COVID-19-Induced Disruptions of School Feeding Services Exacerbate Food Insecurity in Nigeria

Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review

Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.

Pivoting school health and nutrition programmes during COVID-19 in low- and middle-income countries: A scoping review

Background

Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions.

Methods

We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible.

Results

We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition.

Conclusions

We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.

Effects of COVID-19 Pandemic on Nutritional Status, Feeding Practices, and Access to Food Among Infants and Children in Lower and Middle-Income Countries: a Narrative Review

Purpose of Review

The COVID-19 pandemic has affected children across the planet and the consequences on their health, nutritional status, and social structure have been more pronounced in low- and middle-income countries (LMICs). This review will focus on the effects of the COVID-19 pandemic on infant growth and feeding practices and access to food and obesity prevalence among children in LMICs. An electronic search was performed on MEDLINE and Embase to identify relevant articles in the English language.

Recent Findings

A higher prevalence of infections by the SARS-CoV-2 virus and a lower mortality rate were found in children in LMICs compared to western countries. In 2020, 22% and 52% of the wasting and deaths in children under 5 years of age in LMICS came from the sub-Saharan Africa region, respectively. Despite the decrease in stunting from 40% in 1990 to 24.2% in 2019, the prevalence remains above 30% in LMICs. Regarding breastfeeding practices in LMICs, many organizations recommend breastfeeding for infants and children born to infected mothers with SARS-CoV-2. This pandemic has resulted in higher food insecurity and disruption to access to health care and nutrition-related programs from schools; this situation has been more detrimental for younger children from LMICs.

Summary

Given the devastating effects of the COVID-19 pandemic on the nutritional status, higher food insecurity, and lack of access to health care for infants and children in LMICs, efforts from government, world organizations, and non-for-profit institutions should be implemented to ameliorate the effects of this pandemic.

COVID-19 in rural Africa: Food access disruptions, food insecurity and coping strategies in Kenya, Namibia, and Tanzania

This study assesses the extent of COVID-19-related food insecurity in Kenya, Tanzania, and Namibia. Using the Household Food Insecurity Access Scale, we measure food insecurity in various dimensions and document several food access disruptions associated with the COVID-19 pandemic between April and July 2020. Furthermore, we assess the association of COVID-19 countermeasures with the adoption of various strategies in line with the coping strategies index. We rely on a unique phone survey that followed households who participated in an earlier field-based survey. First, through Ordinary Least-Squares and Probit regressions, we show a strong and statistically significant association between COVID-19 countermeasures and food access disruptions and food insecurity in each of the three countries. We then use a multivariate probit regression model to understand the use of the various coping strategies, including reducing food intake, increasing food search, and relying more on less nutritious foods. We provide evidence on the complementarities and trade-offs in using these coping strategies. COVID-19 and related lockdown measures coincided with a deleterious increase in food insecurity in rural Africa.

N. Rodrigues EL, Etuge P, Warner Y, Kessler H, Mitchell A. School Meal Programs in Africa: Regional Results From the 2019 Global Survey of School Meal Programs

Introduction

School meal programs operate throughout Africa, serving as a social safety net and aiming to improve children's nutrition, influence their dietary choices, and strengthen the agrifood economy through local procurement. Despite their rapid expansion in the past decade, there has been no systematic effort to comprehensively document school feeding activities across the continent.

Methods

Detailed information on school feeding activities in each country was captured in the Global Survey of School Meal Programs©, which launched in 2019. An invitation to participate was extended to each government, which appointed a national-level respondent to gather information on every large-scale school meal program in the country.

Results

Forty-one countries in Africa (38 in sub-Saharan Africa) responded to the survey in 2019 with information on 68 large-scale programs that together reached 60.1 million children. Across these countries, the aggregate school feeding budget was USD 1.3 billion. Diversity in school meal programs is evident across regions, country income levels, and levels of national commitment. Coverage rates tended to be highest in southern Africa, in countries with school feeding as a line item in the national budget, and in countries with the greatest domestic share of the school feeding budget. Diversity in the school menu tended to be greatest in programs that sourced food through domestic purchase rather than relying on foreign in-kind donations. To address micronutrient malnutrition, about two-thirds of the programs served fortified foods, and one-quarter included micronutrient supplements. Even as rates of overweight/obesity are rising among African school children, just 10% of school meal programs identified its prevention as an objective.

Conclusion

The extent to which school meal programs in Africa are supported with domestic funding reflects a dramatic shift in favor of national ownership and domestic food procurement. At the same time, programs have grappled with inadequate and unpredictable budgets and challenges related to supply chains and logistics—impediments that need to be addressed if these programs are to achieve their objectives. Overall, the survey results underscore the important position of school meal programs within African food systems and their potential (if well-designed) to sustainably improve food security, child health, and nutrition.

Food Insecurity among Adolescent Students from 95 Countries Is Associated with Diet, Behavior, and Health, and Associations Differ by Student Age and Sex

Background

Adolescents' developmental tasks and challenges vary based on age, sex, and social context. Food insecurity affects adolescents, but existing research has been limited to a few country contexts and has treated adolescence as a singular developmental moment with limited consideration of potential differences in how food insecurity relates to developmental experiences based on adolescent age and sex.

Objectives

We aimed to describe relations between student-reported food insecurity and students' profiles of nutritional, physical activity, school absenteeism, health/mental health, and victimization experiences, and how these differ by student age and sex.

