Assessment of Nutrition Education Practices and Their Impact on Child Health Among Primary School Pupils in Rural Communities in Nigeria

lists of included articles were scanned for further studies. National survey data on child nutrition were drawn from the Nigeria Demographic and Health Survey 2018 and 2023–24. 3.3 Eligibility criteria Studies were included if they: 1. were conducted in Nigeria; 2. involved primary school pupils (roughly aged 5–15) or their teachers; 3. reported on at least one of the following: nutrition education content or delivery, teachers’ nutrition knowledge, pupils’ nutrition knowledge or dietary practice, anthropometric status, micronutrient status, helminth infection or school feeding; and 4. were published between 2008 and 2025 in English. Studies focused only on children under five, on secondary school students alone, or on clinical populations were excluded. Rural-only and rural–urban comparative studies were given priority, but urban intervention studies were retained because they are currently the only Nigerian evidence on the effect of nutrition education. 3.4 Data extraction and synthesis For each study, the following were recorded: author and year, state and setting (rural, urban or both), design, sample size, population, and main findings relevant to the research questions. Findings were then grouped into four themes that mirror the research questions: (a) nutrition education practices and teacher preparedness; (b) the nutritional and health status of rural pupils; (c) the effect of nutrition education interventions; and (d) the role of school feeding and the wider school environment. 3.5 Quality appraisal Each study was judged informally against the criteria commonly used for observational and quasi-experimental research: clarity of sampling, sample size, use of standard measurement tools (for example, WHO AnthroPlus z-scores for anthropometry), presence of a comparison group and appropriateness of analysis. Studies were not excluded on quality grounds, but weaknesses are noted where they affect interpretation. In general, the prevalence studies were stronger methodologically than the intervention studies, most of which lacked a control group or follow-up beyond the end of the programme. 3.6 Ethical considerations This review used only published and publicly available data, so formal ethical approval was not required. Each primary study is cited so that readers can verify the original findings. 4. Results 4.1 Overview of included studies Eighteen primary studies met the inclusion criteria: four nutrition education interventions, two surveys of teachers, eight studies of pupils’ nutritional or dietary status, two studies of pupils in schools running the NHGSFP, and two studies of helminth infection. They span all six geopolitical zones, though the South-West is over-represented, and most were cross-sectional. Table 1 summarises them. Table 1. Summary of included studies Study State / setting Design and sample Key findings Adeoya et al. (2023) Oyo , urban Quasi-experimental, 100 pupils, Primary 4–5, 6 weeks Knowledge mean 20.9 → 22.8; attitude 13.5 → 18.2 (both p < .05) Global Journal of Health Science (2019) Ogun , semi-urban Quasi-experimental, 3 arms, 240 pupils, Primary 5–6 Nutrition education, lifestyle modification and both combined all improved knowledge and healthy eating; girls gained more Ejoh & Oyedele (n.d.) Oyo Garden-enhanced pilot, 24 children aged 6–11, 4 weeks Significant rise in nutrition knowledge; gardening and cooking demonstration feasible Akinlade et al. (n.d.) Ogun (Ilishan- Remo), semi- rural Pupil knowledge survey with education intervention Evaluated pupils’ knowledge and an intervention in a public school Ido LGA teacher survey Oyo (Ido LGA), peri-urban/rural Cross-sectional, 387 teachers 57.1% good, 38.5% fair, 4.4% poor knowledge; public-school teachers Study State / setting Design and sample Key findings scored lower; time and funds the main barriers Alaba & Addo (2017) Ogun Cross-sectional, 100 teachers 55% had good nutrition knowledge; called for practical, food-based content and teaching aids Ayogu et al. (2018) Enugu (Ede- Oballa), rural Cross-sectional, 450 children aged 6–15 Stunting 41.6%, underweight 18.2%, thinness 20.0%, zinc deficiency 43.3%, vitamin A deficiency 51.1% Adenuga et al. (2017) Ogun (Obafemi Owode), rural and urban Cross-sectional, 1,160 pupils Stunting 46.2% rural vs 33.8% urban (p < .001); older pupils most affected Ekiti rural–urban study (2024) Ekiti, rural and urban Comparative cross- sectional, 983 pupils Low dietary diversity 24.8% rural vs 8.5% urban; malnutrition 48.6% rural, 47.1% urban Anambra rural– urban study (2015) Anambra, rural and urban Comparative cross- sectional, 365 pupils Stunting 3.3% rural vs 0.5% urban; underweight linked to low parental education Mafuyai et al. (2012) Plateau , rural Descriptive survey Mean BMI 12.6 kg/m2; nutritional status judged