The Effect of School Lunch Program (SLP) Towards Nutrition Knowledge, Attitude, Practices and Nutrition Status of Adolescents in Islamic Boarding School
Phase: NA
Conditions: Anemia, Stunting, Underweight
Sponsor: Institut Pertanian Bogor

 
SLP Protocol 
 
 
 
 
1 
 
The Effect of School Lunch 
Program (SLP) Towards 
Nutrition Knowledge, Attitude, 
Practices and Nutrition Status of 
Adolescents in Islamic Boarding 
School  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cooperation  
Department of Community Nutrition  
Faculty of Human Ecology, IPB 
PT. AJINOMOTO Indonesia 
 
December 18 2017 
 

 
SLP Protocol 
 
 
 
 
2 
INTRODUCTION 
Background 
The Indonesian government has established “Twelve Years Education 
Mandatory Program”. The program’s objective is that all 7-18 years old children 
pursue their education until senior high school. The problems that we are still 
facing are the high  drop-out rate of elementary school students and there are 
many students that don’t continue to senior high school or junior high school. 
According to the Indonesian Central Statistic Agency/ Badan Pusat Statistik (BPS), 
the percentage of drop-out children was 0.67% (BPS 2013). This is a complex 
problem that is not only caused by parents’ poverty and the problem inadequate 
and improper education facilities, but also caused by low nutritional status and 
health condition of school-aged children which leads to low academic performance 
of the students in Indonesia. 
Malnutrition in school-age children results in children becoming weak, tired 
and sick, so children are often absent and have difficulty following and 
understanding lessons at school. Many students are forced to repeat a year or 
leave school (drop out) due to severe malnutrition. This is a serious obstacle to 
efforts to enlighten the nation through education. The Basic Health Research 
Study/ Riset Kesehatan Dasar (Riskesdas) review of several studies show that 
nutritional problem in children and adolescent are still high. 
Based on Riskesdas (2013), according to age criteria, 26.4% of patients 
with anemia were in 5-14 age groups while 26.4% of patients with anemia were 
in the 15-24 age groups. Based on this data, the prevalence of anemia is greatest 
among women, including adolescent women. According to the Department of 
Health (2008), 28% of adolescents in West Java suffered from anemia. The 
incidence of anemia in adolescents is strongly related to nutritional intake. Low 
intake of micronutrients (minerals and vitamins) is one of the causes of high 
incidence of anemia in adolescents. Kurniawan's research (2006) showed that the 
prevalence of anemia in adolescents in rural areas is quite high, that is, equal to 
21.8%.  

 
SLP Protocol 
 
 
 
 
3 
Anemia can cause fatigue, decrease concentration so that it decreases 
academic achievement, and can decrease productivity. Apart from this, anemia 
also decreases immunity so that those affected are more susceptible to infection 
(Permaesih & Herman 2005). Anemia occurring in adolescent girls also increases 
the risk of impaired physical and mental function, and may increase the risk of 
complications during pregnancy.  
Elementary school-aged children and adolescents are in a rapid and active 
growth period. In this period, they need appropriate and adequate nutrient intake, 
in both quantity and quality. One of the nutrient intake fulfillment of school children 
and adolescent is obtained from the food consumed during school hours. 
Meanwhile, most of the schools in Indonesia does not have a good quality canteen, 
for providing nutritious, healthy, and safe food for the students. Morover, most of 
the students are not used to having breakfast at home so school canteen/cafetaria 
or food availability at school have an important role for fulfilling children’s nutrient 
requirement at school. Thus, snack food safety and quality is the factor that needs 
attention so that students can consume healthy, nutritious, and safe food. 
The government has initiated a number of projects to overcome this 
problem. To improve nutritional, the government implemented the Supplementary 
Food Program for School children/ Pemberian Makan Tambahan – Anak Sekolah 
(PMT-AS) from 1997-2000, then in 2010 and 2011 the PMT-AS program was 
reintroduced in the form of supplying snacks containing 300 kcal and 5 grams of 
protein, in 27 districts in 27 provinces. The PMT-AS program was stopped again 
because the evaluation found some weaknesses of the program, among others: 1) 
food was served in the form of snack loaded with carbohydrates and little protein, 
but no vegetables and fruit components (as a source of mineral vitamins), 2) it 
was given after 9 am so it did not meet the function as a breakfast substitute 
(supposedly before the activity / learning process begins) 3) it did not involve the 
school canteen in food production so that it required larger operational funds 
(needed to supply cooking utensils to the School Committee to process food), so 
it was not possible to maintain sustainability.  
A review of several supplementary food programs/ PMT-AS have proven 
that providing supplementary food have positive effect on nutritional status, 

 
SLP Protocol 
 
 
 
