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A COMPARATIVE STUDY OF DIETARY PRACTICES AND NUTRITIONAL STATUS OF SECONDARY STUDENTS IN DAY SCHOOLS TO THOSE IN BOARDING SCHOOLSA CASE STUDY OF LIGHT SECONDARY AND

VOCATIONAL SCHOOL, BULENGA

TABLE OF CONTENTS

DECLARATION …………………………………………………………………………………..i

APPROVAL ……………………..……………………………………………………………….ii

DECLARATION.. i

DEDICATIONS. ii

ACKNOWLEDGEMENT. iii

LIST OF TABLES. viii

LIST OF FIGURES. ix

ACRONYMS. x

ABSTRACT. xi

CHAPTER ONE:  INTRODUCTION.. 1

1.0 Introduction. 1

1.1 Background. 1

1.2 Problem Statement 3

1.3 Objectives of the Study. 3

1.3.1 General Objectives. 3

1.3.2 Specific objectives. 4

1.4 Research Questions. 4

1.5 Hypothesis. 4

1.6 Scope of the study. 4

1.6.2 Geographical Scope. 4

1.6.2 Content Scope. 5

1.6.3 Time Scope. 5

1.6 Significance of the study. 5

1.7 Limitation of the study. 6

1.8 Conceptual framework. 6

CHAPTER TWO: LITERATURE REVIEW… 7

2.0 Introduction. 7

2.1 Nutritional and Dietary Needs of the Adolescent 7

2.2 Dietary Diversity. 9

2.3 Measuring the Nutritional Status and Dietary Intake of Adolescents. 10

2.3.1 Height-for-age. 10

2.3.2 Weight-for-age. 10

2.3.3 Weight-for-height 11

2.3.4 BMI/BMI-for-age. 11

2.4 Dietary Pattern and Nutritional Status of Adolescents. 11

2.5 Malnutrition in Uganda. 12

2.6 Factors that determine the provision of adequate meals in boarding and non-boarding schools. 12

2.7 Knowledge Gap. 13

CHAPTER THREE:  METHODOLOGY. 14

3.0 Introduction. 14

3.1 Study Area. 14

3.2   Study Design. 15

3.3  Study Population, Sample size and sampling technique. 15

3.3.1 Target Population. 15

3.3.2  Sampling Technique. 15

3.3.2  Sample Size. 15

3.4   Data Collection. 16

3.4.2 Focus Group Discussion. 17

3.4.3 Measurement tools. 19

3.5 Measurement of variables. 19

3.5.1 Nutritional status. 19

3.5.2 Dietary Pattern. 19

3.6 Sources of Data. 19

3.6.1 Secondary Data. 19

3.6.2 Primary Data. 20

3.7 Quality Control 20

3.7.1 Validity. 20

3.7.2 Reliability. 20

3.8 Data Analysis Plan. 21

3.9 Ethical Consideration. 21

CHAPTER FOUR. 23

DATA PRESENTATION, ANALYSIS AND INTERPRETATION.. 23

4.1 Introduction: 23

4.1.1 Socio-Demographic characteristics of day scholars and boarder students. 23

Table 5: showing the comparison of the body mass index of boarder and day scholars. Error! Bookmark not defined.

CHAPTER FIVE. 32

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS. 32

5.1 Introduction. 32

5.2 Discussion of results. 32

5.3 Conclusion. 34

5.4 Recommendations. 34

REFERENCES. 36

STUDY QUESTIONNAIRE. 41

LIST OF TABLES

Table 1: Population, Sample Size and Sampling Techniques. 16

Table 2: showing the demographic characteristics of day scholars and boarding students. 23

Table 3: Comparison of nutrition status of day scholars and boarders in light secondary and vocational school, bulenga. 25

Table 4: Showing body mass index. 28

Table 5: showing the comparison of the body mass index of boarder and day scholars. Error! Bookmark not defined.

Table 6: Table showing the foods eaten by day scholars and boarders. 29

Table 7: Showing factors affecting the provision of adequate meals. 30

LIST OF FIGURES

Figure 1: Conceptual framework showing the relationship dietary patterns and nutritional 6

Figure 2:  Response Rate. Error! Bookmark not defined.

ACRONYMS

URT                United Republic of Tanzania

RDA               Recommended Dietary Allowance

NHANES       National Health and Nutrition Examination Survey

FAO                Food and Agriculture Organization

DD                  Dietary diversity

HDD               Household Dietary Diversity

FCS                 Food Consumption Score

IDD                 Individual Dietary Diversity

UNSCAN       United Nations System Standing Committee on Nutrition

U.S                  United States

BMI                Body Mass Index

WFP                 World Food Program

WHO              World Health Organization

ABSTRACT

The purpose of the study was to compare the dietary practices and nutritional status of secondary students in day schools to those in boarding schools at Light Secondary and Vocational School, Bulenga.  This study was guided by 3 objectives namely: to assess and compare the nutritional status of day and boarding students, to compare the dietary diversity scores of day and boarding students and to identify factors that determines the provision of adequate meals to day and boarding students in Light sec and vocational school Bulenga

.

This research was a cross sectional research design. The target populations of this study were the students, teachers and parents at Light Secondary and Vocational School Bulenga. The study employed the simple random sampling technique to come up with a sample size of 104 respondents from a population of 500. Data was meticulously gathered on key variables such as weight, height, age, sex, parents’ occupation and education using written questionnaires and double entered into SPSS version 20.

The findings of this study revealed general low food consumption scores for both day scholars and boarders with only one person achieving an acceptable score and others poor (47) and borderline (52) scores. The commonly consumed foods at school included posho, porridge, chapatti, mandazi, rice, bread and sodas. A higher percentage of those with low DDS were borders (63.2%) while a higher percentage of those with high DDS were day scholars (83.3%).

The mean BMI for boarding section students was 15kgm².while that for day scholars was 19.8%. This shows that the day scholars have a higher BMI than their boarding section counter parts. Inadequate and unreliable funds are major constraints in the provision of adequate diet in boarding institutions.

In conclusion under nutrition is prevalent in many adolescents in schools which may be attributed to low dietary intake and diversity and the associated factors.

CHAPTER ONE:  INTRODUCTION

1.0 Introduction

This study focused on dietary practices and nutritional status of students in both day and boarding secondary schools.  In this chapter, background issues are presented under sub-topics: background to the study, statement of the problem, general purpose of the study, objective of the study, research questions, research hypothesis, scope of the study and significance of the study.

1.1 Background

Students in secondary schools are within the age group (15-19) years, with some younger or older than the required age and they are generally considered to be old enough to control what they eat. Examples of food served at school include posho, rice, potatoes, cassava and bananas eaten together with meat or fish or legumes like beans and peas also with fruits and vegetables (Malingumu, 2008). Parents provide money to day students to purchase food whilst at school,those in boarding schools may send snacks to supplement the meals provided by the school. What is consumed is greatly influenced by: peers, mass media, social and cultural norms, lack of nutrition knowledge while the influence of the family tends to decline (Forthing et al., 1991). This can lead to poor quality diets which are low in calories and most essential nutrients. Mostly adolescent girls are at risk of inadequate intakes for various reasons: dieting, discrimination, early pregnancy, lower energy intake than boys (Dennison & Shepherd, 1995).

