
Anemia and weight imbalance were problems identífied in these Brazilian school
children. Brazilian children were heavier for their short stature. Obesity could be a
problem for this group of six to 12-year olds as they gain weight after reaching a
permanent height when growth ceases.
North Afiican and Middle-Eastem Studies
Northem Afiicans have a relatively similar life style and common religious
practices with the Middle Eastem people. Thus the studies of the nutritional status of
64 these children are viewed together. Because of perceived cultural similarities, nutritional
experiences by school children also were perceived to be similar.
Al-OIthaineen, Osman & AI Orf (1999) investígated the prevalence of iron
deficiency anemia among 1,210 giris aged seven to 14 years from 25 primary schools in
Riyadh, Saudi Arabia. The reference standard for determining iron defíciency anemia
was based on hemoglobin levels below 12g/dl; the WHO standard to define a deficiency
level. The dietary intake questíonnaire revealed that approximately 81%o of the girls ate
breakfast while approximately 17%) of the girls depended on snacks offered in the school
canteen. Slightíy higher than 81%) of the children brought their lunches from home. Of
the 1,210 school children participating in the study, 55.4%o (670) had hemoglobin levels
below the WHO standard. The seven and the 14-year olds showed the highest prevalence
of iron deficiency anemia. The high prevalence among the seven-year-olds was attributed
to over indulgence in low iron content foods of low nutrient density bought from the
school canteen, while the high prevalence among 14-year olds was attributed to
menarche.
The authors also investigated wasting and stunting among study participants.
Height and weight for age were compared with the NCHS reference growth curve.
Wastíng was found to be prevalent among the seven and 14-year olds at 23.1%o and
21.4%) respectively. Similariy, stunting was found to be prevalent in only the seven and
the 14-year age groups but not in students aged eight to 13 years. The prevalence of
obesity was rather low ranging from 6.4% to 13.7%o among all age groups. Overall, iron
deficiency was a major nutrition problem of seven and 14-year old Saudi primary school
65 giris. The same ages also were most likely to be stunted and shorter than their Amerícan counterparts.
Al-Isa and Moussa (2000) assessed the nutritional status of 8,957 elementary school children aged six to 10 years from the fíve Kuwait govemorates. The children's weight-for-height (W/H), height-for-age (H/A), and stature provided data as an indicator
of nutíitíonal status, and these data were compared with the Natíonal Center for Health
Statístics/Center for Disease Control (NCHS/CDC) of the US Natíonal Academy of
Sciences. Based on the WHO standards, obesity was defíned as W/H of 2.00 to 5.00
standard deviation (SD) scores, underweight as W/H of ^.00 to -2.00 SD scores, and
stature as H/A of-5.00 to -2.00 SD scores of the NCHS/CDC reference populatíon.
The mean weight of Kuwaiti schoolboys ranged from 22.6 to 34.9 kg, while their
mean height ranged from 117.4 to 135.8 cm. The mean weight of Kuwaití schoolgirls
ranged from 21.6 to 34.9 kg, and height from 117.0 to 137.1 cm. More male children
(677 or 15.7%)) than females (615 or 13.8%) were obese. Underweight was equally and
minimally prevalent in both genders (3.7% in males vs. 3.8% in females). Similariy, more
males (417 or 9.5%)) than females (207 or 4.6%) were sttmted. However, more males
were likely to be taller than females (76 or 1.7% males as compared to 47 or 1.0%
females).
Overall, Kuwaiti elementary schoolboys in the six to 10-year age group were
heavier and taller than Kuwaiti female counterparts. Kuwaiti children were obese when
compared to their American counterparts. However, Kuwaiti male students were more
likely to be overweight than American male children. The nutritional stattis of Kuwaiti
66 school children was reported to have improved when compared to results of previous studies. Changes in W/H and H/A indicated an increase in weight and height in the
Kuwaiti school population. The positive weight and height trend was attributed to
improved nutritional intake due to economic improvements following the marketing of
the nation's vast oil reserve. However, the significant changes noted between W/H
proportions indicated a trend of childhood obesity and the development of chronic
disease associated with over nutrition, a secondary consequence of economic betterment.
Generally, Kuwaiti children were heavier and shorter than their American counterparts.
The differences in W/H and H/A were linked more to the genetic make-up of the children
rather than nutritional deficiencies. School-based nutrition education could impact
Kuwaití school children's health (Al-Isa et al., 2000).
Hasan, Batieha, Jodou, Khawaldeh & Ajlouni (2001) reported the growth status of
7,240 Jordanian children aged six to 17 years from 23 military fiinded schools. The
Center for Disease Control (CDC) height-for-age and weight-for-age growth charts
served as reference standards to measure the Jordanian growth status.
The Jordanian schoolboys' height-for-age coincided with the lO'*' percentile of the
CDC charts. The giris' height-for-age fluctuated between the 5"" and lO"" percentiles at
age six to 14.5 years and remained above this percentíle untíl age 17.5 years. The boys'
weight-for-age was reported at shghtly above the 25"" percentíle of the CDC charts untíl
age 13.5 years, then it fluctuated between 25"^ and 50"" percentíles untíl age 17.5 years.
The Jordanian giris' weight-for-age increased from slightly below the 50"^ percentile at
age 12.5 years to slightíy above the same percentile at age 17.5 years.
67 The authors also compared the Jordanian school children's body mass index
(BMI) with that of their American counterparts. The BMI values were calculated as
weight (kilograms) divided by the square of height (meters). The Jordanian male BMI
approximated the 50'*" percentile on the CDC charts. The female BMI matched the same
percentile until age 13.5 years when the values increased to the 75"" percentíle at age 17.5
years.
Overall, weight and height of Jordanian school children fell below those of their
American counterparts. However, the Jordanian girls tended to be heavier than their
American counterparts after age 13.5 years. Height-for-age, a parameter indicative of the
past nutritional status, was lower than weight-for-age when compared to the CDC
reference standards. The signifícantly lower height-for-age was attributed to malnutrition,
large family size, poor family income, episodes of illness during infancy and childhood,
and also to consanguinity in Jordanian children. The increased weight of girls was
attributed to a sedentary lifestyle pattem that Jordanian females engaged in after puberty.
Although short for their age, Jordanian students were generally heavier for their height.
Continental African Studies
Apart from Northem Africa, the remainder of Afiica appears to have a relatively
similar culttire of food and/or eating habits. Prior studies of the nutritional quality of
meals in schools and/or the health status of school children in the continent of Afiica
have occurred in Sudan, Nigeria, Zimbabwe, South Afiica, and Botswana. Conclusions of
68 school children's nutritional status have been based on WHO/FAO recommendations that
utilize the British and US reference standards.
In Nigeria, food offered in school cafeterias was used as the basis for evaluating
students' food intake and compared with intemational standards to draw conclusions on
their nutíitional status. Ene-Obong (1993) reported the nutrient compositíon of school
meals and snacks served to 50 13-18 year old Nigerian students residing in boarding
houses. The author used direct chemical analysis and food composition tables to
determine the nutrient composition of meals and snacks. Computations were based on
lOOg edible portions of the foods comprising meals and snacks. The direct chemical
analysis derived protein, fat, carbohydrate, calcium, phosphoms, iron, and kilocalorie
levels. The complexity of the chemical analysis technique contributed to the selectíon of
a small study sample.
The chemical analysis of school meals indicated that many foods contained a high
moisture and low fat content. Because of the high moisture content, the nutrient content
of school meals was low. Student meals contained minimal amounts of protein, fat, and
carbohydrate per lOOg edible portions. Calcium, iron, phosphoras, and kilocalorie
contents per lOOg edible portions also were low. Similarly, snacks contained minimal
energy and nutrients per lOOg edible portions. Thus, snacks contributed little to students'
nutritional intake (Ene-Obong, 1993).
The lower fat content confírmed a general trend found in previous studies about
Nigerian cuisine. The high moisture and low fat composition in the school meals also was suggestive of low energy density of foods used in student meals in boarding houses.
69 The author also evaluated the quality of school meals and snacks. The quality was determined by nutrient density or the index of nutritional quality (INQ). An INQ was defíned as the ratío of the nutrient composition of food to the nutrient requirements of the students, using 1000 kilocalories as the common denominator for comparison of the two values. An INQ value of one or greater indicated suffícient nutrients of meals or diets in proportion to their kilocalorie content, while an INQ less than one was indicatíve of insuffícient nutrient content of the food or diet to meet recommended standards when consumed at required amounts (Ene-Obong, 1993).
School meals contained acceptable ESÍQ levels for protein (0.97-4.03), iron (3.43-
14.2), and fell below acceptable levels for calcium (0.18-2.97) and phosphoras (0.17-
1.09). However, this potential was defeated since portions actually served to the students were less than amounts to provide 1000 kilocalories (Ene-Obong, 1993).
Snacks consumed in recommended amounts based on INQ values tended to be good sources of protein and phosphoras. Ranges of INQ values of all nutrients depending on the snack ranged from zero to >1.0. The potential for snacks to provide adequate protein and phosphoras to adolescents was defeated because students consumed amounts below the quantities required to provide 1000 kilocalories. Snacks also were consumed less frequently than meals (Ene-Obong, 1993).
The author further evaluated the contributíon of school meals and snacks to the students' actual intake and RDA based on the 1985 FAO/WHO recommendations for protein and kilocalories, while those for calcium, iron, and phosphoras were based on
1972 recommendations. Generally, more students obtained more nutrients from school
70 meals. Male students aged 16-18 years obtained higher kilocalories, calcium, iron, and
phosphoras intakes from school meals. The female students obtained more nutrients from
snacks than the males (Ene-Obong, 1993).
Except for protein and iron, the nutrient contributions of school meals and snacks
were low. In general, the low levels of nutrient contributíons were attributed to meal sizes
and quantities of snacks consumed that were below the quantities required to provide
1000 kilocalories. However, the low level of energy contributíon to students' actual (66-
79%) and recommended (47-56%) intakes was linked to the rather high moisture and low
fat content of local ingredients. Low calcium intake was attributed to a general lack of
fraditional calcium-rich food sources, less frequent consumption of milk/milk products
and vegetables, and consumption of highly processed cereals. Less frequent consumption
of vegetables, unprocessed cereals, and use of small amounts of palm oil in meal
preparation, rendered contribution of vitamin A to students' intake minimal (Ene-Obong,
1993).
Because of a generally poor nutrient intake of these Nigerian secondary school
adolescents, the author recommended improvement of their school meals by:
• Increasing the amount of vegetables consumed through school vegetable gardens
• Employing the services of Home economists/nutritíonists
• Organizing routine workshops/seminars for managers of school meals
• hicreasing the amount paid for school feeding when payment is part of school
fees
71 • Introduction of school milk programs by the govemment where govemment is not
involved in school feeding program. (p. 204-205)
AIso in Nigeria, early childhood feeding practices were used to assess students' health and nutrition status and the retroactive impact on academic achievement. Abidoye
(2000) compared school academic performance among 285 Nigerian primary school pupils of varying nutritional and health status. Academic performance was measured
using school examination records reflecting grades obtained based on the country's
fraditíonal grading scale of A (at least 70%), B (60-69%), C (50-59%), D (40-49%), and
E (below 40%o). More pupils received B (26.6%) and C (42.5%)) grades while very high
marks of A were received by 2.8% of students and failing grades were received by 3.5%.
The author evaluated the children's health and nutritional status of their first four
years of life. Five percent of the children were breast-fed for a maximum of four years
and 95% were breast-fed for at least four months. The duration of breast-feeding did not
have an effect on later school academic performance as shown by an average
performance of grade C, nor did the frequency of feeding (Adiboye, 2000).
The effect of anemia on academic performance of pupils was assessed. Of the 285
sttidy participants, 112 (39%o) were anemic while 175 (61%) were not. However, because
of the subjectíve nature of the clinical evaluatíon, the anemic condition of these primary
school children was cautiously interpreted. The prevalence of anemia was attributed to
nutritional defíciencies, high load of intestinal helminthes, malaria, and frequent
infections of other types. The academic performance of anemic children was comparable
to that of non-anemic children across the grading scale (Adiboye, 2000).
72 Weight-for-age and height-for age also were used to determine the nutritional status of the Nigerian primary school children. Less than one-third of the children were within the normal weight-for-age (29%o) and normal height-for-age (26%)) ranges. Most children were mild to moderately underweight (67%o) and were short for their height
(72%o). Four percent of the children were severely underweight and six percent were severely stimted. Underweight and short statures, both indicating nutritíonal defíciencies, were both linked to prolonged and/or minimal breast-feeding during the early stages of life. Less consumption of milk, meat, físh, and fi-uits,an d missing meals often contributed to protein and micro nutrient defíciency (Adiboye, 2000).
Based on their nutritional status, the well-nourished primary school pupils received the highest number of A grades while the mild to moderately malnourished children got mainly C and D grades. The severely malnourished children managed only one to two percentages of the B, C, and the D bands on the grading scale. Students' good health and nutritional status that was reinforced by their mother's levels of education positívely impacted academic performance.
Overall, Nigerian students consumed infrequent, small meal portions in schools.
Because of this, students consumed energy and most nutrients in amounts below what they needed for health maintenance. The below standard nutritíon intakes impacted students' academic performance negatively.
Studies in South Afiica considered anthropometry, ethnicity, locale, physical state, and food intake to evaluate and draw conclusions on students' health and nutritional status. Ramphele, Heap and Trollip (1995) reported the physical health status of 806 10-
73 14 year old black South Afiican students from three schools. A survey was used to obtain data on the nutritional status, menarche, blood pressure, eyesight, observable physical abnormalities, hospital attendance, and injuries. Criteria used to determine nutritíonal status included weight-for-age, and height-for-age as defined by gender. Based on US reference growth charts, acute under-nutrition was set below the fifth percentíle weight-
for-age, and chronic under-nutrition below the fifth percentile height-for-age mark.
Approximately seven percent of the participating students were reported at below
the fifth percentile weight-for-age and about one-fifth below the frfth percentile height-
for-age mark. A higher proportion of male students was likely to be in the below fifth
percentíle weight-for-age (13.1%)vs. 3.7%) and height-for-age (24.4% vs. 16.7%)
categories than female students. Older students were more likely to fall in these
categories than younger students were. While 14-year old males constituted higher
proportions in the below 5* percentíles of weight-for-age (18.2%) and the height-for-age
(37.5%), the 12-year olds and 13-year olds constítuted the highest proportions in below
the 5"" percentíle weight-for-age (5.3%o) and height-for-age (18.4%o) respectively.
Overall, students were undemourished. Chronic under-nutrition was more likely
to be noted in male and older students and was linked to poverty and poor living
conditíons associated with the locale where the students lived (Ramphele et al., 1995).
Nutritional status in schools also was assessed based on locatíon variables in
South Afiica. Dietary intake of 431 black South Afiican female students aged 17-34
years were examined by Steyn, Senekal, Brtis and Nel (2000) in order to identify urban-
raral differences. Food frequency questionnaires and interview methods were used to
74 obtain retrospective diet data. Nutrient intakes were determined using local food tables and a 13-food group classificatíon.
With the exception of sugar, urban and raral students consumed comparable amounts of energy and macronutrients (protein, fat, carbohydrate, and fiber). Urban students consumed more sugar (65.8 g) than raral students (52.2 g). The energy contribution of sugar to total energy intake was higher for urban than for raral students
(10.4% vs. 8.9%o). The higher sugar intake was attributed to a higher intake level of confections and sweets. Rural students consumed higher amounts of legumes and commeal, characteristic of a traditional diet.
Urban and raral students' micronutrient intakes also were comparable. However, urban students consumed more vitamin A (351%) than did their raral counterparts
(275%o) based on the RDA of 600 RE/day. The higher vitamin A intake of urban students was attributed to higher frait consumption. Except for low calcium intake, students consumed at least two-thirds of the RDA of micronutrients. While students' consumption of iron and zinc was at 67% of RDAs, their vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin C, and vitamin B12 intakes exceeded 100% of RDAs. Low calcium intake was associated with the minimal intake of dairy products by the Afiican population and reinforced cultural food habits, genetically related lactose intolerance, and price (Steyn et al., 2000).
Results from urban/raral students were compared with previous studies of white students of similar age. White and black students showed consistency in comparable energy intake. However, white students consumed less carbohydrate (264 g vs. 343 g)
75 and more fat (~89 g vs. ~79 g) than black students. The urban-black students' diet : was more comparable to the rural-black students' diet than to white students (Steyn et al.,
2000).
A nutrition knowledge test (NKT) determined student nutrition knowledge levels
of four basic nutrition concepts including: use of food by the body, relationship between
nutíients and health, nutrients and the life cycle, and food safety. A nutrition knowledge
score of <30 denoted a poor knowledge level. The students' NKT average score of 25.23
was indicative of poor nutrition knowledge. Students were likely to be more
knowledgeable on the topic of life cycle nutritíon and least knowledgeable in food safety
issues. While black urban and raral students had similar and lower nutrition knowledge
levels, white students responded with considerably higher knowledge levels on the NKT
(Steyn et al., 2000).
Students' nutritional status also was based on anthropometric measurements.
Body mass index (BMI) and waist hip ratio (WHR) were used. A BMI >30 and a WHR
>0.80 denoted obesity. Although urban and raral students were anthropometrically
comparable, raral students had a greater WHR (0.76) than urban students (0.73) and more
raral students had a WHR >0.80 (18.57% vs. 4.44%) than urban students. More black
students (~ 46%)) than white students (~ 8%o) had a BMI of >25 indicatíve of these
students being at risk of overweight. White students also were taller than black students.
Overall, urban and raral black South African students' nutritional characteristics were comparable and indicated problems of inadequate calcium intake and lower nutrition knowledge in both urban and raral black students, prevalence of overweight in raral black
76 students, and high simple carbohydrate consumption within the urban black students
(Steyn et al, 2000).
Students' nutritional assessment in the Sudan focused on the effect of the offered basic diet on the anthropometric measurements of meal recipients compared to their intemational counterparts. Elkhalif, Godbi and Mohammed (2000) reported the nutritíonal status of 226 university students aged 19-27 years living in residential halls in
Sudan. The authors used a 24-hour recall format to interview students and used the information to calculate their kilocalorie, protein, total fat and iron intakes. Adequacy of nutrient intake by students was based on RDA as stipulated by the FAO/WHO and
defrned by age group.
On average, male students consumed 2266 kcal, 91g protein, 27g total fat, and
19mg iron per day. Female students consumed 1852 kcal, 55g protein, 41g total fat, and
lOmg iron on average per day. While total daily kilocalorie intake provided only 24.5%
of needs for the male students and 15.8%o for the female students, consumption of protein
exceeded FAO/WHO RDA levels by 73%o for males and 29% for females. Female
students had a lower intake of iron than males. The lower consumption of protein and
iron by female students was attributed to a limited intake of animal food sources. Lower
iron intake also was linked to the high consumption of cereal and legumes, which also
contained phytates inhibiting iron absorptíon (Elkhalif et al., 2000).