 
4 
attendance rate, and students ability in following classes at school. PMT-AS 
provides snacks while school meal service (school feeding) provides complete meal 
so that the benefit of school food service will be better.Whaley (2003) conducted 
a study on the impact of food interventions on cognitive development in school 
children in Kenya. In that study, there were four treatment interventions: meat, 
milk, energy and control (without intervention). Indicators of the effectiveness of 
the intervention could be seen in a cognitive test taken 3 times before, during and 
after the intervention (21 months). The results of the study showed that the 
intervention of providing animal food sources had a positive impact on the 
cognitive performance of school children in Kenya. Other studies related to feeding 
school children were conducted by Kustiyah (2004), which demonstrated that iron 
and protein consumption correlate positively with hemoglobin levels in elementary 
school children and that blood glucose levels have a significant positive effect on 
the improvement of word and image memory in elementary school children. A 
similar study conducted by Soetrisno et al. (2005), which analyzed the effect of 
adding high glycemic supplementary food on the concentration improvement of 
elementary school students showed that the intervention group’s academic 
performance was better than the control group. 
The results of the research conducted by Bogor agricultural university 
(Institute of in cooperation with Univ. of Tokyo in Japan which provided a lunch 
intervention for one month (August-September 2015) to school students in 
Sukajadi village, Bogor. This revealed a significant increase in nutritional status 
(body mass index, or BMI) and hemoglobin (Hb) levels before and after 
intervention. The results also showed that lunch intervention in the form of a 
balanced meal which constitutes 30% of Recommended Daily Allowance (RDA) 
can significantly increase carbohydrate, protein, calcium, iron, vitamin A and 
vitamin C intake. Furthermore, it was also shown that there was a significant 
change in nutritional knowledge scores and attitudes toward nutrition (unpublished 
research report). 
In 2016, the Ministry of Education and Culture in cooperation with IPB, 
World Food Program (WFP) and other relevant stakeholders pioneered and 
implemented the School Child Nutrition Program (PROGAS) in three sub-districts 

 
SLP Protocol 
 
 
 
 
5 
in East Nusa Tenggara Province. This program provided breakfast to children with 
a complete menu for 96 days.  The results of this activity indicate that nutritional 
status was improved in school children receiving breakfast. The results of the 
PROGAS study showed an increase in energy intake and nutrients before and after 
the program, and the percentage of students with normal nutritional status also 
increased (69.1 % to 75.1 %). Mean Hb levels also increased (11.7 g / dl to 12.6 
g / dl). 
Many stakeholders have made efforts to improve nutrition, including the 
private sector through corporate social responsibility (CSR) programs. CSR PT 
Ajinomoto Indonesia has implemented various nutritional improvement programs 
in cooperation with the Department of Community Nutrition, FEMA-IPB.  The 
Ajinomoto IPB Nutrition Program was a healthy school cafeteria empowerment 
program to provide nutritious and safe snack food for 3 years (2011-2013). This 
program consisted of nutrition education for students, teachers, parents and school 
snack vendors, supplementary feeding, school gardens and pioneering the 
establishment of a healthy canteen and school library. This activity resulted in 
improved nutritional status (anthropometry- body weight/age), anemia status and 
increased nutritional knowledge in students, and the healthy school cafeteria 
became a model for neighboring schools. In addition, PT Ajinomoto Indonesia 
actively supports nutrition-related activities such as the nutrition fair, and cooking 
competitions. The development of learning modules that integrate university 
courses with an understanding of monosodium glutamate and various food safeties 
related training programs. 
Based on above mentioned, nutritional improvement in school-aged 
children in Indonesia is still needed, and one of the ways is by integrating nutrition 
education and providing lunch at school to support balanced nutrition behaviour 
change, as well as Clean and Healthy Lifestyle Behavior or Praktek Hidup Bersih 
dan Sehat (PHBS) which will improve the health and nutrition condition of the 
school. Thus, the Department of Community Nutrition, Faculty of Human Ecology, 
Bogor Agricultural University in collaboration with PT Ajinomoto Indonesia, a 
private company who has high commitment to support nutrition improvement, will 

 
SLP Protocol 
 
 
 
 
6 
conduct nutrition education and school lunch program for students, especially in 
Islamic Boarding School. 
 
