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CHAPTER 1

INTRODUCTION

BACKGROUND OF THE STUDY

Every human being has the right to health. This is a basic right which is

guaranteed under the Philippine Constitution of 1987 Article 11, Section 15 stated

that “The state shall protect and promote the right to health of the people and instill

consciousness among them”.

In this connection, all the public schools here in the Philippines have been

required by the Department of Health to have a regular health and nutritional

program for the children. Aside from this advocacy, there is also a habitual growth

monitoring and feeding program. Furthermore, there are also nutritional education

schemes for the concerned pupils, parents, teachers and school heads in how to

eliminate the habitual absenteeism, dropping out of schools and failures of grades of

many elementary students. Likewise, many other factors are being given focus by

the health organizations together with the Department of Education and they include

the academic performance of the pupils that is under the satisfactory level. Besides,

most of the students, especially in the lower sections; do not have the ability to give

focus and concentration in the class discussion

DepEd Order 87, s. 2012 entitled Guidelines on the Implementation of the

HNC-Funded School-Based Feeding Program (SBFP) states that the Department of

Education (DepEd) through the Health and Nutrition Center (HNC) relaunched the

Breakfast Feeding Program (BFP) to address the malnutrition problem and short-

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term hunger among public school children. This program was renamed School-Based

Feeding Program (SBFP) in order not to limit the feeding to breakfast only. This is to

allow the school administrators to decide what time to conduct the feeding that will

best address the nutritional needs of the learners.

Health and education are directly related with each other. Poor health and

malnourishment had been recognized as one of leading causes of absenteeism and

dropping out of school. Hunger also play a vital role tostudent’s life. Some students

choose to work to have food in the table than go to the school. This attitude often

leads to poor academic performance or worst dropping out of the school.

undernourished children are not in a position to learn and absorb the lesson given by

the teacher. They lacked in focus, attention and motivation to study because of poor

nutrition. Cognitive functioning such as memorization, comprehension and logical

thinking are also affected since a lot of nutrients needed by the body and brain are

not sufficient like iron, folate, protein, calcium and other vitamins.

The Department of Education focuses in improving the health and nutrition

status of schoolchildren through the Feeding Program conducted in public school.

Through this program, poorest children benefits more and help those who are most

disadvantaged the chance to take better advantage of their educational opportunities

(Del Rosso, 2009). The Health and Nutrition Center of DepEd is mandated to

safeguard the health and nutritional well- being of the total school population, giving

priority to the elementary grade school children. Muhi (2009) and Palacol (2007)

emphasized the effects of health and nutrition on the academic performance of

students. The problems facing Filipino children are directly related to these four

core: health, nutrition, education, and protection.


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School health and nutrition programs are among the most effective

interventions that exist to improve both children’s education and health. Citing the

World Health Organization, Jamorabo-Ruiz and Serraon-Claudio (2010)

acknowledged that nutrition is an input to and foundation for health and

development. Better nutrition means stronger immune systems, less illness and

better health. Healthy children learn better. Healthy people are stronger, are more

productive and more able to create opportunities to gradually break the cycles of

both poverty and hunger in a sustainable way. Better nutrition is a prime entry point

to ending poverty and a milestone to achieving better quality of life.

These situations prompted the researcher to conduct this study to find out the

nutritional status as an indicator of the academic performance of grade six pupils in

Sampaguita Elementary School.

REVIEW OF RELATED LITERATURE

This chapter presented the different literature and studies to gave more insights to the

present study. The pieces of information were organized according to themes.

Likewise, the theoretical and conceptual framework and research paradigm are

presented in this chapter.

Nutrition and Cognition

Relationships between nutrition and brain function have been the focus of

much research. Studies have shown the impact of dietary foundations on normal

brain functions. Chemical messengers within the brain called neurotransmitters have

been studied in conjunction with nutrition. It has long been suspected that the
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relative abundance of specific nutrients can affect cognitive processes and emotions.

Newly described influences of dietary factors on neuronal function and synaptic

plasticity have revealed some of the vital mechanisms that are responsible for the

action of diet on brain health and mental function. Several gut hormones that can

enter the brain, or that are produced in the brain itself, influence cognitive ability. In

addition, well-established regulators of synaptic plasticity, such as brain-derived

neurotrophic factor, can function as metabolic modulators, responding to peripheral

signals such as food intake. Understanding the molecular basis of the effects of food

on cognition will help us to determine how best to manipulate diet in order to

increase the resistance of neurons to insults and promote mental fitness (Nat Rev

Neurosci, 2008).

Cognitive development is influenced by many factors, including nutrition.

There is an increasing body of literature that suggests a connection between

improved nutrition and optimal brain function. Nutrients provide building blocks that

play a critical role in cell proliferation, DNA synthesis, neurotransmitter and

hormone metabolism, and are important constituents of enzyme systems in the brain

(Lozoff and Georgieff, 2006; Zeisel, 2009; De Souza et al., 2011;

Zimmermann, 2011).

Kar et al. (2008) compared the performance of adequately nourished children

to malnourished children and also compared age related differences in cognitive

function and found that the malnourished children differed from the adequately

nourished children on tests of phonemic fluency, design fluency, selective attention,

visuospatial working memory, visuospatial functions, verbal comprehension and

verbal learning, and memory. Results for the verbal fluency test show adequately-
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nourished children achieved higher mean scores in both age categories, five- to

seven- year olds and eight- to ten- year olds (4.3 and 5.7 respectively), when

compared to their malnourished counterparts (1.36 and 4.4 respectively). Some of

the other results had similar findings such as visual construction adequately

nourished in both age categories (10.0 and 15.8) score higher than malnourished

students (3.0 and 4.8) in the same age categories and also for verbal learning (32.4

and 42.3 vs. 26.9 and 30.7). These results show age

related differences within each group as well as between the two age groups. Kar et

al. also found a lack of age-related improvement in malnourished children when

looking at cognitive functions of attention, cognitive flexibility, visuospatial

construction, ability and verbal learning. Malnourished students showed lower

results than the adequately nourished students but they did show age related

improvement for these same functions. Differences were tested for statistical

significance. Test scores for adequately nourished children between 5- to 7- years

olds and 8- to 10- year olds were found significant but most of the test scores for

undernourished children showed a delay in development of certain cognitive

functions.

Factors that Affect Nutrition

Annik Sorhaindo and Leon Feinstein (2006), shared an article entitled “What

is the relationship between child nutrition and school outcomes?” He stated that

there was a complex interrelationship between nutrition, social and economic factors

and health and education. Food preferences are affected by social and family factors

such as the behavior of parents and peers, advertising and marketing and practices
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related to food production and consumption. And, while the constraints of low

income create practical barriers to healthy eating, additional socio-environmental

factors, such as culture and lack of literacy and education reinforce the effects of

deprivation.

Food as a Source of Good Nutrition

Erickson (2006) pointed out five key components required to keep the brain

functioning correctly. The substances, all found in food, are important to brain

development and function. Proteins are found in foods such as meat, fish, milk, and

cheese. They are used to make most of the body’s tissues, including

neurotransmitters, earlier identified as chemical messengers that carry information

from brain cells to other brain cells. A lack of protein, also known as Protein Energy

Malnutrition, led to poor school performance by children and caused young children

to be lethargic, withdrawn, and passive, all of which help affect social and emotional

development.

Erickson, (2006) revealed that carbohydrates are commonly found in grains,

fruits, and vegetables. Carbohydrates are broken down into glucose (sugar) which is

where the brain gets its energy. Fluctuating levels of carbohydrates may cause

dizziness and mental confusion, both of which can affect cognitive performance.

Eating a carbohydrate-heavy meal can cause one to feel more calm and relaxed

because of a brain chemical called serotonin and its effect on mood. Serotonin is

created within the brain through the absorption and conversion of tryptophan.