Provision of food to school children can increase school enrolment (Ahmed, 2004) and attendance especially for girls (Jacoby etal, 1996) when combined with quality education, School feeding programs lead to educational success (Tan et el., 1999). With appropriately designed rations, school feeding programs can improve the nutrition status of students by addressing micronutrient deficiencies. It is during the period of adolescence that nutrient needs are the greatest (Lifshit Z, Tarim and Smith, 1993),optimal nutrition is a requisite for achieving full growth potential (McAnarner et al, 1992).

There had been a number of problems experienced in running school diet programmes such as insufficient funds, councils not budgeting for school diet, lack of areas for gardening in schools, less number of donors interested to contribute in school diet, lack of appropriate infrastructure like store and cooking facilities, limited public awareness on the importance of school diet, poor and lack of skilled personnel to manage programme in schools (URT-MOEVT, 2013).Continuous insufficient intake of micronutrients by school going adolescents may result in poor health, reduced physical growth and a decline in educational performance (Ochola et al., 2014). In Uganda, the poor diet is reported to negatively influence academic performance, (Nabaseruka, 2010). This, therefore, puts the country at risk of not only producing an educated young population with reduced performance but also perpetuating malnutrition.

The prevalence of malnutrition particularly among adolescents is an alarming global problem affecting about one third of the world population. Children in boarding schools may be at higher risk of developing nutrient deficiencies compared to those in day schools, probably due to financial constraints in running boarding facilities. A study carried out in a boarding school in Nigeria to assess the nutritional status of forty students between the ages of 10 to 19 years showed that students in that boarding school were generally malnourished with inadequate energy intake especially among students of younger ages (Akinyemi et al., 2009).

On the other hand, Uganda’s adolescents in boarding schools feed on imbalanced diet consisting of porridge for breakfast and beans with highly polished posho, cassava and polished rice for lunch and supper. Beans adequately provide protein and energy but inadequate amounts of micronutrients such as vitamin A, iron, and calcium to meet the adolescent Recommended Dietary Allowance(RDA) requirements. These foods are disliked by the adolescents and treated as food for the poor (Pereznieto et al, 2011). In an attempt to satisfy their nutritional demands, they resort to energy-rich but nutrient-lean snacks sold in school canteens. This leaves them in a wanting nutritional state, as neither do the foods provided by the school sufficiently cater for a balanced diet (Turatsinze, 2012) nor do the different snacks available to them in school canteens (Valverde et al.,2015). Although, there is a 7-year (2009-2015) National Strategic Plan for the Health and Development of adolescents and Young people, there is inadequate information regarding adolescents’ dietary intake and nutritional status in Uganda.

Few studies have recorded the dietary patterns among school children in Uganda. A study in Eastern Uganda identified the major dietary components in the diets of children (aged 9 to 15) and found the diets were primarily carbohydrate staple-based, with high consumption of dark leafy vegetables, and low consumption of animal-origin foods, which are considered to be important sources of iron (Acham et al., 2012).In terms of nutrients intake, the majority of studies targeting school children focused on a single type of nutrient, such as iron, zinc or Vitamin A (Tidemann-Andersenet al.2011). Studies combining macronutrients and major micronutrients intake are lacking. Better understanding of information on the intake of macro- and micronutrients would not only give us a general overview on the nutritional status in terms of dietary intake in the population, but also provide evidence for future interventions to improve the overall nutritional status of children.

1.2 Problem Statement

Boarding schools feed on an imbalanced diet consisting of porridge, highly polished posho, polished rice with beans for breakfast, lunch and supper respectively, (Nabaseruka, 2010).These foods are disliked by the adolescents consequently obtaining almost all their energy and major nutrients from snacks sold in school canteens leaving them in a wanting nutritional state, as neither do the foods provided by the school sufficiently cater for a balanced diet (Turatsinze, 2012) nor do the different snacks available to them in school canteens(Valverde et al.,2015).According to UNESCO 2005, well-managed boarding schools provide good nutrition that children introduce to their own homes.

The scarcity of information on the dietary diversity and nutritional status of secondary school students in Uganda is serious and merits further investigation. This study thus seeks to compare the dietary diversity and nutritional status of boarding and non-boarding students in Bulenga S.S. Their nutritional status will be compromised if their diet is not diverse, hygienically prepared and the portion size consumed. The capacity of secondary schools to provide good nutrition is uncertain. Therefore, the study investigated factors that influence the provision of adequate meals in the selected school.

1.3 Objectives of the Study

1.3.1    General Objectives

The main objective of this study is to compare the dietary practices and nutritional status of students who are either boarding or day scholars in Light secondary and vocational school Bulenga.

1.3.2    Specific objectives

1. To assess and compare the nutritional status of day and boarding students in Light sec and vocational school Bulenga.
2. To compare the dietary diversity scores of day and boarding students in Light sec and vocational school Bulenga.
3. To identify factors that determines the provision of adequate meals to day and boarding students in Light sec and vocational school Bulenga.

1.4 Research Questions

4. What is the nutritional status of students inLight secondary and vocational school Bulenga.
5. What are the dietary diversity scores of students in Light sec and vocational school Bulenga.
6. What are the factors that determine the provision of adequate meals in the boarding and non-boarding students in Light sec and vocational bulenga.

1.5 Hypothesis

It is well established that the dietary diversity of developing countries like Uganda is monotonous; so I hypothesize that: Non-boarders will feed on more than 4 food groups per day as compare to boarders since they stay with their homes.

7. H₀: Students who are non-boarders feed on more than 4 food groups per day.
8. H₁: Students who are boarders has a minimum dietary variability of 4 food groups per day.

1.6 Scope of the study

1.6.2 Geographical Scope

The study was carried out in Bulenga at light Secondary and vocational School which is both day and boarding located in Sumbwe Parish, Wakiso Sub-county, Wakiso District of Central Uganda along Mityana Road. This study was carried out in Light sec and vocational school Bulenga because it consists of students from diverse social, cultural, economic, religious and ethnic groups as well as being a population made of the young generation who are highly susceptible to changes that are current in dietary patterns and nutrition related conditions.

1.6.2 Content Scope

The scope of this study focused on the dietary intake of students who are either residential or non-residential in secondary schools, a case study of Light sec and vocational school Bulenga. Dietary intake is conceived as the dependent variable and nutritional status is the independent variable.

1.6.3 Time Scope

This research study was carried out from April to May 2019 and various literatures with regard to the research study were reviewed from 2010 to 2017.

1.6 Significance of the study

There is scarcity of information on the dietary diversity and nutritional status of adolescents in Uganda. The information gathered from this study may guide in menu planning and general decision making in various second schools. The findings may be useful to other institutions including the Uganda Health Service Commission, organizations that are into school feeding and adolescent health programs such as World Food Program (WFP), Association of Church-Based Development Projects NGOs (ACDEP), and Catholic Relief Service (CRS).