Objective 
 
a. Program Objective 
School Luch Program (SLP) aims to increase balanced nutritional knowledge, 
attitude, and practice, as well as Clean and Healthy Life Style Behavior or PHBS 
through nutrition education and provision of lunch for students in Darussalam 
Islamic Boarding school to support and realize healthy and achieving students 
 
The key performance indicators of SLP are as follows: 
1. Number of beneficiaries  
2. Number of eating days 
3. Number of menus and average nutrient contents in developed lunch menus 
4. Number of lunch menus finished (eaten completely) by beneficiaries 
5. Number of nutrition education modules developed 
6. Number of nutrition education sessions and classes conducted 
7. Number of beneficiaries who attended nutrition education sessions 
8. Number of nutrition education and training of trainers (TOT) classes 
conducted for teachers 
9. Number of teachers who attended TOT on nutrition education 
10. Number of training sessions on sanitation and hygiene of food handlers 
conducted 
11. Number of food handlers who attended of training sessions on sanitation 
and hygiene 
12. Development of school garden 
 
b. Study Objective 
 
The main objective of this study is to assess the impact of the school lunch 
program and nutrition education towards the change in knowledge, attitude, 
and behavior on balanced nutrition and clean and healthy lifestyle behavior. 

 
SLP Protocol 
 
 
 
 
7 
The secondary objective is to assess the program impact on energy and 
nutrient intake, nutrition status, hemoglobin concentration, physical fitness and 
concentrating ability of students. 
 
 
HYPOTHESIS 
After getting the SLP, all of the participant will: 
1. 
Increase in knowledge, attitude, and practice of balanced nutrition and healthy 
and clean lifestyle 
2. 
Increase energy and nutrient intake  
3. 
Improve nutritional status (BMI/age and middle upper arm circumference 
(MUAC)) 
4. 
Increase hemoglobin levels  
5. 
Improve students' physical fitness. 
6. 
Increase student's concentration (instantaneous memory)  
7. 
Increase student attendance in learning activities at school  
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SLP Protocol 
 
 
 
 
8 
METHODOLOGY 
 
Design, location and time 
This research will be conducted using pre-post quasi experimental design. 
Subjects consist of only intervention group, who are measured before and after 
the intervention or program period. SLP in Darussalam Islamic Boarding School 
consists of: 
a. 
Balanced Nutrition Education and PHBS for the boarding school students and 
teachers 
b. 
Provision of lunch 
c. 
Food processing training, food sanitation hygiene and food safety for food 
handlers. 
The location of this activity is determined purposively at the Islamic boarding 
school, in the neighborhood of the IPB (Institut Pertanian Bogor) campus with the 
following basic criteria for the school: 
a. 
Has apparent nutritional problems among the students 
b. 
It has a kitchen and dining area for its students in need of improvement 
c. 
Has a strong commitment to cooperate in running the program.  
This activity will be held at the Darussalam Islamic Boarding School located 
in Laladon Bogor area. There are 450 students consisting of both male and female 
students. This Islamic boarding school has a kitchen that is used to process and 
cook food for the students. The eating area is divided into two areas, in the form 
of a shared dining room for the male students and a terrace for the female students. 
The Islamic boarding school also has a garden area that is used for gardening 
activities for the students but it has not been managed sustainably. 
The overall project period is 18 months (2017/09-2019/03), which includes 
design, baseline, mid line and end line data collection (3 times), implementation 
and reporting activities. The implementation of the school lunch program will be 
for 1 academic year (8 active months after the reduction of holidays and 
examination months), starting immediately after Institutional Review Board (IRB) 
approval of both Bogor University and Ajinomoto Co. Inc. until Novermber 2018. 
Lunch will be served 7 days per week with the total of 220 days (Fig 1).  

 
SLP Protocol 
 
 
 
 
9 
 
Fig1. Time schedule of the study 
 
Subjects 
 
Subjects are all the students residing in the Darussalam Islamic Boarding 
School which consists of adolescents’ age 13-18 years old. All the children in the 
school (n=450) is included in the study to measure the primary outcome, which is 
change in knowledge, attitude and practice on balanced nutrition and clean and 
healthy lifestyle behavior. A blanket approach is used in this study due to the 
characteristic of the intervention, which is institutionalized in the school, where it 
is not possible to select only a sub sample of subjects to be given the intervention. 
The inclusion criteria of the subjects include 1) have resided in the boarding school 
at least one year, and 2) apparently healthy. Meanwhile the exclusion criteria are 
children who has Hb concentration < 7 g/dl or BMI for age z score < -3. 
 
Only a sub sample of the subjects will be assessed for the secondary 
outcomes, especially in Hb concentration. The minimum sample size needed for 
the sub sample analysis is 150 subjects. This is based on the minimum sample size 
recommended by World Health Organization (WHO) (1996). The sample size was 
selected to detect a minimum change of 0.57g / dL in the subject's Hb level with 
a standard deviation (SD) of 1.01 g / dL, 95% confidence interval and 0.80 
statistical strength.  The sample size was calculated using the following formula 
(WHO, 1996): 
n ≥ 2 (Sd)2 (Z ß   Zα)2 
 
 
 
 
 
d2 
n = sample size 

 
SLP Protocol 
 
 
 
 
10 
s = SD Hb level (1.01 g / dL) 
Zβ = normal distribution with power 90% (1.28) 
Zα = normal distribution with 95% confidence interval (1.96). 
d = mean difference of Hb level between two groups was 0.5 g / dL 
 
Based on these calculations, the minimum number of subjects is 86 children. 
With addition of dropout rates, the total number of sub sample recruited is 150 
subjects. 
 