The authors compared the contribution of protein, fat, and carbohydrates to the
total kilocalorie intake of the students using the distributíon of a balanced diet at 55-60%
from carbohydrate, 10-15% from protein, and 20-30% from fats. Contributíons to
77 kilocalorie intake from carbohydrate exceeded the recommended levels for both male and female students. While the kilocalorie contributíon of protein intake of males also exceeded the recommended levels, the contribution made to females' intake was acceptable. The contribution of fat to the female students' diets also was within the recommended standards. However, the fat contributíon to male students' kilocalorie intake was below the recommended standards (Elkhalif et al., 2000).
The BMI for students were compared with the FAO classificatíon defrned by chronic energy deficiency (CED) grades one, two, and three. The CED grade three represented the highest levels of underweight, while grade one represented moderate levels. Of the 113 male students participatíng in the study, 19% represented CED grade three, 22%o represented grade two, and 24%o represented the grade one BMI category.
More female students were likely to be represented in CED grade one (27%o) and two
(31%o) than in the BMI grade three (13%o) category. However, about one-third of male and about one-fourth of female students had normal BMI values, while a small number of males (2%o) and females (5%) were obese. The high incidence of underweight among
Sudanese students was attributed to insufficient intake of food both quality and quantity
(EIkhalifetaI.,2000).
The nutrient intake of Sudanese male and female students living in university residence halls fell below the FAO/WHO recommendations, except for protein. Female students consumed less iron than males. In most Afiican countíies such as the Sudan, students residing at schools experience a nutritional advantage. Students are not only more likely to be provided meals, but also the meals are provided on a consistent basis.
78 The consistency and higher nutrition quality of these meals provided to students in schools play an important role in improving their health and nutrition status, compared to that of children not in school.
In Zimbabwe, the evaluation of school children's nutritional status was based on
comparing anthropometric indicators to those of American children. Nyirongo, Chideme-
Maradzika, Woelk, Chapman and Siziya (1999) compared nutritional indices of 939
Zimbabwean school children aged five to 16 years to the intemational reference standard.
Weights and heights were compared on the NCHS reference children for the
Zimbabwean children.
Considering that Zimbabwean children were of low to medium economic status,
they were neither stunted (3.9%) nor wasted (1.9%o) when compared with their American
counterparts, who were of higher economic status. However, consistent with findings
from investígatíons from other developing countries, including Botswana (Coriett, 1986),
the span of Zimbabwean children's heights and weights were below the fifth, 50' and
95* percentile values between the top and bottom percentiles of the reference population.
Zimbabwean male children were likely to be the farthest below the 95"" percentile
weight-by-age on the reference standard. Zimbabwean children with stunting or wasting
appeared to be more impaired due to genetic factors than due to socioeconomic status.
Zimbabwean children were believed to be lighter and shorter than the NCHS reference
populatíon. However, they exhibited similar proportions of height-for-age <90% and
weight-for-height <80%o to the reference population.
79 Similar to Zimbabwe, evaluatíons of school children in Botswana focused on growth pattems and were compared to intemational growth charts. Coriett (1986) assessed the growth pattem of 721 six to 14 year-old Tswana school children.
Assessment críteria for growth development were anthropometric measures including height, weight, triceps skin-fold thickness, and upper arm circumference. In general, school children exhibited height and weight development pattems similar to other
Afiican children. Similar annual increases in school children's upper arm circumference measurements were noted. Male students' triceps skin-fold development was more consistent than that of female students.
Anthropometric measurements also were compared to the NCHS and the British reference standard values. Children exhibited mean heights and weights generally below the 50"^ percentile of reference values with height tending to fall in the lowest percentiles.
Male students tended to have weights falling in the lowest categories on the intemational reference standards. However, school children matched the 50"^ percentiles when height and weight were combined. Older school children were more likely to match >50"^ weight-for-height percentile than the younger children. The tendency for Tswana school children to be shorter than their American counterparts was attributed to a delayed growth velocity. The tendency for school children to measure within the lowest height percentiles also was linked to the genetic size differences between Americans and
Batswana.
In general, Tswana school children were shorter and lighter than American and
British children. The consistency with which Tswana children's development pattem
80 resembled that of other Afiican children but differed from that of American and British children, demonstrated the need to adjust intemational reference standards to judge growth and development of the natíons' people.
The Impact of Food Service Persormel and Their SkiIIs on Children's Nutrient Intakes
The skill level and perceptíons of those preparing, serving food, and teaching the school children likely impact their nutrient intake. This section discusses aspects of school-based foodservice operations impacting nutrient quality, factors impacting customer service in school meal programs, and students' perceptions of healthy meals.
School-based Food Service Impacting Nutrient Quality
Abilities of food service persormel impact the nutritíonal quality of meals. SkiII level is likely to depend on the levels of training, experience, and prior continuing education.
A mailed questionnaire listing 55-job related areas considered important for the effectíve performance of food service managers/supervisors was retumed by 217
Tennessee school food service managers/supervisors (Sneed, 1992). Issues receiving more than a 90%o response included state/federal regulations, personnel, food production and delivery, equipment and financial management, menu planning and design, and marketing and microcomputer applications. Less important were issues of nutrition, facility design and space allocation, and professional development.
81 The authors further determined that the school food service managers needed continuing education in food service. Of the 55 related jobs, personnel management, microcomputer applications, employee orientation and training, and menu planning and design were perceived as areas representing the greatest training need by school food service managers, in order for them to increase effectíveness. School food service managers indicated a preference for continuing education programs to be delivered at convenient locations, also indicating days and summer as preferred times. Methods of delivering the continuing education programs had to be cost effective in dollars and time.
The highly rated importance and high need for continuing education indicated for such areas as persormel management, employee orientation and training, and menu plarming for the effectiveness of managers, require attention to match the needs identified by school food service managers/supervisors to enhance effectíveness in their jobs.
The nutritional quality of foods and menus are perceived to increase when school food service personnel receive continuing education in skill deficits. Sneed and White
(1993) studied perceived continuing education needs in US child nutrition programs. The authors mailed questíonnaires to 1,200 school food service managers and 1,200 directors/supervisors. The questionnaire included 48 areas related to school-level food service managers' jobs. Respondents perceived the highest continuing education needs to be in the areas of state/federal regulations; personnel laws; health and safety laws, inspection and enforcement; work simplification; employee motivation; fransmitting child nutritíon mission and values; building professionalism in staff; tíme management; building team work; and employee motivation. More directors/supervisors (>50%) than
82 school food service managers (33%)) perceived high need levels for continuing education in these areas for managers.
The authors also assessed the relationship existing between the managers and supervisors' perceptions of continuing educatíon needs in relation to environmental and personal factors. Environmental factors included grade levels, student enrollment, and food production systems in the school; and personal factors included certifícation status, work experience in food service, and specifícally, school food service. Continuing education needs were highly related to school food service managers in schools with all grade levels with a higher student enroUment, and with more food service work experience. However, uncertifred school-level food service managers were perceived to need more continuing education than those certifíed for the job. While study participants showed consistency with previous fíndings of continuing education programs delivered at convenient locations and at preferred times, they indicated a preference for interactive, participatory methods of delivery as opposed to non-interactive ones. There was overall consistency in that managers and supervisors indicated a high need for continuing education for food service personnel in schools.
The quality of being functionally adequate in performing tasks and assuming the role of a specified positíon with the requisite knowledge, ability, capability, skill, judgements, attitudes, and values also is perceived to increase the nutritional quality of meals. Sneed and White (1993) developed 124 competencies perceived to be important for the ftmctional adequacy of school food service managers. An intensive process of competency development encompassed a review of literature, on site observations.
83 discussions, and reviews by experts. The authors also used questionnaires to validate the
competency statements. Validation was determined by ratings of importance reflecting
1,200 managers' and 1,200 directors/supervisors' perceived needs for contínuing
education.
In general, issues related to safety, personal hygiene, sanitatíon, food
temperatiu-es, service of meals, and adherence to federal regulations received the highest
ratings. Managers and directors' ratings for importance were influenced by student
enrollment and personal certification and job experience factors. Managers from schools
with higher enrollments had a greater continuing education need for fmancial
management and record keeping than those from schools with lower student enrollments.
Certifíed and experienced managers considered food production and personnel
management competencies to be important. The level of directors' education influenced
the ratings of the competencies. Directors with lower education levels perceived
procurement as more important, while those with higher education levels indicated a
higher priority for fínancial management and record keeping, as continuing education
needs. Similar to the managers, certifícation status influenced priority ratings of
competencies.
Work experience influenced the number of times competency performance was
achieved. Managers and directors who had been at the job for at least 11 years reported
performing competencies more often. However, the number of times competencies were
performed declined after 30 years. Managers in schools with conventional, base, and
84 central kitchens indicated a higher frequency of competency performance for food production than managers receiving food from extemal production sources.
Continuing education planners should consider the level and needs of school food service managers. The use of competency statements to evaluate continuing needs of food service managers at the school level would provide the basis for plarming and providing meaningful education and training to improve knowledge and skills.
When providing professional continuing education for food service personnel, the quality level of functionally and adequately performing tasks is perceived to increase.
Gregoire and Sneed (1994) reported perceived continuing education needs of 600 district school nutrition directors/supervisors in the US. A questiormaire consisting of 46 topics specifrc to continuing education needs of district directors/supervisors was mailed.
Generally, district directors perceived their continuing education needs to be in the areas related to human resource management (employee motivation, building professionalism and teamwork in staff, and staff development) and marketing (merchandising food and marketing food products/services). District school nutrition supervisors in the southeast region were more likely to indicate a greater need for continuing education for these topics than those from other regions; and the southem plains region indicated the least need. Directors with higher education levels, who were certifíed and/or registered dieticians and had longer food service work experience, indicated a greater need for continuing education. Consistent with previous fíndings, supervisors from districts with higher student enrollment also were likely to indicate a perceived need for continuing education.
85 Supervisors' preferred methods for delivering continuing education also were identifíed by the authors. Directors indicated a preference for state, district, and local- level workshops and professional association meetings for obtaining continuing education. Directors' preferences for methods were associated with education level, certification/registration status and school food service work experience. While supervisors still seeking food service qualifrcatíon preferred collaborative delivery, those who were certifred and/or registered dietitians and had more work experience preferred professional association meetings and workshops to obtain continuing education
(Gregoire & Sneed, 1994).
Overall, directors perceived their greatest need for continuing education to be areas related to human resources management and marketing. The greatest needs for continuing education indicated by supervisors supported providers conducting a needs assessment before plarming and delivering continuing education programs.
Continuing education needs specified by food service personnel should be considered by program planners and should ultimately improve program quality.
DeMicco, Palakurthi, Sammons and WiIIiams (1994) surveyed 342 school food service directors in Pennsylvania to identify priority management and nutrition training needs for directors, their managers and assistants. A mailed questíonnaire listing 130 tasks/job- related areas performed at different professional levels in 11 fimctional areas was utilized. Training needs important to directors included knowledge of USDA and the
Pennsylvania Department of Education (PDE) regulatíons, establishment and evaluation of quality programs, the Dietary Guidelines and menu planning, budgeting, and time
86 management. However, directors identífíed safe food handling and practices, portion control, customer service, food merchandising, working with students, and the Dietary
Guidelines as important training needs for managers. Training needs for assistants included safe food handling and practices, working with students, meal preparation, portion control, and customer service. Identifíed prioritíes reflected the nature of the respective job levels.
These authors also determined preferred methods of delivering nutrition education and fraining programs, including location and preferred times, of directors, managers, and assistants in food service. While directors preferred to receive their nutrition education and training during working times and at "off-site" locations, they preferred that their managers and assistants receive the training during summer months, and at "on-site" locations after working hours. Directors viewed collaborative and non-collaborative modes of delivery equally appropriate to use when delivering programs to food service professionals at all three levels. The majority of the directors (52%) felt a two to four hour period was suffîcient to deliver programs, while fewer (4%o) opted for eight-hour duratíon (DeMicco et al., 1994).
Different prioritíes emerged based on job expectations at each of the three levels studied, but these were based on the directors' perceptions and did not include surveys completed by managers and assistants. Adheríng to preferred methods of delivery, timing, and locations would enhance success of these nutrítion education and training programs.
87 To assure delivery of nutrítional quality, periodic evaluation of tools guiding meal productíon is essential. Menu planning, purchasing, and production practíces of 41 distíict directors/supervisors and 405 unit managers in Utah school food service operations were assessed for promotion of the DGAs (MiIIer, Gould, Pearson and Jensen,
1994). A mailed questíonnaire that enabled evaluating menu and recipe modifícatíons, food preparatíon techniques, and frequency of food purchase for certain food items included in school meals was utilized. Directors and unit managers agreed on using standardized recipes, using measuring utensils, weighing ingredients, using portion confrol, and draining browned meat more often. Directors and managers were more highly in agreement on using portion control and draining meat (100%) than they were on using standardized recipes (93%)). However, directors and managers somewhat disagreed on how often they used certain foods on the students' menus. While managers reported more frequent use of low-fat ground turkey, directors reported frequent use of ground beef entrées. Managers also reported using cooking methods that increase the fat content of vegetables, and using bread of lower-fíber content, while the directors reported the reverse.
The authors conducted observations in 10 of the participating schools. A standardized checklist indicating cooking techniques used by food service persormel in school kitchens was employed. In general, observations revealed that cooking techniques in all schools showed that actual practíces did not promote the DGAs. Non-promotion of the DGAs was likely to be observed during the preparatíon of all food items (Miller et al.,
1994).
88 Directors and managers were consistent regarding planning, purchasing, and preparatíon techniques. Inconsistencies emerged between the reports and actual
observations. Suggested improvements included clear communication of policy
expectatíons by directors to managers. Clearer communication was thought to improve
the likelihood that meals would meet the mandated nutritional requirements.
Efforts to evaluate institutions' compliance with tools aimed at promoting school
children's nutrition and health status are vital ventures. Hurd, Friedman and Cise (1996)
surveyed food service directors from 1,063 Texas public school districts for compliance
with US Dietary Guidelines of the child nutritíon programs. An 80-questíon instrament
sought information to evaluate compliance status. Practices that promoted
implementation of the guidelines (food purchasing, and creating and adopting recipes and
menus) were evaluated in relation to their contribution to guideline compliance. Food
service directors reported offering fresh fraits and vegetables at the majority of school
districts (70%)). The majority of food service directors also reported altering menus to
reduce sugar {11%), and altering recipes (81%) and purchasing low salt (44%) to modify
sodium. In addition, food service directors reported practices that did not contribute to
compliance with the guidelines.
Directors from larger school districts were more likely to indicate compliance
with guidelines than those from smaller school districts. The strongest support was noted
for the "choose a diet with plenty of vegetables, fi-uits,an d grain products" guideline. The
increased likelihood for larger school districts to comply with the guidehnes was
89 attíibuted to these directors having better access to food products and greater economic and educational resources.
Conforming to menu planning guidelines is a diffícult task that when consistently evaluated, would improve the nutritional adequacy of meals. WiIIiams, Gregoire, Canter, and Shanklin (1997) examined menu planning using a mailed questíonnaire in 382 US elementary schools from four states in the mountain plains region. Most food service directors (89%)) were high school graduates. Most menu planners (79%) were indifferent to the menu planning process resufting in over half (54%) spending fewer than five hours per month on this task. Elementary schools in the districts were likely to use one menu plarmed monthly. Menus for elementary students also were less likely to be reviewed, cycled, or plarmed to offer self-serve food items to elementary students. Most meal planners considered the DGAs always and USDA guidelines sometimes when planning meals for elementary students. However, meal plarmers rarely conducted nutrient analysis on menus, an omission that could negatively impact the nutritional quality of meals.
Factors Impacting Customer Service in School Meal Programs
In addition to being knowledgeable, skiUfirl, capable, judgemental and competent in their jobs, food service staff should have good rapport with students. Fulkerson,
French, Story, Snyder and Paddock (2002) observed how interactíons of 235 food service staff members from 16 Minnesota high school cafeterias influenced student food choices.
Observations were made and a checklist was used to record staff-student interactive
90 behaviors. Interaction behaviors were described as staff-student verbal exchanges
followed by student food choices.
One hundred percent of staff-student observatíons recorded projected a positíve
affect from staff members and 99%) of the students were observed projecting a positive
affect. While no staff-member spontaneously recommended products to students, 7.6% of
the students asked for recommendations regarding the food products they purchased. In
general, staff-student interactions were positive. Despite this positive interaction, staff
members recommended products only when the students requested. Because students
purchased all products recommended by food service staff members, it appears that the
latter influenced students to piu-chase healthful food products in school cafeterias.
The authors also assessed food service staff members' perceptions about their
influence on student food choices in school cafeterias. A survey questionnaire containing
attittrdinal question items was used to assess what the staff members perceived pertaining
to their influence on student food purchases in high school cafeterias.
Most staff members (99.1%o) agreed that schools had the responsibility to provide
healthfttl foods to students. Approximately half of the study participants believed that as
staff members, influencing what students purchased in school cafeterias was an important
part of his or her job. Although more (79.6%) of the staff members were comfortable
giving students recommendatíons, a few (27.7%) also beheved they could influence
students on what food products to purchase in school cafeterias. Few staff members
beheved they could influence the students' food purchase choices. Staff members thought
their likelihood to influence students' food purchases was minimal because they
91 perceived students as the prime decision makers in their purchase processes before coming to the cafeteria.
Students also were perceived to be open to suggestions based on staff member recommendatíons conceming what to buy in the cafeteria. Staff members indicated an interest in receiving training about healthful eatíng for teenagers, and leaming how to encourage healthful eating among students. These results indicated that training school food service staff was imperative to improving the quality of adolescent food intake.
The extent and nature of nutrition education offered in catering-related (food service management) courses positively impact the quality of service and the nutrient content of meals. Eves, Comey, Kipps and Noble (1996) compared the changes in approach to teaching nutrition to students seeking catering qualifications in 244 institutions in England and Wales to students of ten years prior. The authors mailed a survey to food preparation/production college lecturers to provide information on catering-related aspects that included how they implemented and promoted nutrition and health recommendations.
Institutions indicated a reduction in clock hours of nutrition education in catering- related courses, which was attributed to time constraints and the lack of instmctional staff enthusiasm to address the role of nutrition and health. With less nutrition educatíon, more sttidents studying for catering-related qualifications enter the profession less equipped to reinforce what is required and/or expected of them to help consumers improve their ability to make more nutritious eating choices.
92 The authors further investigated how attitudes had changed toward nutrítion education and teaching health enhancing cateríng practices. Generally, a positive change in attítude toward nuttition educatíon and a willingness to introduce altemative methods of food preparatíon were higher in the current than the previous study. This improved attitude was associated with a greater exposure to foods prepared to incorporate elements of healthy eating, and to perceived customer interest in eating more healthy meals.
The beliefs, attitudes, and perceptions that school caterers possess about nutrítion have a signifrcant impact on the nutritional quality of meals they plan, prepare, and serve to school children. Comey, Eves, Kipps and Noble (1998) investígated attitudes of 152 school caterers on providing healthier meals to school children in the United Kingdom
(UK). The UK govemment recommended that lunch menus would provide a higher level of nutrition by including plenty of starchy carbohydrates and non-starch polysaccharides, vegetables, fhrit, less fatty foods, and plenty of frait juice.
