title: School feeding: outcomes and costs.
abstract: BACKGROUND
  School-feeding programs are popular development assistance programs in developing countries but have previously had few sound, empirical analyses of their effectiveness and costs.
  
  
  OBJECTIVE
  The goals of this study were to provide a realistic estimate of the costs of school feeding and combine these estimates with outcome information to obtain the cost per outcome.
  
  
  METHODS
  Cost studies were conducted in three African countries by reviewing school-feeding costs provided by the World Food Programme and interviewing stakeholders in ministries of education and in the community. In another African country, existing costing information was used. To compare across the countries, costs were standardized for a 200-day school year, a 700-kcal per day ration, and when children were not fed. To obtain cost per outcome data, outcomes were obtained from a review of school-feeding studies.
  
  
  RESULTS
  The cost of school feeding ranged from U.S. $28 to U.S. $63 per child per year (weighted mean cost of U.S. $40 per child per year). The cost for an extra day of attendance was less than U.S. $10 per student, while the cost per extra kilogram of weight ranged from U.S. $38 to U.S. $252. Costs for cognitive outcomes were similarly variable.
  
  
  CONCLUSIONS
  This analysis estimates a higher average cost but a narrower range of costs when compared with previous estimates, reflecting the greater precision of the current analyses. The cost per outcome was high, but this analysis does not capture the full range of outcomes (e.g., social protection, educational achievement) potentially derived from school feeding.
authors.affiliation: Program for Appropriate Technology in Health, Washington, DC 20006, USA. rgalloway@path.org
authors.forename: Rae
authors.initials: R
authors.lastname: Galloway
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kristjansson
authors.forename: Aulo
authors.initials: A
authors.lastname: Gelli
authors.forename: Ute
authors.initials: U
authors.lastname: Meir
authors.forename: Francisco
authors.initials: F
authors.lastname: Espejo
authors.forename: Donald
authors.initials: D
authors.lastname: Bundy
mesh_terms: D000293:Adolescent; D000349:Africa; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003365:Costs and Cost Analysis; D003906:Developing Countries / Q000191:economics; D005522:Food Services / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007360:Intelligence; D017063:Outcome Assessment, Health Care; D012572:School Health Services / Q000191:economics*; D012574:Schools / Q000191:economics*