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SCHOOL FEEDING PROGRAMS AND NUTRITIONAL OUTCOMES: A CASE STUDY OF OSUN STATE GENERAL HOSPITAL OSOGBO
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
School feeding programmes represent a multisectoral intervention aimed at simultaneously addressing childhood hunger, improving nutritional status, and enhancing educational outcomes among school-aged children. The Federal Government of Nigeria launched the National Home-Grown School Feeding Programme (NHGSFP) to provide one nutritious meal per school day to public primary school pupils, with the dual objective of reducing short-term hunger and improving learning outcomes (Agu, Agbo & Nwachukwu, 2023). As of 2022, Nigeria had an estimated 20 million out-of-school children, with poverty, hunger, and inadequate nutrition cited as major contributors to school non-attendance (UNESCO, 2022), underscoring the programmatic relevance of school feeding.
The NHGSFP was first introduced in 2005 and relaunched in 2016 under President Muhammadu Buhari as a flagship social investment initiative. In 2024, President Bola Ahmed Tinubu restructured the programme under the Renewed Hope Agenda, renaming it the Renewed Hope–National Home-Grown School Feeding Programme (RH-NHGSFP), with a target of feeding over 10 million Nigerian primary school pupils and reducing out-of-school children through improved nutritional and educational support (RH-NHGSFP, 2024). The programme is also designed to support smallholder farmers by using locally sourced agricultural produce, thereby linking school feeding to broader rural economic development objectives.
In Osun State, the NHGSFP has been implemented in public primary schools since 2005, and Osun State General Hospital Osogbo serves as a reference institution for assessing the nutritional outcomes of school-age children in the state. An early study of the programme conducted at a public primary school in Ile-Ife, Osun State, found that 65.4% of pupils were classified as having a healthy weight, suggesting improvements in dietary intake linked to the feeding programme (Falade et al., 2012). However, the nutritional adequacy of the meals provided and their long-term impact on health outcomes as assessed by clinical facilities such as Osun State General Hospital has not been comprehensively examined.
A scoping review of the impacts of school feeding programmes in low- and middle-income countries found consistent evidence linking school meals to reduced short-term hunger, improved anthropometric measures, and better classroom concentration and cognitive performance (Wang & Fawzi, 2020). In northeast Nigeria, a study by Barnabas, Bavorova & Madaki (2024) found that school feeding programmes positively influenced school attendance and enrolment. In Ondo State, a 2024 descriptive cross-sectional study by Obembe et al. found that stunting (30.3%) and wasting (23.9%) were significantly more prevalent among pupils from public schools which are the primary target of the NHGSFP compared with private school pupils, raising questions about the programme’s adequacy in addressing the nutritional deficits it was designed to remedy (Obembe et al., 2024). Similarly, the contribution of school meals to recommended nutrient and energy intake among Nigerian children has been quantified: a study of the NHGSFP in Zaria found meaningful dietary contributions from programme meals but also identified potential micronutrient gaps (Zailani, Owolabi & Sallau, 2023).
The design of the NHGSFP is grounded in evidence from the broader school feeding literature. A global analysis using human-centred design frameworks to assess social protection interventions for vulnerable children in Nigeria found that a nutrition-sensitive approach, integrating the NHGSFP with other welfare programmes, significantly enhanced the programme’s coverage and impact (GAIN, 2024). Despite the programme’s reach and aspirations, it has been characterised by funding irregularities, inadequate cooking infrastructure, and inconsistent food quality, particularly in southeast Nigeria (Ebimgbo, 2023; Agu et al., 2023). Whether similar constraints are operative in Osun State and how they translate into measurable nutritional outcomes in clinical settings remains an unresolved empirical question.
1.2 Statement of the Problem
Despite the wide implementation of the NHGSFP across Nigeria, empirical evidence on its specific nutritional impacts as measured through clinical outcomes at tertiary health facilities like Osun State General Hospital Osogbo remains sparse. Challenges such as inadequate funding, poor cooking facilities, and variability in meal quality have been documented in southeast Nigeria (Ebimgbo, 2023; Agu et al., 2023), and similar constraints are likely operative in Osun State, yet the extent to which these challenges translate into measurable nutritional deficiencies among programme beneficiaries has not been independently assessed through hospital-based data.
