Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial
Background Two billion children globally are estimated to live in conflict-affected areas. School feeding programmes (SFPs) are a widely implemented safety net that supports children during and after conflict. Objective We evaluated the effectiveness of providing milk alongside a high energy biscui...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | Inglés |
| Published: |
Elsevier
2025
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10568/175529 |
| _version_ | 1855519485156392960 |
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| author | Bliznashka, Lilia Michail, Monica George Elsabbagh, Dalia Gelli, Aulo Hamid Hossam Al-Qadi, Ahmed Abdel Saif Al-Ariqi, Munir Hassan Hanash Qasim, Wajdan Hanash Qawi Al-Athouri, Saeed Abdul Hamid Ahmed Abdullah, Majed Abdel Ali Naji Iskandar, Samia Majed Hamoud Al-Battah, Nazma Saleh Hamid Mansour, Salah Fazaa Mohammed Al-Saadi, Samar Saeed Goel, Mayank ElHelbawy, Sherif Rahman Qasem, Adeeb Abdul Bahader, Hussein Al-Haj, Waleed Mohammed Al-Qasus, Adnan Yahya Ohiarlaithe, Micheal Suliman, Hala Ghimire, Pramila AlSabahi, Mohammed AlBasha, Muna Alameri, Abdulhafeed Akther, Shahida Qahtani, Fadhl Abdullah Basaleem, Mohammed Hassan, Mustafa Bawazir, Samah |
| author_browse | Akther, Shahida Al-Haj, Waleed Mohammed Al-Qasus, Adnan Yahya AlBasha, Muna AlSabahi, Mohammed Alameri, Abdulhafeed Ali Naji Iskandar, Samia Majed Bahader, Hussein Basaleem, Mohammed Bawazir, Samah Bliznashka, Lilia ElHelbawy, Sherif Elsabbagh, Dalia Gelli, Aulo Ghimire, Pramila Goel, Mayank Hamid Ahmed Abdullah, Majed Abdel Hamid Hossam Al-Qadi, Ahmed Abdel Hamid Mansour, Salah Fazaa Hamoud Al-Battah, Nazma Saleh Hanash Qasim, Wajdan Hanash Hassan, Mustafa Michail, Monica George Mohammed Al-Saadi, Samar Saeed Ohiarlaithe, Micheal Qahtani, Fadhl Abdullah Qawi Al-Athouri, Saeed Abdul Rahman Qasem, Adeeb Abdul Saif Al-Ariqi, Munir Hassan Suliman, Hala |
| author_facet | Bliznashka, Lilia Michail, Monica George Elsabbagh, Dalia Gelli, Aulo Hamid Hossam Al-Qadi, Ahmed Abdel Saif Al-Ariqi, Munir Hassan Hanash Qasim, Wajdan Hanash Qawi Al-Athouri, Saeed Abdul Hamid Ahmed Abdullah, Majed Abdel Ali Naji Iskandar, Samia Majed Hamoud Al-Battah, Nazma Saleh Hamid Mansour, Salah Fazaa Mohammed Al-Saadi, Samar Saeed Goel, Mayank ElHelbawy, Sherif Rahman Qasem, Adeeb Abdul Bahader, Hussein Al-Haj, Waleed Mohammed Al-Qasus, Adnan Yahya Ohiarlaithe, Micheal Suliman, Hala Ghimire, Pramila AlSabahi, Mohammed AlBasha, Muna Alameri, Abdulhafeed Akther, Shahida Qahtani, Fadhl Abdullah Basaleem, Mohammed Hassan, Mustafa Bawazir, Samah |
| author_sort | Bliznashka, Lilia |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background
Two billion children globally are estimated to live in conflict-affected areas. School feeding programmes (SFPs) are a widely implemented safety net that supports children during and after conflict.
Objective
We evaluated the effectiveness of providing milk alongside a high energy biscuits (HEBs) SFP in Yemen on children’s and caregivers’ outcomes.
Methods
We implemented a two-arm longitudinal cluster-randomised controlled trial from December 2023 to May 2024. 42 schools in Al Mukha district were randomly assigned (1:1) to: control, where children received HEBs (2 packets (100 grams) daily), or milk, where children received HEBs plus a 120 ml carton of ultra-high temperature milk. Children aged 6-18 years were randomly selected for enrolment. The primary outcomes were children’s dietary diversity and milk consumption. Secondary outcomes were children’s cognition, learning, attendance, nutritional status, and health. Tertiary outcomes were child and caregiver mental health, and household food security. We conducted intent-to-treat analysis using linear mixed effects models accounting for clustering.
Results
1,299 children were enrolled. After five months, the intervention increased milk consumption, but had no effect on dietary diversity. Children’s cognition [mean difference (MD) 1.00 (95% CI 0.40, 1.61)], literacy [1.14 (0.36, 1.92)], and numeracy [1.06 (0.46, 1.67)] scores improved. Cough symptoms declined: -0.12 (-0.2, -0.03). There were no changes in school attendance or nutritional status. The intervention reduced conduct problems in children [-0.52 (-0.97, -0.08)], severe anxiety in caregivers [-0.03 (-0.06, -0.001)], and household severe food insecurity [-0.09 (-0.17, -0.001)].
