Evaluation of the association between nutrition knowledge and nutritional status among public and private upper primary school pupils

BACKGROUND: To promote appropriate dietary habits, nutrition knowledge is essential at an early age, as well as providing a healthy food environment. This study evaluated nutrition knowledge and its relation to the nutritional status of upper primary school pupils from public and private basic schools. METHODS: This cross-sectional study included 388 randomly selected upper primary school pupils, 210 from public and 178 from private schools in Ho. A questionnaire was administered to collect data on socio-demographics, nutrition knowledge, diet history, and nutritional status. Nutrition knowledge was assessed with multiple-choice questions. Correct responses were aggregated for each pupil. Anthropometric measurements were taken to assess pupils' nutritional status. Dietary intake was assessed by a 24-h recall to determine dietary diversity. Ordinal regression was used to examine the association between nutrition knowledge and ordered nutritional status in SPSS version 26. RESULTS: Private school pupils had a higher nutrition knowledge score (20.8 ± 3.6) than public school pupils (15.0 ± 3.5). Undernutrition was higher among public school pupils, whilst overnutrition was higher among private school pupils. A total of 36 private school pupils (20.2%) had a waist circumference-for-age > 85th percentile, compared to 7 public school pupils (3.3%). A high level of nutritional knowledge was associated with a marginal, non-significant reduction in the likelihood of a pupil falling into elevated BMI and waist circumference categories across both school types. CONCLUSIONS: Nutrition knowledge was higher among private school pupils than their public school counterparts. Stratification by nutrition status among both groups revealed a distinct divergence: undernutrition was more prevalent in public schools, whereas overnutrition predominated in private schools. Additionally, high nutrition knowledge marginally reduced the risk of falling into high BMI and waist circumference categories, but the difference was not statistically significant. To address the suboptimal nutritional status observed across both school sectors, targeted interventions such as shifting nutrition knowledge from purely theoretical form to an experiential type, behavior focused health education at an early age are required. While nutrition knowledge remains foundational, optimizing a child's nutritional status also requires a multi-factorial approach that targets home and school food environments, physical activity levels, portion control, and socio-economic constraints.