The School Food Environment in Ghana is Associated With Dietary Diversity and Anemia: Findings From the 2022 National Nutrition and Health Survey of In-School Adolescents.

BackgroundSchool food environments may play an important role in shaping children's dietary habits, health, and nutrition.ObjectivesThis study aimed to evaluate associations between the school food environment and nutrition among in-school adolescents in Ghana.MethodsData were collected in Ghana in 2022 in a national nutrition and health survey of adolescents attending junior (JHS) and senior high schools (SHS). Foods observed on campus or reported in the dietary recall were aggregated, a composite Adolescent Dietary Diversity Score (ADDS) was derived, and the proportion achieving minimum dietary diversity was estimated. Multi-level regression models were used to assess associations between a ranked school food environment score (FES) and nutrition outcomes.ResultsThe number of food groups served or available for purchase was 6.2 in JHS and 8.1 in SHS (-value <.0001). The mean (95% CI) FES was 10.9 (10.1, 11.7) at JHS and 14.3 (13.6, 14.9) at SHS. ADDS ranged from 4.1 to 4.8 across strata. Higher FES was positively associated with ADDS and minimum dietary diversity among SHS students and negatively associated with anemia in 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) compared to students in low FES schools.ConclusionsHigher FES was associated with greater dietary diversity among SHS students and lower odds of anemia in girls and boys, suggesting that the school food environment may play a role in determining nutrition outcomes.