School Feeding Program in Addis Ababa, Ethiopia: Safety and Nutritional Quality of Meals and Programmatic Challenges
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Date
2024-11
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Addis Ababa University
Abstract
The implementation of SFPs faces significant challenges, including limited institutional capacity, resource constraints, and inadequate food safety measures. Existing literature highlights a lack of data in these areas, emphasizing the need for comprehensive research to enhance program effectiveness and protect student well-being. In Ethiopia's SFP, issues persist regarding food provision, infrastructure, and administrative concerns related to food quality and hygiene. Previous studies in Addis Ababa which evaluated dietary quality and food safety knowledge among food handlers; however, they were not comprehensive. Therefore, this research aims to fill critical gaps by assessing the dietary quality of school meals, microbiological safety, food safety knowledge among food handlers, and the perceived benefits and challenges of the SFP in Addis Ababa.
A cross-sectional study was conducted involving 293 adolescents from 20 schools. The dietary intake was evaluated via a multiple-pass 24-hour recall method against the RDA. Dietary diversity was measured using a 12-food groups score and analyzed with STATA software. Microbial contamination in RTE and drinking water was assessed collecting samples from 18 primary school kitchens in March and April 2024. This included microbiological analysis for 37 cooked food samples and 18 drinking water samples following ISO and NMKL guidelines. The KAP regarding food safety was evaluated employing structured face-to-face interviews (knowledge with a 29-question questionnaire (70% cutoff), attitudes with a 22-question scale, and practices with a 22-question instrument (scores of 16 or more indicating good practices)). Data were analyzed using descriptive statistics, pairwise correlations, and multiple linear regressions. Additionally, a qualitative phenomenological study was carried out in May 2023 on 98 participants (48 mothers of the students, 20 students, 20 school principals, and 10 experts gathered through key informant interviews and focus group discussions). The qualitative data was transcribed, translated, and thematically analyzed using ATLAS-TI software.
The study highlighted significant nutrient inadequacies of meals provided to adolescents in schools. While school meals contributed a sufficient amount of carbohydrates (74.4%) of the RDA, they fell short in other essential nutrients: energy (34.1%), protein (42.5%), calcium (9.3%), zinc (14.6%), iron (52.9%), vitamin A (14.0%), thiamine (16.7%), vitamin B12 (12.8%), and niacin (3.8%). Moreover, this study assesses the 24-hour DDS of public primary school
adolescents. Key findings reveal that 88.1% achieved adequate dietary diversity (DDS of 5 or higher), with 34.7% scoring 5, 38.5% scoring 6, 13.1% scoring 7, and 2.8% scoring 8. Despite a diverse diet, significant nutrient inadequacies persisted in both the school meals and overall 24-hour dietary intakes.
The microbiological analysis of RTE meal samples indicated an overall acceptable level of quality and safety. However, several concerns were identified. Yeasts and molds exceeded reference standards in 78.4% of the RTE cooked meal samples (>102 cfu/ml), while E. coli surpassed the acceptable limit in 10.8% of samples (>102 cfu/ml), and S. aureus counts exceeded limits in 5.4% of samples (103 -104). Cooked rice showed the highest microbiological counts, particularly for E. coli and S. aureus. Approximately, 14.4% of the food samples were deemed unsatisfactory, exhibiting contamination from E. coli, S. aureus, and yeasts and molds. Regarding drinking water quality, 23.4% of samples were found to be non-potable, raising concerns about the total APC, TC, and FC. Notably, 72% of drinking water samples exceeded the APC criteria (>100 cfu/ml), 16% surpassed the TC standard (>1 cfu/ml), and 5.5% exceeded the FC threshold.
The study revealed high levels of knowledge (85.8%), positive attitudes (79.6%), and satisfactory practices 72.3% among food handlers. Key factors influencing these outcomes included education, years of service, and marital status. Education was found to significantly enhance knowledge (p = 0.004) and practices (p < 0.001). While years of service positively influenced knowledge (p < 0.001), it had a negative impact on practices (p = 0.019). Marital status also played a role, with significant associations observed in attitudes (p = 0.046) and practices (p = 0.043). Logistic regression analysis highlighted the importance of specific facilities: having a separate storage area for raw and RTE foods reduced unsatisfactory food safety practices by 55% (AOR = 0.45), while a water facility in the kitchen decreased poor hygiene practices by 46% (AOR = 0.54). Additionally, a hand-washing facility lowered the odds of poor practices by 35% (AOR = 0.65). Notably, food handlers with higher attitude scores had an 81% lower likelihood of exhibiting poor food safety and hygiene practices (AOR = 0.19).
Moreover, a qualitative study shed light on the benefits and challenges of the SFP, showcasing positive impacts on attendance, academic performance, reduced dropout rates, financial relief, improved behavior, and a safer learning environment. However, challenges such as underpaid kitchen workers, operational issues, reduced reading time, increasing food costs, limited market
access, inadequate infrastructure, and growing the intention of dependency were also identified. This study emphasiz the necessity of enhancing nutritional adequacy, ensuring microbiological safety, sustaining food safety knowledge, and addressing program challenges to optimize the SFP in Addis Ababa.
The study underscores the critical need to address nutrient inadequacies among school adolescents by prioritizing menu planning that incorporates nutrient-dense foods and implementing cost-effective strategies utilizing locally sourced options. Implementing nutrition education programs and collaborating with stakeholders on tailored initiatives such as community gardens, partnerships with local farmers, and enhancing the availability of free nutritious meals—are essential for promoting student well-being.
While the microbiological quality of meals served through the Addis Ababa SFP generally meets established standards, some food samples exceeded permissible limits, indicating hygiene challenges that must be addressed through stringent hygiene practices.
Also, food handlers in the program exhibited high knowledge and positive attitudes towards food safety, yet significant gaps in actual practices highlight the need for targeted educational interventions that consider local and cultural influences. Future researches should focus on objective measurements to better understand food safety practices and their implications for public health.
Overall, although the SFP seems to contribute to a safer learning environment and improved educational outcomes, these conclusions may rely more on perception than on measurable evidence. However, urgent action is needed to address critical issues such as underpaid kitchen staff, operational inefficiencies, rising food costs, and inadequate infrastructure. To ensure the program's long-term sustainability, it is essential to implement strategies for reducing workloads, enhancing kitchen infrastructure, adhering to government guidelines, and promoting self-reliance among schools.
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Keywords
Knowledge, Attitudes, and Practices, Adolescents, Dietary Intake, Food Handlers, Microbial Contamination, Microbiological Safety, Nutritional Quality