BACKGROUND

Middle childhood and adolescence (5–19 years) are transformative life stages involving profound physiological and social development. Nutritious diets and essential nutrition services are crucial for development during these life stages, supporting pubertal maturation, neurodevelopment, and linear growth (1,2). Globally, school meal programmes are one of the largest and most widespread social safety nets for these age groups, and are one component of school health and nutrition programmes (SHN) (3). While SHN programmes are widely recommended, and school meals are widely implemented, the nutritional quality of school meals is not always guaranteed and the global coverage of schools with comprehensive packages of interventions is still low (4). Additionally, barriers to school attendance such as lack of inclusive education or high opportunity costs means that a large number of 5–19 year olds are not at school and therefore do not benefit from SHN programmes (5,6). Hence, it is important for both school-going children and adolescents, as well as out-of-school children and adolescents, that there are other effective delivery platforms for reaching this age group with nutrition services.

The 2023 Global Education Monitoring (GEM) Report revealed that, in 2022, 250 million children and adolescents were out of school. It also highlighted that school completion rates drop significantly with age, from nearly 90% in primary education to around 60% in secondary, meaning that the older end of the age range is especially lacking access to services (7). Sub-Saharan Africa alone represents nearly 30% of the global out-of-school population, with Central and Southern Asia following at 20% (7). Out-of-school children and adolescents are often marginalised from the health system and are likely to live in resource-poor settings, leaving them particularly vulnerable to malnutrition (8,9). Many factors differentially affect girls’ school attendance: in Sub-Saharan Africa, for every 100 young men completing secondary school, only 79 young women do (7). Societal and socio-economic disparities – including early marriage, pregnancy, poverty, violence, and traditional roles – hinder girls’ education and increase their vulnerability to poor health and nutrition (10). Ensuring these girls, as well as other out-of-school children and adolescents, receive health and nutrition interventions via safe, accessible platforms is crucial.

Currently, nutrition interventions beyond schools are rare: in a review of interventions in low- and middle-income countries, only four out of 103 were outside educational settings (11). The 2021 Lancet Series on Adolescent Nutrition identified a critical need for new approaches to reach those who rarely attend or never attend school, in order to improve nutrition literacy, ensure food and nutrition security, and address specific nutrition issues (12). Community-based ‘beyond school’ approaches can offer a potential avenue to engage hard-to-reach school-aged children and adolescents. Community-based platforms, as outlined by Patton et al., typically involve cooperation among local government, families, youth-focused organisations, and religious groups, with the goal of nurturing positive youth development by promoting vital life skills, empowerment, social and emotional skills, and proficient problem-solving capabilities (1).

School-aged children and adolescents often face challenges in accessing health services and lack financial resources, making them particularly vulnerable to nutrition and health issues. However, there is a lack of evidence on effective and context-specific communitybased interventions. The necessity for this evidence is underscored by the Emergency Nutrition Network’s (ENN) research prioritisation exercise, which identified the investigation of ‘optimal delivery platforms for effective uptake of nutrition interventions, considering scale, sustainability, and youth engagement’ as a top priority by stakeholders for improving adolescent nutrition (13). Following this exercise, a research roadmap was developed that highlighted the need to explore the role of communitybased platforms in the delivery of nutrition interventions for children and adolescents beyond schools (14).

Aim

This report aims to showcase effective community-based strategies for providing nutrition interventions to school-aged children and adolescents outside of school settings, highlighting a selection of innovative approaches via diverse case studies.