Nutrition Education Series Issue 17

Community Participa tion in Nutrition Education

A Training Manual

compiled by

Paz Concepcion-Lutz

Ministry of Education, Cultural Affairs and Sports in collaboration with the

Institute of Education and Assisted by UNDP/UNESCO Project:

The National Dissemination of an Innovative Primary School Curriculum Adapted to the Local Environments

Unesco Division of Science

Technical and Environmental Education

ED.88IWSI53 Paris, 1988

CONTENTS

Preface

In t roduct i

Par t One

Chapter I Chapter II Chapter III Chapter I V Chapter V

Par t Two

Chapter V I Chapter VI1 Chapter VII I Chapter IX

Par t Three

Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 Module 8

References

Appendices

Appendix I Appendix II Appendix III

Appendix I V

Th Bunumb Cont t

C O M M U N I T Y P A R T I C I P A T I O N IN NUTRITION E D U C A T I O N

Hea l th and N u t r i t i o n in Communi ty Educat ion K n o w i n g Your Community Understanding Community Part ic ipat ion The Roles o f the Teacher as Community Animateur The Community Organization Approach

T E A C H I N G - L E A R N I N G IN C O M M U N I T Y P A R T I C I P A T O R Y A C T I V I T I E S

School Community Hea l th Ac t ion Programmes Pre-Service and In-service Teacher Educat ion Integrated HeaIth and N u t r i t i o n in Pr imary Schools Evaluat ing Teaching-Learning Effectiveness

T R A I N I N G MODULES FOR TEACHERS

N u t r i t i o n in Community Educat ion N u t r i t i o n a l Requirements f o r Specific Groups I n f a n t N u t r i t i o n N u t r i t i o n and Growth Local Foods and Eat ing Habits Preparation and Preservation o f Foods Improved N u t r i t i o n Through Home Gardens Water, Heal th and Sanitat ion

Community N u t r i t i o n Survey N u t r i t i o n Status o f the Child Mothers’ Workshop in Nutr i t ion: Questionnaire .... Pretest .... Lessons Scope and Sequence f o r Pr imary Home Economics

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Among the key issues and problems fac ing n u t r i t i o n education today, pertinent to Sierra Leone, are: (a) how to improve classroom n u t r i t i o n teaching at p r imary l e v e l (b) how to incorporate ef fect ive ly n u t r i t i o n education i n t o pre-service and in-service teacher t ra in ing (c) how to link in-school learn ing and out-of-school educational act ivi t ies (d) how to assess and evaluate n u t r i t i o n teaching and learn ing and (e) how to promote n u t r i t i o n education in the community. The Sierra Leone Government/ M in i s t r y o f Education, as o f 1985, has addressed these issues, u t i l i z i ng the outcomes o f the Bunumbu Project (1974 - 1982) experiment in the U N D P / UNESCO assisted project called "Nat ional Dissemination o f an Innovat ive Pr imary School Cur r i cu lum Adapted to the Loca l Environments".

This t ra in ing manual i s a compilat ion o f the concepts, body o f knowledge and processes wh ich were gained f r o m the Bunumbu experience. I t emphasizes communi ty par t ic ipat ion in cur r icu lum development in heal th and nu t r i t i on education, bo th f o r p r imary schools and teacher education, and consists o f th ree parts. Par t I deals w i t h Communi tv Par t ic ipat ion in N u t r i t i o n Education. Par t II discusses Teaching - Learn ing in Communi tv Par t ic ipatorv Activit ies, while Par t III contains Tra in inp Modules f o r Teachers. M u c h o f the materials were contr ibutions o f e i t h e r papers or comments and outcomes f r o m seminars and several cur r i cu lum w r i t i n g workshops in communi ty development, heal th and nut r i t ion.

I t i s hoped that teachers and teachers-to-be, through the use o f this manual wou ld be better equipped to in f luence children's and family's food and nu t r i t i on habits, improve the d ie tary related behaviour, and promote the health status o f t h e communities that they serve.

The views expressed i n the text are those of Unesco.

PREFACE

The f i nanc ia l assistance towards the preparation o f this document and the i r related activit ies, f r o m the N u t r i t i o n and Hea l th Educat ion D iv i s ion o f Science, Technical and Envi ronmenta l Education, UNESCO and f r o m UNICEF, Sierra Leone, i s gratefu l ly acknowledged. But a l l the materials put together and their t ry-out wou ld no t have been possible w i thou t the cooperation and involvement o f the p r imary teachers in several p r imary schools, lecturers and s ta f f o f the Teacher Colleges and the Inst i tu te o f Education du r ing the product ion and t ra in ing workshops related to t h i s Manual. T o a l l o f these colleagues in education, who are too many to mention, and to the about 120 mothers in the f i v e regional centres o f the Dissemination Project, who par t ic ipated ef fect ive ly in the workshops, a special thanks i s extended. Gra te fu l appreciation i s also given to other agencies in Sierra Leone, l i k e the World Food Programme- FAO, Cathol ic Re l i e f Services, P L A N International, Peace Corps, t h e R u r a l Water Supply Unit o f the Ministry o f Energy and Power, and the Resource Centre o f Sierra Leone Home Economics Association, f o r the i r cooperation and support. The permission granted by WHO to use in part, sources in their related publications i s he re in acknowledged w i t h thanks.

Final ly, cred i t goes to M i s s Le t ic ia Gbenga f o r t yp ing this manuscript as we l l as the other materials used in the preparation o f this manual, and to Mr. Alusine Bangura f o r the i l lustrat ions in the visual aids.

Paz C. Lutz, Ph. D.

those of the authors and not necessarily

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INTRODUCTION: THE BUNUMBU CONTEXT

Bunumbu Teachers College in Sierra Leone, f r o m 1974 to 1982 was the center o f a UNDP/UNESCO assisted project, called "Tra in ing o f Pr imary School Teachers f o r R u r a l Areas". The project was conceived to support the educational development po l i cy o f g i v ing p r i o r i t y to p r imary education w i t h a v iew o f improv ing condit ions o f r u r a l l iv ing. Among i t s many aims, the Five-Year Nat iona l Development P lan f r o m 1974 to 1979 (wh ich was extended to an addi t ional three years) inc luded the fo l lowing:

"To accelerate the expansion of Pr imary Education, especially as regards teacher education.

T o make the content of education in a l l subsectors more relevant to the economic and social needs o f the country.

T o raise the l e v e l o f l i teracy, by bo th p r imary and out-of- school education."

Sierra Leone's development problems suggest that i t i s a s i tuat ion wh ich i s in many respects analogous to that of i t s s is te r A f r i c a n countries, such as:

- 85% o f a to ta l populat ion of 3.0 m i l l i o n l i v e in r u r a l areas. roughly 90% o f adults l i v i n g in r u r a l areas are i l l i te ra te and have l i t t l e or no education or organized non- fo rma l education.

- 75% o f t he w o r k i n g populat ion are employed in subsistence level agriculture. there i s roughly 60% wastage f r o m p r imary to secondary levels o f education

- some 60% o f p r imary school teachers have no teaching q u a l i f i c a t i o n a n d t h e remainder are in great need o f in-service t ra in ing

-

-

- teachers' colleges are unable to supply the demand fo r more teachers to handle increased enrolment

- the academic cu r r i cu lum i s geared to promot ing upward mob i l i t y w i t h i n the school system and eventual ly h igher education

- rough ly 40% o f the p r imary school age group are actual ly enrolled and in some r u r a l areas, even as l o w as 109'0.

In the Bunumbu project, communi ty education in both fo rma l and nonformal systems was aimed towards improv ing the qua l i t y o f l i f e in the surrounding villages, by promot ing the people's ab i l i t y to respond posit ively to the i r l i f e situation, b y work ing together to improve the qua l i t y o f the i r l i v e s and by enhancing the roles o f schools, to be more responsive to the needs o f the communi ty and make the home-school relat ionship an integrated one. I t i s a imed at improv ing the qua l i t y o f p r imary education system through a number o f innovat ive educational practices.

Innovations in the Bunumbu Proiect

As a p i l o t project, i t i n i t i a ted i n t o twenty villages w i t h i n a perimeter wi th 20 miles radius, a r e f o r m in the p r imary school cur r i cu lum by in t roduc ing pract ica l subjects l i k e Home Economics, Practical Arts, Agr i cu l tu ra l Science and Communi ty Development. Emphasis was placed upon in tegrat ing subjects through cross subject approach, and developing systematic units o f instruct ion, i nc lud ing classroom evaluation techniques and p rov id ing teacher guidelines f o r covering the units and syllabuses.

Related to this, was i t s in-service t ra in ing programme, wh ich emphasized cur r i cu lum development. The essence of t h i s innovat ion i s tha t cu r r i cu lum i s developed at t h e "grass roots" b y the users - the classroom and student teachers,

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guided o r supervised by subject specialists and by teacher trainers. Teachers par t ic ipat ing in cur r icu lum w r i t i n g workshops received lectures a n d guidelines in producing inst ruct ional units and demonstrations in new teaching techniques. The cur r i cu lum wr i t ing workshops updated teacher s k i l l s in p lann ing lessons through use o f behavioural objectives, local resources and materials, improv ing teaching methods and learn ing processes, as we l l as techniques f o r evaluation.

The teachers w o r k in "subject panels" and the materials they produce are f i e l d tested wi th their o w n pupils. While teachers grow professional ly w i t h updated content and methodology, there i s a continuous programme o f cur r i cu lum development. F ig 1 shows the model o f the Bunumbu process f o r cur r i cu lum development.

The guidelines f o r w r i t i n g units and syllabuses emphasized the cross subject approach and promoted a n integrated exchange among teachers and lecturers o f various disciplines. Close relat ions between the Bunumbu Teachers College and the p r i m a r y schools were promoted through par t ic ipat ion o f lecturers and teachers in the workshops.

By 1982, teacher-designed pr imary school syllabuses h a d been prepared f o r a l l subjects, inc lud ing Home Economics. O f the more than 150 inst ruct ional units, about 20 o f the units are in home economics and more than h a l f o f these, deal wi th topics related t o foods, n u t r i t i o n and c h i l d care o r mother craf t . The emphasis o n n u t r i t i o n education, wi th in the f rame work o f the home economics syllabus o f Bunumbu Teachers College cen- tered o n the n u t r i t i o n and heal th problems as i t a f fected these small, remote, agr icu l tura l villages. More important ly, in designing educational programmes that meet communi ty problems and st imulate people t o p l a n a n d imp lement developmental activities, the Home Economics d e p a r t m e n t w i t h t h e col laborat ion o f the Hea l th Educat ion department undertook a "reaching out"

process that invo lved n o t on ly the pre- service and in-service teachers and pupils, but also, t h e community. The instruct ional materials fac i l i ta ted pupils' understanding and knowledge, promoted teachers' dialogue with communi ty members and integrated communi ty par t ic ipat ion in the school curr iculum. By promot ing heal th and n u t r i t i o n education a t the pr imary school level, the Bunumbu project had env isaged t h a t w i t h c o m m u n i t y involvement, the school populat ion wou ld improve i t s nu t r i t i ona l status and heal th behaviour, thereby, promot ing the heal th status o f their respective communities.

Wi th regard to i t s teacher education programme, the project sought t o develop a new breed o f teachers, who as communi ty animateurs, change agents and faci l i tators can contr ibute t o the t ransformat ion o f r u r a l communities and improve their qua l i t y o f l i fe . The content and approach o f the teacher education cur r i cu lum in Bunumbu Teachers College were made consistent wi th the basic philosophy and concepts o f the rura l - oriented pr imary school curr iculum.

The scope o f the new teacher education programme consists o f teaching- learning act iv i t ies organized around three ma in themes, each one f o r every year o f t h e three year programme. The f i r s t year has f o r i t s theme -- Skill Achievement f o r Communi ty Education. I t promotes the mastery o f basic s k i l l s needed by the teacher-to-be f o r e f fect ive par t ic ipat ion in various aspects o f communi ty development. In the second year, the theme i s Content Achievement f o r Communi ty Educat ion and i t provides f o r t h e trainee t o acquire necessary content materials a n d how to organize them. The theme f o r the third year i s called, Professional Achievement f o r Communi ty Education. In this year, the trainees develop prof-essional competencies.

Throughout the three years o f pre- service training, the ski l ls , content and professional competencies are developed through work-or iented projects and activities. These projects are assigned to

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Teachers Colleges Pr imary Schools

Pre-test/Field T r y outs/Post-test

I Problem Ident i f i ca t ion

Or ien t a t i on Meetings Planning Solutions Educational Strategies

r Situation Analysis

r

Audience, Targets in Pre-service and In-service Communi ty Teachers

Teaching Modules

Inst ruct ional Units Workshops

Guidel ines f o r Communi ty Par t ic ipat ion

Mo t hers ' Works hops

Fig. 1 Curriculum Development i n the Bunumbu Process

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groups of eight to ten student-teachers under the supervision o f three or f o u r lecturers. F o r example, du r ing the f i r s t year, projects migh t include s k i l l development in pract ica l arts and r u r a l technology, such as weaving, ceramics, blacksmithing and cane furn i ture-making. In the second year, the trainees focus o n "what we need to k n o w f o r everyday l iving", wh ich integrates the pract ica l subjects wi th science, mathematics, communication arts, and community studies. D u r i n g practice teaching in the third year, the trainees are expected to demonstrate classroom teaching s k i l l s and, in addition, to conduct r u r a l s tud ies and surveys, to p lan and car ry out se l f -he lp projects in the vil lages such as, construction o f vi l lage markets, t own h a l l or barrie, digging o f latr ines or water well, c ra f t t ra in ing f o r out-of-school youth, and adul t act ivi t ies in nutr i t ion, health or agriculture.

In effect, student teachers find themselves in the p i l o t schools/villages o f f e r i n g af ternoon classes f o r pre-and post-natal care, demonstrating new ways to prepare nu t r i t ious meals, constructing model ki tchens and many other 'food- centered', communi ty oriented activit ies. Other students wou ld have f a r m projects, adul t l i teracy classes, construction o f water wells, la t r ine or market sheds. Their t ra in ing focuses on s k i l l s development f o r communi ty education as we l l as the science o f pedagogy. The d e p a r t m e n t o f C o m m u n i t y / R u r a l Development Studies o f the Teacher Colleges assists in t h e development o f s k i l l s in the teacher tha t wou ld enable him/her to func t i on as communi ty animateur, o r change agent and as fac i l i ta to r f o r communi ty education.

Communi ty Development Councils in t h e p i l o t v i l l a g e s p r o m o t e d school/community in tegrat ion through r u r a l technology workshops, s e l f -help programme and communi ty education. Wi th the help o f lecturers f r o m the college and p r imary teachers as project leaders, adul t education and l i teracy programmes, publ ic lectures and women's demonstration classes f o r

health and n u t r i t i o n were held. Focus was also given to establishing cooperatives and mutua l a id organizations. The community became involved in gathering in fo rmat ion about the i r problems, p lanning f o r the i r solutions and act ing upon them. Inservice t ra in ing by and f o r vi l lage craftsmen and mobile craf ts team in local communities re in forced the pract ica l arts t ra in ing in the p i l o t schools and the Bunumbu Teachers College. Thus, the p r imary schools became communi ty education centres.

These innovat ive educational practices at the Bunumbu Teachers College resulted in the fo l low ing outcomes:

A cur r i cu lum f o r p r imary schools relevant to the communi ty

A cadre o f t ra ined teachers f o r r u r a l areas

(a)

(b) A new teacher p ro f i l e (c)

(d) School/Community in tegrat ion (e) Teacher pre- and in-service

educational programme. (f) I n s t i t u t i o n b u i l d i n g f o r

communi ty education

The government o f Sierra Leone, because o f the results o f the Bunumbu project, decided to expand the project's programme in other areas o f the country through a UNDP/UNESCO assisted project start ing in 1985 f o r a period o f f ou r years, called "Nat ional Dissemination o f an Innovat ion in Pr imary Education." In general, this project w i l l concentrate on (1) the improvement o f the p r imary school cur r i cu lum in the schools attached to the other fou r teacher t ra in ing colleges in Sierra Leone: Bo, Freetown, Maken i and Port Loko (See Fig. 2) (2) a correspond- i n g improvement o f p r imary teacher education (3) the l i n k i n g o f p r imary teacher t ra in ing colleges w i t h local communities, and (4) developing pr imary schools i n to communi ty educational centres capable o f p rov id ing learn ing programmes f o r both ch i ldren and adults. In a decade, the Bunumbu Pi lo t project has been translated i n t o the 'Bunumbu experience' and the 'Bunumbu context' has now become a par t o f t he dissemination process.

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Fig. 2 Locations of Teacher Training Colleges i n Sierra Leone

I @ Teacher Colleges

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ñILOMElERS O 10 A0 6 0 80 IOC

MILES O 10 A0 60

mununtu

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L I B E R I A

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Part One

COMMUNITY PARTICIPATION IN NUTRITION EDUCATION

". . Perhaps the most significant achievement of the "Bunumbu Experience" i s that it ascended from being simply another "project" to being a "spirit". This intangible or abstract effect seemed to have brought about an entirely rzew attitude - one of cooperation and self- help -within the minds of those involved in project activities. Local students, graduates, teachers, administrators and Community Leaders speak of the "Bunumbu Spirit" as a symbol of "getting a j ob done."

Terminal Report, March 1983 UNDP/SIL/73/009 UNESCO, 1983

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CHAPTER 1

H E A L T H A N D NUTRITION IN C O M M U N I T Y E D U C A T I O N

Communi ty Education i s aimed at human resource development b y p rov id ing the necessary knowledge o f t h e social and physical environment, by developing capacities and s k i l l s towards ef fect ive par t ic ipat ion in local-level problem-solving and self-reliance in development activit ies. People should be given the oppor tun i ty to part icipate in determining the i r goals and to make decisions f o r major changes in their communities. The philosophy f o r community development stems f rom the b e l i e f that people accept change and seek improvement.

N u t r i t i o n and health-related problems o f Sierra Leone should be a major consideration f o r communi ty education. Sierra Leone has an i n f a n t mortal i ty, estimated to be one o f the highest in the world. I t i s estimated at over 200 per 1000 l i v e births, d i f f e r i n g markedly b y regions. C h i l d mor ta l i t y rate, covering t h e 0-5 years age group, i s estimated at 366 per thousand. L i f e expectancy i s presently to be 47 years f o r men and 50 years f o r women. The predominant causes o f mor ta l i t y in Sierra Leone are due to inadequate nut r i t ion, over-crowded housing and communicable diseases as we l l as to the lack o f basic environmental heal th conditions, i.e. safe d r i n k i n g water supply and sanitation. Ma jor communicable diseases l i k e measles, malaria, tetanus, tuberculosis and whooping cough account f o r the bulk o f i n f a n t and c h i l d mor ta l i ty . Respiratory diseases, skin ulcers, he l - m in i th i c infections, anaemia, schisto- somiasis and diarrhoea, also constitute serious heal th problems. Ma lnu t r i t i on exists in both u rban and r u r a l areas. A nat ional survey conducted in 1978 concluded that nearly 24% o f a l l ch i ldren in the 0-5 years o f age group su f fe red f r o m chronic under-nourishment. The average da i l y in take o f food necessary in order to lead a healthy l i f e remains f a r below the required l e v e l w i t h i n the

average household. I t fo l lows that approximately 30Yo o f the young ch i ld ren are under-weight, wi th the peak being attained in the second year o f age. (Country Hea l th Resources U t i l i z a t i o n Review, 1984).

The most impor tan t heal th and nu t r i t i ona l work in the communi ty consists o f prevent ion rather than cure. Ch i ld ren are more vulnerable than adults to the effects o f poor n u t r i t i o n and heal th conditions. Under-f ives are at a n age when poor n u t r i t i o n can contr ibute to serious i l lnesses. The younger school c h i l d i s also at an age where poor f o o d can have permanent e f fec t on his heal th and development. Mothers have special dietet ic needs du r ing ante-natal and post- na ta l nurs ing periods. The problem o f lack o f food, att i tudes and bel iefs about cer ta in foods complicated w i t h lack o f knowledge about sound n u t r i t i o n contr ibute to their being i l l - f e d and in i l l -health. A l though ine f f i c i en t f ood product ion and d is t r ibu t ion systems contr ibute to the prevalence o f under-nutr i t ion, parents need a bet ter understanding o f the nu t r i t i ona l needs o f the fami ly , especially, the young i n f a n t or ch i l d and how to explo i t exist ing food resources w i t h i n their purchasing power.