The authors used focus groups and questionnaires to determine relevant factors perceived by caterers when providing healthy school lunch menus. Questions were modeled on the Theory of Reasoned Action that sought to analyze the relative importance of probabilistic and normative beliefs on respondents' intentions to perform a particular behavior. Probabilistic or evaluative beliefs addressed attitudes and were weighted by the respondents' perceptíon of whether the outcome of the belief was "good" or "bad."
Normative beliefs focused on the power of attitudes to influence others to change behavior, where the influence was weighted by the respondents' motivation and willingness to comply with the wishes of others (Comey et al., 1998).
93 School caterers believed and perceived that the provision of starchy carbohydrates, vegetables, fiirits, oven-baked and not fried, and fiber-rich foods were
"good" or made a positive nutritíonal contribution to school lunch menus. These food choices being "good" was associated with the belief that they were nutritious, healthier, more colorful, and provided satiety. However, the provision of the vegetables, fiiiit, and frber-rich foods in school menus was believed and perceived to be wasteful. The wastefttlness of providing these foods was associated with the perceptíon and belief that school children did not like them. Because caterers also believed and perceived the stakeholders (parents and school children) wanted these foods included in school menus, they showed positive attitudes and intentions to provide these types of foods in school menus (Comey et al., 1998).
The caterers' beliefs about their influence on children's food choices, and their role in providing a healthy diet and teaching children about eating healthy, also were investigated. Approximately 74%o of the caterers beheved they had influence on children's food choices with a few (14%) believing they had a very high level or no influence at all. Similarly, most caterers were positíve about their role in providing healthy diets in schools (95%), and in teaching children about healthy eating (76%)
(Comeyetal., 1998).
Overall, school caterers indicated positive attitudes and a willingness to provide more healthy meal items in Britísh schools. These positive behaviors suggested opportunitíes to utilize all stakeholders involved in the provision of menus and the improvement of the status of the children's nutritíon and health in schools.
94 Students' Perceptions of Healthy Meals
When food choices are available to students, they base their choices on the eating pattems they leamed as younger children. Not only are these food choices a revelation of the developmental stages of eating, but also they are a predictor of adult food choices.
Therefore, the students' knowledge and attitudes should be evaluated and used to tailor school meals to meet their nutritional needs. Seaman, Bower and Fleming (1997) assessed nutrition knowledge and attitude toward healthy eating of 103 13-14 year old students from five Scottish schools. The authors used a seven-day unweighed diet diary and a questionnaire containing forced-choice questions seeking knowledge on nutritíon and eating habit information.
Students predominantly obtained their lunch meals from school cafes, local shops, and home. The students' choice of locatíon to obtain lunch was impacted by the offering of a variety of menu selections, and the choices of their fiiends. Students were more likely to purchase school lunches within the same price bracket, with most of them (99%) preferring lunch with a frxed price.
Over half of the students indicated a high affínity to relatively sugar- or fat-rich foods, and for pasta, brown bread, and beef burgers. However, except for one school identífíed as a control school because of its healthy eating policy, students showed a greater dislike for fiiiits, vegetables, and fish. Similariy, students liked many foods with added salt while those from the school with the healthy eating policy indicated a high dislike profíle for food in which salt was added.
95 The authors further assessed students' food consumptíon pattems. A food frequency questiormaire was used to assess students' food consumption pattems. The results from the food frequency questionnaire were compared with data from the seven- day unweighed food diaries. In general, the two sets of data equally estímated that over
50% of the students consumed relatively high sugar and/or high fat foods at least four times in a week. Students' consimiption of vegetables was low contrasted with the frequency of eating finaits, which was more than four times a week. Students from the school with a healthy eating policy consumed less fiirits and vegetables than expected.
Students' food preferences also were measured as part of the questiormaire.
Preferences identifíed those foods considered attractive by students attending the different schools with special attention given to the school with the healthy eating policy.
Most students indicated a strong liking for chocolate (72%o), and chips (60%). Most students had similar degrees of liking and disliking brown bread, pasta, baked potatoes, fiiiits, and vegetables. Male and female students were equally likely to like or dislike the same foods on their lunch menus.
Food consumption pattems of students were assessed and compared with the seven-day unweighed food diaries. Generally, more sttrdents consumed biscuits (74 %), and chocolate (70%) at least four times in a week. Chips (60%) were consumed at least six times a week. While half of the student participants from the school with the healthy eating policy ate fraits and vegetables at least four times a week, less than 10% of the students from other schools consumed fresh fraits at least once a week, the latter indicating a poor fiiiit/vegetable consumption. Similarly, male and female students were
96 likely to indicate similar food preferences except for those attending the school with the healthy eating policy.
Overall, students appeared to know the benefíts of consuming milk (96%), fraits and vegetables (95%), spreads (84%), low fat meats (83%), and also the benefíts of low fat cooking methods (74%). Most students (89%) also were knowledgeable about the healthy eating guidelines. Despite their high levels of nutrition knowledge, students demonsfrated a lack of using this knowledge to make healthy food choices to enhance their health and wellbeing. The gap that existed between students' food/nutrition knowledge and food habits suggested that nutrition education in itself might not be the solutíon to the problem of poor eating habits.
Foods students perceive as healthy also impact their food choices. Noble, Comey,
Eves, Kipps and Lumbers (2000) reported perceptions of the healthiness of foods commonly served during school lunches of 123 children ages 9 tol4, from 14 British schools. The "stacking box" and interview methods were implemented to ascertain children's perceptions of the healthiness of foods and the reasons for their perceptions.
The "stacking box" and interview methods entailed stimulating discussion with children through the use of high-quality photographs of foods and/or dishes representative of those offered in school lunches. Foods were strategically grouped into protein foods representing the main part of the meal, foods providing starch, vegetables, and puddings. Children chose and used photographs from each food group and assembled their "preferred" meals while ranking all the foods in each food group in order of preference. Children used the same photographs and assembled their "healthy" meals
97 while ranking all the foods within each food group in accordance with what they perceived as healthy. They provided reasons for their ranking.
Foods perceived as most healthy in each food group by students also were the least preferred. Conversely, foods more preferred by students were perceived as less healthy. The inverse relationship of "healthiness" vs. "preferred" illustrated that the idea of healthful foods was relatívely unimportant to children's food choices.
The authors investígated the relatíonship of children's perceptíons of "healthy" foods served at school Ivmches to their preferences of "preferred" foods. "Healthy" meals provided greater amounts per MJ of protein, thiamin, folate (25mg/MJ), vitamin C, and vitamin A than "preferred" meals. "Preferred" meals provided a higher percentage contribution of carbohydrate from starch, and provided greater amounts per MJ of riboflavin, calcium, and sodium than "healthy" meals. Foods perceived as "healthy" had a higher nutrient content.
The reasons for perceptions of "healthiness" also were investígated. Students exhibited a sound knowledge and understanding of the contemporary meanings of
"healthy" and "unhealthy" foods. However, students' reasons for their perceptions of
"healthiness" lacked precise detail. Students also were less aware of the sources and functions of nutrients, and less aware about the relationships between foods and health.
Students' lack of awareness may lead them to poor food choices and a strategic approach to assist students to put their knowledge into practice is imperative.
98 Teacher Participation in School Feeding Programs
Teachers play a signifícant role and contribute to the realization of feeding program objectives. Because their role is to educate children, teachers' core participatíon is demonstrated in the educatíon-related objective of school feeding programs (Bomay et al., 1990; Florencio, 2001; Latham, 1979). As they use the programs to formeriy or informally educate children, teachers integrate nutrition education and teach children about good food practices, desirable food habits, nutrition, and health.
Teachers have the responsibility of communicating information about healthfiil eating pattems consistent with dietary guideline tools to promote healthier eating habits of students in schools. Stmhldreher, Zuchowski and Liddel (1996) surveyed 355 West
Virginia family and consumer sciences educators for compliance with incorporating the promotion of healthful eating for the new millermium. The authors used mailed questiormaires to determine whether educators integrated the Dietary Guidelines into curriculum content, classroom activities, and laboratory experiences. Most family and consumer sciences educators indicated consistency in compliance for implementing the
"eat a variety of foods" guideline into curriculum content (97%), classroom actívitíes
(95%), and into laboratory experiences (83%). Family and consumer sciences educators were likely to be consistent in compliance for implementing Dietary Guidelines in curriculum content rather than in classroom activities or laboratory experiences, with the latter method used least often.
The authors also assessed educational preparation/training of educators for ability to implement the Dietary Guidelines. While more family and consumer sciences
99 educators indicated it was easy to implement "eat a variety of foods" (82%), and "choose plenty of vegetables/fraits and grains" (76%), they indicated difficulty in implementing
"maintain healthy weight" (11%), "choose a low fat/cholesterol diet" (12%), "use sugars in moderatíon" (14%o), and "use salt and sodium in moderation" (10%). Over 75% of educators perceived themselves adequately prepared to teach the Dietary Guidelines.
However, 15% of the educators indicated they lacked preparation for implementíng the guidelines and they perceived themselves as not contributíng to the promotíon of healthful eating for the new miUermium.
Implementation of guidelines into the laboratory experiences would demonstrate healthier methods of food preparatíon and reinforce leaming. Family and consumer sciences educators play a key role in nutrition education programs and in promoting the nutrition and health status of student populations, and eventually, the general population.
Students studying food- and health-related curriculum subjects, receive information contributing to informed food choices. Because of the nutrition knowledge they receive, these students are thought to make better food choices. Seaman and Young
(1996) investigated the relationship that home economics teaching and nutrition knowledge had on food intake of 80 Scottish students aged 14-16 years. A seven-day unweighed dietary diary and questiormaire technique determined eating pattems of adolescents studying home economics to those studying altematíve subjects.
Comparisons of average energy and nutrient intakes between the two groups indicated that students had low energy intakes, and students studying home economics had lower intakes. Students studying home economics derived less energy from fats and
100 refined sugars while deriving more from protein and starch than those studying altemative subjects. The lower energy intake of students studying home economics was associated with the positive behavior students exhibited due to translation of theoretícal health education messages into practice. However, the low energy intake by students also suggested a possible lack of vision in portion size estimation.
Students studying home economics varying from that of those studying altemative subjects did not differ greatly in micronutrient intake. However, vitamin C, phosphoras, calcium, iron, and folic acid intakes among students studying home economics were lower than that of their counterparts. The low average intakes by students studying home economics were linked to fmdings from previous studies suggesting that students in the home economics discipline ate less than those in other disciplines. Overall, students stíadying home economics were unable to put theory into practice, and did not make expected improved food consumption choices.
According to Florencio (2001), FCS/HE teachers do not only participate by providing nutrition education related to feeding programs. For instance, in Filipino schools these teachers also collaborate by supervising the preparation and serving of meals/snacks to students. hi Botswana, Bomay et al (1990) report that Home Economics teachers are charged with the responsibility of participating in the practical preparation and cooking of food at the schools where they teach.
101 Summarv
School feeding programs are a common phenomenon in both developed and developing countries. These programs were initiated primarily to enhance the nutritional and health status, as well as the academic performance, of school children. Monitoring and evaluating school feeding programs help ensure that meals provide adequate nutrients in order to realize program aims. While developed countries continue to monitor, evaluate and improve program delivery through research, particularly on the nutritional quality of school food service meals, such initiatives are lagging behind in developing countries.
Because of the limited research in developing countries, this study was based on a somewhat global perspective, a perspective which provided a holistic overview of the nutritional quality of meals consumed at the targeted schools, as well as the nutritional and health status of many of the world's school children. Teacher participation and other factors perceived to impact the nutritional quality of school meals were also reviewed.
Global studies showed that many children receive meals that are not in accordance with intemational reference standards (e.g., Recommended Dietary
Allowances, food group guidelines). While students from developed countries typically receive more than the recommended amounts, those from developing countries receive less than the recommended amounts. Consumption of food above recommended amounts in developed countries was attributed to the plentitude of food choices from a variety of meal sources from which students choose. However, consuming food below recommended amounts in developing countries was attributed to various factors. No or
102 limited meal item choices and less than ideal provision of good food sources of certain nutrients are characteristic of meals in these countries. School meals and snacks that have the potential to provide school children adequate nutrients may also fail because inadequate portion sizes are offered, and food groups are offered less frequently than recommended. Globally, vegetables and finaits are minimally provided or omitted from schools meals. In addition, milk and/or dairy products and other sources of animal origin are minimally provided or omitted in school meals in developing countries.
Consumption of foods in less than recommended amounts resulted in school children of developing coimtries being stunted and underweight. In contrast, excessive consumption resulted in school children, mainly in developed countries, having a higher weight and body mass index, ultimately predisposing them to other health related problems including hypertension, diabetes, dental caries, and cardiovascular disease.
Schools with a healthy eating policy successfially provided students the required nutrient quality. The quality of nutrition, however, depended on the skills and abilities of those plarming and preparing the food (i.e., school food service persormel). School food service persormel perceive themselves as not possessing adequate skills and abilities for their job. Causal factors contributing to personnel possessing inadequate skills and abilities, included limited training, the limited continuing education school food service personnel receive, and minimal experience in food-related aspects. Two factors perceived to increase students' nutritíonal benefits from school feeding programs are providing continuing education for school food service personnel, and positive verbal interactions between students and food service staff during meal times.
103 Teacher participatíon in school meal programs benefíts students. Assisting school management to achieve the nutrition education-related broad objectives of school feeding programs in and beyond the classroom emerges as a key participatory role of teachers.
Because of their expertise, FCS/HE teachers can also supervise and assist in preparing, cooking and serving food to students at the schools. The teachers' positive attítudes help students receive more nutritíonal benefíts from school feeding programs.
Food- and nutrition-related studies indicate that Botswana has the potential to use its food supply to provide adequate and balanced meals for its people. Despite this potential, nutritional problems are predominant in the country, with protein calorie malnutrition and micro nutrient deficiencies of vitamin A, iodine and iron being the most highly experienced. Diet-related non-communicable diseases, particularly hypertension and diabetes, and communicable disease (especially HFV/AIDS) that have a negative impact on health also are being experienced by Batswana. The detectíon of these diseases continues to indicate a rapid increase in their occurrence.
While nutritional problems are considered the ultimate manifestation of social and biological factors in society, primary problems in Botswana appear to incorporate household security, a lack of nutritíon knowledge, and a lack of dietary diversification.
However, poverty appears to be the core cause of nutritional deficiencies in Botswana.
The govemment of Botswana has realized the potential the country has for providing balanced diets and has initiated nutrition intervention programs to assist vulnerable groups, including school children. Nutrients likely to be missing in the diet at the household level are provided in meals at school through the school feeding program
104 initíative. Successful provision of these meals helps ensure that adequate nutrients in school meals can be achieved through continued monitoring and evaluation of school feeding programs. Through monitoring and evaluation processes, ways to improve program delivery particularly that of nutritional quality can be sought.
From the generalized notion that program monitoring and evaluation would lead to improved quality, it was possible to assess the nutritional quality of meals offered to
Botswana junior secondary school students, rather than contínue to assume they receive adequate nutrients from school meals. Similarly, it was possible to assess the impact
FCS/HE teacher participation has on the school meal, rather than continue to assume that their participation improves the quahty of school meals.
However, virtually no research had been conducted in Botswana schools to analyze the nutritional quality of meals students receive, nor had there been any research investigating the impact that participation by FCS/HE teachers in school feeding programs has on the nutritional quality of these meals. This gap in research supported a need for an investigation of these issues.
105 CHAPTER III
RESEARCH DESIGN AND PROCEDURES
This chapter provides a descriptíon of the research procedures that were used to investígate the nutritional quality of meals offered to students in Botswana junior secondary schools and determine whether or not participation of Family and Consumer
Sciences/Home Economics (FCS/HE) teachers makes a difference in the nutritional quahty of these meals. Specifically included are: sample design; development of instíToments; information on the pilot study; the collection of the data; and the methods used to analyze the data.
Sample Design and Selection
The population of the study was the 206 govemment-fimded junior secondary schools situated in the education regions five (i.e., central, northem, southem, south central, westem) of Botswana. Regions in which schools are situated include both mral and urban settings. The Republic of Botswana map (Department of Surveys & Lands,
1998) located in the pocket at the back of this document shows the distribution of schools throughout the country. There are 61 schools in the central region, 34 in the northem, 36 in the southem, 55 in the south central, and 20 in the westem regions. Approximately
29% of these schools have boarding facilitíes, and 71% do not (Table 3.1). The approximatíon of the regions is illustrated in Appendix A. The numbers of schools in each region also are shown on the map.
106 Table 3.1: Regional Distributíon of Junior Secondary Schools in Botswana
Type of School Regions Total
Central North South SouthCentral West
Boarding Schools 18 10 10 7 14 59
Non-Boarding Schools 43 24 26 48 147
Total 61 34 36 55 20 206
A proportional stratifred random sample of 98 (47.6%)) junior secondary schools was chosen from the total jimior secondary schools in Botswana. Using this method, the strata are the fíve regions. Based on the total number of schools in each region (Table
3.1), it was determined that 41.6% of the sample or 29 schools should be from the central region, 16 from the northem, 17 from the southem, 26 from the south central, and 10 schools from the westem regions (Table 3.2). Boarding and non-boarding schools also stratífíed the sample. The sfratifíed random sample also is illustrated according to the fíve
Botswana's educatíon regions in Appendix B. The sample represented 48% of the populatíon of 206 junior secondary schools, and consisted of 30%o of the boarding schools and 70%) of the non-boarding schools. The potential respondents included 98 school food service supervisors and the approximately 196 FCS/HE teachers teaching at the selected schools.
107 Table 3.2: A Regional Proportional Cross-Section Sample of Junior Secondary Schools in Botswana
Type of School Regions Total
Central North South SouthCentral West
Boarding Schools 9 4 5 4 7 29
Non-Boarding Schools 20 12 12 22 69
Total 29 16 17 26 10 98
Description of the Sample
A total of 294 surveys for this study were mailed to a contact person to distribute to the school headmasters at 98 junior secondary schools. The headmasters then distributed the surveys to the food service supervisors and the FCS/HE teachers. A total of 197 surveys were retumed and 192 (65.3%o) of those were usable for the study. Five surveys were eliminated because they were not completed entirely. Therefore, usable surveys for this study were from 67 school food service supervisors and 125 FCS/HE teachers at 67 junior secondary schools. The regional distribution of the schools where respondents provided the data for this study is presented in Table 3.3. The data-producing sample represented 32.5% of govemment-fimded junior secondary schools in Botswana.
Of the 67 schools that responded, 29.9% were from central, 23.9% south central, 17.9%
108 each were from the northem and southem and 10.4% from the westem regions. A total of
22 (32.8%) had boarding facilities and 45 (67.2%) did not. The numbers of the schools in each region where data were obtained are shown in Appendix C. The majority of the junior secondary schools (80.6%)) were situated in raral settings and the rest (19.4%o) in urban settings.