low; authors recommended education on local foods Borno rural study Borno (Bama, Banki), rural Cross-sectional, 400 pupils 62% low socioeconomic class; underweight common and rising with age; no obesity Adedeji et al. (2018) Plateau , urban Cross-sectional, 450 pupils aged 6–12 Stunting 10.5%; higher in public schools, poorer families and children of less-educated mothers Osun–Gombe survey (2021) Osun and Gombe, community Cross-sectional, 1,200 aged 6–19 Under- and overnutrition co-exist (double burden) Obembe et al. (2024) Ondo Cross-sectional, 234 public and 227 private pupils Stunting 20.7% overall, 30.3% in public schools; wasting 23.9% in public schools NHGSFP blood- pressure study Oyo and Ogun Cross-sectional, 40 NHGSFP schools Stunting 41.6% at 10–15 years vs 11.3% at 5–9 years; hypertension 6.0% Imo STH study (2015) Imo (Amaruru), rural Cross-sectional, 284 pupils Helminth infection 30.3%; boys 38.4% vs girls 21.1% Study State / setting Design and sample Key findings North-Central STH study (2024) North-Central, rural and urban Cross-sectional, 1,372 pupils aged 4– 12 Infection 16.8%; rural 18.3% vs urban 15.3%; boys higher 4.2 How nutrition is taught: practices and teacher preparedness Across the studies that describe classroom practice, a consistent picture emerges. Nutrition is taught as a short topic within broader subjects, mostly through lecture and note-copying. Practical elements such as tasting sessions, food demonstrations, gardens or school meal discussions appear only in research projects, not in routine teaching. Teaching aids are scarce, which is why the Ilaro authors specifically recommended posters and games (Alaba & Addo, 2017). Teacher preparedness is moderate at best. In Ido LGA, just over half of teachers had good knowledge of malnutrition, and the gap between private and public-school teachers is worrying because rural children overwhelmingly attend public schools. Teachers themselves named insufficient instructional time and insufficient funding as the main barriers to teaching nutrition and physical education. Neither teacher study found that years of experience or qualification predicted knowledge, which suggests that pre-service training does not reliably equip teachers on this subject. 4.3 The nutritional and health status of rural pupils The burden in rural schools is heavy and is consistently worse than in towns. The clearest direct comparisons are shown in Table 2. Table 2. Rural–urban comparisons among primary school pupils Indicator Study Rural Urban Stunting Adenuga et al. (2017), Ogun 46.2% 33.8% Low dietary diversity Ekiti study (2024) 24.8% 8.5% Stunting Anambra study (2015) 3.3% 0.5% Helminth infection North-Central study (2024) 18.3% 15.3% Three further patterns stand out. First, deficits grow with age: in Oyo and Ogun, stunting was almost four times higher among pupils aged 10–15 than among those aged 5–9, and in Obafemi Owode younger pupils had much lower odds of stunting than those over 13. Second, hidden hunger is widespread. In rural Ede-Oballa, roughly half of the children were vitamin A deficient and more than four in ten were zinc deficient (Ayogu et al., 2018). Third, infection and nutrition are tightly linked. Whipworm infection was associated with markedly higher odds of zinc and vitamin A deficiency, and helminth prevalence in rural pupils ranged from 18.3% to 30.3%. Social determinants recur in nearly every study: low parental, especially maternal, education; poverty; large family size; poor toilet facilities; and attending a public rather than a private school. These are precisely the conditions that characterise rural communities. 4.4 Effect of nutrition education on pupils Every Nigerian intervention identified reported a positive change in knowledge. In Ibadan, mean knowledge scores rose from 20.9 to 22.8 and attitude scores from 13.5 to 18.2 after six weeks (Adeoya et al., 2023). In Ikenne, nutrition education, lifestyle modification and their combination all improved both knowledge and self-reported healthy eating. The Ibadan garden pilot showed that hands-on gardening and cooking could be delivered to young children and raised knowledge scores. The limits of this evidence are just as clear. All four interventions were short, ranging from four to six weeks. None used a randomised design with a separate control group in the same period, and none followed pupils for months afterwards to see whether changes lasted. Outcomes were self-reported knowledge, attitude and practice. No Nigerian study identified in this review measured the effect of classroom nutrition education on height, weight, BMI, haemoglobin, micronutrient status or worm burden. In addition, all four interventions were delivered in urban or semi-urban Oyo and Ogun State schools, not in remote rural areas. 