The high dietary requirements of nutrients for this delicate period in the lifecycle cannot be overemphasized. Additional concentration therefore needs to be paid to this group because they are in a transitional period where puberty begins and develops habits which may probably be maintained in later life.

Findings of this study would be critical in designing of targeted programs to prevent intergenerational malnutrition which is a threat to the battle against malnutrition in developing countries. The extra demands of nutrients to support the rapid growth spurts associated with puberty is very critical in order not compromised growth and development as well as prevent complications in later life.

Moreover, information on the nutritional status and dietary diversity of adolescents is scarce and the growth references for this age group are inadequate. Therefore when more information is gathered, it added up to the existing information which could serve as a guide for future research works in this field and similar fields.

The findings of this research may be essential in the future research on individual dietary diversity and inclusion of local foods on the 24-hour dietary recall tool. Information was gathered on factors influencing provision of adequate diets in boarding institutions. In addition, the information was core in assessment regarding the effects of residential status of students in secondary schools on their nutritional requirements and dietary habits.

1.7 Limitation of the study

Financial costs to cover the purchase of stationery, movements to meet respondents and facilitations like airtime. The researcher minimized some expenditure did not add value to the study by concentrating on the most important aspects in relation to the study variable.

Poor response, this took the form of unanswered and semi answered questionnaires and unwillingness of the respondents to answer some of the questions. The researcher explained the sole purpose for the research study hence this helped to clear out the issue of partially answered questions.

Time constraint, this is the most pressing element since the study was conducted during the semester academic activities and both academics and research demanded for the researchers time. The researcher drafted a plan that was carefully followed to ensure the planned activities are accomplished within the designated periods.

1.8 Conceptual framework

This study focuses on the relationship between the dietary patterns and the nutritional status among secondary school students. From the FIVIMS nutritional status conceptual framework, poor nutritional status results from a complex set of elements. In this study the modified form of the conceptual framework is developed in the context of the study.

Figure 1: Conceptual framework showing the relationship dietary patterns and nutritional

Status

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

Globally, it is recognized that adolescents are tomorrow’s adult population and their health and well-being are crucial. Adolescents who suffer from growth retardation as a result of poor dietary intake, tend to perform poorly in school, reduce productive capacity in adult life, reduce intellectual capacity, become small women who are more likely to have small babies and more vulnerable to infectious diseases such as meningitis and pneumonia due to impaired immunity, (WHO, 2005).According to Kurz, 1997, maternal mortality is higher among adolescents girls than women aged 20-34. Low birth weight and prematurity are found among younger mothers. This chapter reviews the concept of malnutrition, dietary diversity, food habits of adolescents in developed and developing countries and health related factors affecting adolescents.

2.1 Nutritional and Dietary Needs of the Adolescent

The period of adolescence is a time of very rapid growth and high demands for nutrients and energy. The rapid growth period starts at the age of 10 or 11 for girls and at the age of 12 or 13 for boys and continues for about 2.5 years. Adolescents need high intakes of calories, vitamins and minerals, especially iron, calcium, vitamins A, C and D. During this time, boys and girls begin to reach puberty (gaining sex characteristics to mature into men and women) and nutritional needs start to differ, although good nutrition is essential for both sexes to grow into healthy adults. Energy needs of adolescents are influenced by activity level, basal metabolic rate, and increased requirements to support pubertal growth and development. Basal metabolic rate is closely associated with the amount of lean body mass. Adolescent males have higher caloric requirements since they experience greater increases in height, weight, and lean body mass than females (Story et, 2005).

One day dietary recall data from the third National Health and Nutrition Examination Survey

(NHANES III), 1988-94 showed a mean energy intake of 1793 calories/day for females ages 12-19 and 2843 calories/day for males ages 12-19(Troiano et al, 2000). Using CSFII data, Subar and colleagues (Subar et al, 1998) showed the top 10 sources of energy among teens were milk, breads, cakes/cookies/donuts, beef, cereal, soft drinks, cheese, chips, sugar, and chicken. In NHANES III, beverages provided 21% of energy intake, with soft drinks alone providing 8% caloric intake among adolescents. The adolescent growth spurt is sensitive to energy and nutrient deprivation. Chronically low energy intakes can lead to delayed puberty or growth retardation (Pugliese et al, 1983) Insufficient energy intake may occur because of restrictive dieting, inadequate monetary resources to purchase food, or secondary to other factors such as substance abuse or chronic illness. Foods that contribute the most carbohydrate to the diets of adolescents include (in descending order) yeast bread, soft drinks, milk, ready-to-eat cereal, and foods such as cakes, cookies, quick breads, donuts, sugars, syrups, and jams (Subar et al, 1998).

Major sources of total and saturated fat intakes among adolescents include milk, beef, cheese, margarine, and foods such as cakes, cookies, donuts, and ice cream (Subar et al, 1998).

Milk provides the greatest amount of calcium in the diets of adolescents, followed by cheese, ice cream and frozen yogurt (Subar et al, 1998). The most common dietary sources of iron in diets of adolescents included ready-to-eat cereal, bread, and beef.  The top five dietary sources of vitamin A in the diets of adolescents are ready-to-eat cereal, milk, carrots, margarine, and cheese. Beta-carotene, a precursor of vitamin A, is most commonly consumed by teens in carrots, tomatoes, spinach and other greens, sweet potatoes, and milk (Subar et al, 1998)

On average, adolescents who use tobacco and other substances have poorer quality diets and consume fewer fruits and vegetables, which are primary sources of vitamin C. Adolescents are also noted of their excessively unhealthy foods and drinks, adolescents also do not consume enough nutritious foods. Numerous studies have found that adolescents do not eat nutritious foods. Only 2% of children meet the dietary recommendations (Story &Neumark-Sztainer, 2005).These eating habits, if not corrected, can continue well into adulthood (Shaw, 1998; DeBate, Topping, & Sargent, 2001).

The prevalence of malnutrition particularly among adolescents is an alarming global problem affecting about one third of the world population. Children in boarding schools may be at higher risk of developing nutrient deficiencies compared to those in day schools, probably due to financial constraints in running boarding facilities. A study carried out in a boarding school in Nigeria to assess the nutritional status of forty students between the ages of 10 to 19 years showed that students in that boarding school were generally malnourished with inadequate energy intake especially among students of younger ages (Akinyemi et al., 2009).

On the other hand, Uganda’s adolescents in boarding schools feed on an imbalanced diet consisting of porridge for breakfast and beans with highly polished posho, cassava and polished rice for lunch and supper. Beans adequately provide protein and energy but inadequate amounts of micronutrients such as vitamin A, iron, and calcium to meet the adolescent Recommended Dietary Allowance(RDA) requirements. These foods are disliked by the adolescents and treated as food for the poor (Pereznieto et al, 2011). In an attempt to satisfy their nutritional demands, they resort to energy-richbut nutrient-lean snacks sold in school canteens. This leaves them in a wanting nutritional state, asneither do the foods provided by the school sufficiently cater for abalanced diet (Turatsinze, 2012) nor do the different snacks available to them in school canteens(Valverde et al.,2015).Although, there is a 7-year (2009-2015) National Strategic Plan for the Health and Development of adolescents and Young people, there is inadequate information regarding adolescents dietary intake and nutritional status in Uganda.

