Nudging children toward healthier food choices: An experiment combining school and home gardens

School gardens have become a widely used approach to influence children's food knowledge, preferences and choices in low- and high-income countries alike. However, evidence indicates that such programs are more effective at influencing food knowledge and preferences than actual food choices. Such finding may occur because school gardens insufficiently influence the food behavior of parents and because healthy food items are not always available in children's homes. We tested this hypothesis using a one-year cluster randomized controlled trial in Nepal with 15 treatment and 15 control schools and a matched sample of 779 schoolchildren (aged 8–12) and their caregivers. Data were collected before and after the intervention during the 2018–2019 school year. In addition, children's food consumption was monitored using a monthly food logbook. Average treatment effects were quantified with a double-difference estimator. For caregivers, the intervention led to a 26% increase in their food and nutrition knowledge (p < 0.001), a 5% increase in their agricultural knowledge (p = 0.022), a 10% increase in their liking for vegetables (p < 0.001), and a 15% increase in home garden productivity (p = 0.073). For children, the intervention had no discernible effect on food and nutrition knowledge (p = 0.666) but led to a 6% increase in their liking for vegetables (p = 0.070), healthy food practices (p < 0.001), and vegetable consumption (October–December +15%; p = 0.084; January–March +26%; p = 0.017; April–June +26%; p = 0.088). The results therefore indicate both schools and parents matter for nudging children toward healthier food choices

Drivers of food choice among children and caregivers in post-earthquake Nepal

Food systems in many countries are experiencing a shift from traditional foods towards processed foods high in sugar, fat and salt, but low in dietary fiber and micronutrients. There is an urgent need to better understand drivers of changing food behavior, particularly for lower-income countries. This study analyzes drivers of food choice among children and parents in rural Nepal. It uses qualitative data collected through key informant interviews and focus group discussions with school children, parents and teachers. The study reveals substantial changes in food behavior during the past decade with increased consumption of rice, meat, and highly processed snack foods while an increased consumption of fruit and vegetables is not evident. It identifies cash availability is the main driver of increased rice, meat and snack food consumption. The second driver is the 2015 Nepal earthquake, which accelerated the transition from home-grown food to purchased food as people got habituated to eating more meat and snack foods while reconstruction tripled local wages and changed the food environment. This shows how humanitarian assistance in the wake of extreme shocks can unintentionally contribute to unhealthy eating habits. An integrated school and home garden intervention appears to contribute to healthier diets

Effect of an Integrated School Garden and Home Garden Intervention on Anemia Among School-Aged Children in Nepal: Evidence From a Cluster Randomised Controlled Trial

This publication is with permission of the rights owner (Sage) freely accessible.Background: Integrated school and home garden interventions can improve health outcomes in low-income countries, but rigorous evidence remains scarce, particularly for school-aged children and to reduce anemia. Objective: We test if an integrated school and home garden intervention, implemented at pilot stage, improves hemoglobin levels among school children (aged 9-13 years) in a rural district in the mid-hills of Nepal. Methods: We use a cluster randomized controlled trial with 15 schools each in the control and treatment groups (n = 680 school children). To test if nutritional improvements translate into a reduction of anemia prevalence, hemoglobin data were collected 6 months after intervention support had ended. Using structural equation modeling, we estimate the direct and indirect effects of the treatment through several pathways, including nutritional knowledge, good food and hygiene practices, and dietary diversity. Results: The integrated school and home garden intervention did not lead to a direct significant reduction in anemia. Causal positive changes of the treatment on nutritional outcomes, although significant, are not strong enough to impact hemoglobin levels. The program improved hemoglobin levels indirectly for children below 12 by increasing the use of good food and hygiene practices at home. These practices are associated with higher hemoglobin levels, particularly for girls, young children, and in households where caregivers are literate. Conclusions: Even integrated school and home garden interventions are not sufficient to reduce anemia among school children. Incorporating behavioral change components around food and hygiene practices into integrated garden interventions is important to unlocking their health impacts.Bill and Melinda Gates Foundation https://doi.org/10.13039/100000865Peer Reviewe

A School Health Project Can Uplift the Health Status of School Children in Nepal.

