Pivoting school health and nutrition programmes during COVID-19 in low- and middle-income countries: A scoping review

Background Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions. Methods We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5–19.9 years) were eligible. Results We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n=8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n=4), physical activity curriculum and exercise training (n=3), mental health counselling and curriculum (n=3), or were multi-component in nature (n=5). While school meals, physical activity, and mental health programmes were adapted by outof-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition. Conclusions We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.