SCHOOLBASED SUPPLEMENTARY FEEDING: ARE

WE GAINING
Agdeppa, Imelda;Oro, Emilita;
Capanzana, Mario;Lainez, Carmina;Kirstein, Itliong;Sarmiento, Ian;Baguilat, Irish;

© 2018, EMILITA ORO, IIRR

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IDRC Grant/ Subvention du CRDI: 108156-001-Improving food and nutrition security in the
Philippines through school interventions
 Annex 4. Working paper on School-based Supplementary Feeding: Are We Gaining

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7 Are We Gaining
Supplementary Feeding:
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Emilita Monville Ora. RN. MPH

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Country Director, Philippine Program
Regional Center for Asia
International Institute of Rural Reconstruction
Km 39, \/.C. James Yen Center. Biga, Silang, Cavite 4115
Philippines
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Imelda Angeles-Agdeppa, PhD

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Assistant Scientist
Food and Nutrition Research Institute-Department of Science and

Technology (FNRI-DOST)
FNRI Bldg, D051 Compound,
Marv/1 Manil: Dhilinninac
Gen. Santos Ave., Bicutan, Taguig City. lg
tét 537-2934. 337-207; to 31 lo: 223:.

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E-mail: iangelesagdeppa@yahoo,com.ph

Project title‘
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Philippines through School Interventions

Project Implementation:
201 6-201 8

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Project Team
Principal Investigators
Emilita Monville Oro, RN, MPH
Imelda Angeles-Agdeppa, PhD

Researchers Technical Advisers

Ma. Shiela S. Anunciado Mario V. Capanzana
Ronnie M. De Castro Julian F. Gonsalves
Kirstein D. Itliong
Carmina Alicia N. Lainez
Ian Curt R. Sarmiento

Project Manager
Irish P. Baguilat

Department of Education Virgilio O. Guevarra

Rizalino Jose T. Rosales Yolanda S. Oliver
Ella Cecilia G. Naliponguit Galileo L. Go
Maria Corazon C. Dumlao Sentinel Research Schools
Magdalane Portia T. Cariaga Julugan Elementary School Personnel
Ferdinand M. Nuñez Sunnybrooke Elementary School
Mei-Ling V. Duhig Personnel
Diosdado M. San Antonio Tinabunan Elementary School
Annaliza T. Araojo Personnel
Neil B. Evangelista Region IVA Lighthouse Schools
Romeo E. Endraca Personnel
Rolando B. Talon, Jr.

Department of Agriculture
Felix Joselito H. Noceda
 School‐based Supplementary Feeding: Its
Implementation and Benefits
Introduction

The Philippine National Nutrition Survey conducted by the Food and Nutrition Research
Institute of the Department of Science and Technology (DOST‐FNRI) in 2008 showed that
about 4 million children were undernourished. The prevalence of underweight was 25.6% or
2.6 million (FNRI‐DOST, 2008). In the 2015 national data estimates on 5‐10‐year‐old children
showed that the prevalence of underweight is 31.2%; stunting, 31.1%; and wasting, 8.4%
(FNRI‐DOST, 2015).

The response of the Department of Education (DepEd) to address the undernutrition

problem is the implementation of the School‐Based Feeding Program (SBFP) and Gulayan sa
Paaralan Program (GPP). The SBFP subsidized by the government provides one lunch per
day per child costing P18.00 per day, including operational cost which aims to improve
school attendance and reduce dropout rates. On the other hand, the GPP or school
gardening aims to promote food security in schools. School gardens serve as a ready food
source of vegetables in sustaining feeding programs and as a learning laboratory. However,
there is a disconnect in the actual implementation of the SBFP and GPP. In the previous pilot
study a model linking the two programs and adding nutrition education as an integral
component for sustainability was evaluated. Results revealed that the integrated model on
bio‐intesive gardening, nutrition education and supplementary feeding (GarNESupp) yielded
significant findings on improved garden produce, enhanced knowledge, attitude and
practice of parents, and better nutritional status of children. This 3‐year action research
project (Phase 1) jointly implemented by the International Institute of Rural Reconstruction
(IIRR), DOST ‐ FNRI and DepEd funded by the International Development Research Centre
(IDRC) from 2012 to 2015.

The Phase 2 of the project (2016 to 2018) concentrated on fine‐tuning the established
GarNESup model and identifying effective mecahnisms of scaling – up. Results of this study

1|Page
could serve as a basis for policy recommendation and development of guidelines for
nationwide implementation of the GarNESupp. A total of 58 public elementary schools
within Region 4A were selected to be lighthouse schools that features the three
interventions ‐ regular school feeding program, a well‐sustained bio‐intensive garden, and
school‐based nutrition education activities. Three schools were designated as sentinel
research sites.

Definition of terms

Nutritional assessment is defined as the appraisal of available information to provide a

description of existing nutritional situation or nutritional status (FNRI, 1998).

Nutritional status is defined as the condition of the body resulting from the intake,
absorption, and utilization of food. Clinical examinations, biochemical analyses,
anthropometric measurements, and dietary studies are used singly or in combination to
determine this condition (FNRI, 1998).

Anthropometry is defined as the measure of the variation of the physical dimension and
gross composition of the human body at different age levels and degrees of nutrition
(Jelliffee, 1966).

Body mass index (BMI) is an indicator of nutritional status expressed as body weight in
kilograms divided by the square of the height in meters. It provides a measure of body mass,
ranging from thinness to obesity (WHO, 2007).

Weight‐for‐age is the simplest and most common indicator for the assessment of growth. It
compares the weight of an individual to a standard or reference weight‐for‐age. This
indicator is useful for rapid screening because it combines acute and chronic malnutrition
(WHO, 2007).

Stunting or being too short for one’s age is defined as a height that is more than two
standard deviations below the WHO child growth standard’s median. It is the consequence

2|Page
of long‐term nutritional deprivation and often results in delayed mental development, poor
school performance, and reduced intellectual capacity (WHO, 2007).

Wasting or thinness is a condition where the child’s weight is lower than that of a normal
child of the same height. It is a symptom of acute undernutrition, usually a consequence of
insufficient food intake or a high incidence of infectious diseases, especially diarrhea (WHO,
2007).

Underweight is low weight for age. As weight is easy to measure, this is the indicator for
which most data have been collected in the past. Evidence has shown that the mortality risk
of children who are even mildly underweight is increased, and severely underweight
children are at even greater risk (WHO, 2007).

Overweight is defined as abnormal or excessive fat accumulation that may impair health.
Overweight is a BMI greater than or equal to 25 (WHO, 2007).

Obesity is defined by the WHO as a BMI greater than or equal to 30 (WHO, 2007).

Normal is defined as a child whose weight/height‐for‐age falls between ‐2 and +2 z‐score

line (WHO, 2007).

Methodologies

Data collection

Anthropometric measurements

As per DepEd Memorandum No. s. 2016, nutritional assessment of Kinder to Grade 6 pupils
should be conducted during the first week of classes. For the study, the FNRI verified the
nutritional assessments in three sentinel schools and three LH schools from July to August
2016. The three sentinel schools were all in the province of Cavite: Sunny Brooke

3|Page
Elementary School (SBES) in Gen. Trias, Tinabunan Elementary School (TES) in Imus City, and
Julugan Elementary School (JES) in Tanza. The three LH schools were Malitam Elementary
School (MES) in Batangas City; San Antonio Central Elementary School (SACES) in San
Antonio, Quezon; and Liliw Central Elementary School (LCES) in Liliw, Laguna.

Weight was measured using a calibrated digital double window weighing scale (SECA)
recorded to the nearest 0.1 kg. Students were in light clothing, their footwear removed, and
pockets emptied. Height was measured using a stadiometer (SECA) recorded to the nearest
0.1 cm. Students were barefoot and were asked to remove headwear or pony tail. All
equipments were calibrated every before use.

The FNRI devised a simple program using MS Excel in computing the nutritional status of the
children. The WHO child growth standards were used as basis for the computation of
nutritional status.

Indicator Cut‐offs
Weight‐for‐age Underweight <‐2 SD
Normal ‐2.0 to +2.0 SD
Overweight >+2.0 SD
Height‐for‐age Underheight/stunted <‐2 SD
Normal ‐2.0 to +2.0 SD
Tall >2.0 SD
BMI‐for‐age Severe thinness <‐3.0 SD
Thin <‐2.0 to ‐3.0 SD
Normal ‐2.0 to +1.0 SD
Overweight >+1.0 to +2.0 SD
Obese >+2.0 SD

Children identified as severely wasted and wasted were included in the SBFP.

Socio‐economic interview

Face‐to‐face interviews using pretested questionnaires were administered to the

parents/caregivers of the beneficiaries to obtain household socioeconomic and
demographic data.

4|Page
Food diversity

An individual dietary diversity questionnaire was administered to the parents/caregivers of

the beneficiaries to determine the diversity in food consumption of the child in the past
week. Dietary diversity is a qualitative measure of food consumption that reflects household
access to variety of foods and is also a proxy for nutrient adequacy of the diet of individuals
(FAO, 2010). Fourteen (14) food groups were included in the individual dietary diversity
score such as cereals, vitamin A rich vegetables and tubers, white roots and tubers, dark
green leafy vegetables, other vegetables, vitamin A rich fruits, other fruits, organ meat, flesh
meat, eggs, fish, legumes, nuts and seeds, milk and milk products, oils and fats. Sweet
products and spices, condiments, beverages products are not included in the score.

Supplementary feeding activity

The recipes developed during Phase 1 were utilized by the schools. To maximize the
produce from the gardens, the feeding coordinator and the garden teacher have sustainably
coordinated with each other on what is grown for use in the feeding.

In the sentinel schools, food preparation and cooking, serving, and cleaning activities were
done by the assigned feeding coordinator and volunteer mothers. All schools have hired
cooks wherein the salary was charged against the allotted operational cost from the funds
of the supplementary feeding.

Each child was served with rice and vegetable recipes for 120 days. Instructions were given
to feeding coordinators to maintain standard serving portions and were instructed to weigh
the food waste. Since previous study revealed that children who were rehabilitated for 120
days in‐school feeding, after the 2 months summer break some children have reverted to
underweight upon school entry. Hence, the present study had evaluated whether and
extended feeding for another 80 days is beneficial. Each sentinel school had their own
strategies to catch the children for feeding.

5|Page
Monitoring

Weight was monitored monthly while height was measured every quarter.

Implementation of the SBFP was observed during monitoring visits. Adherence to the food
safety standards were checked.

Feeding coordinators were provided a consumption form to record the attendance, recipe
for the day, plate waste, and reasons for the children’s absence.

Ethical considerations

The study was reviewed and approved by the FNRI Institutional Ethics Review Committee.
The study was carried out in accordance with the declaration of Helsinki, guided by the
Council for International Organizations of Medical Sciences Ethical Guidelines for Biomedical
Research Involving Human Subjects and the National Guidelines for Biomedical/Behavioral
Research.

Consent to participate in the study was sought from parents of the children. Children aged 7
years and above were asked to sign an assent form.

