OBJECTIVE

This review aimed to (i) synthesise evidence of the impact of publicly procured school meals programmes on nutritional outcomes of children/adolescents (5-18 years) in sub-Saharan Africa and (ii) identify challenges and facilitators to implementing effective school meals programmes.

DESIGN

Mixed-methods systematic review ( 7 databases). Nutritional outcomes assessed were anthropometrics (underweight, stunting, wasting, overweight/obesity), micronutrient deficiencies, food consumed and food environment. Qualitative findings were coded using a nine-step school food system framework: and .

SETTING

Sub-Saharan Africa.

PARTICIPANTS

Children/adolescents (5-18 years), parents, school personnel and government officials.

RESULTS

Thirty-three studies (twenty-six qualitative, seven quantitative) from nine sub-Saharan African countries were included. Six studies found a positive impact of publicly procured school meals programmes on nutritional outcomes (wasting ( 1), stunting ( 3), underweight ( 1), vitamin A intake ( 1) and dietary diversity ( 1)). Fifty-three implementation challenges were identified, particularly during (e.g. training, payment), (e.g. meal quantity/quality/diversity, utensils) and (e.g. funding, monitoring, coordination). Implementation facilitators were identified ( 37) across (e.g. programme coordination), (e.g. food preferences, reduced stigma) and (e.g. engagement, positive perceptions). Included policy recommendations targeted , , and in nine, fifteen and twenty-five studies, respectively.

CONCLUSIONS

As many challenges remain, strengthening implementation (and therefore the nutritional impact) of school meals programmes in sub-Saharan Africa requires bold commitment and improved coordination at multiple levels of governance.