Adolescents who eat with their families generally consume more nutritious meals throughout the day, compared to those who eat alone or with friends (Story &Neumark-Sztainer, 2005). According to Delisle et al., 2004, iron, zinc, calcium and vitamin A are key deficiencies among adolescents. The health status of an individual in general depends largely on his/her nutritional status which intend is being influence by eating pattern, lifestyles factors, and infection in few cases, past malnutrition, low body nutrient stores and teenage pregnancies.

2.2 Dietary Diversity 

Dietary Diversity refers to the number of foods consumed across and within food groups over a reference time period (Ruel, 2003). Dietary diversity is a qualitative measure of food consumption that reflects household access to a variety of foods, and is also a proxy for nutrient adequacy of the diet of individuals (FAO, 2011). Dietary diversity (DD) relates to nutrient adequacy (coverage of basic needs in terms of macro and micro nutrients) and to diet variety/balance, which are two of the main components of diet quality. DD is thought to reflect the adequate intake of essential nutrients either at the household level (HDD), in which case it can be measured by a HDD score (HDDS) or by a Food Consumption Score (FCS), or at the individual level (IDD), in which case it can be measured by an IDD score (IDDS) (UNSCN, 2008).

A study in Iran used a dietary diversity score adapted from the DQI-R to consider dietary adequacy amongst adolescents aged 10 to 18 years old showed that the dietary diversity score correlated well with the mean adequacy ratio for 12 nutrients (r = 0.42, P<0.001) and that there was a statistically significant correlation between the nutrient adequacy ratios of most nutrients with the dietary diversity score (Mirmiran et al., 2004). Hence, dietary diversity has long been recognized by nutritionists as a key element of high-quality diets. Increasing the variety of foods across and within food groups is recommended by most dietary guidelines, in the United States (U.S. Department of Agriculture Human Nutrition Information Service 1992) as well as internationally (FAO, 1996), because it is thought to ensure adequate intake of essential nutrients and thus to promote good health. Additionally, with the current recognition that dietary factors are associated with increased risks of chronic diseases, dietary recommendations promote increased dietary diversity along with reducing intake of selected nutrients such as fat, refined sugars, and salt (Ruel et al, 2002).

2.3 Measuring the Nutritional Status and Dietary Intake of Adolescents

Generally, anthropometric measurements provide one of the most important indicators of a person nutritional status. When the parameters height, weight, and age measures are combined, the four indices of physical growth used in describing the persons nutritional status are height for age, weight-for-age, weight-for-height and BMI/BMI-for-age.

2.3.1 Height-for-age

Low height-for-age index identifies past under-nutrition or chronic malnutrition. It cannot measure short term changes in malnutrition. For children below 2 years of age, the term is length-for-age; above 2 years of age, the index is referred to as height-for-age. A deficit in length-for-age or height-for-age is referred to as stunting.

2.3.2 Weight-for-age

The WFA index is used to assess underweight. It shows how a childs weight compares to the weight of a child of the same age and sex in the WHO standards. The index reflects a childs combined current (acute) and past (chronic) nutritional status. Thus, it is unable to distinguish between the two.

2.3.3 Weight-for-height

The WFH index is used to assess wasting. It shows how a childs weight compares to the weight of a child of the same length/height and sex in the WHO standards or NCHS references. The index reflects a childs current nutritional status. This index is problematic because at a given height, the median weight differs depending on age. This does not allow analysis of weight-for-height across wide age categories (Cogill, 2003).

2.3.4 BMI/BMI-for-age

Body Mass Index (BMI) is an anthropometric index of weight and height that is defined as body weight in kilograms divided by height in meters squared (Keys et al., 1972). BMI is the commonly accepted index for classifying adiposity in adults and it is recommended for use with children and adolescents. BMI is a screening tool used to identify individuals who are underweight or overweight. BMI is NOT a diagnostic tool (Barlow and Dietz, 1998). Because BMI changes substantially as children get older, BMI-for-age is the measure used for children ages 2 to 20 years. Because adiposity varies with age and gender during childhood and adolescence hence, BMI is age and gender specific (Hammer et al., 1991; Pietrobelli et al., 1998).

2.4 Dietary Pattern and Nutritional Status of Adolescents

Several studies mostly in developed countries outlined that adolescents engaged in unhealthy dietary patterns such as snacking, skipping meals, low intake of fruits and vegetables and milk, as they strive to establish themselves as adults in society. According to the National Adolescent School Health Survey (US Dept Health and Human Services, 1989), more than 50% of the respondents missed breakfast, 90% snack, with only 39% reported eating nutritious snacks. A study in Austria (Nowak and Speare, 1996) indicated inadequate intake of fruits, vegetables and dairy products among adolescents. In the USA, adolescents frequently had intake of vitamin A, vitamin E, calcium, magnesium and zinc below recommended levels (Johnson et al, 1994). In Nigeria, street foods contributed 21% (boys) and 29% (girls) of adolescents energy intake, 50% of dietary protein, 64% of calcium, and almost 60% of vitamin A (Oguntona and Kanye, 1995)

According to Gursoy et al, (2008), a psychosocial factor that affects almost all of the students is the “taste and sensory perception of food”. The second noticeable factor is the “health and nutritious value of food”. The time conserved and the convenience in the preparation of food is one of the lifestyle factors that affect more than half of the students. The cost of the food was also found to have an effect. Among the third group of factors categorized as “media”, the leading factor is advertisement, effective in one third of the students. Among boys and girls, there was no statistical difference in the type of meal skipped.

2.5 Malnutrition in Uganda

In Uganda, scholars have estimated the prevalence rate of stunting among children under the age of 5 years old to be between 30-39.9% (WHO, 2012) with some estimates over 45%(15,16) depending on the region. In 2006, USAID estimated the prevalence rate of wasting and underweight in Uganda to be 6% and 16% respectively. In addition to stunting, wasting, and underweight indicators, Uganda also has a high prevalence of micronutrient deficits, specifically Vitamin A and Iron deficiencies (Acham, 2012). Vitamin Adeficiencies alone will result in over 160,000 child deaths from 2006-2015, according to USAID(FANTA 2010). The prevalence of malnutrition throughout Uganda is a public health concern. In fact,scholars attribute 60% of all deaths of children less than 5 years of age in Uganda either directlyor indirectly to malnutrition (Kikafunda, 1998). Unfortunately, gaps exist throughout the literature with regards to measuring school-age childrens malnutrition levels. A recent study estimates that10%, 9%, and 13% of the school-age children in Uganda are underweight, thin, and stunted, respectively (Acham, 2012). In Wakiso District, a study in 2012 found that 22% of school-age children were stunted, 5% were underweight, and approximately 19% suffered moderate acute malnutrition (Francis, 2012).

2.6 Factors that determine the provision of adequate meals in boarding and non-boarding schools.

According to Gursoy et al,(2008), a psychosocial factor that affects almost all of the students is the “taste and sensory perception of food”.  The cost of the food has an effect on adolescents dietary intake”. This may be due to inadequate knowledge on what constitute a balanced meal. In an environment where food insecurity is rife, adequate knowledge on the nutritional value of locally available food is a requisite in planning balanced meals. However, this is not so, as most of the available nutritional value of foods are complex and difficult to interpret without experts advise.