4.5 School feeding and the wider school food environment The NHGSFP is the largest nutrition intervention in Nigerian primary schools, but its educational potential is largely unused. In Ondo State, after more than five years of the programme, public school pupils still had higher stunting (30.3%) and wasting (23.9%) than private school pupils who did not receive meals, though the authors note there was no baseline against which to judge change (Obembe et al., 2024). Grey literature from North-Eastern Nigeria suggests that the programme may improve dietary diversity and height-for-age. None of the feeding studies described any structured nutrition teaching around the meal. Outside the programme, food sold by unregulated vendors remains the default mid-day meal for many older pupils. 5. Discussion The central finding of this review can be put simply: nutrition education in Nigerian primary schools works for knowledge, but there is no Nigerian evidence yet that it works for health, and rural children, who need it most, are the least likely to receive it in a meaningful form. 5.1 A curriculum present on paper but thin in practice Nutrition is not absent from the Nigerian primary curriculum. The problem is the form it takes. A topic covered in two or three lessons a term, taught from a textbook and examined by recall, will produce children who can list the six classes of food but who still skip breakfast and buy fried snacks at break. The teacher surveys reinforce this. Teachers with only moderate knowledge, little time and no materials are being asked to change children’s habits. It is not surprising that they fall back on definitions and notes. The rural dimension sharpens this. Rural public schools tend to have larger classes, fewer resources and a higher share of teachers working outside their specialism. The Ido LGA finding that public school teachers knew less than private school teachers, together with the Jos finding that stunting was higher in public schools (Adedeji et al., 2018), suggests a double disadvantage: the children with the greatest nutritional need sit in the classrooms least equipped to teach nutrition well. 5.2 Why knowledge gains do not automatically become health gains The intervention studies show that Nigerian children respond quickly to well-designed teaching. A six-week programme produced measurable improvement in Ibadan, and girls in Ikenne responded particularly well. This is encouraging. However, the step from knowing to eating differently, and from eating differently to growing better, depends on conditions that schools do not fully control. The first is food access. In rural Ekiti, one in four pupils had a low dietary diversity score. In Ede-Oballa, weekly household food expenditure and household income predicted undernutrition (Ayogu et al., 2018). A child cannot act on a lesson about fruit and protein if the household cannot afford them. The second is infection. With helminth prevalence of up to 30% in rural schools, and with clear links between worm infection and micronutrient deficiency, improving diet alone will not restore growth unless hygiene and deworming improve too. The third is timing. Much stunting is established before school entry, and the evidence that it worsens with age in school suggests that the school years are a period of continued faltering rather than recovery. Nutrition education can slow that decline, but it cannot erase early deficits by itself. This is consistent with the conceptual framework in Section 2.5. Knowledge and attitude are intermediate outcomes. They are necessary but not sufficient. The Nigerian studies stopped at this intermediate step, so they cannot tell us how much of the remaining distance education can cover. 5.3 The missed opportunity of school feeding The NHGSFP places a meal in front of millions of pupils every school day. In principle, that meal is the best teaching aid a nutrition lesson could have: real food, eaten together, that teachers can talk about. In practice, none of the feeding studies described any structured educational component. Meanwhile, the Ondo findings show that the meal alone has not closed the nutritional gap between public and private school pupils. Linking the two, so that the meal becomes a daily nutrition lesson and the lesson refers to the meal, is a cheap and obvious step that has not yet been taken at scale. The Ibadan garden pilot points in the same direction. Gardens give rural schools something they have in relative abundance, which is land and farming knowledge in the community. A school garden can supply vegetables to the feeding programme, give children hands-on lessons and involve parents who farm. This would also align with the “home-grown” principle of the NHGSFP itself. 