The 150 sub sample subjects are recruited through a screening phase for 
Hb concentration and nutrition status (BMI/age z score). Students who are 
shown to have Hb concentration of less than 11 g/dl for girls and 12 g/dl for 
boys and more than 7 g/dl for both boys and girls will be prioritized as the sub 
sample subjects. When sub sample size is not met, the next priority will be 
students with BMI/age z score less than -2 SD and more than -3 SD. 
 
Recruitment, explanation of the subjects and informed consent 
 
The recruitment of subjects begins with coordination with the teachers of 
the Darussalam Islamic Boarding School. Parents are invited to school after the 
holiday break and will be gathered. Explanation about the study and the 
participation of their children will be conducted during this meeting by the research 
team. Parents who approve their child’s participation in this study will be asked to 
sign the informed consent. 
 
Explanation of the study will also be conducted for the students in a 
separate classroom by the research team, accompanied by classroom teachers. If 
the prospective subject is interested, we will proceed to describe the study in detail 
and obtain his/her informed consent (see Appendix 1). The informed consent will 
be collected at the end of this presentation, in written form, from the subject and 
their parents or his/her legal representative (see Appendix 1). 
 
 
Determining the menu 

 
SLP Protocol 
 
 
 
 
11 
Menu planning is implemented by considering nutritional requirements for 
school-age children according to their age based on the following conditions:  
a. 
The lunch menu should meet 30% of the daily nutritional requirements. 
b. 
The lunch menu consists of a staple food, animal or plant-based side dishes, 
vegetables and fruit. Milk may be added to the lunch menu. 
c. 
The lunch menu should be easy to process, be liked by the children, and use 
fresh, unadulterated local materials. 
 
The following table shows the recommended daily nutritional requirements for 
students (adolescent) and the recommended portions of food and drink which were 
used as a reference in determining nutritional content of the lunch menu.  
 
Table 2. Recommended dietary requirement for school children 
Age group Weight Height Energy Protein Fat  Carbohydrate Fiber 
Fe  
(kg) 
(cm) (kcal) (gram) Gram 
(gram) 
(gram) (mg)  
Male 
 
 
 
 
 
 
 
 
 
 13-15 years 
46 
158 
2475 
72 
83 
340 
35 19 
16-18 years 
56 
165 
2675 
66 
 89 
368 
37 15 
 
Female 
 
 13-15 years 
46 
155 
2125 
69 
71 
292 
30 26 
 
16-18 years 
50 
158 
2125 
59 
71 
292 
30 26 
Source: RDA for Indonesians 2013 
 
Table 3. Recommended daily portions of food and drink for adolescents age 13-15 
years and 16-18 years 
 
 
 
Food ingredients 
Female 
Male 
13-15 
years 
16-18 
years 
13-15 
years 
16-18 
years 
Staple food 
Steamed rice 
4 ½ p 
5 p 
6 ½ p 
8 p 
Side dishes - 
animal products 
Fish 
3 p 
3 p  
3 p 
3 p 
Side dishes - 
plant products 
Tempeh 
3 p 
3 p 
3 p 
3 p 
Vegetable 
Spinach 
3 p 
3 p 
3 p 
3 p 
Fruit 
Ambon banana 
4 p 
4 p 
4 p 
4 p 
Oil 
Cooking oil 
5 p 
5 p 
6 p 
6 p 
Sugar 
Cane sugar 
2 p 
2 p 
2 p 
2 p 
Drinks 
 
Milk 
1 p 
- 
1 p 
- 
Water 
8 p 
8 p 
8 p 
8 p 
Key: p = portion 
Source: Balanced Nutrition Guidelines 2014 

 
SLP Protocol 
 
 
 
 
12 
 
The nutritional content of the lunch menu is designed to meet 30% of the 
daily nutritional requirements of students and contains 635-776 Kcal of energy with 
18-22 grams of protein. The lunch menu is served in the form of a full menu 
consisting of staple food, animal products, plant products, vegetables and fruit by 
utilizing local food. The menu cycle used is a set menu cycle of 10+1 day cycle. 
An example of the menu is presented in the following table. 
 