The second noticeable factor is the “health and nutritious value of food”. The time conserved and the convenience in the preparation of food is one of the lifestyle factors that affect more than half of the students. The cost of the food was also found to have an effect. Among the third group of factors categorized as “media”, the leading factor is advertisement, effective in one third of the students. Among boys and girls, there was no statistical difference in the type of meal skipped.

Inadequate and unreliable government subventions (funds), according to UNESCO, well-managed boarding schools provide good nutrition, hygiene, sanitation, a balance daily routine of personal care, sports and recreation and study habits that children introduce to their own homes and families and to their lives as adults (UNESCO, 2005) and emphasizes lack of healthy food in case of under-funding.

2.7 Knowledge Gap

Most of the researchers have shown the problem of School Feeding Programme in relation to student academic performance. Some other studies have also indicated the influence of school feeding at primary school level. Limited studies seem to have focused on of school feeding at secondary school level. This study therefore looks at the school feeding in student in secondary schools.

CHAPTER THREE:  METHODOLOGY

3.0 Introduction

This chapter presents the methodology that was used in the study. This includes the research design, study population, sample size, and data collection method, sources of data, data reliability, data validity, data processing, analysis and presentation, measurement of variables and limitations of the study.

3.1 Study Area

The study was carried out in Light Secondary and Vocational School Bulenga which is both located in Sumbwe Parish, Wakiso Sub-county, Wakiso District of Central Uganda 11 kilometers from Kampala City Center along Mityana Highway. The school started on 22^nd June 1993 with 4 students, 8 teachers and four support staff under Mr. Joseph Mbuga Kiberu the founder Director of the school.  The original name for school was Light Academy Bulenga which was changed during the time of registration and classification of the schools where they were advised to get a name which reflected the curriculum they were offering and since their vision is to “establish a leading educational complex in East Africa,” The Director therefore choose Light Secondary and Vocational School, Bulenga a name which was not bound by curriculum but worth for Primary, Secondary and for tertiary education and when they started the Primary wing the Light Primary School Bulenga came up.

The school has a very humble beginning of what is now a giant educational complex which grown and expanded to currently 700 boarders and about 300 day scholars.  the schools growth is attributed to excellent discipline, high quality education, a record of very good performance usually 100% pass predominately in 1^st and 2^nd grades at U.C.E while U.A.C.E usually above 80% attain the minimum university entry requirements.  The school upholds a philosophy of “Education for self-reliance giving a unique curriculum and wide variety co-curricular activities, entrepreneurship education, business education and sciences are some of the subjects offered in their curriculum.  It has modern facilities like well-equipped library, computer laboratory and modern science laboratories to ensure excellent teaching of science subjects.  Therefore, this study was carried out in Light Secondary and Vocational school, Bulenga because it consists of students from diverse social, cultural, economic, religious and ethnic groups as well as being a population made of the young generation who are highly susceptible to changes that are current in dietary patterns and nutrition related conditions.

3.2   Study Design

An analytical cross sectional design was adopted in the proposed study. This design is used where there is a cross section of respondents and data is collected from them at a single point in time. A cross sectional survey provides a systematic description that is as factual and as accurate as possible. The study applied quantitative and qualitative approaches. Quantitative designs therefore helped to describe the current conditions and investigate the established relationships between the identified variables. Quantitative approaches was adopted when sampling, collection of data, data quality control and in data analysis.

3.3       Study Population, Sample size and sampling technique

3.3.1    Target Population

Kombo and Tromp (2006) define target population as a group of individuals, objects or items from which samples are taken for measurement. The target population of this research was the head teachers, educational stake holders, teachers, parents, day students and boarding students.

3.3.2    Sampling Technique

According to Kombo & Tromp (2006) sampling design refers to the part of the research plan that indicates how cases or respondents are to be selected for observation. The researcher employed probability and non-probability sampling techniques to obtain information from the sample according to the groups divided. In probability sampling, the researcher selected respondent by using simple random sampling techniques whereby every unit has a chance of being selected. Simple random sampling was used together information from 5 teachers, 75 boarding students, 35 day students and 15 parents.

3.3.2    Sample Size

The sample size of this study was104 respondents because; it was difficult for the researcher to cover the whole population in Light sec and vocational school Bulenga thus few respondents were selected to represent the entire population and were divided into four groups that is educational stakeholders, teachers, parents, boarding students and day scholars as seen in the table below;

Table 1: Population, Sample Size and Sampling Techniques

Source: Primary Data

Sample size formula

N=N1+N(e)2

N = Population

e = Confidence level at 0.05

The sample size (n) is calculated according to Fisher et al., 1991s formula

n=Z2*p(1-p)/e21*p(1-p)/(e2*N)

Where: Z = confidence level (1.96 or 95%)

p = Estimated proportion of population (0.5)

N = population size

E = margin of error (0.05)

3.4   Data Collection

The questionnaires comprised of close and open responses. The questionnaires were designed after a thorough examination of literature on the issue. It was not be adapted from a specific questionnaire. The questionnaire contained six sections all of which were responded by participants except section E in which respondents height and weight was measured by the researchers. Section F was administered to both students and staff to assess factors affecting the provision of adequate diet.

Section A: Socio-demographic characteristics: age, sex, religion, ethnicity, parents educational level and parents occupation.

Section B: Dietary intake: 24 hours dietary recall, reasons for missing meals, breakfast, lunch, and supper at home/dining hall, and frequency of snacking.

Section C: Motivators and Barriers to eating balanced healthy diet; what stops one from eating a well-balanced healthier diet, what encourage you to make improvements to the way you eat, types of food often buy at school and one main reason for choice of food purchased at school.

Section D: Health and sickness/socio-economic status: illness suffer in the past two weeks, where they seek treatment, source of drinking water, kind of toilet facility, source of lighting for the household, type of fuel use for cooking, and household assets.

Section E: Nutritional status by BMI: weight in kilograms, height in meters and BMI-for-age.

Section F: Factors affecting the provision of adequate diet: factors affecting the quality and quantity of food provide for boarders.

The 24 hour dietary recall part of section B of the questionnaire was administered twice to respondents, a week day and week end. Respondents were verbally asked of atypical days.

3.4.2 Focus Group Discussion

This method was used to the students to discuss about the types, quality and quantity of food provided to students. In this regard, questions were prepared for the key informants. Therefore this method was employed to the 20 students, five students from day scholar and 15 students from boarding section. The method was used to them because they are thought to be able to read, write, and discuss their opinions on their dietary practices and nutritional status.

Independent and Dependent Variables

The independent variables of the study included:

Residential status: Boarding or non-boarding

Age: was provided by respondent

Sex: male or female

Religion: respondent were elicited of religious affiliation; Muslim, Christian, traditionalist and others

Level of education of parents: were elicited from respondent; No, Primary, secondary high/vocational/technical, tertiary

Occupation of parents: were elicited from respondent; professional/technical/managerial skill, clerical, sales and services, skill manual, unskilled manual or agriculture.

