4.5.1 Socio-demographic characteristics Household Head
In light of the findings of this study that was conducted in primary schools in urban and peri-urban areas of the South-east district Botswana, the results showed that less than half of the learners (41.6%) came from male-headed households, which is similar to national statistics (Statistics Botswana, 2018). The association between female headed households and being of a low socio- economic status is well-documented (Nwosu & Ndinda, 2018; Muleta & Deressa, 2014). It is therefore not surprising that a higher percentage of learners from the private school came from father/male-headed households.
Mode of Transport
When comparing the mode of transport to type of school, the majority of learners attending government schools (SFP beneficiaries), walked to school while learners from the private school used either public transport or were transported with a vehicle from home. When comparing learners from urban versus peri-urban areas, the mode of transport to get to school was public transport or walking, while peri-urban learners most often walked to school. A study conducted by Porter, Abane, Munthali, Robson & Mashari (2011), investigated the mode of transport used by learners to get to school in Ghana, Malawi and South Africa. The finding was that the majority of children from both urban and rural areas walked to school. These findings are not in agreement with that of the current study, possibly due to a difference in the socio-economic status of the learners surveyed or the fact that learners attending peri-urban schools in the current study, do not equate to the rural participants in the study cited. In addition, the study also highlighted the fact that despite the availability of good transport systems in urban areas, affordability thereof could be a barrier to making use of it, despite unfavourable weather conditions, harsh terrain and safety risks associated with walking. A study by Rothman, Macarthur, To, Buliung & Howard (2015) that examined the risk of walking to school in urban areas, found that a higher prevalence of walking was associated with higher pedestrian collision rates (IRR=3.47; 95% CI=1.15). It was
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also observed that some of the younger learners that did not form part of the study sample, were seen walking to school unaccompanied by an adult. Despite the risks involved in walking to school, the health benefits of walking are well documented (Chillon, Panter, Corder, Jones &
Sluijs, 2015; Roth, Millett & Mindell, 2012). However, when comparing studies conducted in westernized countries, the distance to school was found to be a major barrier to walking to school (Su, Jerrett, Macconnell, Berhane, Dunton, Shankardass, Reynolds, Chang & Wolch 2013).
However, the latter study showed that learners enrolled in the free lunch program, were positively associated with walking to school (OR=3.66; 95%CI = 1.64 – 8.21).
4.5.2 Dietary diversity
Although school feeding is associated with improved dietary diversity (Zenebe, Grebremedhin, Henry & Regassa, 2018), in the current study, 41.5% (n=137) of the learners that were beneficiaries of the SFP, had a low dietary diversity score. In addition, despite the SFP intervention, there was significant difference between the learners in government and private schools regarding the dietary diversity scores. The current study therefore demonstrated that other factors may contribute to the lack of dietary diversity observed, or that the SFP did not make a significant contribution to the dietary diversity of its beneficiaries. This indicates that there is a need to assess the nutritional impact of the SFP and assess the efficiency of the programme in timeously providing food according to the set food ration scales that guide meal provision at government schools. Although not captured by the data collection tools, one of the major concerns regarding the SFP expressed by recipients, was the inconsistent availability and delivery of certain food items. Another reason for the suboptimal DDS documented for so many learners, is that their home diets might centre around the consumption of food groups similar to that provided by the SFP which is also deficient in fruit and vegtables. However, 64.9% of peri-urban learners had a low DDS, indicating that that a possible reason for this finding could be affordability as well as availability. Other studies have linked seasonality to low dietary diversity (Abizari, Azupogo, Nagasu, Creemers & Brouwer, 2017). Hence this may also contribute to a lack of dietary diversity as some of the home grown foods provided through letlhafula food programme are based on seasonal produce. A study by Taruvinga, Muchenge & Mushunje (2013) found that female headed households have a greater likelihood of attaining a high dietary diversity compared to male headed households. However, in the current study, the majority of learners were from female headed
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households. The low DDS of learners from peri-urban areas was similar to the findings of a study that examined DDS among rural households in North Central Nigeria, as results also revealed a lack of dietary diversity (Agada & Igbokwe, 2015). It is therefore important to note that children consuming a diet that lacks variety and hence has a low dietary diversity, are at risk of developing nutritional deficiencies (Ochola & Masibo, 2014; Olumakaiye, 2013).
In terms of DDS documented per school surveyed, the school with the lowest mean DDS (2.6 ± 0.5) was located in an urban area, while the school with highest mean DDS was the private school and therefore a not a beneficiary of the SFP. The private school also had the lowest score for the HFIAS. Baratani primary school, located in peri-urban area had the highest mean HFIAS score.
Assuming that learners from the private school are from higher socio-economic status and are food secure, the results are consistent with a study by Faber, Schwabe & Drimi (2009). In the latter study, households with a low DDS (< 4) had a higher HFIAS than households with a DDS above 4. In a study by Zenebe et. al (2018), beneficiaries of the SFP had a higher mean DDS (5.8 ± 1.1) than the non-beneficiaries (3.5 ± 0.7) (P < 0.001). However, the low DDS among learners participating in the SFP can be attributed to school meals with limited variety, especially with regards to fruits and vegetables (APPENDIX O).
4.5.3 Food security
The majority of learners who were severely food insecure attended schools that were located in peri-urban areas. Availability and access to nutritious foods have been found to be an obstacle to improved dietary diversity among rural populations (Govender, Pillay, Siwela, Modi &
Mabhaudhi, 2017).
4.5.4 Physical Activity Levels
The current study documented that the majority of learners from urban areas had a moderate PAL.
Although the same held true for learners from peri-urban areas, more learners in peri-urban areas had a high PAL than their urban counterparts. A cross-sectional study that surveyed urban South African learners 8 to 14 years of age, found that there was a gender and regional difference in physical activity levels of the study participants (Van Biljon, Mckune, DuBose, Kolanisi &
Semple, 2018). The difference in PAL documented for urban versus peri-urban learners in the current study, could be attributed by the fact that the majority of learners walked to school whereas
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learners in urban areas walked to school and were dropped off at school, either by a vehicle from home or due to using public transport.