Tryptophan is absorbed within the blood and this absorption is enhanced with

carbohydrates.
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Meyer, (2005) said that good nutrition is important in supporting growth and

maximizing learning potential. Due to current research, we are becoming

increasingly educated on the role nutrition plays on the body’s and mind’s ability to

grow and the performance of our potential learning capacity. Nutritional intake

affects energy levels, physical stamina, mood, memory, mental clarity, and emotional

and mental well-being. Research is proving good nutrition is pertinent for the brain,

so the old adage, “You are what you eat” is proving to be true. Parents and educators

need to educate today’s youth to make healthier food choices because they are being

raised in a culture of fast food. Because today’s children are being raised during a

time when many meals are not being prepared at home, America is seeing the

negative outcomes of poor nutritional choices.

Elementary students that have a positive perception of school meals tend to

be more satisfied with the school foodservice and nutrition program; therefore they

are more likely to participate in the school food program Meyer, (2005). As student

progress their tastes change and to keep up with those changes the school food

environment tends to become increasingly less healthy Finkelstein et al., (2008).

These less healthy choices are more options for food opportunities that compete with

the main lunch line that provides healthier options. Providing quality food that is

appealing to students will help promote healthy eating among students as will

limiting students’ access to low-nutrient, high-energy foods. School meal programs

play an important role in the nutritional adequacy of students’ diets. Dietary

adequacy is of the utmost importance for students with their nutrient requirements to

sustain normal growth and development. Even mild nutrient deficiencies can end

with negative long-term effects on growth and function Sampson et al., (1995)
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Dietary Allowance

 In an article about the “Daily Requirements for Elementary School

Students,” (2013) focusing on dietary allowance, complex carbohydrates and protein

are particularly important for five- to eleven-year-olds, who need roughly from 1,400

to 2,000 calories a day. If they are very active, their calorie intake can be in the upper

range and if they are fairly inactive, they should have a little less. Vegetables 2 cups,

fruits 1 ½ cups, grains 5 to 6 cups, meats and beans 5 ounces, dairy 3cups, oils 4

teaspoons, and fats and sweets limit as much as possible. (American Heart

Association: Dietary Recommendations for Healthy Children)

For food portions for 8-11 years old, another article (2012) said that, Children

need to eat a variety of nutritious foods, in the right proportions. This article is about

the age, correspondents profile and dietary allowance. They should choose foods

from each of the five food groups every day. The amount of food children need

depends on their body size and how active they are. Daily recommended serves: kids

aged 8-11 years should aim for 1-2 serves of fruit; 3-5 serves of vegies; 2-3 serves of

dairy; 4-9 serves of bread, cereals and grains; 1-1½ serves of meat; and no more than

1-2 serves of ‘sometimes’ foods. Drink plenty of water. The cheapest, healthiest and

most thirst-quenching drink is plain water. Kids need to drink more fluid on hot or

humid days, and if they sweat or are physically active. Avoid soft drinks, fruit juices,

sports drinks, energy drinks and flavoured milk.

An article entitled “Nutrition for Children and Teens: Helping Your Kids Eat

Healthier” written by Maya W. Paul and Lawrence Robinson (2012). This article

about the meal habits, dietary allowance, and classroom performance. They

enunciated that healthy eating can stabilize children’s energy, sharpen their minds,
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and even out their moods. While peer pressure and TV commercials for junk food

can make getting kids to eat well seem impossible, there are steps parents can take to

instil healthy eating habits without turning mealtimes into a battle zone. By

encouraging healthy eating habits now, you can make a huge impact on your

children’s lifelong relationship with food and give them the best opportunity to grow

into healthy, confident adults. Children develop a natural preference for the foods

they enjoy the most, so the challenge is to make healthy choices appealing. Of

course, no matter how good your intentions, it’s always going to be difficult to

convince your eight-year-old that an apple is as sweet a treat as a cookie. However,

you can ensure that your children’s diet is as nutritious and wholesome as possible,

even while allowing for some of their favourite treats. The childhood impulse to

imitate is strong, so it’s important you act as a role model for your kids. It’s no good

asking your child to eat fruit and vegetables while you gorge on potato chips and

soda.

School Health Education

The primary goals of school health education are to help individuals adopt

behaviours and to create conditions that are conducive to health. Thus, the clear and

precise delineation of behaviours and conditions specifically relevant to healthy

nutrition is essential for the development of effective school health education efforts.

Close collaboration between education, health and food officials; the school health

team; the community advisory committee; and other school and community

members is necessary to identify the nutrition-related behaviours and conditions

relevant to health in each community.


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School health education is designed to help students acquire the knowledge,

attitudes, beliefs and skills which are needed to make informed decisions, practice

healthy behaviours and create conditions that are conducive to health.

 Knowledge provides a factual background on which to base decisions, such

as knowledge about the relationship of eating and health and about planning

for healthy nutrition using assessments and nutritional guidelines.

 Attitudes provide a personal perception for decisions, such as feeling

responsible for one's own health and the health of others.

 Beliefs provide a conviction for decisions, such as a belief that healthy eating

makes a positive difference in well-being.

Optimizing the Implementation of School Health and Nutrition Program

Elementary Schools

As the first educators of their children, parents can provide important

information that will assist in the development and implementation of the child’s

educational program. Parents reinforce and extend the educational efforts of teachers

and are a very important part of the school team. They need to feel that their child is

part of the group and has been accepted on an equal footing with the others; that the

teacher is cooperating with them; and that they have a role to play in their child’s

education. In addition, parent associations provide valuable information and

resources related to students’ needs and strengths. In addition, teachers benefit from

contact information about various community-based agencies and other professionals

who focus on children with special learning needs, and should be encouraged to

contact them as needed, and use the resources they provide. These organizations may

need to provide local, regional, and provincial opportunities for specific development
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and help identify local mentoring supports. The rationale for school-based

health and nutrition programs and the approach to their implementation have

undergone a paradigm shift over the past two decades. The traditional perception of

these programs as seeking to improve the health of school children cannot be

justified on the basis of mortality or public health statistics alone. Instead, it is

increasingly recognized that a major—perhaps the major— impact of ill health and

malnutrition on this age group is that on cognitive development, learning, and

educational achievement. Improving students' health and nutritional status can

redress common sources of absenteeism, poor classroom performance and early

school dropout, and thus boost the possibility of Education for All. Patanao (2010)

stated in her study that healthier children stay in school longer, attend more regularly,

learn more and become healthier and more productive adults. In consequence, the

clearest benefit of school health and nutrition programs is measurable in terms of

education outcomes and their economic returns.

Healthy School Environment

The school's environment plays a significant role in determining whether

interventions to promote health and healthy nutrition will be effective and

sustainable. Thus, students should have access to food of high nutritional value and

to the support of persons around them to develop and maintain a healthy diet. A

Health-Promoting School provides a safe and healthy environment that presents a

realistic and attractive range of health choices to encourage a healthy lifestyle. It also

helps students and others develop their physical, psychological and social potential

.In a Health-Promoting School, the physical and psychosocial school environment

should be consistent with and reinforce other health promotion efforts.


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1. Physical environment

The physical environment includes the school building, classrooms,

eating facilities, water and foods provided at school and the surroundings in

which the school is situated .Hernandez (2011) states in her studies that the

state of well-being of the school child is also influenced by the quality of his

physical environment. A safe water supply food sanitation, proper waste

disposal, good drainage help prevent gastrointestinal disease including

parasitism. On the other hand, waste disposal etc. predisposes the school

child to the aforementioned ailments. These ailments affect adversely his

nutritional and health status. The control of his environment through

environmental sanitation therefore ensures good nutrition and therefore

promotes and maintains good health.

