Impact of free school lunch program on nutritional status and academic outcomes among school children in India: A systematic review

Introduction Mid-day meal programmes (MDM) were introduced in India to improve school attendance, nutritional status and educational outcomes of school children. Numerous primary studies have examined the impact of the MDM programmes on both nutritional and educational outcomes in various settings across the country. However, synthesising the findings from these studies has been challenging. To address this gap, we conducted a systematic review to assess the effects of MDM programmes on the nutritional and academic outcomes of school children in India.Methods A comprehensive literature search was conducted, and relevant studies published between 1997 and 2022 were included. Two reviewers independently conducted study selection, data extraction and risk of bias assessment. The results were synthesised descriptively.Results The systematic review included 31 studies. Among them, 16 studies focused on academic outcomes, while 18 studies reported children's nutritional status. Studies on MDM Scheme (MDMS) in children show mixed results on nutritional outcomes. While some studies show marginal improvements in height and weight measurements, others show no significant improvement. Regular MDMS access improves enrollment, attendance and retention rates for children, with lower dropout rates and higher academic achievement. However, its impact on academic performance remains unclear.Conclusion The MDM programme in India was effective in improving the academic achievement and a few nutritional outcomes of school children, underscoring the importance of sustaining MDM programmes in India.Protocol registration number The review was prospectively registered in PROSPERO (CRD42023391776). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023391776.https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023391776