945241

research-article2020
PED0010.1177/1757975920945241Original ArticleJ. Antwi et al.

Original Article

Primary school-based nutrition education intervention

on nutrition knowledge, attitude and practices among
school-age children in Ghana
Janet Antwi1 , Agartha Ohemeng2, Laurene Boateng3,
Esi Quaidoo2 and Boateng Bannerman4

Abstract: This study was performed to evaluate the effect of a six-week nutrition education
intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age
children (aged 6–12 years) in basic schools in Ghana. Short-term effects of nutrition education training
sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate
the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs.
5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of
children in the intervention group strongly agreed they enjoyed learning about food and nutrition
issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference
in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices
(3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed
among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition
knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031)
and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could
have positive impacts on knowledge and attitudes of school children, and may be crucial in the
development of healthy behaviors for improved nutrition status.

Keywords: Nutrition education, nutrition knowledge, attitude and practices (KAP), nutrition status,
school-age children, Ghana, sub-Saharan Africa, dietary diversity score, school-based

Introduction (KAP) to make wise dietary and lifestyle choices

which may lead to optimum nutrition statuses (2).
Childhood malnutrition remains a challenge and Several studies that have applied nutrition education
a major public health concern in sub-Saharan Africa interventions have reported positive impacts on the
(1). Nutrition education is now recognized as an nutrition knowledge of school-age children (SAC)
essential catalyst for nutrition impact, and is and their ability to differentiate adequate nutrition
demonstrably capable of improving dietary behaviors from inadequate (3,4). Some studies
behavior and nutrition status on its own. It provides noted an increase in regular consumption of dairy
the nutrition knowledge, attitude and practices products, vegetables and fruits (5–9) and Lee et al.

1. Department of Agriculture, Nutrition and Human Ecology, Prairie View A&M University, USA.
2. Department of Nutrition and Food Science, University of Ghana.
3. Department of Nutrition and Dietetics, University of Ghana.
4. Nutrition Linkages Project, University of Ghana.

Correspondence to: Janet Antwi, Department of Agriculture, Nutrition and Human Ecology, Prairie View A&M
University, 100 University Drive, Prairie View, TX 77446, USA. Email: [email protected]

(This manuscript was submitted on 23 December 2019. Following blind peer review, it was accepted for publication on
19 June 2020)
Global Health Promotion 1757-9759; Vol 27(4): 114­–122; 945241 Copyright © The Author(s) 2020, Reprints and permissions:
http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975920945241 journals.sagepub.com/home/ghp
https://doi.org/10.
1177/1757975920945241
https://doi.org/
 J. Antwi et al. 115

