Introduction
Many children in Malaysia still suffer from different types of malnutrition. Micronutrient deficiencies remain prevalent with more than half a million adolescents aged 15 to 19 anaemic, while only a third of schoolchildren had the recommended calcium intake.
In 2019, 21.8% of children below 5 and 12.7% of children aged 5 to 17 were stunted i.e. too short for their age. At the other end, overweight and obesity affected 5.6% of children below 5 and about one in three children aged 5 to 17.
Despite rising incomes and standard of living in Malaysia, the situation worsened over the years. The current COVID-19 pandemic will likely exacerbate this as more families struggle with financial shocks particularly due to job and income losses. From April to June 2020, close to 791,800 persons were reported as unemployed, almost a quarter of a million more than in the previous quarter. This was compounded by disruptions to welfare programmes such as the nationwide school feeding programme for poor children, Rancangan Makanan Tambahan (RMT). As children did not go to school during the Movement Control Order (MCO), many pupils were deprived of their daily RMT meals. In 2018, about 489,117 students were registered for the RMT, or about 18% of all primary school students.
With most schools resuming since July 2020, schools should be leveraged to improve children’s nutrition. What children eat in school is largely determined by what is provided, and this inadvertently shapes their dietary habits. School is the next best place, after home, to inculcate good eating practices. Meanwhile, the benefits of children from different backgrounds helping one another to share the same meals are important for fostering social cooperation, interaction, consideration and camaraderie.
Eating at School During the COVID-19 Pandemic
As part of the new normal, standard operating procedures (SOPs) with regards to eating in school were introduced to prevent the spread of the COVID-19 virus. Students either bring their own meals from home or pre-order packed foods at school to eat in their respective classrooms during recess.
At least some parents have expressed concerns about the nutritional value of school meals. Anecdotes suggest that meals sold include deep-fried bread and fried noodles with little or no vegetables. The menu choices served to children for years before the COVID-19 pandemic suggest little change. It is hard to defend these foods as nutritionally balanced. While there are guidelines for school food suppliers i.e. the Healthy School Canteen Guidelines, much more pro-active monitoring of school food serving is desirable.
There is also need for the Ministry of Health (MOH) to advise on the menus and related matters to improve the nutritional value of the food served much more cost effectively. MOH’s Program Hidangan Berkhasiat di Sekolah (HiTS) in north Johor and elsewhere in Malaysia appears to have been able to significantly improve children’s physical and cognitive development at much lower cost.
Improving Nutrition Through Schools
The new SOPs provide a unique opportunity to improve food choices and dietary practices in schools. More parents are now aware of the meals available every day in schools, making it easier for them to track and assess the quality of meals.
With a direct interest in their children’s development, parents should be allowed to participate more in drafting healthy menus together with schools and food suppliers, and in ensuring that meals served are nutritionally balanced. Importantly, nutritionists from the MOH’s district offices must always be included to provide expert advice on the menu and nutrition standards.
For simple reference, all meals prepared must follow the MOH’s Healthy Plate, where ‘plates’ should be half-filled with fruits and vegetables, a quarter-filled with protein sources, and another quarter-filled with carbohydrates. Even if students only want snacks for dietary energy for the remainder of the school day, the options should be healthy i.e. optimum in terms of caloric content and meeting the children’s other daily micronutrient needs. Decisions on the menu would also need to ensure broad affordability.
For better enforcement, accountability can be enhanced by regularly taking photographs of prepared meals and ensuring that food served does not contain toxic substances, such as agrochemicals. This can be done with teachers actively sharing reports and photographs of eating activities with parents and nutritionists using appropriate and convenient means such as Whatsapp, Telegram and Facebook.
School Feeding Programme for All
It goes without saying that these suggested improvements apply to RMT as well. Including all students regardless of socioeconomic backgrounds in the programme (not just the poor), is more pressing than before.
Poor nutrition and bad eating habits are not problems of the poor alone. For example, in 2019, about 16.8% of children below 5 years old from T20 households were stunted, not far off from the 22.4% prevalence rate in B40 households. By targeting only poor kids, these children are automatically excluded.
Using the poverty line income (PLI) as the eligibility threshold means children are excluded when household income is above the PLI, even just marginally. Administrative obstacles to register for the programme and to prove eligibility can also be deterring factors. The value of school meals under RMT is significant, about RM60 per month. For families with several children, that adds to substantial costs. In this context, RMT can be a way to reduce household expenditure burden.
A universal programme would also eliminate possible shaming of students receiving food assistance as all children, regardless of background, eat the same meals at the same table. As children from different walks of life gather, positive values such as mutual understanding and cooperation can be instilled.
Furthermore, school feeding can informally educate kids on the importance and benefits of adopting a healthy diet. A universal school feeding programme can ensure that the why and how of eating healthily are ingrained in all children’s minds.
Investment for the Future
According to the World Health Organization, “(t)he enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” Since eating right is key to good health, it should be attainable by all.
What we eat affects our immune systems, including the ability to fight and recover from infections—an essential ability through life. Good nutrition during childhood and adolescence are linked to better health outcomes through life, physical and cognitive development as well as higher income earning capabilities. As such, eating right is imperative for children’s biological and personal growth and the long-term growth of the nation, making nutrition interventions high return investments.
If we are serious in ensuring the best for our kids today and in a post-pandemic era, then we need to get serious about improving our children’s health, including child malnutrition. Budget 2021 is the opportune time for the government to show this commitment.