Data management and analysis

This study used MS Excel 2010, MS Access, StataMP 13, and R Studio. MS Excel was used in
data encoding, while MS Access 2010 was used in the consolidation of the data. Statistical
analysis was done using StataMP 13. Paired t‐test was used to determine the significant
change in anthropometric measures of the students between time periods of feeding
activity. The McNemar change test was done to determine significant change in the
prevalence of stunting and undernourishment among students included in the feeding
program. Pearson R correlation, Spearman’s rho correlation, and chi‐square test for
association were used to determine the factors that may affect the changes in
anthropometric measures. Pearson R correlation was used to determine the relationship
between two continuous variables, e.g., increment in weight and total number of

6|Page
participants in the feeding activity, whereas Spearman’s rho was used to determine the
relationship between two variables if one of the measurements was categorical, e.g.,
nutritional status of students and total number of participants in the feeding activity. Chi‐
square test for association was done to determine the association between two categorical
variables, e.g., nutritional status of students and food pattern. Descriptive statistics such as
frequency, percentage, mean, etc. were derived using the same software. R Studio was used
for graphical representation.

Results

Profile of students in sentinel schools

Of the 541 students identified as undernourished in sentinel schools, only 277 had complete
anthropometric data during the 120 feeding days. About 264 students had incomplete data
due to reasons of dropout, transfer out, or absences during data collection. Among those
with complete data, about 43% (119) of the students, were aged between 5.1 and10 years
old (average of 8.3 years) and 57% (158) were aged between 10.1 and19 years old (average
of 11.6 years).

Table 1. Distribution of students in sentinel schools included in the feeding program with
complete and incomplete data, by gender, per age group
≤5 y.o. 5.1‐10 y.o. 10.1‐19 y.o. Total
n (%) n (%) n (%) n (%)
Complete data 119 (22.00) 158 (29.21) 277 (51.20)
Incomplete data 6 (1.11) 159 (29.39) 99 (18.30) 264 (48.80)
Dropout 2 (0.37) 7 (1.29) 9 (1.66)
Transferred out 9 (1.66) 3 (0.55) 12 (2.22)
Due to absences 6 (1.11) 148 (27.36) 89 (16.45) 243 (44.92)
Gender
Female 65 (54.62) 75 (47.47) 140 (50.54)
Male 54 (45.38) 83 (52.53) 137 (49.46)

Table 2. Mean age of students in sentinel schools included in the feeding program, by age
group
Age group (years) Mean age Min Max
5.1 to 10 (n=119) 8.3 5.5 10
10.1 to 19 (n= 158) 11.6 10.1 16.8

7|Page
Socio‐economic characteristics

Table 3 shows the distribution of the households in sentinel school by household

characteristics and age group. About 64% of the students aged 5.1‐10 y.o. belong in single/
nuclear families or households which consists of only the parents and their unmarried
children while 36% belong to extended families or households. The most common type of
dwelling was single detached or duplex with a total percentage of 90%.

About 74% of the students aged 10.1‐19 y.o. belong in single/ nuclear families and most of
them live in the single or duplex type of dwelling unit with a total percentage of 86%.

Table 3. Distribution of household in sentinel by household characteristic and age group

5.1‐10 y.o. 10.1‐19 y.o.
Characteristic of Household n (%) n (%)
n=81 n=81
Type of Household
Extended with non‐relative families/person 29 (35.80) 21 (25.93)
Single/Nuclear 52 (64.20) 60 (74.07)
Type of Dwelling
Single Detached/Duplex 73 (90.12) 70 (86.42)
Apartment/Townhouse 8 (9.88) 11 (13.58)

Table 4 shows the distribution of the households of the students in sentinel school by health
and sanitation and age group. The main source of drinking water of the household was
purified water bottle. Majority of the household used water sealed for their waste
materials. And the most common method of garbage disposal was thru a collection system.

Table 4. Distribution of household in sentinel by health and sanitation and age group
5.1‐10 y.o. 10.1‐19 y.o.
Health and Sanitation of the Household n (%) n (%)
n=81 n=81
Source of Drinking Water
Deep Well 1 (1.23) 1 (1.23)
Purified Water Bottle 72 (88.89) 70 (86.42)
Waterworks 8 (9.88) 10 (12.35)
Source of Water
Others (Dug well, stream, rain, peddler, etc.) 10 (12.35) 9 (11.11)

8|Page
Shared 14 (17.28) 17 (20.99)
Owned 57 (70.37) 55 (67.90)
Type of Waste Disposal
Sanitary Pit Privy 13 (16.05) 13 (16.05)
Water Sealed 68 (83.95) 68 (83.95)
Type of Garbage Disposal
Covered pit 4 (4.94) 3 (3.70)
Open pit 1 (1.23) 1 (1.23)
Open pit the burned 4 (4.94) 4 (4.94)
Thrown directly to river 1 (1.23) 0 (0)
With garbage collection system 71 (87.65) 73 (90.12)

Table 5 shows the distribution of the households of the students by 1SEC and age group.
About 31% of the households of students aged 5.1‐10 y.o. belong to the three least
spending household group (Cluster 1‐3) while 22% belong to the top three spending
household groups (Cluster 7‐9).

For students aged 10.1‐19 y.o., 38% of the households belong to the three least spending
household group (Cluster 1‐3) while 19% belong to the top three spending household
groups (Cluster 7‐9).

Table 5. Distribution of household by socio‐economic cluster and age group

5.1‐10 y.o. 10.1‐19 y.o.
Socio‐economic Cluster n (%) n (%)
n=81 n=81
1 3 (3.70) 6 (7.41)
2 11 (13.58) 12 (14.81)
3 11 (13.58) 13 (16.05)
4 12 (14.81) 12 (14.81)
5 13 (16.05) 13 (16.05)
6 13 (16.05) 10 (12.35)
7 9 (11.11) 9 (11.11)
8 8 (9.88) 6 (7.41)
9 1 (1.23) 0 (0.00)

Analysis of the 120 feeding days with complete data in sentinel schools

Table 6 shows a significant increase in the mean weight of students included in the feeding
program from baseline to endpoint in both age groups and gender, by time period.

9|Page
Table 6. Mean weight of students included in the feeding program in sentinel schools, by
age group between time periods
Age group (years) Mean weight(kg) Mean difference p value
(n)/sex
Base Mid End Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
mid end end mid end end
5.1 to 10 (n=119) 18.50 19.68 20.35 1.18* 0.67* 1.85* 0.000 0.000 0.000
Male (n=54) 18.68 19.89 20.41 1.21 0.52 1.73 0.000 0.000 0.000
Female (n=65) 18.34 19.50 20.29 1.16 0.80 1.95 0.000 0.000 0.000

10.1 to 19 (n=158) 24.96 26.39 27.58 1.43* 1.19* 2.62* 0.000 0.000 0.000
Male (n=83) 25.32 26.53 27.71 1.21 1.17 2.39 0.000 0.000 0.000
Female (n=75) 24.57 26.23 27.44 1.67 1.21 2.88 0.000 0.000 0.000
Paired t‐test
*Significant at 0.05

There was also a significant increase in the mean height of students included in the feeding
program from baseline to endpoint in both age groups and gender, by time period (Table 7).

Table 7. Mean height of students included in the feeding program in sentinel schools, by
age group between time periods
Age group Mean height(cm) Mean difference p value
(years) (n)/sex
Base Mid End Base‐ Mid‐ Bas‐ Base‐ Mid‐ Base‐
Mid End End Mid End End
5.1 to 10 (n=119) 120.48 122.51 124.12 2.03* 1.61* 3.64* 0.000 0.000 0.000
Male (n=54) 120.40 122.39 123.90 1.99 1.51 3.50 0.000 0.000 0.000
Female (n=65) 120.55 122.61 124.30 2.05 1.70 3.75 0.000 0.000 0.000

10.1 to 19 (n=158) 134.87 137.19 138.94 2.32* 1.75* 4.07* 0.000 0.000 0.000
Male (n=83) 134.71 136.93 138.61 2.21 1.68 3.89 0.000 0.000 0.000
Female (n=75) 135.04 137.48 139.31 2.44 1.83 4.27 0.000 0.000 0.000
Paired t‐test
*Significant at 0.05

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 134.00
132.00
130.00 1.32
128.00 2.21
126.00
124.00
122.00 1.51
120.00 1.99
118.00
116.00
114.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 128.60 130.81 132.13
Mean Height 120.40 122.39 123.90

Figure 1. Comparison of mean height increase of male students aged 5.1‐10 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

The increment in the mean height of male students aged 5.1‐10 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower than the normal increase in males
for the same age group in the same period. However, the increment in the mean height
from midline to endpoint (after 3 months with 60 feeding days) was higher compared with
the normal increase in males for the same age group in the same period (Figure 1).

134.00
132.00
130.00 1.51

128.00 2.48
126.00
124.00
122.00 1.70
120.00 2.05

118.00
116.00
114.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 128.51 130.99 132.49
Mean Height 120.55 122.61 124.30

Figure 2. Comparison of mean height increase of female students aged 5.1‐10 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

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The increment in the mean height of female students aged 5.1‐10 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower compared with the normal increase
in females for the same age group in the same period. However, the increment in the mean
height from midline to endpoint (after 3 months with 60 feeding days) was higher than the
normal increase in females for the same age group in the same period (Figure 2).

155.00

150.00
1.69

145.00 2.67

140.00

135.00 1.68
2.21
130.00

125.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 147.50 150.17 151.86
Mean Height 134.71 136.93 138.61

Figure 3. Comparison of mean height increase of male students aged 10.1‐19 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

The increment in the mean height of male students aged 10.1‐19 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower compared with the normal increase
in males for the same age group in the same period. A similar result was observed from
midline to endpoint (after 3 months with 60 feeding days) (Figure 3).

12 | P a g e
 155.00

150.00
1.46
2.56
145.00

140.00

135.00 1.83
2.44

130.00

125.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 148.18 150.74 152.20
Mean Height 135.04 137.48 139.31

Figure 4. Comparison of mean height increase of female students aged 10.1‐19 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

The increment in the mean height of female students aged 10.1‐19 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower compared with the normal increase
in females for the same age group in the same period. However, the increment in the mean
height from midline to endpoint (after 3 months with 60 feeding days) was higher than the
normal increase in females for the same age group in the same period (Figure 4).

Table 8 shows the distribution of stunting in students in sentinel schools by age group, at
baseline, midline, and endpoint. There was no significant decrease in the prevalence of
stunting in both age groups, by time period (Appendix Table A1).

