Eating habits among primary and secondary school students in the Gaza Strip, Palestine: A cross-sectional study during the COVID-19 pandemic

Background: The COVID-19 pandemic has a great impact on the eating habits, dietary intake, and purchasing behaviours of students. At this critical moment, there is an urgent need to identify the eating habits of school students, in particular, who live in low-income countries, during the lockdown period. Therefore, the present study aims to identify the influence of COVID-19 on the eating habits, quality and quantity of food intake among school students in the Gaza Strip, Palestine. Methods: A cross-sectional study was carried out among 2398 primary and secondary school students aged 6-18 year old through an online questionnaire which included questions on socio-demographic, eating habits as well as quality and quantity of food intake. Students over the age of 11 years completed the questionnaire on their own, whereas for students under the age of 12 years, the students' guardians were instructed to answer the questionnaire on their behalf. A Wilcoxon Signed-Rank and McNemar tests were applied to perform a comparison between general dietary habits before and during COVID-19. Also, a Wilcoxon Signed Rank test was used to compare the median scores of food quality and quantity before and during the COVID-19 pandemic based on student's sociodemographic. Results: During the COVID-19 pandemic, there was a significant increase in eating home-cooked foods (91.6%), avoiding ordering food from outside per week (93.3%) and buying groceries online (7.7%) (p < 0.001). There was a marked increase in the students reporting fear about food hygiene outside the home from 20.8% before COVID-19 to 72.9% during the COVID-19 period (p < 0.001). The results showed that the median score for food quality during the COVID-19 pandemic (11.0/6.0) was significantly higher than the before COVID-19 period (10.0, IQR = 8.0) (p < 0.001). The results revealed that the median score for food quantity before the COVID-19 pandemic (15.0, IQR = 5.0) was significantly higher than the during COVID-19 pandemic (14.0, IQR = 7.0) (p < 0.001). The results showed significant differences between the before and during COVID-19 period for food quality and quantity across socio-demographic variables (gender, age group, parent's highest level of education, monthly household income, and household size). During the COVID-19 pandemic, students from a high-income and a small size family had the highest score in terms of food quality and quantity among other counterparts when compared to other counterparts. Conclusion: Eating habits have significantly altered among school students during the COVID-19 pandemic. In spite of some good healthy habits enhanced among students, the quantity and the quality of the food was compromised. Therefore, the responsible officials at the Ministry of Education must focus on enhancing school students' awareness towards increased intake of healthy food and adopting good eating habits during the spread of pandemics and health diseases to avoid its negative effects on students.