enjoy greater learning productivity per year in the form of school attendance and homework
completion. Young children who are malnourished also tend to show less positive affect, be
less attentive, more apathetic, have poor social skills and have lower levels of play than healthy
children (Gardner et al, 1999; Graves, 1978; Galler and Ramsey, 1989, Richardson et al, 1972).
9
Randomised trials that have provided food supplements to improve the nutritional status
of children have yielded gains of between 6 and 13 developmental quotient points for treatment
children compared to those in the control group with regards to motor development, mental
development and cognitive development (Waber et al, 1981; Grantham-McGregor et al, 1991;
Pollit et al, 1993; Pollitt et al, 2000). /footnote A longitudinal study in Kenya (Sigman et al,
1989) documented that children who were better nourished achieved higher scores on a test of
verbal comprehension and higher scores in Ravens matrices. Improved attention spans were
particularly evident for well-nourished girls. Sigman et al (1991) also examine the extent to
which cognitive abilities of 5 year olds in Kenya was affected by nutritional status. They show
that food intake during the first two and a half years of life, and physical stature at two and
half, was associated with better cognitive skills at age 5. Less information is available on the
long term benefits of nutritional supplementation to children who are already malnourished,
and the evidence that does exist has been the product of flawed research designs. These include
low take-up of nutritional supplements, small sample sizes, and a follow-up period that was too
short for any real benefits to have accrued. However, evidence from a study in Guatemala
where food supplementation was begun during pregnancy and continued until the child was
aged 2 suggest significant benefits, with these infants exhibiting less anxiety at age 6-8 and
greater social skills (Pollitt et al, 1993; Barrett et al, 1982).
Provision of food supplements in the form of school meals may yield additional benefits over
and above nutritional benefits. There is some evidence to suggest that this may also encourage
attendance at school. Vermeersch and Kremer examine the effect of school meals on school
participation in Kenya, and find that participation was 30% higher in Kenyan pre-schools
where a free breakfast was introduced, than compared to control pre-schools where no such
intervention occurred. Despite the fact that the provision of meals reduced teaching time, they
also show that test scores were 0.4 standard deviations higher in treatment schools, although
this was only the case if the teachers had good qualifications prior to the implementation of the
programme. Alderman et al (1997) find that in Pakistan, a childs health and nutritional status
is a significant predictor of school enrolment, and this is particularly the case for girls, thereby
closing the gender education gap. Attanasio and Vera-Hernandez (2007) conduct an evaluation
of a large scale community nursery programme in rural Colombia, which was implemented with
the specific aim of providing nutritional supplementation and childcare to poor households.
10 Attanasio et al (2007) demonstrate that this programme had large and significant effects,
both on the outcomes of the children, but also in terms of a labour supply effect for mothers
in particular. More specifically, they show that a 6 year old boy who had been enrolled in
this programme since birth would be 4.36 centimetres taller on average than boys who had
not benefited from this programme, with an estimate of 4.41cms for girls. Moreover, mothers
whose children were enrolled in this programme were 31% more likely to have been employed
than mothers whose children were not enrolled.
Schultz (2007) examines the impact of the PROGRESSA programme in Mexico, which
9A longitudinal study by Berkman et al (2002) in Peru demonstrates that stunting at age 2 impacts negatively
on cognitive outcomes measured at age 9, while a study in the Philippines demonstrated that stunting at age 2
led to higher drop out rates, later enrolment ages, higher grade repetition, and lower IQ scores amongst children
at age 8 and 11. Walker et al (2005) provide evidence from Jamaica that shows that stunting before age 2 is
associated with lower cognitive abilities and school achievement and higher dropout rates at age 17.
10In rural communities, eligible parents were asked to form local parents associations, and each association
then elected a community mother. The community mother provided the childcare, and received up to a maximum
of 15 children (all children of parents who were members of the parents association) in her home, in return for
which the parents paid a small monthly fee to her. In addition, the state provided funds to provide food which
was delivered on a weekly basis to the community mothers home. The children received three nutritionally
balanced meals a day, lunch and two snacks as well as a nutritional drink. These food supplements were
designed by a nutritionist to provide 70% of the daily recommended caloric intake for these children.
15