Which interventions are (or could be) implemented in schools to promote nutritious diets of adolescents living in urban Africa in the context of nutrition transition

This study addressed the pressing issue of high undernutrition rates alongside increasing overweight and obesity among adolescents in Kenya. Recognising schools as critical settings for shaping dietary habits, the study aimed to identify effective school interventions that could promote healthy diets and prevent nutritional issues in adolescents aged 14-18 years within urban environments in the country.
The study focused on three main objectives:

1. Mapping the current implementation of comprehensive School Food and Nutrition Programmes (SFNPs) in Kenyan schools at policy and school levels, comparing them against international good practice indicators.
2. Identifying challenges to the effective implementation of SFNPs.
3. Identifying solutions to address these challenges through new or improved interventions in school food environments.

The Nutrition Research Facility (NRF) conducted a series of consultations with decision-makers in EU Member States, EU partner countries, within Delegations of the EU in partner countries and within the European Commission, in order to identify their current concerns in relation to nutrition issues in development contexts. This question arose from a consultation workshop focusing on African countries.

The study followed a 4-step process:

1. Identifying international good practice indicators to design, monitor and evaluate school nutrition programmes, based on a thorough search of global policy documents, scientific publications, and experts consultations.
2. Assessing Kenyan policies and practices through a desk review of 38 national policies and a cross-sectional study in 30 schools assessed implementation levels using observations and interviews with stakeholders.
3. Identifying challenges and solutions: 7 participatory workshops were conducted in schools with teachers, students, parents, and food vendors to identify key challenges and brainstorm solutions, tailored to school contexts.
4. Discussing with national-level decision-makers and implementers: A workshop with 31 stakeholders validated findings and provided additional insights into challenges and solutions for improving SFNPs.

First, a list of 58 good practice indicators for comprehensive school nutrition programmes was identified accross five main domains: school premises, school community, external school food environment, policy environment, and cross-cutting issues (such as gender or social inclusion).

Second, the study gathered evidence on the extent of current implementation of comprehensive SFNPs targeting adolescents at policy and school levels; and compared the level of policy adoption and implementation in Kenya to international good practice indicators.

Finally, 34 challenges to the implementation of comprehensive SFNPs were identified (particularly in food provision; pricing; labelling; food safety; physical education; water, sanitation and hygiene (WASH); and school gardens). Potential solutions were pinpointed through participatory methods involving the school community and national stakeholders: 29 recommendations and 48 solutions were proposed, some requiring government investment in infrastructure and others feasible at the school level with lesser resources.

While there is strong national policy guidance on SFNPs including food safety, health services, nutrition education, and WASH, only nutrition education is sufficiently implemented in schools. Other components, such as food provision, food promotion, physical education, and community involvement, were only partially addressed, highlighting the need for bigger efforts. There is no requirements for schools to have their own food and nutrition policies, which is a shortcoming. More attention should also be paid to the external school food environment. There is need to advocate for investment and funding to promote healthy diets and improve adolescent nutrition.

Further work is required to translate the recommendations into feasible and actionable interventions.

Adolescents’ nutrition and dietary habits have long-term health and well-being implications, with far-reaching impacts on education, gender equality, and inclusive economic growth. Proposed solutions would promote resilience in communities while creating opportunities for local engagement. These interventions not only support healthier generations but also advance equitable access to resources.

Main contact: Michelle Holdsworth

Organisation: Institut de Recherche pour le Développement (IRD)

Email address: michelle.holdsworth@ird.fr

African Population Health Research Centre (APHC)