Food Hab i ts Which Contr ibute to Under- nu t r i t ion

Food habits are d i f f i c u l t to change. They ar.e -deepl'y' rooted in the past f o r a l l people and in t imate ly woven in customs, religious bel iefs, educational and economic attainments o f a g iven society. The fa i l u re to prov ide enough o f the r i g h t amounts and kinds o f foods to those w i t h greatest nu t r i t i ona l need may be rooted in food habits, traditions, b e l i e f s and p l a i n ignorance. Eat ing practices w h i c h contr ibute to th: - n u t r i t i o n problems (not in rank ing order) are as follows:

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- n o d e f i n i t e da i l y meal times f o r ch i ldren in the fami ly ;

Social Factors

- families eating f r o m a communal bow l a t t he same time, where smaller and weaker ch i ld ren receive less f ood than the more aggressive children;

- breakdown o f t rad i t iona l methods o f f a m i l y spacing and lack o f access to in- fo rmat ion and services o f modern methods o f contraception;

- social restrictions re la t ing to the consumption o f an ima l prote in b y pregnant and lactat ing women;

- f ood restrictions tha t affects certain members o f the community;

- customs, routines and practices that prevent ch i ldren and workers f r o m tak ing food before leaving f o r school or work;

- customs, routines and practices that a l low f o r on ly one meal a day, usually cooked in the late afternoon;

- cooking one meal a day consisting o f t h e same diet or menu each day (not always well-balanced) and w i t h left-over foods (usually improper ly preserved) sometimes being saved and eaten t h e next morning;

- poor conditions f o r preserving foods, coupled w i t h the humid weather, causing many foods to become spoiled and dangerous f o r consumption.

Before t r y i n g to change people's food, i t i s impor tant to find out what i s wrong w i t h the local diet, w h y people have cer ta in eating patterns, how deep-rooted are be l ie fs and prejudices, how much o f the problems i s due to poverty and inab i l i t y to buy or produce more and how much i s due to ignorance.

Food habits that are most closely associated w i t h f a m i l y sentiments are the most tenacious throughout l i f e . Ea t ing together as a f a m i l y brings closeness and solidarity. Long i n t o adulthood certain foods are valued f o r reasons to ta l ly apart f r o m any nu t r i t i ona l value. In nearly a l l societies, lav ish amounts o f foods are served on special occasions such as wedding, feasts or funerals, - the more lav ish the spread t h e greater the compliments to the host. Even the low- income famil ies w i l l borrow money on the next harvest or take years to repay in order to prov ide a feast. In general, l o w income i s correlated w i t h inadequate food in take or h i g h carbohydrate w i t h nutrient inadequacy.

Prestige Food. One o f t h e wonders o f the modern food w o r l d i s the widespread consumption o f sof t drinks and beer even though they are expensive and nu t r i t iona l l y negligible.

Advertisements. Media has many times brought attention to the consumer certain foods to buy and create a demand. Likewise, advertisements may help create prejudices and bel ie fs , va l i d and otherwise, especially when consumption i s associated w i t h i l lness, as in the case o f sugar, viz- a-viz saccharin or other non-caloric sweeteners, f ood f lavoring, processed foods, etc.

Bel iefs, Taboos and Re l ig ion Some foods are considered " l ight" or "heavy" or l i ke l y to produce winds, constipation, worms, etc. In many parts o f Sierra Leone, eggs are thought to cause s ter i l i ty in women or make ch i ldren steal. Each re l ig ion has very specific r u l e s on what foods are acceptable or taboo.

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Fami l ia r i t y . Homemakers become fami l i a r w i t h foods wit-purchasing power. A h i g h carbohydrate diet, usually l ow cost and nu t r i t iona l l y inadequate, i s a much accepted practice in many families.

immunization, medical history, special care f o r t h e chi ld. Parents keep this char t a t home and where i t concerns a chi ld-at- risk, i t s i n fo rma t ion should encourage parents to be more invo lved and responsible for the child’s heal th care.

The Assessment o f Nu t r i t i ona l Status Dietary Evaluation

Baseline i n f o r m a t i o n about t h e nu t r i t iona l status o f the community can be attained f r o m both direct or ind i rec t assessment.

Nut r i t iona l Anthropometry

Selected body measurements can give valuable i n fo rma t ion concerning certain types o f ma lnu t r i t ion in wh ich body size and gross body composition are affected. Nu t r i t i ona l anthropometry i s concerned w i t h the measurement o f the variat ions o f the physical dimensions and the gross composition o f the human body at d i f f e r e n t age levels and degrees o f nut r i t ion.

The most usua l anthropometr ic measurements are (a) weight (b) height. W h i l e there i s no easy and satisfactory way to measure the nu t r i t i ona l status o f a ch i l d a t a single examination, the two most common methods are the weight f o r age (Gomez-type) nu t r i t i on classif icat ion and the measuring strip. (See Module on N u t r i t i o n and Growth) These measures are compared to local standards when available, f o r weight-for-age and height- for-age, and weight f o r height according to sex. However, the most w ide ly available general anthropometric standards o f reference are the Harva rd standards or Ba ldwin standards.

Growth Charts

A growth c h a r t i s basically a graph f o r under- f ive on wh ich a child’s weight i s shown at d i f f e r e n t ages. (See Module on N u t r i t i o n and Growth). I t w i l l give graphic plots o f weight f o r age over a number o f years, n o w the d i rect ion or

_->-*_<-. .-.-*-.--. .- angle o f a child’s own growth l ine. Other impor tant features o f the growth chart include in fo rma t ion about ch i l d and fami ly ,

The assessment o f f ood consumption in re la t ion to nutrient and energy requi rements i s cal led d ie tary evaluation. The household food consumption survey, consists of three steps:

assessment o f f ood consumption- recording quanti t ies o f f ood eaten du r ing a set period, say, 7 days b y weighing and measuring foods in the raw state or perhaps cooked portion.

calculat ion o f nutritive value o f f ood - f ood composition tables, preferably local, i f avai lable are used to calculate value. Food composition should be calculated per day. Cooked servings may be used and weighed i f d is t r ibu t ion w i t h i n the f a m i l y i s used.

comparison w i t h nu t r i t i ona l requ i re - ments - the d ie tary data forms the basis f o r pract ica l measures to improve the nu t r ien t intake, inc lud ing n u t r i t i o n education.

The twenty- four-hour recal l i s an abbreviated survey method. The inter- viewer asks the householder on a l l foods consumed du r ing the previous 24 hours. The diets o f school ch i ld ren can be evaluated by a mod i f i ca t i on o f this method - such as, determin ing the frequency o f consumption o f various items in their diets, to get a general idea o f the food pat tern o f t h e community.

V i t a l and H e a l t h Stat ist ics

A considerable amount o f i n fo rma t ion can be collected wh ich may give an insight i n to the characteristics o f the communi ty and i t s l i f e , heal th and mor ta l i t y experience. This ind i rec t assessment comes f r o m populat ion histograms o f

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various age groups, wh ich could reveal if the populat ion i s preponderantly young and therefore give c r i t i ca l clues to the existence o f n u t r i t i o n problems.

Morb id i ty and Mor ta l i t y Statistics

Death rates in the second year of l i f e may be the best indicators o f chi ldhood mor ta l i t y f r o m malnut r i t ion. This i s the classical age-group pr inc ipa l l y a f fected b y kwashiorkor. At t h i s time, the ch i l d i s experiencing the "transitional" d ie tary period, when the ma in foods are l i ke l y to be largely carbohydrate. (See Module on Nu t r i t i ona l Requirements f o r Specific Groups.) Incidence o f acute diarrhoeal diseases and i t s repeated occurrence in a c o m m u n i t y has i m p l i c a t i o n s f o r environmental sanitation, home management o f the in fect ion and prevalence o f the use o f rehydrat ion therapy f o r t h e community. Parasites and diarrhoea reduce the e f f i c i ency o f nutrient absorption. Maternal mor ta l i t y rate as we l l as the number o f pregnancies, s t i l l and l i v e births in the reproductive h is tory o f the mother in a household may be correlated w i t h heal th care practices viz-a-viz, prenatal and post na ta l care, f a m i l y p lanning attitudes and nu t r i t i ona l requi rements du r ing pregnancy.

School-Community Relat ionship

T o b r i n g about behavioural changes in a

community, i t i s impor tant to understand the economic, social and cu l tu ra l factors wh ich in f luence dietary patterns, f ood intake, and thus, nu t r i t i ona l status. N u t r i t i o n education begins by i den t i f y i ng the nu t r i t i on and heal th problems, analy- z ing the nature o f the problem and rev iewing the behaviour or practice that i s related to the problem. A ful l understanding o f the factors wh ich contr i- bute to the problem should now lead to school-community relationships.

The nu t r i t i on educator should focus on the in tegrat ion o f these problems in school learnings and the targets themselves should be involved in explor ing new nut r i t iona l practices, i.e. preparing balanced meals and d iets f o r specific groups, food substi tut ion and improved sources o f food nutrients. Schools should invo lve the pupils and communi ty groups to conduct the i r assessment o f nu t r i t iona l status, collect d ie tary in format ion, recognize physiological indicators o f malnutr i t ion, iden t i f y def ic ient groups and the incidence o f deficiencies.

___r__ -=-

The increasing ro le o f the schools as community education centres prov id ing "out r exi--~rj~-v$~ in hea 1 t h and nut r i t ion, E a t i n g teaching -1 earn in g n ut r i t i o n u t i l i z i ng communi ty par t ic ipat ion toward realistic solutions are a l l aimed towards the protection and promot ion o f the health o f the pupils, home and the community.

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CHAPTER 2

K N O W I N G Y O U R C O M M U N I T Y

T o be able to in t roduce innovat ive and ef fect ive techniques in nu t r i t i on education, i t i s impor tant to determine what are the nu t r i t iona l and health-related problems that serve as constraints to ‘healthy eating’ as we l l as the avai lable loca l resources tha t can be u t i l i zed to solve them. As in most r u r a l areas in developing countries, the adverse nu t r i t i on situation cannot be solved alone by fo rma l education experiences but by e l i c i t ing also the active par t ic ipat ion o f the community in promot ing the goals o f n u t r i t i o n edu- cation. The Bunumbu experience starts w i t h a community survey and an identi- f i ca t ion o f the ‘ f e l t needs’ wh ich sensi t izes the community to their problems and indicate targets f o r n u t r i t i o n education outside the fo rma l system. The f ind ings become a basis f o r teaching-learning situations that are relevant to the needs o f t h e children, and wh ich promote nu t r i t i on practices through communi ty part icipation.

In fo rmat ion about the Community

The purpose o f a communi ty survey i s to acquire i n fo rma t ion that w i l l help d e f i n e nu t r i t i on and heal th education activit ies. (See Appendix I). The socio-economic data and demographic charac,teristics o f the community w i l l reveal the social and economic potent ia l f o r community part icipation, local fac i l i t ies and resources f o r nu t r i t i on education. I t provides in fo rmat ion on the household size, composition, ethnic grouping, income-level, h o u s i n g c o n d i t i o n s a n d genera l environmental sanitation. Wi th regards to the communi ty and ch i l d nu t r i t i on surveys, data about practices in re la t ion to i n f a n t feeding, nu t r i t i on status o f the child, household eating habits, home hygiene, health care and beliefs concerning food consumption are taken into account in the content o f inst ruct ional materials and in health promot ion activi t ies wh ich are community-based. As a body o f in fo rma-

t i o n and data-gathering device, the com- munity survey should also inc lude a study o f the att i tudes towards n u t r i t i o n and health-related practices in the community. These attitudes, in add i t ion to the knowledge and behaviour o f t he n u t r i t i o n education targets w i l l in the long-run be impor tan t indicators to determine the effectiveness o f t h e educational activit ies.

In the community, there are f o r m a l and i n f o r m a l groups and organizations, key people, leaders and youth who can contr ibute to t h e communi ty par t ic ipat ion process. A survey w i l l i den t i f y members o f the communi ty who comprise the Communi ty Development Counci l (CDC) and in some areas, women and teachers are members o f these committees. School based organizations, l i k e the Parent Teacher Association (PTA), social and trade unions are valuable sources f o r communi ty action. Members o f these groups and other ind iv idua ls can prov ide inputs in the f o r m o f labour f o r self-help projects, access to land, water and other services, resources and s k i l l s f o r income generating activit ies, l inkages to various governmental and non-governmental sectors in the area, problem-solving machinery and decision-making apparatus.

Leaders, women, teachers and pupils par t ic ipate to i d e n t i f y the i r perceived problems and f e l t needs, wh ich prov ide direct ions f o r communi ty involvement in nutri t i on educa tion.

I n fo rma t ion f o r t h e Community

A n y communi ty survey should be carr ied out w i t h the ful l knowledge and unders tand ing o f the Commun i t y Development Counci l or the vi l lage elders on i t s purpose. The assessment of communi ty needs and resources needs to be shared and discussed w i t h the community, before, du r ing and a f te r the survey. This w i l l spark the in te res t o f the

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people o n what i s t he i r local si tuation and st imulate them to think about what can be done by themselves.

A f t e r the survey, the headmaster and s ta f f o f the p r imary school in the communi ty and/or the Communi ty Development coordinator o f student teachers, should discuss the results and col lect ively p lan on what the school can in i t i a te or fac i l i ta te to get the community involved. In a meeting w i t h the CDC, based on the resu l t s of the survey and other in format ion, the group must recognize and de f ine the needs and problems, compare the present conditions w i t h the des i red goals and decide i f i t i s feasible to attain. The group must also discuss the p r i o r i t y o f the things they want to do, what resources are available to them in the community, and the i r capacity to successfully complete their plans.

I t i s the role o f t h e school personnel or s ta f f from Teacher Colleges to i n f o r m the communi ty /CDC what services and materials f r o m governmental and non- governmen ta l agencies can supplement the i r resources. Fo r example, the construction o f water we l l or la t r ine as possible solutions wou ld requ i re a l l the i n fo rma t ion about the use o f local labour and materials, the technical support f r o m the R u r a l Water Supply Unit, M in i s t r y o f Energy and Power, o r f r o m the non- governmental agency support ing water wel l construction, the communi ty responsibilities f o r i t s maintenance, and the behavioural changes requi red to achieve t h e benef i t s o f the heal th fac i l i t y . I f supplementary foods f o r in fan ts i s t h e problem, educational act iv i t ies should be planned and assistance f r o m non-governmental organizations concerned w i t h food- for - work, o r feeding o f under-f ives should be explored and solicited.

D u r i n g these meetings and dialogue w i t h the Communi ty Development Counci l or

w i t h other groups and individuals, emphasis should be on the social potentials o f the group to undertake i t s ini t iat ives, in order to develop confidence in t h e i r ab i l i t y to carry out their responsibilities. More attention should be made to cooperative spirit, group pride and sentiment. Two- way communication between leaders and their people, and between the school and the community should be promoted to ensure popular support and vo luntary part icipation.

The Community Development Council

Communi ty development i s a process f o r change. I t i s bo th the means and the end, and i s aimed towards a better way o f l i v i n g and o f do ing things, in i t ia ted and sustained by the community itself, in an almost complete mobi l izat ion and harness- i n g o f the physical, economic and social potentials o f the local communi ty groups. The processes mot ivate and stimulate active par t ic ipat ion and enthusiastic response to t h e outcome. I t w i l l succeed i f people themselves choose to do what they f e e l i s best f o r them, make widespread use o f loca l manpower and material resources and i f there i s a good- sized organized local group that plans, implements and works on the i r chosen ac t iv i ty/project.

Communi ty Development Councils (CDC), composed o f communi ty leaders, respected members o f t h e community, school personnel, and youth are organized to promote cooperative act ion and use educational inst i tut ions as catalysts f o r change, I t serves as a voice o f the c o m m u n i t y d i s c u s s i n g p r o b l e m s , exchanging ideas and f i n d i n g solutions to a communal problem. Depending upon the size o f the community, the CDC has officers, an executive committee and subcommittees as we l l as a general assembly.

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Community Development Council

Executive Commit tee

5 - 7 members

I Officers

Chairman Vice-chairman President Vice-president Secretary Treasurer Aud i to r Development

Di rector

General Assembl v Residents 18 yrs. 7 and above 1;-

The structure of t h e CDC need not be the same for a l l communities - bu t i t w i l l depend upon par t icu lar need and local situations. What i s impor tant i s that i t i s representative o f the e n t i r e community, i t i s simple, f lex ib le and composed o f people who have abilities, experience and readiness to work on a vo luntary basis.

Paramount among the purposes o f the CDC are:

(a) to ident i f y the f e l t needs o f the communi ty

(b) to sensi t ize community members to the problems

(c) to discuss and find solutions to i t s problems, and

(d) to marshal1 available local ma- terials, labour and other r e - sources for development pur - poses.

I

Standing Committees

Agr icu l tu re Educat ion Hea l th and N u t r i t i o n Social, Cultural, Publ ic

Works and U t i l i t i e s Local Indust r ies Fin an c e P lanning Evaluat ion

I t i s through the funct ions o f these CDC’s that self-help projects are planned and carr ied out. Through t h e CDC’s, people learn how to help themselves. I t becomes a vehicle f o r coord inat ing a l l community act iv i t ies and services.

I f teachers and other government workers are to promote school-community integration, they must work w i t h i n d i v i d - uals and groups, help them think clearly and constructively about problems and translate these needs i n t o teaching- learn ing situations, promot ing under- standing o f rights, du t ies and privileges, as wel l as obligations o f the people to i t s own community, government and country. The process could wel l begin in school, reach out to act ive c i t izen par t ic ipat ion and implement communi ty action.

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CHAPTER 3

UNDERSTANDING COMMUNITY PARTICIPATION

N u t r i t i o n education recognizes that nu t r i t iona l diseases and poor nu t r i t i on status o f the people come. f r o m f o u r factors: (1) d ie tary deficiency (2) ignorance (3) eating habits and (4) standard o f l i v ing . I f the p r inc ipa l object o f nu t r i t i on education i s to ensure that each ind i v idua l eats suitable food to safeguard h i s health, then, the rudime.nts o f nu t r i t i on must be taught in as early as p r imary schooling, and publ ic awareness o f nu t r i t i on problem must be increased. I t s content and materials must be derived f r o m the resources, experience and needs o f the community. The "target populat ion" must be studied and the activi t ies adapted to their special requirements, preferences and problems. The higher the degree o f par t ic ipat ion o f the target populat ion the more ef fect ive w i l l be the i r learning. The greater the involvement o f the communi ty in a planned act iv i ty , t h e more w i l l be i t s success. Communi ty par t ic ipat ion provides unique opportunities f o r determining rea l health problems in re la t ion to the physical environment, f ood product ion and the people's nutri tion.

Types o f Community Participation or Involvement

Community par t ic ipat ion i s a process or tool f o r development - i nvo l v ing people in assessment o f the situation, de f i n i t i on o f the problems and p lann ing actions.

Community par t ic ipat ion depending upon the community's degree o f i n i t i a t i ve may be classified as a) sDontaneous or voluntary - where a social group i t se l f takes the i n i t i a t i ve to part icipate in the administrat ion o f an educational ac t i v i t y or a project; b) induced, wh ich i s the most common f o r m o f involvement, wh ich resu l t s f r o m innovations introduced by the implementing agency rather than the community and c) comDulsorY, wh ich usually takes the f o r m o f mustering t h e

communi ty f o r manual labour or a f inanc ia l contr ibution, and i s no t an educational act ivi ty, in the s t r ic t sense.

T h r e e types o f c o m m u n i t y par t ic ipat ion are described: t h e f i r s t , sometimes r e f e r r e d to as nomina l or passive, amounts to no more than a one- way f l o w o f i n fo rma t ion to a communi ty through the members attending meetings or receiving in format ion. There i s n o genuine involvement. I t i s o f ten reported that there are many part icipants in an activi ty, mere attendance being wrongly equated w i t h part icipation. The second type o f involvement i s consultation. The community i s no t on ly i n fo rmed but i t reacts and expresses opinions. This i s a f a i r l y l ow level o f involvement since those who are tak ing pa r t are no t necessarily the decision-makers. The consultation should be two-way, especially when i t i s between school administrators or personnel and the community. The third type o f involvement implies the sharing o f Dower. The questions tha t arise relate to the extent the community's power (whether legal or by regulat ion) to i n s i s t that i t s po in t o f v iew be taken i n t o consideration. I t implies that the communi ty has been associated w i t h a decision - i t has a voice in the decision mak ing body. When the CDC i s headed b y the Paramount Chief, b y v i r tue o f t rad i t iona l au thor i ty and legal powers, h e has access to government sectors and has in f luence to speak f o r the community.

To insure involvement, certain conditions are necessary: a) the goals are strongly des i red by the target audience, b) the means o f mak ing t h e in fo rmat ron i t requ i res i s avai lable to the community, c) there i s good motivation, d) t h e communi ty i d e n t i f i e s their needs, c lar i f ies o n i t and shares in the methods and processes in implementing i t s tasks and e) a po l i t i ca l w i l l on the par t o f t he leaders and members o f t h e communi ty to act o n the

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decisions o f the group.