(10) observed improved nutrition statuses from a burden of malnutrition among SAC is becoming
long-term nutrition intervention program on a increasingly important.
sample of SAC. A more recent study conducted The purpose of this study was to determine the
among SAC girls in Egypt found that nutrition impact of a nutrition education intervention on
education significantly improved positive dietary nutrition KAP and nutrition status of SAC in Ghana.
habits such as eating breakfast regularly and It was hypothesized that nutrition education
snacking on fruits and vegetables (11). While SAC intervention would have a positive effect on nutrition
are at a critical age for forming good dietary habits KAP and nutrition status in the intervention groups
and are an appropriate target for effective nutrition compared to control groups.
education interventions, there is limited information
among this age group in Ghana. Most studies have
Methods
focused on caregiver nutrition knowledge and the
resulting nutrition impact on very young children Study design and area
(12,13).
Current sustainable development goals (SDG) This intervention study employed a pre-post
along with previous millennium development goals controlled design to assess the effect of nutrition
(MDG) have continually focused primarily on education that is incorporated into the existing
children aged five years or under, notwithstanding a physical education (PE) lessons on nutrition KAP
crucial necessity to tackle malnutrition among all and nutrition status among SAC aged 6–12 years in
populations (14,15). Although, children aged five or two areas in Ghana. The study also used a similar
under serve as a leading surrogate for whole design to assess the short-term effect of nutrition
populations in the surveillance of countries’ education on the knowledge and perception of PE
nutrition status, it is necessary to target expansive teachers and home-based caregivers in the
age groups. Yet, there is lesser extent of nutrition intervention schools. The study was conducted from
research and interventions of these global agendas June 2018 through December 2018. The study areas
among SAC (16), despite marked effects of were Dzorwulu in the Accra Metropolitan District,
nutritional status on their cognitive function and Greater Accra Region, and Asesewa sub-district in
intelligence quotient, school achievement, and the Upper Manya Krobo district of the Eastern
health (17,18). Studies such as these highlight the Region of Ghana.
concurrence of undernutrition and overnutrition
and the need for public health efforts to be tailored Study population and sampling
to tackling the double burden of malnutrition within
similar populations (19). The study population consisted of school-going
In Ghana, countrywide data on the nutrition children aged 6–12  years in grades 1–6, their
statuses of SAC are currently scarce; however, primary home-based caregivers, and PE teachers in
Danquah et  al. (12) reported that 52.2% of SAC the study intervention schools. In each study area,
were stunted, while 46.5% were found to be two public basic schools were conveniently selected
underweight in the Ashanti region. More recently, to be included in the study after obtaining
Aryeetey et al. (20) reported overweight and obesity permission from the respective district directorates
prevalence of 17% among Ghanaian SAC of ages of the Ghana Education Service. In both areas, one
9–15 years. Over the years, there have been various school was randomly assigned to the intervention
school-based nutrition efforts such as the school group and the other to the control group. Using a
feeding program incorporated into the primary 95% confidence rate, 4% error margin, and 80%
school system in Ghana (21). Nevertheless, these power to detect a 10% significant difference (P <
efforts do not underscore the provision of nutrition 0.05) in proportion in nutrition knowledge between
knowledge and skills to the children that is integral intervention and control groups, the minimum
to the attainment, adoption and maintenance of required sample size was determined to be 86 (i.e.,
nutrition-enhancing behaviors at an early age (22– 86 in the intervention group and 86 in the control
24). Therefore, the need for nutrition education as a group). This was adjusted to 100 per school to
prevention and/or intervention to address the double account for non-responses.

IUHPE – Global Health Promotion Vol. 27, No. 4 2020

116 Original Article

•• Recruitment of school-age children and hygiene. In addition, home-based caregivers received

caregivers a one-day nutrition education training from the
research team on similar nutrition topics to implement
changes in nutrition choices at home. Each nutrition
In the intervention school in the Greater Accra topic was taught to children for two hours each week
Region, the study was explained to home-based for six weeks, in addition to the standard PE class.
caregivers (i.e., family members, mainly parents of Approaches to emphasize nutrition concepts taught
the school children) during Parent Teacher to the children included small group discussions,
Association meeting and those with children within group works, hands-on activities, workbook
the target age group who consented by signing an assignments, singing sessions, and nutrition
informed consent form were recruited (n = 101). competitions. The control group received the standard
However, in the control school, all children within PE curriculum by the Ministry of Education
the study age group were given approval letters to throughout the study period. The curriculum is
be given to the caregivers to complete and return. All mainly focused on physical fitness and is delivered
the children who returned the approved letters (n = through field-based physical activity.
104) were recruited into the study. The two schools
(one intervention group and one control group) in
the Eastern Region had less than 100 children in the Data collection procedures
target age group, therefore each child who met the
Research assistants were well trained to administer
inclusion criteria and agreed to participate was
the study tools and conduct measurements prior to
recruited into the study (n = 146).
commencement of data collection. All of the
assessment tools and procedures were pre-tested in
•• Recruitment of teachers a similar population, at a different location, before
the tools were implemented in the main study.
A total of seven teachers who teach PE in the
intervention schools were selected based on the •• Sociodemographic information
inclusion criterion that the teacher was a PE teacher
of the targeted study children. Information on age, gender, ethnicity, educational
level, current class in school, occupation, marital
Description of nutrition intervention status, income (adult participants only), religion,
residence, and household size were obtained with a
The Social Cognitive Theory framework was the validated questionnaire.
basis for the nutrition education intervention for all
participants in the intervention cohort. This theory
holds that a substantial part of an individual’s •• Nutrition knowledge, attitude and practices
knowledge acquisition is based on their social context (KAP) data
with interactions between personal characteristics,
behavioral patterns, and environmental factors (25). The knowledge questions focused on five areas:
The selected PE teachers in the two intervention food nutrient and function, food choices, nutrient
schools were given a two-day training based on the deficiency, sources of nutrients, and food and energy.
modules taught to the children. The principal However, the specific questions differed for lower
investigator interacted with and directed the teachers (grades 1–3) and upper (grades 4–6) primary school
with instructions for implementation and delivery of level children. All other parts of the questionnaire
each topic in the module, where information on used were similar for all the children. The attitude
nutrition for children was given; teaching aids and and practice questions focused on four areas: food
models were also supplied to assist in teaching. The intake, diet quality, food choices, and food and
intervention encompassed six nutrition topics health. To generate KAP scores for each participant,
including food groups, functions of food, food choices a correct answer to each question was assigned a
(breakfast and snacks), portion and serving sizes, value of one, and an incorrect answer was coded as
physical activity, and food safety and personal zero. For each participant, all scores under this
IUHPE – Global Health Promotion Vol. 27, No. 4 2020
 J. Antwi et al. 117

