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Nutrition and Cognition in School-Aged Children: A Brief Review

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 INTERNATIONAL JOURNAL OF EDUCATIONAL BENCHMARK (IJEB),
Benchmark Journals eISSN: 2489-0170 pISSN:2489-4162 University of Uyo

Nutrition and Cognition in School-Aged Children: A Brief Review

Ojo, Yetunde Abiola, Ph.D

Department of Counselling and Human Development Studies,
University of Ibadan
Ojoyetty33@yahoo.com
Abstract

Children are the future of every nation. Community and national development is greatly
influenced by the level of education of its citizens. There is an increasing body of literature
that suggests a link between adequate nutrition and optimal brain function. This paper briefly
describes the research carried out on the impact of nutrition on cognitive functions and
school performance. This became imperative because in the present contemporary world,
student academic performance is nothing to write home about, parents and educators have
long searched for answers on the relationship between what children eat and their test
scores. Thus, an in-depth understanding of the nature of relationship that exists between
nutrition and cognition is important to create appropriate population-based dietary policies
for child nutrition. This paper reviewed relevant literature on nutrition and brain function,
nutrition in school-aged children as well as its impact on cognitive development and
education. It was concluded that the role nutrition plays in academic performance cannot be
over-emphasized. It was finally recommended among others that free school feeding
programmes should be made available for school children at all levels. Also, nutrition
education programmes and counselling should be included in the school curriculum.

Key Word: Nutrition, Cognition, Children and School Performance

Introduction

In recent years, researchers have shown increasing interest in looking at the impact of
nutrition on academic performance. Children of today would later become functioning
members of the society. Their health, academic achievement and attainment are major
determinants of the economic growth and overall progress of the nation. The early years of
life is a time of rapid brain development which includes neural plasticity, working memory,
attention and inhibitory control. Poor nutrition during the formative years could have
irreversible consequences. According to UNICEF (2013), about one third of under-five aged
children mortality is attributable to under-nutrition and 165 million children in the world
under the age of five are afflicted by stunting. For millions of children, it means they are

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forever, stunted, smaller than their non-stunted peers. It is estimated that over 200 million
children under 5 years of age in the developing world have significantly impaired growth.
In a study carried by Kreb-Smith, Guenther, Subar, Kirkpatrick and Dodd (2010),
more than 90% of children aged 4 to 18 did not meet recommendations for vegetable intake
and more than 75% did not meet guidelines for fruit intake while more than 90% of children
consume more than the recommended amounts of solid fats and added sugars. The Youth
Risk Behaviour Surveillance System conducted a research and found that the number of
children and adolescents who are not eating the recommended daily amounts of fruits and
vegetables to be 76.1%, with 82% not drinking the daily recommended amount of milk
(Engle,2010). The centre for Disease Control and Prevention in 2012 asserts that more than
one-third of children and adolescents aged 6 to 19 was considered overweight and obese yet,
many children’s diets lack micronutrient. This is an indication that malnutrition exists among
school-aged children which is a violation of child’s right.
Ogannah (2015) assert that schooling builds human capital - skills, abilities, and
resources which ultimately shapes health and well-being. Considering the amount
government invests yearly on education, it is very disheartening that Nigeria is far behind in
academic performance compared with other developing countries of the world with similar
economic development. There are many reasons for this poor academic performance; poor
nutrition may be a contributing factor. And since high academic achievement could lead to
economic growth and development, hence, inadequate nutrition during childhood may result
in more serious problems than expected. It may also lead to the nation’s low output and low
socioeconomic status of citizens thereby hindering the overall development of the nation.