The condition of the physical environment can have a powerful effect

on reinforcing or contradicting health education and nutrition interventions in

the school .The following nutrition-related aspects of a healthy physical

environment can be integrated into a Health-Promoting School, supported by

related school health policies:

• Sanitation: In schools, the presence of clean water, safe food and

sanitary facilities as well as proper waste collection and disposal are

essential to good health and nutrition.. Adequate sanitation

contributes to reducing the risk for food-borne and other infections

related to health and nutrition.


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• Healthy Food Choices: A Health-Promoting School promotes and

provides appropriate healthy and high quality foods and meals to

offer opportunities for healthy choices.

• Pleasant Eating Environment: A pleasant eating environment in a

Health-Promoting School provides sufficient space and comfortable

surroundings for socializing during meal times and for enjoyment of

food, which in turn enhance mental, social and physical health.

• Outside Vendors: Efforts to create a health-conducive environment

should also include food vendors that may be present on or near the

school property, who provide an important source of food for

students. Schools should strive to gain cooperation with vendors to

offer nutritious food choices to encourage the school's health

promotion efforts.

• Special Facilities: A Health-Promoting School may also have

facilities to carry out practical nutrition-related activities, such as

food preparation, food experiments and growing food .

School Health Services

As stated in one article entitled “American School Health Association

(2007),” ‘schools are ideal places to reach children and youth’. Because children’s

health and learning are linked, children cannot learn when they are not well or when

health concerns interrupt their ability to concentrate. For this reason, schools are

specifically identified in 13 of Healthy People 2000’s objectives. Objective 8.4 calls

for increasing to at least 75 percent the proportion of the nation’s elementary and

secondary schools that provide planned and sequential kindergarten to 12th grade
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comprehensive school health education. These studies suggest that if students are not

in good health, they will not be able to learn and achieved to their highest potential.

There is a wide range of school performance problems that have been linked

unhealthy and high-risked behaviors. Dropping out, truancy, and delinquency are

related to such behaviors. Lower academic achievement, as measured by grade point

average, test scores and education level, as well as memory, attention and motivation

has been linked to unhealthy behaviors.

School health services help to prevent, reduce, monitor or treat important

health problems or conditions as well as foster health and well-being. In a Health-

Promoting School, health services work in partnership with and are provided for

students, school personnel, families and community members. They should be

coordinated with other services and activities at school and in the community to

utilise the potential of specialist resources to provide advice and support for health

promotion and nutrition interventions. Schools and communities need to consider

what preventive and treatment services are best provided at school sites and avoid

duplicating services available in the community that would easily be accessible for

students and school personnel.

Screening/Diagnosis

Screening and diagnosis of health and nutritional status, including conditions

of malnutrition, can play an important role in planning efforts to enhance health or

influence unhealthy eating habits. Nutritional screening can include food

consumption surveys, which are compared to food guidelines, as well as

measurements of body weight and height, which are compared to a subject's age and

sex.
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What is Malnutrition?

Malnutrition is any physical condition resulting either from an inappropriate

or inadequate diet, such as a diet that either provides too much or too little of

necessary nutrients, or from a physical inability to absorb or metabolize nutrients.

Malnutrition can be related to various factors, such as infections which lead to poor

appetite and malabsorption, poverty, and lack of access to food, sanitation and/or

health services. Malnutrition negatively affects the quality of life and learning as

well as death and disease status. Malnutrition includes over nutrition and nutritional

deficiencies as well as under nutrition which impair health, intellectual activity,

adaptive behaviour, education, productivity and well-being, and can induce death.

Indicators of Nutritional Status

The nutritional status of an individual depends on how well requirements for

energy and more than 50 different nutrients are met. Requirements and eating

behavior (what, where, when and how often specific foods are eaten) are determined

by a large number of physiological, pathological, psychological, cultural and socio-

economic factors. Because of this, there is no single measurement that will give

comprehensive information on nutritional status. Therefore, a combination of

methods, including anthropometric measurements, biochemical analyses, nutrient

intakes and clinical signs of malnutrition is usually used. The interpretation of these

variables and conclusions reached will depend on the norms or standards used for

comparison.

Arkansas was the first to launch what became a massive experiment in school

nutrition in 2003, requiring schools state wide to shape up nutrition and physical

activity policies. Among the changes: no more soda and junk food in elementary
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school vending machines. Parents, however, were slow to improve meals in their

own homes despite evidence that poor nutrition can impair children's ability to learn.

Hunger, whether caused by a skipped meal, an unbalanced meal, or chronic under-

nourishment, interferes with concentration at school. The body can't stockpile

glucose, the main source of energy from food. Completely dependent upon glucose

for energy, the brain is a powerhouse requiring consistent food intake to function

properly. This makes the brain sensitive to variations in glucose levels, so just one

skipped breakfast can reduce a child's learning ability for morning lessons.

1. Obese

Following up on Arkansas (2003)' effort to curb obesity in schools,

researchers at the Fay W. Bozeman College of Public Health noted that

obesity can be correlated with poor academic performance. The researchers

were quick to point out that psychological effects of weight-based teasing

played a role in poor academic performance among overweight children.

Malnutrition can lead to health and physical problems even at the subclinical

level. Children who are sick or in pain are not effective learners. Dr. Jim

Raczynski, lead investigator for many of the Arkansas school, nutrition and

obesity studies, argues that obesity is as likely a culprit in poor health as

malnutrition. "Childhood obesity increases the chances for significant

childhood health problems as well as adult health problems," he said. " ...

Parents should try to limit their children's access to unhealthy foods." Written

by Christine Reifeiss (2011).Obesity stands as the most recently area of study

regarding children and learning.


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Poor body image and lack of self-esteem are often present in these

youth which limits their ability to develop social skills. As a result, they feel

disconnected. A disconnection from school has been related to lower

academic performance.

2. Overweight

In a 1999 journal article, by C. Junjana, L. Lebel, L. Mo-suwan, and

A. Puetpaiboon titled "School performance and weight status of children and

young adolesecents in a transitional society in Thailand," a study confirmed

that overweight children were twice as likely to have lower grades in

language and math. The derived conclusion from this study was that being

overweight and becoming overweight during adolescence was associated

with poor academic performance.

3. Normal

The article written by Nancy Clarke last 2011, entitled “Nutrition And

Academic Achievement”, stated that the link between good nutrition and

academic achievement is real, based on healthy foods’ effects on learning,

memory and social interaction. This article talking about the association of

the nutritional balance to the classroom performance. While adult scholars

can benefit, children and adolescents who are still maturing especially need

both the nutrition and the academic advancement to develop physically and

mentally.

4. Wasted and Severely Wasted

Based on the Research On Nutrition & School Performance by Sage

Kalmus (2011), studies by the U.S. Department of Agriculture and other


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organizations have found that a child's poor eating habits could lead to a

variety problems with energy, focus, mood and concentration, as well as

directly impair that child's capacity to learn. Medical experts also associate

undernourishment with reduced activity levels, social interactions and

curiosity. In addition, undernourished children have been found to experience

difficulty fighting off infections, causing them to fall ill more frequently, miss

more days of class and struggle harder to catch up with the rest of the class

Nutrition and Food Programmes

Children who are not adequately nourished are more likely to be

absent from school, less likely to concentrate and perform well and more

likely to be susceptible to infections. Therefore, a Health-Promoting School

should integrate efforts to ensure students' nutritional adequacy into a variety

of its health promotion interventions. Where needed, the school can provide

nutritious meals or micronutrient supplements that help relieve some of these

problems. In an article made by Youmans (2001), he stressed that nutrition is

the foundation of good health, while education is the cornerstone of good

nutrition. To internalize such beliefs, it was stressed that the school children

must be taught proper selection and an environment conducive to the

utilization of nutrients provided by the food must be maintained. Getting the

proper nutrients every day is not achieved in man by instinct, but is

accomplished through occupational knowledge. Thus, one must know how to

utilize the existing food supply, so as to derive maximum nutritional benefits

from it. Hence, to establish good food habits, people must be able to learn

and nutrition educators must be able to teach the proper food preparation.
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Feeding Programmes

School feeding programmes are one example of interventions aiming

at increasing food availability while promoting healthy eating .These

programmes might provide breakfast, lunch and/or snacks at reduced price or

free of charge, providing calories, protein and micronutrients to

schoolchildren without adequate food. Feeding programmes have been shown

to increase weight and in some cases also school attendance and achievement

.The composition of provided meals in terms of food items and nutritional

value has been shown to play a role in educational achievement. For instance,

research with elementary and high school students in Chile (2009) showed

improvements in educational accomplishments with more frequent

consumption of dairy products and with more nutrient intake, in particular

protein and calcium.