section were summed up and the total value was knowledge. Paired t-test was employed in determining
used to represent the KAP score for that person changes in nutrition knowledge, attitude, and dietary
(school child, home-based caregiver, teacher). For diversity pre- and post-intervention. The mean
the teachers and home-based caregivers, data was differences in study variables at pre- and post-
collected before and soon after (a few hours for intervention were compared between intervention
caregivers, and at the end of the second training day and control groups using independent t-test and chi-
for teachers). For the children, the post-intervention square statistics. All data analyses were performed
data collection occurred after six weeks of nutrition using SPSS version 20.0 and P-value of < 0.05 was
education intervention. considered statistically significant.

•• Dietary intake and food frequency Results

Sociodemographic characteristics of school
The dietary intake data was gathered using
children and their caregivers
single 24-hour recall and food frequency methods.
Each child was asked to list and describe all foods There were 351 school children included in the
and beverages consumed at school and at home in study, out of which 325 completed the post-
the past 24 hours, indicating the time and source intervention survey. With the exception of ethnicity
of the food. Visual household measures and food (P = 0.04), all other baseline variables were similar
models were used to help children estimate the between intervention and control groups. The
amounts of foods and beverages consumed. The overall mean age (± standard deviation) of the
24-hour recall information was used to calculate children was 9.6 ± 1.8 years, with about 70% of
dietary diversity scores as a measure of nutrition them between the ages of 9 and 12 years. About half
practice using the Food and Agriculture (49.3%) of the study participants belonged to the
Organization guidelines (26). Ga/Ga-Adangme tribe (Table 1). A total of 121
caregivers participated in this study, out of which
•• Anthropometric data 99 also provided post-nutrition education data. The
mean age of the caregivers was 38.5 ± 10.8 years.
Standing height was measured to the nearest On the average, every household consisted of three
0.1 cm, without shoes, using a calibrated stadiometer adults and three children below the age of 18. The
and while wearing light clothes and without shoes, majority of the caregivers who participated in the
an electronic weighing scale was used to take study were women (73.6%) and were the parents
weights to the nearest 0.1 kg. Each measurement (81.8%) of the study children (Supplemental
was taken in duplicates and the average values were Table 1).
used for calculations of z-scores using the WHO
AnthroPlus software. Stunting, underweight and Nutrition knowledge, attitude and practices
wasting were defined in this study as height-for-age
Z scores (HAZ), weight-for-age Z scores (WAZ) and At baseline, nutrition knowledge scores of school
weight-for-height Z scores (WHZ) ⩽ −2SD, children were similar for the intervention and
respectively and BMI-for-age Z scores (BAZ) ⩾ 2SD control groups. The six-week nutrition education
and ⩾ 3SD as overweight and obesity, respectively. intervention significantly improved the nutrition
knowledge of children in both the lower and upper
Statistical analysis primary levels in the intervention group (Table 2). In
addition, children in the intervention group had
The primary outcome of this study was nutrition higher scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001)
KAP scores, with nutrition status as the secondary compared to the controls in the lower primary level,
outcome. The maximum possible score for the and there was a tendency for the intervention
nutrition knowledge assessment was 20; below the children to have higher scores at the upper primary
mean score was deemed low nutrition knowledge level (9.3 ± 3.0 vs. 8.5  ± 3.0, P = 0.09) when
and above the mean score was deemed high nutrition compared to their control colleagues.