According to Levinger (1996), vast numbers of school-aged children in developing

countries face major health and nutrition problems that adversely affect their ability to take
advantage of the limited educational opportunities available to them. Brown, Beardslee and
Prothrow-Stith (2008) noted that poor nutrition can leave students’ susceptible to illness or
lead to headaches and stomach aches, resulting in school absences. Also, UNICEF (2013)
identified slower memory recall, hyperactive and attention problems, lower test scores and
class repetition as consequences of malnutrition. Diets high in trans and saturated fats can
negatively impact learning and memory, students’ thinking skills, behaviour, and health,
nutritional deficiencies early in life can affect and the overall cognitive development of
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school-aged children (Tara,2005). Thus, access to proper nutrition improves students’

cognition, concentration, and energy levels. Ogannah (2015) submitted that chronic
malnutrition experienced during early life inhibits growth, retards mental development, and
reduces motivation and energy level, causing a reduction of educational attainments and
delay in school entry. In principle therefore, nutritional problems in the school-aged child
may carry into adulthood thereby enabling them to be prone to adult diseases such as
ischemic heart disease, hypertension, some types of cancer and diabetes (Lahey and Rosen
2010).
Keeping all this in view, it becomes imperative to understand the role of specific
nutrients in the development of cognitive functions of children. This in-depth understanding
will enable parents, educators, policy makers and government at all levels to give cognizance
to nutritional issues and interventions, and also create appropriate population-based dietary
policies for infant and child nutrition.
Early childhood nutrition programmes as a way to raise living standards in developing
countries have been increasingly promoted by policy makers (World Bank 1993).Such
programmes have been argued to improve diet in the crucial first years of life, enhances
intellectual development and, ultimately, academic success (Brown and Pollitt 1996).
Issues in Healthy nutrition and Malnutrition
An integral component of daily life that contributes to the neurological, physical,
mental, emotional and social well-being of individuals is said to be healthy nutrition. It
encompasses having access to micronutrient-rich food; safe water; proper health care; and
good hygiene practices. Nutrition is influenced by three broad factors: food, health and care
(UNICEF, 2013). Nutritional well-being is determined by consuming safe food as part of an
appropriate and balanced diet that contains adequate amounts of nutrients in relation to bodily
requirements (WHO, 1998). Good nutrition during childhood lays the foundation for a
healthy individual at later years of life. School-aged children grow rapidly; hence, it is of
necessity to make provision for the needed diet at this stage of development. Good nutrition
is the first line of defence against numerous childhood diseases, which can leave indelible
mark on a child for life.
Begum and Nessa (2008) defined malnutrition as a pathological state resulting from a
relative or absolute deficiency or excess of one or more essential nutrients, it is one of the

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principle public health problems affecting large sections of populations especially children in
developing countries. In a study carried out by Benítez-Bribiesca(1999) on 13 severely
undernourished infants, compared to seven adequately fed babies fewer numbers of neurons
with shorter dendrites and abnormal dendritic spines in individuals with malnutrition was
found. Malnourished children have less energy and interest for learning that negatively
influences cognitive development (Engle, 2010). Malnutrition could lead to decreased
attention, deficient learning, and lower educational achievement.

Cognition and Cognitive Functions

Cognition represents a complex set of higher mental functions sub-served by the
brain, and includes attention, memory, thinking, learning, and perception (Bhatnagar and
Taneja, 2001). Attention and memory are two major cognitive functions in school-aged
children. Attention is the processes through which sensory focus is directed toward external
stimuli. This include, maintaining alertness and orienting toward compelling external stimuli.
Attention is commonly considered to be a unitary construct (Engle, 2010). It allows children
to accrue important information about their surroundings and to engage in the dynamic social
interactions that form the basis for interpersonal relationships as well as the ability to monitor
a stimulus stream for the occurrence of a specific target.

Memory implies the encoding, storage, and retrieval of information. From a

developmental perspective, the capacity to hold information and process it supports various
higher level accomplishments such as language, categorization, and social cognition.
Memory is of two types namely; explicit and implicit memory. Explicit memory is also
known as declarative memory which refers to the ability to remember unique events, facts,
and people and depends on the integrity of the hippocampus and surrounding cortical areas,
which are collectively called the medial temporal lobe (Sakai, 2005). Implicit memory
accumulates more slowly as the result of repetition, as in the acquisition of the motor skills
necessary to play a musical instrument or drive a car, and which has been related to the
functions of the basal ganglia structures situated in the dorsal striatum (Neville and
Bavelier,2002). Working memory refers to the ability to hold information “on line,” use it to
accomplish a goal, and then discard it. Working memory has been linked to development of
prefrontal cortex. The capacity to hold information in working memory emerges during the

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first year and working memory capacity continues to improve during childhood (Reznick,
Morrow, Goldman and Snyder, 2004). Other cognitive abilities in school-aged children
include; categorization, problem-solving and counting.

