Effects of school feeding programmes integrating food systems components on health, nutrition, education and food systems outcomes in low- and middle-income countries: a systematic review protocol.

Abstract

School feeding programmes reach over 466 million children globally, making them one of the largest social safety nets worldwide. Beyond providing immediate nutritional benefits, school feeding programmes increasingly aim to strengthen local food systems through procurement from smallholder farmers, support for sustainable agriculture, community kitchen involvement and broader development outcomes. However, evidence on how school feeding programmes can simultaneously improve nutrition and educational outcomes while transforming food systems in low and middle-income countries (LMICs) remains fragmented. This systematic review will synthesise evidence on the effects of school feeding interventions with explicit food system components on health, nutrition, education and food system outcomes among school-age children and adolescents in LMICs. We conducted comprehensive searches in MEDLINE (PubMed), Embase (Ovid), CENTRAL (Cochrane Library), Web of Science, Google Scholar, completed on 18 February 2026, with grey literature searches ongoing and to be completed subsequently. We will include randomised controlled trials (RCTs), non-RCTs and quasi-experimental studies with comparison groups examining school feeding interventions with food system components among school-age children and adolescents (5-19 years) in LMICs. Two reviewers will independently screen titles and abstracts, review full texts, extract data and assess study quality using the Cochrane Risk of Bias tools (RoB 2 for RCTs and Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) for non-randomised studies). Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We will conduct narrative synthesis using the Synthesis Without Meta-analysis (SWiM) guidelines and meta-analysis where appropriate. Ethical approval is not required for this systematic review as no primary data will be collected. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs targeting international organisations, governments and development partners working on school feeding and food systems in LMICs.<b>Registration:</b> Open Science Framework https://osf.io/p83tb/.