Table 4. Children's lunchtime menu cycle for 10 days + 1 
No. Food group 
Cycle - 
1 
2 
3 
4 
5 
6 
1 Carbohydrate Steamed 
rice 
Steamed 
rice 
Steamed 
rice 
Steamed 
rice 
Steamed 
rice 
Steamed 
rice 
2 Animal 
protein 
Fried 
chicken 
with spices 
Yellow 
pickled fish 
Boiled eggs 
in Sweet 
soy sauce 
Spiced 
beef 
Steamed-
spiced 
Chicken 
(Chicken 
parcels) 
Tuna with 
spicy sauce 
3 Vegetable 
protein 
Steamed 
Tofu (Tofu 
parcels) 
Fried tofu 
 
 
Tempeh 
cakes 
Stir Fried 
tempeh in 
green 
chili 
Tofu in 
spicy 
sauce 
Steamed 
tofu and 
tempeh 
parcels 
4 Vegetable 
Vegetable 
stir-fry 
Sautéed 
green 
beans with 
sweet soy 
sauce 
Sautéed 
white 
mustard 
corn with 
meatballs 
Clear 
vegetable 
soup  
Sour clear 
vegetable 
soup 
Clear 
vegetable 
soup with 
spinach and 
corn 
5 Fruit 
Papaya 
Watermelo
n 
Melon 
Orange 
Snake 
fruit  
Papaya 
 
Food group 
Cycle - 
7 
8 
9 
10 
1 
1 Carbohydrate Steamed rice 
Steamed rice Steamed 
rice 
Steamed 
rice 
Steamed 
rice 
2 Animal 
protein 
Egg omelet with 
carrots and 
shrimps 
Beef - 
Balinese style 
Chicken in 
curry sauce 
Steamed 
spiced fish 
Quail egg 
and shrimp 
with spicy 
sauce 
3 Vegetable 
protein 
Curry tempeh / 
tofu 
Fried tempe 
Potato 
cakes 
Carrot and 
tofu roulade 
Tofu cakes 
4 Vegetable 
Sautéed beans - 
baby corn 
Sautéed water 
spinach 
Sautéed 
beansprout
s with 
salted fish 
Vegetables 
in clear 
broth 
Kimlo 
5 Fruit 
Banana 
Watermelon 
Melon 
Banana 
Orange 
 
 
 

 
SLP Protocol 
 
 
 
 
13 
 
 
 
 
Steps of the Study 
 
a. Preparation 
This program is held at the Darussalam Islamic Boarding School located in 
Laladon Bogor area.  
b. Initial data survey (Baseline data) 
Prior to baseline survey we begin with screening of Hb concentration and 
nutritional status (BMI/age z score) to select the 150 sub-sample for secondary 
objective assessments. This initial data survey is also expected to provide an 
overview of the subject candidate. We will include subjects who are anemia, 
stunted and are underweight as our sub sample subjects. After the screening 
phase we conduct baseline data collection which includes energy and 
nutritional intake data, knowledge, attitudes and practice of balanced nutrition 
(including Clean and Healthy Lifestyle Behavior, see appendix 5), short-term 
memory, and physical fitness. We also collect attandance in classes as 
secondary data (Fig 2). 
 
c. Intervention 
a. Nutrition Education on Balanced Nutrition and PHBS 
The purpose of the nutrition education is to improve the knowledge about 
balanced nutrition and PHBS of students and teachers (See appendix 4). 
Nutrition education for students is conducted three times (2 sessions 
delivered by teachers, and 1 session delivered by research staff) every 
month throughout the intervention period. TOT for teachers is done every 
2 months. 
b. Training of food processing, hygiene, sanitation, and food safety for food 
handlers will be conducted once a month. 
c. Provision of lunch 

 
SLP Protocol 
 
 
 
 
14 
Before students are given intervention, all students will be provided with 
anthelmintic to be consumed. Lunch will be provided 7 times a week, from 
12:00 to 13:00. Lunch is prepared and processed by three cooks at the 
boarding school. The description of lunch provision is as follows: 
• 
Thepreparationandprocessingoffoodisdonemaximum 
4 
hoursbeforelunchandheld inside the boardingschool. 
• 
The menuisevaluatedbythe person in chargeofthe program who has 
beentrained. 
• 
The lunchdistribution isdecentralized, which is foodserved in 
thediningroomof male studentsandfemalestudents. 
• 
Washhandsbeforeandaftermealsis mandatory for all students 
 
This activity aimed to provide knowledge and skills for food handlers so 
they will be able to process food properly and safely. This training is 
conducted every month. 
 
d. School garden 
This activity is conducted to optimize the utilization of the school yard. The 
purpose of this activity is to increase the student’s interest in agriculture 
and to get a better knowledge about vegetables and fruits. 
.  
d. Monitoring and Evaluation 
Monitoring and evaluation is conducted to ensure that the implementation of 
the intervention is based on the plan. Monitoring is conducted every month 
by collecting weight and height data, compliance of the student’s 
consumption, evaluating of the menu, and evaluation of the absence of the 
students in the class. 
 
e. Mid line and end line data survey 
The midline and end line data survey are conducted to assess the impact of 
the intervention during the middle and the end of the intervention. Both 

 
SLP Protocol 
 
 
 
 
15 
surveys are conducted by collecting the same data that is collected at baseline 
survey (Fig 2, see appendix 5).   
 
