International Course in Food Science and Nutrition



International Course in Food Science and Nutrition

TECHNICAL DOCUMENT:

“PROMOTION OF HEALTHY EATING HABIT IN PRIMARY SCHOOL IN URBAN AREAS”

1. Agnieszka Niemyjska

2. Agnes Kihamia

3. Prosi Bangi

4. Jorge Blanco Anesto

5. Alain Kassongo

6. Islam Qazi Shafayetul

MARCH 2003

1. TITLE:

“Promotion of Healthy Eating Habit in Primary School in Urban Areas”.

2. DEFINITION OF THE INTERVENTION:

Obesity is considered as an epidemic in the world, it’s associated with Coronary Heart Disease (CHD), Diabetes Mellitus (DM), and Lipid disorder (LD). Dietary habits, physical activity and genetic factors have been considered as the main etiological factors are closed relate with this disease. There are several conditions that influence over this problem like: urbanization, socialization, industrialization and globalization. Improving the eating habit in primary schools in urban areas can be change the panorama of the epidemic. School staffs have access to large numbers of children in an environment that has the potential to support healthy behaviour and is favorable for the delivery of health promotion programmes. The promotions of healthy eating habit consist of activities will modify of school meals (to eat more vegetables and fruits, to reduce sugar and fat consumption, to eat more rich-fiber food) and the development and implementation of school action plans designed to promote healthy eating and physical activity. Primary school are particularly suitable for such programmes as health messages targeted to children at this age group are like to contribute to behavioral change which could bring life time improvement in their health as they grow up to adulthood. School based programmes might be able to reversing obesity. Therefore, this health promotion programme aims to prevent all pupils who are at high risk of becoming overweight.

3. JUSTIFICATION AND RELEVANCE:

3.1 Justification:

The intervention is justified when de magnitude of the problem is big enough to be considered as a public health problem:

✓ In 1995, there were an estimated 200 million obese adults worldwide and another 18 million under- five children classified as overweight.

✓ As of 2000, the number of obese adults has increased to over 300 million.

✓ In developing countries, it is estimated that over 115 million people suffer from obesity-related problems.

✓ Childhood obesity has reached epidemic proportions, an estimated 22 million children less than 5 years are overweight and million older children.

✓ Countries like Mexico, Peru and Chile, children between 4-10 years, the rates of obesity and overweight is higher than 25 %, also in Egypt, Zambia and Morocco. In countries like Cameroon, Tanzania, Rwanda, Uganda and Yemen the rates is between 10-15%.

2. Relevance:

Promotion healthy eating habit in primary school in urban areas can be:

➢ Long-term solution with maintained effect.

➢ Improve and change the inadequate food habits and increase the consumption of healthy food.

➢ Will be integrated with other programmes at the community to reducing risk factors for obesity.

4. OBJECTIVES:

4.1. In Terms of Outputs:

❖ Personal teaching trained in healthy eating habits.

❖ Children trained in healthy eating habits and healthy life.

❖ Establishments of healthy food like: shops, eating place.

❖ Development of didactic and educational materials.

❖ Modification of school meals.

❖ Improve physical education and playground activities.

2. In Terms of Outcomes:

- BROAD

❖ To decrease the risk factors for obesity in primary school.

- INTERMEDIATE

❖ To improve eating behaviour.

❖ To increase the knowledge of nutrition of the children and teachers.

❖ To change the lifestyle.

5. TARGET GROUP:

▪ Risk group: All children in primary school who are living in the intervention area.

▪ Target group: All children in primary school that will select to participate in the intervention, between 8-10 years because they were cognitively able to complete questionnaires.

▪ Beneficiaries: The whole population living in the intervention area.

6. STRATEGIES:

1. Actors:

• Sponsors (Government and International agencies: UNICEF, WHO and ngo’s).

• Project managers.

• Local academic researchers.

• Project team:

o Educational scientists.

o Nutritionists.

o Health officers.

o Social workers and communication experts.

o Health educators.

• Training team and implementers:

o Nutritionists.

o Training experts.

o Health educatory.

o Teachers.

• Associations:

o Schools.

o Parents.

o Neighborhood.

• Influencing People:

o Head of School.

o Ministry of Education.

o Ministry of Health.

• Target Group:

o School children.

o Women and men

o Teachers.

