Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial

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cg.authorship.typesCGIAR single centreen
cg.authorship.typesCGIAR and advanced research instituteen
cg.authorship.typesConsultanten
cg.contributor.affiliationInternational Food Policy Research Instituteen
cg.contributor.affiliationSaint Petersburg Collegeen
cg.contributor.donorHSA Groupen
cg.contributor.donorCGIAR Trust Funden
cg.contributor.initiativeFragility, Conflict, and Migration
cg.coverage.countryYemen
cg.coverage.iso3166-alpha2YE
cg.coverage.regionAsia
cg.coverage.regionWestern Asia
cg.creator.identifierLilia Bliznashka: 0000-0003-2084-1141en
cg.creator.identifierAulo Gelli: 0000-0003-4977-2549en
cg.howPublishedGrey Literatureen
cg.identifier.dataurlhttps://hdl.handle.net/10568/172594en
cg.identifier.doihttps://doi.org/10.2139/ssrn.5196994en
cg.identifier.projectIFPRI - Nutrition, Diets, and Health Uniten
cg.identifier.projectIFPRI - Poverty, Gender, and Inclusion Uniten
cg.identifier.publicationRankNot rankeden
cg.reviewStatusInternal Reviewen
cg.subject.impactAreaNutrition, health and food security
cg.subject.impactAreaPoverty reduction, livelihoods and jobs
dc.contributor.authorBliznashka, Liliaen
dc.contributor.authorMichail, Monica Georgeen
dc.contributor.authorElsabbagh, Daliaen
dc.contributor.authorGelli, Auloen
dc.contributor.authorSchool Milk Initiativeen
dc.date.accessioned2025-04-03T16:53:33Zen
dc.date.available2025-04-03T16:53:33Zen
dc.identifier.urihttps://hdl.handle.net/10568/174006
dc.titleEffect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trialen
dcterms.abstractBackground: Two billion children globally are estimated to live in conflict-affected areas. School feeding programmes (SFPs) are a widely implemented safety net that supports children during and after conflict. We evaluated the effectiveness of providing milk alongside a high energy biscuits (HEBs) SFP in Yemen on children’s and caregivers’ outcomes. Methods: We implemented a two-arm longitudinal cluster-randomised controlled trial from December 2023 to May 2024. 42 schools in Al Mukha district were randomly assigned (1:1) to: control, where children received HEBs (2 packets (100 grams) daily), or milk, where children received HEBs plus a 120 ml carton of ultra-high temperature milk. Children aged 6-18 years were randomly selected for enrolment. The primary outcomes were children’s dietary diversity and milk consumption. Secondary outcomes were children’s cognition, learning, attendance, nutritional status, and health. Tertiary outcomes were child and caregiver mental health, and household food security. We conducted intent-to-treat analysis using linear mixed effects models adjusting for clustering. The trial was registered with ISRCTN (ISRCTN12225603). Findings: 1,299 children were enrolled. After five months, the intervention increased milk consumption, but had no effect on dietary diversity. Children’s cognition [mean difference (MD) 1.00 (95% CI 0.40, 1.61)], literacy [1.14 (0.36, 1.92)], and numeracy [1.06 (0.46, 1.67)] scores improved. Cough symptoms declined: -0.12 (-0.2, -0.03). There was no effect on school attendance or nutritional status. The intervention reduced conduct problems in children [-0.52 (-0.97, -0.08)], severe anxiety in caregivers [-0.03 (-0.06, -0.001)], and household severe food insecurity [-0.09 (-0.17, -0.001)]. Interpretation: Adding a daily milk drink to an HEB SFP in Yemen resulted in numerous benefits for children and their families. Hybrid models to incrementally improve meal quality are feasible, acceptable, and lead to meaningful impacts. More research is needed on medium- and long-term benefits.en
dcterms.accessRightsOpen Access
dcterms.audienceScientistsen
dcterms.available2025-04-02en
dcterms.bibliographicCitationBliznashka, Lilia; Michail, Monica George; Elsabbagh, Dalia; Gelli, Aulo; and the School Milk Initiative. Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial. SSRN Preprint. First available online on April 2, 2025. https://doi.org/10.2139/ssrn.5196994en
dcterms.extent31 p.en
dcterms.issued2025en
dcterms.languageen
dcterms.licenseOther
dcterms.publisherElsevieren
dcterms.relationhttps://hdl.handle.net/10568/168698en
dcterms.relationhttps://hdl.handle.net/10568/163038en
dcterms.relationhttps://hdl.handle.net/10568/170264en
dcterms.relationhttps://hdl.handle.net/10568/151737en
dcterms.subjectmilken
dcterms.subjectmicronutrientsen
dcterms.subjectfood fortificationen
dcterms.subjectschool feedingen
dcterms.subjectdieten
dcterms.subjectnutritionen
dcterms.subjectchild developmenten
dcterms.typePreprint

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