Based on the Research On Nutrition & School Performance (2011) by

Sage Kalmus, Studies by the U.S. Department of Agriculture and other

organizations have found that a child's poor eating habits could lead to a

variety problems with energy, focus, mood and concentration, as well as

directly impair that child's capacity to learn. Medical experts also associate

undernourishment with reduced activity levels, social interactions and

curiosity. In addition, undernourished children have been found to experience

difficulty fighting off infections, causing them to fall ill more frequently, miss

more days of class and struggle harder to catch up with the rest of the class.

Deficiencies like Iron is instrumental to proper brain function, with

nerve impulses slowing for lack of sufficient iron. Research published in the
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Journal of School Health reveals that children with iron deficiencies

significant enough to cause anemia, a condition affecting 53 percent of school

children, are at an academic disadvantage and that their cognitive

performance appears to improve following iron therapy. Iodine deficiencies

in early years have similarly been associated with poor cognition and school

achievement. Also considered vital for academic success is an adequate daily

supply of proteins, complex carbohydrates and calcium.

Excesses too many fats and sugars in a child's diet can negatively

affect behavior in school, particularly those behaviors most beneficial for

academic success, such as mood, focus and energy levels. As well, an excess

of fats and sugars can cause childhood obesity, which research has also

associated with academic difficulties, in part by promoting sleep disorders

affecting attention. To help maintain adequate blood sugar levels to support

academic achievement, natural sugars, such as those found in fruits, are a

healthier alternative to refined sugars, such as those found in many juice

beverages and breakfast cereals.

Background on School Feeding Programs

Based on the 2007 Food and Agriculture Organization’s (FAO) estimate, 923

million people in the world were chronically hungry, which was an increase of about

75 million people from the 2003-05 estimates (FAO 2008). Many of these are

children, and a vast majority of them are in developing countries. These numbers

suggest that the Millennium Development Goals related to hunger and malnutrition

may not be met by 2015. The persistence of hunger, malnutrition, and micronutrient

deficiencies can have long lasting effects on the health status and productivity of
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people and their nations. Early malnutrition can adversely affect physical, mental,

and social aspects of child health, which in turn leads to underweight, stunted

growth, lowered immunity, and mortality. Research has shown that the physical

effects of malnutrition as measured by indicators such as body mass index (BMI),

have a significant impact on an individual’s productivity and wages (Broca and

Stamoulis 2003). Jomaa et al. (2011, p. 84) state that “childhood undernutrition

imposes significant economic costs on individuals and nations, and that improving

children’s diets and nutrition can have positive effects on their academic

performance and behaviors at school as well as their long-term productivity as

adults.” Alderman, Hoddinott, and Kinsley (2006) found that malnutrition led to

delayed entry to school, less overall schooling, smaller stature, and 14% lower

earnings as adults.

Policy makers may use a number of interventions to target various groups

within a population through social safety nets to address the problem of hunger and

malnutrition. One intervention that governments and non-governmental

organizations (NGO) have utilized in targeted areas where a significant part of the

population faces poverty and chronic hunger is Food for Education (FFE). FFE

provides food to school children or their family in exchange for enrollment and

attendance in school, and directly relates to the first three Millennium Development

Goals: to eradicate extreme poverty and hunger, achieve universal primary

education, and promote gender equality and empower women by 2015. As early as

the 1930s, the United States and the United Kingdom utilized FFE to improve

children’s health (Gokah 2008); these early programs took the form of school

feeding programs (SFP), where participants were fed a meal or a snack at school. As
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a social safety net, FFE programs have also gained popularity among political

leaders and policy makers in developing countries in Asia, Africa, and Latin

America. The 2011 World Food Prize was shared by John AgyekumKufuor, former

president of Ghana, and LuizInácio Lula da Silva, former president of Brazil, for the

successful social programs, including school feeding, that each nation has

established. Brazil and India have established school feeding programs by passing

legislations. Brazil added school feeding to its constitution (Bundy et al. 2009) while

in 2001 in India, the Supreme Court mandated that all state governments must

provide cooked meals in targeted schools Afridi (2010).

One of the motivations for establishing school feeding programs is to provide

targeted families and their children, including girls, an incentive to attend school

Jomaa (2011). However, in recent years, the idea of using school feeding programs

as a vehicle for agricultural development has also gained momentum. The rationale

behind school feeding programs based on the use of locally-produced food is that

they can provide a regular market opportunity and a reliable source of income for

smallholder farmers Sumberg & Sabates-Wheeler (2011). In addition, there are other

benefits to using locally-produced food for school feeding particularly around

appropriateness of the food, sustainability, and cost. A recent $12 million grant by

the Bill and Melinda Gates Foundation to the Imperial College in London for ‘Home

Grown School Feeding’ (HGSF) is an example of an initiative supporting

government action to deliver cost effective school feeding programs sourced from

local farmers in sub-Saharan Africa to foster the development of local economies.

The 2011 funded USAID, Brazil and Mozambique“TrilateralCooperation – Food

Security” project to design and promote the “Alive School” program in Mozambique
23

is another example of a school feeding program designed on the concept and

principle of ‘home grown school feeding’ whereby food will be directly purchased

from the local farming community to foster local economic development. School

feeding programs can thus be a powerful instrument for achieving many multi-

sectoral benefits – education, gender equality, food security, poverty reduction,

nutrition and health, and agricultural development. The recent food, fuel and

financial crises have highlighted the importance of school feeding programs both as

a social safety net for children living in poverty and food insecurity, and as a tool for

stimulating local agricultural production and economic opportunities in rural

communities.

Types of Food for Education Programs

There are two forms of distribution of food in FFE programs: school feeding

programs and take-home rations. School feeding programs (SFP) provide meals or

snacks to school children on the site, whereas take-home rations (THR) are provided

to school children for consumption at home. Under SFP, the food provided to school

children can be either prepackaged or cooked on site. Table 1 lists some of the pros

and cons of these different types of FFE programs from the perspective of achieving

the desired effects and takes into consideration the possibility of linking with

agricultural development goal.

The benefit of the food provided under the school feeding programs is

conditional on the attendance of the child on that specific day. Thus an advantage of

the SFP is that it serves as an incentive for children to attend school on a daily basis

to receive a meal, whereas to receive the benefit of THR, students need only to

attend a specified minimum number of days. The meals served at school may be
24

nutritionally dense and can be easily fortified with additional nutrients that may be

scarce in local diets, such as iron or vitamins A and E. Targeting is broad in that all

children at the school are fed; it would be difficult to discern between children of

different socio-economic status (SES) within a school setting and likely disruptive to

the educational experience if some students were fed while others were not. Food

may be cooked on site or in the form of prepackaged processed foods such as

nutritional biscuits.

