Healthy Kitchens, Healthy Children: the impact of linking community kitchens to a school food program on children's diet diversity, nutritional status and school performance

ISRCTN ISRCTN15931286
DOI https://doi.org/10.1186/ISRCTN15931286
Secondary identifying numbers A 102829 -P 22047
Submission date
25/09/2018
Registration date
22/10/2018
Last edited
25/04/2022
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Other
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Palestinian refugee children in Lebanon attend schools run by the UN Relief Works Agency for Palestine Refugees (UNRWA). Most schools have a small private food seller selling packaged foods inside the school, with products generally high in fat, sugar and salt. The aim of this study was to investigate the effect of the offering of a subsidised healthy daily school meal at these schools on diet diversity, nutritional status, school attendance and school performance of children.

Who can participate?
Children aged 6 years or older, attending one of four selected elementary schools in two Palestinian camps in Beirut. Children were asked to declare any food allergies they may have in advance of participation.

What does the study involve?
Children attending two intervention schools were offered the option of purchasing a subsidised healthy school meal on a daily basis, in addition to receiving nutrition and health education sessions. Children attending two control schools were offered nutrition and health education sessions only.

What are the possible benefits and risks of participating?
Possible benefits of participating include a potentially improved school meal, and therefore nutrition for children. There are no known risks to participants taking part in this study. Risks of food-borne illness were mitigated by ensuring rigorous food safety standards for the program. Risks of allergies were mitigated by ensuring that children declared allergies in advance.

Where is the study run from?
The study is run from the Center for Research on Population and Health at the American University of Beirut and four schools in two Palestinian camps in Lebanon will participate

When is the study starting and how long is it expected to run for?
September 2013 to December 2017

Who is funding the study?
The Nestle Foundation for the Study of Problems of Nutrition in the World (Switzerland)

Who is the main contact?
Dr Hala Ghattas
hg15@aub.edu.lb

Contact information

Dr Hala Ghattas
Scientific

American University of Beirut
PO Box 11-0236/EPHD, Riad El Solh
Beirut
1107 2020
Lebanon

Phone +961 1 350 000 Ext 4679
Email hg15@aub.edu.lb

Study information

Study designInterventional non-randomised study
Primary study designInterventional
Secondary study designNon randomised study
Study setting(s)School
Study typeOther
Participant information sheet Not available in web format, please contact Hala Ghattas (hg15@aub.edu.lb) to request a participant information sheet
Scientific titleHealthy Kitchens, Healthy Children: a community-based intervention linking community kitchens to a school food program - the Healthy Children component
Study acronymHealthy Kitchens, Healthy Children- Children's study (HKHC-C)
Study objectivesThis study aimed to investigate the effect of a two-pronged intervention that employed women through social enterprises (Healthy Kitchens) to deliver a subsidised healthy daily school meal to elementary schoolchildren in Palestinian camps (Healthy Children).

We hypothesised that children participating in the Healthy children component of the intervention would have improved dietary diversity, nutritional status, school absenteeism and educational achievements.
Ethics approval(s)1. American University of Beirut Social and Behavioral Sciences Institutional Review Board (AUB
SBS IRB), 20/12/2013, ref: FHS.HG.01 / FHS.HG.02
2. University of Maryland Institutional Review Board (UMD IRB), 02/12/2013, ref: 535188-1
Health condition(s) or problem(s) studiedChildren's diet diversity and nutritional status
InterventionThis study, Healthy Children, is a component of a wider study called Healthy Kitchens, Healthy Children.
The Healthy Schools component is an 8 month, non-randomised school-based intervention, where 2 schools are allocated to receive the intervention and 2 neighbouring schools are allocated to the control group. Intervention schools received a series of 4 interactive health and nutrition classes, and a daily health subsidised snack, made by the women in the Healthy Kitchens component (covering 15% of children's energy requirements and over 30% of iron, folate and Vitamin A requirements), which children purchased at a cost of 0.25 USD/day. Children in the control group received the 4 interactive health and nutrition classes only.
Intervention typeOther
Primary outcome measureSchoolchildren’s diet diversity assessed using the Diet Diversity Score (DDS) at the baseline and
after 8 months
Secondary outcome measuresThe following are assessed at the baseline and after 8 months:
1. Nutritional status, assessed by measuring height and weight and recording age and calculating
indices such as height-for-age Z-score and BMI-for-age Z-score
2. Haemoglobin, assessed using a Hemocue
3. School absence, assessed by the number of school days missed between the baseline and the
end of the study
4. Educational outcomes, including final language and maths grades
Overall study start date01/09/2013
Completion date01/12/2017

Eligibility

Participant type(s)Other
Age groupChild
Lower age limit6 Years
SexBoth
Target number of participantsBetween 1200-1500 (at least 300 children in each school)
Total final enrolment1362
Key inclusion criteria1. Child aged over 6 years
2. Registered student in one of four specified UNRWA schools
Key exclusion criteriaNone - children were asked to declare any food allergies they might have
Date of first enrolment04/06/2014
Date of final enrolment31/05/2016

Locations

Countries of recruitment

  • Lebanon

Study participating centre

Center for Research on Population and Health
Faculty of Health Sciences
American University of Beirut
Bliss Street
Hamra
Beirut
1107 2020
Lebanon

Sponsor information

The Nestle Foundation for the Study of Problems of Nutrition in the World
Research organisation

Place de la Gare 4 - PO Box 581
Lausanne
CH-1001
Switzerland

Website http://www.nestlefoundation.org/e/about.html
ROR logo "ROR" https://ror.org/021k07d19

Funders

Funder type

Research organisation

The Nestle Foundation for the Study of Problems of Nutrition in the World

No information available

Results and Publications

Intention to publish date01/01/2019
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot expected to be made available
Publication and dissemination planData and results of the study have been presented at four conferences; some resulting in
published abstracts.
We have prepared the following for publication:
1. Presenting the protocol and process evaluation of the intervention
2. Presenting the outcomes of the Healthy Children (children's component) of the study
3. Using data from the study, we validated a child food security tool
IPD sharing planThe datasets generated during and/or analysed during the current study are not expected to be made available due to the fact that studies were conducted with vulnerable refugee populations, and data transfer agreements with the collaborating organisations restrict our ability to share these data with third parties.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Abstract results results presented at 21st International Congress of Nutrition 01/01/2017 No No
Abstract results results presented at Experimental Biology, Chicago, 01/04/2017 No No
Other publications Process evaluation 22/11/2019 25/04/2022 Yes No
Results article 24/11/2020 25/04/2022 Yes No

Editorial Notes

02/11/2018: Internal review.