Levels o f Part ic ipat ion

A. Problem Analvsis, The th ing a communi ty wants, or thinks i t needs - i t s " f e l t needs", - may no t always be the same as the "actual needs" - the things that are rea l ly necessary. Planned interviews, questionnaires, observations and i n f o r m a l discussions w i l l reveal the communi ty problems and what causes them. Perhaps, in the community, i t was found that agr icu l tura l product ion i s low, f a m i l y income i s inadequate or tha t there i s a

consultation w i t h community leaders or the Communi ty Development Counci l (CDC) to understand the nature o f the problem i s the start towards de f i n ing the problem. A re f lect ion and verbal izat ion o f these f e l t needs and an analysis o f the situation to de f i ne t h e problem b y the communi ty i t s e l f i s the f i r s t leve l o f communi ty part icipation.

h igh incidence o f kwashiorkor. A

B. Presentation and In terpretat ion o f Data. This l e v e l o f communi ty par t ic ipat ion depends upon the n u t r i t i o n i n fo rma t ion and related data collected f r o m planned in terv iews and discussions w i th communi ty members. The target populat ion can prov ide clues about the i r health status and social and cu l ture background as they a f fec t the ab i l i t y o f the communi ty to solve their o w n problems. Responses to the survey w i l l reveal wh ich families, ind iv idua ls and social groups are at special r i s k s o f nu t r i t i ona l problems. Women's responses can be collected in an assembly or workshop setting, whi le older ch i ldren can assist in gathering i n fo rma t ion about their younger brothers and s is te rs a t home or other ch i ldren in the community.

In terpretat ion o f the f ind ings o f the communi ty n u t r i t i o n survey and the discussion o f the resources needed and possible sources o f act ion towards the solut ion o f the identified problems, i s the second level o f communi ty part icipation.

C. I d e n t i f v i n n a Solution. Group interaction, group decision-making and

social cohesion are necessary elements in the work o f the Communi ty Development Councils in iden t i f y i ng a solut ion to a community problem. The discussion o f possible courses o f act ion should indicate weaknesses, requisites f o r the community, in ternal and external resources, as we l l as i t s probable resu l t s and consequences. The community then decides on what act ion to take.

The solut ion should encourage local in i t ia t ives and responsibilities. Developing the innate potent ia l f o r community involvement and self-help w i t h the par t ic ipat ion o f as many as possible i s as equally impor tant as the goal that the group has set out to achieve.

The third l e v e l o f community par t ic ipat ion in i d e n t i f y i n g a solut ion f r o m among possible solutions ensures a community-based decision.

D. Planning and Implementinq Communitv Action. An impor tant aspect o f p lanning f o r communi ty par t ic ipat ion in nu t r i t i on education i s a l is t ing o f the specific objectives f o r change in nu t r i t i on behaviour. Communi ty par t ic ipat ion in nu t r i t i on education may specif ical ly help government to implement a certain general social objective as "operation feed the nation" or reducing i n f a n t mor ta l i t y and morb id i ty .

In setting up objectives, considera- tions need to be given to the fol lowing:

a) the target audience - mothers, under- fives, farmers, teachers, youth, school children, etc.

b) the behaviour aimed f o r - using toilets, bo i l ing d r i n k i n g water, preparing ORS, cul t ivat ing a home garden, preparing weaning foods, k i t chen hygiene, etc.

c) conditions to b r i ng about change - i n s t r u c t i o n a l units, m o t h e r s ' demonstrations, f i e l d trips, meetings, growth monitoring, media campaign, etc.

d) indicators o f change - improved know ledge a n d unders tand ings , attitudes, hea l th fac i l i t i es and nut r i t ion-re la ted practices.

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At this level o f part icipation, constraints t o the ac t i v i t y that are l i k e l y to occur must be i d e n t i f i e d and appropr iate responses planned, such as:

1. Poor attendance a t communi ty meetings - change time, site, etc. (small number; some groups no t no t represented; f e w women.) separately

- arrange t o meet unrepresented groups

- de f ine the purpose o f meet ing more

- p rov ide new incentives t o at tend (film, clearly.

food, brochures)

2. Poor reception o f project p lanning - pay courtesy visits to communi ty o r coordinators by communities. leaders

- invo lve communities in data col lect ion - use local op in ion leaders f o r assistance - address communi ty meetings prov ide

more and readi ly understood i n f o r m a t i o n t o communities

3. D i f f i c u l t i e s with vo luntary labour contr ibutions, by communities.

- a l low choice o f labour or cash contr ibut ions

- make tasks compat ib le wi th t rad i t ion f o r cer ta in classes, religions, sex

- set t ime table according t o wishes to the communi ty

- arrange communi ty requisites tak ing i n t o account other communi ty work, physical capacity, m igra t ion patterns, labour types

4. D i f f i c u l t y in understanding their - del ineate funct ions a n d responsibi l i t ies roles and responsibilities. c lear ly

- encourage the team spirit.

The Community as a Learning Group

The local capacity f o r organization among group and associations in Sierra Leone should no t be underestimated. Trad i t iona l expertise a n d knowledge must be taken i n t o account, because whatever experience the communi ty has acquired i s der ived f r o m the i r o w n culture. Often, i t i s not a lack of education that prevents communi ty action, but rather, a lack o f f inanc ia l and mater ia l resources. The fa i l u re o f many communi ty development projects can be traced t o neglecting to use local s k i l l s and experience.

Communi ty par t ic ipat ion should be a learning experience. The i n f o r m a l t ra in ing wh ich schools make avai lable as communi ty

educat ion centres provides programmes n o t on ly in n u t r i t i o n and health, but also in func t iona l l i teracy, c r a f t development and agr icu l tura l extension services. I t stresses "part ic ipatory t ra in ing" w h i c n i n a i c a t e s an or ientat ion t o trying t o increase the extent o f par t ic ipat ion o f the trainees in the learn ing process as w e l l as in communi ty action.

The major t ra in ing o f people accom- pl ished through communi ty par t i c ipa t ion i s that o f pract ical experience in running thei r o w n af fa i rs . Problem-based learn ing i s a process by wh ich a target audience learns by u t i l i z i n g a problem as a stimulus to discover the i n f o r m a t i o n needed t o understand the problem and i s mot ivated to act upon a solution. I t no t on ly

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increases their learn ing potent ia l but also the knowledge about nu t r i t ion- related issues in the community.

D u r i n g the p lanning o f the community project/act ivi ty, i t i s impor tant that unreal ist ic or unattainable tasks are not incorporated in the goals and that the extent o f communi ty involvement and responsibil i t ies are clearly defined, such as:

- who participates in p lanning - the communi ty i n fo rma t ion and

communication ne t work - col lect ion o f local materials or

storage o f equipment - vo luntary labour and other

services - fund collection

safe storage o f materials and equipment selection o f communi ty members f o r special tasks and t ra in ing ident i f i ca t ion o f problem data col lect ion and evaluation mon i to r ing o f act ivi t ies and indicators extent o f government and external support materials f o r communi ty education/ nu t r i t i on education ro le o f ‘external’ agents o f change

N u t r i t i o n education i s a community- oriented programme. I t s u l t imate success depends upon the people themselves and the type and nature o f messages that are received and acted upon by the community.

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CXAPTER 4

THE ROLES OF THE TEACHER

AS COMMUNITY ANIMATEUR

Working w i t h the communi ty goes beyond the t rad i t ional roles o f the teachers. While classroom inst ruct ion i s expected t o expand knowledge, create awareness, change behaviour and improve heal th a n d nu t r i t i ona l status, i t cannot be expected to promote heal thy l i v i n g i f the pupils are ill-nourished, and subject to diseases, i f the school does no t ma in ta in sanitary and hygienic conditions, a n d the communi ty remains ignorant o f problem solving. School-community relat ionships should enable the pupils to ma in ta in and improve the i r o w n heal th and promote within the communi ty their share of the responsibilities t o protect the heal th of others. I t w i l l depend upon the qua l i t y and mot ivat ion o f the teachers themselves. I t means developing new roles, do ing the right things and doing them together with the people.

Change Agent

Heal th and n u t r i t i o n education in the Community i s more ef fect ive i f t h e teacher has good relat ions with the members o f the community. I t i s impor tant f o r people to see tha t the school i s responding to their 'problems and needs and invo lv ing them in doing something to solve these problems. The people w i l l be convinced that a programme i s wor thwh i le i f they see that t h e teachers are doing good and sincere work.

As a change agent, t h e i n i t i a l step i s to win the confidence and cooperation o f the people. Broaden your contact w i th the leaders o f the community. Count o n the Communi ty Development (CDC) t o take some responsibi l i ty f o r the success o f their programme. The par t ic ipat ion o f the com- munity i s usual ly decided by communi ty leaders.

In work ing w i th the people, the key

approaches are as fol lows:

A. Find a communi tv feeling. T a l k about things you have in common - food, clothing, health, worship, work, chi ldren, etc. Establ ish common interests in the basic areas o f everyday l i v i ng .

B. Start where the ueoule are. Find out what they t h i n k i s the i r imperat ive need or needs o f the local i ty. Discuss their interests. Get t o k n o w a l l about their level o f technology, degree o f literacy, f o o d habits, customs, etc. K n o w the extent o f cooperative practices. Appreciate the likeness o f the i r ways and bel iefs wi th yours a n d understand the reasons beh ind the dif ferences.

C. H e l u the ueoule bel ieve that thev can improve the i r si tuation. Get to k n o w their reasons f o r do ing things the way they do. M a k e the people aware and understand the possible consequences o f change o f the very elemental human situations related t o the i r way o f l i fe, i.e. less faecaLrelated diseases by hav ing a safe water supply o r use o f latr ine, reduced i n f a n t mor ta l i t y by improved feeding practices and home hygiene, improved n u t r i t i o n with home gardens, etc.

D. C a r r v o n act iv i t ies in wh ich the people themselves are interested. People w i l l be interested in act iv i t ies wi th concrete outcomes. Use the people's own organization and exist ing physical and social resources. Spend more t ime in f i n d i n g out wha t people want fo r themselves and less t ime o n what you and other "specialists" think the people need.

E. Watch the Deoule's pace and keeu in pace w i th them. Be content wi th smal l beginnings. G o slow a t the beginning. A l l o w t ime f o r questions to be fo rmula ted and asked. Never forget that i t takes

21

time to get things done.

F. Place resrionsibil i tv on the rieorile. Recognize any progress they make to enable the communi ty to realize that i t i s t he i r project. At the same time, expect growing pains, l i k e people hoping that could have the i r own way or assuming more responsibi l i ty than they can handle. Ant ic ipate one ac t i v i t y to another. The energy and resources must be o f the people, by the people and f o r the people. Y o u are only the "spark plug".

Adu l t Educator

The f i r s t f unc t i on o f the adul t educator i s to inspire both a desire f o r change and a n understanding that change i s possible b y people's own action, e i ther i nd i v idua l l y or in cooperation w i t h others. When the people's f e l t need i s improved health, the communi ty must be aware o f the ro le o f safe water supply, sanitation and nu t r i t i on practices as co-factors in promot ing health, even as they are taught improved ag r i cu l tu ra l practices or preventive medicine. There i s no compartmentalized solut ion to problems. The work o f t he adu l t educator must be linked w i t h various areas o f knowledge and common sense to make community act ion effect ive.

To help adults learn or to change their behaviour the adu l t educator must involve the learners in the i r own education. By d raw ing out the things the learner already knows and shows the i r relevance to the new th ing wh ich i s to be learned, the teacher has done three things: a) he has built t he self-confidence o f t he i nd i v idua l who wants to learn b y showing him that h e i s capable o f contr ibuting, b) h e has demonstrated the relevance o f the experience and c) by sharing his know- ledge, h e has shown that the learner can extend h i s understanding and better cont ro l over their l ives. Fo r example, the learner may k n o w what time o f the year malar ia i s worse and wh ich group or work place i s bad ly affected. The adul t educator can present cer ta in factors in the community, such as breeding places,

housing conditions and environmental hygiene that cont r ibute to i t s prevalence as bases f o r greater understanding and mot ivat ion to act on their problem. H e uses a var ie ty o f methods and techniques to fac i l i ta te learn ing and community part icipation.

The teacher o f adults becomes a leader, a guide along a pa th wh ich a l l in the community w i l l t rave l together.

Fac i l i ta tor o f School-Community Relationships

The teacher, as fac i l i ta to r o f school- community relationships interprets school health and n u t r i t i o n programmes to famil ies and communities, and participates in suitable committee mechanisms o f e i ther school or community. H e comes wi th a knowledge about personal and community health, home ch i l d care and nu t r i t i on that can be integrated in school-community act ion programmes. As a fac i l i ta tor , h e has s k i l l s in desirable interpersonal rela- tionships and cooperative work to promote the health and nu t r i t i on status o f both the ch i ldren and members o f the community. H e has adequate background on the content o f the school subject areas that can be translated to communi ty learnings f o r both the pupils and the people, and o f the ways in wh ich the teacher may work properly and ef fect ive ly w i t h t h e community.

As a faci l i tator, h e can link community groups, heal th and social agencies to develop a sanitary environment in the school and in the community, promote sound nu t r i t i ona l practices and health habits, and at the same time, provide opportunities f o r continuous community educa tion.

T o increase the desire o f the people to improve nut r i t ion, interesting and ef fect ive messages must be passed on effect ively. The fo l l ow ing pointers should be considered:

1. Catch the at tent ion and in terest o f the mothers. Answer w i t h sincerity

22

their questions and use as examples par t icu lar situations they are fam i l i a r with, such as the enlarged thy ro id o f a neighbor, the ye l low eyes o f a child, or distended stomach o f an in fan t .

2. The message should be simple. B r ing out one idea at a time. The ideas should be closely connected to something a mother already knows. Fo r example, in supplementary feeding f o r infants, f o u r months and above, expla in the value o f adding pa lm oil, fish meal or bean to r ice pap or porr idge to increase i t s nu t r i t i ve content.

3. The message should aDDlv to the mothers’ si tuation and the i r homes and desires. The use o f water f o r heal ing various illnesses or infirmities in the household relates to much o f the mothers’ needs when someone i s ill.

4. The message should be heard. seen and understood. U s e simple statements, c l a r i f y w i t h visuals or demonstrations to explain what you’re ta lk ing about, and receive f r o m the mothers their own ideas about your message. Repet i t ion w i l l

re in force the message.

5. A local proverb. ioke or sonp can make i t easy to remember a message. The part icipants could in te rpre t the message using the i r own cu l ture and t rad i t iona l common sense o f communicat ing ideas through story te l l ing and proverbs. Many health songs can be translated in ethnic languages and rhythm.

6. A f r i e n d a n d resDec t fu l relationshiD i s a great h e i D when teachinR or learning. M a n y teachers create their o w n barriers to learn ing by the i r own arrogant attitudes. A welcoming smile, a he lp fu l deed, and sincere at tent ion to the learners w i l l lead to a good work ing and learn ing environment.

Continuous learn ing and teaching take place in the community. Communi ty animateurs/teachers help parents learn. Parents help ch i ldren learn. Ch i ld ren help parents learn. Everyone he lps student teachers learn. College lecturers help student teachers learn. College lecturers learn f r o m everyone in the community.

23

CHAPTER 5

THE COMMUNITY ORGANIZATION APPROACH

The behavioural changes aimed f o r in n u t r i t i o n education in general are directed to the f a m i l y as a whole, but part icular ly, to populations-at-risk such as pregnant and lactat ing women and ch i ldren under two years old. Thus, i t i s desirable to carry out i n d i v i d u a l and f a m i l y contacts, to understand and correct, where necessary, the attitudes, bel iefs and food practices that in f luence the nu t r i t i ona l needs o f the indiv iduals.

However, where repeated contacts may b e restr icted before the i n d i v i d u a l targets are able t o adopt o r change their food patterns, etc., group support w i l l be needed. I t i s easier to change the th ink ing o f groups than that o f individuals. Small group discussions that focus o n the nu t r i t i ona l aims o r message requi re ski l led leadership t o guide the group to become aware o f the need f o r change and t o assume responsibi l i ty f o r bringing about the change. Large audiences can be reached by use o f certain communication media, i.e. radio, films, exhibits, newspapers, etc., but f o r mass media t o be effect ive, i t should be fol lowed up by communi ty level contacts

Elements in the Community Organizat ion Approach

The communi ty organization approach combines the i n d i v i d u a l and small group approaches, and depending upon the circumstances, may inc lude the use o f mass media. Hea l th promoters, n u t r i t i o n educators, school personnel and other sector representat ives p o o l t h e i r knowledge, experience and resources and develop ways and means by wh ich heal th and n u t r i t i o n problems are solved. This approach encourages leaders wi th in t h e community to assume responsibi l i ty f o r iden t i f y ing and solv ing their heal th and

n u t r i t i o n problems. Par t icu lar at tent ion should be g iven t o the f o l l o w i n g elements:

M u t u a l trust must be developed between the communi ty and the school system implement ing heal th and n u t r i t i o n education. The contacts must promote understanding, demonstrate interest and commitment f r o m the programme organizers and invo lve the people in the planning, as well.

Special at tent ion should be p a i d t o leader ident i f i ca t ion , especially women, a n d t o u t i l i ze them in the educational act iv i t ies a n d the diffusion o f the practices a imed f o r in the heal th a n d n u t r i t i o n pro- grammes.

There should be mult i -sectoral representation in the heal th and n u t r i t i o n commit tees o f t h e Communi ty Development Council, who w i l l be responsible f o r the heal.th and n u t r i t i o n programmes. Membership in these committees should come f rom a l l sections o f the community.

Del iberate e f fo r t s should be made t o reduce the social distance that people perceive between themselves a n d the communi ty workers o r heal th educators. Ca l l ing in the homes o f the members o f the CDC, part ic ipa- t i n g in the social act iv i t ies o f the community, learn ing and pract ice o f communi ty dialects a n d customs, greeting and t reat ing the residents o f the communi ty nicely, are among the means by w h i c h social distance can be reduced.

Every member should be encouraged to greater ac t i v i t y by giving .him approval and recogni t ion f o r the par t he plays in the heal th and n u t r i t i o n programme in the community.

25

(6) Some o f the f e l t needs o f the communi ty may not be related to heal th or nu t r i t ion . People reject programmes, no t because o f their lack o f interest , but because they perceive other needs as being more pressing. While the communi ty heal th and n u t r i t i o n workers may no t be able to satisfy these needs direct ly, they m igh t be able to assume some res- ponsib i l i ty in help ing the community to find a way o f satisfying them. By showing readiness to help, the worker gains no t on ly people’s confidence but also increases the chance o f success o f t h e programme.

(7) Par t ic ipat ion in some type o f ac t i v i t y b y as many members o f the communi ty i s a key to the success o f communi ty organization efforts. Similarly, leaders and others could be given responsibi l i ty f o r educational activities, l i k e mak ing f a m i l y contacts, ar ranging and conducting o f group meetings, exhibit ions, mothers and vi l lage workshops.

(8) In p lanning educational activities, consideration should be given to the amount o f f ree t ime that women have, the ava i lab i l i t y of human and mater ia l resources, and their educational l e v e l and ab i l i t y to undertake the act iv i ty .

(9) Many communities have organized groups fo rmed to meet different pur- poses, such as rel igious groups, po l i t ica l groups, occupational groups, mothers’ clubs, you th clubs, etc. Build up personal relationships w i t h the heads o f the groups, arrange f o r session w i t h the i r members and encourage them to set an example in heal th and n u t r i t i o n practices.

Target Groups and Educational Approaches

There i s no u n i f o r m method that can be used to educate d i f f e r e n t target groups in a population. The methods chosen wou ld be determined largely by factors l i k e cu l tu ra l differences, levels o f education, perception about health and nu t r i t i on problems, proposed solutions, readiness to accept innovation, competence o f personnel and cost factors. These targets groups consist o f the ent i re community f o r whom programmes are planned: women ( inc lud ing pregnant and lactat ing mothers), school children, vi l lage elders, trainers, and organized groups. I nd i v idua l and small group approaches and other educational act ivi t ies should be adopted f o r the general public, wh i le special programmes may be needed to reach populations-at-risk, especially, the under-f ives.

26

Part Two

TEACHI NG-LEARN1 NG IN COM M U N I T Y

PARTICI PATORY ACTIVITIES

. . . With the involvement of teachers in curriculum development and in-service activities related to the (Bunumbu) project, (91% of headmasters report) there had been improved learning activities with consequent increase in level of achievement (93% of respondents). These viewpoints expressed by headmasters can be just i f ied on the grounds of relatively high pupils scores on the end of unit tests."

- Evaluation of Curriculum Report, A. Labor, Institute of Education, 1985

27

CHAPTER 6

SCHOOL C O M M U N I T Y H E A L T H A C T I O N PROGRAMME

(SCH AP)

Hea l th and n u t r i t i o n education cannot be successful i f the school act ivi t ies are limited only to p rov id ing inst ruct ion and other related services w i t h i n the compound o f the school. Learnings should no longer be conf ined to the f o u r walls o f the classroom but should be extended to solve communi ty problems and generate ru ra l /u rban development act ivi t ies w i t h the cooperation and support o f the home and community.

The m a i n objectives o f the School Community Hea l th Ac t ion Programme are to in i t ia te and implement communi ty act ivi t ies in conjunction w i t h school learning and to u t i l i ze loca l human and mater ia l resources to promote the health status c..f the community.

The SCHAP provides opportunities (a) f o r communi ty par t ic ipat ion in improv ing environment o f schools (b) to carry out "outreach " act ivi t ies corre 1 at e d w i t h environmental heal th inst ruct ion in schools and (c) f o r par t ic ipat ing in heal th improvement programmes in the community.

