Quality of Home Packed School Lunch Among Children Attending Kindergarten School in Jimma Zone, South West Ethiopia, 2026

Effect of Nutrition Education on the Diet Quality of Home Packed School Lunch Among Preschool Children Attending Kindergarten School in Jimma Zone, South West Ethiopia, 2026

A balanced diet is critical for preschool aged children; meals must be sufficiently diverse to provide the essential nutrients required for rapid physical and cognitive development. Because dietary habits established in early childhood often persist into adulthood, prioritizing this age group is a cost-effective investment in long-term national health and productivity. However, the National Food Consumption Survey in Ethiopia indicates a significant gap in dietary quality, with only 20% of households across all age groups consuming five or more food groups. Implementing multi-component nutrition interventions is essential, as these strategies significantly influence both the eating habits and dietary preferences of preschool children.

Background and Rationale Dietary habits acquired during early childhood frequently persist through adolescence and into young adulthood. Children develop preferences for foods through repeated exposure and are influenced by parental modeling, rewards, and shared mealtime enjoyments. Beyond individual factors, child nutrition is shaped by a complex interplay of parental preferences, parenting styles, food security, and environmental influences such as media and childcare policies. In the school environment, key drivers include nutrition policies, formal curricula, and the knowledge and practices of staff.

Study Aim and Design This study aims to evaluate the impact of a multi-component nutrition education intervention on the diet quality and dietary preferences of kindergarten students in the Jimma Zone, Southwest Ethiopia. A mixed-methods approach will be employed, utilizing a cluster randomized controlled trial (cRCT) and concurrent cross-sectional design.

Methodology A total of 451 students from ten clusters (schools) will be enrolled. These clusters will be randomly assigned to either the intervention or control group (5 schools each), with approximately 45 students selected per cluster. The intervention includes weekly nutrition education for parents delivered via leaflets and mHealth (vie Telegram) and school based nutrition information for students led by trained female health care providers/nutritionists.

Outcome Measures & analysis The primary outcomes are mean child diet quality (DDS) and dietary preferences, assessed at baseline and endline. Data will be managed via double entry in EpiData and analyzed using STATA version 15.1. Following an intention-to-treat (ITT) principle, a Difference-in-Differences (DiD) estimator will be used to compare the change in mean scores between groups over the 6-month intervention period. To account for the clustered nature of the data and potential residual confounding, Generalized Estimating Equations (GEE) and mixed-effects multilevel linear regression models will be applied.

Inclusion criteria

• Children aged 4-7 years attending kindergarten schools in the selected clusters.
• Parents or caregivers willing to provide written informed consent.

Exclusion Criteria:

• Students who will not finish the school year/intervention semister in the selected cluster/school.
• Mothers/caregivers who will not give consent for the participation in the study will be excluded.