Characterizing food, diary and beverage availability in primary schools premises in North Macedonia COSI-Study

Abstract

Introduction: Childhood obesity remains a global public health challenge. As part of the World Health Organization's (WHO) Childhood Obesity Surveillance Initiative (COSI), North Macedonia participates in each data collection round to monitor primary school nutritional environments across the country. School nutrition environment characteristic exploration is necessary for managing and tracking childhood obesity and associated risk factors over time. Aim: Using WHO COSI-6thround data, the aim of this study was to depict availability of select foods, dairy and beverages in a nationally representative sample of primary schools across North Macedonia. Material and methods: Data were drawn from the WHOCOSI-6thround conducted in North Macedonia in 2022. A designated official (n=111) at the respective primary school reported availability of the following: (1) food (fruits, vegetables, ice cream, sweet snacks, and savory snacks), (2) dairy (milk, yogurt, and/or ayran), (3) beverages without added sugar (water, tea, and fruit juices), and (4) beverages with added sugar (non-carbonated fruit juices, carbonated drinks, hot drinks [e.g., cocoa], and flavored milk).Additionally, the designated school official reported whether their primary school had a canteen and/or shop/cafeteria where foods or beverages could be purchased. Results: Across primary schools in North Macedonia, availability of healthy options(i.e., fruits and vegetables)was lower as compared to energy-dense selections (i.e., sweet and savory snacks). Overall, 18.3% of schools offered dairy products (including milk, yogurt, and ayran).Water was the most commonly available (69.0%) beverage. No significant differences emerged in availability of food, dairy, beverages without added sugar or beverages with added sugar across primary school enrollment (small versus large). Less than one-fifth of primary schools had a canteen (17.4%) and/or shop/cafeteria (14.4%) where foods or beverages could be purchased. Conclusion: In conclusion, access to food, dairy, and beverages for primary school children in North Macedonia was limited.