5.4 Gender, age and the double burden Two subgroups deserve attention. Older pupils, especially those aged 10 and above, show the highest stunting in several studies, yet the NHGSFP mainly targets primary one to three. This leaves the most affected age group outside the feeding programme. Boys had higher helminth infection in both STH studies, while girls appeared to gain more from education in Ikenne. These patterns suggest that programmes should not be one-size-fits-all. At the same time, the Osun–Gombe survey and the Ondo data show that overweight is appearing alongside undernutrition, and the Oyo–Ogun study found hypertension in 6.0% of pupils. Rural areas are not immune to cheap, energy-dense processed foods. Nutrition education in rural schools therefore needs to address both sides: getting enough of the right foods and avoiding the wrong ones. 5.5 Comparison with wider evidence These findings echo studies from other low- and middle-income countries. In Nepal, a 12-week school nutrition education programme improved adolescents’ knowledge and attitudes (BMC Nutrition, 2024). Ethiopian studies of primary pupils have recommended combining community-based nutrition education with school feeding and economic support. The common lesson is that education is most effective as one part of a package rather than as a stand-alone activity, which is exactly the gap observed in Nigeria. 6. Recommendations, Limitations and Conclusion Conclusion Rural Nigerian primary school pupils carry a heavy and largely invisible burden of malnutrition. Stunting affects four in ten children in some rural communities, micronutrient deficiencies are common, worm infection is widespread and dietary diversity is poor. Schools are well placed to respond, and national policy already gives them that role. Yet nutrition education as currently practised is mostly a brief, theory-based topic delivered by teachers who lack time, materials and training. The Nigerian evidence shows that when nutrition is taught well, children learn quickly and their attitudes change. What it does not yet show is whether that learning translates into better growth and health. Closing that gap requires two things. Practically, nutrition education must be connected to food, through school feeding and gardens, to hygiene and deworming, and to parents. Scientifically, it must be tested properly in rural schools with outcomes that matter for children’s bodies, not only their test scores. A rural child who learns what a balanced meal looks like deserves a school system that also helps make that meal possible. 6.1 Recommendations For federal and state education authorities (UBEC and SUBEBs) 1. Revise the primary curriculum so that nutrition is taught as a sequenced strand from primary one to six, with at least one practical activity per term, rather than as isolated topics. 2. Produce low-cost teaching kits built around locally available foods, such as picture cards of local vegetables, legumes and fish, a simple food-group poster in Hausa, Igbo, Yoruba and English, and a handwashing demonstration set. 3. Include nutrition and school health in in-service training for public primary school teachers, prioritising rural local government areas. For the National Home-Grown School Feeding Programme 4. Add a short, structured “meal-time lesson” component, in which teachers or cooks spend five minutes linking the day’s meal to food groups and hygiene. 5. Pilot school gardens in rural schools that supply vegetables to the programme and serve as outdoor classrooms. 6. Consider extending feeding, or at least nutrition education with a food component, to pupils in primary four to six, who show the highest stunting. For health authorities and schools together 7. Combine nutrition education with regular deworming, safe water and handwashing facilities, since infection undermines dietary gains. 8. Introduce simple annual growth monitoring (height and weight) in rural schools, which would also generate the outcome data that is currently missing. 9. Involve parents through Parent–Teacher Association meetings and take-home activities, because household food choices are made by caregivers, not pupils. For researchers 10. Conduct cluster-randomised or well-controlled trials of nutrition education in rural schools, lasting at least one school year, that measure anthropometry, haemoglobin and dietary diversity alongside knowledge. 11. Prioritise the North-West and North-East, where under-five stunting is highest and school- based evidence is thinnest. 12. Evaluate the NHGSFP with proper baselines so that its nutritional impact, with and without an educational component, can be judged. 6.2 Limitations of this review Several limitations should be kept in mind. The review is narrative rather than a formal systematic review, so although searching was structured, some studies, particularly those in print-only local journals, may have been missed. Most included studies were cross-sectional and cannot establish cause and effect. The intervention studies were small, short and conducted mainly in urban or semi-urban South-West Nigeria, which limits how far their findings apply to remote rural communities. 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