IUHPE – Global Health Promotion Vol. 27, No. 4 2020

118 Original Article

Table 1.  Demographic characteristics of study school children.

Variables Intervention Control Total P-value

n (%) n (%) n (%)

Gender 0.18
 Male 83 (47.20) 95 (54.30) 178 (50.70)  
 Female 93 (52.80) 80 (45.70) 173 (49.30)  
Mean age n (mean ± SD) 176 (9.50 ± 1.85) 175 (9.70 ± 1.74) 351 (9.60 ± 1.80) 0.29
Age categories 0.58
  6–8 years 55 (31.30) 50 (28.60) 105 (29.90)  
  9–12 years 121 (68.80) 125 (71.40) 246 (70.10)  
Ethnicity 0.04
 Ga/Ga-Adangme 89 (50.60) 84 (48.00) 173 (49.30)  
 Ewe 36 (20.50) 31 (17.70) 67 (19.1)  
 Akan 27 (29.10) 31 (17.70) 58 (16.50)  
 Northern 24 (13.60) 20 (11.40) 44 (12.50)  
 Other 0 (0.00) 9 (5.10) 9 (2.60)  
Area of residence 0.21
  Within school community 99 (56.30) 110 (62.90) 209 (59.50)  
  Outside school community 77 (43.80) 65 (37.10) 142 (40.50)  

Data were expressed as mean ± standard deviation (SD) or frequency (%). P-value is significant at < 0.05. Pearson chi-
square for categorical variables and independent t-test for continuous variables.

Table 2.  Nutrition knowledge of study children before and after intervention.

Grades 1–3 (lower class) Grades 4–6 (upper class)

  Intervention Control P-value1 Intervention Control P-value1

Pre-intervention 6.8 ± 2.1 6.4 ± 2.2 0.19 8.2 ± 2.5 8.6 ± 3.0 0.35

Post-intervention 8.8 ± 2.0 5.9 ± 2.1 < 0.0001 9.3 ± 3.0 8.5 ± 3.0 0.09
P-value2 < 0.0001 0.04 0.007 0.69  

Data were expressed as mean ± standard deviation. P-value is significant at < 0.05.

1Comparison of intervention and control groups using independent t-test.
2Comparison of pre- and post-intervention time points using paired t-test.

Teachers’ nutrition knowledge, perception and learning about food and nutrition issues at baseline;
self-efficacy improved at the end of the training the reverse was reported at endline. Thus, a higher
session. The mean score of nutrition knowledge at proportion of children in the intervention group
the end of the training was significantly higher said that they enjoyed learning about food and
(12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.03) than the mean nutrition issues (88% vs. 77%, P = 0.03). On the
score before they received the training. other hand, a significantly higher proportion of
Overall, the nutrition knowledge of caregivers of children in the control group believed that eating
children in the intervention schools improved after healthy foods was only important during illness,
the intervention (mean score: 5.86  ± 0.73 to compared to the intervention group (81% vs. 68%,
6.24 ± 1.02, P = 0.009). P = 0.02).
For nutrition attitudes, a higher proportion of Contrary to expectation, the dietary diversity
children in the control group said that they enjoyed score (measure of nutrition practice) of the