Table 3.3: Regional Distribution of Junior Secondary Schools in Botswana that Provided Data
School Type Regions Total
Central North South South Central West
Boarding Schools 22
Non-Boarding Schools 14 13 45
Total 20 12 12 16 67
Demographic information sought to describe school service supervisors included gender, age, job title, and qualificatíons. As reported in Table 3.4, 48 supervisors were females and 19 were males. Supervisors' ages ranged from less than 24 years to 40 years and older with the largest group being 35-36 years
109 The majority, 44 supervisors (65.7%)) held assistant administrator positions.
Thirteen supervisors were matrons and seven were boarding masters. The three supervisors, who also held teacher positions, constítuted the smallest portion of supervisors. Approximately 37% of the supervisors had received prior training in various food-related frelds including catering (9), nutrition/dietetics (5), and home economics
(11). The remaining 63%) of the supervisors had had either no or unrelated food training.
Less than one-third of the school food service supervisors reported receiving in-service training related to meal preparation supervision. Except for one, all school food service supervisors indicated they needed in-service training.
110 Table 3.4: Summary for Demographics for School Food Service Supervisors in Botswana Jtmior Secondary Schools
Characteristics N %
Sex Female 48 71.6 Male 19 28.4 Age Group <24 1 1.5 25-29 11 16.4 30-34 16 23.9 35-39 20 29.9 >40 19 28.4 Title Assistant Administrator 44 65.7 Matron 13 19.9 Boarding Master 7 10.4 Teacher 3 4.5 Qualification Catering/Hotelier 9 13.4 Nutrition/Dietetics 5 7.5 Home Economics 11 16.4 Other (accounts, typing, nursing) 29 43.3 None 13 19.4 Years Experience in School Meal Preparation Supervision 0-5 31 46.3 6-10 22 32.8 11-15 12 17.9 >16 2 3.0 Received in-service training Yes 19 28.4 No 48 71.6 Need Training Yes 66 98.5 No 1 1.5
One hundred and twenty-fíve FCS/HE teachers completed surveys for this study.
The majority (98.4%) of the teachers was female and 1.6% was male. The sample was
divided into five age groups. There were 44 teachers in the 25-29 year and 38 in the 30-
34 year age groups. The 35-39 year and the 40+ year age groups together consisted of 38
111 teachers, representing 30.4%o of the teachers who responded. The smallest group was the
<24year age group that consisted of fíve teachers representing 4.0% of teachers who responded.
Except for the youngest respondents who held Form V/Grade 12 General
Certifícates of Educatíon (GCE), 94%o reported having various FCS/HE related post secondary qualifícatíons. Slightly over 80%o had Diplomas in Home Economics
Education. Approximately 14%o of the teachers had Bachelor of Science in Home
Economics Educatíon (B. SC. HE Ed.), Bachelor of Education (B. Ed.), Bachelor of Arts
/Educatíonal Studies (B. A. Ed. Stud.), and/or Bachelor of Science in Consumer
Education (B. Sc. Cons. Ed.) degrees.
The FCS/HE teachers had teaching experience ranging from three months to 24 years. Slightly less than 60%o of these teachers had at least six years teaching experience.
The FCS/HE teachers were administrators (4.0%), heads of home economics/practical subjects (34.4%), senior teachers (12.8%), assistant teachers (44.8%), and temporary teachers (4.0%)). Temporary teachers were the fíve who reported having a GCE qualifícation discussed in the previous paragraph. A summary of the demographic data for the FCS/HE teachers is reported in Table 3.5.
112 Table 3.5: Summary for FCS/HE Teacher Demographics in Botswana Junior Secondary Schools
Characteristics N %
Sex Female 123 98.4 Male 2 1.6
Age Group <24 5 4.0 25-29 44 35.2 30-34 38 30.4 35-39 24 19.2 >40 14 11.2
Highest Qualification Diploma in Home Economics 103 82.4 B Ed./B A (Ed. Stud.) 5 4.0 B Sc. HE Ed. 9 7.2 B Sc. Consumer Ed. 3 2.4 GCE (Form V/Grade 12) 5 4.0
Teaching Position/Title 4.0 Administrator 5 HOD/Coordinator 43 34.4 Senior Teacher 16 12.8 Assistant Teacher 56 44.8 Temporary Teacher 5 4.0
Years Teaching Experience 41.6 0.25-5 52 6-10 44 35.2 11-15 23 18.4 16-20 5 4.0 1 0.8 >20
Design and Development of Tnstraments
Two instraments, one adapted from an existing questionnaire and another developed by the researcher, were used for collecting data from school food service
113 supervisors and FCS/HE teachers. The stractures of these survey instraments are discussed in the paragraphs that follow.
The Menu Quality Survey Instrament
The Menu Quality Survey instrament (Appendix B) consisted of fíve sectíons:
• Section A had questions regarding information on the schools;
• Sectíon B asked information about the meal preparation supervisors;
• Section C focused on the expertise of the menu planners;
• Section D included menu design and fimding; and
• Section E, the food account section, had questions that sought information about foods and estimated portion sizes that were offered to students at the schools.
The food account section was adapted from a food frequency questionnaire. The food frequency questionnaire was originally developed to assess energy and/or nutrient intake by asking how frequently populations consumed a limited number of foods that provide major sources of nutrients. This instrament enabled respondents to indicate daily or weekly frequencies they offered food items, and estimated portion sizes to individuals
(Lee&Nieman, 1995).
For this study, school food service supervisors estimated portion sizes of foods that were commonly offered to students in Botswana during one week. Foods were classified into seven groups, including cereals, vegetables, fiaiits, meat/fish/poultry, legumes, beverages including milk, and energy supplement foods. These foods were further placed into Energy Giving/Supplements, Body Building, and Protective food
114 groups that are used for menu planning purposes in Botswana. The nutritional quality of meals was evaluated by examining the specific foods offered to students at individual schools.
The Teacher Participation Survey Instrament
The Teacher Participation Survey instrament (Appendix C) was developed for this study. The instrament consisted of three sectíons and a total of 19 questions. Section
A had six questions that were used to obtain general information about the schools.
Section B consisted of seven questions that asked FCS/HE teachers about their participation in school feeding programs at the schools where they teach. The last section had six questions used to obtain the teachers' demographic information. The questions in the Teacher Participation Survey instrament were based on prior studies that have addressed teachers' attitudinal issues toward school lunches (Florencio, 2001; Hori et al.,
2001). FCS/HE professionals served as the panel of experts in validation of this instrament.
Pilot Studv
The pilot study was conducted using a sample comprised of food service supervisors and FCS/HE teachers at four non-boarding junior secondary schools in the central education region in Botswana. The sample group included four food service supervisors and six FCS/HE teachers teaching at the selected schools.
115 The pilot study was conducted to test and refíne instrament instractíons and questions, and to identify areas of needed clarificatíon. Specifically, respondents indicated the level of agreement and/or disagreement with the instractions and questíons used in the menu and the teacher participatíon instraments. The pilot study provided data on validity and reliability of the survey instraments. Additionally, respondents were asked to indicate how long it took them to complete each instrament.
A packet containing an informational letter to the school headmaster, food service supervisor and FCS/HE teacher, a Menu Quality Survey instrament, and a Teacher
Participation Survey instrament was mailed in June 2002 to a contact person to forward to each of the four junior secondary schools. To expedite the process, express mail was used to send mail to and from Botswana. The letters explained the purpose of the study and requested cooperation of the school headmasters and respondents at the schools. The contact person made an in-person follow-up to all four schools two weeks after delivering the packets.
Several conclusions were drawn from pilot study findings that guided the refinement of the instraments for collecting the final data. The Menu Quality Survey required more changes than the Teacher Participation Survey. A number of items were re-written, eight items were deleted, and examples were provided where necessary to improve the quality of the instraments. hi response to suggestions made by school food service supervisors, familiar terminology and appropriate portion sizes used at the schools were incorporated into the Menu Survey instrament. Renumbering items and clarifying statements also were done in response to FCS/HE teachers' suggestíons.
116 Reliabilitv and Validity of Instraments
The food frequency questionnaire has been used and found reliable in many
settings (Lee & Nieman, 1995). Because it lacks a standard method of design and
analysis, its validity is, however, questionable (Wise & Birrell, 2002). Content validity
was used to establish the appropriateness of the instraments. The pilot study was
conducted and provided data that was used to address the questionable content status of
the instíarments. As reported in the pilot study section, the data obtained from the
respondents led to deleting eight items, rewriting several statements, clarifying several
statements by providing examples in the instraments These changes improved the content
vahdity of the instmments.
Data CoUection
Review procedures for the protection of human subjects were followed and the
study was approved by the Texas Tech University Human Subjects Committee before
proceeding with the collection of data. Prior to mailing the surveys to Botswana in
October 2002, a letter requesting permission was mailed to the Principal Education
Officer at the Department of Teacher Training and Development of the Ministry of
Education in Botswana (Appendix D). The letter explained the purpose of the research and requested that the offrcer ask school headmasters for their cooperation and fiall support.
The survey packets were mailed to the contact person in Botswana in October
2002 to be delivered to the school headmasters at the selected schools. The survey packet
117 included a letter to the school headmaster/headmistress (Appendix E), school food service supervisor (Appendix F) and FCS/HE teacher (Appendix G); Menu Quality
Stuvey (Appendix H) and Teacher Participation Survey (Appendix I) instraments.
Because disturbances taking place at that time in Botswana led teachers to adopt a 'no work/go slow' attitude at the schools nationwide, the distribution of surveys was delayed untíl March 2003.
Several weeks after the survey packets were first delivered, the contact person made physical visits and/or follow-up telephone calls to the schools. This effort increased the retum rate required for statistical analysis to yield meaningful research conclusions.
Out of the targeted 98 school food service supervisors and 194 FCS/HE teachers at the 98 junior secondary schools, 67 and 194 respectively, school food service supervisors and
FCS/HE teachers from 67 schools completed and retumed the surveys that were used for the study.
Analvsis of Data
The summary statistics and analyses were computed using the Statistical Package
for the Social Sciences (SPSS version 11, 2002). The research questions and data analysis procedures were as follows:
Questíon #1, "How do the meals included in the Ministry of Education (MOE) menu plan written for schools compare with the food group national menu planning
standards?" required no statistical analysis. Because national standards indicate food
group proportions to guide menu planning, the foods listed in the MOE menu plan were
118 placed into appropriate food groups and were used for the descriptive analysis according to the description of boarding and non-boarding schools. This made menu plan comparisons possible.
Question #2, "How do school feeding program menu plans compare with the
MOE menu plan and with the national food group menu planning standard?" was answered using descriptive statistics (i.e., ranges, means, SD) and inferentíal statístics.
The inferential statistics of the one sample t-test identífied the differences between menu plans: school menu plans vs. MOE menu plan; and school menu plans vs. the national standard menu plan guide.
Question #3, "What factors contribute to the compliance of school feeding program menu plans with those written by the MOE and with the national food group planning standards?" was answered with multiple regression analysis. The Energy
Giving, Body Building and Protective food group proportions computed from the various foods that were offered in the school menu plans were the dependent variables. The number of the years the supervisor had worked in the supervisory position at the school, his/her age group, the size of the place where the school was located, student population, and the number of kitchen hands/cooks working with the supervisor were the independent variables. Multiple regression best predicted the independent variable that influenced the dependent variables.
The ordinal scale 1-5 was used to represent the school food service supervisors' age group. The < 24 year old age group was represented by 1, 25-29 year age group by
119 2, 30-34 year age group by 3, 35-39 year age group by 4, and the > 40 year age group by
5.
A similar ordinal scale also was used to identify the size of the locations in which schools were situated: 1 = smaller village/settlement; 2 = small village; 3 = large village;
4 = town; and 5 = city. Although this method is typically used for coding ordinal categorical variables, it has a drawback. The scale implies that a large village is three times as large as a smaller village/settlement, although in this study this may not have been trae.
Question #4, "What is the nature and extent of FCS/HE teacher involvement in school feeding programs?" was answered with descriptive statistics. Frequency values were used to enumerate and describe the types of school feeding program-related activities in which teachers were involved. The school food service supervisors and the
FCS/HE teachers themselves were asked to report the activities that were thought would positively impact program delivery particularly its nutritional quality. The supervisors were asked whether or not teachers assisted them with menu planning, making decisions on modifying menus, and/or providing in-service to the food service staff In addition to providing in-service training and menu planning, the teachers were asked specifically asked about their involvement in assisting school food service staff with the actual preparation of the meals and food purchasing at the schools where they taught.
Question #5, "Is there a difference in the compliance of menus with the national food group menu planning standard between junior secondary schools where FCS/HE teachers are involved in feeding programs and where they are not?" was answered with
120 independent samples t-tests. The nutritional quality of menus, determined by food group proportions, was the independent variable, while teachers' feeding program participatory activities served as the dependent variable. The independent samples t-tests provided clarifícation on the effects of the principal role FCS/HE teachers played to impact positively the nutritional quality of school meals.
A summary of the research questíons and statistical procedures that were used to answer each question are presented in Table 3.6. The survey instraments that were used to collect data also are identifred for each question.
121 Table 3.6: Summary of Research Questions and Statistícal Procedures Used in the Menu Quality and Teacher Participation Survey
Question 1: How do the meals included in the Ministry of Education (MOE) written for junior secondary schools compare with the national food group reference standards?
Instrument: The existing MOE menu plan and the national menu plan guide
Instrument Scoring: Numeric scoring of foods listed on the MOE guide and a sum of all scores of foods listed. Numeric sum scoring of each food group expressed as a percentage or proportion of total sum of all foods listed was used to assess the nutritional quality.
Analysis: Descriptive
Question 2: How do school feeding program menus compare with the: MOE written menu plan?
Instrument: Menu Quality Survey Section D & E - Food accounts
Instrument Scoring: Numeric scoring of foods listed on the school menu guide and a sum of all scores of foods listed. Numeric sum scoring of each food group expressed as a percentage or proportion of total sum of all foods listed used to infer nutritional quality. Average proportion values from the MOE menus compared with those of the school menus.
Statistical Procedure: One-sample t-test
National food group menu plan standards?
Instrument: Menu Quality Survey Section D & E - Food accounts
Instrument Scoring: Numeric scoring of foods listed on the school menu guides and a sum of all scores of foods listed. Numeric sum scoring of each food group expressed as a percentage or proportion of total sum of all foods listed used to infer nutritional quality of feeding programs. Average food group frequency proportion values from school menus compared with the food group national reference standard.
Statistical procedure: One-sample t-test
122 TabIe3.6(continued):
Question 3: What factors contribute to compliance of school feeding program menus with the MOE and the national food group menu planning standards?
Instrument: Menu Quality Survey Sections A & B - School and Menu planners information
Instrument Scoring: Numeric scoring of factors enumerated and/or described
Statistical Procedure: Multiple regression
Question 4: What is the nature and extent of FCS/HE teacher participation in the school feeding programs?
Instrument: Teacher Participation Survey Section B - Feeding program participatory activities at school level
Menu Quality Survey Sections B & C - Menu planners and funding activities
Instrument Scoring: Numeric scoring of activities
Statistical Procedure: Descriptive statistics - Frequency values to describe the types of activities in which teachers were involved.
Question 5: Is there a difference in the nutritional quality of menus with the national food group reference standards in the junior secondary schools where the FCS/HE teachers participate in the feeding programs or not?
Instrument: Teacher Participation Survey Section B - Feeding program participatory activities at the school level
Menu Quality Survey - Sections B, C, D & E - Menu planners, fiinding, menu planning activities & food accounts
Instrument Scoring: Numeric scoring of foods listed in the school menu guides and a sum of all scores of foods listed. Numeric sum scoring of each food group expressed as a percentage or proportion of total sum of all foods listed was used to infer the nutritional quality of feeding programs. Average food group frequency proportion values for school menus were compared with the food group reference standards.
Statistical Procedure: Independent samples t-tests
123 Summarv
This chapter described the design, methods and procedures for the study. Data were collected from a proportional stratífíed random sample consistíng of 98 food service supervisors and 196 FCS/HE teachers at the 98 Botswana govemment-flinded secondary schools situated in five educatíon regions. Contact person mailed two survey instmments to the school headmasters at the 98 schools. A total of 194 surveys were completed and retumed to the contact person who then mailed them to the researcher. Sixty-seven and
125 surveys completed by respectively, school food service supervisors and FCS/HE teachers were used for this study. A Menu Quality Survey instmment was adapted to obtain data for assessing the nutritional quality of meals offered to students at govemment-flrnded junior secondary schools. The nutritíonal quality of meals offered at the schools and meals encouraged by MOE were compared with the national reference standards, the food group menu planning criteria. A Teacher Participation Survey instrament was developed to obtain data from FCS/HE teachers on types of activities describing their involvement in school feeding programs, and how these activities impacted the nutritional quality of meals offered to students at the schools. Data. including the regional location and the boarding or non-boarding status of the school, were collected to describe junior secondary schools constituting the sample.
Demographic data including gender, age, level of education, food-related training, and school food service-related experience were collected to describe school food service supervisors. hr addition to gender, age and level of education, teaching experience was included in the demographic data used to describe FCS/HE teachers in the sample.
124 Descriptive statistics and inferentíal one-sample t-test statistícal procedures were employed to compare differences between the two (i.e., the MOE and the school) menu sets and the national food group reference menu plan standards. Multiple regression was utílized to determine the independent variable that best influenced the nutritional quality of school meals. Frequency values were used to determine the school feeding program-
related activities in which FCS/HE teachers were involved that could be targeted when
utihzing the expertise of these teachers to improve program delivery, particularly the
nutritional quality of the meals. The independent samples t-test was used to provide
clarifrcation on whether or not participatíon by the FCS/HE teachers did in fact positívely
impact the nutritional quality of meals offered to students and culminate in the
identification of factors to be considered by policy makers.
125 CHAPTER FOUR
ANALYSIS AND INTERPRETATION OF DATA
This chapter reports the fíndings of the study that investígated the nutritíonal
quality of meals offered to students in Botswana junior secondary schools and determined
whether or not participation of Family and Consumer Sciences/Home Economics
teachers makes a difference in the quality of the meals. Specifícally, this chapter
identífies each of the questions posed in the study, describes how the data were analyzed,
and explains the results.
Research Ouestions
The research questions for this study were designed to examine the nutritional
quality of meals served to students in Botswana, and to examine whether teacher participatron in food service programs in schools would positively impact the quality of meals. Five research questions were addressed.
Research Question Qne
How do the meals included in the Ministry of Education (MOE) menu-plan written for junior secondary schools compare with the national food group menu- plarming standards?
To answer this research question and make comparisons, the list of foods stated in the MOE menu-plan was converted into proportions by the researcher to match the
126 format used in national food group menu planning. Conversions were based on the number of times (frequency) the MOE recommended that each food should be offered to the boarding and to the non-boarding students during one week of school.
Bread, com products, sorghum products, rice and mashed potatoes were Energy-
Giving foods offered on the weekly MOE menu plan. Beef, including ground beef,
chicken, beans, and milk were foods offered weekly from the Body Building food group.