There are various ways in which food may be procured for the school feeding

programs. Until the recent past, food for these programs often came from donations

from developed countries in the form of food aid and delivered through organizations

such as the World Food Program (WFP). More recently, there has been more

emphasis on local (i.e., national or community level) procurement, as in the case of

Burkina Faso (Upton et al. 2012). Local (national level) value-added production has

also become more frequent in Bangladesh where wheat flour donated through WFP

was processed by seven local firms in a competitive bidding process to produce the

fortified biscuits used in the Bangladesh school feeding program (Ahmed 2004),

while in the Brazilian HGSF model as much food as possible is sourced from local

communities to keep down costs and support local agriculture.

In the case of THR and SFP based on pre-packaged snack or a beverage, the

program may have to rely on a functional food processing sector at the regional or

national level to meet the needs. Take-home rations (THR) are usually conditional

to meeting a minimum threshold of attendance, and are usually distributed monthly;

in Burkina Faso, the WFP managed program requires attendance of 90 percent for

that month to receive the monthly ration Kazianga et al. (2008).


25

This type of program may be useful in targeting specific groups of children or

families within a community, as the distribution may occur in a separate location

from the school or may occur outside of regular school hours. In areas where

enrollment and attendance of children is lower for girls, THR programs may be

employed to boost their attendance (and thus promote education for girls). Some

FFE programs may include both SFP and THR, and some SFPs may act as a possible

THR when children are given pre-packaged foods that can be consumed at home and

possibly shared with other family members.

Households may decide to keep children from school based upon the direct

and indirect costs of attending school. Direct costs include fees, books and supplies,

uniforms and travel to school, while indirect costs are in the form of the opportunity

costs of children’s time. Rather than attending school, households may elect to have

their children take care for other family members, engage in household chores, work

on the family farm or business, or work in a wage earning job Cheung & Perrotta

(2010). If the expected benefits of a child’s education do not exceed the costs of

attending school, then the household will not send their child to school Adelman et

al. (2009). For families that can afford to send only one or some of their children to

school, the decision of which children to enrol in school may be determined by who

the family feels has the highest expected returns to education, which in many cases

means that girls are kept at home. Reducing the cost of schooling would increase

enrolment and attendance rates for children in such circumstances. In the case of a

SFP, both a hungry child and parents will have an incentive for daily attendance,

while for a THR program the parents have the incentive to send their children to

school for at least the minimum amount of time required to receive the rations
26

(which varies by program). The additional food provided from a THR program can

be used to supplement the family’s nutritional needs or sold for additional income.

For households that benefit from SFPs, the meal provided at school is one fewer

meal that the household needs to provide to their child. From this perspective, both

the SFP and THR help the families by subsidizing the cost (i.e., the opportunity cost)

of sending their children to school.

Impact on Nutritional Status

Although FFE programs are promoted for increasing educational

achievement, they also play an important role in achieving the nutritional goal (albeit

for children that already passed the critical early childhood influencing phase). For

families facing poverty, food choices are usually limited, resulting in nutritionally

inadequate diets that are often deficient in vital micronutrients Ash et al. (2003).

Deficiencies of micronutrients such as iron or vitamin B-12 can result in increased

vulnerability to infections, stunted growth and diminished cognitive performance in

school-age children Arsenault et al. (2009). The most important period of growth

and body composition occurs in the first several years of life, well before enrollment

in a FFE program would begin. But SFP meals or snacks can be easily fortified to

help provide micronutrients that are commonly missing from children’s diets.

Behavioral Outcomes

School feeding programs are premised on the expectation that serving food at

school will increase enrollment and daily attendance of students. Thus, school

feeding programs are hypothesized to alter the schooling decision for families who

would not have sent their children to school otherwise Adelman, Gilligan, & Lehrer

(2008). This behavioral change by both the parents and the children is reflected in
27

the rates of increase in such outcomes as enrollment, attendance, and length of

schooling, and decrease in dropout rate, tardiness, and absenteeism.

Cognitive Outcomes

There are studies that looked at the impact of FFE programs on the cognitive

development of school children. Of these, six looked at impacts on academic

performance, while ten looked at other cognitive effects, as tested by tools such as

the Wechsler Intelligence Scale for Children (WISC) and the Raven’s Colored

Progressive Matrices. These tests measured various signs of cognitive development,

such as reasoning, memory, attention, and speed of decision making.

In the Bangladesh study, Ahmed (2004) tested 1,648 grade five students from

the treatment groups to see the effects of fortified snacks on school performance.

Since students had not finished grade five at the time of the testing, all students were

tested using a grade four test. The test scores for three subjects, Bengali, English,

and mathematics, and a combined score were all estimated using Tobit regressions.

Total test scores improved by 15.7 percent in the treatment group over the control,

with mathematics improving by 28.5 percent and English 22.2 percent; Bengali

scores increased but not statistically significantly. Similar to the study by Ahmed,

Meyers et al. (1989) found significantly greater improvements in total scale score

and language sub score, while marginal improvements were seen in mathematics and

reading sub scores. Not all of the results from studies looking at impacts of the FFE

programs on student achievement were as strong as those found by Ahmed (2004)

and Meyers et al. (2003).

Adrogué and Orlicki (2011) analysed a SFP conducted in Argentine national

public schools; in their non- experimental design, they found the impact of the SFP
28

on school scores for students in grade three. The language scores for the third grade

students increased by 0.15 SD, but there was no significant effect on mathematics

scores. Kazianga et al. (2009) found no significant impact on performance in

mathematics. Tan, Lane, and Lassibille (2009) saw improved math and English test

scores due to the school feeding programs, but no impact on Filipino language test

scores.

Whaley et al. (2003) examined the impact of three different diets in rural

Kenya on the cognitive development of school children. Four different feeding

interventions - meat, milk, energy or the control (who were not fed) - were randomly

assigned to 555 grade one children for 21 months. The study found that children

who received supplementary meat or energy diets statistically outperformed the

control group on arithmetic ability. Verbal comprehension showed no statistically

significant difference in test scores. The other studies in this review compared milk

or meat to other treatment groups, though the study by Lien et al. (2009) in Vietnam

used milk or fortified milk to compare to a control group that consumed nothing.

Lien et al. (2009) did conduct several cognitive development tests in which milk

drinking children were found to have significantly higher work speed and higher

efficiency in the later part of the exercise. Recall of memorized words and numbers

was significantly higher for milk drinkers. Those consuming fortified milk

outperformed the regular milk drinking group (but results were not reported) Lien et

al. (2009).

Osendarp et al. (2007) conducted a study of school-aged children (6-10 years

old) in Adelaide, Australia, and Jakarta, Indonesia. Treatment groups were given one

of four different beverages fortified with differing amounts of a variety of


29

micronutrients and two omega-3 fatty acids. The children (396 in Australia and 384

in Indonesia) were assigned to the treatment groups in 2-by-2 factorial randomized

control double blind trials over the course of a year. Subjects from these two

locations were chosen to represent two socio-economic groups: (a) children who

were well-nourished and came from families with a high socioeconomic status, and

(b) children who were marginally nourished and came from low socioeconomic

status families. Cognitive testing occurred at the baseline, 6 months, and 12 months,

and included the longest battery of tests of any study in this review. Results indicate

significant increases in scores on tests representing verbal learning and memory in

Australia. A similar effect was observed among Indonesian girls.

Malnutrition remains one of the major obstacles to human well-being and

economic prosperity in developing countries (Ecker & Nene 2012, Stevens et al.,

2012). The most recent report from Save the Children stated that adults who were

malnourished as children earn twenty percent less in academic performance, on

average, than those who were not (Save the Children, 2012). Majority of the children

interviewed highlighted that they came to school without having any breakfast. Most

of the respondents narrated that their lack of food and basic meals was a contributing

factor in dropping out of school. It was a major issue as they narrated that:

Sometimes we go to school without a meal. Some grade seven learners have dropped

out of school because of not having any food at home. We sometimes only have one

meal a day and sometimes sleep without taking in any food. We eat low calorie and

less nutritious food like black tea in the morning and sadza and vegetables

sometimes at lunch and /or supper.

