Improving school-age nutrition and school performance through amaranth plus flaxseed food product distribution in Sidama, Ethiopia: a study protocol.

Primary school-age children are particularly vulnerable to undernutrition, especially anaemia and underweight. School feeding programs in food-insecure areas aim to reduce undernutrition, but many vulnerable children in Ethiopia have not benefitted due to inadequate food quality and sustainability challenges. Exploring underutilized nutrient-rich foods may help address the shortage of energy-dense supplements for these programs. Amaranth, with its leaves consumed as a vegetable and seeds used like cereals, has shown superior nutrient content when compared to maize. Previous interventions with amaranth in younger children demonstrated a significant reduction in anaemia prevalence. This study aims to assess nutritional health and to reduce undernutrition among school children by promoting amaranth-plus-flaxseed food from locally grown, standardised foods in Sidama, Ethiopia. Under this research project, the following three study designs will be undertaken: a laboratory-based food analysis study, a cross-sectional study, and an experimental pilot study. In the pilot study, we aim to observe a weight increase of 0.5 kg, a haemoglobin increase of 0.5 mg/dl, and a reduction in school dropout. This protocol outlines the detailed procedure of the school intervention from food formulation to the pilot study. The outcomes generated from this project will provide policymakers with valuable insights to consider alternative approaches for school intervention.