IUHPE – Global Health Promotion Vol. 27, No. 4 2020

 J. Antwi et al. 119

Table 3.  Dietary diversity score for study children practice using dietary diversity score (Table 3), in
before and after intervention. intervention compared to control groups. The
improvement in nutrition knowledge and positive
Intervention Control P-value1
attitude is similar to findings in other studies which
Pre-intervention 5.6 ± 2.1 4.7 ± 1.6 < 0.0001 showed that nutrition knowledge and attitude is
DD crucial in the development of healthy behaviors and
Post-intervention 4.8 ± 2.0 5.1 ± 1.4 0.18 increased self-efficacy (23,27–29).
DD Caregivers’—particularly mothers’—knowledge
P-value2 < 0.0001 0.01   and attitudes of serving foods may impact children’s
attitude regarding practices (30–33). Although
DD refers to dietary diversity score based on FAO
teachers improved their nutrition knowledge, our
guidelines of 13 food groups. Data were expressed as
mean ± standard deviation. P-value is significant at < study did not focus on changes in the physical food
0.05. environment at home or school in terms of food sold
1Comparison of intervention and control groups using by food vendors to children (34,35). Social Cognitive
independent t-test. Theory (SCT) includes reciprocal determinism as a
2Comparison of mean scores calculated using FAO guide-
relevant process among people’s characteristics,
lines (pre- vs. post-intervention time points using paired their behaviors, and their environments to promote
t-test.
behavior change. Core constructs of SCT for
individual outcome in knowledge acquisition for
intervention group decreased over the study period, making changes are influenced by behavioral
while that of the control group increased. Both of determinants that may be facilitators or barriers in
these changes were statistically significant within achieving positive health behaviors (25). Consistent
groups but not between groups (Table 3). with SCT theories, we trained and included teachers
and home-based caregivers to facilitate engagement
Nutrition status with children. Teachers provided the information
needed for knowledge acquisition and served as role
There were no differences between the two study models, while caregivers reinforced the knowledge
groups in terms of any of the anthropometric acquired from school at home. However, the
indicators that were assessed. Although there was a unchanged school and home food environments
tendency for the intervention group to have a lower may have acted as a barrier to achievement of
proportion of stunted children compared to the positive behavior practice. Befort et al. (36) reported
control group (3.6% vs. 8.2%, P = 0.08), six weeks that availability and accessibility to healthy foods is
is a narrow period to use to establish a significant an important factor in promoting positive nutritional
HAZ effect post-intervention (Supplemental Table 2). behavior. Moreover, a sufficient implementation
period of about 10–15 hours’ nutrition education
intervention was required to achieve considerable
Discussion
effect in children’s nutrition knowledge and attitude,
The findings of our study showed that the and a minimum of 50 hours to produce behavioral
nutrition education intervention produced changes (37,38). Thus, the decrease in practice using
statistically significant improvements in nutrition dietary diversity score observed in our study may be
knowledge scores particularly among lower primary attributed to a combination of insufficient period of
school children in the intervention group as implementation and inadequate changes in the food
compared to the control group at the end of six environment.
weeks. It could be that the lower primary school Although stunting was the most prevalent
children were more responsive, hence this nutritional deficit, there were no statistically
observation. Moreover, there were positive effects significant changes in nutrition status—the secondary
observed within the intervention group of the upper outcome of this study—between intervention and
primary class with the pre- and post-measurements control groups. The lack of improvement in nutrition
(Table 2). We also observed positive changes in practices may have contributed to this observation.
attitude, but a not statistically significant decrease in Children’s good nutrition practices and dietary intake