Health and Nutrition Outcomes


30

Studies in this review included evaluation of impacts of FFE interventions on

health and nutrition related outcomes. The studies covered different types of

outcomes, which can be grouped into four categories: anemia, calories (energy),

nutrient status, and morbidity and illnesses. Results exhibit consistent positive effects

on the well-being of the children, with the exception of nutrient related outcomes,

which had mixed results. Calories, in themselves, would normally be an input in the

interventions and inappropriate as an outcome. However, the authors of the studies

that included calories (or energy), were attempting to measure the degree to which

the intervention “sticks” to the children. In other words, the researchers wondered if

the children receive all of the benefit from the FFE and are not penalized later by

parents by changing the distribution of food within the household to others (i.e.,

siblings, adults) not receiving the FFE benefits.

In the study by van Stuijvenberg et al. (2009), fortified biscuits were

compared to regular biscuits to see the impact on the micronutrient status of primary

school children. The study had particular interest in improving the status of iron,

iodine, and vitamin A in children, as deficiencies in any of these three have been

shown to affect the mental development and learning ability of children, lead to

greater susceptibility of illnesses and infections and lead to further long-term health

issues Van Stuijvenberg et al. (2009). The biscuits were fortified with iron, iodine

and β-carotene, which is a form of vitamin A. After a cross-sectional survey of the

community dietary intakes, which revealed micronutrient deficiencies children faced,

data on micronutrient status of the treatment and control groups were collected at the

baseline, six months and 12 months after the intervention. Significant treatment

effects were found for serum retinol (a measure of vitamin A); serum ferritin, serum
31

iron, transferrin saturation (measures of iron); urinary iodine; hemoglobin and

hematocrit (measures of degree of anemia). The presence of anemia decreased at a

higher rate for those in the treatment group over the course of the intervention, while

goiter did not decrease. The intervention also impacted the number of days the

children in the treatment group missed school for respiratory related illnesses. Days

missed from school due to diarrhea related illnesses were significantly fewer.

Ash et al. (2003) provided fortified beverages and placebos to children in six

rural primary schools in Tanzania. Like the intervention in Tanzania, the fortification

included iron, a form of vitamin A, and iodine plus other micronutrients, such as zinc

and vitamin B-12 Ash et al. (2003). In the treatment group, of those anemic at

baseline, a cure rate of 21 percent was seen and 27 percent of the potential new cases

of anemia were avoided in the treatment group Ash et al. (2003).

The rate of serum retinol concentrations (vitamin A) decreased from 21.4

percent to 11.3 percent in the treatment group compared to no significant change in

the control group Ash et al. (2003). The treatment significantly increased hemoglobin

concentration in the fortified group over the nonfortified group. In another fortified

food program, Muthayya et al. (2009) found that the high micronutrient treatments

significantly improved a number of micronutrient and biochemical indicators.

Twelve months after the beginning of the intervention, the researchers found that for

anemia, iron, folate, and vitamin B-12 deficiencies, the high micronutrient groups

were able to significantly drop the prevalence over that of the low micronutrient

groups. Similar impacts were seen in both the high socioeconomic (Australia) and

low socioeconomic status (Indonesia) children in the Osendarp et al. (2007) study.

Treatment groups that received micronutrients showed improved blood


32

concentrations of hemoglobin, folate, vitamin B-12, and serum ferritin over the

course of the 12 month study.

Impact of School Meal Programs

Food for education programs (FFE), including meals served in school and

take-home rations conditional on school attendance, have recently received renewed

attention as a policy instrument for achieving the Millennium Development Goals of

universal primary education and the reduction of hunger in developing countries.

These programs attract children to school by providing nutritious meals in exchange

for school participation. If children are undernourished, the programs may also boost

learning and cognitive development by improving attention spans and nutrition. The

attraction of these programs is their potential to improve both school participation

and learning and cognitive outcomes by increasing the consumption of nutritious

food by undernourished children Adelman et al. (2008).

According to Adelman et al. (2008), in-school meals programs may also have

an impact on cognitive development, though the size and nature of the effect vary

greatly by program, micronutrient content of the food, and the measure of cognitive

Development used.Most empirical findings suggest that school feeding programs

have a positive impact on learning achievement, as measured by increases in test

scores and on drop-out rates. Furthermore, the subject of the achievement test seems

to matter. In general,school feeding does not seem to have the same impact on all

subjects, even within a given study. Ahmed (2004), using an econometric

specification to isolate the effects of the program in Bangladesh, found that students

in program schools score 15.7 percenthigher than did students in the control schools.

He further decomposed this increase into the three subjects that make up the total
33

score and found that the improvement was due mainly to an increase in the

Mathematics test score. Tan, Lane, and Lassibille (2009) evaluated the impact of the

school feeding program in the Philippines, and they found that the impacts of the

school feeding program were not significant at the school level. Kremer and

Vermeersch (2004) found that the treatment impact alone was not significantly

different from zero. However, school meals increased test scores in schools where

the teacher was experienced. This result was found by regressing the test score on

both a treatment variable as well as a treatment variable interacted with the teacher’s

experience.

Micronutrient Supplementation

Erickson (2006) discussed vitamins and minerals as an important substance

for the functioning of the brain. Most important are the vitamins A, C, E, and B

complex vitamins. Manganese and magnesium are two minerals essential for brain

functioning; sodium, potassium and calcium play a role in message transmission and

the thinking process.

Deficiencies like Iron is instrumental to proper brain function, with nerve

impulses slowing for lack of sufficient iron. Research published in the Journal of

School Health (2008) reveals that children with iron deficiencies significant enough

to cause anemia, a condition affecting 53 percent of school children, are at an

academic disadvantage and that their cognitive performance appears to improve

following iron therapy. Iodine deficiencies in early years have similarly been

associated with poor cognition and school achievement. Also considered vital for

academic success is an adequate daily supply of proteins, complex carbohydrates and

calcium. They also stated that children with nutritional deficiencies are particularly
34

susceptible to the moment-to-moment metabolic changes that impact upon cognitive

ability and performance of the brain. Treatment with nutritional supplements can

result in improved performance. Among the well-nourished, augmentation of nutrient

intake has less of an impact on cognitive performance

Diets deficient in essential vitamins and minerals can have an enormous

health impact. Thus, micronutrient supplementation is another example of nutrition

interventions to prevent specific deficiency diseases in individuals and to promote

well-being. This intervention method supplies micronutrients separately from the

normal diet. Children who receive supplements must obtain them regularly;

therefore, schools are an appropriate place to distribute them. Micronutrient

supplements can be given orally or by injection. These supplements may include

vitamin A capsules to prevent blindness, iron tablets to prevent anaemia and iodized

oil or iodized salt to prevent goitre and mental retardation. Ample evidence exists of

the value of treating micronutrient deficiencies resulting in improved performance at

school or work and reduced burden of illness, disability and death.

What is Healthy Nutrition?

Healthy nutrition takes many forms and is understood differently in different

countries and among different cultures. In general, healthy nutrition should be an

integral part of daily life that contributes to the physiological, mental and social well-

being of individuals. It is the combined effect of food, health and care. Nutritional

well-being is determined by consuming safe food as part of an appropriate and

balanced diet that contains adequate amounts of nutrients in relation to bodily

requirements. The health and lifestyle of an individual influences the extent to which

food contributes to good social, mental and physical well-being. Care is shown by
35

providing time, attention and support in the household and the community to meet

the food and health needs of the child and other family members. Furthermore, social

ties are validated and maintained by the exchange of food since offering food is

associated with offering love, affection and friendship.