Conclusions
Adding a daily milk drink to an HEB SFP in Yemen resulted in numerous benefits for children and their families. Hybrid models to incrementally improve meal quality are feasible, acceptable, and lead to meaningful impacts. More research is needed on medium- and long-term benefits. |
| format | Journal Article |
| id | CGSpace175529 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Elsevier |
| publisherStr | Elsevier |
| record_format | dspace |
| spelling | CGSpace1755292025-12-09T19:56:28Z Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial Bliznashka, Lilia Michail, Monica George Elsabbagh, Dalia Gelli, Aulo Hamid Hossam Al-Qadi, Ahmed Abdel Saif Al-Ariqi, Munir Hassan Hanash Qasim, Wajdan Hanash Qawi Al-Athouri, Saeed Abdul Hamid Ahmed Abdullah, Majed Abdel Ali Naji Iskandar, Samia Majed Hamoud Al-Battah, Nazma Saleh Hamid Mansour, Salah Fazaa Mohammed Al-Saadi, Samar Saeed Goel, Mayank ElHelbawy, Sherif Rahman Qasem, Adeeb Abdul Bahader, Hussein Al-Haj, Waleed Mohammed Al-Qasus, Adnan Yahya Ohiarlaithe, Micheal Suliman, Hala Ghimire, Pramila AlSabahi, Mohammed AlBasha, Muna Alameri, Abdulhafeed Akther, Shahida Qahtani, Fadhl Abdullah Basaleem, Mohammed Hassan, Mustafa Bawazir, Samah capacity building school feeding conflicts emergencies schoolchildren dietary diversity randomized controlled trials Background Two billion children globally are estimated to live in conflict-affected areas. School feeding programmes (SFPs) are a widely implemented safety net that supports children during and after conflict. Objective We evaluated the effectiveness of providing milk alongside a high energy biscuits (HEBs) SFP in Yemen on children’s and caregivers’ outcomes. Methods We implemented a two-arm longitudinal cluster-randomised controlled trial from December 2023 to May 2024. 42 schools in Al Mukha district were randomly assigned (1:1) to: control, where children received HEBs (2 packets (100 grams) daily), or milk, where children received HEBs plus a 120 ml carton of ultra-high temperature milk. Children aged 6-18 years were randomly selected for enrolment. The primary outcomes were children’s dietary diversity and milk consumption. Secondary outcomes were children’s cognition, learning, attendance, nutritional status, and health. Tertiary outcomes were child and caregiver mental health, and household food security. We conducted intent-to-treat analysis using linear mixed effects models accounting for clustering. Results 1,299 children were enrolled. After five months, the intervention increased milk consumption, but had no effect on dietary diversity. Children’s cognition [mean difference (MD) 1.00 (95% CI 0.40, 1.61)], literacy [1.14 (0.36, 1.92)], and numeracy [1.06 (0.46, 1.67)] scores improved. Cough symptoms declined: -0.12 (-0.2, -0.03). There were no changes in school attendance or nutritional status. The intervention reduced conduct problems in children [-0.52 (-0.97, -0.08)], severe anxiety in caregivers [-0.03 (-0.06, -0.001)], and household severe food insecurity [-0.09 (-0.17, -0.001)]. Conclusions Adding a daily milk drink to an HEB SFP in Yemen resulted in numerous benefits for children and their families. Hybrid models to incrementally improve meal quality are feasible, acceptable, and lead to meaningful impacts. More research is needed on medium- and long-term benefits. 2025-09 2025-07-07T19:21:13Z 2025-07-07T19:21:13Z Journal Article https://hdl.handle.net/10568/175529 en https://hdl.handle.net/10568/168698 https://doi.org/10.2139/ssrn.5196994 https://hdl.handle.net/10568/163038 https://hdl.handle.net/10568/151737 Open Access Elsevier Bliznashka, Lilia; Michail, Monica George; Elsabbagh, Dalia; Gelli, Aulo; et al. 2025. Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial. Journal of Nutrition 155(9): 2955-2964. https://doi.org/10.1016/j.tjnut.2025.06.021 |
| spellingShingle | capacity building school feeding conflicts emergencies schoolchildren dietary diversity randomized controlled trials Bliznashka, Lilia Michail, Monica George Elsabbagh, Dalia Gelli, Aulo Hamid Hossam Al-Qadi, Ahmed Abdel Saif Al-Ariqi, Munir Hassan Hanash Qasim, Wajdan Hanash Qawi Al-Athouri, Saeed Abdul Hamid Ahmed Abdullah, Majed Abdel Ali Naji Iskandar, Samia Majed Hamoud Al-Battah, Nazma Saleh Hamid Mansour, Salah Fazaa Mohammed Al-Saadi, Samar Saeed Goel, Mayank ElHelbawy, Sherif Rahman Qasem, Adeeb Abdul Bahader, Hussein Al-Haj, Waleed Mohammed Al-Qasus, Adnan Yahya Ohiarlaithe, Micheal Suliman, Hala Ghimire, Pramila AlSabahi, Mohammed AlBasha, Muna Alameri, Abdulhafeed Akther, Shahida Qahtani, Fadhl Abdullah Basaleem, Mohammed Hassan, Mustafa Bawazir, Samah Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial |
| title | Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial |
| title_full | Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial |
| title_fullStr | Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial |
| title_full_unstemmed | Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial |
| title_short | Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial |
| title_sort | effect of adding milk to a micronutrient fortified high energy biscuit school feeding programme in yemen a cluster randomised controlled trial |
| topic | capacity building school feeding conflicts emergencies schoolchildren dietary diversity randomized controlled trials |
| url | https://hdl.handle.net/10568/175529 |
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