IUHPE – Global Health Promotion Vol. 27, No. 4 2020

120 Original Article

provide the energy and nutrients essential for growth and home food environments may be crucial. The
and development and have direct positive effects on findings may be valuable to policy makers in the
their weight and/or height, and overall health (39). In education sector because they revealed that nutrition
addition, the duration of the nutrition education education incorporation into the primary school
intervention may have been inadequate to allow mainstream curriculum is feasible, and provide the
drastic changes in the weight and height of school strategies to achieve it.
children. Most nutrition education intervention
studies that showed improvement in nutrition Acknowledgements
knowledge, dietary attitudes and habits with We are indebted to our research assistants Patience Anku,
subsequent significant changes in wasting, stunting, Obed Harrison, Elizabeth Duah, Gloria Osei Owusu,
or underweight status were conducted for a relatively Norincia Osei-Boateng, Deborah Amoah, Nancy Okai,
longer period compared to this current study Peace Mensah, Mary, Abigail, Francis and Michael of
University of Ghana for their untiring support during data
(34,39,40). Archibald, Graber and Brooks-Gunn (41)
collection. We cherish the school principals, primary
documented that during early childhood, the body school teachers, school children, caregivers and school
grows at an alarming rate; however, the rate slows cooks/vendors of the four primary schools that participated
down for young children between ages 5 and 11 years for the immense contribution and support during the
and may occur in spurts throughout childhood, implementation of the study.
adolescence, and puberty (41–44). Our sample of
primary school children was made up of more than Declaration of conflicting interests
80% between the ages of 5 and 11 years. The author(s) declared no potential conflicts of interest
An important strength of our study is the inclusion with respect to the research, authorship, and/or publication
of this article.
of home-based caregivers and teachers. Our study
also contributes to the limited data available on the
Funding
nutrition KAP and nutritional status of SAC in
Ghana. There were some potential limitations that The author(s) disclosed receipt of the following financial
support for the research, authorship, and/or publication of
may have influenced the findings of our study. A this article. This work was supported with funding from
methodological weakness of our study is not using the Institute of International Education (IIE) through the
the same sample recruitment techniques at all the Carnegie African Diaspora Fellowship Program (CADFP)
schools. This was due to one school’s inability to to JA and AO to undertake this research. The IIE or CADFP
had no influence in the design, data collection, analysis or
organize a PTA meeting within the study period, and
writing up of the study.
unequal number of school children at two schools.
The use of the self-reported 24-hour dietary recalls
Research ethics approval
and food frequency may result in either over- or
underestimation of actual dietary intakes. Due to The study was conducted in accordance with the
Declaration of Helsinki (1964) and was approved by the
time, financial and human resource constraints, the College of Basic and Applied Sciences, University of Ghana
nutrition education was conducted for only one day Institutional Review Board (IRB, {study # ECBAS 029/17-
for the caregivers and could not be extended to the 18}) and State University of New York at Oneonta IRB
entire school term for the primary school children, and (study # 529).
did not take place for the school cooks/food vendors.
ORCID iD
Janet Antwi https://orcid.org/0000-0002-8270-7717
Conclusion
Supplemental material
The findings of this study have further reinforced
Supplemental material for this article is available online.
the school as an important learning environment to
incorporate nutrition education for passing on
References
nutrition knowledge and attitudes to primary school
children which are essential to managing
1. undp.org [Internet]. Rome: United Nations
Development Programme; 2012 [cited 2017 Jul 21].
undernutrition and childhood obesity. Involving
Available from: https://www.undp.org/content/dam/
teachers and caregivers to enhance knowledge, in rba/docs/Working%20Papers/Nutrition%20
addition to improving dietary choices in the school Challenge.pdf
IUHPE – Global Health Promotion Vol. 27, No. 4 2020
 J. Antwi et al. 121