Protective foods offered weekly included vegetables (i.e., cabbage, mixed vegetables and
piunpkin) and fiorits (i.e., apples and oranges).
Rice, chicken, pumpkin, and apples were offered only once per week in the MOE
menu plan for both boarding and non-boarding schools. The majority of the foods (bread,
com and sorghum products, mashed potatoes, beef, beans, milk, cabbage, mixed
vegetables and oranges) were offered more times per week in the boarding school than in
the non-boarding school menu plan. Because sorghum products, milk, mixed vegetables
and oranges were included by the MOE in the weekly menu plan for moming, evening or
weekend meals, these were not offered in the non-boarding school menu plan. Thus, the
MOE menu plan reflected food offered more frequently per week to students in the
boarding than the non-boarding school menu plan. hr the boarding schools and the non-
boarding school menu plan, Energy Giving foods were offered 31 tímes vs. 10 times;
Body Building foods 13 times vs. 5 times; and Protectíve foods 12 tímes vs. 3 times.
Therefore, foods were offered a total of 56 times in boarding schools compared to 18
times per week in non-boarding schools. The number of times per week that the MOE
127 suggested that foods be offered on the school menu plans is presented in Table 4.1.
Information for boarding and non-boarding schools is included.
The frequencies by which foods in specifíc food groups were offered in the MOE menu plan were proportioned to match the national food group proportion standard
suggested as a menu-planning guide in Botswana. Of the 56 times that all foods were
offered in the menu plan for boarding schools, Energy Giving foods were offered 31
times per week, Body Building foods 13 tímes, and Protective foods 12 times a week. For
non-boarding schools, the MOE menu plan encouraged offering Energy-Giving foods 10
times per week, Body-Building foods 5 times and Protective foods 3 times per week.
128 Table 4.1: Foods Offered on the MOE Menu Plan at Botswana Junior Secondary Schools
(N=22)
Food Group Foods Tvpe of School
Boarding Non-Boarding
Energy Giving
Bread 17 5
Com Products 5 4
Sorghum Products 7 0
Rice 1 1
Mashed Potatoes 1 0
Total 31 10
Body Building
Beef 4 2
Chicken 1 1
Beans 3 2
Milk 5 0
Total 13 5
Protective
Cabbage 2 1
Mixed Vegetables 6 0
Pumpkin 1 1
Apples 1 1
Oranges 2 0
Total 12 3
129 A balanced meal in Botswana is expected to consist proportionally of approximately 67% Energy Giving and 17% each of the Body Building and Protectíve food groups. The food group proportion comparisons between the MOE and the natíonal menu plan standards (Table 4.2) were used to compare the nutritíonal quality of meals offered in the MOE menu plan with the natíonal food group menu plan standards.
The meals in the MOE menu plan provided slightly over 50% of the foods in the
Energy-Giving food group in both boarding and non-boarding school menu plans, which is below the natíonal menu plan level of 67%o. The Body Building food group proportions were offered at a 23%) level in the boarding school menu plan and at a 28%) level in the non-boarding school menu plan, which were both higher than the 17%o level in the national menu plan standards.
Table 4.2: MOE Menu Plan vs. Food Group National Menu Plan Standards in Botswana
Menu Plan Standard Food Group Proportions
Energy-Giving Body Building Protective
(%) (%) (%)
National 67 17 17
MOE Boarding School 55 23 21
MOE Non-Boarding School 56 28 17
Note: Due to rounding up to the nearest integer, the percentages may not add up to 100%
130 The MOE menu plan also had a higher Protective food group proportion level offered in the menu plan for boarding schools (21% vs. 17%)), while it was included at the recommended level of 11% in the non-boarding school menu plan. The mixed vegetables and milk offered during breakfast and/or supper contributed to the higher proportion levels for Body Building and Protective foods in the boarding school menu plan. Higher
Body Building food group proportion levels in the non-boarding school menu plan could be attributed to a comparatively fewer number of Energy Giving foods listed to be served at this type of school.
A graph showing the distributíon of percentages of all the three food groups in the natíonal menu plan standards and the MOE standards for boarding schools and non- boarding schools is presented in Appendix J.
In summary, lower Energy Giving food group proportions in the MOE menu plan
indicate that the govemment-planned menus are inadequate in energy providing foods.
However, the higher proportions that the MOE menu plan presented in the Body Building
and the Protective food groups indicate that the designed menus are providing adequate
nutrients in these food group categories.
Research Ouestion Two
How do school feeding program menu plans compare with the MOE menu plan
and with the national food group menu planning standards?
131 Data in the food account section of the Menu Quality Survey instrament were examined separately for the 22 boarding schools and the 45 non-boarding schools to address question.
To answer this question, frequencies, means, ranges, and standard deviations (SD) were calculated. The list of foods offered in the MOE menu plan for the boarding schools and the non-boarding schools discussed earlier (Table 4.1) were compared with the list of
foods offered in menu plans for those types of schools. In other words, the MOE menu plan for a boarding school plan was compared with menu plans from the 22 boarding
schools, while a non-boarding school menu plan was compared with those from the 45
non-boarding schools. The one-sample t-tests also were calculated to determine the
significant differences between the number of times that the MOE recommended each
food to be offered on the menu and the actual number of times that the schools offered
the same foods on weekly menus. The portion sizes of foods also were identífied to give
insight on the adequacy with which each food was offered at the schools.
Energy Giving Foods
Bread, com products, sorghum products and rice were included in the boarding
schools, non-boarding schools, and were included in the MOE menu plans. The MOE
menu plan also included mashed potatoes in the boarding school menu plan. Because
boarding schools offered four meals per day in a seven-day week as compared to the two
meals offered per day by non-boarding schools in a fíve-day week, the latter offered
foods less frequently in their menu plan than the former. According to the MOE, bread
132 should be offered 17 times per week in boarding schools vs. five tímes in non-boarding schools; com products fíve times vs. four times; sorghum products seven times vs. zero; and mashed potatoes once vs. zero. Rice should be included only once per week in the menu plan for both boarding schools and non-boarding schools.
The number of times per week that Energy Giving foods were included in the
MOE menu plan and the mean number of frequencies they were included in the boarding schools and non-boarding schools are presented in respectívely, Tables 4.3 and 4.4. The t-test values also are reported in these tables.
The boarding schools offered bread in their menu plans ranging from four to 16 times per week, with one school providing it four times and two schools providing it 16 times. None of the boarding schools provided bread 17 times per week as recommended by the MOE. The non-boarding school s offered this commodity in their menus ranging
from two to frve times per week.
133 Table 4.3: t-test Comparisons of Times per Week Energy Giving Foods were Offered Between the Boarding Junior Secondary Schools and the Ministry of Education in Botswana. (N = 22)
School Meal Plans
Food MOE Standard Mean SD t value
Bread 17 12.00* 3.10 7.68
Com 5 4.50 2.20 1.05
Sorghum 7 5.80* 1.70 -3.30
Rice 1 1.45* 0.50 4.18
Mashed Potatoes 1 0 0 0
Note: *SignifícantIy different from MOE standard (p < 0.01)
Table 4.4: t-test Comparisons of Times per Week Energy Giving Foods were Offered Between the Non-Boarding Junior Secondary Schools and the Ministry of Education in Botswana (N = 45)
School Meal Plans
Food MOE Standard Mean SD t - value
Bread 5.00 4.07* 0.96 -6.50
Com 4.00 2.73* 1.12 7.61
Sorghum None 1.80* 0.92 13.13
Rice 1.00 1.07 0.33 1.35
Mashed Potatoes None
Note: *Signifícantly different from MOE standard (p < 0.01)
134 Of the 45 non-boarding schools, 22 (48.89%) offered bread fíve times per week, the level recommended by the MOE. The mean number of tímes that bread was offered per week in boarding schools and non-boarding schools was 12.00 and 4.07 respectively, which are signifícantly lower than the 17 and 5 times per week as suggested by the MOE
(t = - 7.68 and t = - 6.50, respectively with p < 0.001 for both cases). The majority of the
schools may have failed to include bread at the required number of times per week because of its high cost and unavailability in certain areas of the country.
Com and sorghum are Botswana's staple cereals. Com products were included in
the boarding school menu plans ranging from two to 11 times per week. Only nine
(40.91%)) served com products at or above the frve times per week in their menus that the
MOE recommended. The non-boarding schools offered com products ranging from zero
to six times in weekly menus. Slightly over 25%) of the non-boarding schools included
this food commodity at levels stipulated in the MOE weekly menu plan. The mean number of times that boarding schools included com products in menu plans per week was 4.50 while that of non-boarding schools was 2.73. The mean number of times that com products was offered in boarding schools is not signifícantly different from the five times recommended by the MOE, while in non-boarding schools it is signifícantly lower than the four times per week recommended by this govemment department (t = - 1.05 with p = 0.31 and t = - 7.61 with p < 0.001 respectívely).
Sorghum products were included in boarding school menu plans ranging from two to nine times per week. Of the 22 boarding schools, only eight (36.35%) included sorghum products at or above the MOE recommendation of seven times per week in
135 menu plans, while the remaining majority offered it below the recommended levels.
Although sorghum products were not included in the MOE menu plan for non-boarding schools, most of these schools (91.11%)) included it in their weekly menu plans. Most of the schools (82.22%o) included it at least twice per week in their menu plans. The mean ntunber of times that sorghum products were included in boarding and non-boarding schools was respectively, 5.77 and 1.74. These mean values are signifrcantly lower than the seven times and zero times that the MOE recommended for the boarding and the non- boarding schools (t = - 3.30 with p = 0.003 and t = 13.13 with p < 0.001) respectively.
In general, most of the schools included staple cereal products in their menus below the required number of times per week. This could possibly be due to the students' general dislike of these readily available local products.
Except for one non-boarding school that did not include rice in its menu plan for that week, the rest of the schools in the sample included rice at least once in their weekly menus. Of a total of 67 schools, 12 (54.56%) of the boarding schools and 40 (88.89%) of the non-boarding schools included rice once per week in their menu plans, the level recommended by the MOE, while 10 (45.45%) of the boarding and 4 (8.89%) of the non- boarding schools included it twice per week. The mean number of tímes that rice was included in the weekly menus was 1.45 by boarding schools and 1.07 by non-boarding
schools. The mean number of times at the boarding schools is signifícantly higher from the ministry's recommendation of once only per week for boarding schools, while that for non-boarding schools is not signifícantly different than the recommendatíon (t = 4.18 with p < 0.001 and t = 1.35 with p = 0.18 respectively). Almost all schools complied with
136 the MOE to include rice at least once per week in menu plans, probably because students
were provided with a special meal once per week, and rice was a special food item in the
Botswana diet.
Although the MOE recommended that the boarding schools should include
mashed potatoes in their menus once every week, none of these schools provided this
food item to their students. Exclusion of mashed potatoes in menu plans could have been
because this commodity was expensive and/or unavailable in most raral parts of
Botswana.
With the exceptíon of rice that was served in schools as recommended by the
MOE, most of the Energy Giving foods were provided at levels below those stated by this
govemment department. Including these foods in school weekly menu plans below the
levels recommended by the MOE indicates that the menu plans implemented by the
schools do not foUow the guidelines provided by the MOE. Because the MOE menu plan provided the Energy Giving foods below the national food group standards, this also indicates that schools are providing meals that do not meet the energy requirements stipulated in the national standards. A graphical comparison of the number of times per week Energy Giving foods were offered in Botswana boarding and non-boarding schools is presented in Appendix K
Body Building Foods
Beef, chicken, beans, and milk represented the Body Building food group in the menu plans. The MOE recommended that beef be offered four times per week by boarding schools and twice per week by non-boarding schools, chicken once only per
137 week by all the schools, three times vs. twice per week for beans, fíve times vs. zero per week for milk in menu plans.
A comparison between the MOE weekly menu plan standards and the mean number of times that foods from the Body Building food group were included in the schools menu plans are reported in Table 4.5 for boarding schools and Table 4.6 for non- boarding schools. Mean and t test values are reported in these tables.
Table 4.5: t-test Comparisons of Times per Week Body Building Foods were Offered Between the Boarding Junior Secondary Schools and the Ministry of Education in Botswana (N = 22)
School Meal Plans
Food MOE Standard Mean SD t value
Beef 4.00 2.64* 0.80 -7.55
Chicken 1.00 1.32* 0.48 3.13
Beans 3.00 1.95* 0.90 -5.46
Milk 5.00 0.00 0.00 0.00
Note: *SignificantIy different from MOE standard (p < 0.01)
138 Table 4.6: t-test Comparisons of Times per Week Body Building Foods were Offered Between the Non-Boarding Junior Secondary Schools and the Ministry of Education in Botswana (N = 45)
School Meal Plans
Food MOE Standard Mean SD t value
Beef 2.00 2.33* 0.80 3.71
Chicken I.OO 1.24* 0.48 3.39
Beans 2,00 1.20* 0.90 -6.18
Milk None 0.07 0.33 —
Note: *Signifícantíy different from MOE standard (p < 0.01)
The boarding schools menus offered beef ranging from two to five times per week while non-boarding schools offered it ranging from once to four times per week. AII the
schools offered beef in thefr weekly menus. Two out of 22 (9.09%) of the boarding
schools and all the non-boarding schools offered beef at or above the required number of times suggested in the MOE menu plan. The mean number of times that boarding schools provided beef in menus per week was 2.64 and by non-boarding schools was 2.33, which
are significantly lower than the MOE suggested four times and significantly higher than
the twice per week (t = - 7.55 with p < 0.001 and t = 3.71 with p < 0.001) respectively.
These mean values indicate that beef was offered more frequently at the non-boarding
schools, therefore slightly exceeding the MOE recommended level of twice per week.
139 AII 67 schools in the sample included chicken at least once per week, and approximately 30%) of the schools included it in meals more than once per week. The boarding schools included this food item once to twice per week and non-boarding schools once to three times per week in menu plans. The mean number of times that chicken was included in menu plans was 1.32 at boarding schools and 1.24 at non- boarding schools, which are significantly higher than the recommended once per week
(t = 3.13 with p < 0.005 and t = 3.39 with p < 0.001) respectively. Because chicken is considered a special food commodity, this could have contributed to it being included at a higher frequency than the MOE recommended. Chicken also is commonly served with rice, hence the similarity in the high compliance by all the schools to include both these foods in menu plans per week as recommended by the MOE.
Beans, a source of second-class protein, was used to substitute for beef in school meals and was included in boarding schools within a range of once to four times a week and zero to three times per week in non-boarding schools. Six (27.27%o) of the boarding schools and 16 (35.56%)) of the non-boarding schools that ahogether constituted about one-third of the sample, included beans at or above the number of tímes per week suggested by the MOE. The mean number of times per week that this food item was included in menus was 1.95 and 1.20 in boarding and non-boarding schools respectívely.
These mean values for serving beans are offered at a significantly lower frequency than the MOE standards of thrice per week at boarding schools and that of twice per week at the non-boarding schools (t = - 5.46 and t = - 6.18 with p < 0.001 for both cases).
Because beans were not offered by the majority of the schools at the required number of
140 times recommended by the MOE, this is an indication that altematíve sources of Body
Building nutrients are not fully utilized to provide variety and balanced meals.
With the exceptíon of two non-boarding schools, milk was not included in weekly menus at the schools. As little as two tablespoonfials of milk were reported having been included in hot beverages such as tea, coffee, or cocoa at most all the schools. Little or no milk in school menu plans indicates that this important source of nutrients including protein, minerals, and vitamins is not utilized to enhance and/or maintain the nutritional and health status of the students in Botswana jimior secondary schools. A graphical comparison of the number of times per week Body Building foods were offered in
Botswana boarding and non-boarding schools is presented in Appendix L.
Other Body Building Foods
Eggs, canned fish, and tripe/offal (variety meats) were included once per week in menu plans by less than 10%o of the sample. Although these food items were not included by a significant number of schools, it is an indication that schools can provide variety in the meals they offer their students. This also, however, may indicate that schools prefer including foods that are listed in the MOE menu plan to foods that may be available regionally.
Some Body Building foods were included in menu plans at or above the required number of times per week suggested by the MOE, while others were included at levels below the required number of times per week. Despite the differences in individual
141 offering from Body Building foods, many schools are providing adequate or more foods from this food group to the students.
Protective Foods
Vegetables (i.e., raw and/or cooked cabbage, pumpkin, and mixed vegetables) and fi-uits (i.e., apples and oranges) were listed in the MOE menu plan and represented the
Protective food group. According to the MOE, cabbage should be included twice per week in the boarding school menu plan and once only in that of the non-boarding schools, piunpkin and apple once only in all the schools, and oranges twice in boarding schools vs. none in non-boarding schools. Tables 4.7 and 4.8 report the mean and the t- test values comparing weekly Protective foods offered between boarding schools and non-boarding school meal plans and the MOE menu plan standards.
142 Table 4.7: t-test Comparisons of Times per Week Protectíve Foods were Offered Between the Boarding Junior Secondary Schools and the Ministry of Educatíon in Botswana (N = 22)
School Meal Plans
Food MOE Standard Mean SD t value
Cabbage 2.00 2.90* 0.90 4.31
Pumpkin 1.00 0.40* 0.70 -4.16
Apples 1.00 0.90 0.60 -1.00
Oranges 2.00 0.30 0.70 1.00
Note: *Significantíy different from MOE standard (p < 0.01)
Table 4.8: t-tests Comparisons of Times per Week Protective Foods were Offered Between the Non-Boarding Junior Secondary Schools and the Ministry of Education in Botswana (N = 45)
School Meal Plans
Food MOE Standard Mean SD t value
Cabbage 1.00 1.84* 1.09 4.93
Pumpkin 1.00 0.10* 0.30 18.96
Apples 1.00 0.60* 0.60 -4.63
Oranges None 1.00* 00 ~
Note: *SignifrcantIy different from MOE standard (p < 0.01)
143 Boarding schools included cabbage ranging from once only to four tímes per week in menu plans. Except for one, all boarding schools included cabbage at or above the required twice per week recommendation by the MOE. The non-boarding schools included this vegetable ranging from zero to fíve times per week in menus. Twenty-one
(95.45%)) of the boarding schools and 26 (57.78%) of the non-boarding schools met or exceeded twice and the once only per week offer that the MOE suggested cabbage should be included in weekly menus at these schools. The mean number of times that cabbage was offered in the boarding school menus was 2.86 and 1.84 at non-boarding schools.
These mean values are a signifrcantly higher frequency than the MOE recommendation
(t = 4.31 and t = 4.93, respectívely with p < 0.001 for both cases), an indicatíon that the schools that included cabbage in menu plans did so more frequently than the MOE recommendation. This could be attributed to cabbage being a commonly used vegetable in the diet of Botswana.
According to the MOE, pumpkin should be included once only per week in boarding and non-boarding schools menu plans. Only seven (31.80%) of the boarding schools and two (4.40%)) of the non-boarding schools met or exceeded the once only per week that pumpkin was to be included in the schools' weekly menus. That the mean value for offering pumpkin was 0.41 for boarding schools and 0.07 at non-boarding schools indicate that this vegetable was offered at a signifícantly lower frequency than the MOE recommendation of only once per week (t = - 4.16 and t = -18.96, respectívely with p < 0.001 for both cases).
