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 centre
cg.authorship.typesCGIAR and advanced research institute
cg.contributor.affiliationInternational Food Policy Research Institute
cg.contributor.affiliationUniversity of Edinburgh
cg.contributor.affiliationSchool Milk Initiative
cg.contributor.affiliationHayel Saeed Anam Group
cg.contributor.affiliationHumanitarian Development Program
cg.contributor.affiliationTetra Pak
cg.contributor.affiliationWorld Food Programme
cg.contributor.donorCGIAR Trust Fund
cg.contributor.donorHSA Group
cg.contributor.initiativeFragility, Conflict, and Migration
cg.contributor.programAcceleratorFood Frontiers and Security
cg.creator.identifierLilia Bliznashka: 0000-0003-2084-1141
cg.creator.identifierAulo Gelli: 0000-0003-4977-2549
cg.howPublishedFormally Published
cg.identifier.dataurlhttps://doi.org/10.7910/DVN/UO3VPK
cg.identifier.doihttps://doi.org/10.1016/j.tjnut.2025.06.021
cg.identifier.projectIFPRI - Poverty, Gender, and Inclusion Unit
cg.identifier.projectIFPRI - Nutrition, Diets, and Health Unit
cg.identifier.publicationRankA Plus
cg.isijournalISI Journal
cg.issn0022-3166
cg.journalJournal of Nutrition
cg.reviewStatusPeer Review
cg.subject.impactAreaNutrition, health and food security
cg.subject.impactAreaPoverty reduction, livelihoods and jobs
dc.contributor.authorBliznashka, Lilia
dc.contributor.authorMichail, Monica George
dc.contributor.authorElsabbagh, Dalia
dc.contributor.authorGelli, Aulo
dc.contributor.authorHamid Hossam Al-Qadi, Ahmed Abdel
dc.contributor.authorSaif Al-Ariqi, Munir Hassan
dc.contributor.authorHanash Qasim, Wajdan Hanash
dc.contributor.authorQawi Al-Athouri, Saeed Abdul
dc.contributor.authorHamid Ahmed Abdullah, Majed Abdel
dc.contributor.authorAli Naji Iskandar, Samia Majed
dc.contributor.authorHamoud Al-Battah, Nazma Saleh
dc.contributor.authorHamid Mansour, Salah Fazaa
dc.contributor.authorMohammed Al-Saadi, Samar Saeed
dc.contributor.authorGoel, Mayank
dc.contributor.authorElHelbawy, Sherif
dc.contributor.authorRahman Qasem, Adeeb Abdul
dc.contributor.authorBahader, Hussein
dc.contributor.authorAl-Haj, Waleed Mohammed
dc.contributor.authorAl-Qasus, Adnan Yahya
dc.contributor.authorOhiarlaithe, Micheal
dc.contributor.authorSuliman, Hala
dc.contributor.authorGhimire, Pramila
dc.contributor.authorAlSabahi, Mohammed
dc.contributor.authorAlBasha, Muna
dc.contributor.authorAlameri, Abdulhafeed
dc.contributor.authorAkther, Shahida
dc.contributor.authorQahtani, Fadhl Abdullah
dc.contributor.authorBasaleem, Mohammed
dc.contributor.authorHassan, Mustafa
dc.contributor.authorBawazir, Samah
dc.date.accessioned2025-07-07T19:21:13Z
dc.date.available2025-07-07T19:21:13Z
dc.identifier.urihttps://hdl.handle.net/10568/175529
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. Objective 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 accounting for clustering. Results 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 were no changes in 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)]. Conclusions 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.audienceAcademics
dcterms.available2025-07-01
dcterms.bibliographicCitationBliznashka, Lilia; Michail, Monica George; Elsabbagh, Dalia; Gelli, Aulo; et al. Effect of adding milk to a micronutrient fortified high-energy biscuit school feeding programme in Yemen: A cluster-randomised controlled trial. Journal of Nutrition. Article in press. First published online on July 1, 2025. https://doi.org/10.1016/j.tjnut.2025.06.021
dcterms.issued2025
dcterms.languageen
dcterms.licenseCC-BY-4.0
dcterms.publisherElsevier
dcterms.relationhttps://hdl.handle.net/10568/168698
dcterms.relationhttps://doi.org/10.2139/ssrn.5196994
dcterms.relationhttps://hdl.handle.net/10568/163038
dcterms.relationhttps://hdl.handle.net/10568/151737
dcterms.subjectcapacity building
dcterms.subjectschool feeding
dcterms.subjectconflicts
dcterms.subjectemergencies
dcterms.subjectschoolchildren
dcterms.subjectdietary diversity
dcterms.subjectrandomized controlled trials
dcterms.typeJournal Article

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