Nature o f SCHAP

The aims o f School Communi ty Hea l th Ac t ion Programme goes beyond the objectives o f classroom instruct ion. I t suggests that heal th and nu t r i t i on education should no t be the responsibi l i ty o f the heal th or home economics teacher on ly but should also be the concern o f every one in the school as we l l as in the home and community. The concerns should be on the change o f behaviour, habits and attitudes w i t h respect to good sanitation, prevention o f diseases, nut r i t ion, home hygiene and communal health.

pupils and communi ty members can focus:

S - C - H- A - Access to heal th services P - Personal hygiene and physical

Safe water supply and sanitat ion Contro l and prevent ion o f diseases Home, ch i l d care and n u t r i t i o n

education

The SCHAP becomes a partnership between the school and communi ty b y i nvo l v ing the Communi ty Development Counci l (CDC) as we l l as the Parent Teacher Association, women, youth and rel igious groups and other communi ty organizations.

Community Par t ic ipat ion in SCHAP

The SCHAP i s i n i t i a ted i n t o the communi ty through a communi ty survey, wh ich may be conducted b y teachers, student teachers or older pupils. The survey instruments integrate data search in health, nu t r i t i on , agr icu l tu re and vocational resources and the results should be discussed w i t h the C D C and other members o f the community. The communi ty assesses the situation, i d e n t i f i e s the problems and what i s recognized as p r i o r i t y needs become targets o f SCHAP.

Needs and problems o f the communi ty and the avai lable loca l resources are u t i l i z e d to link in-school and out -of school learnings through SCHAP. While schools prov ide inst ruct ion on the relevant topics, the communi ty act iv i t ies w i l l focus o n their par t ic ipat ion and roles in meeting those needs. The p r imary schools serve as communi ty education centres p rov id ing "extension" services and where necessary, u t i l i z e the assistance o f the s ta f f o f the Teacher Colleges.

The acronym - SCHAP - serves as a guide to the areas in wh ich teachers,

29

The school plans i t s own activi t ies for a year-round time-table, based on the subject learnings that could be "extended" to the community. The activi t ies can be distributed and staggered among the various classes who w i l l engage in some community-oriented act iv i ty . This pro- gramme i s discussed w i t h the Communi ty Development Counci l or w i t h women's groups and other target audiences so they can i d e n t i f y wh ich areas are o f their pri- mary interest o r need, and what inputs are expected f r o m the teachers and pupils in the school and the community. The fo l l ow ing l isting f o r such a programme, w h i c h ensures par t ic ipat ion a l l year round by a l l classes:

Programme Act iv i t ies

1. Safe Water Sumlv and Sanitation

- out o f school learn ing - school sanitat ion campaign - construction o f latr ines - communi ty sanitat ion day - mon i to r ing water we l l qua l i t y - on-site water we l l maintenance

2. Cont ro l o f diseases

- environmental sanitat ion - disease surveil lance - personal hygiene drills - small talks in communicable

diseases

3. Home. C h i l d Care and N u t r i t i o n

- home gardens - home hygiene - growth mon i to r ing - food handl ing and preservation - home craf ts - weaning foods

4. Access to health services

- school heal th records - immunizat ion - f i r s t a id - deworming programme

5. Personal Hygiene and Phvsical Educa t i on

- ch i l d health day or week - sports f i t n e s s tests - sports contest

Other act ivi t ies to promote the SCHAP include:

a) Visits to schools b y parents and to homes b y teachers, especially on health status o f par t icu lar child, or exchange o f in fo rmat ion on health, nut r i t ion, agr icu l tura l and vocational practices.

b) Cu l tu ra l act ivi t ies related to ground- breaking or inaugurat ion o f well, immunizat ion and f a m i l y p lanning campaigns, school f a i r and agr icu l tura l exhibits.

c) Mothers' workshops on sanitation, ch i l d care, nut r i t ion, immunization, etc.

- ch i ld- to-ch i ld programme

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CHAPTER 7

PRE-SERVICE AND IN-SERVICE TEACHER EDUCATION

N u t r i t i o n education programmes by themselves have l i t t l e chance o f b r ing ing about change, i f teachers do no t relate what they teach to the needs and problems o f the communi ty they serve. In order to accomplish this, they need t ra in ing in how to do this ef fect ive ly . Their t ra in ing must necessarily conta in t h e ingredients that w i l l make them think and do as d e s i r e d Such t ra in ing r e f e r s to the in-service re - orientat ion f o r teachers who have had no oppor tun i ty to widen their knowledge in t h e context o f communi ty education in nu t r i t i on and f o r pre-service teacher education wh ich develops no t on ly s k i l l s in both pedagogy and community development but also knowledge related to heal th and nut r i t ion.

Roles o f t h e Teacher

To be effective, the teacher i s expected to:

1. 2.

3.

4.

5.

6. 7.

8.

9. 1 o.

11.

12.

U s e local language in class inst ruct ion Link classroom activi t ies w i t h communi ty related subjects Organize pupils in groups to engage in pract ica l act ivi t ies U s e personal efforts to improvise ma terials Relate topics f r o m other subjects and link classroom learn ing w i t h pupils’ experiences in the communi ty Supervise pupils’ pract ica l act ivi t ies Show concern f o r pupils and encourage se l f -he lp act ivi t ies in asking them to provide their o w n local ly avai lable learning materials Plan f i e l d surveys f o r pupils to collect specimens, etc. Organise out-door act ivi t ies U s e inst ruct ional units and local resources as teaching aids U s e the localised vi l lage workshops f o r demonstration purposes Encourage pupils to think by prov id ing mental drills

13. Assess pupils’ achievements 14. Engage communi ty craftsmen as re-

15. Assess his work 16. Take measures to avo id fu r the r

sources f o r h i s teaching

mistakes in his work.

Out-of -school, t h e teacher per forms the fo l l ow ing roles as adu l t educator and extension worker:

1. 2.

3. 4.

5. 6.

7.

8.

9.

1 o.

Conducts adu l t l i teracy classes Takes pa r t in gardening and communi ty fa rm ing Teaches out-of-school ch i ld ren Participates in vi l lage construction work Undertakes pract ica l arts act iv i t ies Engages in cu l tu ra l act iv i t ies as a resource person Disseminates ideas and services to the communi ty through demonstrat ion and exhibits Makes support ing agencies aware o f communi ty needs Cooperates w i t h extension agencies work ing in the communi ty Participates in i) Construction, extension and

repai r o f school buildings ii) Construction o f water wells and

latr ines iii) Planning and organization o f

vi l lage workshops

As a change agent, the teacher (a) takes par t in meetings at communi ty level, persuading and mot iva t ing people to change (b) makes people sensitive to the i r needs, (c) part icipates in local communi ty surveys f o r loca l resources in teaching and problem solving (d) makes people aware o f i m p r o v e d health, n u t r i t i o n a l a n d agr icu l tura l practices and (e) assists in planning solutions to people’s problems by organizing self-help and construction projects, sessions f o r crafts, thrift and credi t societies and cu l tu ra l act iv i t ies to raise funds.

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(The roles presented above are summaries o f act ivi t ies o f Bunumbu pro ject - t ra ined teachers who were observed in t e n p i l o t schools and com- munities. N o one teacher was observed to be per fo rming a l l the roles but various combinations o f these roles were per formed by the d i f f e ren t teachers observed. - S. Bockarie, R u r a l Educat ion Evaluat ion in Sierra Leone. 1986)

Pre-service teacher education

The pre-service t ra in ing in n u t r i t i o n education i s integrated i n to the Home E c o n o m i c s p r o g r a m m e w i t h Communi ty /Themat ic approach. T h e s k i l l - - or iented type o f programme promotes l inkages between teacher education and the p r imary school curr iculum, new approaches to teaching practice, t ra in ing in cur r icu lum wr i t ing, use o f local materials f o r developing teaching aids and the in tegrat ion o f learn ing activi t ies across subject areas and productive work orientation.

Below i s a n out l ine o f the syllabus fo r food and n u t r i t i o n in the Teacher Cer t i f icate Programme:

1.

2.

3.

4.

5. 6.

7.

8.

9.

General in t roduc t ion to nut r i t ion, de f i n i t i on o f foods, nutrients and nut r i t ion. H o w and w h y nutr ients in the food are used b y the body. Classif icat ion o f foods, p lant and animal foods, f ood groups. Food value - especially local foods. a) Sources b) Functions c) Deficiencies and digestibi l i ty. Physical changes in food du r ing cooking. K i t c h e n hygiene. Home garden. a) planning, preparation and care o f a small k i t chen garden b) economy o f home product ion c) t rad i t iona l and new crops that can be grown. Ma lnu t r i t ion . a) deficiency symptoms and diseases b) ma l and under nu tri tion. Basic methods o f cooking and the principles invo lved e.g. boil ing, f ry ing, stewing, steaming, baking, gri l l ing. Choice and cost o f foods in season. Bo th prac t ica l and theoretical

knowledge w i l l be gained, but most o f the theory work should be done through self-study and assignment.

P r a c t i c e t e a c h i n g p r o v i d e s opportunities f o r the student teacher to conduct communi ty surveys, organize Home econornics/Home management classes f o r mothers, development projects in heal th and nut r i t ion, develop school farms and vegetable gardens, par t ic ipate in cu l tu ra l activit ies,craft training, etc. In general, the trainees embark in nu t r i t i on and income generating activi t ies w i t h women and conduct extension work in nutr i t ion.

In-service Tra in ing f o r Nu t r i t i on Education

The m a i n purpose o f in-service t ra in ing i s to upgrade the teaching s k i l l s and knowledge o f the unt ra ined or unqua l i f ied teachers in heal th and nut r i t ion. The in t roduc t ion o f the new pr imary cur r i cu lum necessitates the orientat ion and t ra in ing o f the school teachers in the use o f the inst ruct ional units w i t h i t s methodology, and the applications o f communi ty organization approach in nutr i t ion. The modular approach in promot ing teaching-learning in local environments provides the i n i t i a l t ra in ing to key p r imary teachers in nu t r i t i on and heal th education, who in turn become trainers and resource persons. These teaching modules (see Par t III) have strong emphasis in the use o f community par t ic ipat ion in understanding health and nu t r i t i on situations in the community, development o f concepts and learning activi t ies f o r heal th and nu t r i t i on and exemplars f o r teaching w i t h visual aids. The school-based mini-workshops assist newly appointed teachers in the school, upgrade-older teachers’ educational s k i l l s and involve communi ty leaders in adul t education activit ies.

T ra in ing in cur r icu lum w r i t i n g techniques and in communi ty par t ic ipatory activi t ies are conducted du r ing review o f ins t ruc t iona l units and examin ing workshops to p lan f o r outcomes in out-of- school activit ies.

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CHAPTER 8

I N T E G R A T E D H E A L T H A N D NUTRITION

IN P R I M A R Y SCHOOLS

N u t r i t i o n education in school should be directed towards t h e health problems o f the chi ld. Because the health o f the ch i l d i s in f luenced p r imar i l y by what h e does, not b y what h e knows, health education should be behaviour centered. Teachers, therefore, need to accept the fac t tha t the promotion o f heal th i s an in tegra l pa r t o f education. They must do away w i t h t rad i t ional teaching methods that p u t much emphasis on rote learn ing and chalk and ta lk methods to prov ide in format ion, and re ly instead on "doing" or act ivi tycentered learning and changing behaviour. Just as the mother has shaped to a great extent the health personality o f a ch i l d by the time h e comes to school, the teacher's health practices and learn ing activi t ies in school p r e impor tant on the pupils. They must have the support o f a well-defined syllabus w i t h inst ruct ional guidelines and approaches.

Environmental Studies f o r Pr imary Schools

Envi ronmenta l Studies i s a new subject f o r classes I and II in p r imary schools. I t s a i m i s to provide learn ing experiences f o r the ch i ldren to develop understandings about t h e nature o f the soc ia l , b i o l o g i c a l a n d p h y s i c a l environments, to improve attitudes and practices concerning healthy l i v i n g and to appreciate the services and interactions among people and between people and things in the environment. I t integrates learnings in Social Studies, Science and Hea l th Education.

The learn ing concepts f o r Classes I and II are categorized under Home Environment, School Envi ronment and Use fu lness o f Things in the Environment. Through these u n i f y i n g concepts are six themes or strands: (1) Heal thy l i v i n g (2) Groups (similari t ies and differences) (3)

Customs and t rad i t ions (4) In ter re la t ion- sh ips (5) Services and (6) Changes. (See Tables I - II Scope and Sequence Char t f o r Envi ronmenta l Studies)

In tegrated Learn ing Activi t ies

Hea l th and n u t r i t i o n concepts can be integrated i n t o other cu r r i cu lum areas. F o r example:

Music Ac t ion songs based o n care o f body parts Song about ingredients in ora l rehydrat ion solut ion Drum rhythms f o r par t icu lar heal th habi ts /pract ices, spel l ing, a n d exercises

Language Arts vocabulary study and w o r d games based o n hea l th and n u t r i t i o n activi t ies w r i t i n g paragraphs about "How to prepare beniseed mix," "How I feed my baby brother," "How I care f o r m y home garden", etc. story-tel l ing about illnesses a t home essays o n importance o f balanced meal; funct ions o f f ood

Arts cut outs f o r p ic tu re collage o f nu t r i t i on concepts d rawing food charts, objects used in personal hygiene, heal th activi t ies o f members o f t he fami ly , etc. d rawing heal th and n u t r i t i o n practices i .e. b r e a s t f e e d i n g , ORT, immunization, c h i l d g rowth drawing the food pathway

Agr icu l tu ra l Science - mak ing a calender o f f a rm ing

activi t ies according to food values

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TABLE I SCOPE AND SEQUENCE CHART - ENVIRONMENTAL ST- J IES

PRIMARY I

Exploring our Environment

Patterns i n the Environment

Term I Term II Term III

Theme Proper Use o f Things i n the Environment

1.

2 .

3 .

4 .

5 .

6 .

Healthy L iv ing

Group ( S i m i l a r i t i e s / Differences)

Customs and Trad i t ions a t home

In ter re la t ionsh ips

Services

Changes

Parts o f the body. Good eat ing habi ts . Personal Hygiene. Cleanliness i n the

environment.

Food f r o m p lants and animals. Proper use and care o f things our environment.

Members o f the fami ly . Things a t home and a t school. Respect f o r school Animals 61 p l a n t s Places where p lants and properties. i n the surroundings. animals l i v e . Water i n the environment.

Greetings and respect Observing school regulations Fest iva ls i n the com- for elders. Celebra- i n community. Celebrations munity e.g. , Ramadan, t ions and ceremonies a t school. Christmas.

Objects used i n f e s t i v à ì s .

Roles o f members i n School regulations. the family. Roles and r e s p o n s i b i l i t i e s i n school.

Proper use and care o f hea l th f a c i l i t i e s a t home and i n school.

Occupations and ser- Occupations i n the environ- Things and services vices o f parents. ment. found i n the market.

Changes i n c h i l d r e n , Changes i n time, season and Making water safe t o plants and animals. weather. drink. Sani tat ion a t

home' i n school.

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TABLE II S SCOPE AND SEQUE NCE C M T - ENVIRONMENTAL STUD=

E R J l w L u

Theme

Term I Exploring our

Environment

Term II Patterns i n

the Environment

Term III Proper use o f Things i n the Environment

1. Hea.Z'.",y L iv ing Care o f d i f f e r e n t p a r t s o f the body. Keeping neighborhood clean.

2 . Group (S imi la r i t i es / Differences)

3 . Customs and Tradit ions

Groups o f people i n the school. Groups o f people i n the neighbor- hood.

Fest ivals/celebrat ions i n the neighborhood and t h e i r s ignif icance.

4 . In terre lat ionships The r o l e o f the school as p a r t o f the neigh- borhood.

5 . Secvices

6 . Changes

Occupations using mater ia l things i n the neighborhood.

Time d a i l y rout ine i n school. Growth i n p lants and animals.

Things t h a t make people ill. Care o f the body when ill.

Other l i v i n g and non-living things i n the neighborhood.

Sanctions and taboos i n our neighborhood.

How the neighborhood meets the needs o f the school.

H a t e r i a l s produced i n the neighborhood.

Changes i n physical environ- ment. Change i n state o f matter .

Foods we e a t , care o f the foods. Care of household uten- s i l s . Protect ing water sources.

Leaders o f our neigh- borhood and t h e i r functions. Areas o f non-l iv ing things i n the environmént . Preparation f o r fes- t i v a l s and celebra- tions*. A c t i v i t i e s during f e s t i v a l s and celebrat ions.

Other f a c i l i t i e s i n the neighborhood.

Movement o f people and goods i n our neighborhood.

How ve change the physical environment i n the neighborhood.

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Home Economics f o r Classes III to V I and nut r ients in school garden - mapping garden plots f o r year round

produce

Mathematics - equivalent measures f o r common

household items, i.e. milk or sardine tins, beer bottles, bot t le caps, etc.

- f ract ions in food servings, recipes, d is t r ibu t ion o f crops

- percentages in crop production, populat ion statistics

- graphs and tables using heal th o r n u t r i t i o n statistics, i.e. g rowth chart, height f o r weight, weight f o r age.

Social Studies - food taboos among ethnic and

rel igious groups - v i s i t s to heal th clinic,food market,

construction s i tes o f water well, latrine, etc.

- i d e n t i f y i n g occupational act ivi t ies re la ted to food

- appreciat ing roles o f the heal th and n u t r i t i o n worker

- discussing e f fec t o f cl imate on food storage and preservation

- communi ty act ivi t ies f o r heal th and n u t r i t i o n

Pract ica l Arts - mak ing heal th tools, i.e. p a l m f ly

swatters, water dippers, bucket covers, basket f ood t ray covers, plate rack, cooking stove, etc.

- d r a f t i n g room arrangements, garden plans

Science - water, a i r and soi l po l lu t ion - water and insect-borne diseases - biological changes in pregnancy and

lactat ion - diseases caused by lack o f nut r ients - d e s c r i b i n g c h a r a c t e r i s t i c s o f

malnourished ch i ldren - experiments in food preservation, i.e.

sundrying, chemical additions, smok- i n g

- l i f e cycles o f parasites and vectors in water and food

The Home Economics cur r i cu lum i s divided i n t o th ree areas: Food and Nut r i t ion , Need le Work and Home Management and C h i l d Care. In the school timetable, these subjects are taught in the f i r s t , second and third terms respectively. W i th in the context o f the Bunumbu project, Home Economics aims to make a valuable cont r ibu t ion towards the development o f heal th and happy families through nut r i t ion, hygiene, c h i l d care and home management, and an awareness o f vocational opportunit ies in home economics related activi t ies and o f basic s k i l l s in needlework, c h i l d care and home management. (See Appendix I V - Scope and Sequence f o r Home Economics in Pr imary Schools)

Integrated i n t o these learnings are the out-of-school act ivi t ies of pupils concerned w i t h the improvement o f nu t r i t i on through demonstrations in better use of avai lable foods, product ion o f essential foods in home gardens, the prevention o f f ood wastage through improved storage, preservation, handl ing and market ing and wise selection o f foods f o r the da i l y diet o f the i n d i v i d u a l and the fami ly . L ikewise, under community development projects, the pupils part icipate in the promot ion o f heal th and sanitary fac i l i t ies both in school and in the community.

In tegrat ion o f H e a l t h and Nu t r i t i on through Problem-Solving

To make the learnings in health and nu t r i t i on relevant t o communi ty situations, they should focus on the needs and problems o f the community. The problem- solving approach becomes a u s e f u l tool f o r integrating heal th and nu t r i t ion :

(a) De f in ina the moblem: Small local surveys f o r heal th and socioeconomic needs, gathering epidemiological data, heal th records o f the pupils and morb id i ty i n fo rma t ion in the community w i l l expose the school

36

c h i l d t o experiences within and outside the school, and help the c h i l d to understand t h e problem.

(b) Analysis o f t h e Droblem: Descriptions and considerations o f the cu l tu ra l factors w h i c h in f luence the problem, t h e d is t r ibut ion and magnitude o f the problem, and the causes o f the problem should f o r m par t o f the content o f the heal th a n d n u t r i t i o n experiences.

(c) Findina solutions: Pupils explore the means and resources t o use in order to reduce o r el iminate the problem. Parents, ch i ldren and other members o f the communi ty are invo lved in appropr iate heal th and n u t r i t i o n behaviour.

Pract ical teaching and act iv i t ies out- side the classroom t o u t i l i ze local fac i l i t ies and resources w i l l he lp raise the awareness and consciousness leve l o f the pupils a n d mothers t o mot ivat ions that could lead t o new behaviours and actions.

The t ra in ing modules f o r teachers in heal th a n d n u t r i t i o n and the guidelines f o r SCHAP prov ide strategies f o r i d e n t i f y i n g the factors related t o the problem and integrates communi ty par t ic ipatory ac- t iv i t ies and out-of-school learning,.