144 Similarly, the MOE included apples once per week in menu plans for all the schools. Sixteen out of 22 (72.73%)) of the boarding schools and 25 out of 45 (55.56%o) of the non-boarding schools included apples at least once per week in their menu plans. The mean values for offering apples were 0.86 at boarding schools and 0.60 at non-boarding schools. The mean value for offering apples is not signifícantly different from the once per week that the MOE recommended for boarding schools (t = -1.00 with p = 0.33) while at non-boarding schools it is signifícantly lower than this recommended offer
(t = -4.63 withp< 0.001).
In general, very few schools included apples and pumpkin in their menu plans per week. Because apples and pumpkin are common ingredients in the Batswana diet, failure to include them in school menus could be attributed to a probable lack of funds and/or the foods not being in season, particularly pumpkin.
The MOE suggested that only boarding schools include oranges twice per week in their menu plans. However, because oranges are the cheapest finits imported into
Botswana, some non-boarding schools also included them in the students' menus. A total of 14 schools, approximately 21%o of the sample offered oranges no more than twice per week in the menus at all the schools that included them. The mean value of 0.30 at boarding schools and that of 1.00 at non-boarding schools indicate that schools, and specifícally boarding schools, are not including oranges at the level recommended by the
MOE.
The MOE recommended that the menus in boarding schools include mixed vegetables only six times per week in the form of soup at breakfast. None of these
145 schools complied with this MOE recommendation, possibly because it is not common for soup to be included in the Botswana nationals' diet and because soup is not often served at breakfast. AII the boarding schools substituted mixed vegetables with a cereal product, mainly bread, com or sorghum products that are commonly included in breakfast meals.
Although bananas were not included in the MOE menu plan, seven or approximately
1 \% of the schools included bananas in their menus only once per week. A graphical comparison of number of times per week Protectíve foods were offered in Botswana boarding and non-boarding schools is presented in Appendix M.
Even though foods from the Protective food group, particularly fraits, were not included in menu plans by some of the schools, other schools included them in adequate amotmts. Unfortunately, limiting or excluding fi-uitsan d vegetables in meals negatively impacts the students' nutritional and health status.
Food Group Proportions
The foods included in school menus were grouped and identified as Energy
Giving, Body Building or Protectíve food groups depending on the number of times each school included them in menu plans. The food group proportions enabled the researcher to compare the nutritional quality of meals offered to students at the Botswana junior secondary schools with the national food group standards. The food group proportions based on the menu plans recommended by the MOE and the national standards have been reported earlier (Table 4.2) in this chapter.
146 Presented in Figure 4.1 are the percentages of the boarding schools and the non- boarding schools that met or exceeded the food group proportions required on the MOE menu plan. Figure 4.2 illusfrates the percentages for the boarding and the non-boarding schools that met or exceeded the food group proportions stipulated on the national standards. These food group proportions have been discussed earlier in this document.
100 100 D Boarding Schools 80 62 58 D No-Boarding Schools - 60 49 o o o 40
20 5 9 1 1 Energy Body Protective Giving Building Foods Foods Foods
Figure 4.1: Schools Meeting or Exceeding MOE Meal Plan
147 100 98 D Boarding Schools 80 - • No-Boarding Schools 64 59 58 60 - o o - O 40 32 00 20 0
Energy Body Protective Giving BuiMing Foods Foods Foods
Figure 4.2 Schools Meeting or Exceeding National Standards
One himdred percent of the boarding schools met or exceeded the 55%) level the
MOE recommended for the Energy Giving foods while 49% of the non-boarding schools met or exceeded the 56%o requirement set for them by the ministry. While only five percent of the boarding schools provided the Body Building foods at or exceeding the
MOE required level of 23%o, the majority (62%o) of the non-boarding schools met or exceeded their targeted level of 28%o. The ministry's recommended proportion level of
21%) for Protective foods in menus was achieved or exceeded by only nine percent of the boarding schools, and the proportion of 17%o for this same food group recommended for non-boarding schools was met or exceeded by 58% of these schools.
In general, the boarding schools satisfied the level of the Energy Giving food group proportion in their menu plans as recommended by the MOE but did not satisfy those for the Body Building and the Protective food groups. The non-boarding schools
148 provided more foods from the Body Building and the Protective food groups than what the MOE recommended in the menu plan. AIso, more non-boarding schools provided foods from these food groups in the meals at or above their required level than did the boarding schools.
As shown in Figure 4.2, 59%o of the boarding schools included the Energy Giving foods at or above the 61% natíonal standard level while none of the non-boarding schools met this requirement in their menus. Sixty-four percent of the boarding schools and 98%) of the non-boarding schools, respectívely, met or exceeded the \1% set on the natíonal standards for the Body Building food group. Shghtly over 30% of the boarding schools and close to 60%) of the non-boarding schools satisfred the national standards of 17% for the Protective food group proportion in menus.
Although some schools included proportions of the food groups as required, the portion sizes served to students may have been inadequate, particularly the Protective foods such as salads. The school food service supervisors estimated that cereal products were served generously using cup measures, while vegetables were served using tablespoon measures at the schools. The FCS/HE teachers provided expert information on whether or not meals included in feeding programs at the schools where they taught were balanced. They observed that the Body Building and the Protective foods were not represented daily in student menus, and that serving sizes were generally too small.
Research Ouestion Three What factors contribute to the compliance of school feeding program menu plans with those written by the MOE and the national food group planning standards?
149 Data from Sectíon A and Section B were subjected to multíple linear regression analyses to determine significant effects on Energy Giving, Body Building, and
Protective food group proportions (dependent variables) by the independent variables.
The food group proportions, which were computed from the various foods offered in the school menu plans, were the dependent variables. Proportions, expressed in percentages, were the numbers of times foods represented each food group divided by the overall total number of times that foods were offered to students in school meal plans. The number of years the supervisor worked in the supervisory position at the school, his/her age group, the size of the location where the school was situated, the number of people constítuting the kitchen staff, and the student population were the independent variables.
While the supervisors' work experience, the number of the people constituting kitchen staff and the student population were treated as numerical variables, the numbers
1-5 were used to identífy the supervisors' age group and the size of the locations in which the schools were situated. More specifically, the following ordinal scale was used for the age group: 1 = 24 years or younger, 2 = 25-29 years of age, 3 = 30-34 years of age, 4 = 34-39 years of age, and 5 = 40 years or older. To identífy the size of the locatíon in which the school was situated: 1 = smaller village/settlement; 2 = small village;
3 = large village; 4 = town; and 5 = city. Although this method is typically used for coding ordinal categorical variables, it has a drawback. The scale assumes that the difference in size between a town and a city is the same as the difference in size between a large village and a town, and the same as the difference in size between a small village
150 and a large one, and the same difference between a small village and a smaller village/settlement. However, in this study, this may not be trae.
The summaries of multiple regressions for variables influencing the proportions or percentages in meal plans offered weekly to students in junior secondary schools are reported in Table 4.9 for the Energy Giving foods, 4.10 for Body Building foods, and
4.11 for Protectíve foods. Only the number of kitchen hands or cooks working at the schools signifícantly influenced the nutritional quality of Energy Giving, Body Building and Protective foods offered weekly in meals included in the feeding programs in
Botswana jtmior secondary schools. The amount of varíance in food group proportions accounted for by the five independent variables were 25%o for Energy Giving, 28%) for
Body Building, and 8%o for Protective foods.
Table 4.9: Summary of Multiple Regression Analysis for Variables Influencing Energy Giving Foods Offered in Junior Secondary School Weekly Meal Plans in Botswana
Variable Un-standardized Beta Standard Error Standardized Beta
Years worked -.0009 .003 -.040
Age group .007 .011 .074
Location size -.004 .010 -.056
Number of kitchen staff .030* .009 .465
Student population -.00007 .000 -.123
* Significant at p < 0.05 R^ = .245
151 Table 4.10: Summary of Multiple Regression Analysis for Variables Influencing Body Building Foods Offered in Junior Secondary School Weekly Meal Plans in Botswana
Variable Un-standardized Beta Standard Error Standardized Beta
Years worked -.0004 .002 -.031
Age group -.003 .007 -.061
Location size .010 .006 .240
#of kitchen staff -.020* .005 -.389
Student population .00002 .000 .053
* Significant at p < 0.05 R^ = .284
Table 4.11: Summary of Multiple Regression Analysis for Variables Influencing Protective Foods Offered in Junior Secondary School Weekly Meal Plans in Botswana
Variable Un-standardized Beta Standard Error Standardized Beta
Years worked .001 .002 .083
Age group -.003 .009 -.051
Location size -.007 .008 -.128
#of kitchenstaff -.020* .007 -.310
Student population .00005 .000 .125
*Signifícant at p <0.05 R^ = .081
152 Research Question Four
What is the nature and extent of FCS/HE teacher participatíon in the school feeding programs?
To address this question, numeric scoring was used to identify the feeding program-related activities in which the FCS/HE teachers participated at their schools. The activities were reported by the school food service supervisors depending on whether or not the FCS/HE teachers assisted them in the identifíed activities that included menu planning, making decisions on modifying menus, and/or providing in-service training to food service staff at the school level. The FCS/HE teachers also were asked to indicate whether or not they were assisting the school food service staff in the actívitíes that they thought would positively impact program delivery particularly its nutritional quality. The teachers were specifrcally asked about their involvement in assisting school food service staff with menu plarming, actual preparation of meals, food purchasing, and providing in- service training to the food service staff at the schools where they taught.
The MOE menu plan was used in all 67 junior secondary schools where the data were obtained. Twenty (30%)) of these schools used the menu plan as it was and the other
47 (70%o) used it with some modifícatíons or changes. As shown in Table 4.12, the school administrators took the lead in deciding what modifícations were to be made on the school menu plans. The cooks and the students were more likely to be consulted than the
FCS/HE teachers on deciding what changes needed to be made. Other stakeholders making decisions included other teachers, catering committee members, matrons, and assistant administrative staff The level at which the FCS/HE teachers were consulted in
153 matters related to school menu plan modifícations indicates that they were not actively
involved in this important matter. Therefore, it seems as though the school authoritíes
may not be using specialized teachers' expertise to guide menu plamiing. It also is
unclear who is responsible for making sure that balanced meals, aimed at enhancing and
maintaining the nutritional and heahh status of the recipients (the students), are provided
for feeding programs implemented at junior secondary schools.
Table 4.12: Menu Plan Modifícation Decision-Makers at Junior Secondary Schools in Botswana
Decision Maker Title Frequency
School Administrators 40
Cooks 14
Students 13
FCS/HE Teachers 7
Other Teachers 7
Catering Committee 7
Matron 2
Supplies Offrcer 2
Bursar 2
154 Approximately 29%) of the school food service supervisors indicated that they received in-service fraining to enhance feeding program-related skills. The in-service training was more likely to be provided by the FCS/HE education offícers based at the
MOE headquarters than from their teacher counterparts who were based at the secondary schools. Matrons, govemment auditors and accountants also provided the in-service training. The FCS/HE education offícers probably provided the in-service training because they are charged with the responsibility of the professional development of school food service supervisors. The number of times that the FCS/HE teachers participated in providing in-service training to school food service staff indicates that they were not actively involved. This also could indicate little or no collaboration of stakeholders in ensuring that school meals are balanced for positive effect on students' leaming as well as their physiologic development.
The 125 FCS/HE teachers were asked to indicate the nature of the activities in which they were involved that they thought would positívely impact feeding program delivery, particulariy in the area of nutritíonal quality. A total of 123 (98.4%) FCS/HE teachers supervised students during meal times as part of routine duty. This activity enabled these teachers to observe the foods that were included in the menu plans at their schools. Approximately 61% of the teachers who supervised students during meal times believed that menus planned at their schools did not result in balanced meals for the students compared to 39%o who believed that meals were balanced. The 61% of the teachers who believed that meals were not balanced also believed that all the major food groups, Energy Giving, Body Building and Protective, needed attention in order for the
155 school menu plans to provide well balanced meals to students. All of these teachers observed that the menu plans provided meals with too large amounts of Energy Giving foods while 46% and 53% believed that the amounts of Body Building and Protectíve foods were too small respectively. It also was the belief of all the teachers who observed food group imbalances that the Body Building and the Protective foods were lacking in meals on some days.
Fifteen percent of the FCS/HE teachers reported that they participated in and ensured that the feeding program at the schools where they taught provided students with balanced meals. Eleven (9%o) of these teachers assisted in menu plarming and provided guidance in food purchasing; six (5%)) provided in-service training to the food service staff; and two (2%o) helped identify outlets where the schools could purchase foods that were used to cook students' meals.
The majority (84%)) of the teachers indicated that they were not involved in the feeding programs. A total of 90 (72%o) of the teachers did not participate because they were not asked and/or did not serve on the school's catering committee. Twelve (10%)) of these teachers indicated that participating in the program was not part of their job, four
(3%o) had no time, and four (3%) believed that menu planning was the responsibility of the MOE.
Asked whether or not they would participate if they were requested, almost all
(about 97%)) of the teachers indicated they were willing to be involved. The FCS/HE teachers would be wiUing to participate in feeding program-related activities, including menu planning to ensure that meals are balanced; guiding the food service staff in matters
156 related to purchasing food; providing in-service training with emphases on food, personal and kitchen hygiene, and batch cooking; and preparing meals for students.
In general, the teachers were not involved in feeding programs. With proper planning and communication, there is a clear indication that teachers are willing to participate if they were asked to do so. As the employer, the MOE could make participating in feeding programs part of all FCS/HE teaching positíons at the schools where they teach, or could include this job descriptíon of FCS/HE teachers in designated positions of responsibility such as the head of department (HOD). At the school level, teachers would participate if they were members of the committees that are responsible for the welfare of the students, and especially student feeding.
Research Ouestion Five
Is there a difference in the compliance of menus with the national food group
menu planning standards between junior secondary schools where FCS/HE teachers are
involved and where they are not?
This question was answered using ranges and averages of proportions of Energy
Giving, Body Building, and Protective food groups. The food group proportions were
computed separately for the junior secondary schools where FCS/HE teachers reported
that they participated in school feeding programs and for those schools where teachers
did not participate.
Nineteen teachers reported participatíon from 17 (slightly over 25%) of the
schools from the fíve education regions in Botswana. Five teachers were from five
157 schools in the cenfral region, two from two schools in the north, four from four southem region schools, four from three south central schools, and four teachers were from three schools in the westem region. The representation of schools by the regions was reported earlier in this document.
The schools where FCS/HE teachers participated in feeding programs included meals with a proportion for the Energy Giving food group ranging from 44%-72%o, Body
Building 14%o-28%o, and Protectíve food group ranging from 7%o-33%. The groups of foods in the schools that reported non-teacher participation in feeding programs were included ranging from 36%o-83%) for Energy Giving, Body Building 12%-38%o, and
Protective food group 5%o-32%) in menus. On average, menus in schools were similar regardless of FCS/HE teacher participatíon in feeding programs. Table 4.13 reports the food group sample average proportions for Energy Giving were 58% vs. 60%o, Body
Building 23% vs. 25%o, and Protective 20% vs. 16% for schools where FCS/HE teachers either participated or did not.
158 Table 4.13: A Comparison of Food Group Proportion Averages Between Schools' Menu Plans With or Without FCS/HE Teacher Participation and National Standards
Menu Plan Food Group Proportion Averages
Energy Giving Body Building Protectíve
(%) (%) (%)
National 67 17 17
Teacher Participation 58 23 20
No Teacher Participation 60 25 16
Average proportions for each food group in schools with FCS/HE teacher participation and schools with no teacher participation were computed using independent
samples t-tests. The analysis showed: t = - 0.82 (p = 0.42) for Energy Giving, t = - 1.33
(p = 0.19) for Body Building, and t = 1.89 (p = 0.07) for Protective food group. No signifícant differences were noted between schools with or without FCS/HE teacher participation. With or without participation in school feeding programs by the FCS/HE teachers, on average all schools provided Energy Giving food proportions slightly below the level recommended by the national food group menu planning standards. On average all schools, however, included the Body Building food group proportion above the recommended levels. While the schools where teachers participated also had a higher
159 average food group proportion than the national standards in the Protective food group category, the food group proportion at the schools where participation by the teachers was not recorded was neariy at the required level of 17% in their menus.
Because the meals at the schools where the FCS/HE teachers participated were not meeting the requirements of the national food group menu planning standards, this could be an indication that these teachers must follow certain regulatíons that require them to not change the menu plans that exist at the schools. Thus, this does not accord them an opportunity to put what they teach into practice; nor does it impact positively the implementation of school feeding programs, specifically the nutritional content of the school meals. However, this conclusion is treated with caution since only an insignificant number of the FCS/HE teachers participated in menu modifrcations and menu plarming, activities that could highly impact feeding program delivery and particularly the nutritional quality.
Summary
AII 67 govemment-fimded junior secondary schools utilized the menu plan that the MOE provided to guide the implementation of feeding programs at these junior secondary schools in Botswana. The foods provided in the meals in the MOE and in the school menu plans were categorized into the Energy Giving, Body Building, and
Protective food groups.
The national standards require that a balanced meal should consist proportionally of approximately 61% Energy giving and 17% each of the Body Building and the
160 Protective food groups. The analysis of the list of foods provided in the MOE guidelines established that menu plan consisted proportionally of 55% Energy Giving, 23%o Body
Building and 2I%o Protective foods for boarding students. The MOE included meals that were proportionally 56%) Energy Giving, 28% Body Building and 17% Protectíve foods for non-boarding students. These proportions indicated that the MOE recommended a menu plan that included Energy Giving foods at a proportion below that which was required in the national standards, and above that of which was required of Body
Building foods. The MOE also included meals with a higher proportion of Protective foods than required by national standards in the non-boarding school menu plan, while providing it at the required level in boarding school menus.
The nutritional quality of meals at the Botswana junior secondary schools were evaluated by categorizing foods offered. A proportion of each food group was calculated based on the frequency by which specific foods were offered in each food. The food group proportions were then judged against the food-group national menu plan standard used for this purpose in Botswana.
In general, the boarding schools included meals with adequate Energy Giving foods proportion. However, only a small number of schools satisfied the Body Building and the Protective food group proportions required by both the natíonal and MOE standards.
Although the proportion of the Energy Giving food group was adequately included in menu plans by all the boarding schools, all the schools did not adequately include the other two food groups. For instance, the FCS/HE teachers observed that foods
161 from the Body Building and the Protective food groups were not provided daily in menu plans. The estimated portion sizes by the school food service supervisors also indicated small amounts were being served to students. Therefore, a conclusion that indicates that adequate proportions for these food groups were included in some of the schools' menu plans should be freated with caution.
Multiple regression analyses were performed on food group proportion data and five predictors: the number of years that the supervisor worked in a school food service supervisory position, his/her age group, size of the place where the school was located, student populatíon, supervisor's age group, and the number of kitchen staff working at the school. Only the number of people constítuting the catering staff influenced the
Energy Giving, Body Building, and the Protective foods offered in school meal plans.
