Strengths and Limitations
Overall, the current investigation showed no adverse incidences alongside improvements in cognitive function in the school feeding and school feeding + MNP groups. Therefore, it can be concluded that the provision of a school meal, with or without MNP, is a safe and tolerable approach for the enhancement of cognitive function in early-stage primary school children in northwest Pakistan. A strength of the study was the use of the RCPM, which is non-verbal and independent of the cultural context, allowing for comparison with differing international and socioeconomic environments. In addition, the study was conducted over a 12-month period, such that the baseline and endpoint tests were both conducted at the same point in the academic calendar, thus negating any potential seasonal effects. A limitation of the trial is that the sample was not randomized and that the baseline characteristics of the three schools were not homogeneous. This is reflected in the difference in mean age between the children receiving lunch and lunch with micronutrients (mean age 8.5 and 7.9 years, respectively) and those not receiving the school lunch (mean age 5.1 years) (