Community-based nutrition-sensitive approach to address short-term hunger and undernutrition among primary school children in rural areas in a developing country setting: lessons from North and North-Eastern Uganda

Background: Undernutrition in childhood is an important factor that greatly impedes the achievement of full human potential at adulthood. Despite increased enrolment of pupils in primary schools in developing countries, short-term hunger and undernutrition continue to impact negatively on school attendance, retention and education outcomes in economically disadvantaged rural areas. This study examined the feasibility of a community-based participatory action research approach building capacity of rural women food vendors to use local food resources to produce nutritionally enhanced food products for primary school feeding in rural localities in a developing country setting. Methods: Mixed methods approach incorporating focus group discussions (FGDs) to evaluate parents’ and school administrators’ perceptions of the community-based approach, participatory experimental improvement of nutritional quality of an energy-based cassava product (gari) involving community women food vendors, and cross-sectional acceptability assessment of improved products among rural primary school children. Qualitative content analysis, one-way analysis of variance and correlation analysis was used to analyse FGD data, compare nutritional profile and consumer sensory profile of different products, and examine associations between sensory attributes and acceptability of the products, respectively. Results: The approach of using local food resources to produce nutritious products targeting school feeding was strongly recognised by parents, school administrators, teachers and small scale rural women food vendors as an adoptable nutritionsensitive means of addressing short-term hunger among primary school children in rural settings. The action research resulted in a highly accepted nutritionally enhanced product (consisting of cassava, soy and silver fish) exhibiting superior nutritional properties (23.29% protein, 90.5 g/100 g calcium, 4.5 g/100 g zinc, 11.6 g/100 g iron, 40.40 g/100 g phosphorus, 61.57 μg/100 g vitamin A) compared to the original energy-dominated cassava product (2.18% Protein, 55.6 g/100 g calcium, 1.2 g/100 g zinc, 4.4 g/100 g iron, 6.6 g/100 g phosphorus, 11.23 μg/100 g vitamin A) (p < 0.05). Nutritional computation revealed that serving 120 g of the new product would suffice to meet 30% of the recommended dietary allowance for essential nutrients that children should receive from school meals. Conclusion: Community-level nutrition-sensitive innovation using local foods resources offers the opportunity for rural women food vendors to contribute to addressing short-term hunger and undernutrition challenges in primary schools in economically-disadvantaged localities in developing countries.