When asked about participation in feeding program-related activities at the schools, only a very small percentage of the FCS/HE teachers reported involvement with menu planning, in-service training, and food purchasing. Most of these teachers seemed to be willing to assist, particulariy in ensuring that balanced meals were included in the menu plan, and also in providing in-service fraining to the catering staff These activities have the potential for enhancing program delivery and specifically, nutritional quality.
Average proportions for the Energy Giving, Body Building, and Protective food
groups provided in menu plans at the 17 junior secondary schools where the 19 FCS/HE teachers participated were compared with the average proportions at the 50 junior schools where the teachers did not participate. The schools where FCS/HE teachers participated
included meals that provided a slightly higher proportion of Protective foods in the menu
162 plan than is required in national standards. In summary, the food group proportions were not greatly changed by the participation of the FCS/HE teachers in school feeding programs.
163 CHAPTER FfVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
This chapter presents a summary of the study, including the problem, purpose, fmdings, implications and conclusions based on the analysis of the data. Limitations and recommendations for future research also are presented.
Summary of the Study
The primary purpose of this study was to investigate the nutritional quality of meals offered in Botswana govemment-funded junior secondary schools. In addition, the study determined whether or not participation by Family and Consumer Sciences/Home
Economics teachers in feeding programs makes a difference in the nutritional quality of
these meals. The study provided baseline information that was used to describe feeding
programs currently existing in Botswana junior secondary schools. Specifically, the
research questions investigated in the study were:
1. How do the meals included in the Ministry of Education (MOE) menu plan
written for junior secondary schools compare with the food-group national menu
plarming standards?
2. How do the schools feeding program menu plans compare with the MOE and
with the food-group national menu planning standards?
3. What factors contribute to the compliance of school feeding program menus with
the food-group national menu planning standards?
164 4. What is the nature and extent of FCS/HE teacher participatíon in junior secondary
school feeding programs?
5. Is there a difference in the nutritíonal quality of meals in junior secondary schools
where FCS/HE teachers participate and where they do not?
The review of the literature indicated that school feeding programs are a common phenomenon in both developed and developing countries. These programs were initiated primarily to enhance the nutritional and health status of school children, as well as to enhance their academic performance. To improve program delivery and realize goals of these programs, developed countries periodically evaluate school feeding programs.
Because there is limited research that investigated the nutritional quality of feeding programs in schools in developing countries, undertaking this study was a worthwhile research endeavor. Additionally, results of the review of the literature indicated that virtually no research had been conducted in Botswana schools to analyze the nutritional quality of meals students receive, nor had there been any research investigating the impact that participation by FCS/HE teachers in school food programs has on the nutritional quality of school meals. A somewhat global perspective was used to study the problem of nutritíon in the schools. Therefore, this study filled this gap by addressing these issues.
Survey data were collected from a proportional stratified random sample consisting of 67 food service supervisors and 125 FCS/HE teachers at 67 Botswana govemment- fimded secondary schools. AII 67 schools utílized the Ministry of Educatíon menu guidelines.
165 Of the 67 schools, 29.9% were from the central, 23.9% south central, 17.9% each
from the northem and southem, and 10.4% from the westem regions. Twenty-two
(32.8%) of these schools had boarding facilities and 45 (67.2%) did not. The majority
(80.6%)) of the junior schools were situated in raral settings and the remaining 19.4% in urban settings. Respondents from these schools were 67 school food service supervisors and 125 FCS/HE teachers.
Of the 67 school food service supervisors, the majority (71.6%)) were female.
Almost all (98.6%)) of the supervisors were at least 25 years of age. The majority (65.7%) of the supervisors held assistant administratíve positions, and 62.1% of them had no food-related training. The fact that the majority of supervisors were not trained for the job has implications for limited capability in identifying and addressing problems in the school feeding program.
Of the 125 FCS/HE teachers, 98.4%o were female and 1.6% were male. Ninety-six percent (120) of the teachers were at least 25 years old. A total of 120 (96%)) of the teachers had post-secondary qualifrcations in FCS/HE-related training including diplomas in Home Economics, Bachelor of Science in Home Economics Education, and Bachelor of Science in Consumer Studies. The FCS/HE teachers were administrators, heads of
Home Economics/Practical subjects, senior teachers, assistant teachers, and temporary teachers. The teachers' teaching experience ranged from three months to over 24 years.
Because FCS/HE teachers teach at the junior secondary schools, there is an implication that their food-related expertise could be used to improve the quality of feeding programs.
166 Two survey instraments were used in the study. The Menu Quality Survey was adapted from a food frequency questionnaire designed specifically to assess the food intake of the designated populations. Of the seven sections included in the instrament, the food account sectíon was used to obtain data pertinent to the specifíc foods and serving portion sizes offered to the students in Botswana junior secondary schools. The Teacher
Participation Stu^ey was developed by the researcher to obtain data from teachers on activities describing their involvement in school feeding programs and how these activitíes impact the nutritíonal quality of meals.
Descriptive statistics (frequencies, means, ranges, SD, and numeric scores) were used to identify and categorize foods into Energy Giving, Body Building and Protective food groups that were used as the basis for comparing the MOE and the schools menu plans with the food-group national menu plan standards. Numeric scoring also was used to identify school feeding program-related activities in which FCS/HE teachers participated. Inferential statistics (one-sample t-tests, multiple regression, independent samples t-tests) were used to determine signifrcant differences between the MOE, school menus and the national menu plan standards.
Summary and Discussion of Findings and Implications
Global studies showed that not all children receive meals that are in accordance with intemational standards. In the developing countries such as the United States (Baker et al, 1997; Barghart & Devaney, 1993; Fox et al, 2001; Ho et al, 1990; Hoover et al,
1998; Wildey et al, 2001) and in Europe (Colqohoun et al, 2001; De Vito et al, 1999;
167 Soriano et al, 2000) school meals provided nutrients exceeding the American and the
European standards. AII the nutrients associated with chronic diseases, fat, cholesterol, sodium, sugar and calories, were provided in excess. Excesses were contributed to by the plentitude of food choices from a variety of meal sources including a la carte menus from cafeterias, vending facilities, and sack lunches brought from home. Conversely, schools from the developing countries provided meals below the intemational standards set by intemational organizations including the WHO, FAO and UNICEF.
Because students from developed countries typically receive more than recommended amotmts, they become overweight and/or obese. On the other hand, stíadents from some developing countries receive less than the recommended amounts, which sometimes result in nutritional problems such as stunting and/or underweight.
To respond to research question one, the foods listed on the MOE menu plan were first categorized into the Energy Giving, Body Building and Protective food groups depending on the major nutrient they contain, expressed into proportions, and then compared with the food-group national menu plan standards. The foods were separately categorized and expressed into food group proportions for boarding and non-boarding schools as indicated on the MOE menu plan.
The food-group national menu plan standards require that balanced meals consist proportionally 67%o Energy Giving, \1% each Body Building and Protective foods. The
MOE planned menus for boarding schools proportionally consisted of 55% Energy
Giving, 23%) Body Building, and 21%o Protective foods. The meals this ministry
168 department planned for non-boarding schools consisted proportionally of 56% Energy
Giving, 28% Body Building, and 17% Protective foods.
Overall, the MOE planned menus were below menu standards in energy providing
foods. However, the MOE menu plan presented proportions of the Body Building and the
Protective food groups in excess of what is required in the national standards. This reflects the FAO (1997) belief that utilizing food groups is not necessarily the best way to improve meal quality and prevent under nutrition. Rather than solely relying on food groups that have traditionally been used to plan balanced meals, FAO suggests that other altemative methods should be explored and used for this purpose. For instance, the food guide pyramid that is used in the United States is an expansion of the food groups that makes meal planning easier and could be adapted and used in Botswana.
According to Rolfes, DeBrayne & Whitney (1998), the versatíle feature of protein, the main constituent in Body Building foods, enables it to be converted and used for energy. Therefore, it could be argued that the excess Body Building foods offered in the MOE menu plans could be used to supplement the energy that is inadequate in the ministry's planned menu. Because Body Building foods are more expensive than the traditional energy food sources such as cereals (Chengeta et al., 1999; FAO, 1997), the
MOE is using the expensive food sources to supplement energy/caloric needs in school menus. Planning menus with adequate nutrients utilizing foods from cereals and cereal products would be cost effective and at the same time could provide energy/caloric needs.
Detailed guidelines, similar to those on the American food guide pyramid or Chinese
169 pagoda, on how to use the food groups when planning meals would also assist the MOE in this endeavor.
Research question two sought to compare the school menu plans with the MOE menu plan and with the national food-group menu planning standards. A similar procedure to categorize foods into the three food groups, according to boarding or non- boarding school status, was followed to group the foods offered at the schools.
AII of the boarding schools and 49% of the non-boarding schools provided
Energy Giving foods in amounts that met or exceeded the MOE requirements. While all schools included rice as recommended by the MOE, none of these schools included mashed potatoes from this food group in the menus. Only 5% of the boarding schools and
62%) of the non-boarding schools met or exceeded the MOE requirement for the Body
Building food group. All the schools included chicken in their menus while only two of the 67 included milk in menu plans. Only a few schools provided fish, eggs and variety meats as altemative Body Building food sources, an indication that schools have potential to provide variety in meal planning. Nine percent and 58%o of the boarding and non- boarding schools, respectively, included the Protective food group at or above the required level in meals.
Only 59%) of the boarding schools met or provided the Energy Giving foods while none of the non-boarding schools did as required by the national standards. The national standards as required for the Body Building were met or exceeded by 64% of the boarding schools and 98% of the non-boarding schools. Protectíve foods were met or
170 provided in excess of the national requirement by 32% of the boarding schools and 58% of the non-boarding schools.
There is an indication that schools are not following the guidelines established in the natíonal standards when planning and implementíng feeding programs. Because the
MOE provides a list of foods to include in the menu plan, the schools could fínd it easier to follow this plan than the national standards where only food group percentages are provided as guidelines. Therefore, failure to meet the national standards in the schools' feeding programs by may be related to the fact that the MOE does not have a detailed national descriptive food list that should be followed when making menu plan recommendations to the schools.
Other contributing factors for schools not meeting the national standards could be the remoteness of the schools' locatíons where there is limited or no accessibility to supermarkets to purchase supply. Another problem is that some foods such as fi-uitsan d vegetables are seasonal and are unavailable at certain times of the year. Because the
MOE is the sole sponsor of the school feeding program, it also is possible that limited fimding may have contributed to the schools' failure to include foods at the required levels.
As indicated by the mean number of times, most of the food items were offered less frequently than the MOE stipulated. Offering food items less frequently in junior secondary schools could emanate from similar problems that beset the new school feeding program existing in Botswana primary schools. The Botswana Daily News (June
19, 2003) reported a number of problems at the schools including poor or irregular supply
171 of food items and poor quality of food items. Despite differences in individual offerings, overall, schools provided adequate foods from the Body Building and Protective food groups in school menus. However, when examined from the perspectíves of quantíty and the frequency by which foods from the Body Building and Protectíve food groups were provided, serving sizes reported by the supervisors were generally too small. hi additíon, these food groups were not daily represented in menus, according to expert FCS/HE teacher observation. This finding concurs with Ene-Obong's study (1993) that reported that small portion sizes were consumed less frequently at Nigerian schools. Even though some of these meals could provide adequate nutrients, their small portion sizes that were served less frequently than required, defeated the potential that these meals had in providing adequate nutrients to the students in this country.
Research question three examined factors contributing to the compliance of school feeding program menu plans with the national food group plarming standards.
Findings indicated that only the number of kitchen staff working at the schools influenced the foods from the Energy-Giving, Body Building, or Protective food groups offered in school menu plans. Seaman, Bower & Fleming's (1997) research determined that educated and skilled school food service personnel who also receive continuing education impact nutrient content of meals. Unfortunately, the Botswana junior secondary school food service staff is neither trained nor receives continuing education.
Although this was made in conjunction with primary schools, the Botswana Daily News
(June 19, 2003) also confrrmed that the catering staff at the schools lacks expertise in matters related to food handling in this country. Therefore, working along Seaman,
172 Bower and Fleming's fíndings, the nutritional quality of the meals offered at the junior secondary schools would have been even better, had the catering staff at these schools in
Botswana been educated and also receiving continuing education.
The nature and extent of FCS/HE teacher participation in the school feeding program were examined in research question four. Numeric scores of the activities revealed that only 19 of the 125 (15.20%o) teachers reported being involved in feeding program-related actívities at the schools where they taught. Eleven (8.80%) assisted with menu plarming, six (4.80%o) provided in-service training, and two (1.60% helped the school identify supermarkets where food could be purchased. Most reported that they did not participate because they had not been asked, neither were they placed on committees responsible for the students' welfare. FCS/HE teachers unanimously said they would be willing to assist if asked, particularly in providing in-service training on nutrition and in ensuring that balanced meals were included in menu plans.
Research question frve examined the menus in junior secondary schools where
FCS/HE teachers were involved in the implementation of school feeding programs and in the schools where they were not in order to determine if the presence of the teachers made a difference in the nutritional quality.
Nearly all (98%) of the teachers supervised students during meal times. Other activities where the FCS/HE teachers were involved were examined and reported in question four. The menus at schools where teachers participated included Energy Giving food proportion ranging from 44% 72%, Body Building 14% - 28%, and Protective 7%
- 33%). Schools where non-teacher participation in programs was reported included food
173 group proportions in the ranges of 36% - 83% for Energy Giving, 12% - 38% Body
Building, and 5%o - 32% for Protective. hi comparison, the food group sample average proportions for teacher participatíon vs. non-teacher participation were 58%) vs. 60%o for
Energy Giving, Body Building 23% vs. 25%, and Protective 20% vs. 16%.
In general, the food group proportions required for good nutrition were not greatly changed by the participation of the FCS/HE teachers in school feeding programs. This finding is not consistent with Hori et al (2001) and Florencio's (2001) studies that concluded that teachers who had positive attitudes and participated in feeding programs positively impacted program delivery at the schools. However, from this researcher's perspectíve, the type of the actívities FCS/HE teachers participated in were not conducive to signifícantly changing the nutritional quality of meals at the schools. Additionally, few
FCS/HE teachers participated in making decisions on menu modifrcations and plarming menus at the schools where they teach. Therefore, the conclusion that participation by
FCS/HE teachers did not change the nutritional quality of meals offered in schools should be treated with caution.
Conclusions
Based on the fíndings in this study, various factors related to school food service have implications on the physical, mental and academic well being of students. The following conclusions were supported by this research:
174 1. The MOE provided a menu plan that was followed by the schools in Botswana when implementing feeding programs. However, the plan does not adequately provide
Energy Giving food group proportions as required by national food group standards.
2. Body Building and Protective food groups are not represented daily in student menus. Serving sizes also are generally too small.
3. There was a tendency for schools with a larger catering staff to adequately provide foods from the various groups. Thus, providing an adequate number of kitchen service providers may impact the quality of menus. At the same time, employing supervisors who possess food-related skiUs and who also continually receive in-service fraining may impact nutrient content of meals in the schools. Other factors, including supervisor's level of training, may contribute to school feeding programs' comphance with national food group plarming standards.
4. Schools located in larger villages, towns or citíes may offer more Energy
Giving and Body Building food groups because of the availability and accessibility of supermarkets and food supplies.
5. More teachers would be willing to participate in food service activitíes, such as menu planning and in-service training of food service providers, if they were asked.
6. Food group proportions were not greatly changed by FCS/HE teacher participation.
175 Limitatíons of the Studv
The limitations of this study include:
1. A sample of limited size was used to obtain data for this study. Therefore, fíndings may be unique to the feeding programs in the schools from which the data were obtained. hnplicatíons of the fíndings may be generalized only to schools with similar characteristics.
2. The accuracy of the self-reported data collected in this study depended on the honesty of the respondents. Therefore, results and conclusions for the study were based on volunteered information provided by the respondents.
3. The analyses of nutritional quality of school menus were based on food groups,
which may not have provided suffrcient information for drawing meaningfirl conclusions
about meal quality.
4. The adapted design of the Menu Quality Survey and the design of the Teacher
Participation survey instmments had flaws identifred during the process of inputting data.
For instance, questíons with ordinal and categorical data were grouped together in most
cases. 5. The data collection process using a long-distance, "remote control" style
proved difficult. The method denied this researcher the practical data collection experience,
delayed the research process, and made personal contact with educators in Botswana
impossible.
176 6. The lack of other research on school menus in Botswana, along with the limitations of this investigation, proved challenging. Eariier research related to school menus in this country could have helped establish reliability.
Recommendation s
The following recommendations are based on the fíndings, limitations, implications and conclusions of this study.
1. Food-group natíonal standards should be up-dated along the lines of the food guide pyramids existing in other countries, including the United States. This could enhance the Botswana Ministry of Educatíon's previous attempts to address menu plarming in ways that would include adequate proportions of Energy-giving foods.
2. Menus should be planned to provide daily requirements of Body Building and
Protective food groups. The Ministry of Education might consider developing a system that utilizes foods produced during students' required practical leaming experiences in
Agricultural Science Education courses in Botswana junior secondary schools. Such a process could enhance the quality of meals offered at these schools.
3. Steps should be taken to ensure that an adequate number of food service personnel are employed. Because food-related knowledge and skills are critical in making decisions that could impact positively program delivery, employing trained food service staff and continuing to provide for their professional development also should be considered.
177 4. School administrators need to consider facilitating teacher participatíon, particularly FCS/HE teachers, in food service programs to help ensure that adequate nutíntion is provided in school meals. The food-related expertise of these teachers could improve menu plarming at the school level.
5. h is recommended that FCS/HE teachers, rather than waiting to be asked, should use their ovm expertise and initíate actívitíes designed to improve school feeding program delivery in the schools where they teach. These actívities might include assisting in menu plarming, and being involved in the actual preparatíon, cooking, and serving of meals to students. This researcher believes that such initiatives could assist in improving the nutritional quality of meals in Botswana junior secondary schools.
6. It is recommended that this study be replicated with a larger sample of schools in
Botswana to determine if results would be consistent. Similar research also should be conducted in other developing countries to determine areas in which school feeding programs need to be brought into compliance with their national food standards.