Development of memory in children most especially declarative memory is very rapid

throughout the first two years of life. This cognitive development is evident in increased
attention, language acquisition, and increasing knowledge. There is a difference in the brain
development of explicit and implicit memory in infants. Implicit memory is developed
through maturation of striatum, cerebellum, and brain stem which are all involved in implicit
learning. Explicit memory development depends heavily on structures in the medial temporal
lobe, including the hippocampus and the parahippocampal cortex.

Recall in memory(otherwise called memory call) is regarded as the mental process of

retrieving information from what was stored in the past. It is one of the three core processes
of memory including encoding and storage. There are three main types of recall namely: free
recall, cued recall and serial recall. Free recall describes the process in which a person is
given a list of items to remember and then is tested by being asked to recall them in any order
(Bower and Gordon, 2000). Free recall often displays evidence of primacy and recency
effects. Primacy effects are displayed when the child recalls items presented at the beginning
of the list earlier and more often. The recency effect is when the child recalls items presented
at the end of the list earlier and more often (Bower and Gordon, 2000). Cued Recall is when a
child is given a list of items to remember and is then tested with cues to remember material.
The presentation could either be visual or auditory. Serial recall is the ability to recall items
or events in the order in which they occurred (Henson, 1996). Serial-order also helps a child
to remember the order of events in lives, for instance, autobiographical memories.

Influence of Nutrition on Brain function

All human developmental processes are disposed to the influence and interplay of
biological and environmental factors. According to Giedd, Stockman, Weddle, Liverpool,
Alexander-Bloch, Wallace (2010), brain development follows a genetic programme which is
influenced by environmental factors including nutrition. Hsu, Lee and Chiu (2007) assert that
during embryonic, fetal and early postnatal life, genetic determinants specify the fate of

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neuronal progenitors and their migration to brain regions. Heng, Moonen and Nguyen(2007)
submitted that these genetic determinants also modulate synaptic signal transmission and
contribute to the establishment and maintenance of the central nervous system.
Environmental influences may modify gene expression through epigenetic mechanisms,
whereby gene function is altered through the processes of DNA methylation, histone
modification and the modulating effect of non-coding RNAs, without the alteration of the
gene sequence per se(Jacobson, Jacobson and Muckle, 2008). Nutrition is a nurturing
(environmental) factor which can directly modify gene structure and mediate the expression
of genetic factors by providing the specific molecules that enable genes to exert their
potential on brain growth and development. The brain is a specialized tissue in which
functionality depends upon the generation of electrical potentials and their conduction
through long axonal components of cell-bodies and through the synaptic gaps between these
cell-bodies. Nutrients which include choline, folic acid, iron, zinc and special fats such as
gangliosides, sphingolipids and docosahexaenoic acid (DHA) are important for
synaptogenesis particularly for brain growth (Jacobson, Jacobson and Muckle, 2008) and
retinoic acid, the active form of vitamin A, is involved in central nervous system
morphogenesis and patterning (Parada, Gato and Bueno, 2008).
Levitt (2003) noted that environmental(nurturing) factors play an equally critical role
in shaping the neural configuration through postnatal synaptic “blooming and pruning” that
incorporates ongoing experiences into the developing synaptic architecture of the brain.
Environmental factors act by modifying gene expression through epigenetic mechanisms
(Zeisel, 2009). The epigenetic effect of nutrients was exerted by altering histone acetylation,
and the effects of hypoglycemic diets on the genetic expression of neuronal factors (Levi and
Sanderson, 2004). Neuron is one of the cells that constitute nervous tissue which transmit
and receive nervous impulses; axon is a long projection of the neuron that conducts nerve
impulses away from the nerve cell body; dendrite is a branching projection of the neuron that
conducts nerve impulses toward the nerve cell body; synapse is the place between nerve cells
through which nerve impulses pass from one neuron to another and Myelin is a soft white
material of lipid and protein that covers axons to insulate and accelerate nerve impulse.
Good nutrition are required for the creation of new neurons, for the growth of axons
and dendrites, for the formation of synapses, and the covering of axons with myelin, which is

