{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:53:21Z","timestamp":1782492801287,"version":"3.54.5"},"reference-count":38,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Ministry for Economic Cooperation and Development (BMZ) and WFP","award":["104110EH"],"award-info":[{"award-number":["104110EH"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,19]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Globally, school meals programmes (SMPs), otherwise referred to as school feeding programmes, are widely implemented with the aim of improving multisectoral outcomes, including education, health and nutrition, social protection and agriculture, among other cross-cutting impact areas. Despite their widespread adoption and the broad recognition of their potential benefits, evidence on their actual impact across these diverse outcomes remains limited, fragmented and often inconclusive. This lack of consolidated and robust evidence has prompted growing interest from development and humanitarian agencies, practitioners and policymakers in generating high-quality data to inform the design, implementation and scaling of these interventions. Therefore, to address this gap, we plan to conduct a systematic review aimed at assessing the effectiveness and cost-effectiveness of SMPs on outcomes related to education, health and nutrition, social protection and agriculture in low-income and middle-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A comprehensive literature search will be conducted on relevant studies published between 2007 and 2025. The study will focus on four primary outcomes, which will include education, health and nutrition, social protection and agriculture. This systematic review will align with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search seven databases: MEDLINE (via Ovid), Scopus, Web of Science, CINAHL, Embase (via Ovid), PubMed and Global Health (via Ovid) using predefined keywords. The risk of bias of randomised and non-randomised studies will be assessed using the Cochrane Risk of Bias tool and the Risk of Bias In Non-randomised Studies - of Interventions tool, respectively. Two reviewers will independently select studies, extract data and assess risk of bias. All included studies will be summarised and meta-analyses will be conducted when appropriate. Heterogeneity will be assessed using the I\u00b2 statistic, subgroup analyses and meta-regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations and dissemination<\/jats:title>\n                    <jats:p>This study will not involve the collection of primary data and will thus not require any ethical approval. The dissemination of the outcome of the study will be through global conferences, policy briefs and scientific journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024628180.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113159","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:20:47Z","timestamp":1774534847000},"page":"e113159","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness and cost-effectiveness of school meals programmes on education, health and nutrition, social protection and agriculture in low-income and middle-income countries: a systematic review protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1258-0535","authenticated-orcid":false,"given":"Gilbert N.","family":"Miki","sequence":"first","affiliation":[{"name":"Research Consortium for School Health and Nutrition, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy K.","family":"Kiboi","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3116-2593","authenticated-orcid":false,"given":"Eric O.","family":"Ohuma","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald A. P.","family":"Bundy","sequence":"additional","affiliation":[{"name":"Research Consortium for School Health and Nutrition, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026062609364298000_16.3.e113159.1","unstructured":"World Food Programme . State of School Feeding Worldwide 2024. Rome, World Food Programme. 2024. doi:10.71958\/wfp130772"},{"key":"2026062609364298000_16.3.e113159.2","unstructured":"United Nations . Transforming our world: the 2030 agenda for sustainable development. New York: United Nations, 2015. 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Washington, DC: World Bank, 2018:xiii\u2013xxv."},{"key":"2026062609364298000_16.3.e113159.7","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1086\/674097","article-title":"School Meals as a Safety Net: An Evaluation of the Midday Meal Scheme in India","volume":"62","author":"Singh","year":"2014","journal-title":"Econ Dev Cult Change"},{"key":"2026062609364298000_16.3.e113159.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdeveco.2009.02.002"},{"key":"2026062609364298000_16.3.e113159.9","doi-asserted-by":"crossref","unstructured":"Valencia V , Wittman H , Jones AD , et al . Public Policies for Agricultural Diversification: Implications for Gender Equity. Front Sustain Food Syst 2021;5. doi:10.3389\/fsufs.2021.718449","DOI":"10.3389\/fsufs.2021.718449"},{"key":"2026062609364298000_16.3.e113159.10","unstructured":"Pastorino S , Springmann M , Backlund U , eds. School meals and food systems: rethinking the consequences for climate, environment, biodiversity, and food sovereignty. London: London School of Hygiene & Tropical Medicine, 2023. Available: https:\/\/researchconsortium.schoolhealthnutrition.org"},{"key":"2026062609364298000_16.3.e113159.11","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.3390\/su11051425","article-title":"Agrobiodiversity and Public Food Procurement Programs in Brazil: Influence of Local Stakeholders in Configuring Green Mediated Markets","volume":"11","author":"L. Resque","year":"2019","journal-title":"Sustainability"},{"key":"2026062609364298000_16.3.e113159.12","unstructured":"Bedasso B . Feeding kids may look expensive by standard value-for-money metrics, but it promotes equity in outcomes beyond just test scores. In: Sandefur J , ed. Schooling for all: feasible strategies to achieve universal education. Washington, DC: Center for Global Development, 2022: 36\u201348."},{"key":"2026062609364298000_16.3.e113159.13","unstructured":"School Meals Coalition . Rome: School Meals Coalition, 2024. 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