Methods

Using cross-sectional data from the Global School-based Student Health Survey, we examined adolescent reports of their food security among 337,738 students 11-18 y old from 95 countries. We identified their profiles of focal experiences, and used mixed-effects linear and logistic regression models to examine differences in these profiles by student food insecurity and how these differ by student age and sex.

Results

Of students, 25.5% aged 11-14 y compared with 30% aged 15-18 y reported food insecurity in the past 30 d. Food insecurity was associated with less frequent fruit and vegetable intake; more frequent soft drink intake; worse mental health; less physical activity; more missed school; higher odds of smoking, drinking, and using drugs; and more bullying victimization and sexual partners. Food insecurity was associated with reduced age- and sex-specific protection: greater substance use among younger adolescents, more sexual partners among older females, and greater worry among younger males. Food insecurity was also associated with increased age-specific risk: greater soft drink consumption among younger adolescents.

Conclusions

Across countries, adolescent food insecurity was associated with poorer nutritional, mental health, behavioral, and relationship profiles; these associations differed with student age and sex. Food insecurity interventions should attend to adolescent developmental stage and the gendered contexts through which adolescents navigate daily life.

Lessons Learned for Emergency Feeding During Modifications to 11 School Feeding Programs in Latin America and the Caribbean During the COVID-19 Pandemic

BACKGROUND

School feeding programs (SFPs) can play a crucial role in the emergency food and nutrition response, but there is a dearth of information on how SFPs operate during emergencies.

DESIGN AND METHODS

A rapid comparative assessment of 11 SFPs throughout Latin America and the Caribbean during the COVID-19 pandemic. Data from (1) systematic document search and (2) surveys with key informants (n = 23) about barriers/facilitators to modifications were systematically analyzed using a multiple case study approach.

RESULTS

During the pandemic, all SFPs continued (although continuation plans varied from a few days in Chile to >1 month in Puerto Rico) via food kits, food vouchers, and/or grab n' go meals. The SFP implementation was highly dependent on the programs' autonomy and financial support, which impacted their logistics to acquire and distribute foods during the pandemic. The types of foods offered in some SFPs suggest that established nutritional guidelines were not always followed. Key informants expressed concerns about the deterioration of the nutritional quality of foods offered during the pandemic and lack of community engagement that impeded distribution to the neediest.

CONCLUSIONS

Results underscore the urgency for clear implementation guidance on how to modify SFP during emergencies. Public health implications include (1) allocation of autonomous resources to an intersectoral working group to safeguard nutritional benefits during emergencies, (2) strengthening efforts of SFP community engagement before and during emergencies, and (3) establishing guidelines of the types of foods that can be distributed to meet the nutritional needs of beneficiaries during emergencies.

Viewpoint: High-frequency phone surveys on COVID-19: Good practices, open questions

Following the onset of the COVID-19 pandemic, face-to-face survey data collection efforts came to a halt due to lockdowns, limitations on mobility and social distancing requirements. What followed was a surge in phone surveys to fulfill rapidly evolving needs for timely and policy-relevant microdata for understanding the socioeconomic impacts of and responses to the pandemic. Even as the face-to-face survey data collection efforts are resuming in different parts of the world with COVID-19 safety protocols, the rapidly-acquired experience with phone surveys on the part of national statistical offices and survey practitioners in low- and middle-income countries appears to have formed the foundation for phone surveys to be more commonly implemented in the post-pandemic era, in response to other shocks and as complementary efforts to face-to-face surveys. Informed by the practical experience with the high-frequency phone surveys that have been implemented with support from the World Bank Living Standards Measurement Study (LSMS) to monitor the socioeconomic impacts of the COVID-19 pandemic, this paper provides an overview of options for the design and implementation of phone surveys to collect representative data from households and individuals. Further, the discussion identifies the requirements for phone surveys to be a mainstay in the toolkits of national statistical offices and the directions for future research on the design and implementation of phone surveys.

Home food insecurity during the suspension of classes in Brazilian public schools due to the COVID-19 pandemic

Objectives

We sought to evaluate the effect of socioeconomic conditions and variables related to the COVID-19 pandemic on the food insecurity of students during suspension of classes in public schools.

Methods

This was a telephone survey (n = 612) of adults responsible for purchasing food through representative samples of students in two Brazilian municipalities in June and July 2020. The outcome was food insecurity, assessed using the Brazilian Food Insecurity Scale. Multivariate logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (CIs) for sociodemographic and pandemic-related factors of COVID-19.

Results

The total prevalence of food insecurity in households was 82%, with 65.7% mild food insecurity, 11.3% moderate, and 5.0% severe. After adjustment for confounding factors, households with the highest number of children (OR = 2.17; 95% CI, 1.10–4.27) and households that received local-government basic food baskets (OR = 1.64; 95% CI, 1.04–2.58) were significantly associated with food insecurity. Furthermore, households that did not experience a decrease in income during the pandemic were inversely associated with food insecurity (OR, 0.17; 95% CI, 0.09–0.32).

Conclusions

The prevalence of food insecurity was high, and policies for the distribution of food baskets may not be sufficient to guarantee food security for the most vulnerable families with a greater number of children. Considering the possible worsening of food insecurity during the COVID-19 pandemic, the National School Feeding Program has the potential to play a strategic role in promoting food security for students.