Fig 2. Data collection according to subjects 
 
 
 

 
SLP Protocol 
 
 
 
 
16 
Types and Methods of Data Collection 
 
The types of data collected are secondary and primary data. The secondary 
data are school profiles and attendance of students in the class. The primary data 
are characteristics of students (name, age, gender), medical history, family 
characteristics (age, education, parents occupation), eating habits, nutrient intake, 
knowledge, attitudes and practices on balanced nutrition and clean and healthy 
lifestyle behaviour, weight and height, physical fitness, concentration (short-term 
memory), and Hb concentration of the subject. 
Secondary data isobtained fromthe students registry. Primary data are 
collected through interviews using questionnaires and direct measurements. Food 
consumption or nutrient intake data is collected by interviews using 24 hour food 
recall method. Bodyweight data is obtained by measurement using the weight 
scales with 0.1 kg accuracy. Body height data is obtained by measurement using 
microtoise with precision of 0.01 cm. Physical fitness is measured by the 
enumerator using the Indonesian Physical Fitness Test. Concentration data is 
obtained by conducting a test using a prepared questionnaire. Blood Hb data is 
obtained  by taking blood in the finger prick capillary blood, then the blood Hb is 
determined using Hemocue. Table 5 below describes in detail the variables and 
indicators that will be measured during the study. 
 
 
 

 
SLP Protocol 
 
 
 
 
17 
Table 5. Variableand data collection method  
 
Variable 
Collecting method 
Collecting time 
School profile 
Name 
Secondary data 
Baseline 
Accreditation status 
Address 
Number of the students 
Student characteristic 
Name 
Interview with questionnaire 
Baseline 
Age  
Sex  
Class  
Address  
Family socio-
demography 
Father/mother’s name 
Interview with questionnaire 
Baseline 
Father/mother’s age 
Father/mother’s education 
Father/mother’s occupation 
Health history 
Sickness occurred from the last 1 month  
Interview with questionnaire 
• Baseline 
• Midline 
• End line 
Eatinghabits 
Eating habits for source of protein, fruits, and 
vegetables from the last 1 month  
Interview with questionnaire 
• Baseline 
• Midline 
• End line 
Study habits 
Studying time, sleepy during studying habits, 
concentration.  
Interview with questionnaire 
• Baseline 
• Midline 
• End line 
Knowledge, Attitude, 
and Practice (KAP) 
KAP about balanced nutrition (Questions 
number 3-10, 12, 14 in the KAP questionnaire) 
Interview with questionnaire 
• Baseline 

 
SLP Protocol 
 
 
 
 
18 
 
Variable 
Collecting method 
Collecting time 
about Balanced 
Nutrition and Clean 
and Healthy Lifestyle 
Behaviour 
KAP about Clean and Healthy Lifestyle 
Behaviour (Questions number 1, 2, 11, 13, 15 
in the KAP questionnaire)  
 
 
• Midline 
• End line 
Sports habits 
Types of sports that often done  
Interview with questionnaire 
• Baseline 
• Midline 
• End line 
Food intake 
Intake of energy and other nutrients 
2x24 hours recall (interview), translated into 
nutrients and compared with nutritional 
adequacy 
• Baseline 
• Midline 
• End line 
Nutritional status 
ofthestudents 
Weight 
Measurement with digital scale  
• Baseline 
• Midline 
• End line 
Height 
Measurement with microtoise 
MUAC 
Measurement MUACwith tapeline 
Anemiastatus  
Hb concentration 
Blood collection from fingerprick, the blood Hb 
is determined by usingHemocue. 
• Baseline 
• Midline 
• End line 
Physical fitness 
Physical fitness 
Indonesian PhysicalFitnessTest 
• Baseline 
• Midline 
• End line 
Concentration/shor-
term memory 
Short-term memory by remembering few of 
pictures and words  
Measurement of short-term memory by 
remembering few of pictures and words (Serial 
recall) 
• Baseline 
• Midline 
• End line 
School attendance 
Total days of absence from the last 1 month  
Secondary data (student presence record) 

 
SLP Protocol 
 
 
 
 
19 
 
Variable 
Collecting method 
Collecting time 
Total days of absence because of sickness from 
the last 1 month 
Every month on 
intervention 

 
SLP Protocol 
 
 
 
 
20 
Data Analysis 
After data collection, the entry process will be followed by data cleaning to 
identify extreme value and check the validity of data. Descriptive and inferential 
analysis will be conducted, including univariate and bivariate with SPSS for 
windows version 20. Table 6 below presents the detail for data categorization. 
 
