Food environments shaping small fish consumption among primary school-age children in Northern Uganda

Abstract Small fish are increasingly recognized as affordable, nutrient-rich animal-source foods, yet little is known about their consumption among primary school-age children, particularly within home and school food environments. This study applied Turner’s food environment framework to examine factors influencing fish consumption among primary school-age children in three districts of Northern Uganda. Using a convergent parallel mixed-methods design, we combined quantitative data from a cross-sectional survey of 109 households involving 280 children with qualitative data from 16 focus group discussions with parents. Children consumed fish primarily at home, mainly as environmentally friendly processed small fish, while school meals largely comprised carbohydrate-rich, plant-based foods. Both external and personal food environment factors influenced fish consumption, but affordability emerged as the dominant driver, mediating the effects of availability, market access, convenience, and desirability. We demonstrate that applying the food environment framework provides a comprehensive understanding of how these interacting factors shape children’s fish consumption. The limited inclusion of nutrient-dense small fish in school meals represents a missed opportunity to improve dietary quality and nutrition among school-age children, with implications for nutrition-sensitive and sustainable school feeding programs in Uganda and other low- and middle-income countries.