2. Contento I, Balch GI, Bronner YL, Lytle LA, Maloney 2016–2019 [cited 2017 Jul 21]. Available from:
SK. The effectiveness of nutrition education and https://sustainabledevelopment.un.org/sdg2
implications for nutrition education policy, programs 16. Prendergast AJ. Malnutrition and vaccination in
and research: a review of research. J Nutr Educ. developing countries. Philos Trans R Soc Lond B Biol
1995; 127: 277–418. Sci. 2015; 370: 20140141.
3. Ruzita AT, Mab WA, Ismail MN. The effectiveness of 17. Mukudi E. Nutrition status, education participation,
nutrition education programme for primary school and school achievement among Kenyan middle-
children. Malays J Nutr. 2007; 13: 45–54. school children. Nutrition. 2003; 19: 612–616.
4. Qian L, Newman IM, Yuen LW, Du W, Shell DF. 18. Ghazi HF, Isa ZM, Aljunid S, Mohd AT, Abdalqader
Effects of a comprehensive nutrition education M. Nutritional status, nutritional habit and breakfast
programme to change grade 4 primary-school intake in relation to IQ among primary school
students’ eating behaviours in China. Public Health children in Baghdad city, Iraq. Pak J Nutr. 2012; 11:
Nutr. 2019; 22: 903–911. 379–382.
5. Blanchette L, Brug J. Determinants of fruit and 19. Shrimpton R, Rokx C. The Double Burden of
vegetable consumption among 6–12-year-old Malnutrition: A Review of Global Evidence. Health,
children and effective interventions to increase Nutrition and Population Discussion Paper.
consumption. J Hum Nutr Diet. 2005; 18: 431–443. Washington: The World Bank; 2012 [cited 2020 Jun
6. Morgan PJ, Warren JM, Lubans DR, Saunders KL, 1]. Available from: https://openknowledge.worldbank.
Quick GI. The impact of nutrition education with org/handle/10986/27417
and without a school garden on knowledge, vegetable 20. Aryeetey R, Lartey A, Marquis GS, Nti H, Colecraft
intake and preferences and quality of school life E, Brown P. Prevalence and predictors of overweight
among primary-school students. Public Health Nutr. and obesity among school-aged children in urban
2010; 13: 1931–1940. Ghana. BMC Obes. 2017; 4: 38–49.
7. Powers AR, Struempler BJ, Guarino A, Palmer SM. 21. Buhl A. Meeting Nutritional Needs Through School
Effect of a nutrition education program on the dietary Feeding: a Snapshot of Four African Nations
behavior and nutrition knowledge of second grade [Internet]. Washington: Global Child Nutrition
and third grade students. J Sch Health. 2005; 75: Foundation; 2015 [cited 2017 Jul 30]. Available
129–133. from: http://citeseerx.ist.psu.edu/viewdoc/download?
8. Ransley JK, Taylor EF, Radwan Y, Kitchen MS, doi=10.1.1.656.9697&rep=rep1&type=pdf
Greenwood DC. Does nutrition education in primary 22. Lakshman RR, Sharp SJ, Ong KK, Forouhi NG. A
schools make a difference to children’s fruit and novel school-based intervention to improve nutrition
vegetable consumption? Public Health Nutr. 2010; knowledge in children: cluster randomised controlled
13: 1898–1904. trial. BMC Public Health. 2010; 10: 123–132.
9. Somerset S, Markwell K. Impact of a school-based 23. Shariff ZM, Bukhari SS, Othman N, Hashim N, Ismai
food garden on attitudes and identification skills M. Nutrition education intervention improves
regarding vegetables and fruit: a 12-month intervention nutrition knowledge, attitude and practices of
trial. Public Health Nutr. 2009; 12: 214–221. primary school children: a pilot study. Int Electron J
10. Lee JW, Lee HS, Chang N, Kim JM. The relationship Health Educ. 2008; 11: 119–132.
between nutrition knowledge scores and dietary 24. Vardanjani AE, Reisi M, Javadzade H, Pour ZG. The
behaviors, dietary intakes and anthropometric effect of nutrition education on knowledge, attitude,
parameters among primary school children and performance about junk food consumption
participating in a nutrition education program. among students of female primary schools. J Educ
Korean J Nutr. 2009; 42: 338–349. Health Promot. 2015; 4: 53–62.
11. Salem GM, Said RM. Effect of health belief model 25. Contento IR, Basch C, Shea S, Gutin B, Zybert P.
based nutrition education on dietary habits of Relationship of mothers’ food choice criteria to food
secondary school adolescent girls in Sharkia intake of preschool children: identification of family
governorate. EJCM. 2018; 36: 35–47. subgroups. Health Educ Q. 1993; 20: 243–259.
12. Danquah A, Amoah A, Steiner-Asiedu M, Opare- 26. Food and Agriculture Organization [Internet].
obisaw C. Nutritional status of participating and Nutrition and Consumer Protection Division; [About
non-participating pupils in the Ghana school feeding 60 Screens]. Rome: The United Nations; 2010–2013
programme. J Food Res. 2012; 1: 263–271. [cited 2017 Jul 25]. Available from: http://www.fao.
13. Lartey A. Maternal and child nutrition in Sub- org/3/a-i1983e.pdf
Saharan Africa: challenges and intervention. Proc 27. Addo P, Adua E, Harrison OA, Baah RO, Anderson
Nutr Soc. 2008; 67: 105–108. AK, Steiner-Aseidu M. School-based nutrition
14. un.org [Internet]. New York: United Nations education intervention improves nutrition knowledge
Millennium Development Goal 1—Eradicate Extreme and lipid profile among overweight/obese children.
Poverty and Hunger; 2015 [cited 2017 Jun 19]. Glob J Health Sci. 2017; 9: 109–117.
Available from: http://www.un.org/millenniumgoals/ 28. Hu C, Ye D, Li Y, Huang Y, Li L, Gao Y. Evaluation of
poverty.shtml a kindergarten-based nutrition education intervention
15. United Nations [Internet]. Sustainable Development for pre-school children in China. Public Health Nutr.
Goals; [1 Screen]. New York: The United Nations; 2010; 13: 253–260.