Furthermore, health impact assessment of school feeding programmes has largely relied on anthropometric measurements conducted in schools rather than on clinical nutritional data from health facilities. Evidence from Ondo State indicates that even in states where the NHGSFP has been operational for over five years, significant levels of stunting (20.7%) and wasting (19.4%) persist among public school pupils, underscoring the insufficiency of relying solely on enrolment statistics as proxy indicators of nutritional success (Obembe et al., 2024). Osun State General Hospital Osogbo, as the major secondary referral facility in the state capital, provides an opportunity to examine the nutrition-related presentations of school-age children and to disaggregate these by school feeding programme participation status.
A study assessing the effectiveness of the NHGSFP in the Federal Capital Territory confirmed that the programme had a positive effect on pupils’ nutritional status and cognitive function, but also emphasised that these outcomes were contingent upon consistent implementation and adequate funding (RSISINTERNATIONAL, 2024). The existing Osun State evidence is now over a decade old (Falade et al., 2012), and the relaunch of the programme in 2016 and its restructuring in 2024 introduce substantial changes that warrant updated, facility-level evaluation. The absence of such contemporary clinical evidence limits the ability of programme managers and public health authorities to make evidence-informed adjustments to programme design and delivery in Osun State.
1.3 Objectives of the Study
The main objective is to examine the nutritional outcomes of school-age children in relation to participation in the National Home-Grown School Feeding Programme, using data from Osun State General Hospital Osogbo.
The specific objectives are to:
- assess the nutritional status of school-age children attending outpatient clinics at Osun State General Hospital Osogbo;
- compare nutritional outcomes between children enrolled in the NHGSFP and those not enrolled;
- identify the key nutritional deficiencies among school-age children in the Osogbo catchment area;
- evaluate the adequacy of school meals provided under the NHGSFP in meeting children’s nutritional requirements; and
1.4 Research Questions
- What is the nutritional status of school-age children attending Osun State General Hospital Osogbo?
- Are there significant differences in nutritional outcomes between children enrolled and not enrolled in the NHGSFP
- What are the prevalent nutritional deficiencies in the study population?
- How adequate are the school meals provided under the NHGSFP in meeting children’s daily nutritional requirements?
1.5 Research Hypotheses
H01: There is no significant difference in anthropometric measures between NHGSFP-enrolled and non-enrolled school-age children attending Osun State General Hospital.
H02: Participation in the NHGSFP does not significantly reduce the prevalence of micronutrient deficiencies among school-age children.
H03: There is no significant relationship between the frequency of school meal consumption and clinical nutritional outcomes among school-age children.
1.6 Significance of the Study
This study provides contemporary clinical evidence on the nutritional impact of the NHGSFP in Osun State, contributing to the evidence base needed to guide programme reform in the context of the government’s Renewed Hope restructuring of the programme in 2024 (RH-NHGSFP, 2024). The findings will be relevant to Osun State Ministry of Education, the Federal Ministry of Humanitarian Affairs managing the RH-NHGSFP, and public health nutritionists. The study addresses a methodological gap in the literature by triangulating school-based anthropometric data with hospital-based clinical nutritional assessments an approach that has been identified as a critical need in the Nigerian school feeding evaluation literature (Obembe et al., 2024; GAIN, 2024). The study will also provide baseline clinical data against which future programme evaluations can be measured, addressing the absence of such baselines that has been noted as a significant limitation of existing impact evidence (Obembe et al., 2024).
1.7 Scope and Limitations of the Study
The study is delimited to school-age children (5–14 years) attending Osun State General Hospital Osogbo over the defined study period. Data are collected through clinical records and structured parent/caregiver interviews. Limitations include: the cross-sectional design limits causal inference; children attending the hospital may not be representative of all school-age children in Osogbo; data on actual dietary intake at school are reliant on parental and caregiver recall; and the study does not include a longitudinal follow-up to assess the sustained nutritional impact of programme participation over time.
