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