Another article said that, child’s health is a state of physical, mental,

intellectual, social and emotional well-being and not merely the absence of disease or

infirmity. Healthy children live in families, environments, and communities that

provide them with the opportunity to reach their fullest developmental potential

(WHO Definition). This topic is linked to the sub-problem 5 talking about the

classroom performance of the pupil.

According to the writers named Janet Powney, Heather Malcolm, and Kevin

Lowden who wrote the Health and Attainment, the effects of physical health on

attainment are more pronounced for children at risk and in poverty. These children

are more likely to suffer a range of illnesses, which impacts on the time they spend at

school learning. Simply being poor is associated with poor health, which in turn has

a detrimental effect on learning. Certain illnesses, which impair senses important to

learning, such as hearing or speech, seem to have a particularly detrimental effect on

attainment. A range of other physical health factors, both environmental and

inherited can play a role in limiting learning. These include the effects of passive

smoking, high blood lead levels, anemia and even the level and quality of light.

Physical exercise has been associated with higher motivation at school, reducing

anxiety and depression, and therefore, with a positive effect on schoolwork.

They also restated that poor mental health can manifest in a range of problem

behaviors that can affect concentration, and cause difficulties and low achievement at
36

school itself. Some studies highlight that risk taking involving behaviors that affect

physical and mental health, such as substance misuse, can have a long term

detrimental effect on health, particularly, where substances affect brain function and

personality. Misuse of certain substances including alcohol, tobacco and illegal drugs

is associated, for some pupils, with lower school grades and negative attitudes to

school.

Our health and well-being, quality of life and ability to learn, work and play

depend on how well we are nourished. Good nutrition or nutritional status is the

outcome of many complex and interrelated determinants such as access to adequate,

safe, affordable and nutritious food, and care and health services. The nutritional

status of an individual depends on how well requirements for energy and more than

50 different nutrients are met. Requirements and eating behavior (what, where, when

and how often specific foods are eaten) are determined by a large number of

physiological, pathological, psychological, cultural and socio-economic factors.

Because of this, there is no single measurement that will give comprehensive

information on nutritional status. Therefore, a combination of methods, including

anthropometric measurements, biochemical analyses, nutrient intakes and clinical

signs of malnutrition is usually used. The interpretation of these variables and

conclusions reached will depend on the norms or standards used for comparison.

Synthesis of Related Literature

Research and studies explained that food and nutrition had a significant role

in child’s cognitive functioning and development. Nutrition affected the chemical

messengers within the brain called neurotransmitters that contributes to boost

optimal brain function. Relative abundance of these nutrients can affect cognitive
37

processes and emotions. Erickson (2006) pointed out key components required to

keep the brain functioning correctly. Erickson discussed vitamins and minerals as an

important substance for the functioning of the brain. Most important are the vitamins

A, C, E, and B complex vitamins. Manganese and magnesium are two minerals

essential for brain functioning while sodium, potassium and calcium take part in

message transmission and the thinking process. He also considered an adequate daily

supply of proteins, complex carbohydrates and calcium were vital for academic

success.

Child's poor eating habits could lead to a variety problems with energy, focus,

mood and concentration, as well as directly impair that child's capacity to learn.

Insufficient amount of nutrients needed by the body will lead to malnutrition.

Medical experts associate undernourishment with reduced activity levels, social

interactions and curiosity. In addition, undernourished children have been found to

experience difficulty fighting off infections, causing them to fall ill more frequently,

miss more days of class and struggle harder to catch up with the rest of the class,

thus leading to poor academic performance.

School feeding program is one of the interventions implemented by

Department of Education which aimed to increase food availability while promoting

healthy eating habits..This program provides food rich in protein and micronutrients

to undernourished schoolchildren. Feeding program have been shown to increase

weight and also school attendance and achievement .The composition of provided

meals in terms of food items and nutritional value often leads to educational

achievement.
38

THEORETICAL FRAMEWORK

Social Cognitive Theory (SCT) of Bandura supported the study because the

researcher was developing a behaviour towards the participants by utilizing the

feeding program conducted in the school. Introducing them to more nutritious food

such as vegetable and fruits rich in nutrients were not only the focused of the study.

It also gave awareness to the participants that good health also developed sound

mind and cognitive functioning. Thus developing a self-regulatory efficacy

behaviour that will lead them to healthier choices of food.

Bandura’s Social Cognitive Theory (SCT) delineates the presumed sources

and mediators of behavior and behavior change. In self-efficacy, he posited that

when behavior change requires regular performance of familiar behaviors, self-

regulatory efficacy supersedes performance self-efficacy. With the growing

proliferation of good-tasting and affordable lower fat foods, fruits and vegetables,

and whole grain foods, individuals’ confidence in their abilities. In previous research,

self-efficacy has been associated with healthy nutrition patterns. The perceived social

support for healthy eating from important others, such as family and friends (a

precursor to self-efficacy in SCT), has been associated with better nutrition. In

outcome expectations, social, physical and self-evaluative outcomes expected of

behavior are dependent on the individuals’ efficacy beliefs and serve as incentives

(or disincentives) for healthier food choices. Self-efficacy and outcome expectations

are posited to influence behavior directly and through the development and use of

self-regulatory behaviors. Among people who desire a healthy diet and who have

access to healthy foods, the content their diets will be determined largely by how
39

well they set goals, plan, and monitor—self-regulate—what they buy and eat.

Stronger efficacy beliefs lead individuals to expect to reap the benefits and avoid the

difficulties associated with healthy nutrition. Individuals with higher self-efficacy

and more favorable outcome expectations will ultimately be more likely to

implement the self-regulatory strategies essential to adopting and maintaining

healthier eating patterns.

In this theory, family and school have a vital role in developing the behavior

of school children towards the connection of proper nutrition to good academic

performance.

CONCEPTUAL FRAMEWORK

The researcher’s understanding of the theoretical framework and insights

gained led to the development of this conceptual framework. Pupils learn better and

faster when they are healthy and have sound mind. Good health and nutrition are

needed to achieve one's full educational potential because nutrition affects

intellectual development and learning ability . Multiple studies report significant

findings between the nutritional status and cognitive test scores or school

performance. Consistently, children with more adequate diets score higher on tests of

factual knowledge than those with less adequate nutrition. Feeding program was one

of the intervention given by the school for severely wasted students. Having a well

nourished students could led them to better performance in school. Thus, improving

their academic performance in school.

Analysis of the Academic


Nutritional Status of Feeding Program
Performance in
the Pupils School (GPA)
40

Figure 1. Conceptual Framework

Research Paradigm

Input Process Output


Demographic Profile of Analysis of the Enhanced
the Participants: Relationship between
School Feeding
Age Nutritional Status
Program in
Gender and Academic
Sampaguita
Nutritional Status of the Performance among
Elementary School
Respondents Grade Six
Weight Pupil
Height
of Sampaguita
Grade Point Average
(GPA) Elementary School
For the First
Quarter
Grade Point Average
(GPA)
For the Fourth
Quarter

The research paradigm of this research work is based on the In-put-Process-

Output concept.

The researcher used the nutritional status of severely wasted students as an

indicator of academic performance of the participants. The researcher also identified

the weight and height before and after the feeding program; and their Grade Point

Average for the first and fourth quarter to know the relationship of academic

performance and nutritional status of severely wasted students . These participants

underwent an intervention through the school feeding program. The data gathered

were processed using the methodological procedure to thoroughly analyze and


41

understand the result and came up to an enhanced feeding program of Sampaguita

Elementary School.