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fatty matter that accelerates the speed of nerve impulses traveling from one cell to another.
Some nutrients facilitate the incorporation of experiences into cognitive functions by being
the basic structural components of neuronal cell-bodies and synapses (Zeisel, 2009). Nutrient
plays a critical role at the cross-roads of the biological and nurturing factors that mediate
brain growth and development such as cell proliferation, DNA synthesis, and production of
key neurotransmitters such as acetylcholine, dopamine, and serotonin, hormone metabolism,
maintenance of brain tissue and are important constituents of enzyme systems in the brain.
Hence, each child is born with the intrinsic capacity to learn, but how and what the child
learns could be determined by the environment.

Nutrition in school-aged children

It has been recommended by nutritionists that children should eat five times in each
day. Children should be provided with food that will give an adequate amount of energy such
as fats, carbohydrates, vitamins, minerals and proteins. Proteins help to build human cells
and sources are animal liver, lean red meat, fish, chicken, turkey, seafood, cheese, milk and
eggs and some products derived from soybeans, green beans, dairy foods, peanut butter, soya
products, nuts, seeds, wheat and legumes. The Institute of Medicine in 2012 recommends that
children ages 4 to 8 need at least 19 grams of protein, ages 9 to 13 require 34 grams of
protein, teen girls ages 14 to 18 need 46 grams and teen boys ages 14 to 18 require at least 52
grams of protein every day.

Fat is essential for balanced energy level in children. According to The Institute of
Medicine (2012), school-age children ages 4 and older should consume 25 to 35 percent of
their daily calorie intake from fats, especially mono- and polyunsaturated fats found in
vegetable oils, avocados, peanut butter, hummus, nuts and seeds. Erickson (2006) opines that
fat makes up more than 60% of the brain and acts as a messenger in partial control of aspects
such as mood. Foods rich in omega-3 fatty acids include purified fish oils, canola oil, walnut
oil, walnuts, soybeans, soybean oil, algal oil, flaxseeds, flaxseed oil and pumpkin seeds.
Omega-3 fatty acids such as those found in salmon, kiwi fruit, and walnuts, provide many
benefits in improving memory and learning, much of which occurs at the synapses. Omega-3
fatty acids support synaptic plasticity and seem to positively affect the expression of several
molecules related to learning and memory that are found on the synapses.
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Carbohydrates which are the most important source of energy for the body during
childhood could be derived from sugars, starches and fiber. It provides energy to all tissues in
the human body, especially the brain and red blood cells which normally utilize glucose as
the fuel for cell activity. The Institute of Medicine (2012) suggests that all children ages 1
and older should consume at least 130 grams of carbohydrates every day. Carbohydrates from
whole grains, milk products, fruits, vegetables and legumes increase the nutrition of
children’s diet. Refined grains and added sugar food should be avoided.
Vitamins are essential and vital in a proper diet for small children. Vitamin A is
necessary for correct development of vision, to guarantee the integrity of epithelial tissue and
development of tissue differentiation. The main sources of vitamin A are: liver, dairy
products, eggs, fish, margarine, fruits and vegetables. Vitamins B help in the growth,
sustenance and development of children. Vitamin C is essential for optimum functioning of
the immune system and collagen synthesis. It contains antioxidant properties and plays a
significant support role in the process of iron absorption. Vitamin D in fish, dairy products
and iodine obtain from seafood, dairy products, enriched grains and iodized salt plays an
essential role in metabolizing muscle functioning, cell proliferation and maturation and
correct functioning of the immune system. Vital nutrients for school-age children include
calcium found in dairy products and dairy-free calcium-fortified beverages, iron in meats and
iron-fortified grains.
Minerals in diet are good for children, most especially iron, calcium, magnesium,
phosphorus, sodium, zinc and iodine. Manganese and magnesium are two minerals essential
for brain functioning; sodium, potassium and calcium play a role in message transmission and
the thinking process. Erickson (2006) opine that vitamins and minerals as an important
substance for the functioning of the brain. Most important are the vitamins A, C, E, and B
complex vitamins.
According to The U.S. Department of Agriculture( 2008), girls aged 4 to 8 need 1,200
to 1,800 calories, girls aged 9 to 13 require 1,400 to 2,200 calories and teen girls aged 14 to
18 need about 1,800 to 2,400 calories each day. Boys aged 4 to 8 require 1,200 to 2,000
calories, boys aged 9 to 13 need 1,600 to 2,600 and teen boys aged 14 to 18 need about 2,000
to 3,200 calories per day to maintain a healthy body weight. The National Nutrition Standards
(2000) submitted that meals must provide one third of the RDA of protein, vitamin A,