IUHPE – Global Health Promotion Vol. 27, No. 4 2020

122 Original Article

29. Cown MH, Grossman BM, Giraudo SQ. Nutrition 38. Contento IR, Balch GI, Bronner YL, Lytle LA,

education intervention to improve nutrition-related Maloney SK. Nutrition education for school-
knowledge, attitudes, and behaviors for Hispanic aged children. J Nutr Educ Behav. 1995; 27: 298–
children. Ecol Food Nutr. 2017; 56: 493–513. 311.
30. Ali S, Chaudry T, Naqvi QU. Effect of maternal 39. Awuuh V, Appiah C, Mensah F. Impact of nutrition
literacy on child health: myth or reality. Pak Inst Med education intervention on nutritional status of under­
Sci. 2011; 7: 100–113. nourished children (6–24 months) in East Mamprusi
31. Williams L, Campbell K, Abbott G, Crawford D. Is district of Ghana. Nutr & Food Sci. 2019; 49: 262–
maternal nutrition knowledge more strongly associated 272.
with the diets of mothers or their school-aged children? 40. Khan AZ, Rafique G, Qureshi HA, Badruddin SH.
Public Health Nutr. 2012; 15: 1396–1401. Nutrition education intervention to combat under­
32. Nti CA, Lartey A. Effect of caregiver feeding nutrition: experience from a developing country.
behaviours on child nutritional status in rural Ghana. ISRN Nutr. 2013; 2013: 234–241.
Int J Consum Stud. 2007; 31: 303–309. 41. Archibald AB, Graber JA, Brooks-Gunn J. Pubertal
33. Bellows L, Anderson J. The food friends: encouraging pre- processes and physiological growth in adolescence.
schoolers to try new foods. Young Child. 2006; 61: 37–39. In: Adams GR, Berzonsky MD (eds). Blackwell
34. Lambert J, Agostoni C, Elmadfa I, Hulshof K, Krause Handbook of Adolescence. Oxford: Blackwell
E. Dietary intake and nutritional status of children Publishing Ltd; 2006, pp.24–47.
and adolescents in Europe. Br J Nutr. 2004; 92(Suppl 42. Carter BJ, Birnhaum AS, Hark L, Vickery B, Potter C.
2): S147–S211. Using media messaging to promote healthful eating
35. Perez-Rodrigo C, Aranceta J. School-based nutrition and physical activity among urban youths. J Nutr
education: lessons learned and new perspectives. Educ Behav. 2005; 37: 98–99.
Public Health Nutr. 2001; 4: 131–139. 43. Dollahite J, Hosig KW, White KA, Rodibaugh R.
36. Befort C, Kaur H, Nollen N, Sullivan DK, Nazir N. Impact of a school based community intervention
Fruit, vegetable, and fat intake among non-Hispanic program on nutrition knowledge and food choices
black and non-Hispanic white adolescents: associations in elementary school children in the rural Arkansas
with home availability and food consumption settings. delta. J Nutr Educ. 1998; 30: 289–301.
J Am Diet Assoc. 2006; 106: 367–373.
44. McAleese JD, Rankin LL. Garden-based nutrition
37. Hoelscher DM, Evans A, Parcel GS, Kelder SH. education affects fruit and vegetable consumption in
Designing effective interventions for adolescents. sixth-grade adolescents. J Am Diet Assoc. 2007; 107:
J Am Diet Assoc. 2002; 102(Suppl 3): S52–S63. 662–665.

IUHPE – Global Health Promotion Vol. 27, No. 4 2020