Height: was measured with a microtoise in standing position against a straight vertical wall barefooted and level headed to the nearest 0.1cm.

Weight: was measured with electronic scale with the person in light clothes and bare footed in standing position.

Food habits:

9. Snacks: yes or No;
10. Like skipping meals: yes or No

Factors affecting provision of adequate diet: were explored from respondents opinion on factors affecting the provision of adequate diet in terms of quality and quantity.

The dependent variables included:

BMI-for-age: age was classified using base on CDC-2000 criterion for (5 — 14) years;<5^th percentile determined thinness, 5^th to <85^th percentile determined healthy weight, 85^th to <95^thpercentile determined overweight while>95^th percentile determined obese.

Food consumption score:

Items were grouped into specified food groups (condiments not included). Then the FCS was determined based on the following thresholds: 0-21: Poor; 21.5-35:Borderline; >35: Acceptable. It was done according to WFP guidelines for measuring FCS.

Dietary Diversity: according to frequency of consumption from each food group; ≤ 3 food groups and > 3food groups. It was done according to FAO guidelines for measuring dietary diversity.

3.4.3    Measurement tools

Calories intake was measured using 24 hour dietary recall while nutritional status was measured using anthropometric Assessment tools, calibrated weighing scale, calibrated height rod and MUAC Tape.

3.5 Measurement of variables

3.5.1 Nutritional status

Anthropometric Assessment Tools was done at the anthropometric assessment section of the questionnaire included measurement of students height, Mid-Upper Arm circumference as well as taking weight measures, Calibrated Weighing Scale was also be used to measure the weight of the students in kilograms, Calibrated Height rod was used to measure the height of the students to the nearest centimeter and MUAC Tape is a non-stretchable tape that was be used to measure the mid upper arm circumference (to the nearest centimeter) of the students on their left upper arms(for right handed students and vice-versa)

3.5.2    Dietary Pattern

During structured interviews, 24-hourdietary recalls was conducted using standard protocols to measure students’ calories intake (Witschi, JC, 1990). The recalls were conducted using standardized probing questions, two-dimensional food models to estimate portion size, and a multiple-pass methodology. The interviewer inspected refrigerators and kitchen storage space to better determine foods actually eaten by participants and the materials in which they were prepared or consumed; and, if necessary, care givers provided supplementary information. Participants were contacted by telephone two more times over the next two weeks to obtain two additional 24-hour dietary recalls, one of which were obtained for a weekend day. Mean daily caloric intake was obtained by taking the average of the three 24-hour dietary recalls.

3.6 Sources of Data

3.6.1    Secondary Data

The secondary data refers to the information gathered from secondary hand since they were primary collected, manipulated and used by other researcher. In this study, secondary data was generated from different sources that include: research papers, public talks and website. This mainly focused on to get a wide understanding on the subjects of dietary intake and nutritional status of secondary school students.

3.6.2    Primary Data

The primary data refers to the information generated from the field they are named primary because they are freshly collected by the researchers and have not been manipulated by any other person. Such data are provided by the subjects correspondents in the sample through scheduled interactions by using well prepared tools (Mugenda, 1999). In this study, two tools were employed; questionnaires and interview schedules. The choice of these tools depended on the type and availability of respondents the time available for the study and the expected effectiveness of the instruments.

3.7 Quality Control

Data quality control techniques ensured that data collected is valid and reliable; the instruments were first tested to ensure validity and reliability.

3.7.1 Validity

According to Kothari (2004), validity of the data collection method refers to the procedures which measure what is supposed to measure. To ensure this the researcher ensured that the data collection methods are directed to respondents who are qualified to give information, and that the information obtained would have been representative of information elicited from the entire population.  Further, the instruments were discussed with the supervisor and experts to ensure construct and content validity. The construct validity of the instrument focused mainly on ensuring that the respondents find the questions simple to understand and answer. To establish validity qualitatively , the instruments was given to the experts (supervisor) to evaluate the relevance of each item in the instrument to the objectives and rate each item on the scale of very relevant (4), quite relevant (3), somewhat relevant (2), and not relevant (1).

3.7.2    Reliability

Reliability is the extent to which a test or procedure of data collection provide similar results under similar conditions on all occasions. Qualitatively, reliability of the instruments was established through a pilot test of the questionnaire to ensure consistency and dependability and its ability to tap data that would answer the objectives of the study. The results of the findings were subjected to a reliability analysis. Quantitatively, reliability was established using the Cronbachs Alpha Reliability Coefficient test. Upon performing the test, if the values 0.7 and above, the items in the instrument was regarded reliable.

3.8 Data Analysis Plan

Data was analyzed using Statistical Package for Social Sciences (SPSS) method. The study adopted descriptive and inferential statistics to analyze quantitative data that was obtained from the questionnaires computed frequencies, percentages, standard deviation and mean was obtained. Data was coded and to undertake thematic development and analytical categorization, the researcher reduced the data to manageable levels by use of coding and later transcribing.

3.9 Ethical Consideration

The researcher avoided fabricating, falsifying, or misrepresenting research data to promote the truth and avoid error. To avoid plagiarism, works of different authors were acknowledged whenever they are cited.  Participants were given adequate information about what the study involved and an assurance that their consent to participate would be free and voluntary rather than coerced and make them aware of their right to opt out of the study if they so wish. A formal permission was sought from the Department of Human Nutrition and Home Economics, Kyambogo University to carry out this study. Formal permission for data collection on students nutrition was obtained from Light secondary and vocational school Bulenga. The signing of the voluntary informed consent by each individual respondent was confirmation that the respondents are not coerced to respondent in the study but are doing so willingly. Participants’ names were withheld to ensure anonymity and the researcher protected confidential communications, such as publication.

 3.10 Justice and beneficence: The researcher explained to respondents use of certain gadgets that they didn’t understand or have little knowledge about e.g. camera and tape recorders.

CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.1 Introduction:

This chapter presents the analysis and interpretation of the research findings. The findings were based on the primary data collected from the field with the aid of the self-administered questionnaires. It also presents the demographic characteristics of the respondents who participated in the study. The data was analyzed with the aid of computer software known as Statistical Package for Social Sciences (SPSS) and summarized in the frequency tables that are used to illustrate the level of responses.

4.1.1 Socio-Demographic characteristics of day scholars and boarder students

Table 2: showing the demographic characteristics of day scholars and boarding students

Source: Primary Data

Majority 38 (79%) of the day scholars were in the age bracket of 16-17 years while only 9(17%) of the boarders were in that age bracket. The table further indicates that 35 (67%) of the respondents in boarding were in the age bracket of 13-15 years and only 6 (12.5%) in that age bracket among the day scholars. More to that, the results further show that the least percentage of respondents was in the age category of 18years and above for both boarders and day scholars (15.4% and 8.3% respectively).

The table indicates that the percentage of Christian students in both day and boarding is similar (83%) and the percentage of Muslims is similar also similar in both categories (17%), These results further show that the percentage of Christians in the school is higher than that of the Muslims.