2. Activities:

1. For the promotion of healthy eating habit:

6.2.1.1 Selecting which kind and preparation of food should be promoted (vegetable, fruits, cereals, whole grains, avoid excess fat and sugar products consumption).

It is preferable to select only a few foods to avoid confusion in the target population. The criteria for the choice will be:

➢ What is locally available.

➢ Acceptability of certain kind of foods.

➢ Nutritional value of the food.

➢ Taste and preference.

➢ Method of preparation and menu in the school.

➢ Prices.

➢ Sustainability.

6.2.1.2 Selecting channels of communication:

➢ Among the existing channels of communication:

✓ The cost.

✓ The accessibility.

✓ The easiness to use for the school and children.

✓ The existing nutritional awareness.

✓ The degree of participation of the children and the interactivity of the channel.

✓ The credibility.

✓ The sustainability of the diffusion.

✓ The adequacy with the objectives.

✓ The preference and motivation of the children.

6.2.1.3 Selecting the messages:

The messages should give information on:

❖ The consequence of obesity and related-disease and its influence over the healthy and long life.

❖ Healthy food increases the quantity and quality of life.

❖ Combining physical activities and healthy eating habits reducing the risk of obesity.

The choice of the messages should take into the account:

❖ The principal factors influencing the promotion in the healthy eating habits we want to improve or change:

|EXTERNAL |INTERNAL |

|- Economical |- Motivation |

|- Climatic |- Knowledge |

|- Social |- Decision |

6.2.1.4 Pretesting the supports and the messages:

❖ This can be done by observations, interviews and focus group with children, teachers and people working or collaborating with this intervention. We will take a small sample of target groups to evaluate the acceptability and the motivation of this type of intervention.

6.2.1.5 Training the teachers:

The teachers must acquire the essential qualities to reach the best effectiveness:

❖ An excellent knowledge in nutritional communication.

❖ The skill to establish a horizontal communication and a high interaction with the target group.

❖ The ability to maintain the dynamic discussions.

❖ The ability to interest and motivate the children.

6.2.1.6 Advertisement on the scheduled activities:

By written and pupil to pupil communication to increase children’s participation:

❖ Pupils to parents’ communication.

❖ Teachers to parents’ communication.

6.2.1.7 Educational sessions:

This can be done

✓ with teaching

✓ discussions

✓ with demonstrations

✓ with practical sessions

✓ with debates

✓ Puppet shows

✓ exhibitions

✓ theaters/ Nutrition shows of competitions

✓ by including nutritional education in school curriculum

✓ via posters, leaflets, banners, ratio, TV

✓ with quizzes

6.2.1.8 Physical activities sessions:

✓ playing different games

✓ construction of playing grounds

✓ sport equipments

6.2.1.9 Other activities:

✓ establishment of different healthy food eating places

✓ modification of the school meals

3. Place of action:

✓ The intervention is done at the primary schools and during events like parents’ day, health day, physical activity day

4. The time dimension:

✓ The time of the intervention should be from the start of the new academic year and for a period of three years.

✓ Our intervention will last only for three years, starting from a new academic year, but nutritional education is a long term program and can last several years. This is just to establish the foundation at primary schools and the government to take over.

5. The resources needed:

➢ Human resources: experts, nutritionists and dietitians, teachers, workers and health personnel

➢ Material resources: didactic and educational materials, meeting places, equipments, sport implements and agricultural products

➢ Financial resources: money to purchase the material resources, salaries of the intervening people

➢ Technical resources: documentation, quizzes, different education

7. ACCEPTABILITY:

7.1 The food habit of the community in general and the family in particular:

▪ household level of income

▪ respect of traditional and cultural practices

▪ status and symbol of some fruits

▪ taste preference of the community and the family

▪ the market prices of fruits and vegetables during off seasons

▪ the comfort or convenience of the training sessions as to the time, day, length of discussion and its application

▪ language used in applying nutritional advices

2. For the staff:

➢ Geographical accessibility

➢ Transportation facilities

➢ The perception of the safety condition (both health and life safety)

➢ Working schedules

➢ Level of salary

➢ The opportunity cost

➢ Respect for the cultural and religious practices

➢ Availability of materials used

➢ Language and knowledge used during training sessions

8. FEASIBILITY

8.1 Technical Feasibility:

❖ Attitude of acceptance for the community.