School health is effective in helping students achieve health literacy, enhance their health-related behaviors, and thereby improve their health status. However, in resource-limited countries, evidence is limited to show the impact of school health. We determined the association of the school health and nutrition (SHN) project activities on students' a) health knowledge, b) hygiene practices, and c) health outcomes, one year after the project completion.This is a cross-sectional study conducted among the schools with the SHN project and without the project in four districts of Nepal. We recruited 604 students from six schools in the project group and 648 students from other six schools in the comparison group. We used a self-administered questionnaire to collect the data, and analyzed them using regression models and a structural equation model (SEM).Students from the SHN project group reported the decreased odds of worm infestation (AOR = 0.50, 95% CI: 0.34 to 0.75) and diarrhea/ dysentery infection (AOR = 0.67, 95% CI: 0.47 to 0.97) compared to those in the comparison group. Furthermore, the SEM analysis also showed that the students in the project group were more likely to have better health outcomes (β = 0.03, p< 0.05).Students in the SHN project group were more likely to have better health outcomes compared to those in the comparison group, even after one year of the project completion. As it can bring about sustainable changes for students, it should be scaled up in other parts of the country

Better Learning in Schools to Improve Attitudes toward Abstinence and Intentions for Safer Sex Among Adolescents in Urban Nepal

Background: School-based sex education is an effective medium to convey health information and skills about preventing sexually transmitted infections (STIs) and unwanted pregnancies among adolescents. However, research on school-based sex education is limited in many developing countries, including Nepal. This study thus had two main objectives: (1) to assess students’ evaluation of school-based sex education, and (2) to examine the associations between students’ evaluations of school-based sex education and their (a) attitudes toward abstinence and (b) intentions for safer sex. Methods: This cross-sectional study was conducted among 634 students from six schools in the Kathmandu Valley during May–June 2010. We used a self-administered questionnaire to assess students’ evaluations of school-based sex education, attitudes toward abstinence, and intentions for safer sex. The data were then analyzed using multiple linear regression models. Results: Regarding “information on HIV and sexual health”, many students perceived that they received the least amount of information on HIV counseling and testing centers (mean 2.29, SD 1.00) through their schools. In terms of “support and involvement of teachers and parents” in sex education, parents’ participation ranked as the lowest (mean 1.81, SD 1.01). Audiotapes were reported as the least used among the listed “teaching aids for sexual health education” (mean 1.54, SD 0.82). In multivariate analysis, receiving more “information on HIV and sexual health” was positively associated with more positive “attitudes toward abstinence” (β = 0.11, p = \u3c0.018) and greater “intentions for safer sex” (β = 0.17, p = \u3c0.001) among students. Similarly, increased “support and involvement from teachers and parents” was also positively associated with more positive “attitudes toward abstinence” (β = 0.16, p = \u3c0.001) and greater “intentions for safer sex” (β = 0.15, p = \u3c0.002). Conclusion: Our results suggest that students’ needs and expectations regarding HIV and sexual health education are not being met through their schools. Moreover, comprehensive information on HIV and sexual health along with increased support and involvement of teachers and parents in sex education might help to improve adolescents’ attitudes toward abstinence and intentions for safer sex. Adapting future school-based interventions to incorporate such elements may thus be an effective strategy to promote adolescent sexual health

SEM showing direct, indirect and total effect of the SHN project.

<p>SEM showing direct, indirect and total effect of the SHN project.</p

Comparison of students' health knowledge score, hygiene practices and health outcomes.

<p>Comparison of students' health knowledge score, hygiene practices and health outcomes.</p

SHN activities in the schools (N = 1,247).

<p>SHN activities in the schools (N = 1,247).</p

SEM showing direct and indirect paths between SHN project activities, students' health knowledge, hygiene practices, and health outcomes.

<p>Model Fit: Chi-square = 4391.866, RMSEA = 0.056. * p<0.05; ** p<0.01; *** p<0.001.</p

Comparison of the SHN activities in the schools.

<p>Comparison of the SHN activities in the schools.</p