Agrawal, Amit

Shringarpure, Kalpita

English

Atharva Scientific Publications (E-Jounals)

Vol 3 | Issue 3 | Jul - Sep 2016 Indian J Child Health 186
Editorial
Is the mid-day meal enough?
Malnutrition is a growing public health challenge in today’s age, with undernutrition being the major issue of concern [1]. Although much literature may be found 
related to undernutrition among under-five children and pregnant 
women, there is still a paucity of understanding the undernutrition 
scenario among adolescents, especially in middle and low income 
countries [2]. Focus on adolescent health and nutrition, though 
very recent topic, is now gaining momentum in terms of research. 
Although adolescents form 21.8% of the total population [1], this 
phase of rapid growth and development is often ignored in terms 
of their physical, mental, and nutritional needs. Several Asian and 
Indian studies show micronutrient deficiencies among adolescents, 
which may lead to undernutrition and stunting [3-5].
The mid-day meal (MDM) concept has been initiated to provide 
one-third of caloric requirements and one-half of the protein 
requirements of the school-going children [6]. This concept of 
providing nutritional support through educational institutions was 
initiated by the Madras Corporation through school lunch program in 
1925. In 1984, Gujarat became the first state to introduce this program. 
However, it is of utmost importance to understand that MDM is a 
supplement to ensure adequate growth and requirement and not the 
sole supply of the proteins and nutrients, especially in the adolescent 
growth period. The quality of MDM and its nutritional delivery is an 
important concern [7].
The authors of the research paper published in this issue of “Indian 
Journal of Child Health” have rightly identified the need to look into 
the impact of MDM on the growth of the adolescents [8]. It is often 
seen that children who are given MDMs lack the economic means to 
get a full balanced and nutritious diet at home. There is collinearity 
between the lower socioeconomic status and children going to 
schools that serve MDMs. As seen in this study, adolescents receiving 
MDMs are more undernourished as compared to their counter parts 
not receiving MDMs, who are from higher socioeconomic strata. 
Thereby, a matter of concern is whether “those who get the mid-day 
meal are really the ones who deserve to get it?”
This study being a cross-sectional methodology gives us a 
one-time “snap-shot” of the impact of MDM on the growth of 
adolescents. It looks into whether the undernutrition and stunting is 
more in MDM receiving adolescents (from government schools) as 
compared to non-MDM receiving adolescents (from private schools). 
The two comparison groups, being drawn from government and 
private schools, itself introduce a baseline confounding effect when 
it comes to assessing the nutrition status of the two groups. A further 
research into this matter would be to look into the aspects of home-
based nutrition received from their daily food. Taking similar groups 
for comparison and taking into account the number of meals per 
month (percentage intak) and the economic capacity of their family/
household to spend on nutritious food would give a clearer picture.
Although there is not much difference between the growth 
parameters of the MDM and non-MDM receiving adolescents, their 
actual dietary routine and the quantity of MDM taken as well as 
attitude to eat MDM and its frequency needs to be assessed. Instead 
of using proxy indicators such as government and non-government/
private schools, a clearer picture could be elicited by the actual 
household per capita income, and their percentage spending on the 
food.
A follow-up (longitudinal) study to look into associations with 
economic differences, area of stay, baseline health status, food 
habits, and MDM eating behavior with regression modeling for 
confounders can give a better idea of nutritional status and MDM. 
Studies on quality and quantity of the MDM and its nutritional 
delivery, perceptions of adolescents and their wards, and school 
teachers regarding MDM, methods for advocacy of the importance 
of MDM and cost-effectiveness studies on programmatic efforts may 
be undertaken.
Kalpita Shringarpure1, Amit Agrawal2
From 1Department of Preventive and Social Medicine, Medical College, 
Baroda, Gujarat, 2Department of Pediatrics, Gandhi Medical College, 
Bhopal, Madhya Pradesh, India
Correspondence to: Dr. Kalpita Shringarpure, Department 
of Preventive and Social Medicine, Medical College, Baroda, 
Gujarat, India. E-mail: kshringarpure@gmail.com
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Funding: None; Conflict of Interest: None Stated.
How to cite this article: Shringarpure K, Agrawal A. Is the mid-day meal 
enough? Indian J Child Health. 2016; 3(3):186.


Is the mid-day meal enough?

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Is the mid-day meal enough?

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