article · Journal of Health Population and Nutrition
Malnutrition remains a severe issue in Pakistan, where stunting and wasting affect roughly 40 percent and 18 percent of children. A synthesis of thirteen studies assessing school-based nutrition measures reveals that direct food provision, including fortified food and feeding programmes, delivers the strongest benefits. These interventions achieved reductions of up to 45 percent in child wasting, around 22 percent in underweight rates, and six percent in stunting, though impacts on stunting varied across evaluations. Nutrition education consistently improved knowledge, literacy, and attitudes regarding healthy eating, yet translated inconsistently into actual dietary behaviour changes. Additionally, micronutrient supplementation yielded mixed outcomes, including an absence of significant reductions in anaemia prevalence within longitudinal tracking. Overall, the available evidence is constrained by short study durations and varied methodologies, highlighting the necessity for longer trials to underpin scalable national nutrition strategies.
Child malnutrition carries severe long-term consequences for physical growth and learning potential. In regions where high proportions of children experience stunting and wasting, schools offer a practical route to deliver nourishment and health literacy. Identifying which delivery models directly improve child health assists public health bodies, educational planners, and funders in directing resources toward initiatives that offer measurable improvements in child development.
The findings provide an evidence base for public health authorities, development agencies, and institutional food suppliers designing school feeding and food fortification initiatives. Because operational school feeding programmes do not yet exist at scale in Pakistan, the work sits at the policy design and early implementation stage rather than near-market deployment. Effective rollouts will depend on further longitudinal trials alongside partnerships to supply quality fortified food products.
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Abstract Background School-based nutrition interventions are a pivotal strategy for addressing the high burden of malnutrition in Pakistan, where stunting and wasting affect approximately 40% and 18% of children, respectively. This scoping review aims to map, characterize, and synthesize the existing evidence on school-based nutrition interventions in the Islamic Republic of Pakistan, identifying key implementation modalities, reported outcomes, and critical research gaps. Methods Guided by JBI methodology and PRISMA-ScR standards, a systematic search was conducted across 14 electronic databases (2005–2025). We included peer-reviewed studies focusing on children and adolescents (ages 5–19) in primary and secondary settings. Interventions were categorized into three modalities: food provision, micronutrient supplementation, and nutrition education. Results Thirteen studies met the eligibility criteria. Direct food-based interventions, including school feeding programs and fortified foods, demonstrated the greatest impact on child nutritional status, with reductions in wasting of up to 45% ( p < 0.001), underweight by 21.7–22% ( p < 0.001), and stunting by 6% ( p < 0.001). Additional school feeding interventions were also reported to reduce wasting and underweight significantly (both p < 0.0001), although improvements in stunting were inconsistent. Micronutrient supplementation showed inconsistent effects on anemia, with one longitudinal study reporting no significant reduction in the prevalence of anemia compared with controls. Nutrition education interventions consistently improved nutrition knowledge and literacy, with significant gains in micronutrient knowledge ( p < 0.05), nutrition knowledge retention ( p = 0.00), and fruit and vegetable knowledge, attitudes, and practices ( p < 0.05). However, corresponding improvements in dietary behaviors were inconsistent across studies. Conclusion School-based interventions show promise for addressing Pakistan’s high malnutrition burden (40% stunting, 18% wasting), but evidence is limited by methodological heterogeneity and short intervention duration. Given the absence of operational school feeding programs in Pakistan, these findings provide critical evidence for developing national policies. High-quality, longitudinal trials are urgently needed to confirm sustainability and guide scale-up.
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DOI: 10.1186/s41043-026-01434-3
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