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CHAPTER 9

E V A L U A T I N G T E A C H I N G - L E A R N I N G EFFECTIVENESS

Evaluat ion i s a process o f f i n d i n g out how we l l things are being done and how ef fect ive or e f f i c i en t are the methods and outcomes. I t measures t h e amount of success in achieving pre-determined objectives, the value o f t h e input variables in re la t ion to the outcomes and the benef i t s derived f r o m the activit ies. Evaluat ion i s an on-going process: a t the beginning in setting out objectives and p lanning f o r the act iv i ty , durina the course o f the act iv i ty , to a l low for adjustments o r correct ions where necessary, and at the end, to assess the resul ts and determine how the programme can be improved. I t should be a cooperative e f f o r t o f the school and the community.

The variables that need to be evaluated in health and nu t r i t i on education are the (a) objectives - i t s fo rmula t ion and i t s setting (b) the target groups, inst ruct ional materials and resources - i t s qual i ty and avai lab i l i ty , (c) the processes and activi t ies in training, teaching-learning experiences, i nd i v idua l per f ormance and community par t ic ipat ion and (d) the outcomes - knowledge, attitude, practices and fac i l i t ies built or other products used.

Thè Sett ing and Target Groups

The community, w i t h i t s socio- cu l tu ra l characteristics, i.e. economic status, ro le o f women, food avai lab i l i ty , b e l i e f s about food, organized groups, services, etc. and the school prov ide the settings f o r any educational act iv i ty .

The ind iv idua ls or groups w i t h nu t r i t iona l needs in t h e community, community leaders, education personnel and their roles and resource persons comprise the target groups, wh i le school buildings, equipment, inst ruct ional materials and funds are the mater ia l inputs.

Performance Evaluation

Well-defined objectives in heal th and nu t r i t i on education establish the cr i ter ia against wh ich to measure teaching-learning activi t ies and outcomes. T h e performance objectives have to b e set out care fu l l y - who are the targets/subjects, what i s the expected behav ioura l change, the conditions/processes to a t ta in such change and the indicators to show outcomes. The statement o f objectives should be in behavioural terms and specific.

Fo r example, when the objective i s stated: "...after visual presentation, the pupil l ists the three types o f foods needed b y a growing child.......", i t provides directions f o r i t s evaluation. The response, be i t w r i t t en or o ra l w i l l show the degree o f achievement o f the pre- determined objective. I f the objective r e f e r s to "acceptance and use o f a beniseed supplementary food f o r in fants" or "preparation o f o ra l rehydrat ion solut ion f o r diarrhoea", a f te r a mothers' workshop, the fo l l owup evaluation o f the use and frequency, o r the number o f mothers who can prepare ORS w i l l reveal learnings in the expected behaviour. Thus, evaluation w i l l depend upon the expected behaviour.

H e a l t h and N u t r i t i o n Education Activi t ies

Teaching-learning act iv i t ies in the classroom and out-of-school act ivi t ies o f pupils and teacher, the educational approaches and use o f loca l resources and teaching aids are process variables that need to be evaluated.

The e x t e n t o f c o m m u n i t y part icipation, the roles o f the communi ty leaders, the number o f and attendance in group meetings or workshops, the qua l i t y o f group discussion, the number o f f a m i l y

39

visits and the performance o f i nd i v idua l roles, etc., w i l l re f lect effectiveness o f the educational activit ies. Communi ty part icipation, being par t o f heal th and n u t r i t i o n activit ies, can also be the resul t o f such activit ies, and in nu t r i t i on education, i t i s evaluated bo th as a process and an outcome.

Evaluation o f Outcomes

The health and nu t r i t i on knowledge, the att i tudes or behaviour a f te r the educational activit ies, are the indicators for evaluating effectiveness o f the teaching-learning experiences. Changes in teacher behaviour w i l l also show effectiveness o f t ra in ing programmes.

Other outcomes wou ld be acceptance and practice o f improved heal th and n u t r i t i o n behaviour, the use and maintenance o f heal th facil i t ies, improved nut r i t ion, heal th status o f ind iv idua ls and groups and sanitary conditions in school and community.

Tools f o r Evaluation

School learn ing experiences are subject to many methods o f evaluation, and the choice wou ld depend on the expected outcomes.

(a) Knowledge achievements and student progress may be measured by ora l and wr i t t en test. Objective tests, such as multiple choice, completion or match ing type tests are easier to administer than essay type tests.

(b) A t t i t ud ina l measures are d i f f i c u l t to measure, but essay questions that re f lect predispositions to heal th or nu t r i t i on issues w i l l ind icate a t t i - tudes, i.e. "why I do not l i k e or l i k e ......................... (to use the toilet, to eat eggs, brush m y teeth, etc.)", "I l i k e or do no t l i k e ............... (large families, immunization, work ing in farms, etc.)." The observations o f attitudes can be made on pupils towards cleanliness, sanitation, food habits, out-of-school activit ies, etc.

(c) Many methods could be used to measure changes in heal th and nu t r i t i on practices, i.e. direct observation, sanitary survey o f the school environment, heal th hab i t questionnaire, ch i l d n u t r i t i o n survey, pre-test and post-test studies, etc.

The community survey instruments used at the start of any educational act ivi ty, to collect baseline information, may be used to measure changes in community dimensions a f te r community p a r t i c i p a t i o n i n t h e programme. Interviews, checklists, questionnaires, observations, and committee reports o f the Communi ty Development Counci l are valuable tools to determine extent, qua l i t y and outcomes o f community part icipation.

Hea l th data wh ich can be obtained f r o m the heal th cl inics or dispensers w i l l reveal the frequency/use o f heal th services and facil i t ies, trends in morb id i ty f r o m water-and excreta-borne diseases or nu t r i t iona l deficiencies and qua l i t y o f community par t ic ipat ion in heal th t ra in ing or sessions.

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PART THREE

TRAINING MODULES FOR TEACHERS

"...The content of the teacher training programme ( i n Bunumbu Teachers' College) and the primary school curriculum were made to agree so that teachers in training are made famil iar with the materials they w i l l be using."

Dr. Sandy Bockarie, Science Curriculum Development Centres, Njala University College in a paper, "Antecedents of Curriculum Planning, Development and Implementation: Their effects in the Primary School Curriculum situation in Sierra Leone," presented at the National Seminar on Primary School Curriculum, Institute of Education, October 7 -11, 1984.

41

INTRODUCTION

The t ra in ing modules presented in this section are structured f o r self-study, to be supplemented by learn ing activi t ies that can be undertaken ind i v idua l l y or wi th groups in a classroom setting. In th is way, the trainee participates actively in h i s o w n training. Each module consists o f f o u r parts: (1) the overview or background in fo rma t ion presents the ma in ideas, (2) the obiectives provides a l i s t o f behaviours expected o f the learner upon completion o f the modules, (3) the conceiit develoDment w h i c h formulates the content and the learn ing activi t ies wh ich enable the trainee to verbalize knowledge, demonstrate some learn ing behavior or task related to concept development and (4) communi tv D a r t i c b a t o r v activi t ies w h i c h suggest areas f o r involvement o f the communi ty or f o r outreach services o f the teachers and pupils.

The u l t imate a i m o f these modules i s to prov ide f o r the development o f knowledge, att i tudes and behaviours wh ich wou ld improve the nu t r i t i ona l status and heal th o f the c h i l d and the famil ies in the community. I t i s the ro le o f the teacher to mot ivate and cooperate w i t h community organizations in the local i ty, such as Communi ty Development Council, Hea l th Committee, Parent Teacher Association, etc., in analyz ing problems o f nut r i t ion,

implement the solutions to these problems and to show leadership in communi ty education.

Ti, be able to achieve the ma in ideas and tasks, pay par t icu lar a t tent ion to the objectives, and study care fu l l y a l l that i s wr i t ten under conceDt develoiiment. One trainee may team w i t h others in a small group, to discuss and undertake the learning activit ies, a f te r hav ing read the previous sections. The e n t i r e group o f trainees w i l l then meet to discuss the section on communi ty par t ic ipatory activities, select a suitable ac t i v i t y or task and p lan w i t h the communi ty organization f o r the act iv i ty . Coordinate w i t h your supervisor, and the Communi ty Deve- lopment Department o f the College or w i t h the headteacher in the school, so that the targets are invo lved in problem analysis and problem solving activi t ies as wel l as in a variety o f learn ing situations.

These modules may also be used as a cont inu ing guide f o r classroom teaching and par t ic ipatory activit ies. They can be adapted to suit local conditions and resources or mod i f i ed f o r addi t ional learning activit ies. The learn ing activi t ies may be used f o r format ive evaluation, whi le the objectives suggest the areas f o r summative evaluation.

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MODULE 1

NUTRITION IN COMMUNITY EDUCATION

I. Overview

N u t r i t i o n i s the study o f f ood and the way our bodies use food. A good knowledge o f nu t r i t i on i s essential f o r t h e maintenance o f heal th especially when food habits temporari ly or permanently deteriorate as in i l lness , o ld age, poverty, nu t r i t i ona l diseases, crop fa i l u re and ignorance. I t s u l t imate a i m i s to improve food patterns f o r better health and to assist the communi ty to undertake i t s responsibi l i ty in solving n u t r i t i o n and health problems. I t i s essential to re in force or correct f a m i l y teaching about food and nu t r i t i on because the poor ly nourished c h i l d i s a poor candidate f o r good education.

This module i s concerned w i t h the fo l low ing ma in ideas:

1. N u t r i t i o n education i s a way o f teaching us wh ich loca l foods are good to eat, to safeguard one’s health.

2. N u t r i t i o n education must be adapted to the loca l situation.

3. Teaching approaches f o r n u t r i t i o n depend upon the target audience and the problems at hand.

4. N u t r i t i o n education in both fo rma l and non- fo rmal education depends upon the active par t ic ipat ion o f the learners or target audience.

II. Objectives

At the end o f t h i s t ra in ing module, the learner should be able to:

1. Discuss the importance o f nu t r i t i on education.

2. Exp la in the cu l tu ra l elements that determine good nu t r i t ion .

3. I d e n t i f y some problems that nu t r i t i on education can e f fec t i ve ly concern i tself .

4. Describe techniques in teaching n u t r i t i o n f o r both fo rma l and non- formal systems.

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III. Concept Development and Learning Activi t ies

1. I n d i v i d u a l progress and national development are bo th dependent on heal th - t h e health o f the i nd i v idua l and the heal th o f the nation. In Sierra Leone, 75% o f the people are engaged in agriculture, but the subsistence fa rm ing tha t i s predominantly in practice leads to undernutr i t ion. In t h i s connection, the major publ ic health problems are h i g h i n f a n t and young ch i l d mor ta l i ty , and developmental dis- orders associated w i t h the insu f f i c ien t energy and pro te in intake. As such, the government has among i t s heal th objectives, the fo l lowing: a) cont ro l of major endemic and communicable diseases b) reduct ion o f maternal and i n f a n t mor ta l i t y and c) the improve- ment o f heal th awareness b y t h e populat ion and communi ty par t ic ipat ion regarding hygiene habits and nu t r i t iona l knowledge.

In t h i s context, n u t r i t i o n education i s a imed a t behavioural change and im- proved physiological indicators o f nu t r i t i ona l status.

2. One’s nu t r i t i ona l state i s a f fected b y a complex in teract ion o f factors. The fo l l ow ing i s a schematic diagram of the factors wh ich a f fec t f ood choice and nu t r i t i ona l Sta tus:

Agr icu l tu ra

activi t ies Food avai lable

Practical i ty

xperience Food choice

Cu l tu ra l Food eaten habits of

Mo t i va t i on

Preserva t i on at ing

Preparation

and Storage ’I N u t r i t i o n a l Status

1.1 Discuss how nu t r i t i on issues are related to t h e fo l l ow ing statistics:

Crude birth rate: Crude death rate: I n f a n t mor ta l i t y rate:

over 200 per 1000 l i v e births Ch i l d mor ta l i t y rate:

366 per 1000 l i v e births Maternal mor ta l i t y rate:

4.5 per 1000 de l i ver ies L i f e expectancy a t b i r th :

males 49.6 yrs. females 50.1 yrs.

49 per 1000 28 per 1000

1.2 Describe the roles o f the ind iv iduals concerning these problems.

2.1 Discuss w h y knowledge and mot iva t ion are no t su f f i c ien t to change food choices.

2.2 Give examples o f cu l tu ra l habits o f eating that a f fects one’s nu t r i t i ona l state.

2.3 Exp la in the e f fec t or changes in the i nd i v idua l in terms o f work, ac t i v i t y and disease, due to one’s nu t r i t iona l state.

44

3. In general, f ood ava i lab i l i t y and socio- economic situations a f fec t nu t r i t ion . Thus, i t does no t concern i t s e l f solely w i t h consumption and i t s physiological effects, but also on food production, storage and access to foods.

4. The most common themes re la t ing to health and c h i l d development are: a) special n u t r i t i o n a l needs o f

vulnerable groups, inc lud ing pregnant and lactat ing women, in fan ts and growing children, and weaning practices.

b) balanced d ie ts and functions o f f ood groups.

c) feeding du r ing i l lness , especially the need to rehydrate and nourish young ch i ldren w i t h diarrhoea.

5. Those themes wh ich relate to agricul- tu ra l concerns are: a) backyard product ion and consumption

o f vegetables and other protective foods.

b) the cu l t i va t ion o f new varieties and the nu t r i t i ona l consequences o f cash cropping.

6. Those re la t ing to home and personal hygiene and sanitat ion are: a) Protecting water and food f r o m

con tamina t i on b) Contro l l ing water-site and water-

related diseases c) Preventing water - w as hed dis eases.

7. N u t r i t i o n education relates sc ient i f ic knowledge to the to ta l strategy f o r survival. I t s form, method and content are dependent upon the social and educational context.

Whatever the method and dynamics o f teaching nut r i t ion, the child's l e v e l o f mental development and in terests and t h e local resources avai lable should be the essential guides. The ch i l d should learn by doing things and entering i n t o the discussions, no t solely b y listening, reading and repeating. The teacher induces the c h i l d to work w i t h concrete materials, to observe and investigate

3.1

4.1

4.2

5. I

6.1

7.1

7.2

Organize two panels to debate on: a) Poverty i s (not) the major

constraint to n u t r i t i o n in Sierra Leone.

b) Classroom teaching w i l l (not) change behavior in heal th and nut r i t ion.

Identify the targets f o r n u t r i t i o n education in t h e community.

Exp la in why these targets are considered groups "at risk".

Discuss w h y the content o f n u t r i t i o n education has mu l t i d i sc ip l i na ry aspects.

What diseases can be a t t r ibu ted to "lack o f water?"

Describe some pract ica l act iv i t ies of pupils outside the classroom that wou ld enhance n u t r i t i o n education.

Why types o f teaching aids can be usefu l f o r n u t r i t i o n learning.?

45

the environment, to re f lect upon their 7.3 Role-play a situation where a teacher experiences, t o choose between the /nu t r i t i on educator explains to the wor th and consequences o f actions, and mother that the child's lack o f t o judge and express the i r conclusions activi ty, l ist lessness, etc. may be due about desirable behaviour. to undernutr i t ion. H o w wou ld you

"encounter" the mother w i th problem? The teacher must promote and guide the action, awakening in the ch i l d new interests and behaviour, and to build upon what h a d already been inculcated a t home, wh ich tends to fac i l i ta te a product ive and healthy l i fe . While the interest o f the parents concerning the heal th o f t he i r ch i ldren i s easy to see, i t may be d i f f i c u l t to mot ivate the change in food attitudes and habits o f pupils w i thou t the involvement o f mothers and families.

THINGS TO REMEMBER

The objectives of health and nutrition education in primary schools are:

1.

2.

3.

4.

5.

To enable children and their parents to understand that proper nutrition is essential to good health, normal physical and mental development.

To help children develop desirable practices in relation to food, hygiene and environmental sanitation.

To promote the role of nutrition in the prevention of illness and deficiency diseases.

To teach children about the selection, preparation, and preservation of foods.

To stimulate adequate food production and consumption of food resources in the community.

IV. Community Par t ic ipatory Activi t ies

1. Make a few home v i s i t s to make pre l iminary survey o f the state o f nu t r i t i on o f ch i ld ren under f i ve years old. Discuss w i t h the mothers their possible explanations f o r the state o f the chi ld.

2. Develop a 15 item questionnaire to determine the attitudes, knowledge and practices o f mothers related to nu t r i t i on and each one in te rv iew 3 to 4 mothers. (See Appendix f o r Community N u t r i t i o n Survey F o r m as model.) Discuss w i t h the class the implications o f your collective f indings.

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M O D U L E '2

NUTRITION REQUIREMENTS FOR SPECIFIC GROUPS*

I. Overview

Malnu t r i t i on affects cer ta in ind iv idua ls or groups more than others. This may be due to ignorance about nu t r i t i ona l value o f loca l ly avai lable foods and preparation o f balanced diets, wh ich lead to poor choice o f foods and undernutr i t ion. Certain groups in the populat ion are especially vulnerable to nu t r i t i ona l problems such as the case o f pregnant o r lactat ing women, and in fants below 2 years old, whose food habits need to be improved or enriched.

This module i s concerned wi th the fo l l ow ing concepts:

1. In fan ts 6-24 months o f age need supplementary d i e t f o r growth.

2. Pregnant and lactat ing women r e q u i r e balanced d ie ts and ext ra foods.

3. Manua l and ha rd workers need to have more calorie in take f o r energy.

4. Inva l ids o r convalescents need nour ish ing food to restore the i r strength.

5. Some illnesses are caused by imbalanced d iets or f ood deficiencies.

II. Objectives

At the end o f t h i s t ra in ing module the learner should be able to:

1. Prepare a var ie ty o f supplementary d ie ts f o r in fan ts 4-24 months o f age.

2. Demonstrate the ways o f feeding babies o f 6-24 months o f age.

3. Exp la in the importance o f the diet o f pregnant and lactat ing women.

4. Choose and p lan a var ie ty o f balanced meals f o r pregnant and lactat ing mothers.

5. I l lus t ra te the types o f f ood required du r ing stages o f convalescence.

6. Compare the energy needed f o r some activi t ies per hour

*This module should be learned wi th practicals in the Home Economics k i tchen or laboratory.

47

III. Concept Development and Learning Activi t ies

1. The foods we eat whether liquid or solids can be d iv ided i n t o three groups depending upon what nutrients they conta in and the func t ion o f the nutrient. I. Bodv building grouo: Ch i ld ren need

foods r i c h in prote in f o r growth. Adults and ch i ldren need body bu i l d ing foods to make new blood, hair, skin, etc. as they wear out.

2.

II. Warmth and energv g r o m : Foods that conta in carbohydrates and fats are cal led energy foods. The body needs f u e l to provide warmth and energy.

III. Protective grouo: Foods that conta in v i tamins and minerals give the extra sparkle to heal th and help the body to f i g h t diseases. Inc luded in t h i s group i s water as i t i s necessary f o r the blood and f o r the transportat ion o f the other nutrients.

Good food habits mean that one i s w i l l i n g or strives to eat the foods w h i c h build good health. When essential nutrients are avai lable in our diet, we say the food i s nourishing. The ind i v idua l needs f o r these nut r ients depend upon the 1) height, weight, surface area, age and sex and 2) muscular work. Energy found in the foods i s needed f o r mainta in ing the processes o f l i v i n g - breathing, circulat ion, replacement o f tissues, the maintenance o f t h e body temperature and digestion. Basal metabolism represents the minimum amount o f energy needed to carry on the v i t a l body processes. More energy i s needed by an ind i v idua l to carry out the everyday activi t ies in add i t ion to the needs o f basal metabolism.

3. Energy i s measured in calories, k i l o calorie, joule, k i lo jou le o r megajoule. Today a l l scientists are changing over

1.1 Look at the char t of food groups and identify the foods belonging to each group. Why are they also classified as Go, Grow and Glow foods?

1.2 These foods consist of nutrients. Which are the six nutrients?

1.3 Discuss what you think i s the longest time f o r man to survive w i thout water? People on hunger s t r i ke re fuse food but are forced to take water. Why i s this so?

3.1 Compute for the basic energy needs f o r an i nd i v idua l o f your weight, in joules and in calories.

48

Food Whee l - C h a r t o f Food Groups

4 9

f r o m use o f calorie to the use o f joule. One calorie i s equivalent to 4.2 joules. I f one person’s body weight i s 70 k g (or 154 lbs) he needs 4.2 joules per k i logram (2.2 pounds) o f body weight per hour. Fo r a per iod of 24 hours, h e needs:

70kg x 4.2 (joules) x 24 (hours) = 3056 joules or

7056 -- 4.2 = 1.444 calories

I f you convert /O56 joules to k i l o joules, the person needs 7.05 ki lojoules or kj. One can convert k j to megajoules (mj) b y d i v i d i n g the amount b y 1000, thus; 7.05 k j = . O m j (megajoule). These values represent basal metabolism needs.