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185 APPENDIX A
BOTSWANA EDUCATION REGIONS AND JUNIOR SECONDARY SCHOOL
DISTRIBUTIONS
186 187 APPENDIX B
PROPORTIONAL STRATIFIED SAMPLE OF SCHOOLS SURVEYED
188 189 APPENDIX C
THE NUMBER OF THE ACTUAL SCHOOLS THAT RESPONDED
190 191 APPENDIX D
LETTER TO THE PRINCIPAL EDUCATION OFFICER
192 2619 19* Street, Apt.#09 Lubbock,TX 79410
May 22, 2002
Principal Education Officer, TT &D Ministry of Education P/Bag 005. Gaborone, Botswana
Dear Sir/Madam:
Students spend a greater part of the day at school leaming. To enable them to benefit from education, all Botswana govemment schools provide meals to these students. The benefit that feeding has to students' leaming is well documented. However, the nutritional quality of meals from which students benefit from education is not documented. The enclosed surveys attempt to document the nutritional quality of meals that schools provide students. It was developed for my doctoral research to investigate the nutritional quality of meals served to students in Botswana junior secondary schools. In addition, it determines the impact participation of Home Economics teachers has on the meal quality. The reasons for choosing this topic are many. This investigation will enable me to ftilfill the research requirement for the doctoral degree program while at the same time enable me to enhance my computer skills that are necessary to have when teaching students. Botswana govemment is committed to providing teachers and students all tools necessary to make them computer literate. The research will also make the stakeholders for feeding students aware of the nutritional quality of the meals schools are offering to students. Because school meals should impact positively the nutritional and health status of the students, findings firom this investigation could be used as baseline information to fiirther improve the quality of these meals. A group of sixty junior secondary schools was selected proportionally and randomly from the five Botswana education regions for this study. All Home Economics teachers at these schools also were selected to participate in this study. This letter is to request your support and assistance to distribute the surveys to these schools. The responses will be treated with the highest confidentiality as they will be totally anonymous and will not be traced back to individual schools and/or the teachers at these schools. The surveys will take school meal supervisors and Home Economics teachers approximately 35-40 minutes and 10-15 minutes respectively to complete. I would greatly appreciate it if you would extend your support by requesting school heads to encourage meal supervisors and the Home Economics teachers at their schools to complete and retum the surveys within two weeks upon receiving them. The completed surveys should be retumed to your offíce in the stamped, self-addressed envelopes bearing your name that will accompany the surveys. I would also appreciate it if all completed surveys would be retumed to me in a stamped, self-addressed envelope also included in the surveys. Thank you for your assistance. Should you have questions or concems, please contact me by telephone at (806) 747-2573 or e-mail to [email protected] or by fax at (806) 742-3042.
Sincerely,
Elsie Mosie Ginny Fesltehausen, Ph.D. Doctoral Student Professor College of Human Sciences College of Human Sciences Texas Tech University Texas Tech University
193 APPENDIX E
LETTER TO THE HEADMASTER/HEADMISTRESS
194 2619 19*StreetApt. 9 Lubbock,TX 79410
October 24, 2002
The Headmaster/Headmistress
Dear Sir/Madam:
Thank you for agreeing to let respondents at your school contribute their time to my research efforts. With your guidance, their expertise will be invaluable. Students spend a greater part of the day at school leaming. To enable them to benefit from education, schools provide meals to these students. The benefits that these meals have on students' leaming are well documented. However, the nutritional quality of these meals is not documented, at least in Botswana. The information collected from the enclosed surveys wiU be used to attempt to do so. They were developed for my research study and focuses on the feeding programs at junior secondary schools. They also relate to how Home Economics teachers are involved in making the school feeding programs successful in providing nutritious meals for the students you serve.
Your school is among a group of sixty that were selected proportionally and randomly from the five Botswana education regions for this study. This letter is being sent to request your assistance to distribute: (1) The Menu Survey instrument to the person who supervises meal preparation for students; and (2) The Teacher Particípation Survey instmment to the Home Economics teachers at your school to complete. AU information provided will be treated a confidential and used only for my research.
Your school's personnel response is voluntary, failure to provide some or all the requested information will not in any way adversely affect them or your school. However, because their participation is important for to the success of this research, I do appreciate your effort in encouraging them to complete the surveys. The time needed to complete the surveys varies according to individual circumstances, but the average time is estimated to be 40 - 45 minutes for the supervisors and 15 0-15 minutes for the teachers.
I would greatly appreciate it if you would assist me by ensuring that meal preparation supervisors and Home Economics teachers at your schools retum the completed surveys in the enclosed stamped, self-addressed envelope within two weeks upon receiving the surveys. Thank you for your assistance. Should you have questions or conceras about this request, please feel firee to contact me by email at [email protected] or by fax at (806) 742-3042 or by telephone at (806) 747-2573.
Sincerely,
Elsie Mosie Giriny Fesltehausen, Ph.D. Doctoral Student Professor College of Human Sciences College of Human Sciences Texas Tech University Texas Tech University
195 APPENDIX F
LETTER TO THE SCHOOL FOOD SERVICE SUPERVISOR
196 2619 19*StreetApt. 9 Lubbock,TX 79410
October 24, 2002
Dear Supervisor:
Thank you for taking the time to complete this survey that the Head of your schools has been requested to distribute to you. The survey is in relation to obtaining information about the feeding program at the school where you are the supervisor. The information will be used to determine how you and the people you supervise can be assisted to serve better the students using the school's existing feeding program.
The information you provide will be treated as confidential and only used for my research. Your response is voluntary, and failure to provide some or all of the requested information will not in any way affect you adversely. However, your participation is important to the success of this research, and I do appreciate your effort to answer all the questions.
The time needed to complete this survey varies according to individual circumstances, but the average time is estimated to be 40- 45 minutes. Please retura the completed survey to the person who distributed it to you at your school within two weeks of receiving the survey. Thank you for your help. I appreciate your cooperation.
Sincerely,
Elsie Mosie Giimy Fesltehausen, Ph.D. Doctoral Student Professor College of Human Sciences CoUege of Human Sciences Texas Tech University Texas Tech University
197 APPENDIX G
THE MENU QUALITY SURVEY
198 INSTRUCTIONS Please provide information in all sections. FiII in the blanks or put a check mark (>^) in the spaces provided. Print clearly to ensure yoirr responses are legible.
A. General Information
1. In which region is your schooi located? Cenfral North South South Central West
2. How is the place in which your school is located described? Smaller village/scattered settlement (with populatíon of 250 - 4,999 people) Small village (with population of 5,000 - 9,999 people) Large village (with populatíon of 10,000 - 49,999 people) Town/viIIage town (with populatíon of 50,000 - 99,999people) City (with population of 100,000 people or more)
3. How is your school classified? Boarding for all students Boarding for some students Non-Boarding
4. (a) What is the total number of students in your school?
(b) What is the total number of students boarding?
5. Does your school provide meals to students? Yes No If you answered "No" to Question 5, please stop here and return the survey to the person who distributed it to you at your school.
6. If you answered "Yes" to Question 5, which of these meals does your school provide to the students? (Check all that apply) Breakfast Mid-moming Snack/Tea Break Lunch Supper
199 B. Meal Preparation Supervisor
7. What is your title/position? (Check only one) Mafron Boarding Master Teacher Adminisfrator ChefCook Other (please specify)
8. What is your gender? Male Female
9. In which age group do you belong? < 24 yrs 25 - 29 yrs 30-34yrs 35 - 39 yrs >40yrs
10. In what areas have you had training? (Check all that apply) Catering/Hotelier Nutrition Dietetics Home Economics Other (please specify)
IL (a) How many years have you worked as a meal preparation supervisor in schools?
(b) How many years have you worked as a meal preparation supervisor in places other than the schools?
12. (a) How many kítchen hands/cooks work at your school?
(b) How many of them have had "food-related" training before working at this school?
13. (a) Do you receive in-service training? Yes No
200 (b) If you answered "Yes" to Question 13 (a), who provides it? (Check all that apply) Home Economics education officers Home Economics teachers Home Economics extension workers Nutritionists/Dietitians Other (please specify)
(c) How many times a vear IS in-service training provided? (Check only one) Once Twice Thrice Fourormore
14. (a) If you do not receive in-service training, do you feel you need it? Yes ^No
(b) If you answered "Yes" to Question 14 (a), who do you believe should provide it? (Check all that apply) Home Economics education officers Home Economics teachers Home Economics extension workers Nutritionists/Dietitians Other (please specify)
(c) How many times a year SHOULD it be provided? (Check only one) Once Twice Thrice Four or more
15. (a) Do kitchen hands/cooks at your school receive in-service training? Yes No
(b) If you answered "Yes" to Question 15 (a), who provides it? (Check all that apply): Home Economics education officers Home Economics teachers Home Economics extension workers Nutritionists/Dietitians Home Economics education officers Home Economics teachers Home Economics extension workers Nutritionists/Dietítians Other (please specify)
201 (c) How many times avear is it provided? (Check only one) Once Twice Thrice Fourormore
16. (a) If kitchen hands/cooks at your school do not receive in-service training, do you want them to receive it? Yes No
(b) If you answered "Yes" to Question 16 (a), who do you believe should provide it? (Check all that apply) Home Economics educatíon officers Home Economics teachers Home Economics extension workers Nutritionists/Dietitíans Other (please specify)
(c) How many times a year should in-service training be provided? (Check only one) Once Twice Thrice Four or more
C. Menu Planning and Fundíng
17. Where does your school get funds and/or other contributions such as food to feed the students? (Check all that apply) Govemment Local community School garden/farm Part of school fees Other (please specify)
Note: When you answer the questions that follow, please refer to a copy of the menu plan/guide entítled "Ministry of Education C. J. S. S. Feeding" attached to this survey.
202 18. (a) Do you use the "Ministry of Education C. J. S. S. Feeding" menu plan/guide when preparmg meals for students at your school? -"/gume Yes No if you answered "No" to Question 18(a), skip Questions 18(b), 18(c), and 19, AND go to Question 20.
^^ ylur" cm'''"* "^''" ^^" ^"''"''° ^^ ^^^' ^''"' '' '^' '"'"" Plan/guide used at Exactly as it is without changes/modifications With some changes/modifications
(c) If changes/modifications are made on the "Ministry of Education C. J. S. S. Feeding" menu plan/guide, why are they made? (Check all that apply) Foods on menu plan/guide are too expensive Foods on menu plan/guide are not in season/available Foods on menu plan/guide are not liked by students Foods on menu plan/guide are regarded as taboo Other (please specify)
19. If your school uses the "Ministry of Education C. J. S. S. Feeding" menu plan/guide with some changes/modifications, who is involved in deciding what should be changed'^ (Check all that apply) School administrators Students Parents Cooks Nutritionists/Dietitians Home Economics extension workers Home Economics teachers Agricultural Science Education teachers Science teachers Other teachers Other (please specify)
20. If you answered "No" to Question 18 (a), why is your school not using the "Ministry of Education C. J. S. S. Feeding" menu plan/guide?
Please go to Question 21 on the next page
203 21. If your schoo drafts and uses its own feeding menu plan/guide (that is, the school doesnoí use the "Mmistry of Education C. J. S. S. Feeding menu plan/guide"), who is responsible for draftmg the menu plan/guide for feeding students? (Check all that apply) School administrators Parents Cooks Nutritíonists/Dietítians Home Economics extension workers Home Economics teachers Agricultural Science Educatíon teachers Science teachers Other teachers Other (please specify)
D. Menu Plan/Guide Information
22. Please include a copy of a one-week menu plan/guide used at your school with your completed survey, if your school:
• uses the "Ministry ofEducation C. J. S. S. Feeding" menu plan/guide with some chanees/modifîcations
OR
• uses a menu plan/guide other than the onefrom the Ministry ofEducation.
Please write legibly if copies are not typed.
Note: DO NOT INCLUDE A COPYIF YOUR SCHOOL USES THE "MINISTRY OF EDUCATION CJ.S.S. FEEDING" MENU PLAN/GUIDE EXACTLY AS IT IS WITHOUT SOME CHNAGES/MODIFICATIONS.
Please go to Section E on the next page
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LETTER TO THE FAMILY AND CONSUMER SCIENCES/HOME ECONOMICS
TEACHERS
209 2619 19™Street#9 Lubbock,TX 79410
October 22, 2002
Dear Home Economics Teacher:
Thank you for taking the time to complete this important survey. The survey was developed for my research study and focuses on the feeding programs at junior secondary schools. It also relates to how you are involved in making your school's feeding program successful in providing nutritious meals for the students you serve. This information will be used to document how Home Economics teachers contribute to the successful feeding programs that enhance the nutritional and health status of students in junior secondary schools.
All information you provide will be treated as confidential and used only for my research. Your response is voluntary, and failure to provide some or all of the requested information will not in any way affect you adversely. However, your participation is important to the success of this research, and I do appreciate your effort to answer all the questions.
The time needed to complete this survey varies according to individual circumstances, but the average time is estimated to be 10-15 minutes. Please retum the completed survey to the person who distributed it to you at your school within three weeks of receiving the survey. Thank you for your help. I appreciate your cooperation.
Sincerely,
Elsie Mosie Ginny Fesltehausen, Ph.D. Doctoral Student Professor College of Human Sciences College of Human Sciences Texas Tech University Texas Tech University
210 APPENDIX I
TEACHER PARTICIPATION SURVEY
211 INSTRUCTIONS: Please fill in the blanks or put a check mark {^) in the spaces provided. Print clearly to ensure your responses are legible.
A. General Information
1. In which region is your school located? Central North South South Central West
2. How is the place ín which your school is located described? Smaller viUage/scattered settlement (with population of 250 - 4,999 people) Small viUage (with population of 5,000 - 9,999 people) Large village (with population of 10,000 - 49,999 people) Town/village town (with population of 50,000 - 99,999 people) City (with population of 100,000 people or more)
3. How do you classify your school? Boarding for all students Boarding for some students Non-Boarding
4. (a) What is the total number of students in your school?
(b) What is the total number of students in boarding?
5. Does your school provide meals to students? Yes No If you answered "No" to Question 5, please stop here and return this survey to the person who distributed this survey to you at your school.
6. If you answered "Yes" to Question 5, which of these meals does your school provide to students? Breakfast Mid-moming Snack/Tea Break Lunch Supper
212 B. Teacher Particípation Informatíon
7. Is supervision part of your routine duty when students have meals at your school? Yes No
8. If you answered "Yes" to Question 7, do you beUeve the menu plan/guide used at your school results m balanced meals being provided to students? Yes No If you answered "Yes" to Question 8, skip Questions 9 -13 AND go to Section C, Questions 14 - 19.
If you answered "No" to Question 8, which food group(s) need(s) attention to ensure that the menu plan/guide used resuhs in providing balanced meals to students? (Check aU that apply) Body Building Energy Giving Protective & Regulating Energy Supplements
10. In the chart below, select the reason(s) why you beUeve your school needs to pay attention to the food group(s) you identified in Question 9. (Check all that apply)
Reasons
Food Group Menu plan Menu plan Not provided in Other reasons amounts too amounts too menu plan (please specify) large small Body Building
Energy Giving
Protective & Regulating Energy Supplements |
11. Do you assist in ensuring that the menu plan/guide used at your school provides students balanced meals? Yes No If you answered "No" to Question 11, skip Question 12 AND go to Question 13.
213 12. If you answered "Yes" to Question 11, how do you assist? (Check aU that apply) Assist m plannmg menus for feeding students Provide guidance on which foods to purchase _Assist with training kitchen staff at your school _Assist kitchen staff during meal preparation for students Other (please specify)
13. If you answered "No" to Questíon 11 ...
(a) What are the reasons for not assisting? (Check all that apply) No one asked you to assist h is not in your job description You do not have time to assist Other (please specify) ^
(b) Would you be wUUng to assist if you were asked to participate in ensuring that students are provided balanced meals at your school? Yes No
(c) If you answered "Yes" to Question 13 (b), select how you would be wiUing to assist. (Check all that apply) Assist in plarming balanced menus Guide kitchen staff on food purchasing Provide in-service training for kitchen staff at your school Assist kitchen staff when they are preparing meals for students Other (please specify)
Please go to Section C on the next page.
214 C. Teacher Information
14. What is your title/position? Administrator Senior teacher administrator Home Economics H.O.D./Coordinator Temporary teacher Other (please specify)
15. What is your gender? Male Female
16. What is your nationality? Motswana Other
17. In which age group do you belong? <24yrs 25-29 yrs 30-34 yrs 35-39 yrs >40 yrs
18. What is your highest Home Economics qualiflcation? Diploma in Secondary Education Diploma in Home Economics Education Bachelor of Education Bachelor of Science in Home Economics Education Other (please specify)
19. How many years have you taught Home Economics in Junior secondary schools Senior secondary schools Other institutions (please specify)
215 APPENDIX J
PERCENTAGES OF FOODS OFFERED IN THE NATIONAL STANDARDS AND
THE MINISTRY OF EDUCATION STANDARDS FOR BOARDING AND NON-
BOARDING SCHOOLS
216 FOOD GROUP DISTRIBUTION ea l ( D C pe r M P ^ c Z 5 C tio n
r > c -n
tn C\ ri o Energ1y Giving Body-Buildin g Protecti\« D National 67 17 17
• MOE Boarding Schools 55 23 21
D MOE Non-Boarding 56 28 17 Schools 1
217 APPENDIX K
TIMES PER WEEK ENERGY GIVING FOODS SERVED IN SCHOOLS COMPARED
TO MINISTRY OF EDUCATION STANDARDS
218 20 n •
ne s Pe r Wee k J i O C7 1 1 ru 0 1 • J^^Mashe d Bread Com Sorghum Rice Potatoes aMOE 17 5 7 1 1 • Boarding Schools 12 4.5 5.8 ^ 1.5 0 Mean
Energy Giving Foods on the IVIOE and Boarding Schools Meal Plans
6 - <1> L • E • r- 1 - 1 iB U ^ 1 • Breafed Com Sorghu m Rice DMOE 5 4 0 1 • Non-Boarding Schools 4.1 2.7 1.8 1.1 Mean
Energy Giving Foods on the MOE and Non-Boarding SchoolsMeal Plans
219 APPENDIX L
TIMES PER WEEK BODY BUILDING FOODS SERVED IN SCHOOLS COMPARED
TO MINISTRY OF EDUCATION STANDARDS
220 6
5 ^ a> 1 4 Í» 3 Q. ^ SlUJi , 9 J • • n - • • • Beef Chicken Beans Milk DMOE 4 1 3 5 • Boarding Schools 2.6 1.3 2 0 Mean
Body-Building Foods on the MOE and Boarding Schools Meal Plans
o
^ 2 - 0) 5 1.5 1 I 0) • •^ • - 0> ji 0.5 - l^ I l u 1 1 Beef Chicke•n Beans Milk
• MOE 2 1 2 0 B Non-Boarding Schools 2.3 1.2 1.2 0.1 Mean Body-Building Foodson the MOEand Non-Boarding SchoolsMeal Plans
221 APPENDIX M
TIMES PER WEEK PROTECTIVE FOODS SERVED IN SCHOOLS
COMPARED TO MINISTRY OF EDUCATION STANDARDS
222 3.5 3 — 1 2.5 î 2 a> °- 15 • ne s — • •^ 0.5 0 •- CabbagJe -Pumpkin Apples Oranges DMOE 2 1 1 2 • Boarding Schools 2.9 0.4 0.9 0.3 Mean
Protective Foods on the MOE and Boarding Schools Meal Plans
9 -
1 1-5-
a> i w a> E 0.5 1 i^ n _ 1 - 1 1 Cabbage Pumpkin Apples Oranges
DMOE 1 0 1 0 m Non-Boarding Schools 1.9 0.1 0.6 1 Mean
Protective Foods on the MOEan d Non-Boarding Schools Meal Plans
223