Table 8. Distribution of stunting in students included in the feeding program in sentinel

school, by age group, between time periods
Percentage difference p value
Age group Normal* Stunting*
Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(years) n (%) n (%)
Mid End End Mid End End
(5.1‐10 ) n=119
Baseline
86 (72.27) 33 (27.73)
(Jul 2016)
Midline
87 (73.11) 32 (26.89) 0.84 0.00 0.84 0.706 1.000 1.000
(Dec 2016)
Endpoint
87 (73.11) 32 (26.89)
(Mar 2017)

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(10.1‐19) n=158
Baseline
94 (59.49) 64 (40.51)
(Jul 2016)
Midline
92 (58.23) 66 (41.77) 1.26 1.26 0.00 0.688 0.688 1.000
(Dec 2016)
Endpoint
94 (59.49) 64 (40.51)
(Mar 2017)
McNemar change test
*HAZ (height‐for‐age z‐score)

Table 9 shows the distribution of undernourished students in sentinel schools, by age group,
between time periods. There was a significant decrease in the proportion of undernourished
students aged 5.1‐10 y.o. from baseline (100%) to endpoint (64.71%). Moreover, there was
also a significant decrease in the proportion of undernourished students aged 10.1‐19 y.o.
from baseline (100%) to endpoint (70.25%) (Appendix Table A2).

Table 9. Distribution of undernourished students in sentinel schools, by age group

Percentage difference p‐value
Age group Normal* Undernourished*
Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(years) n (%) n (%)
Mid End End Mid End End
(5.1‐10) n=119
Baseline
0 (0) 119 (100)
(Jul 2016)
Midline
36 (30.25) 83 (69.75) 30.25 5.04 35.29 0.000 0.308 0.000
(Dec 2016)
Endpoint
42 (35.29) 77 (64.71)
(Mar 2017)
(10.1‐19) n=158
Baseline
0 (0) 158 (100)
(Jul 2016)
Midline
34 (21.52) 124 (78.48) 21.52 8.23 29.75 0.000 0.029 0.000
(Dec 2016)
Endpoint
47 (29.75) 111 (70.25)
(Mar 2017)
McNemar change test
*WHZ (weight‐for‐height z‐score)

14 | P a g e
 Male Students Aged 61-120 months in Sentinel

.10

.15

.20

Z-Score .25
BM .
0 0
‘
:-
.

.
- 3 -

.30 :
°

.
-
.

.
,
t
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.35 : o
0
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i i i i i i

70 80 90 100 MO 120

Age

Baseline Midline Endline

Figure 5. Distribution of male students aged 5.1‐10 years old included in the feeding
program in sentinel schools based on BMI Z‐score, by time period

Female Students Aged 61-120 months in Sentinel

.15

.20

Z-Score
BA/l .25

.30

.35
70 80 90 100 1 10

Age

Baseline Midline Endpoint

Figure 6. Distribution of female students aged 5.1‐10 years old included in the feeding
program in sentinel schools based on BMI Z‐score, by time period

15 | P a g e
 Male Students Aged 121-228 months in Sentinel

.10

.15

.20

Z-Score .25
BA/l
.30

.35

-40

120 130 140 150 160 170 180 190

Age

Baseline Midline Endline

Figure 7. Distribution of male students aged 10.1‐19 years old included in the feeding
program in sentinel schools based on BMI Z‐score, by time period

Female Students Aged 121-228 months in Sentinel

Z-Score
BA/l

140 160 180 200

Age

Baseline Midline Endline

Figure 8. Distribution of female students aged 10.1‐19 years old included in the feeding
program in sentinel schools based on BMI Z‐score, by time period

16 | P a g e
Figures 5 and 6 shows the distribution of students aged 5.1‐10 y.o. included in the feeding
program in sentinel schools based on their BMI Z‐score, by gender and time period. It
illustrates that all students at baseline were below the normal cut‐off point. By midline,
there were students above the normal cut‐off point, however, there was minimal increase
in the number of students above the normal cut‐off point from midline to endpoint. The
same result was also observed for students aged 10.1‐19 y.o. (Figures 7 and 8).

Analysis of additional 80 feeding days with complete data

Only 195 out of the 277 students participated in the additional 80 feeding days after the
regular 120 feeding days in sentinel schools. There were 113 students (52 male and 61
female) aged between 5.1‐10 y.o. and 82 students (43 male and 39 female) aged between
10.1‐19 y.o.

Table 10 shows a significant increase in the mean weight of students who participated
during the additional 80 feeding days in both age groups and gender. Similar results were
observed in the mean height of students in both age groups and gender (Table 11).

Table 10. Mean weight of undernourished students included in the feeding program in
sentinel schools, by age group and gender, at the end of regular 120 feeding days and at
the end of the additional 80 feeding days
Age group (years) Mean weight (kg)
Mean
(n)/sex End of regular 120 End of additional p value
difference
feeding days 80 feeding days
5.1 to 10 ( n = 113) 20.44 20.94 0.50* 0.000
Male (n = 52) 20.44 20.87 0.44* 0.000
Female (n = 61) 20.45 21.00 0.55* 0.000

10.1 to 19 (n = 82 ) 25.78 26.57 0.79* 0.000

Male (n = 43) 25.60 26.35 0.75* 0.001
Female (n = 39) 25.98 26.81 0.83* 0.000
Paired t‐test
*Significant at 0.05

17 | P a g e
Table 11. Mean height of undernourished students included in the feeding program in
sentinel schools, by age group and gender, at the end of regular 120 feeding days and at
the end of the additional 80 feeding days
Age group (years) Mean height (cm)
Mean
(n)/sex End of regular 120 End of additional p value
difference
feeding days 80 feeding days
5.1 to 10 ( n = 113) 124.39 126.17 1.78* 0.000
Male (n = 52) 123.88 125.45 1.57* 0.000
Female (n = 61) 124.82 126.78 1.96* 0.000

10.1 to 19 (n = 82 ) 135.55 137.44 1.90* 0.000

Male (n = 43) 134.75 136.59 1.84* 0.000
Female (n = 39) 136.42 138.39 1.96* 0.000
Paired t‐test
*Significant at 0.05

136.00
134.00
132.00 1.75
130.00
128.00
126.00
124.00 1.57
122.00
120.00
118.00
End of regular 120 End of additional 80
feeding days feeding days
Normal Average Height 132.13 133.88
Mean Height 123.88 125.45

Figure 9. Comparison of mean height increase of male students aged 5.1‐10 years old
during the summer feeding program with normal average increase in height (WHO, 2007)

The increment in the mean height of male students aged 5.1‐10 y.o. from end of regular 120
feeding days to end of additional 80 feeding days (after 4 months with 80 feeding days) was
lower compared with the normal increase in males for the same age group in the same
period (Figure 9).

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 138.00
136.00
134.00
132.00 2.04
130.00
128.00
126.00
124.00 1.96

122.00
120.00
118.00
End of regular 120 feeding End of additional 80
days feeding days
Normal Average Height 133.51 135.54
Mean Height 124.82 126.78

Figure 10. Comparison of mean height increase of female students aged 5.1‐10 years old
during the summer feeding program with normal average increase in height (WHO, 2007)

The increment in the mean height of female students aged 5.1‐10 y.o. from end of regular
120 feeding days to end of additional 80 feeding days (after 4 months with 80 feeding days)
was lower than the normal increase in females for the same age group in the same period
(Figure 10).

155.00

150.00
2.24
145.00

140.00

135.00 1.84

130.00

125.00
Mar 2017 Jul 2017
Normal Increase 149.62 151.86
Increase in Mean Height 134.75 136.59

Figure 11. Comparison of mean height increase of male students aged 10.1‐19 years old
during the summer feeding program with normal average increase in height (WHO, 2007)

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The increment in the mean height of male students aged10.1‐19 y.o. from end of regular
120 feeding days to end of additional 80 feeding days (after 4 months with 80 feeding days)
was lower than the normal increase in males for the same age group in the same period
(Figure 11).

155.00

150.00
2.04
145.00

140.00

135.00 1.96

130.00

125.00
Mar 2017 Jul 2017
Normal Increase 149.22 151.23
Increase in Mean Height 136.42 138.39

Figure 12. Comparison of mean height increase of female students aged 10.1‐19 years old
during the summer feeding program with normal average increase in height (WHO, 2007)

The increment in the mean height of female students aged 10.1‐19 y.o. from end of regular
120 feeding days to end of additional 80 feeding days (after 4 months with 80 feeding days)
was lower compared with the normal increase in females for the same age group in the
same period (Figure 12).

Table 12 shows the distribution of stunting in students in sentinel schools, by age group, at
the end of the regular 120 feeding days and at the end of the additional 80 feeding days.
There was no significant change in the prevalence of stunting in both age groups after the
additional 80 feeding days (Appendix Table A3).

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Table 12. Distribution of stunting in students included in the feeding program in sentinel
schools, by age group, at the end of the regular 120 feeding days and at the end of the
additional 80 feeding days
Normal* Stunting* Percentage
Age group (years) p value
n (%) n (%) difference
(5.1‐10) n=113
End of regular 120 feeding days 82 (75.57) 31 (27.43)
1.77 0.625
End of additional 80 feeding days 80 (70.80) 33 (29.20)
(10.1‐19) n=82
End of regular 120 feeding days 45 (54.88) 37 (45.12)
2.44 0.688
End of additional 80 feeding days 47 (57.32) 35 (42.68)
McNemar change test
*HAZ (height‐for‐age z‐score)

There was an increase in the proportion of undernourished students aged 5.1‐10 years from
the end of the regular 120 feeding days and the end of the additional 80 feeding days
(65.49% to 72.57%). However, there was a decrease in the proportion of undernourished
students aged 10.1‐19 years from the end of the regular 120 feeding days and the end of
the additional 80 feeding days (75.61% to 71.95%) (Appendix Table A4).

Table 13. Distribution of undernourished students in sentinel schools, by age group,

during the additional 80 feeding days
Normal* Undernourished* Percentage
Age group (years) p value
n (%) n (%) difference
(5.1‐10) n=113
End of regular 120 feeding days 39 (34.51) 74 (65.49)
7.08 0.077
End of additional 80 feeding days 31 (27.43) 82 (72.57)
(10.1‐19) n=82
End of regular 120 feeding days 20 (24.39) 62 (75.61)
3.66 0.607
End of additional 80 feeding days 23 (28.05) 59 (71.95)
Mc‐Nemar change test
*HAZ (height‐for‐age z‐score)

21 | P a g e
 Male Students Aged 61-120 months in Sentinel

.10

.15

.20

Z-Score .25
BA/l

.30

.35

70 80 90 100 110 120

Age

End of regular 120 feeding days End of additional 80 feeding days

Figure 13. Distribution of male students aged 5.1‐10 years old included in the additional 80
feeding days in sentinel schools based on BMI Z‐score, by time period

Female Students Aged 61-120 months in Sentinel

.15

.20

Z-Score .25
BA/l

.30

.35

70 BO 90 100 110 120

Age

End of regular 120 feeding days End of additional 80 feeding days

Figure 14. Distribution of female students aged 5.1‐10 years old included in the additional
80 feeding days in sentinel schools based on BMI Z‐score, by time period

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 Male Students Aged 121-228 months in Sentinel

Z-Score
BA/l

120 130 140 150 160 170

Age

End of regular 120 feeding days End of additional 80 feeding days

Figure 15. Distribution of male students aged 10.1‐19 years old included in the additional
80 feeding days in sentinel schools based on BMI Z‐score, by time period

Female Students Aged 121-228 months in Sentinel

.10

.15

.20
Z-Score
BA/l
.25

.30

.35

120 130 140 150 160

Age

End of regular 120 feeding days End of additional 80 feeding days

Figure 16. Distribution of female students aged 10.1‐19 years included old included in the
additional 80 feeding days in sentinel school based on BMI Z‐score, by time period

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Figures 13 and 14 shows the distribution of students aged 5.1‐10 y.o. included in the
additional 80 feeding days after the regular 120 feeding program of DepEd in sentinel
schools based on their BMI Z‐score. It illustrates that there was no change in the proportion
of students in the above normal cut‐off point. The same result was observed among
students aged 10.1‐19 y.o. (Figures 15 and 16).