❖ Knowledge of the language as means of communication for both implementers and local people

❖ Existing markets and market price of fruits and vegetables

2. Operational feasibility:

❖ Locally available vegetables, fruits, cereals, grains

❖ Acceptable market price

❖ Knowledge of the local language

❖ Place of education classes conducive to learning

9. PARTICIPATION:

9.1 At the sponsor level:

• The agreement to provide the money which will be based on the justification, relevance and the feasibility of the project.

2. At the manager level:

• The identification of the problem at their level with the appropriate plans to solve it in relation to their personal motivation.

3. At the implementers level:

• They are the link between the manager and the community. Their participation will be influenced by personal motivation, working conditions, salaries, and respect of and for the community.

4. At the target group level:

• Children as a link between their parents, as actors to transmit the message in the future but this will depend on the participation of their parents towards the intervention.

5. Associations:

• Will help in the dissemination of the message which will depend on how they perceive the problem, their own awareness of their role in the improvement of the situations.

10. EFFECTIVENESS

The intervention should be effective after a certain period of time if there is:

• An increase in knowledge of consequences of obesity and a decrease of obesity related disease. (long term)

• An increase in knowledge of fiber rich foods: whole grains, cereals, vegetables and fruit. (short term)

• A reduction in consumption of obesity promoting food like biscuits, chocolate, hamburgers, soft drinks. (short term)

• Availability and acceptability of healthy foods. (short term)

• Improve of nutritional status. (long term)

• Reduction of obesity prevalence. (long term)

• Those factors mentioned above will be achieved depending on the knowledge, motivation, quality and clarity of the message.

• The ability to obtain a change will depend on the quality of the training, whereas the decision to make a change will depend on the respect for traditional, cultural and religious belief about the food.

11. COST

▪ Salaries

▪ Personnel

▪ Equipments

▪ Evaluation and monitoring

▪ Didactic material

▪ Transportation

▪ Air time to broadcast to radio and television

▪ Construction cost

12. SUSTAINABILITY

• Condition to ensure the continuity of the effects, the sustainability of the process or ongoing participation

o Carefully selection of teachers, e.g. select related with nutrition activities

o Involve parents and relatives in planning the activities

o Involve government during the intervention

o Motivation of people involved in the intervention

o Include nutritional education in the school program

o Increase awareness to health practitioners and health systems on nutrition issues

o To ensure the availability and accessibility of food

13. EVALUATION AND MONITORING

13.1 Pre-evaluation

- guaranteed human resources, logistic material and equipment before the start of the intervention

13.2 ongoing evaluation

13.2.1. methods:

o Group discussion

o Observations

o Questionnaires

o Informal discussion

o Roll plays

o Interviews of school authorities, parents, children and teachers

13.2.2 Criteria to evaluate

❖ Degree of participation of the school

❖ Degree of satisfaction of the children, parents and teachers

❖ Opinion about the program from school authorities, children, parents and teachers

❖ Quantity and quality of the educational material

❖ Quality, timing and duration of the educational session

❖ Quantitative and qualitative evaluation of eating places

13.3 Evaluation of the impact of intervention

* How many children and teachers are trained?

* Have children improved their eating habits?

* Are children doing more physical activities?

* What kind of food are children eating?

* Is there an increase in availability and accessibility of healthy food?

* Are they improving their nutritional status? (Indicators: weight, height, MUAC,

skin fold thickness)

* Is there a decrease in obesity prevalence?

14. Synthetic conclusion

- Promotion of healthy eating habits in primary schools in urban areas should be a

long time process

- This is the foundation of a healthy population which will suffer less diseases related

to eating habits and will be less burden to the health service systems and the society

- The main difficulty of this intervention is the modifying of human behaviour. It is our expectation that starting with children will be easier than with adults.

- The parents and the society also have the responsibility to solve this problem of

obesity.

14. REFERENCES:

1) A guide for the elaboration of a technical document for an intervention. Nutrition unit. August, 1995.

2) Comprehensive Participatory Planning and Evaluation (CPPE). Institute of Tropical Medicine of Antwerp, Belgium; Royal Tropical Institute of Amsterdam, The Netherlands.

3) Promotion of vitamin a rich food in rural area. Technical Document. February,1998.[pic]

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