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vitamin C, iron, calcium, and calories. No more than 30% of the meals calories should be
from fat and fewer than 10% of the calories should come from saturated fat. The following
dietary guidelines are recommended for children and adolescents by the National Nutrition
Standards, which was published by the School Nutrition Association (2000):

1) One to two ounces of meat/meat alternative daily;

2) 10-14 serving of grains/bread per week;
3) One half cup fruit daily;
4) One half cup vegetables daily;
5) 8 ounces of milk and dairy products daily;

6) Grains (bread and pasta) daily;

7) Fish: At least three times per week;

8) Cheese: Twice a week;

9) Eggs: Once or twice a week;

10) Legumes: At least twice a week

Impact of Nutrition on Cognitive development and Education

Existing research makes a convincing case that nutrition and health interventions will
improve school performance (WHO, 1992). Good health and nutrition are needed for
concentration, regular school attendance and optimum class performance (Levinger, 1996).
Kleinman and Green (2002) carried out a research study on the implementation of a universal
breakfast program on the academic performance of school-aged children and found that
children who participated in the program have improved nutrition status. Those children with
improved nutrition status experienced decreased hunger, reduced absenteeism, and increased
math scores. Taras (2005) found that schools which had a breakfast program not only had
lower tardiness and absentee rates, but positive effects on brain function and higher scholastic
scores as well. Verbal fluency, arithmetic, attention tests, memory, creativity, endurance, and
general cognitive functioning were found to be a result of eating nutritious food

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According to Chugani (1998), Children’s brains use more glucose than adult brain.
Eating breakfast replenish blood glucose levels that a child’s brain needs to perform well
academically. Thus, regular breakfasts improves brain function by providing the necessary
level of glucose. In a cross-sectional study done in China, Liu , Hwang , Dickerman ,
Compher (2013) found that kindergarten students who ate breakfast had higher IQs than who
ate breakfast sometimes or rarely, and this persisted even after controlling for factors such as
parental education and current living situation. Also, children who eat breakfast regularly
with their parents experience improved communication. It is likely that vocabulary and
comprehension skills improve as a result of regular family meals. In Norwegian, among the
475 high school students surveyed by Overby , Lüdemann and Høigaard (2013) , those who
ate breakfast regularly had a reduced risk of writing, reading, and mathematical learning
difficulties.

S0 (2012) conducted a large study in Korea which examined breakfast consumption

among 75,000 students in grades 7 to 12. Male students who ate breakfast five days per week
experienced improved academic performance compared with those who didn’t eat breakfast.
Among female students, positive associations were seen with as few as two breakfasts per
week. With both sexes, eating breakfast every day showed improved academic performance.
Another research done by Kim, Frongillo and Han (2003) in Korea found that children who
ate breakfast regularly had grade point averages that were 0.15 to 0.28 points higher
compared with those who didn’t eat breakfast regularly. In a similar research carried out by
Asbridge, Florence, and Veugelers (2008), found that students who eat breakfast had higher
cognitive functioning than those who skipped it.
In their research, Lahey and Rosen (2010) found that about one-third of children who
completed a food-habit questionnaire had inadequate fruit and vegetable intake. These
students also showed poor school performance as compared to those students who had an
adequate intake of fruits and vegetables. The study concluded that nutrition affects learning
and behaviour and suggested that diet can influence cognition and behavior in many ways,
which include the condition of not enough nutrition or the condition of the lack of certain
nutrients. Another study by Li & O’Connell (2012) discovered that 5th grade students who
ate more fast food got worse scores on math and reading. Edwards , Mauch and Winkelman
(2011) found that higher mean math standardized test scores were associated with students
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who ate nutritious food more frequently among 800 sixth-grade students in North Dakota’s
Fargo Public Schools, in the United States.