Table 14 shows the distribution of students, by age group, who participated in the additional
80 feeding days after the regular 120 feeding days in sentinel schools. Most of the students
aged 5.1‐10 y.o. (33.63%) complied with the ≤40 feeding day. The same can be observed for
students aged 10.1‐19 y.o. (40.24%).

Table 14. Number and percentage distribution of children who attended the additional 80
feeding day feeding, by age group
5.1‐10 y.o. 10.1‐19 y.o.
Number of feeding days
n (%) n (%)
71‐80 16 (14.16) 7 (8.54)
61‐70 28 (24.78) 21 (25.61)
51‐60 14 (12.39) 10 (12.20)
41‐50 17 (15.04) 11 (13.41)
≤40 38 (33.63) 33 (40.24)
Total no. of students 113 (100.00) 82 (100.00)

The maximum number of feeding days complied with by students aged 5.1‐10 y.o. was 76;
for students aged 10.1‐19 y.o. the maximum number of feeding days was 77. No students
were able to meet the entire additional 80 feeding days (Table 15).

Table 15. Summary statistics of the additional 80 feeding days, by age group
5.1 yrs old 10.1‐19 yrs old
Average 48.51 45.44
Minimum 9 12
Maximum 77 76

24 | P a g e
Dietary Assessment

Spices, Condiments, Beverages 100.00

Cereals 100.00
Eggs 97.62
Meat, Fresh and Processed 96.43
Oils and Fats 95.24
Sweets 90.48
Fish and Shellfish 88.10
Other Fruits, incl. Wild Fruits 79.76
Dark Leafy Green Vegetables, incl. Wild Ones 76.19
Milk and Milk Products 71.43
Other Vegetables incl. Wild Vegetables 69.05
Vitamin A Rich Vegetables and Tubers 65.48
White Tubers and Roots 58.33
Legumes, Nuts and Seeds 47.62
Vitamin A Rich Fruits 34.52
Organ Meats (Iron-Rich) 15.48

0 10 20 30 40 50 60 70 80 90 100

Figure 17. Food group consumption of sentinel students aged 5.1‐10 years old

Figure 17 shows that the most common food group consumed of students aged 5.1‐10 y.o.
were spices, condiments and beverages products (100%), cereals products (100%), eggs
(97.62%), meat products (96.43%), and oils and fats products (95.24%).

25 | P a g e
 Spices, Condiments, Beverages 100.00
Cereals 100.00
Meat, Fresh and Processed 98.88
Oils and Fats 96.63
Eggs 94.38
Fish and Shellfish 92.13
Sweets 85.39
Other Fruits, incl. Wild Fruits 82.02
Dark Leafy Green Vegetables, incl. Wild Ones 70.79
Milk and Milk Products 64.04
Other Vegetables incl. Wild Vegetables 61.80
Vitamin A Rich Vegetables and Tubers 58.43
White Tubers and Roots 53.93
Legumes, Nuts and Seeds 48.31
Vitamin A Rich Fruits 46.07
Organ Meats (Iron-Rich) 29.21

0 10 20 30 40 50 60 70 80 90 100

Figure 18. Food group consumption of sentinel students aged 10.1‐19 years old

Figure 18 shows that the most common food group consumed of students aged 10.1‐19 y.o.
were spices, condiments and beverages products (100%), cereals products (100%), meat
products (98.88%), and oils and fats products (96.63%).

The mean and median dietary diversity score of the students aged 5.1‐10 y.o. in sentinel
school was 9.95 and 10 respectively. For students aged 10.1‐19 y.o., the mean and median
dietary diversity score was 9.97 and 10 respectively (Table 16).

Table 16. Dietary diversity score distribution of the students in sentinel by age group
5.1‐10 y.o. 10.1‐19 y.o.
n (%) n (%)
n=84 n=89
Mean ± SD 9.95 ± 2.19 9.97 ± 2.39
Median 10 10
DDS
5 2 (2.38)
6 5 (5.95) 9 (10.11)

26 | P a g e
 7 6 (7.14) 8 (8.99)
8 10 (11.90) 11 (12.36)
9 8 (9.52) 7 (7.87)
10 14 (16.67) 15 (16.85)
11 17 (20.24) 13 (14.61)
12 14 (16.67) 11 (12.36)
13 5 (5.95) 9 (19.11)
14 3 (3.57) 6 (6.74)

Table 17 shows the distribution of the students in sentinel by food pattern and age group.
The most common food pattern was breakfast‐snacks‐lunch‐snacks‐dinner.

Table 17. Distribution of food pattern by age group

Food Pattern 5.1‐10 y.o. 10.1‐19 y.o.
n (%) n (%)
n=84 n=89
Breakfast‐lunch‐dinner 2 (2.38) 2 (2.25)
Breakfast‐lunch‐snacks‐dinner 14 (16.67) 15 (16.85)
Breakfast‐snacks‐lunch‐dinner 8 (9.52) 5 (5.62)
Breakfast‐snacks‐lunch‐snacks‐ 52 (61.90) 62 (69.66)
dinner
Lunch‐dinner 0 (0.00) 1 (1.12)
Lunch‐snacks‐dinner 2 (2.38) 2 (2.25)
Snacks‐lunch‐dinner 2 (2.38) 2 (2.25)
Snacks‐lunch‐snacks‐dinner 4 (4.76) 0 (0.00)

Table 18 shows that majority of the students aged 5.1‐10 y.o. in sentinel school had
acceptable food consumption. The same was observed for students aged 10.1‐19 y.o.

Table 18. Distribution of students by food consumption group and age group
5.1‐10 y.o. 10.1‐19 y.o.
Food Consumption Group n (%) n (%)
n=84 n=89
Poor 0 (0.00) 0 (0.00)
Borderline 2 (2.38) 5 (5.62)
Acceptable 82 (97.62) 84 (94.38)

27 | P a g e
Profile of students in lighthouse schools

Out of the 336 students identified as undernourished in LH schools, only 224 (66.67%) of
them had complete anthropometric data during the 120 feeding days. About 112 (33.33%)
of the students had incomplete data due to reasons such as being transferred out or
absences during data collection. Those with complete data, about 49% (111) of the
students, were aged between 5.1 and10 years with an average of 100 months old, and 51%
(113) of the students were aged between 10.1 and 19 years with an average of 141 months.

Table 19. Distribution of students in lighthouse schools included in the feeding program
with complete and incomplete data, by gender, per age group
≤5 y.o. 5.1‐10 y.o. 10.1‐19 y.o. Total
n (%) n (%) n (%) n (%)
Complete data 111 (33.04) 113 (33.63) 224 (66.67)
Incomplete data 2 (0.60) 63 (18.75) 47 (13.98) 112 (33.33)
Transferred out 3 (0.89) 2 (0.60) 5 (1.49)
Due to absences 2 (0.60) 60 (17.86) 45 (13.39) 107 (31.85)
Gender
Female 59 (53.15) 48 (42.48) 107 (47.77)
Male 52 (46.85) 65 (57.52) 117 (52.23)

Table 19. Mean age of students in lighthouse schools included in the feeding program, per
age group
Age group (years) Mean age Min Max
5.1‐10 yrs old (n=111) 8.3 5.1 10
10.1 yrs old (n=113) 11.7 10.1 15.4

Socio‐economic characteristics

Table 20 shows the distribution of the households in LH school by household characteristics

and age group. About 70% of the students aged 5.1‐10 y.o. belong in single/ nuclear families
or household which consists of only parents and their unmarried children. Majority of the
students live in a single detached or duplex type of house (96%).

About 62% of the students aged 10.1‐19 y.o. belong in single/ nuclear families. All students
live in single detached or duplex type of house.

28 | P a g e
Table 20. Distribution of household by household characteristic and age group
5.1‐10 y.o. 10.1‐19 y.o.
Characteristic of Household n (%) n (%)
n=54 n=39
Type of Household
Extended with non‐relative families/person 16 (29.63) 15 (38.46)
Single/Nuclear 38 (70.37) 24 (61.54)
Type of Dwelling
Single Detached/Duplex 52 (96.30) 39 (100)
Apartment/Townhouse 2 (3.70) 0 (0)

Table 21 show the distribution of the households of the students in lighthouse school by
health and sanitation, and age group. The main source of drinking water of the household
was waterworks. Majority of the household used water sealed for their waste materials.
And the most common method of garbage disposal was thru a collection system.

Table 21. Distribution of household by health and sanitation of the household and age
group
5.1‐10 y.o. 10.1‐19 y.o.
Health and Sanitation of the Household n (%) n (%)
n=54 n=39
Source of Drinking Water
Deep Well 3 (5.56) 3 (7.69)
Purified Water Bottle 11 (20.37) 12 (30.77)
Waterworks 40 (74.07) 24 (61.54)
Source of Water
Others (Dug well, stream, rain, peddler, etc.) 4 (7.41) 8 (20.51)
Shared 6 (11.11) 2 (5.13)
Owned 44 (81.48) 29 (74.36)
Type of Waste Disposal
Sanitary Pit Privy 1 (1.85) 0 (0)
Water Sealed 53 (98.15) 39 (100)
Type of Garbage Disposal
Covered pit 3 (5.56) 1 (2.56)
Open pit 6 (11.11) 1 (2.56)
Open pit the burned 15 (27.78) 16 (41.03)
With garbage collection system 30 (55.56) 21 (53.85)

Table 22 shows the distribution of the households of the students in lighthouse school by
1SEC and age group. About 39% of the households of students aged 5.1‐10 y.o. belong to

29 | P a g e
the three least spending household group (Cluster 1‐3) while 13% belong to the top three
spending household groups (Cluster 7‐9).

For students aged 10.1‐19 y.o., 33% of the households belong to the three least spending
household group (Cluster 1‐3) while 21% belong to the top three spending household
groups (Cluster 7‐9).

Table 22. Distribution of Households by socio‐economic cluster and age group

5.1‐10 y.o. 10.1‐19 y.o.
Socio‐economic Cluster n (%) n (%)
n=54 n=39
1 5 (9.26) 2 (5.13)
2 11 (20.37) 5 (12.82)
3 5 (9.26) 6 (15.38)
4 7 (12.96) 4 (10.26)
5 12 (22.22) 9 (23.08)
6 7 (12.96) 5 (12.82)
7 3 (5.56) 3 (7.69)
8 4 (7.41) 5 (12.82)
9 0 (0.00) 0 (0)

Analysis of 120 feeding days with complete data

Table 23 shows a significant increase in the mean weight of students included in the feeding
program from baseline to endpoint in both age groups and gender, by time period.