1.8 Definition of Terms
School Feeding Programme (SFP): A structured intervention that provides meals to schoolchildren during school hours to address hunger, improve nutritional status, and support school attendance and performance.
National Home-Grown School Feeding Programme (NHGSFP) / RH-NHGSFP: The Federal Government of Nigeria’s initiative to provide one nutritious meal per school day to public primary school pupils using locally sourced agricultural produce, restructured in 2024 as the Renewed Hope–NHGSFP.
Nutritional Status: The condition of the body in relation to the consumption and utilisation of nutrients, assessed through anthropometric measurements, biochemical indices, clinical examination, and dietary intake.
Anthropometric Measurements: Body measurements used to assess growth and nutritional status, including weight, height, mid-upper arm circumference, and derived indices such as body mass index (BMI) and height-for-age z-scores.
Micronutrient Deficiency: Inadequate intake or absorption of essential vitamins and minerals (such as iron, zinc, vitamin A, and iodine) required in small amounts for normal physiological function.
Body Mass Index (BMI): A measure calculated as weight (kg) divided by height squared (m²), used to classify nutritional status as underweight, normal, overweight, or obese in school-age children using age- and sex-specific reference values.
Stunting: Chronically low height-for-age (below -2 z-scores of the WHO reference median), indicative of prolonged nutritional deprivation.
Food Vendor/Caterer: Within the NHGSFP context, locally engaged cooks and food vendors who prepare and serve school meals to pupils using programme-specified ingredients and dietary guidelines.
References
Agu, O., Agbo, E., & Nwachukwu, T. (2023). An appraisal of the implementation of the national school feeding programme and its effect on enrolment and attendance in public primary schools in Southeast, Nigeria. BMC Nutrition. https://doi.org/10.1186/s40795-023-00695-z
Barnabas, B., Bavorova, M., & Madaki, M. Y. (2024). The effect of school feeding program on pupils’ enrolment, attendance and performance in northeastern region of Nigeria. SAGE Open, 14(2). https://doi.org/10.1177/21582440241255809
Ebimgbo, S. O. (2023). Stakeholders’ perceptions on the nutritional and educational impacts of National Home Grown School Feeding Programme on pupils of rural public primary schools in Ebonyi State, Nigeria. Education 3-13, 53(5), 806–817. https://doi.org/10.1080/03004279.2023.2229863
Falade, O. S., Otemuyiwa, I., Oluwasola, O., Oladipo, W., & Adewusi, S. A. (2012). School feeding programme in Nigeria: The nutritional status of pupils in a public primary school in Ile-Ife, Osun State. Food and Nutrition Sciences, 5, 596–605.
GAIN (Global Alliance for Improved Nutrition). (2024). Leveraging human-centered design to strengthen support for vulnerable children in Nigeria’s National Homegrown School Feeding Programme. GAIN. https://www.gainhealth.org
Obembe, T. A., Bosede, A. O., Ariyo, O., Adeniji, F. I. P., Olaoye, A., & Adebayo, A. M. (2024). Nutritional status of school children in South-west Nigeria: Inferences from a national homegrown school feeding programme. African Health Sciences, 24(1), 239–249. https://doi.org/10.4314/ahs.v24i1.29
RH-NHGSFP. (2024). About the Renewed Hope National Home-Grown School Feeding Programme. Federal Government of Nigeria. https://rhnhgsfp.gov.ng/about
UNESCO. (2022). Education for all global monitoring report. UNESCO.
Wang, D., & Fawzi, W. W. (2020). Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis. Journal of Global Health, 9(2).
Zailani, H., Owolabi, O. A., & Sallau, A. B. (2023). Contribution of school meals to the recommended nutrient and energy intake of children enrolled in the National Homegrown School Feeding Program in Zaria, Nigeria. Archives of Pediatrics, 30, 471–476. https://doi.org/10.1016/j.arcped.2023.03.001