4. Below you w i l l find examples o f how much energy you need per hour o f some activi t ies:

A c t i v i t v f o r one hour mi Resting in a chair 0.063 Wr i t ing 0.084 Typin,g O. 126 Peeling potatoes, serving O. 168 Paint ing a house 0.63 Walking f a i r l y fast 0.84 Wood cut t ing 1.59 Runn ing 2.1 Swimming 2.3

5. The intake o f an i n d i v i d u a l f o r his energy food needs comes f rom carbohydrates wh ich contains sugar, starches and cellulose. The important source o f carbohydrate food i s often called stade. In Afr ica, rice, corn and cassava are staple foods. In addition, i t i s t he cheapest food, bulky, easily satisfies hunger, and provides balanced meal w i t h other foodstuf f . F i f t y f i v e to s ixty percent (55 - 60%) what i s eaten dur ing the day should be carbohydrate food.

6. The fo l l ow ing table gives average everyday needs f o r people o f different ages:

4.1 Change these megajoules (mj) to calories.

4.2 Based on the table o f energy need according to activities, how much megajoules do you think a farmer wou ld need f o r f o u r hours active work? I f you add t h i s to his basic metabolism needs, what wou ld be his dai ly requirements in joules? (Convert megajoules i n t o joules)

5.1 I d e n t i f y the staple foods o f Ireland, U.K. or Europe, I n d i a and China.

5.2 Think o f the Sierra Leone diet f o r a day. H o w much (in percent) o f the food intake consist o f carbohydrate?

6.1 Discuss what wou ld happen i f an i nd i v idua l takes more carbohydrates than h e needs.

50

Chi ldren 1 - Boys 12 -

14 - Girls 12 -

14 - 16 -

II

II

II

1 yrs. 4 8 4 It

6 'I

8

4.600k j 1.100kcal 1.300kj 2.700kcal 2.600kj 3.000kcal 9.600kj 2.300kcal 0.OOOkj 2.400kcal 9.600kj 2.300kcal

Men 55 - 75 1O.OOOkj 2.400kcal Women 55 - 75 'I 7.100kj 1.700kcal

7. Fats and oi ls are also impor tant sources 7.1 Make a l i s t o f t he funct ions o f fats o f energy. One gram o f fats gives in the human body. more than two t imes o f energy than one gram o f carbohydrates. They are the best energy foods, but they are also expensive. Vegetable fats are more desirable than animal fats because o f t h e incidence o f heart disease related to the cholesterol f ound in animal foods. Vegetable fats are cheaper, no t as bulky as carbohydrates and they also tend to leave the stomach re la t ive ly slower, and helps delay the onset o f hunger and contributes to a fee l ing o f satiety fo l low ing a meal.

8. Some pro te in foods are better f o r 8.1 Exp la in what happens to excess body-bui ld ing than others. prote in intake. Why i s i t extravagant

to eat more pro te in than needed? Soya beans 34% prote in Groundnuts, 23% prote in

Legumes D r y Beans

and Peas 20% prote in

Corn, wheat,

Dark green millets, 8-1OYo Pro te in

leaves, 3-7% prote in Irish potatoes

Cassava, sweet

plantain, potatoes, 1% Protein

cabbage

8.2 Why i s there on l y 18% o f p ro te in in f r e s h fish whi le there i s 63% in d r ied f i s h ?

51

9. The fo l low ing table shows the amount of prote in that d i f f e ren t ind iv idua ls need d u r i n g the day:

C h i l d 53 grams Woman 53 grams (average weight, most

teenage

M a n 65 grams ( a v e r a g e w e i g h t

occupations)

g i r l 53 grams

moderately active)

The da i l y allowance o f prote in should be d i v ided among the various meals of the day. There i s no advantage in eating more prote in than the body needs fo r g rowth and repair.

10. Various people have need f o r prote in because o f par t icu lar purposes:

Hea l thy adults need prote in to repai r t he i r bodies. Pregnant women need prote in f o r repair and f o r bu i ld ing t h e new baby who i s growing ins ide them. Nursing mothers need prote in f o r repai r and also to make milk needed to f e e d the growing ch i ld . Ch i ld ren need prote in f o r repair and growth. Sick adults need extra prote in to repair the ha rm caused b y their i l lness. Sick ch i ldren need extra prote in f o r repair as we l l as prote in f o r growth.

foods wh ich contain plenty o f v i tamins and minerals are called protective foods. Eat ing them protects people f r o m certain diseases or weaknesses. Most foods are m ix tu re o f nutrients; prote in and energy foods contain vitamins and minerals as well. Thus, when a person lacks proteins and joules, h e usually lacks v i tamins and minerals, too.

9.1 Look at the poster showing foods and the i r prote in content. H o w much groundnuts w i l l give you 50 grams o f protein? H o w can you increase the p ro te in value obta ined f r o m vegetables?

10.1 Look at the ingredients that are used f o r preparing Ben imix o r porr idge f o r infants. Why i s groundnut o i l added to the porridge? Why i s bean f l ou r an impor tant ingredient in Benimix?

11.1 Look ing back at the Food Wheel, i d e n t i f y the protective foods.

52

12.

13.

14.

V i tamins are the organic 11.2 substances needed in small amounts for normal func t ion ing o f the body.

Theyare named V i t a m i n A, €3, C, D and so on. M ine ra l elements are present as salt in body fluids, in body acids and alkal is and are par t o f many t issues. They are also an essential element in cer ta in hormones. These are calcium, phosphorus, i r o n and iodine. A reasonable var ied d ie t should no t go short o f these minerals, but the i r absence i s also l i ke l y to cause cer ta in i l lnesses.

See Table no. 1 f o r a summary o f the value o f vi tamins and minerals.

12.1

The human body contains n i n e t e e n 13.1 impor tant minera l elements but only four wh ich are l ikely to be absent in the d ie t w i l l be discussed here. 13.2

13.3

13.4

When a ch i l d i s born, his body, 14.1 especially his b ra in keeps on growing fast. H e grows so fast that h e doubles his b i r th-weight in the f i r s t six months o f h i s l i f e and t r ip les i t du r ing his f i r s t year. I f a ch i l d i s to be able to grow as fast, h e needs plenty o f prote in foods. In the f i r s t month o f his l i f e , prote in comes to him in his mother’s milk but f r o m the age o f f ou r months onwards, he must have plenty o f other prote in foods added to his porridge. After a ch i l d i s one year o ld h e grows more slowly but h e i s s t i l l growing, and h e s t i l l needs p lenty of prote in food.

Examine t h e table o n importance o f v i tamins and i d e n t i f y w h i c h sources are better eaten r a w than cooked.

Describe the characteristics o f scurvy, pellagra and rickets.

Exp la in why cer ta in groups o f people need more ca lc ium than others.

Discuss why women are more prone to anaemia.

State the way people f a r f r o m the sea counteract the absence o f iod ine in the i r diet.

Look a t the label o f a mu l t i - v i t am in tablet and l i s t o f minerals tha t are found in them. Which types o f people need these minerals?

What other nut r ients need to be inc luded in the in fants ’ d ie t a f te r 6 months?

53

Table No. 1 Vi tamins and the i r Importance

V i tamins Purpose Resu l t o f

Sources Def ic iency

1. V i t a m i n A

2. V i t a m i n B (Bl -Bld

Thiamine B,

R i b o f l a v i n B,

n ico t in ic ac id

n iac in B,

3. V i t a m i n C (ascorbic acid)

4. V i t a m i n D

5. V i t a m i n E

- g rowth in chi ldren - good eye-sight

especially in the da rk

- healthy t issue in nose, mouth and throat

- g rowth in chi ldren

- healthy nervous

- enables the body to system

produce energy f r o m food

- f o r healthy skin and nervous system

- g rowth in chi ldren - healthy gums - qu ick heal ing o f cuts

and wounds - prevention o f scurvy

- fo rmat ion o f healthy

- f o r absorption o f bonesand healthy teeth

ca lc ium and phos- phorous in the body.

- f o r hormone develop- ment

milk, butter, egg yo lk - n igh t blindness f a t fish or l iver, cheese

carrots, tomatoes, - xeropthalmia mangoes, cabbage, spinach

unpolished rice, - beri-beri Dork,meat, peas and legumes

liver, f i s h , eggs, milk,green,vegetables

meat, especially l i ve r - pellagra groundnuts, beans, cereal bran, breads

oranges, lemon,grapes, grape fruit, guavas,paw- paw, mangoes, cabbage, cau l i f lowers,dark green leaves.

sunshine,cod-liver oil, - r ickets sardines, eggs, cheese, margarine

corn on the cob, un- polished rice, honey, dark lea fy green vegetables.

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Table No. 2 Minerals and the i r Impor tance

Vi tamins Purpose Result o f

Sources Def ic iency

1. Calc ium - growth and develop- ment o f bones and teeth

- c lo t t ing o f blood - proper work ing o f

muscles

2. Phosphorus - combines with ca lc ium f o r forma- t i on o f bones and teeth

produce energy f r o m food

healthy

- enables body to

- keepsbody cells

3. I r o n

4. Iod ine

= fo rmat ion o f red corpuscles o f the blood

- product ion o f hor- mone in thy ro id gland

milk bad teeth

fish, dried fish, sardines, vege- osteomalacia tables

meat nu t r i t i ona l anaemia

dark green leaves nose bleeding lea fy vegetables legumes

fish goitre green vegetables d w a r f ism near the sea

55

15. During pregnancy t h e mother needs ext ra food to make the baby strong and healthy. Inadequate food consumption during pregnancy and lactat ion leads to under-nutr i t ion. Most often, f ood restrictions or food taboos cause the pregnant woman to eat less during pregnancy.

In Sierra Leone, anaemia i s a common disorder o f pregnancy. A n anaemic woman w i l l no t have enough red colour in her blood. The blood w i l l be pale, and i f we look at the inner side o f the lips or lower eyelids, they w i l l be pale, l i gh t pink or white. She w i l l easily become breathless a f te r l i t t l e exertion. H e r face and feet may become swollen. Anaemia in pregnancy can be treated by a good m ixed diet, but in extreme cases, i r o n tablets are added to the diet.

16. During illness, special diet needs to be planned during the three stages o f illness. They need to be l ight, wel l balanced, easily digested and nourishing. (a) Ea r l y stage - liquid d ie t (b) Recovery stage - light diet (c) Convalescence - nourishing, and

easily digestible

15.1 Make l i s t o f foods that w i l l supply most o f the nutrients a pregnant woman needs.

15.2 In te rv iew a woman who i s "high-risk" o f ma lnu t r i t ion in pregnancy. Find out how much she was eating before. D i v i d e that por t ion i n t o f o u r - and show her, that she needs one-fourth (25% extra) more than what she was eating before she became pregnant.

16.1 Make a l i s t o f foods/dishes suitable to the i n v a l i d or convalescent. Give reasons f o r your choices.

16.2 Exp la in the types o f cooking appropriate f o r these foods.

56

THINGS TO REMEMBER

1. Foods contain different nutrients needed for growth and development, energy and protection against diseases and germs.

2. Certain diseases are caused by lack of and insufficient supply of these nutrients.

3. Certain groups in the population who are vulnerable to nutritional problems have specific dietary needs.

IV. Community Participation Activities

1. a) I n v i t e the Communi ty Development Counci l to sponsor a series o f heal th sessions or mothers' workshops, based on nu t r i t i ona l problems or needs in the community.

b) Prepare the inst ruct ional p lan and the visuals/posters tha t w i l l go w i t h the messages or concepts.

c) Conduct demonstrations, especially in the preparation o f weaning foods and the importance o f hygienic practices in food preparation.

2. P lan f o r a "Ch i ld Hea l th Day" in the vi l lage and promote the activit ies, i.e. weigh ing the infants, selecting the A -1 c h i l d o f various age groups in school, heal th talks, dramatizations and other cu l tu ra l activities, immunization, etc.

57

MODULE 3

INFANT NUTRITION

I. Overview

The promot ion o f heal th o f the c h i l d and the prevention o f diseases start du r ing t h e pre-natal period. Thus, i n f a n t n u t r i t i o n plays a major ro le in bo th physical and in te l lectua l development o f the chi ld. Adequate food, medica l care and a l ov ing and s t imulat ing environment a l l cont r ibute to a fu l l development o f the chi ld. Pregnant and lactat ing women need more energy in take and d ie t supplements to prevent pro te in deficiency in the in fant , just as i n fan ts need supplementary foods du r ing the i r weaning period.

The ma in ideas in this module are the fo l lowing:

1. Babies need food in order to grow, learn, and be active.

2. Breast milk i s the best na tura l food f o r babies.

3. Nu t r i t i ona l requi rements o f the i n f a n t vary f r o m 6 months onward wh i le breast feeding.

4. Ch i ld ren w i t h d iar rhea need special foods and drink.

5. Bot t le feeding has i t s l imitat ions.

II. Objectives

1.

2.

3.

4.

5.

6.

7.

8.

At the end o f this t ra in ing module, the learner should be able to:

Give reasons why foods taken du r ing pregnancy are impor tan t to fe ta l development.

Describe the mother contacts w i t h the i n f a n t wh ich promote security and love for the baby.

Exp la in the advantages o f breast feeding.

I d e n t i f y the diseases or i l l n e s s that a f fec t the i n f a n t w i t h l o w birth weight.

Describe the types o f food that an i n f a n t needs to take a f te r 6 months.

Provide guidelines f o r a r t i f i c i a l feeding.

Demonstrate the preparation o f the "special drink" f o r dehydrat ion f r o m diarrhea

L i s t the foods that a ch i l d w i t h diarrhea should be able to eat.

59

m. Concept Development and Learning Activi t ies

1.

2.

3.

The nu t r i t i on o f the ch i l d begins in the womb o f the mother. The nu t r i t i on o f the mother-to-be and the care given to h e r physical condi t ion to prevent i n fec t i on to herse l f and the unborn ch i l d help to have a healthy baby. Good nu t r i t i on helps protect the body against many infections. A pregnant woman or a lactat ing mother needs to eat more and o f the r i gh t f ood to make the baby strong and healthy and to produce more milk f o r the baby. She i s t r u l y "eating f o r two". A var ie ty o f foods w i l l supply most o f the nutrients tha t a pregnant woman needs. She wou ld take 25% more food than what she was eating before she became pregnant.

A c h i l d starts o f f as one ce l l ins ide his mother's womb. H e i s f a r too small to be seen. This ce l l takes in prote in and builds another cell. This goes on until there are mi l l ions o f cells which take o n d i f f e ren t shapes to make the d i f f e r e n t parts o f the child's body such as h i s muscles, h i s eyes, h i s heart and h i s brain.

A c h i l d has to grow very fast and, therefore, h e needs lots o f protein. F r o m the beginning, the prote in has to come to the c h i l d through the umbi l i ca l cord that joins him to the inside o f his mother's womb. A pregnant mother thus eats plenty o f prote in i f she i s to have enough f o r herse l f and f o r the c h i l d tha t i s growing inside her. If a mother has a good diet du r ing

pregnancy, she becomes heavier and puts o n fat. The stored f a t i s impor tan t because i t i s used to make much o f the milk when she i s breast feeding.

Mothers who do no t eat enough food du r ing pregnancy w i l l have smaller babies. Low-b i r th weight babies are especially a t risk o f illnesses, ma lnu t r i t ion and death.

1.1 I d e n t i f y the kinds o f f ood a pregnant woman needs to eat more of.

1.2 Describe the practice you know o f wh ich gives a pregnant woman special foods. Jus t i f y if i t i s nut r i t ious or not.

1.3 L i s t the kinds o f r i g h t f ood and i t s effects on the development and growth o f the unborn chi ld.

2.1 I d e n t i f y the sources o f vegetable prote in f o r those who cannot a f f o r d an imal foods.

3.1 F r o m your personal observations, describe among pregnant women those who are at "h igh risk" o f ma lnu t r i t ion

3.2 I d e n t i f y the diseases or i l l nesses that a f fec t l o w b i r th-weight babies,

60

4.

5.

6.

7.

During breast feeding, much o f the mother / in fan t interactions and bonding takes place. I t permits a closeness between a baby and t h e mother. The i n f a n t needs the lov ing and s t imulat ing environment du r ing breast feeding f o r full development. Breast feeding has been found to be a major cont r ibutor to preventing i n f a n t death and longer birth interval.

Breast milk contains the r i g h t mix tu re o f fats, sugars and proteins f o r a growing baby. Therefore, i t i s easy to digest. I t also contains antibodies wh ich protect t h e ch i l d f r o m in fect ion. Breast milk i s always clean. I t requ i res no special preparation and needs no t to be purchased.

A mother should put her baby to her breasts on the day h e i s born, within 1 or 2 hours a f te r birth. This f i r s t milk i s k n o w n as colostrum. Colostrum i s very good f o r the baby. I t protects t h e baby f r o m infectious diseases, such as diarrhea. The regular milk comes on the third to s ix th day a f te r birth.

Practical ly a l l mothers breast f e e d their babies, and they normal ly know how to do this. But certain points need to be remembered, especially when a mother had d i f f i c u l t y pu t t i ng the baby to the breast. a) The mother should be comfortable.

b) I f she touches the baby’s cheek with he r nipple, the baby w i l l automatical ly turn his head and open his mouth. The baby’s c h i n should be pressed up against the breast. T o a l low the ch i l d to breathe easily, she can ho ld the breast away f r o m the baby’s nose wi th he r fingers.

c) The baby should suck f r o m both breasts a t each feeding. F e e d f r o m the r i gh t breast h a l f o f the time, then, f r o m the l e f t breast. Five to ten minutes f r o m each side - longer as he gets older.

4.1

5.1

6.1

7.1

7.2

Describe a practice in your communi ty that promotes bonding/ in teract ion between mother and i n f a n t du r ing breast feeding.

Give the advantages and b e n e f i t s of breast feeding.

Can a l l mothers breast feed? In terv iew some mothers on the d i f f i cu l t i es or problems they may encounter in breast feeding. What are the i r practices to solve these problems? H o w sound/unsound are these practices?

H o w o f ten should t h e mother breast feed? H o w long should a baby be f e d each time?

Up to what age should a ch i l d be breast fed?

61

FOOD FOR PREGNANT WOMAN

R ' C

62

d) The baby can be breast fed whenever he wants. D u r i n g the f i r s t f e w days, the baby w i l l c r y when he wants milk; mother and baby usually settle in to a rhythm.

e) Small babies need to be f e d a t night. I f they sleep next to the i r mother, sometimes they feed w i thout wak ing the mother.

8. In the f i r s t month o f his l i f e , prote in comes to him in h i s mother's milk, but f r o m the age o f . s ix months onward, h e must have plenty o f other p ro te in foods added to h i s porridge. The f i r s t foods need to be sof t and w i thou t strong spicy f lavour (e.g. curry). The staple d i e t or the cereal in the communi ty should be used to make the f i r s t f ood f o r a n in fan t . I t should be we l l cooked, mashed and made i n t o a porridge. A d d i n g some o i l w i l l increase the energy found in the food. Sugar i s also useful, but sweet foods are bad f o r the teeth.

9. When prepar ing the baby's food, make a porr idge o f local g ra in or soft cooked r ice w i th f i s h meals, groundnut paste o r mashed beans. The consistency of this porridge should be " th ick l i k e borongo" - also cal led "pota-pota" in other parts o f Sierra Leone. Pa lm o i l i s added to the r i ce porr idge f o r extra calories. Since babies have small stomachs that cannot h o l d the foods in one meal, the weaning foods should be f e d twice over 4-5 hour periods. The goal i s to prov ide a t least 400 calories and 15 grams o f p ro te in f r o m the porridge in add i t ion to the 16 02s. o f breast milk in a 24 hour period.

8.1 What feeding practices f o r weanin! are par t o f the customs an( t rad i t ions o f the communi ty?

8.2 Give an example o f a supplementar food f o r a 6-8 month o ld chilc What nutrients are f o u n d in i t How valuable or u s e f u l i s i t to th ch i ld?

9.1 Demonstrate w i th t h e use o f loci measuring u tens i l the preparation (

a weaning food. (Use r i c groundnut, beans, pa lm oil, fi! meal. T e l l how much rice, bean f i s h and pa lm o i l to add. Show tl thickness o f the sof t cooked rice.)

63

WEANING INFANTS

64

10. A f t e r 6 months the c h i l d can take a more var ied diet. Once a c h i l d i s eat ing cereal porr idge well, cooked legumes, potatoes, mashed fruits o r vegetables can be mixed i n t o i t o r g iven separately, gradual ly increasing in quant i ty. The vegetables should be very sof t w i thout fibre, or mashed. F ine ly chopped fish o r meat can be m ixed in but not as essential when adequate amounts and mixtures o f vegetables are given.

11. When there’s a n insu f f i c ien t supply of mother’s milk due to the sickness of mother or t o the absence of t h e mother, bot t le feeding becomes a necessity. Using t inned milk o r powdered milk i s costly and needs preparat ion a n d conservation. I t provides a n unbalanced diet if the formula i s too di lute. Milk i s easily contaminated and when the bott le or rubber teats o r the spoon used are no t sterilized, in fec t ion sets in. The holes o f the rubber teat may either be too small, and cause the c h i l d t o swal low more air, but n o t enough milk, o r too large, that there i s r a p i d feeding and sometimes vomit ing.