Table 23. Mean weight of students included in the feeding program in lighthouse schools,
by age group between time periods
Age group (year) Mean weight Mean difference p value
(n)/sex
Base Mid End Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
Mid End End Mid End End
5.1 to 10 (n=111) 18.03 19.06 19.70 1.03* 0.64* 1.67* 0.000 0.000 0.000
Male (n=52) 17.90 18.95 19.48 1.05 0.52 1.57 0.000 0.000 0.000
Female (n=59) 18.14 19.15 19.89 1.01 0.74 1.75 0.000 0.000 0.000

10.1 to 19 (n=113) 25.25 26.71 27.73 1.46* 1.02* 2.48* 0.000 0.000 0.000
Male (n=65) 25.04 26.46 27.37 1.42 0.90 2.33 0.000 0.000 0.000
Female (n=48) 25.53 27.04 28.23 1.51 1.19 2.70 0.000 0.000 0.000
Paired t‐test
*Significant at 0.05

30 | P a g e
There was also a significant increase in the mean height of students included in the feeding
program from baseline to endpoint in both age groups and gender, by time period (Table
24).

Table 24. Mean height of students included in the feeding program in lighthouse schools,
by age group between time periods
Age group (year) Mean weight Mean difference p value
(n)/Sex
Base Mid End Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
Mid End End Mid End End
5.1 to 10 (n=111) 118.62 120.23 121.78 1.61* 1.55* 3.17* 0.000 0.000 0.000
Male (n=52) 117.64 119.15 120.55 1.51 1.40 2.91 0.000 0.000 0.000
Female (n=59) 119.48 121.18 122.87 1.70 1.69 3.39 0.000 0.000 0.000

10.1 to 19 (n=113) 135.04 136.82 138.60 1.78* 1.78* 3.56* 0.000 0.000 0.000
Male (n=65) 134.17 135.82 137.60 1.65 1.78 3.43 0.000 0.000 0.000
Female (n=48) 136.21 138.16 139.94 1.95 1.78 3.73 0.000 0.000 0.000
Paired t‐test
*Significant at 0.05

135.00

130.00
1.32
2.21
125.00

120.00
1.40
1.51
115.00

110.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 128.60 130.81 132.13
Mean Height 117.64 119.15 120.55

Figure 19. Comparison of mean height increase of male students aged 5.1‐10 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

The increment in the mean height of male students aged 5.1‐10 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower compared with the normal increase

31 | P a g e
in males for the same age group in the same period. However, the increment in the mean
height from midline to endpoint (after 3 months with 60 feeding days) was higher than the
normal increase in males for the same age group in the same period (Figure 19).

135.00

130.00
1.51
2.48
125.00

120.00 1.69
1.70

115.00

110.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 128.51 130.99 132.49
Mean Height 119.48 121.18 122.87

Figure 20. Comparison of mean height increase of female students aged 5.1‐10 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

The increment in the mean height of female students aged 5.1‐10 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower compared with the normal increase
in females for the same age group in the same period. However, the increment in the mean
height from midline to endpoint (after 3 months with 60 feeding days) was higher than the
normal increase in females for the same age group in the same period (Figure 20).

32 | P a g e
 155.00

150.00
1.69
2.67
145.00

140.00

135.00
1.78
1.65
130.00

125.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 147.50 150.17 151.86
Mean Height 134.17 135.82 137.60

Figure 21. Comparison of mean height increase of male students aged 10.1‐19 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

The increment in the mean height of male students aged 10.1‐19 y.o. from baseline to
midline (after 5 months with 60 feeding days) was lower compared with the normal increase
in males for the same age group in the same period. However, the increment in mean height
from midline to endpoint (after 3 months with 60 feeding days) was higher than the normal
increase for in males for the same age group in the same period (Figure 21).

155.00

150.00 1.40
2.50
145.00

140.00

1.78
135.00 1.95

130.00

125.00
Baseline Midline Endpoint
(Jul 2016) (Dec 2016) (Mar 2017)
Normal Average Height 149.22 151.72 153.12
Mean Height 136.21 138.16 139.94

Figure 22. Comparison of mean height increase of female students aged 10.1‐19 years old
during the 120 feeding days with normal average increase in height (WHO, 2007)

33 | P a g e
The increment in mean height of female students aged 10.1‐19 y.o. from baseline to midline
(after 5 months with 60 feeding days) was lower compared with the normal in females for
the same age group in the same period. However, the increment in mean height from
midline to endpoint (after 3 months with 60 feeding days) was higher than the normal
increase in females for the same age group in the same period (Figure 22).

Table 25 shows the distribution of stunting in students in LH schools, by age group at

baseline, midline, and endpoint. There was no significant decrease in the prevalence of
stunting in both age groups, by time period (Appendix Table A7).

Table 25. Distribution of stunting in students included in the feeding program in

lighthouse schools, by age group between time periods
Percentage difference p value
Age group Normal* Stunting*
Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(years) n (%) n (%)
Mid End End Mid End End
(5.1‐10) n=111
Baseline
67 (60.36) 44 (39.64)
(Jul 2016)
Midline
66 (59.46) 45 (40.54) 0.90 3.60 2.70 1.000 0.219 0.453
(Dec 2016)
Endline
70 (63.06) 41 (36.94)
(Mar 2017)
(10.1‐19) n=113
Baseline
65 (57.52) 48 (42.48)
(Jul 2016)
Midline
64 (56.64) 49 (43.36) 0.88 1.94 2.65 1.000 0.500 0.508
(Dec 2016)
Endline
62 (54.87) 51 (45.13)
(Mar 2017)
McNemar change test
*HAZ (height‐for‐age z‐score)

Table 25 shows the distribution of undernourished students in LH schools, by age group and
by time period. There was a significant decrease in the proportion of undernourished
students aged 5.1‐10 y.o. from baseline (100%) to endpoint (58.56%). Moreover, there was
also a significant decrease in the proportion of undernourished students aged 10.1‐19 y.o.
from baseline (100%) to endpoint (67.26%) (Appendix Table A8).

34 | P a g e
Table 25. Distribution of undernourished students in lighthouse schools, by age group
Percentage difference p value
Age group Normal* Undernourished*
Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(years) n (%) n (%)
Mid End End Mid End End
(5.1‐10) n=111
Baseline
0 (0) 111 (100)
(Jul 2016)
Midline
46 (41.44) 65 (58.56) 41.44 0.00 41.44 0.000 1.000 0.000
(Dec 2016)
Endpoint
46 (41.44) 65 (58.56)
(Mar 2017)
(10.11) n=113
Baseline
0 (0) 113 (100)
(Jul 2016)
Midline
29 (25.66) 84 (74.34) 25.66 7.08 32.74 0.000 0.185 0.000
(Dec 2016)
Endpoint
37 (32.74) 76 (67.26)
(Mar 2017)
McNemar change test
*WHZ (weight‐for‐height z‐score)

Male Students Aged 61-120 months in Lighthouse

.10

.15

.20
Z-Score
BA/l .25

.30

.35

60 70 80 90 100 110 120

Age

Baseline Midline Endpoint

Figure 23. Distribution of male students aged 5.1‐10 years old included in the feeding
program in lighthouse schools based on BMI Z‐score, by time period

35 | P a g e
 Female Students Aged 61-120 months in Lighthouse

.10

.15

.20
Z-Score
BA/l .25

.30

.35

60 70 80 90 100 110 120

Age

Baseline Midline Endpoint

Figure 24. Distribution of female students aged 5.1‐10 years old included in the feeding
program in lighthouse schools based on BMI Z‐score, by time period

Male Students Aged 121-228 months in Lighthouse

.10

.15

.20
Z-Score
BA/l .25

.30

.35

120 130 140 150 160 170 180

Age

Baseline Midline Endpoint

Figure 25. Distribution of male students aged 10.1‐19 years old included in the feeding
program in lighthouse schools based on BMI Z‐score, by time period

36 | P a g e
 Female Students Aged 121-228 months in Lighthouse

.15

.20

Z-Score .25
BA/l

.30

.35

130 140 150 160 170 180

Age

Baseline Midline Endpoint

Figure 26. Distribution of female students aged 10.1‐19 years old included in the feeding
program in lighthouse schools based on BMI Z‐score, by time period

Figures 23 and 24 shows the distribution of students aged 5.1‐10 y.o. included in the feeding
program in LH schools based on their BMI Z‐score, by gender and time period. It illustrates
that all students at baseline were below the normal cut‐off point. By midline, there were
students above the normal cut‐off point, however, there was minimal increase in the
number of students above the normal cut‐off point from midline to endpoint. The same
result was also observed for students aged 10.1‐19 years (Figures 25 and 26).

37 | P a g e
Dietary Assessment

Spices, Condiments, Beverages 100.00

Oils and Fats 100.00
Meat, Fresh and Processed 100.00
Cereals 100.00
Eggs 98.33
Sweets 95.00
Fish and Shellfish 90.00
Other Fruits, incl. Wild Fruits 90.00
Other Vegetables incl. Wild Vegetables 73.33
White Tubers and Roots 70.00
Dark Leafy Green Vegetables, incl. Wild Ones 68.33
Milk and Milk Products 65.00
Vitamin A Rich Vegetables and Tubers 65.00
Legumes, Nuts and Seeds 51.67
Organ Meats (Iron-Rich) 35.00
Vitamin A Rich Fruits 28.33

Figure 27. Food group consumption of sentinel students aged 5.1‐10 years old

Figure 27 shows that the most common food group consumed of students aged 5.1‐10 y.o.
old were spices, condiments and beverages products (100%), oils and fats products (100%),
meat products (100%), and cereal products (100%) followed by eggs (98.33%) and sweet
products (95.00%).

38 | P a g e
 Spices, Condiments, Beverages 100.00
Meat, Fresh and Processed 100.00
Cereals 100.00
Sweets 97.87
Oils and Fats 95.74
Eggs 95.74
Fish and Shellfish 91.49
Other Fruits, incl. Wild Fruits 85.11
Other Vegetables incl. Wild Vegetables 70.21
Dark Leafy Green Vegetables, incl. Wild Ones 65.96
Milk and Milk Products 65.96
Vitamin A Rich Vegetables and Tubers 59.57
Legumes, Nuts and Seeds 59.57
White Tubers and Roots 55.32
Vitamin A Rich Fruits 53.19
Organ Meats (Iron-Rich) 38.30

Figure 28. Food group consumption of sentinel students aged 10.1‐19 years old

Figure 28 shows that the most common food group consumed of students aged 10.1‐19 y.o.
old were spices, condiments and beverages products (100%), meat products (100%), cereal
products (100%), sweet products (97.87%), oils and fats products (95.74%), and eggs
(95.74%).

The mean and median dietary diversity score of the students aged 5.1‐10 y.o. in sentinel
school was 10.35 and 11 respectively. For students aged 10.1‐19 y.o., the mean and median
dietary diversity score was 10.36 and 11 respectively (Table 26).

