(P24-034-24) The Ghana School Food Environment Is Associated With Dietary Diversity and Anemia: Findings From the 2022 National Nutrition and Health Survey of In-School Adolescents

Objectives: School food environments may play an important role in shaping children’s dietary habits, health, and nutrition. This study aims to evaluate associations between the Ghana school food environment and adolescent nutrition.

Methods: Data were collected in Ghana in 2022 in a national nutrition and health survey of adolescent girls and boys aged 10–19 years attending junior (JHS) and senior high schools (SHS). Foods observed on campus or reported in 24-hour dietary recall were aggregated into 10 food groups. A composite metric (adolescent dietary diversity score, ADDS) was derived for each adolescent and the proportion achieving minimum dietary diversity cutoffs (≥5 and ≥6 food groups) was estimated. Anemia was measured using venous blood for girls and pooled capillary blood for boys. A food environment score (FES) was created using questionnaire items spanning three dimensions of the school food environment: policy, physical, and sociocultural. The FES was ranked into tertiles (high, medium, and low) and multi-level regression models were used to assess associations between FES and nutrition outcomes.

Results: Among the 240 schools reached, 6331 adolescents participated in the survey. Anemia prevalence was 22% among girls and 11% among boys (p-value < .0001). The number of food groups served or available for purchase was 6.2 in JHS and 8.1 in SHS (p-value < .0001). The mean (95% CI) FES was 10.9 (10.1, 11.7) and 14.3 (13.6, 14.9) at JHS and SHS, respectively. ADDS ranged from 4.1 to 4.8 across all strata (sex, school level, and wealth). A greater proportion of boys consumed pulses compared to girls (45% vs 35%) while more girls consumed other fruits (23% vs 17%). Higher FES was positively associated with ADDS and consuming >5 food groups among SHS students and negatively associated with anemia in both girls and boys. Girls from high FES schools had 24% lower odds of anemia (OR: 0.76, 95% CI: 0.63, 0.93) while boys had 46% lower odds (OR: 0.54, 95% CI:0.34, 0.84).

Conclusions: Among in-school adolescents in Ghana, higher FES is associated with greater dietary diversity among SHS students and lower odds of anemia, suggesting the importance of investing in the school food environment to improve adolescent nutrition, especially among girls who are more vulnerable to anemia.

Funding Sources: Oak Ridge Institute for Science and Education