Table 6. Variable and data processing category  
Variable 
Category  
Source 
Food intake and 
quality  
• Severe deficits (<70% RDA)  
• Medium deficits (70-79% RDA)  
• Mild deficits (80-89% RDA)  
• Normal (90-119% RDA)  
• Over (≥ 120% RDA) 
Ministry of 
Health (1996) 
 
 
 
 
 
 
Nutritional Status 
 
Weight for Age Z-score (WAZ) 
• Obese(> 2 SD) 
• Normal (≥ - 2 SD s/d ≤ 2 SD) 
• Underweight (<2 SD) 
• Severe underweight (< 3 SD) 
Gibson (2005) 
Height for Age Z-score (WAZ) 
• Normal (≥ 2 SD) 
• Stunded (< 2 SD) 
Weight/height 
• Obese (> 2 SD) 
• Normal ( -2 SD s/d 2 SD) 
• Wasted (≤ -2 SD) 
• Severe wasted (< -3 SD) 
Anemia Status 
• Normal (Hb>12 g/dL)  
• Anemia (Hb≤12 g/dL) 
WHO (2001) 
Knowledge of 
Balanced Nutrition and 
Principles of Clean and 
Healthy Living 
• Good (>80%)  
• Fair (60-80%)  
• Poor (<60%) 
Khomsan 
(2000) 
Physical fitness 
• Score: 22 – 25  = very good 
• Score:18 – 21   = good 
• Score: 14 – 17  = fair 
• Score: 10 – 13  = poor 
• Score: 5 – 9 = very poor 
Indonesian 
Physical 
FitnessTest-
Ministry of 
Education 
(1999) 
Concentration/short-
term memory 
• Poor (<80) 
• Good (≥ 80) 
Kustiyah 
(2004) 
Attendance at school • Days of absence  
 

 
SLP Protocol 
 
 
 
 
21 
Variable 
Category  
Source 
• Days of sickness 
 
Statistical analysis consist of 2 types, which are univariate and bivariate. 
a. Univariate analysis 
 
Univariate analysis is used to describe the variable and presented as 
distribution and percentage of each variable. This type of analysis produce table 
of frequency distribution, bar chart, pie chart, or line chart from each variables and 
adjusted with the data scale to simplify the next analysis. 
 
b. Bivariate analysis 
Bivariate analysis is used to analyse 2 variables that are expected to have 
a correlation or significant differences. The statistical test is paired t-test that is 
selected based on data scale and normal distribution from dependent and 
independent variables that will be analysis. 
 
To adjust for the effect of students’ growth and gender towards the intervention 
outcomes, we will conduct a Linear Mixed Effect Models. The model will include 
gender, time, gender*time interaction which will allow the outcome of interest to 
be free from the effect of growth and gender.  
 
The following table presents an alternative plan for different types of tests used 
to analyse the effects of lunch on changes in variables as an indicator of the 
success of this program. 
 
Table 7. Variable and analysis method 
No. 
Variable 
Data Scale 
T-test 
1. 
Energy and nutrient intake 
Ratio 
Paired-t  test 
2. 
Eating habits 
Ordinal 
Wilcoxon test 
3. 
Nutritional status 
• 
WAZ 
• 
HAZ 
• 
Weight/height 
 
Ratio 
Ratio 
Ratio 
 
Paired-t  test 
Paired-t  test 
Paired-t test 
4. 
Anemia status 
• 
Hemoglobin 
 
Ratio 
 
Paired-t test 
5. 
Knowledge of Balanced Nutrition 
and Principles of Clean and 
Healthy Living 
Ratio 
 
Paired-t  test 
 

 
SLP Protocol 
 
 
 
 
22 
6 
Physical fitness 
Ordinal 
Wilcoxon test 
7 
Concentration/short-term 
memory 
Ordinal 
Wilcoxon test 
8 
School attendance 
Ratio 
Paired-t test 
 

 
SLP Protocol 
 
 
 
 
23 
Discontinuation of the study 
 
The subject will be invited to withdraw from the study if there is any suspect 
that he/she is not following the instructions. If the subjects or the legal guardian 
wants, for personal reason, to withdraw from the study, he/she will be free to do 
so, after having informed the project manager. The withdraw statement will be 
signed and by the subject and their parents or his/her legal representative and 
submitted to the project manager (See Appendix 2.). Following any adverse effect, 
the medical doctor responsible for the management of subjects to evaluate 
whether this effect requires discontinuation of the subject. 
 