Table 26. Dietary diversity score distribution of the students in sentinel by age group
5.1‐10 y.o. 10.1‐19 y.o.
n (%) n (%)
n=60 n=47
Mean ± SD 10.35 ± 1.96 10.36 ± 1.99
Median 11 11
DDS
6 5 (8.33)
7 1 (1.67) 4 (8.51)
8 3 (5.00) 7 (14.89)

39 | P a g e
 9 7 (11.67) 7 (14.89)
10 13 (21.67) 4 (8.51)
11 13 (21.67) 8 (17.02)
12 10 (12.77) 10 (21.28)
13 8 (2.13) 6 (12.77)
14 1 (2.13)

Table 27 shows the distribution of the students in LH by food pattern and age group. The
most common food pattern was breakfast‐snacks‐lunch‐snacks‐dinner.

Table 27. Distribution of food pattern by age group

Food Pattern 5.1‐10 y.o. 10.1‐19 y.o.
n (%) n (%)
n=60 n=47
Breakfast‐lunch‐dinner 2 (3.33) 1 (2.13)
Breakfast‐lunch‐snacks‐dinner 7 (11.67) 3 (6.38)
Breakfast‐snacks‐lunch‐dinner 1 (1.67) 2 (426)
Breakfast‐snacks‐lunch‐snacks‐ 47 (78.33) 40 (85.11)
dinner
Snacks‐lunch‐snacks‐dinner 3 (5.00) 1 (2.13)

Table 18 shows that majority of the students aged 5.1‐10 y.o. in sentinel school had
acceptable food consumption. The same was observed for students aged 10.1‐19 y.o.

Table 28. Distributions of students by food consumption group and age group
5.1‐10 y.o. 10.1‐19 y.o.
Food Consumption Groups n (%) n (%)
n=60 n=47
Poor 0 (0.00) 0 (0.00)
Borderline 0 (0.00) 0 (0.00)
Acceptable 60 (100.00) 47 (100.00)

Discussion

Well implemented school feeding programs are one of the established strategies to improve
the health and nutritional status of children, reduce absenteeism, improve education
outcomes and ensure that children remain in school. The SBFP is characterized by on‐site
feeding of beneficiaries for a duration of 120 feeding days using a standard 20‐day cycle
menu. The current school lunch program of DepEd exclusively targets severely wasted and

40 | P a g e
wasted children. The budget allocation per child and day is P 18.00. Each meal should
provide child beneficiaries with at least 300 additional calories. A school‐based feeding core
group consists of teachers and parents who prepare meals and coordinate the feeding.
Procurement of supplies and financial reporting are the responsibility of the school head of
the respective beneficiary schools.

Nutritious school meals contribute to children’s education and welfare, which in turn
contributes to their productivity and to the education and welfare of subsequent
generations. School meal programs benefit families and communities, and contribute to
local and national economic development. The power of school food programs comes from
the entirety of the benefits, the integration of the three pillars of development (education,
health/nutrition, and agriculture) within one program, the anchoring of the programs in
schools, the involvement of all levels of society, and the intergenerational impact.

Implementation of large‐scale school feeding program is complex and difficult; it takes years
to build a solid, well‐performing program, and even solid programs require careful
monitoring and the on‐going adoption of improvements as the programs evolve. Due to
their complexity and the influence of factors outside the programs’ control, measuring the
impact and accurately ascribing attribution to large‐scale school food programs is extremely
difficult, even in situations where financial resources and expertise are available. Despite
these difficulties, when reasonably well‐managed, school meal programs work, in both the
short‐ and long‐term. The evidence shows that the programs have positive impacts on the
pillars of human and economic development: health and nutrition, education, and
agriculture. It is rare that a single program will have benefits in each of these areas, as is the
case with school feeding programs.

Hunger and malnutrition relate closely with the state of food security, when “all people, at
all time, have physical and economic access to sufficient, safe and nutritious food to meet
their dietary needs and food preferences for an active and healthy life”. Many Filipinos
suffer from lack of food or poor diets, despite rising food availability because of inadequate
access to food due to high poverty and low income especially among the rural population
that are generally engaged in agriculture. Higher food prices, especially of the food staple

41 | P a g e
rice, relative to the rest of the Southeast Asian region, exacerbate the situation. The bulk of
Filipinos’ food consumption goes to cereals, followed by meat and fish; per capita
consumption of vegetables only averages 22 kg/yr, compared to the FAO recommendation
of 146‐182 kg/yr. Moreover, episodes of inadequate diet and ill health may be especially
harmful at key stages in the life cycle. A marked increase in stunting among young Filipino
children happens from birth up to the age of two years, owing to poor nutritional status of
pregnant and lactating mothers, and sub‐optimal practices on exclusive breastfeeding and
complementary feeding during this age group. Hunger and malnutrition in the Philippines is
further compounded by frequent natural disasters, which disproportionately affects already
poor and vulnerable populations such as coastal and upland communities, as well as the
urban poor.

Expensive rice hurts consumers, especially the poor, because rice is a very important food
item for Filipinos. It accounts for more than a third (33% in 2012) of the total food
expenditure of the bottom quintile; the single biggest source of energy and protein at 34%
compared to fish (14%), pork (9%), and poultry (6%); and the biggest contributor to per
capita availability of calories at 46% compared to sugar (8%), wheat (7%), and pork (7%).

Food price movements have been volatile to the grave detriment of poor consumers, while
depressing farm incomes. Poor households face greater challenges in boosting diet diversity
compared to higher income households; one reason is that fruit and vegetable retail prices
have increased the fastest compared to other food items.

Food security and nutrition (FSN) are multi‐dimensional phenomena caused by a complex
set of interrelated factors. As a consequence, FSN governance structures are confronted
with multiple challenges as the various agencies involved strive to achieve meaningful
coordination. Unfortunately, the FSN governance structures are unable to transcend the
seemingly inevitable overlap, confusion, and fragmentation of investments/actions across
the various actors, both national and local. Within the nutrition and health delivery system,
most frontline workers especially the Barangay Nutrition Scholars (BNS), remain ill‐equipped
to handle caseloads of households with malnourished children within their communities.

42 | P a g e
These workers labor mostly bereft of tenure, sometimes in difficult environments. Training
outcomes often cannot be sustained owing to frequent turnover of workers.
Resources of for addressing hunger and malnutrition have been inadequate, and much of
those that are available so far have not been place in high‐impact programs. Programs
directed specifically against hunger and malnutrition appear to have been under‐funded,
both at the national and especially at the local levels. A significant part of funds provided to
FSN may have been wasted due to ineffective or stand‐alone programs. There is no shortage
of programs and interventions to address hunger and malnutrition in the country. However,
these have been insufficient to avert hunger and the current public health crisis. Some
direct interventions of the government can stand improvements to effectively address
issues. For instance, micronutrient fortification is marked by low compliance. In the health
care system, key nutrition interventions become just a part of the long list of health
promotion and service delivery activities undertaken by frontline workers in health centers
and in the community. Large‐scale supplementary feeding programs are difficult to sustain
without external support, and have unclear impact on the nutritional status of children. Rice
subsidies are poorly targeted, with a considerable leakage of benefits to the non‐poor.

Gear up food systems toward food affordability, increased incomes and dietary diversity for
poor and food insecure households. This involves a number of strategies that include,
among others: linking small farmers, as suppliers of food, directly to nutrition programs (e.g.
supplementary feeding); further expand women’s participation in the agricultural
production and value chain; and adopt “climate‐smart” interventions to manage climate‐
related threats to stability and diversity of food systems. Along with these, promote
increased dietary diversity in communities under nutrition‐sensitive production systems.

Food intake is strongly affected by purchasing power determined by food prices and
markets, and household incomes. In rural areas, home production (vegetable gardens,
livestock, fishing) may be an alternative source of food.

Availability, whether food is physically at‐hand, will not automatically lead to food security
at the household level, for which the more relevant indicators are accessibility, whether
households can actually obtain available food (food may already be in possession of

43 | P a g e
households via direct production, acquired through the markets wherein access depends in
purchasing power or food affordability), and utilization, whether households are able to
translate food availability and accessibility into an “active and healthy” life, by sufficient
intake and assimilation of nutrients.

Food availability has been improving growth in domestic production but agricultural
productivity is low and lacks diversification. The Philippines has continued to focus
dominantly on its main traditional crops (namely, rice, maize, coconut, and sugarcane),
there has been too little movement towards a more diverse food and agricultural system in
the Philippines despite the greater profitability of growing high value crops (Briones and
Galang, 2013).

Growth in farm labor productivity and wages has been slow while farm sizes have been
declining. Increasing demand for land due to rising rural populations has led to the
subdivision of private agricultural lands.

Rising population and average purchasing power have been substantially increasing
demands for food, fisheries, forest and other products.

Soil degradation is one of the most serious ecological problems besetting agriculture, and a
major threat to food security of the country. It is mainly caused by erosion, which removes
the fertile or nutrient‐rich topsoil, and by the high use of chemical fertilizers in agriculture
(Astorga 1996 cf: Caledorn and Rola, 2003).

Children below two years old are most affected by wasting. Among pre‐school children, the
higher rates that are seen in the first two years of life tend to decrease as the children get
older. Young children tend to exhibit higher rates of acute nutrient deficiency, while in older
children chronic malnutrition is more evident. Among others, iron deficiency anemia (IDA)
compromises the physical and intellectual development of children, especially those below
five years old. While there was a notable decrease in anemia prevalence across all age
groups in the past two decades, the IDA levels remained disturbingly high among children
below three years old especially among infants in 2013.

44 | P a g e
Malnutrition, especially among children, leads to other diseases and causes early death. It
affects child development at a crucial stage, leading to cognitive and behavioral deficits,
retarded learning, and ultimately to lower competitiveness and productivity upon joining
the workforce. The flipside of to the large youth bulge is that if the youth cohort today
suffers irreversible malnutrition outcomes, the long‐term competitiveness and productivity
of the future workforce may be fatally compromised and the health expenses of households
and government could substantially increase. In 2013 the cost of early childhood
malnutrition in today’s workforce, counting only the impact of added education cost,
reduced human capital formation, and excess mortality.

The share of food consumption in total household expenditure has been declining. Food
consumption outside the home has risen dramatically, doubling its share in the food budget.
Within home food expenditure, spending is largest in staples such as cereals (mainly rice),
meat, and fish, and lowest or negligible on nutritious items like fruits and vegetables and
roots and tubers. The shares of items where spending is highest have been declining, largely
due to the increasing share of food expenditure outside the home. This is a matter of
concern because greater dependency on food away from home can increase the likelihood
for developing unhealthy diets, i.e. those high in saturated fats and sugars and low in
nutrient content, thereby worsening the “double burden of malnutrition”.