12. The n u t r i t i o n o f the c h i l d i s endangered by diarrhea. Diar rhea i s a condi t ion in w h i c h 3 o r more watery movements o r stools are passed in a day. I t i s most common between six months and three years o f age and among those less than six months o l d who drink a n i m a l milk or i n f a n t feeding formula. Small ch i ldren w i t h severe diarrhea lose water and salts fast and can d i e qu ick ly f r o m dehydration.

10.1 L i s t the local fruits and vegetables that m a y be used t o improve the var ie ty o f food g iven t o a c h i l d about 9 months - 12 months old.

11.1 Discuss what can be done t o make a r t i f i c i a l feeding less dangerous.

11.2 I f there are ch i ldren o f one year o r less in the communi ty who are bott le fed, compare the i r weights wi th a s imi lar group tha t i s breast fed, and t h e number o f illnesses in the t w o groups. Record this data in the bar chart/graph.

12.1 Describe the ways by wh ich a n organism causing d iar rhea enters the infant’s body.

12.2 State h o w can a mother prevent these con taminat ions.

12.3 Wi th t h e use o f a chart, describe the c h i l d who has lost much water and salt.

65

ORAL REHYDRATION TREATMENT

66

13.

14.

The treatment o f acute diarrhea calls f o r replacement o f water and salts (rehydration). A very young ch i l d should continue to be breast fed and should take ora l rehydrat ion salts. At home, this can be made up o f 1 l i t e r o f clean d r i n k i n g water, w i t h 4 grams o f common s a l t a d 40 or 50 grams o f o rd inary sugar. This may be given as o f ten a f te r a watery stool i s passed.

In many communities, i t i s common practice to starve or restr ict food when ch i ldren have diarrhea. This on ly leads to malnut r i t ion, wh ich w i l l make the c h i l d have diarrhea more frequently. To prevent ch i ldren w i t h d iar rhea f r o m becoming malnourished, i t i s impor tant to give them correct treatment and proper nu t r i t ion .

13.1 Prepare a poster that shows the ingredients o f an ora l rehydrat ion solutions (ORS) w i t h the use o f common measuring devices at home.

13.2 Demonstrate the preparation o f t h e (ORS) u s i n g t h e " l o c a l " measurements.

14.1 Prepare a f l ip char t or a poster showing foods helpful to the ch i l d w i t h diarrhea. Why do you think that roasted corn or bo i led sweet potatoes or toasted bread taken w i t h plenty o f liquids i s also curative?

14.2 Prepare a f l ip char t wh ich shows a mother everyth ing they need to do to care f o r a ch i l d w i t h diarrhea.

THINGS TO REMEMBER

I. Breast feeding is the best feeding until a child is 18-24 months old, but additional foods should be given when the child reaches 6 months of age.

2. Never stop breast feeding during diarrhea.

3. Dehydration is dangerous in diarrhea.

4. Give rehydration fluids along with soft, easily digestible foods for an infant with diarrhea.

V. Community Participatory Activities

1.

2.

3.

4.

In te rv iew a f e w mothers in the communi ty and find out how they f'eed the i r ch i ldren and what they think about breast feeding.

I n v i t e a f e w mothers - (6-10) f o r an i n f o r m a l discussion on what they wish to learn concerning n u t r i t i o n and diarrhea, and show children's drawings on heal th practices.

Conduct a min i -workshop on t h e use o f ORS, i t s preparation and the foods suitable f o r ch i ldren w i t h diarrhea or f o r weaning.

Ask the mothers to compose the i r own songs concerning the ingredients and measurements needed f o r ORS at home ...... These same songs can be taught to ch i ldren in school.

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MODULE 4

NUTRITION AND GROWTH

I. Overview

G r o w t h a n d development are fundamenta l features o f chi ldren. G r o w t h i s the gradual increase in size o f t h e body and i t s organs. DeveloDment i s t h e increase in the number o f s k i l l s per formed by the body, inc lud ing the b r a i n a n d in the performance o f those s k i l l s . I f a c h i l d i s growing well, he i s probably heal thy and adequately nourished. The child's development i s no t on ly in f luenced by n u t r i t i o n but also by the learn ing opportunities prov ided in a l o v i n g and s t imulat ing environment.

The m a i n ideas in this module are:

1. Breast milk i s suited to the growth needs o f babies.

2. Measur ing a child's g rowth i s one way o f measuring h i s heal th a n d qual i ty o f his nut r i t ion.

3. Increase in weight w i t h age i s more impor tant than weight o n any one occasion.

4. A growth char t shows the d i rect ion o f g rowth and the nu t r i t iona l status of the chi ld.

5. M a l n u t r i t i o n slows development.

II. Objectives

At the end o f this t ra in ing module the learner should be able to:

1. Measure growth through body weight a n d height.

2. State some milestones o f development o f the under- f ive.

'3. Describe the nu t r i t iona l needs o f the chi ld.

4. In terpret the data on a growth chart.

5. Demonstrate the use o f the "shakir" strip f o r measuring nu t r i t iona l status o f the chi ld.

6. Identify the characteristics o f kwashiorkor and marasmus.

69

III. Concept Development and Learning Activi t ies

1.

2.

3.

4.

When an i n f a n t started l i f e as one-cell in the womb o f his mother, h e weighed pract ica l ly nothing. As the cells subdivided, f o rm ing muscles, blood vessels, bone, fat, teeth and v i t a l organs, he w i l l continue to grow until h e i s born. Fo r t y weeks later, h e w i l l weigh between 6-1/2 to 9 lbs and h i s length f r o m head to the toes should be about 19-1/2 inches. However, the size and weight o f the body depends upon. the stature o f the parents.

Normally, a mother should ga in f r o m 17 to 22 lbs. du r ing pregnancy. To protect the in fant , she should eat foods r i c h in protein, vitamins, i r o n and calcium, observe proper hygiene, get enough res t and exercise, and obta in tetanus vaccination to prevent tetanus in the newborn. O n delivery, she needs protection f r o m infection, nut r i t ion, adequate warmth, security and comfort.

Breast milk i s the na tura l f ood for babies. I t s composition i s as follows:

Water 86.5% Calc ium 32 m g Prote in 1.3% Phosphorus 18 m g Carbohydrate 9.1%

A c h i l d doubles his birt., weight in the f i r s t six months o f his l i f e , and t r ip les birth weight in h i s f i rs t year. A healthy one year o ld ch i l d weighs about 10 kgs. H e r e are the weights o f heal th ch i ld ren in kilograms:

1.1 Discuss the importance o f pre-natal care and visi ts to under - f i ve cl inics f o r both i n f a n t and mother.

2.1 Exp la in w h y the mother needs extra foods du r ing pregnancy.

3.1 Make a l i s t o f the advantages o f breast feeding.

3.2 Exp la in why breast fed babies have no problem w i t h obesity.

4.1 Convert this table i n t o pounds.

70

A healthy Child's age child's weight

Months Years in ka.

Birth 3.5 k g 4 mo 6.3 k g 6 mo 7.5 k g 8 mo 8.4 k g

10 mo 9.3 k g 12 mo (1 yr) 10.0 k g 18 mo (1-1/2 yrs) 11.3 k g 24 mo (2 yrs) 12.5 k g 36 mo (3 yrs) 14.5 k g 48 mo (4 yrs) 16.5 k g 60 mo (5 yrs) 18.5 k g

4.2 Identify one c h i l d w i t h a k n o w n age. Take his weight and compare i t wi th that shown in the table. I f t h e c h i l d i s under weight, w h i c h kinds o f foods must h e eat and how much o f i t should be given i f h e i s going to grow to t h e r i g h t weight f o r his age?

5. Development or the increase o f s k i l l s 5.1 Discuss factors other than n u t r i t i o n depends ma in l y on the"' b ra in an-d'tlïe that can also in f luence development. nervous system, which l i k e other parts o f the body requ i res adequate nut r i t ion. As the c h i l d grows, he also develops. Below are markers o f development (also sometimes cal led "milestones o f development").

L

-1 , \

Mi 1 est ones Average Near ly a l l o f Development \ Baby babies

Able to s i t with- out support 6 1/2 mo. 9 mo.

Able to wa lk 10 steps w i t hou t support 12 mo. 18 mo.

Able to say single words 15 mo. 21 mo.

Able to speak short phrase 23 mo. 36 mo.

7 1

6. A child’s weight i s a valuable measure o f h i s heal th and nu t r i t ion . Weighing a c h i l d requ i res rel iable equipment and a standard method to achieve results. Beam balance i s usual ly accurate and rel iable but i s o f ten heavy and expensive. A Siir ina scale i s on ly suitable f o r in fan ts and small children, i s q u i t e cheap and reliable. The ch i l d i s placed in a basket, or hooked through the pants o f a ch i l d and suspended f r o m the scale hanging f r o m a branch o f a tree. Bathroom scale common in the stores are convenient to car ry f r o m one place to another, but they may no t be accurate.

7. A growth char t i s basically a graph in wh ich a child’s weight i s shown in d i f f e ren t ages. H e r e i s a typ ica l g rowth chart. Across the graph are printed t w o growth reference l ines. These l ines give the general d i rect ion o f g rowth in healthy children. They are no t the target f o r the growth o f a l l children. I f a child’s weight i s much below these growth reference l i n e s there i s some reason f o r concern, but i t i s t he d i rect ion or angle o f a child’s o w n growth l i n e that i s much more s ign i f icant than any weight recorded below the lower reference l ine.

6.1 Practice reading t h e weight o f a p i l e o f books, a bucket or any object that can be suspended f r o m a beam balance or f r o m the use o f any avai lable scale. (If any trader has one, perhaps i t can be borrowed to expla in d i f f e r e n t types o f scales).

7.1 I d e n t i f y the types o f i n fo rma t ion that can be revealed in the growing chart. Up to what age i s the char t suitable?

7.2 Discuss the importance o f a health record f o r a school chi ld. H o w would you devise a g rowth char t f o r the older school ch i ld?

72

Fig. 1 Example of a typica l g r o w t h c h a r t

73

8. Methods are w ide ly used to measure the nu t r i t i ona l status o f a chi ld. a) Weight f o r age (Gomez-type) N u t r i t i o n Classification: In this classification, the average ser ies o f ch i ldren (up to f i ve years o f age) o f d i f f e r e n t ages are used as standard. According to t h i s system, i f a child’s weight dot at any age i s between 90% and 75% l ine, he i s considered to have degree malnut r i t ion. I f the weight dot i s between 75% and 60% l ines, he has second-degree malnut r i t ion. I f the weight dot i s below the 60% l ine, h e i s said to have third-degree malnut r i t ion. I t must be remembered tha t full diagnosis o f the nu t r i t i ona l status o f the ch i ld should be made on this basis alone. b) The use o f shakir striv i s a qu ick and easy way o f determin ing malnu t r i t ion in chi ldren more than one year o ld and less than f i v e years. Where tape measure i s no t available, use a plastic strip or p la in c lo th about 20 cm. long and 2 c m wide. M a r k in three places, O, 12.5, and 13.5 cm. Color the strip red up to 12.5, yel low up to 13.5 cm., and green, f r o m 13.5 c m to the end. Notches or scratches can be made at these points. Measure the circumference round the middle o f the upper a r m f r o m the O po int and where they meet along the strip w i l l show: red i s malnourished, yel low i s probably malnourished or under nourished and i f green, the ch i l d i s we l l nourished.

8.1 Show according to the poster what percentage o f the standard weight can be diagnosed as 1st degree malnut r i t ion, 2nd degree malnu t r i t ion and 3rd degree malnu t r i t ion?

8.2 Compare a ch i l d too heavy f o r h i s age but h i s weight i s no t mov ing upwards, w i th a ch i l d who i s l i g h t f o r his age but h i s g rowth curve i s moving upwards.

8.3 Make your own Shakir strip using any material you fee l suitable. I s this a suitable method for fol low-up, to see i f the ch i l d i s improv ing or not? Explain.

74

GOMEZ-TYPE CLASSIFICATION OF MALNUTRITION

75

9. I n f a n t nut r i t ion: A ch i l d develops protein-energy malnu t r i t ion when: a) his diet does no t conta in enough prote in - and energy g i v ing foods; b) the absorption o f energy-giving nutrients i s reduced because o f i l lness; and c) increased need f o r prote in and energy-giving nutrients in i l l ness i s no t met. G r o w t h fa i l u re i s the earliest sign o f protein-energy malnu t r i t ion or PEM.

10. There are two severe types of protein- energy malnut r i t ion: Marasmus and Kwashiorkor . Marasmus i s another word f o r starvation and ch i ldren get marasmus because they eat too l i t t l e f ood o f any kind. Kwashiorkor i s a more serious f o r m o f PEM. The most evident sign o f this condi t ion i s body swell ing or oedema, especially in the face, forearms, hands, legs and fee t . The ha i r o f the c h i l d w i t h kwashiorkor becomes pale and thin, f a l l s. out, or breaks easily. The ch i l d i s unhappy, and miserable. The f inger leaves a depression when you press the f r o n t o f the lower leg bone.

11 G r o w t h and heal th dif ferences among adults and specifically, between men and women and among the elderly, are in f luenced by eating right. I t means no t on ly to eat enough, but to eat a balance o f the d i f f e r e n t foods t h e body needs. Anyone who eats we l l gets a l l the v i tamins h e needs. People can be strong and healthy when most o f their prote in comes f r o m plants. But there are also foods or non-foods to avo id tha t do more ha rm than good: alcoholic drinks, tobacco, too much pepper or spices, greasy foods, lots o f sugar and sweets, and too much coffee.

9.1 Look a t the sketch o f the c h i l d w i t h marasmus. Note the fo l low ing characteristics: - very underweight - thin o ld man’s face - - no swell ing - ha i r normal - hungry

thin muscles and no t f a t

Do you know any c h i l d that looks much l i k e the p ic ture?

9.2

10.1

10.2

11.1

11.2

11.3

11.4

At what age do you think P E M i s most common? Why do you think bot t le feeding can be a cause o f mar as mus?

A t what age do you th ink i s kwashiorkor most common? Exp la in why i t can happen especially to the ch i l d who has stopped breast feeding.

Discuss w h y in fect ious diseases af fect nu t r i t ion . Name some diseases where a good d ie t i s as impor tant as medicine.

What i s the advantage o f cooking in i r o n pots?

Exp la in the value o f practice o f soaking dried maize (corn) in lime before cooking as i s done in L a t i n America.

Discuss the ill effects o f alcohol upon the ind iv idual . What are the social problems that can arise f r o m alcoholism?

Analyze the nu t r i t i ona l content o f the non-foods that can adversely a f fec t our bodies.

76

6 yrs. Under Weight Chiid 6yt-S.

Marasmus Kwash io r kor

77

THINGS TO REMEMBER

1. Marasmus and kwashiorkor can be prevented or treated by eating a balance of nutritious foods and by eating enough.

2. The direction of the growth curve is more important than the weight of the child at one given time.

3. Measuring a child’s growth is one way of measuring his health and the quality of his nutrition.

4. Eating right helps the body resist illness.

IV. Community Participation Activities

1.

2.

3.

4.

5.

Teach the mothers in a workshop or demonstration class how to use the shakir strip. Fo l low ing the class activit ies, l e t them br ing back to class the measurement o f the ch i ldren under f i ve years o f age in their household. Make a char t o f t he i r f ind ings and discuss in class the i r understanding o f the chart.

U s e a mother in the community (whose ch i ldren might be a t h i g h risk o f ma lnu t r i t ion) and expla in what m igh t be done to change the f a m i l y d i e t pattern.

Invite the mothers to school to watch a weighing session and help fil l in the heal th record cards o f the children. Discuss the use o f a g rowth char t f o r the under-f ives.

Find out how common malnu t r i t ion i s through a nu t r i t i on survey. Determine i f there are other diseases related to nu t r i t i on deficiency. Discuss w i t h the mothers i f cooking habits and attitudes towards certain foods have something to do w i t h it.

In mothers’ workshops, especially f o r pregnant and lactat ing women, show the visuals on malnu t r i t ion and c l a r i f y values b y asking what they wou ld do i f the malnourished c h i l d i s t he i r own or what they wou ld do to prevent the conditions.

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MODULE 5

LOCAL FOODS AND EATING HABITS

I. Overview

Good food habits help to promote better heal th and nu t r i t ion . The foods we eat are used by our bodies to Go, Grow and Glow. The ava i lab i l i t y o f local foods, the i r accessibility and costs, as we l l as the income o f the consumer a l l a f fec t our eating patterns. Cu l tu ra l practices also a f fec t to a large degree one's access to food, just as customs and t rad i t iona l ways o f l i f e inc lud ing taboos can be det r imenta l to good nut r i t ion. There i s a need to u t i l i ze to the max imum local production, ro ta t ion of crops, preservation and conservation o f f ood resources f o r improved nu t r i t ion .

The ma in ideas in this module are t h e fo l lowing:

1. Bet ter crop varieties are one o f the best ways o f improv ing nu t r i t ion .

2. N u t r i t i v e values o f f ood are changed du r ing cooking or consumption.

3. Preservation problems and seasonal product ion in f luence eating habits.

4. Some taboos promote malnu t r i t ion or undernut r i t ion and h a r m f u1 consequences.

5. Foods that can be stored or kept until some future use, need to be bought in large quantities.

6. Foods wh ich cannot be stored, such as green vegetables, need to be bought da i l y or grown in the backyard.

7. Socio-economic factors responsible f o r ma lnu t r i t ion or undernut r i t ion are "blocks on the food-path" to individuals.

II. Objectives

At the end o f t h i s t ra in ing module, the learner should be able to:

1. Trace the food pa th o f foods until i t reaches the person or c h i l d who eats it.

2. Exp la in fa rm ing practices that serve as blocks to the food path.

3. L i s t the d i f f i cu l t i es in the food pa th f o r town ch i ldren and compare this w i t h those o f the r u r a l chi ld.

4. Identify some o f the blocks on the food pa th as ref lected by customs and practices.

5. Discuss ways and means by wh ich blocks to a food pa th can be removed or reduced.

75

III. Concept Development and Learning Activi t ies

1. Foods that come i n t o our body comes f r o m somewhere - f r o m the f ie ld , gardens, r ivers o r farms. We think o f these foods as going through a "path" until i t gets i n t o t h e body o f the ch i l d who eats it. These paths are called food-Daths and a l l the things tha t block them contr ibute to ma lnu t r i t ion or undernutr i t ion. Food paths are longer f o r t own ch i ldren whose mothers have to b u y food, than they are f o r vi l lage ch i ldren whose mothers grow foods.

2. People too s i c k to work in the farms are no t able to work hard, or i f malnourished may not want work ha rd and are no t able to grow enough food. H e does no t grow enough food so h e stays malnourished.

1.1 Look at the food pa th f o r the town ch i ldren and l i s t t h e paths f o r them - f r o m harvesting, storing, etc.

2.1 Discuss some customs and practices that can block the food pa th or l imit the agr icu l tura l produce before harvest. a) clearing practices b) subsistence fa rm ing against

surplus fa rm ing c) f ood crops against cash crops d) ways o f f a rm ing

2.2 Make a l i s t o f local fruits and vegetables and on another column wr i te i f avai lable a l l year round, January (month, etc.), accordingly. Fo r example:

Fruits: bananas a l l year round p lan ta in June to Oct.

cucumber a l l year round tomatoes January to June beans eggplant, etc. -

Vegetables:

Based o n t h i s l i s t , what crops are beneficial in home gardens?

80

3. 8locks on the food path, f o r example, in cooking can contr ibute to losses in n u t r i t i v e value o f foods, such as overcooking o r discarding bro th of vegetables. Sharing the food among too many chi ldren, or fa ther eating more than his share o f food are blocks to the child's f o o d path. Diseases and parasites are also blocks in the consumption o r use o f foods.

3.1 E x p l a i n how lack o f knowledge about food preparations o r about wh ich foods are right f o r young chi ldren, can be blocks in the f o o d path.

3.2 I l lus t ra te why lack o f love during eating becomes a b lock in t h e food path.

3.3 E x p l a i n why the f a i l u r e to add prote in foods to a child's porr idge i s a block in the f o o d path.

4. Transport d i f f icu l t ies, lack o f fue l , lack o f jobs, prof i teer ing in retai l ing, and 4.1 Discuss the way people buy "prestige" bad budget ing a n d shopping b lock food foods over the advantage o f less path. prestigious foods but more nu t r i t iona l

value. H o w does bott le feeding become a block in the f o o d path?

4.2 Compare the eat ing habi ts of one reg ion in Sierra Leone i.e. Freetown o r Western Area wi th those o f the Nor th, or Ko l i nadugu Province. Has this practice have rel igious o r ethnic basis?

5. Many o f the blocks in the food-path are linked t o one another. F o r example, lack o f knowledge i s tied t o weaning o r feeding practices that are blocks to t h e f o o d path. Heavy rains, drought, insects and pests that destroy crops are blocks to the f o o d pa th and cause malnut r i t ion. Fathers w i thout jobs, s ickly mothers, and bad bott le- feeding can be serious blocks exist ing at the same t ime and may lead to malnut r i t ion.

5.1 Visit one vi l lage a n d observe the ch i ldren under f i ve years. P ick out one c h i l d you think i s inadequately f e d and in te rv iew the mother on what was fed t o the young c h i l d on the previous day.