The results further indicate that majority of the respondents were females in both the boarding section, 42 (81%) and the day section, 35 (73%) of day section. The percentage of males was 19% for boarders and 27% for day scholars.

The findings in the study also indicate that majority 32 (67%) of the day scholars, their parents’ highest academic qualification was tertiary while 23 (44%) boarders had their parents who had with tertiary education. The percentage of boarders whose parents had secondary education and those whose parents had tertiary education was similar. Only 4% of both boarders and day scholars had their parents with no education.

This results shows that 31(65%) of the day scholars in light college had their parents in sales and service professions of the day scholars while 26(50%) of boarders had their parents also doing sales and service as their occupation. Of the day scholars, 15(31%) stated that their parents did technical/professional employment while 25 (48%) of the boarders had their parents doing technical and professional employment.

4.1.2 Dietary intake of students

4.1.2.1 Food consumption scores (FCS)

Table 3: The number of students who had poor, borderline or acceptable food consumption Scores

Source: Primary Data Source

The findings from the study indicate that majority of the respondents had their food consumption score boarderline (66).

Of those with poor food consumption score, 40 where females while males were only 7. Of those who had borderline FCS, 37 were females while 15 were males only one person had their FCS acceptable.

According to the findings in the table, of those who had poor FCS, 22 were boarders and 11 were day scholars while those who had borderline FCS, 37 were day scholars and 29 were borders.

The findings in the table further shows that majority of the students who had a borderline score, 42 had their  parents worked in sales and service while 20 had their parents their professional/technicians. Of the 10 students whose parents were doing unskilled jobs 6 of them had poor food score and the remaining 4 had a borderline food score.

The findings in the study further show that 25 of the students whose parents had secondary school education had a borderline food score and only 13 of them had a poor food consumption score. Majority of the students whose parents had university degree had a food score of borderline (33), while only 16 of them had poor performance. The above findings in the table also show that of the 4 students whose parents had no education 3 of them had borderline performance.

4.1.2.2. 24 hour recall

Graph 1: A bar graph showing foods eaten by the respondents (day scholars and borders) in the last 24 hours

The graph indicates that the commonly eaten foods include posho, porridge, bread, mandazi, chapatti, bread, cassava and rice as most of the respondents reported having eaten them in the past 24 hours.

4.1.2.3 Findings on dietary diversity score (DDS)

Table 4: Showing Dietary diversity score of the students in relation to gender, age, residence and education of their parents.

Source: Primary Data

The findings in the study indicate that most of the students scored low in dietary diversity (74students). Of the students who scored high, 21 were females and 5 were males. While those who scored low, 56 were females and 18 were males.

The findings from the study indicates that majority (42 students) of the boarding section students scored low in dietary diversity while only 28 of the day scholars scored low in dietary diversity.  The results further show that more students in day school (20) scored high more than boarding section students (4).

The findings indicate that majority of the students whose parents had tertiary/university degree had a high dietary score. 4 students whose parents had secondary school education scored high and 2 students whose parents had primary school education scored high and only 1 student whose parents had no education scored high in dietary diversity score.

The study also indicates that most of the boarding section students scored low and the number was only 6. While 20 of the day scholars scored high in the dietary diversity score. As presented by the table indicating that majority 46 of the boarding section students scored low in the dietary diversity score while only 28 of the day scholars scored low.

4.1.3 Anthropometry, BMI and body Composition

Table 4: Showing, weight, height and BMI of boarders and day scholars

Source: primary data

The results from the study indicate that day scholars were relatively heavier than boarders. This is indicated by the fact that the mean weight for the day scholars is 49.5 kg while the mean weight for boarders is 45.5kgs.

The day scholars also have relatively more height than boarders this is shown by the fact that the mean height for day scholars is 143.6cm while that of boarders is 138.7cm.

The findings in the study also show that the day scholars have a higher body mass index than boarders. This is indicated by the mean value of 19.8 while for the boarders is 15.0.

Table 5: Showing the BMI of the students.

Source: Primary Data

The results from the study indicates that majority of the male boarder students are under weight and only 1 student was overweight, the study findings further show that 29 of the female boarding section students were under weight. In addition to the above findings there results further stress that 2 female boarding section students were normal weight while only one was overweight.

There was only one male day scholar student with normal weight and 1 female day scholar students with normal weight the study results further indicate that there were 19 male day scholar students who were under weight and 23 female day scholar students who were normal weight.

The results from the table indicates that 2-day scholar students had normal weight and also 2 boarding section students had normal weight the findings further illustrate that majority both day scholars and boarding section students.

The study findings further show that majority of the students whose parents had no education in both day scholars and boarding section were under weight. While the parents with primary education for day scholars two of them had children with normal weight.

The study results therefore indicate that majority of both day scholars and boarding section students are under weight.

4.1.4 Factor affecting dietary intake

Table 9: Showing factor affecting dietary intake

Source: Primary Data

The study findings show that majority 20(42%) of the Day schooling students agreed that Funds are inadequate and unreliable and 17 (33%) of the day scholars strongly agreed to this. For the boarders, 17(33%) agreed and 10(19%) strongly agreed to inadequate and unreliable funds.

Majority 26 (50%) of the boarding section students agreed that the food served at school is less than the number of students while 12(25%) of day scholars agreed to this. It is also indicated that 21(44%) of the day scholars and 11(21%) of boarders strongly agreed that food served is less than the number of students.

The findings also indicate that the majority of respondents both boarders and day scholars disagreed to cooks smuggling food (25(48%) and 20(42%) respectively). Only 7(13%) of the boarders and 9(19%) of the day scholars agreed to cooks smuggling food.

Majority 18(35%) of the boarding section students agreed that food is improperly cooked while 12(25%) of the day scholars agreed and 16(33%) strongly agreed while 11(21%) of the boarders strongly agreed. the results further indicates that 13(27%) of the day scholars disagreed and 13(25%) of boarders disagreed. This finding therefore shows that the food served at the school is improperly served.

4.1.5 Focus Group Discussion

During the focus discussion group, students stated that,

“There was inadequate supervision of cooks and lack of enough fire wood which partly contribute to serving improperly cooked food.”

Students suggested that,

“The administrators should provide enough firewood and encourage cooks to prepare food in good time.”

They also proposed that,

“The cooking method should be improved on and should also put in place a good storage facilities for both food and firewood”

Students also mentioned that,

“Inadequate water supply, poor time management of cooks and shortage for funds also affect the quality of the food served both at school and at home.”

During discussion group, students were asked whether the food provided to them was enough, a student stated that,

“The food served is enough for everybody though the menu is the same throughout the week and it causes some of them heartburn.”

CHAPTER FIVE

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

The main concern of this study was to compare the dietary practices and nutritional status of secondary students in day schools and to those in boarding schools at Light Secondary and Vocational School, Bulenga. The aim of this chapter is to present the findings, recommendations and draw conclusion on areas for further study.

5.2 Discussion of results

The following are the discussion of the findings;

The average age of students in Light Secondary and Vocational School Bulenga is between 16-17 years old comprising of 17% boarders and 79% day scholars. This implies that on average students are in their adolescences (WHO, 2005). As noted by Cordonier, 1995 majority of adolescents think they are in good health and tend to feel invulnerable with little motivation to protect their health “capital” for the future. This had a direct bearing on health promotion strategies.