According to FNRI‐DOST 2013 data, stunting and underweight decline consistently with
rising wealth levels. However, child wasting did not follow a clear pattern. Worth noting is
the alarmingly high stunting and underweight incidence even at the highest wealth quintile.
This indicates that economic growth, though critical to reducing hunger and malnutrition in
the long run, is unlikely to deliver substantive gains on its own in the short to medium term,
or even eliminate the worst forms of malnutrition in the long term. Still, the FNRI data show
that across all age groups, majority of the children affected by underweight and stunting are
children who come from the poorest families. For wasting, children across all wealth
quintiles and in all age groups from birth up to 19 years old show prevalence rates above
5%, with the exception of rural children aged 5‐10 years old in the richest quintile. In all
indicators and across quintiles, it is remarkable that urban and rural levels of malnutrition

45 | P a g e
are very similar. Even so, many of the factors leading to malnutrition are more prevalent in
the rural areas compared to urban areas.

One manifestation of the poor diet of the Filipino that consumption, thus expenditure, in
vegetables is low compared to spending in cereals, meat and fish. The per capita
consumption of vegetables only averaged 22 kg/yr, much lower than the FAO recommended
level of 146‐182 kg/yr (Batt, 2005). It is interesting to note lower vegetable consumption
with lower socio‐economic classes. Nearly half of households in the poorest 16 provinces
report that carbohydrates account for about 80% of a typical meal. In a given week, about
30% state that their meals are never balanced and only 6% are able to state that their daily
meals are balanced (WFP, 2016). Lastly, the prevalence of children not meeting the
Minimum Acceptable Diet (MAD) requirements is higher among lower income groups (FNRI‐
DOST, 2015).

The reasons for lack of variety and low vegetable consumption vary, some of which are
behavioral in nature (Batt, 2005). Maternal/caregiver feeding beliefs, maternal
characteristics (e.g. level of education, knowledge, working status), household size and food
security status, and other factors can possible influence food choices and feeding practices
that impact the nutritional status of young children in the country (Ocampo‐Guirindola et al
2016). Some Filipinos consider vegetables as a poor man’s diet and thus usually opt to
purchase meat and meat‐based products as a status symbol. Even if convinced of health
benefits, some households still opt to consume fewer vegetables as these require more
preparation and have short shelf life. Some members of the household (more likely young
children) dislike the taste of vegetables. For coastal communities, the preferred diets
consists of fish and rice since these are the ones readily and more cheaply available.
Likewise, where vegetable production abounds, households find repeated consumption of
the same vegetables monotonous, preferring instead to monetize vegetables they produce
and buy less nutrient‐dense, processed food commodities like noodles. Moreover,
expenditures on food outside the home has increased, due partly to the proliferation of
food service establishments. Among urban‐based Filipino families, packaged and instant
foods have become popular even as most of these foods are high in calories, fats, sodium,
and food additives, and relatively bereft of nutrients.

46 | P a g e
Notwithstanding the behavioral considerations, it remains true that diet inadequacy is
strongly correlated with poverty. For a poor household, food expenditure accounts for
nearly 60% of total expenditure, hence eating foods other than staples, even if nutritious, is
hardly an option. This is exacerbated by the high price of the primary food staple rice in the
country, hence crowding out other nutritious foods from the family’s affordable diet. This
lack of access to nutritious food groups could plausibly explain the low consumption for
these foods, and the low proportion of children belonging to the lowest wealth quintiles and
living in rural areas who met the MAD. Improving food affordability will greatly facilitate,
though not guarantee, better diets for poor households.

The World Risk Index ranks the Philippines second most at‐risk country in the world. Climate
change has tremendous impacts on livelihood and socioeconomic conditions of the exposed
population, especially to vulnerable and marginalized sectors of Philippine society. Studies
on social impacts of climate related disasters showed that livelihood, safety and security,
level of food and nutrition security were highly compromised during and after climate
related disaster events (GGGI 2016; Pulhin 2016, IPCC AR5 2015).

Health and nutrition services were also devolved to local government units (LGUs) and the
provision of these is through their health offices. Local nutrition committees are organized
at all sub‐national levels to manage and coordinate the planning, implementation,
monitoring and evaluation of local hunger‐mitigation and nutrition action plan as part of the
local development plan. The Barangays are at the forefront of health and nutrition services
and facilities. Barangays are expected to deploy Barangay Nutrition Scholars (BNS). BNS are
volunteer health workers involved in a wide range of activities that include house‐to‐house
surveys; identification of malnourished children through the Operation Timbang Plus (OPT
Plus), an annual nationwide weigh‐and‐height‐taking activity, quarterly growth monitoring,
accompanied by counseling and referral; community mobilization; nutrition education;
supplementary feeding program management; record‐keeping; and assisting with other
health activities such as immunization and deworming.

Poor households face greater challenges in boosting diet diversity compared to higher
income households for several reasons, one of which is that fruit and vegetable retail prices

47 | P a g e
have increased the fastest compared to other food items. Also, poor households generally
do not have access to refrigeration, thus cannot store fresh nutritious foods longer. In many
cases, both spouses go to work, limiting time available to prepare nutritious food. Poor
households have physical access to food, but food prices limit their actual access.

THE FSN service delivery mechanism is profoundly impaired. In the nutrition and health
delivery system, frontline workers, especially the BNS and BHW are likewise ill equipped to
handle caseloads of households with malnourished children within their communities.

Nutrition education activities are on‐going but hardly seem to make a difference in how
households actually practice home food preparation. Difficulties can be traced to gaps in
knowledge and consistent application of nutritionally‐sound food choices and eating
practices by mothers and caregivers.

Large‐scale supplementary feeding programs implemented by LGUs are anchored on day

care center and schools, and are difficult to sustain without external support. The case of
school‐based feeding illustrates the implementation problem of direct interventions. The
DepEd School‐Based Feeding Program provides a free meal to pupils for a cycle of 100 to
120 days. However, only 70% of children verified as wasted at the start of a cycle attained
normal status by the end of cycle. Ten percent verified as normal at the start of a cycle
worsened to wasted status by end of cycle. Of a group of pupils who had transitioned from
severely wasted to normal over a cycle, 52% were founded to be wasted one year after the
program. It appears the cycle was too short to fully address child malnutrition. Moreover,
interventions must be introduced to capacitate families in addressing nutritional needs of
children (Albert, Abunda, and Angeles‐Agdeppa, 2016).

Conclusion

The SBFP implemented through the integrated model (GarNESupp) resulted in a significant
increase in mean weight and height among schoolchildren. Further improvement in mean
weight and height was observed even with an additional 80‐day feeding period. The

48 | P a g e
implementation of different nutrition modalities have mended the disconnect between
SBFP and GPP, resulting in improved implementation of the SBFP with improved nutritional
status of children as visible outcome.

Recommendations

 The SBFP should be implemented for at least 180 feeding days as evidenced by the
significant increase in mean weight and height after the additional 80 feeding days.

 There should be timely release of funds to implement the program within the 180
feeding days under the school year.

 A memorandum on the implementation of nutrition education in schools should be

issued as the study proved that nutrition education bridges the gap between
gardening and feeding programs and helps achieve sustainability of the programs.

 Focused targeting resulting in obtaining standard weight and height measurement

tools is necessary. This may result in lower number of beneficiaries. Extra funds
could be requested by the regions from national officials to increase the meal
cost/per/child/day from P 18.00 to P 20.00 so that proper serving portions per child
per day is observed.

 Strategies such as regular meetings and organized feedback mechanisms or other

creative school‐based approaches should be installed to sustain funding support
from external sources or partners.

 Regular capability building of the feeding, agricultural, and other SBFP members of
the core group should be conducted to equip them with skills on proper
documentation and to update them with state‐of‐the‐art information.

49 | P a g e
Appendices

Table A1. Distribution of stunting in students included in the feeding program in sentinel
schools, by age group and gender between time periods
Age Percentage
p value
groups Time Normal* Stunting* difference
(years) period n (%) n (%) Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(n)/sex Mid End End Mid End End
Base 86 (72.27) 33 (27.73)
5 to 10
Mid 87 (73.11) 32 (26.89) 0.84 0.00 0.84 0.706 1.000 1.000
(n =119)
End 87 (73.11) 32 (26.89)
Base 39 (72.22) 15 (27.78)
Male
Mid 38 (70.37) 16 (29.63) 1.94 3.70 1.85 1.000 0.500 1.000
(n = 54)
End 40 (74.07) 14 (25.93)
Base 47 (72.31) 18 (27.69)
Female
Mid 49 (75.38) 16 (24.62) 3.07 3.07 0 0.625 0.500 1.000
(n = 65)
End 47 (72.31) 18 (27.69)

Base 94 (59.49) 64 (40.51)

10.1 to 19
Mid 92 (58.23) 66 (41.77) 1.26 1.26 0.00 0.688 0.688 1.000
(n = 158)
End 94 (59.49) 64 (40.51)
Base 47 (56.63) 36 (43.37)
Male
Mid 47(56.63) 36 (43.37) 0 1.2 1.2 1.000 1.000 1.000
(n = 83)
End 48 (57.83) 35 (42.17)
Base 47 (62.67) 28 (37.33)
Female
Mid 45 (60) 30 (40) 2.67 1.33 1.34 0.625 1.000 1.000
(n = 75)
End 46 (61.33) 29 (38.67)
McNemar change test
*HAZ (height‐for‐age z‐score)

Table A2. Distribution of undernourished students in sentinel schools, by age group and
gender by time period
Age Percentage
Normal Undernourished p value
group Time difference
* *
(years) period Base Mid‐ Base Base Mid‐ Base
(n)/sex n (%) n (%)
‐Mid End ‐End ‐Mid End ‐End
5 to 10 Base 0 (0) 119 (100)
(n = Mid 36 (30.25) 83 (69.75) 30.25 5.04 35.29 0.000 0.308 0.000
119) End 42 (35.29) 77 (64.71)
Base 0 (0) 54 (100)
Male
Mid 18 (33.33) 36 (66.67) 33.33 1.86 35.19 0.000 1.000 0.000
(n = 54)
End 19 (35.19) 35 (64.81)
Base 0 (0) 65 (100)
Female
Mid 18 (27.69) 47 (72.31) 27.69 7.69 35.38 0.000 0.302 0.000
(n = 65)
End 23 (35.38) 42 (64.62)

50 | P a g e
10.1 to Base 0 (0) 158 (100)
19 (n = Mid 34 (21.52) 124 (78.48) 21.52 8.23 29.75 0.000 0.029 0.000
158) End 47 (29.75) 111 (70.25)
Base 0 (0) 83 (100)
Male
Mid 15 (18.07) 68 (81.93) 18.07 10.85 28.92 0.000 0.064 0.000
(n = 83)
End 24 (28.92) 59 (71.08)
Female Base 0 (0) 75 (100)
(n = Mid 19 (25.33) 56 (74.67) 25.33 5.34 30.67 0.000 0.388 0.000
75) End 23 (30.67) 52 (69.33)
McNemar change test
*WHZ (weight-for-height z-score)

Table A3. Distribution of stunting in students included in the feeding program in sentinel
schools, by age group and gender at end of regular 120 feeding days and at end of the
additional 80 feeding days
Normal* Stunting* Percentage
Age group (years) (n)/sex n (%) n (%) difference p value
Base End Base End (Base‐End)
5 to 10 ( n = 113) 82 (75.57) 80 (70.80) 31 (27.43) 33 (29.20) 1.77 0.625
Male (n = 52) 38 (73.08) 37 (71.15) 14 (26.92) 15 (28.85) 1.93 1.000
Female (n = 61) 44 (72.13) 43 (70.49) 17 (27.87) 18 (29.51) 1.64 1.000