A study done by Paramji and Sharma (2007) using sixty girls of 7-9 years belonging
to low socio-economic group in Ludhiana city found that the intake of all nutritious food
(protein, calcium, ß carotene and Vitamin C) increased significantly in the experimental
group after nutritional counselling . Hematological profile and IQ scores significantly
increased and percentage of girls in high intellectual score category increased from 23.3 to
43.3. This may be due to increased food intake and also due to adoption of desirable
nutritional practices.

In a survey research, Dodsworth (2010) recruited 1,194 students aged 7 to 12 in an

eighth grade class for 14 class days. Participants completed questionnaires each day about
nutritional choices and the instructor evaluated major areas of academic achievement daily.
The areas of academic achievement that were examined include participation, attendance,
work, and behaviour. A 5 point scale was developed to rank participants, nutrition for the day
and achievement and provide for correlation between the two areas under investigation.
Participants were given a questionnaire about their personal nutritional choices when they
entered the science class each day, for 14 class days. The survey had six questions on it and
was completed at the beginning of class each day for the duration of the study. The study
found that those that take nutritious food had an average academic achievement score of
4.343 while others had an average academic achievement score of 3.800.
Conclusion

Improving children’s health is very crucial in achieving improved academic

performance. Since the progress of a nation depends on the health of its citizens,
developments in the effort to enhance education and school performance should emphasize
on improved health and the nutrition status of school-aged children. By doing this, the nation
can boast of citizens with good health and sound mind, higher output including high and
outstanding performance in school. Also, there is need for an enabling school environment
through well-articulated policies, projects, and programmes /interventions to ensure
wholesome development of Nigerian children and enhance their quality of life.

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In this contemporary world, many parents because of job demands and daily hassles
opt for fast foods for their children and wards. This excessive intake of total fat, saturated fat,
and cholesterol contributes to health problems and poorer performance (Zhang, Hebert &
Muldoon, 2005). There is an adage that says “You are what you eat”. Good nutrition during
the early years of life is important for growth support and maximizing learning potential.
Good health and nutrition are needed for increased energy levels, mental clarity, emotional
and well-functioning, concentration, regular school attendance and optimum school
performance. However, poor nutrition often poses a serious barrier to equipping children with
the necessary tools and skills for success.
Recommendations

1. Health and Physical education teachers are to lead the quest for the prevention of
unhealthy students by developing nutrition curriculum which incorporates innovative
themes that influence both health and academic performance.
2. Workshop could be organized on the developed nutrition curriculum for students,
parents and teachers so as to help improve nutrition beliefs and behaviours. Such
nutrition education programmes and counselling may be done in schools, through
community organizations, or through a private practice.
3. Nutrition education needs to be included in every school curriculum as learning to
know “What to eat and Why” is an essential aspect of child’s education.
4. Teaching all children the meaning and importance of good nutrition will ameliorate
the issues of nutrition illiteracy and misunderstandings.
5. Monthly nutrition posters should be placed on bulletin boards at schools and nutrition
newsletters with sample menus and up-to-date nutrition.
6. Teachers should send information to families consistently so as to stimulate parental
involvement and help mothers make good food choices for their children. Hence, this
will improve nutritional status of children to the desired level.
7. Schools should establish committees that include parents and community members to
promote a healthy school atmosphere by focusing on nutrition and vending policies.
8. School vendors should only sell foods and beverages that contribute to meeting the
dietary needs of students and not for profits.

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9. A policy of subsidizing the price of food could be adopted. Food subsidy will help
children from low socio-economic status to have access to nutritious food at an
affordable price.
10. Provision of lunch during school period should be made for all students to support
nutritional needs of school children.
11. The school authority should ensure students are not starting the school day hungry as
such school breakfast programs should also be made available.

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