STATEMENT OF THE PROBLEM

The main concern of the study is to determine the nutritional status as an indicator of

academic performance among grade six pupils in Sampaguita Elementary School

that can be an input to an Enhanced School Feeding Program.

Specifically, it sought to answer the following questions :

1. What is the nutritional status of the participants before and after the feeding

program

1.1 Weight

1.2 Height

2. What is the Grade Point Average (GPA) of participants for the:

2.1 First Quarter

2.2 Fourth Quarter

3. Is there a significant relationship between nutritional status and academic

performance of the participants?

4. What appropriate program can be developed based on the result of the study?

Hypothesis

There is no significant relationship between nutritional status and academic

performance of the participants during the school year 2014-2015.

SCOPE AND LIMITATIONS


42

This study aims to find out if nutritional status can be an indicator of

academic performance of severely wasted students in Sampaguita Elementary

School. The academic performance was based on the Grade Point Average (GPA) for

the first quarter and fourth quarter of the participants. It focused on how their

nutritional status affect their academic performance and cognitive functioning. The

target participants of the study was composed of fifty (50) severely wasted students

who were chosen using purposive sampling.

SIGNIFICANCE OF THE STUDY

The result of the study may be beneficial to the following:

School Administrators. This study may provide the school administrators

some insights in solving problems arising among elementary pupils’ nutritional status

and classroom performance. Knowing these connections they may perceive higher

grade or rate for the pointing system per schools given by the division by having

excellent strategies to enrich the teachers’ awareness about the pupils’ skills and

needs.

Teachers. The school is the institution for formal education. The awareness

of the teacher on the child’s needs are necessary in planning activities in the school

and to know the proper way to empower pupils to perform better in their school

performance.

Pupils. The findings of this study are relevant to the pupils’ development.

This may shed information that having a good nutrition is essential to their academic

performance.
43

Parents. This study will help the parents to know how to be more creative

and show compassion to their children by motivating them to take the proper food

and vitamins.

Clinic Personnel. May conduct physical and health examination regularly

Edukasyong Pantahanan at Pangkabuhayan (EPP Teachers). May keep

on teaching pupils actual preparation of nutritious food during EPP classes.

Curriculum Maker. To continue the efforts in implementing health

programs design for the improvement of the nutritional status of pupils.

Future Researcher. This research may give future researchers and graduate

students insights for conceptualizing similar or related studies that may help them

fulfill a requirement in their chosen field.

DEFINITION OF TERMS

The following terms in the study were operationally defined to provide better

understanding of their use and application in the study.

Academic performance. Refers to the Grade Point Average of the

participants

Body Mass Index (BMI). BMI is a number calculated from a person’s height

and weight. It provides a reliable indicator of body fatness for most people

and is used to screen for weight categories that may lead to health problems

(CDC, 2000).

Gender. A sexual identification of the participants.

Health. A physical condition of the participants.


44

Nutritional status. The assessment of the state of nourishment of the

participants.

Severely-wasted Are the grade six pupil enrolled at Sampaguita Elementary

School having a deficient nutritional status.

Teachers’ assessment. A process in which they make a judgment about a

student or a situation, or the judgment they make, while the evaluation is a

judgment about how good, useful, or successful something is.

Chapter 2

METHODS

This chapter presents the procedures and processes employed in the conduct

of the study. It includes the research design, the respondents, instruments used and

techniques in gathering and interpreting the data.

Research Design
45

This study utilized the experimental method which is a systematic

and scientific approach to research wherein the researcher manipulates one or more

variables, controls and measures any change in other variables. Richard Shavelson &

Lisa Towne (2002) concluded that “from a scientific perspective, randomized trials

are the ideal for establishing whether one or more factors caused change in an

outcome because of their strong ability to enable fair comparisons”. Similarly,

Richard Mayer (2005) notes: “experimental methods— which involve random

assignment to treatments and control of extraneous variables Mayer states that if one

wants to determine whether a particular instructional intervention causes an

improvement in student learning, then one should use experimental research

methodology. That’s why the researcher made used of true experiment, before and

after performance designs were the preferred method to compare participant groups

and measure the degree of change occurring as a result of treatments or

interventions. Thus, this research was designed to look into what is the current status

of the phenomenon under study.

Population and Sampling

The respondents of the study were 50 severely-wasted grade six pupils of

Sampaguita Elementary School S.Y. 2014-2015. Their age ranges from 11 to 13

years old. The participants were categorized as experimental group. The age and

gender of the participants were tabulated below:


46
Age Participants
f %

11 14 28
12 25 50
13 7 14
14 2 4
15 2 4
Total 50 100
Participants
Gender f %
Male 28 56
Female 22 44
Total 50 100

Sources of Data

The researcher used the nutritional status pre-assessment of the pupils

needed for the study. The Nutritional Card of the pupil is a data accomplished by the

teacher at the beginning of the school year specifically every 1st week of the Month

of July. It is a standardized data formulated and given by the DepEd. It contained the

data that were stated in Chapter 1. A letter requesting for permission to conduct the

study was given to the Superintendent of the Division of City Schools Caloocan

through the District Supervisor, Principal.

Data Gathering Procedures

The researcher started gathering data using the internet and found some

books and magazines at the library that were related to the study.

After the granting of permit by the Division Superintendent, the researcher

secured the data of the Nutritional Status of the pupil thru their Nutritional Card from

the adviser of the pupil. The researcher categorized the participants as experimental

group.

The researcher requested the Grade Point Average of the respondents for the

first quarter from their respective adviser. The data were gathered in the end. After
47

the first quarter, the participants was given the treatment through the school feeding

program After the given period of time, the researcher gathered the Grade Point

Average (GPA) for the fourth quarter of the participants. The researcher also

gathered the nutritional status of the participants after the feeding program. The data

gathered were subjected to statistical treatment to further analyze the result.

Data Analysis

The data gathered by the researchers were tallied, tabulated and

utilized the following statistical treatment to ensure validity and reliability of the

result:

Frequency and Percentage Distribution was applied in treating the data on

the profile of the respondents in terms of age, gender, family income, mother’s

occupation, father’s occupation, height, and weight of the respondents.

The formula for frequency and percentage is:

Where:

P = Percentage

f = Frequency

n = Number of Respondents
48

T-test was used to determine the existence or absence of a statistically

significant difference between the mean values of the data gathered.

T-test used mean and standard deviation of two samples to make a

comparison. The formula for T test is given below:

X1 - X2
T= S21 + S22
N1 N2

Where:

X1¯ Mean of first set of values

X2¯ Mean of second set of values

S1 Standard deviation of first set of values

S2 Standard deviation of second set of values

N1 Total number of values in first set

N2 Total number of values in second set.

References:

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Food Policy Project, Dhaka.
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Meyers AF., Sampson AE., Weitzman M., Rogers BL., & Kayne H. (1989). School Breakfast
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INTERNET SOURCES

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Africa: evidence from school-based health programmes in Ghana and Tanzania.
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the Royal Society of Tropical Medicine and Hygiene 92:254-261,1998b

Kids’ Health, Inc. Increasing Academic Performance While Reducing Obesity


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malnutrition-deped#ixzz2khnKYJM

http://docs.schoolnutrition.org/newsroom/jcnm/05spring/fns.asp

http://ivythesis.typepad.com/term_paper_topics/2011/05/academic-performance-of-
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Glewwe, P., Jacoby, E., & King, E. (1999). Early Childhood Nutrition And Academic

Achievement: A Longitudinal Analysis. [Pdf.] FCND DISCUSSION PAPER NO. 68.


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Hildenbrandt, J., 2010. Link Between Nutrition and Academic Performance.

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Overweight Teen, n.d. The Relationship between Nutrition and Performance at


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quality-on-academic-performance-in-children/.

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