10.1 to 19 (n = 82 ) 45 (54.88) 47 (57.32 37 (45.12) 35 (42.68) 2.44 0.688

Male (n = 43) 23 (53.49) 24 (55.81) 20 (46.51) 19 (44.19) 2.32 1.000
Female (n = 39) 22 (56.41) 23 (58.97) 17 (43.59) 16 (41.03 2.56 1.000
McNemar change test
*HAZ (height-for-age z-score)

Table A4. Distribution of undernourished students in sentinel schools, by age group during
the additional 80 feeding days
Normal* Undernourished*
Age group (years) Percentage
n (%) n (%) p value
(n)/sex difference
Base End Base End
5 to 10 ( n = 113) 39 (34.51) 31 (27.43) 74 (65.49) 82 (72.57) 7.08 0.077
Male (n = 52) 19 (36.54) 15 (28.85) 33 (63.46) 37 (71.15) 7.69 0.289
Female (n = 61) 20 (32.79) 16 (26.23 41 (67.21) 45 (73.77) 6.56 0.289

10.1 to 19 (n = 82 ) 20 (24.39) 23 (28.05) 62 (75.61) 59 (71.95) 3.66 0.607

Male (n = 43) 8 (18.60) 9 (20.93) 35 (81.40) 34 (79.07) 2.33 1.000
Female (n = 39) 12 (30.77) 14 (35.90) 27 (69.23) 25 (64.10) 5.13 0.688
McNemar change test
*WHZ (weight-for-height z-score)

Table A5. Distribution of stunting in students included in the 200 feeding days in sentinel
schools, by age group between time periods
Age group Percentage difference p value
Time Normal* Stunting*
(years) Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
period n (%) n (%)
(n)/sex Mid End End Mid End End
5 to 10 Jul 2016 81 (71.68) 32 (28.32)
0.89 0 1.77 1.000 1.000 0.625
(n = 113) Dec 2016 82 (72.57) 31 (27.43)

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 Mar 2017 82 (72.57) 31 (27.43)
Jul 2017 80 (70.80) 33(29.20)
Jul 2016 37 (71.15) 15 (28.85)
Male Dec 2016 36 (69.23) 16 (30.77)
1.92 3.85 1.93 1.000 0.500 1.000
(n = 52) Mar 2017 38 (73.08) 14 (26.92)
Jul 2017 37 (71.15) 15 (28.85)
Jul 2016 44 (72.13) 17 (27.87)
Female Dec 2016 46 (75.41) 15 (24.59)
3.28 3.28 1.64 0.625 0.500 1.000
(n = 61) Mar 2017 44 (72.13) 17 (27.87)
Jul 2017 43 (70.49) 18 (29.51)

Jul 2016 46 (56.10) 36 (43.90)

10.1 to 19 Dec 2016 45 (54.88) 37 (45.12)
1.22 0 2.44 1.000 1.000 0.687
(n =82) Mar 2017 45(54.88) 37 (45.12)
Jul 2017 47 (57.32) 35 (42.68)
Jul 2016 22 (51.16) 21 (48.84)
Male Dec 2016 22 (51.16) 21 (48.84)
0 2.33 2.32 1.000 1.000 1.000
(n = 43) Mar 2017 23 (53.49) 20 (46.51)
Jul 2017 24 (55.81) 19 (44.19)
Jul 2016 24 (61.54) 15 (38.46)
Female Dec 2016 23 (58.97) 16 (41.03)
2.57 2.56 2.56 1.000 1.000 1.000
(n = 39) Mar 2017 22 (56.41) 17 (43.59)
Jul 2017 23 (58.97) 16 (41.03)
McNemar change test
*HAZ (height-for-age z-score)

Table A6. Distribution of undernourished students included in the 200 feeding days in
sentinel schools, by age group between time periods
Percentage
Age group p value
Time Normal* Undernourished* difference
(years)
period n (%) n (%) Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(n)/sex
Mid End End Mid End End
Jul 2016 0 (0) 113 (100)
5 to 10 Dec 2016 35 (30.97) 78 (69.03)
30.97 3.54 7.08 0.000 0.523 0.077
(n = 113) Mar 2017 39 (34.51) 74 (65.49)
Jul 2017 31 (27.43) 82 (72.57)
Jul 2016 0 (0) 52 (100)
Male Dec 2016 18 (34.62) 34 (65.38)
34.62 1.92 7.69 0.000 1.000 0.289
(n = 52) Mar 2017 19(36.54) 33 (63.46)
Jul 2017 15 (28.85) 37 (71.15)
Jul 2016 0 (0) 61 (100)
Female Dec 2016 17 (27.87) 44 (72.13)
27.87 4.92 6.56 0.000 0.581 0.289
(n = 61) Mar 2017 20 (32.79) 41 (67.21)
Jul 2017 16 (26.23) 45 (73.77)

Jul 2016 0 (0) 82 (100)

10.1 to 19 Dec 2016 17 (20.73) 65 (79.27)
20.73 3.66 3.66 0.000 0.607 0.607
(n = 82) Mar 2017 20 (24.39) 62 (75.61)
Jul 2017 23 (28.05) 59 (71.95)
Jul 2016 0 (0) 43 (100)
Male Dec 2016 7 (16.28) 36 (83.72)
16.28 2.32 2.33 0.016 1.000 1.000
(n = 43) Mar 2017 8 (18.60) 35 (81.40)
Jul 2017 9 (20.93) 34 (79.07)

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 Jul 2016 0 (0) 39 (100)
Female Dec 2016 10 (25.64) 29 (74.36)
25.64 5.13 5.13 0.002 0.688 0.688
(n = 39) Mar 2017 12 (30.77) 27 (69.23)
Jul 2017 14 (35.90) 25 (64.10)
McNemar change test
*WHZ (weight-for-height z-score)

Table A7. Distribution of stunting in students included in the feeding program in

lighthouse schools, by age group and gender between time periods
Age Percentage difference p value
Time Normal* Stunting*
group() Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(n)/sex
period n (%) n (%)
Mid End End Mid End End
Base 67 (60.36) 44 (39.64)
5 to 10
Mid 66 (59.46) 45 (40.54) 0.90 3.60 2.70 1.000 0.219 0.453
(n = 111)
End 70 (63.06) 41 (36.94)
Base 26 (50.00) 26 (50.00)
Male
Mid 26 (50.00) 26 (50.00) 0 1.92 1.92 1.000 1.000 1.000
(n = 52)
End 27 (51.92) 25 (48.08)
Base 41 (69.49) 18 (30.51)
Female
Mid 40 (67.80) 19 (32.20) 1.69 5.08 3.39 1.000 0.250 0.625
(n = 59)
End 43 (72.88) 16 (27.12)

Base 65 (57.52) 48 (42.48)

10.1 to 19
Mid 64 (56.64) 49 (43.36) 0.88 1.94 2.65 1.000 0.500 0.508
(n = 113)
End 62 (54.87) 51 (45.13)
Base 35 (53.85) 30 (46.15)
Male
Mid 34 (52.31) 31 (47.69) 1.54 3.08 4.62 1.000 0.500 0.4531
(n = 65)
End 32 (49.23) 33 (50.77)
Base 30 (62.50) 18 (37.50)
Female
Mid 30 (62.50) 18 (37.50) 0 0 0 1.000 1.000 1.000
(n = 48)
End 30 (62.50) 18 (37.50)
McNemar change test
*HAZ (height‐for‐age z‐score)

Table A8. Distribution of undernourished students in lighthouse schools, by age group and
gender by time period
Age Percentage
p value
group Time Normal* Undernourished* difference
(years) period n (%) n (%) Base‐ Mid‐ Base‐ Base‐ Mid‐ Base‐
(n)/sex Mid End End Mid End End
5 to 10 Base 0 (0) 111 (100)
(n = Mid 46 (41.44) 65 (58.56) 41.44 0.00 41.44 0.000 1.000 0.000
111) End 46 (41.44) 65 (58.56)
Male Base 0 (0) 52 (100)
(n = Mid 21 (40.38) 31 (59.62) 40.38 1.93 42.31 0.000 1.000 0.000
52) End 22 (42.31) 30 (57.69)
Female Base 0 (0) 59 (100) 42.37 1.69 40.68 0.000 1.000 0.000

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(n = Mid 25 (42.37) 34 (57.63)
59) End 24 (40.68) 35 (59.32)

10.1 to Base 0 (0) 113 (100)

19 (n = Mid 29 (25.66) 84 (74.34) 25.66 7.08 32.74 0.000 0.185 0.000
113) End 37 (32.74) 76 (67.26)
Male Base 0 (0) 65 (100)
(n = Mid 16 (24.62) 49 (75.38) 24.62 1.53 26.15 0.000 1.000 0.000
65) End 17 (26.15) 48 (73.85)
Female Base 0 (0) 48 (100)
(n = Mid 13 (27.08) 35 (72.92) 27.08 14.59 41.67 0.000 0.092 0.000
48) End 20 (41.67) 28 (58.33)
McNemar change test
*WHZ (weight‐for‐height z‐score)

Table A9. Relationship between educational attainment of parent and total number of
days complied with during the additional 80 feeding days
Number of feeding days
5.1‐10 years old
Coefficient p value
Educational attainment of father ‐0.3845* 0.0011
Educational attainment of mother ‐0.224 0.0643
10.1‐19 years old
Educational attainment of father ‐0.2134 0.1694
Educational attainment of mother 0.0489 0.7556
Spearman’s rho
*Significant at 0.05

Table A10. Relationship between nutritional status at the end of the additional 80 feeding
days and other factors that may affect nutrition status of students in sentinel schools
Nutritional status after the 80 feeding days
5.1‐10 years old
Coefficient p value
No. of participation days 0.1105 0.3488
Total household members employed 0.1678 0.1530
Total number of earning family member 0.0835 0.4796
Monthly income 0.0542 0.6464
Average expenditure 0.0208 0.8607
Socioeconomic score ‐0.0035 0.9761
Total food group consumed ‐0.1002 0.3957
10.1‐19 years old
No. of participation days ‐0.1027 0.4969
Total household members employed ‐0.1956 0.1927
Total number of earning family member ‐0.0980 0.5170
Monthly income ‐0.2353 0.1155
Average expenditure ‐0.0492 0.7454
Socio‐economic score ‐0.2032 0.1756

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Total food group consumed 0.0085 0.9555
Spearman’s rho
*Significant at 0.05

Table A11. Association between nutritional status at the end of the additional 80? 200?
feeding days and other factors that may affect the nutrition of students in sentinel schools
Nutritional status after the 200 feeding days
5.1‐10 years old
Computed chi‐square p value
Food pattern 7.0399 0.532
Household type 2.6148 0.271
10.1‐19 years old
Food pattern 4.7859 0.572
Household type 5.7346 0.057
Chi‐square test
*Significant at 0.05

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