Ethical considerations 
 
This study will be conducted in accordance with the Declaration of Helsinki 
(http://www.wma.net/en/30publications/10policies/b3/) and Ethical Guidelines for 
Medical 
and 
Health 
Research 
Involving 
Human 
Subjects 
(http://10.136.68.34/keijiban/K242/Ethical%20Guidelines%20for%20Medical%20
anf%20Health%20Research%20Involving%20Human%20Subjects.pdf). 
This 
study protocol will be conducted after approval by the Clinical Research Ethics 
Committee of Bogor University and Ajinomoto Co., Inc. Procedures are fully 
explained to all subjects, and written informed consent is obtained from subject, 
parents/ legal guardian, and boarding school representative. We will contact the 
subject’s parents by phone and by letter.  
 
Privacy and Confidentiality 
 
The samples and data will be stored in anonymous form, since each subject 
will be paired to a digit code.  
 
Storage and handling of samples and information 
 
The samples and data will be stored in anonymous form, since each subject 
will be paired to a digit code. Therefore, persons managing the data will not be 
able to identify the participant and merge his/her identity with results obtained 
during the study. Only the project manager will directly be involved in the study 
who will merge the name with the code will be able to do so. The digital file 

 
SLP Protocol 
 
 
 
 
24 
containing the pairing will be securely locked. Data will be saved and stored in a 
special hard drive which is protected and only able to be accessed by the program 
manager.  
 
Exclusion of subjects in the analysis 
 
Subjects that do not meet 80% of compliance in menu eating and 80% of 
attendance in nutrition education sessions will be excluded in the analysis. These 
conditions include and not limited to conditions where extreme illness, not borne 
by the intervention, occurs based on the medical doctors/ physician’s judgement. 
 
Emergency procedures 
 
We do not foresee emergency issues, as the study do not involve any 
invasive procedures. However, should any accident happen during the study, 
physician in charge of this study will examine for any health issues. 
 
Conflict of interest 
 
This study is conducted in joint research between Bogor University and PT 
Ajinomoto Indonesia. The subjects will not be paid for their participation in the 
study. Only the costs of medical exams and physicians will be covered by the 
project. 
Publication 
 
Publication of the data is regulated by the non-disclosure agreement signed 
between Bogor University and PT Ajinomoto Indonesia.  
 
Place of facilities 
 
The facilities for recruiting and collecting data of the subjects will be at 
Darussalam Islamic Boarding School. 
 
Physician of responsibility 
The Physician responsible for the management of the subjects will be dr. Naufal 
Muharam Nurdin, M.Si. 
 

 
SLP Protocol 
 
 
 
 
25 
Reference 
 
[ACDP] Analytical and Capacity Development Partnership. 2013. Evaluation of the 
Supplemental Food for School Children Program.  Jakarta (ID) : 
KEMENDIKBUD. 
 
KEMENKES. 2015. Peraturan Menteri Kesehatan Republik Indonesia Nomor 41 
Tahun 2014 tentang Pedoman Gizi Seimbang. Jakarta : Kemenkes 
 
Kustiyah L., 2004. Kajian pengaruh intervensi makanan kudapan terhadap 
perubahan kadar glukosa darah dan daya ingat anak sekolah dasar. 
[disertasi]. Bogor: Program Pascasrjana  IPB. 
 
Pertiwi KI, Hardinsyah, Ekawidyani KR. 2014. Konsumsi Pangan dan Gizi serta 
Skor Pola Pangan Harapan (PPH) pada Anak Usia Sekolah 7-12 Tahun di 
Indonesia. Jurnal Gizi dan Pangan, Juli 2014, 9(2): 117—124 
 
[Riskesdas] Riset Kesehatan Dasar. 2010. Laporan Nasional Riset Kesehatan Dasar 
(Riskesdas) 2010. Jakarta (ID) : Badan Penelitian Dan Pengembangan 
Kesehatan, KEMENKES RI.  
 
[Riskesdas] Riset Kesehatan Dasar. 2014. Laporan Nasional Riset Kesehatan Dasar 
(Riskesdas) 2013. Jakarta (ID) : Badan Penelitian Dan Pengembangan 
Kesehatan, KEMENKES RI. 
 
Whaley S, M Sigman, C Neumann, N Bwibo, D Guthrie,  RE Weiss, S Alber  & SP 
Murphy. 2003. The impact of dietary intervention on cognitive development 
of Kenyan School Children. Journal of Nutrition, November 2003 Vol. 133 No. 
115-11 pg 3965S. 
 
Santosa, CM dan Wiyanto, M. 2004. Kajian manfaat pemberian makanan tambahan 
terhadap antropometri, gambaran darah dan parasit usus murid sekolah 
dasar.Berkala llmu Kedokteran,Vol 36 No 3. 
 
Soetrisno, USS,  Almasyhuri,  dan Karyadi, L. 2005. Pengaruh makanan tambahan 
glikemik tinggiterhadap peningkatan konsentrasi belajar santri sekolah dasar. 
Penel Gizi Makan, 28(2): 83-91.