The School Food Environment in Ghana is Associated With Dietary Diversity and Anemia: Findings From the 2022 National Nutrition and Health Survey of In-School Adolescents

Abstract

Background

School food environments may play an important role in shaping children's dietary habits, health, and nutrition.

Objectives

This study aimed to evaluate associations between the school food environment and nutrition among in-school adolescents in Ghana.

Methods

Data were collected in Ghana in 2022 in a national nutrition and health survey of adolescents attending junior (JHS) and senior high schools (SHS). Foods observed on campus or reported in the dietary recall were aggregated, a composite Adolescent Dietary Diversity Score (ADDS) was derived, and the proportion achieving minimum dietary diversity was estimated. Multi-level regression models were used to assess associations between a ranked school food environment score (FES) and nutrition outcomes.

Results

The number of food groups served or available for purchase was 6.2 in JHS and 8.1 in SHS (P-value < .0001). The mean (95% CI) FES was 10.9 (10.1-11.7) at JHS and 14.3 (13.6-14.9) at SHS. ADDS ranged from 4.1 to 4.8 across strata. Higher FES was positively associated with ADDS and minimum dietary diversity among SHS students and negatively associated with anemia in girls and boys. Girls from high FES schools had 24% lower odds of anemia (OR = 0.76; 95% CI = 0.63-0.93) while boys had 46% lower odds (OR = 0.54; 95% CI = 0.34-0.84) compared to students in low FES schools.

Conclusions

Higher FES was associated with greater dietary diversity among SHS students and lower odds of anemia in girls and boys, suggesting that the school food environment may play a role in determining nutrition outcomes.

Plain language title

The School Food Environment in Ghana is Related to Dietary Diversity and Anemia

Plain Language Summary

The foods that children eat while at school have an important impact on their health and nutrition. We collected data among in-school girls and boys aged 10–19 years in Ghana. Students were asked what they had eaten in the last 24 h and were asked questions about their general food practices at school, such as what foods are included in school meals, what foods they typically bring to school, and what foods they buy at school. We also collected blood from students to test for anemia. School leaders were interviewed to better understand school programs and activities related to food and nutrition, including questions about the school meals program and food vendors present on campus. We used the information we gathered from these interviews to create a school food environment score. We found that, on average, students consumed fewer than 5 out of 10 food groups on a given day. We also found that senior high schools tended to have a larger variety of foods available and had a higher food environment score compared to junior high schools. In schools with higher food environment scores, students were more likely to eat a larger variety of foods and less likely to have anemia. These findings may be used to improve existing nutrition programs in Ghana and to design future programs focused on the health of school children.