The findings of this study indicate generally low food consumption scores for both day scholars and boarders with only one person achieving an acceptable score. The findings also continue to indicate that the commonly consumed foods at school included posho, porridge, chapatti, mandazi, rice,  bread and sodas.

These results are similar to those of Pereznieto et al, (2011). He states that Ugandan adolescents in boarding schools feed on an imbalanced diet consisting of porridge for breakfast and beans with highly polished posho, cassava and polished rice for lunch and supper. Beans adequately provide protein and energy but inadequate amounts of micronutrients such as vitamin A, iron, and calcium to meet the adolescent Recommended Dietary Allowance (RDA) requirements. These foods are disliked by the adolescents and treated as food for the poor.  In an attempt to satisfy their nutritional demands; they resort to energy-rich but nutrient-lean snacks sold in school canteens. This leaves them in a wanting nutritional state, as neither do the foods provided by the school sufficiently cater for a balanced diet (Turatsinze, 2012) nor do the different snacks available to them in school canteens (Valverde et al.,2015).

The results indicate that a higher percentage of those with low DDS were borders(63.2%) while a higher percentage of those with high DDS were day scholars(83.3%). This result is also in line with Oguntona and Kanye, (1995) who indicate that adolescents in boarding sections tend to have poor diet because the school normally faces financial constraints and it is unable to provide the healthy meals needed by the students.

This view was also with Story & Neumark-Sztainer, (2005) who stated that adolescents who eat with their families generally consume more nutritious meals throughout the day, compared to those who eat alone or with friends. Delisle et al., (2004) further indicates that iron, zinc, calcium and vitamin A are key deficiencies among adolescents therefore those adolescents who stay in boarding schools and normally do not.

The study reveals that most of the students were underweight, This finding is similar to Kubreizia study in 2011 on 100 adolescents in upper primary school children in Tamale indicate 10% underweight, 7% at risk of becoming overweight and 4% overweight (Kubreizia et al, 2011). Akinyemi et al., (2009) also  indicates the prevalence of malnutrition particularly among adolescents as an alarming global problem affecting about one third of the world population.

The results also indicate that the mean BMI for boarding section students was 15kgm².This finding indicates that majority of the students in the boarding section are under weight.  According to WHO, (2017), when the Body mass index is below 18.5, the person is considered underweight.  This is in agreement with a study carried out by Akinyemi et al., 2009 in two Nigerian schools. It showed that students in boarding school were generally malnourished with inadequate energy intake especially among students of younger ages. Children in boarding schools may be at higher risk of developing nutrient deficiencies compared to those in day schools, probably due to financial constraints in running boarding facilities.

The results in the study further indicate that the mean body mass index for day scholar is 19.8kgm².This finding shows that the day scholars have a higher BMI than their boarding section counter parts.

From the study several factors affect the provision of adequate diet in terms of both quality and quantity. As reported by the students, inadequate and unreliable funds were the factor most highly agreed to. These among others like poor management of cooks, inadequate water supply were reported. In UNESCO, 2005 study in Mongolia and Vietnam it was indicated that well-managed boarding schools provide good nutrition, hygiene and sanitation. UNESCO also emphasizes the risk of unhealthy buildings and lack of healthy food in case of under-funding.

5.3 Conclusion

While we are worried about obesity and its adverse effects among many adolescents, under nutrition is also prevalent in many of the adolescents in schools in both day and boarding.

Inadequate information concerning nutrition is a possible gap among many adolescents, parents, teachers and administrators which requires bridging to ensure good nutrition is achieved.

Inadequate and unreliable funds are major constraints in the provision of adequate diet in schools even in homes for adolescents.

There is still  inadequate information regarding adolescents’ dietary intake and nutritional status in Uganda.

5.4 Recommendations

Health services providers in educational institutions should educate students on nutrition needs in schools and how it affects their nutritional status and general life performance including school performance.

Nutrition education on appropriate nutritional practices should be provided to the students, teachers, parents and the school administration in order for required nutrition practices in the schools to be implemented.

Government or agencies responsible for the release of feeding subventions to schools should ensure adequate and reliable release of such funds. Alternately, school farms and backyard gardening should be encourage and supported in schools.

Nutrition surveillance should be established and intensified to monitor the dietary behaviours and nutritional status of adolescents in secondary schools.

Catering departments in schools should ensure variety in their daily food supplies to meet nutritional needs of students.

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WHO. (2012). 1990-2011 Levels and Trends in Child Malnutrition. World HealthOrganization.WHO-WorldBanks-UNICEF.

STUDY QUESTIONNAIRE

Consent statement

Dear respondent,

I seek for your consent to participate in this study. I am an Undergraduate student of Kyambogo University, Kampala, Uganda. The study aims to compare the dietary practices and nutritional status of secondary students in day schools to those in boarding schools at Light Secondary and Vocational School, Bulenga. The methods of data collection we use are non-invasive and had no effect on your health. Nutrition and health awareness was created among the 300 participants through explanations and interpretations of readings and measurements. Relevant advice and information will be given for dietary improvement, for better current and future health.

All information collected will be handled with confidentially. If you agree to participate in this study, please sign in the space below and proceed with the rest of the questionnaire

Names: …………………………………………………………………………………..

Class:…………………………………………………………………………………….

Signature:………………………………………………………………………………..

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS

To be filled by both borders and day scholars

Now I am going to ask you questions about yourself. Circle or fill in the correct choice for you. Code will be filled by study team.

SECTION 2: DIETARY INTAKE

How many days in the last seven days did YOU eat any of the following foods?

Indicate the number of days each of the foods has been consumed

FEEDING PRACTICES

To be filled by borders

Now I am going to ask you about your usual eating habits and dietary patterns during school time.

(Circle the most appropriate for you)

*A snack is a portion of food, smaller than a regular meal, generally eaten between meals

SECTION 3: Dietary diversity and diet composition

To be filled by day scholars

Please indicate if you agree or disagree with the following statements about you

SECTION 4: ANTHROPOMETRY AND BODY COMPOSITION MEASUREMENTS

SECTION 5: FACTORS AFFECTING THE PROVISION OF ADEQUATE MEALS

Please indicate if you agree or disagree with the following statements

FOCUS GROUP DISCUSSION GUIDE FOR STUDENTS

1. In your own opinion, is the quantity of food provided to you enough: Yes ( ) No ( )
2. If No, what factors account for the inadequate quantity of the food?

………………………………………………………………………………………………………

3. What do you suggest should be done to improve the quantity?……………………………………………

………………………………………………………………………………………………………

4. In your own opinion, is the quality of the food served to students the best? Yes ( ) No ( )
5. If No, what factors account for the poor quality of food?

………………………………………………………………………………………………………

6. What do you suggest should be done to improve the quality of the food?

………………………………………………………………………………………………………

7. A part from the listed factors that affects the quantity and quality of the food, list other factors if any in this space?…………………………………………………………………………………………………………….

Staff Questionnaire.(to be filled by both teaching and non teaching staff members)

Parents questionnaire