Strategic model for sustaining coverage of the nutritional needs of school-aged children in rural Madagascar

In Madagascar, the nutrition of school-age children is a strategic issue at the intersection of food security. In the Malagasy context, school feeding appears to be a major lever for social protection and resilience. However, ensuring adequate nutritional coverage in the long term does not depend solely on the existence of school canteens. In light of this issue, this research aims to propose a strategy to ensure the long-term coverage of their nutritional needs. Thus, the research question is: ‘How can we develop, based on observed dietary profiles and key variables of the food system, a sustainable strategy to meet their nutritional needs?’ The hypothesis posits that identifying dietary profiles and strategic food variables enables the development of a relevant, hierarchical intervention model. Multiple Correspondence Analysis, Discriminant Factor Analysis and a MICMAC-type structural analysis were used to classify the variables according to their influence and interdependence. The study is based on two datasets: an anthropometric dataset of 2,464 children and a dietary dataset of 269 child-households. The results indicate a high prevalence of underweight status at 41%, with a marked increase among 10–15-year-olds. The malnutrition observed is not solely due to a lack of calories, but primarily to poor dietary diversity and limited access to protective foods. Three types of variables were examined: driving variables, which structure the food system; intermediary variables, which determine nutritional quality; and dependent variables, which reflect the system’s outcomes. The model proposes an integrated strategy based on access to protective foods, school feeding, nutrition education, support for local production, and a multisectoral approach linking agriculture, health, education and social protection.