Ask the f o l l o w i n g questions:

a) D o parents a n d ch i ldren eat together?

b) D o younger ch i ld ren have a plate to themselves?

c) H o w o f ten are they fed? d) H o w f a r do ch i ld ren have to wa lk

t o school? e) D o they have breakfast before

they go? f) D o the ch i ldren get any f o o d in

the midd le o f the day?

Discuss your f ind ings in the class and determine wh ich pract ice i s a b lock in the child's food path.

T A B L E NO. 1 SOME BLOCKS ON THE WAY THE FOOD T R A V E L S

Clearing Plant ing Growing and Harvesting

- malnourished farmers - wrong crops planted - no credi t to buy

- too many people, no t - cash crops g r o w n f e r t i l i z e r

enough land instead o f food crops - too much r a i n o r ra ins too late

- f i e l d s no t cleared - lack o f knowledge before ra ins start - too l i t t l e r a i n

- wrong varieties o f crops - too m a n y people planted - farmers and f a m i l y too

leaving farms to work sick to work in the in town - w r o n g c u l t i v a t i o n f i e l d s

practices that lead to soil erosion - wives o f husbands in

paying jobs

- too proud to work on l and

Stor ing Transport ing Wholesaling and Reta i l ing

- lack o f knowledge - bad roads - too large p ro f i t s f o r wholesalers, middlemen

- pests destroy stored - n o lorr ies to transport or retailers food crops produce

- f ood bought expensively - reckless drivers crash in small amounts

the i r lorr ies

- pet ro l shortage

Shopping/Earning Cooking Shar ing and Eat ing

lack o f knowledge o f good nutrients

money spent on non- foods

persuasive advert ising on wrong products

no t enough money

lack o f jobs or unem- ployment

- lack o f f u e l

- lack o f knowledge o f r i gh t f ood f o r ch i ldren

- idle mothers, sick mothers no t cooking - food f o r ch i ldren

- wrong cooking practices -

fa ther eats more than h i s share

too many ch i ld ren share too l i t t l e f ood

worms prevent body use food proper ly

to

to

s ickness p r e v e n t i n g c h i l d to eat

lack o f love and warmth du r ing meals

a3

6. Processing o f f ood i s one o f the steps in the food pa th that may be pr io r to storage between transport ing and wholesaling. B y processing, the food changes in some way, such as gr ind ing maize i n to f lour, mak ing garrie f r o m cassava, d ry ing or smoking fish, or mak ing sugar f r o m sugar cane. Cooking some food a t home f o r p reserva t ion a n d storage, i.e. preserving fruits i n t o jams and marmalades, are no t blocks, and are seldom the cause o f malnut r i t ion.

7. Another way o f promot ing the food pa th i s to have home gardens. The food pa th becomes shorter and w i t h less tendency to be blocked. Budgeting the money f o r purchases of the r i gh t foods and spending i t wisely i s hard ly the solut ion f o r those wi th so l i t t l e money. Bad budgeting in wage earner w i thout al locating enough money f o r f ood and their fam i l y needs i s a b lock in the money pa th that leads to the food user.

6.1 L i s t the impor tant sources o f prote in in t h e local market and discuss ways they are preserved f o r f u t u r e needs.

6.2 Describe the food pa th o f pa lm o i l until i t reaches the body o f the town chi ld. Think o f ways this path can be blocked along the way.

7.1 Think o f a large f a m i l y composed of parents and 6 children, w i t h short in te rva l o f about one year between these children. Discuss the blocks that are a l l tied together in the food pa th o f this fami ly , when the fa ther becomes jobless.

7.2 Discuss some food taboos and comment i f they are beneficial, harmless or h a r m f u l customs.

a4

THINGS TO REMEMBER

1. Some customs and taboos related to food consumption can be harmless or lead to malnutrition.

2. Selective farming of better crop varieties for year round produce i s one of the best ways of improving nutrition.

3. The most serious block to the food path of the child i s in the sharing and eating practices in the household.

4. When you see a malnourished child, look for the blocks on his food path.

IV. Community Par t ic ipat ion Act iv i t ies

1. a) Study the f o o d habits o f a f a m i l y w i th regard to:

1. Number 12 yrs.,

2. Number fami ly) .

o f persons to feed ( indicate number below f i v e years, between 6- 3-18 yrs., adults and elder ly above 55 years).

o f meals per day (a meal i s one prepared f o r a l l members o f the

3. Approx imate costs o f the food prepared f o r the day.

4. Any illness ind icat ive o f under-nourishment and parasites, anaemia o r contaminat ion in food, i.e. diarrhea, d u r i n g the week.

b) Discuss with the mother the measures to be taken t o improve n u t r i t i o n o r sani tat ion in the household o r organize a heal th session among mothers to this ef fect .

2. Ask the mother o r head o f household i f there i s any f o o d they d o no t eat and the reason why this i s "taboo." a) Rel ig ious reasons should be respected and c l a r i f i e d by some exchange o f views related to other religions. b) Where the reason i s s t r ic t ly superst i t ion and w i thout basis, p l a n w i th your group o r classmates a v isual camPainn using posters o n the posi t ive aspects o f the f o o d tha t i s negatively perceived by the household.

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MODULE, 6

PREPARATION A N D PRESERVATION OF FOODS*

I. Overview

A knowledge o f the preparation o f goods and the changes in n u t r i t i o n value wh ich foods undergo du r ing handl ing and cooking, t h e tastes o f t h e ind iv idua ls or the f a m i l y implies bet ter use o f food and nutrients. The ma in a i m o f cooking foods i s t o make food more digestible. While physical and chemical changes take place du r ing cooking, t h e texture o f the food i s altered, thus help ing mastication. In cooking, the na tura l f lavours o f food i s enhanced and a combination o f foods make i t more appetizing and nutr i t ious. When t h e product ion or ava i lab i l i t y o f f ood i s on ly seasonal, simple methods o f preservation should be employed loca l l y and improved to be o f bene f i t to the community.

This module i s concerned w i t h the fo l low ing concepts:

1. D i f f e r e n t methods o f cooking are used f o r preparing d i f f e ren t types of f ood at home.

2. Some cooking methods have the advantage o f re ta in ing the f o o d nutrients, preventing food spoilage, o f qu ick cooking and improv ing taste, f l avou r and appearance.

3. Some cooking methods have the disadvantages o f being slow or cooked too long and o f destroying certain nutrients in the food.

4. Improper ly cooked food can cause illnesses and diseases.

5. The methods o f preserving and storing foods depend upon the types of f ood and the condi t ion under wh ich i t can be stored.

II. Objectives

At the end o f t h i s t ra in ing module, t h e learner should be able to:

1. Exp la in the advantages and disadvantages o f the fo l l ow ing cooking methods: boil ing, stewing, steaming, roasting, f r y i n g and baking.

2. Demonstrate the different methods used f o r prepar ing food at home.

3. Discuss the conditions necessary to prevent and destroy organisms wh ich cause food decay or spoilage.

4. Demonstrate the various techniques o f loca l f ood preservation by phys ica l o r chemical means.

*This module should have pract ica l work in the Home Economics k i tchen or laboratory.

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III. Concept Development and Learn ing Activi t ies

1. The heal th o f the f a m i l y depends largely upon the proper preparation of food. Cooking no t on ly sterilizes food and destroys h a r m f u l bacteria and parasites, but i t also improves the appearance o f some food and makes i t a t t ract ive to the eye. In general, foods are cooked by a) wet methods - boil ing, stewing and steaming and b) d r y methods - roasting, or gri l l ing, bak ing and f ry ing .

2. Boi l ing foods b y complete immersion in liquid i s amost suitable method f o r mak ing foods remain moist, o f requ i r ing l i t t l e attention and when boi l ing i s completed in a f e w minutes, i t requires l i t t l e f u e l and w i l l have vegetables re ta in i t s v i v i d colours. I t s disadvantage i s that there w i l l be some loss o f minerals, v i tamins and f lavour i n t o cooking liquid.

3. Steaming i s cooking w i t h heat coming f r o m steam r is ing f r o m boi l ing water. Small pieces o f f r e s h fish or meat, root vegetables and puddings or custards may be steamed. There are two methods o f steaming: 1) Food placed in a covered steamer over bo i l ing water. A double boi ler can also serve the same purpose. 2) Food placed in a covered b o w l standing in a sauce pan w i i h bo i l ing water up to h a l f the level o f the covered bowl. Steamed food remains moist, and looses less weight than food cooked b y other methods. Steamed food i s easily digestible and retains most o f the nutrients. I t requ i res less attention. I f using a t i e red steamer, a complete meal may b e cooked, thus saving cooker space and fuel.

1.1 Give reasons why you should cook beef. Dork, or chicken. Compare these reasons w i t h w h y you wou ld cook cassava, sweet Dotato or bread fruit. a) what methods o f cooking are applicable to the forementioned foodstuffs?

2.1 Make a l i s t o f foods tha t can be eaten b y ord inary boi l ing.

2.2 Discuss why in some cases i t i s be t te r to use t h e "stock" in wh ich food i s boiled, and no t discarded.

3.1 Demonstrate the use o f a steamer in preparing green lea fy vegetables. What advantages do you see? Why i s steaming a kind o f "dry" cooking?

aa

4. Cooking b y stewing i s long, slow process, w i t h the use o f a t igh t ly covered pot and in a small amount o f liquid. A gentle heat a f te r the i n i t i a l boil ing, o r stewing in a covered casserole in a moderately heated oven w i l l save fue l , i f the oven i s also used f o r bak ing another dish.

A major advantage o f stewing i s that a satisfying meal may be cooked in one vessel, thus saving fuel, cooking space, attention and washing up.

5. Bak ing i s a n expensive way o f cooking, requ i r ing oven space and more fue l . Bak ing in a closed, unvent i la ted oven r e s u l t s in foods wh ich have at t ract ive appearance and f lavour. A home made oven can be made w i t h a pot w i t h a f la t cover, so that wood charcoal can be placed on top as we l l as under t h e pot. In many villages, home made bread baked in a po t are sold to neighbors.

6. Cooking under or over rad ian t heat i s known as grilling. I t may also be called roasting when done in an open hearth - such as roasting a piglet or a shank o f beef. G r i l l i n g i s a qu ick and appetizing method o f cooking small pieces o f good qua l i t y foods, as steak, l o i n chops or freshly caught fish. L i t t l e preparation i s requi red and there i s l i t t l e loss o f f ood value. To enhance the f lavour o f g r i l l ed meat, they are first marinaded in lemon, vinegar or oil, sugar and other spices.

4.1 Show the d i f ference between stewing and boi l ing. What types o f meat or vegetables are economical f o r stewing?

5.1 L i s t the ways oven cooking may be u t i l i z e d in preparing d i f f e r e n t foods.

5.2 Demonstrate the set up o f a home- made or improvised oven. H o w can t h i s po t be u t i l i zed f o r "water-bath" cooking or steaming?

6.1 Collect some examples o f marinades tha t are used f o r meats. What vegetables can also be roasted?

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7. F r y i n g ut i l izes o i l in cooking. I t may be done by shallow f r y i n g w i t h l i t t l e oil, as egg, pancakes or f r i t te rs . In deep f ry ing, the food i s completely immersed in o i l and must be o f the r i gh t heat. Sausage and bacon w i t h h i g h f a t content can be d r y fried. Occasionally remove the f a t as you continue f ry ing . Coating foods w i t h batter protects the food f r o m h i g h temperature wh i le f ry ing .

8. I t i s good practice to preserve foods f o r a la ter use, especially when there i s a surplus o f crops, o r to prevent spoilage o f loca l foods w i thout refr igeration. Impor ted foods are e i ther canned or bot t led and they use chemicals as preservatives.

Domestic f o o d storage w i thou t chemicals can easily be used, more cheaply and safely. Some o f these are:

- regular sunning o f the crops (cereals, g ra in legumes)

- smoking, wh ich keeps out weevils

- add i t ion o f certain na tura l compounds to the crops in storage e.g., a) ho t ch i le peppers wh ich make i t uncom- for tab le f o r the pests, b) orange peel - the o i l in the peel contains a potent insecticide and i t i s absolutely safe. The peel can be ground, dried and powdered.

- charcoal coolers f o r preserving butter

7.1 State some guidelines for deep f ry ing.

8.1 Make a l i s t o f preserved foods in the market or a t home and t e l l how they were preserved.

8.2 Look at the labels o f impor ted foodstuf fs and identify what preservatives are used.

- steel drums or plastic buckets, as water f i l t e r s , packed in layers w i t h appropriate and avai lable materials.

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9.

1 o.

F o r f o o d t o ma in ta in i t s max imum ,9.1 n u t r i t i v e value and palatabi l i ty, i t must be preserved when f r e s h and a t i t s most nut r i t ious stage. I t may be

dangerous to preserve food wh ich has already deteriorated and decayed. D u r i n g sun drying, salt ing or smoking we must insure that f l ies and insects do no t contaminate the food. When preserving foods i t i s essential t o destroy various spoilage agents l i k e bacteria and prevent or render inact ive decomposing elements in the air. Good processing and storage o f an imal foods depend o n clean hands, c l e a n c l o t h e s a n d n o f l y contamination.

Personal hygiene, f o o d hygiene and 10.1 k i tchen hygiene must be observed in food preparat ion and service in order to avo id in t roduc t ion o f h a r m f u l bacteria i n t o our meals. Diseases l i k e dysentery, lassa fever, hepatitis, 10.2 diptheria, trichinosis, botul ism and salmonellosis are a l l contracted f r o m poor storage, improper methods o f preservation and cooking, use o f unsafe water and contaminated meat. 10.3

G o to t h e marke t and observe wh ich preserved fish may no t have been f r e s h when preserved. Describe the d i f ference in salted fish o r smoked fish among those preserved when f r e s h or no t fresh.

Have you experienced the presence o f maggots in some preserved fish o r dried meat? Why i s this so?

E x p l a i how lassa fever i s t ransmit ted by i t s carr ier. Show pictures o f the types o f rats that are carr iers o f the disease.

Make a table w i t h a l i s t o f food contaminants and in the opposite column, ind icate the prevent ive measure to keep the food safe.

Trace the transmission cycle o f parasites in food, i.e., tapeworm, trichinosis, etc.

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T H I N G S TO REMEMBER

1. Different cooking methods have advantages and disad vantages.

2. Improper storage of raw and cooked local foods bring about economic waste and health problems.

3. Effective preservation methods prevent existence of micro-organisms which cause spoilage.

IV. Community Participation Activities

1. In te rv iew the women in the communi ty about the i r storage and preservation problems.

Discuss

a) relat ionship o f food hygiene - sanitat ion - disease b) stor ing surplus produce through sun drying c) steaming t o re ta in more nutr ients in foods, i.e., vegetables.

2. Demonstrate t o the vi l lagers a n updated method o f smoking fish t o preserve the catch.

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MODULE 7

IMPROVED NUTRITION THROUGH HOME GARDENS

1. Overview

The ma in ideas in this module are the fo l lowing:

Successful home gardens depend upon cu l tu ra l practices f o r g rowing specif ic crops.

Home gardens w i t h a var ie ty o f crops serve basic d ie tary needs and economic objectives.

Home gardens must be planned according to the social, economic and c l imat ic environment.

1.

2.

3.

II. Objectives

At the end o f this t ra in ing module, the learner should be able to:

Discuss t h e uses and importance o f home gardens.

I d e n t i f y the d i f f e r e n t types o f crops that can be grown in a "mixed home garden."

Name the nutrients that can be derived f r o m the produce o f the home garden.

Plan and design a home garden.

Discuss how garden products can be stored and preserved.

Recognize the problems o f home gardens in the area as basis f o r problem solving.

1.

2.

3.

4.

5.

6.

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III. Concept Development and Learn ing Activi t ies

1. Home gardens represent the most viable method whereby a r u r a l f a m i l y can hope to meet i t s da i l y nu t r i t i ona l needs. As a self-sustaining system composed of annuals and perennials plus small domesticated l ivestock as chickens and ducks, i t can also be refer red to as m ixed gardens. In the past, home gardens tended to stress vegetables as the ma in component o f the system. While they have the potent ia l to y ie ld the best resu l t s in the shortest period o f time, the i r usefu lness i s limited since they cannot f o r m the basis of a permanent, self-generating, s e l f - contained eco-system.

2. Home gardens are much more than a place f o r ra is ing food. The trees prov ide shade, a windbreak and f i r e wood. The gardens also supply bu i ld ing materials, fibre, cooking oil, spices and cond'ments, household utensils, mater ia l f o r mak ing mats, baskets, etc. Livestock are excellent sources o f d ie tary nutrients and also fer t i l izer . Med ic ina l herbs are c ruc ia l to health o f r u r a l fami l ies who may no t be able to a f f o r d o r obta in rel iable drugs. The gardens also o f f e r protection and privacy, and in most cases serve to demarcate boundaries. Surplus produce can be sold f o r addi t ional income.

1.1 Look at a backyard home garden in your area and identi fy a l l the plants that are grown w i t h i n t h e v ic in i ty , and classify them as trees, shrubs, or replantable.

1.2 In te rv iew the head o f the household and find out how the choice o f plants were made. A long w i t h the f ind ings o f the other learners, determine the mode or ma jor i t y response. Possible answers wou ld be: f a m i l y preference, income, climate, nu t r i t i ona l value, f requen t needs, or other.

2.1 Dis t inguish the mixed home garden f r o m the garden intended f o r commercial use.

2.2 Make a l i s t o f herbs and plants that serve as home remedies for body ailments.

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3. A t yp i ca l garden might resemble a t ropical forest. Dominat ing t h e f i r s t canopy level, there are coconut o r pa lm o i l trees g iv ing only l i g h t shade, and rising beneath them o r close b y are a canopy o f various fruit trees as bananas, papayas, l i m e and oranges. Bamboo i s there also. Some ferns may grow o n the trunks o f the fruit trees. The ground level i s reserved f o r l o w and t r a i l i n g plants as sweet potatoes, cocoyam and herbs. C l imb ing vines such as y a m and chuchu may also be found along wi th other ornamentals. A mixed garden such as th is , uses fruit trees as i t s basic skeleton - and companion p lant ing o f vegetables provides a continuous source o f nut r i t ious food, wh i le plants and f lowers at t ract the bees f o r mak ing honey and f o r pol l inat ion.

4. Livestock are a n impor tant component o f the home garden. They prov ide food and valuable organic waste matter f o r fer t i l izer and they o f ten feed o f f the excess a n d unusable p lant refuse o f the household, such as r ice hulls, corn stalk leaves and weeds. Ducks, rabbits, pigs and chickens scavenge f o r f o o d and yet, they prov ide qua l i t y meat. Fish ponds can also serve as pest managers because f i s h o f ten eat h a r m f u l as w e l l as benef ic ia l crawl ing insects. Some herbs in the home gardens act as na tura l insect o r pest repellant. Because the gardens do n o t contain a h igh concentration f o r any one species, a major pest build up i s unl ike ly .

3.1 F r o m the l i s t o f crops that were ident i f ied, state the nutr ients f o u n d in them. Discuss i f the crops grown meet t h e d ie tary needs o f the fami ly .

3.2 De.termine wh ich f e r n s are edible.

3.3 Describe some o f the usefulness of other plants besides being d ie tary sources.

4.1 In your area, wh ich animals are the most desirable to raise? Describe some guidelines for production.

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5. Produce that i s harvested f r o m the garden just before meal preparation retains nearly a l l i t s nutrients, unlike produce that i s bought a t the market and may have travel led some distance. The mixed home garden can counteract the inadequate supply o f quant i ty and qua l i t y foods brought on by transport or d is t r ibu t ion and market ing problems. I t can help safeguard the health o f the f a m i l y and ensure a var ied and h i g h qua l i t y diet f o r all.

6. Below i s a basic food guide f o r adults using crops f r o m the home garden:

Protective foods

a) One or more serving o f green lea fy vegetables and yel low vegetables dai ly: one cup r a w and h a l f a cup cooked.

b) One or more servings o f fruits r i c h in v i tam in C.

Enerav foods

Three or more servings dai ly: One cup mashed or one medium sized root crop, a cup o f r ice o r garrie.

Protein foods *

Three or more servings da i l y from:

a) iegumes, h a l f a cup cooked, or b) one quarter cup o f cooked fish,

c) nuts, quarter o f a cup roasted chicken or meat

5.1 In terv iew one head o f household that has used the home garden extensively and inv i te him or her to come to the class to ta lk o f the benef i t s derived f r o m the home garden, inc lud ing h i s gardening practices, and roles o f the f a m i l y members in home gardening.

6.1 I d e n t i f y the food crops f r o m the home garden that wou ld meet the da i l y nu t r i t i ona l requi rements o f the adult.

JC Eggs (1-2) may be eaten a f e w times a week.

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7. In a school communi ty programme to introduce and establish home gardens, i t i s impor tan t to i d e n t i f y exist ing resources and to locate at least one home gardener f o r potential as a demonstration o r model garden. Questions about motivation, household needs, pupils’ perceptions about gardening and the ava i lab i l i t y o f communi ty resources must be addressed du r ing communi ty development counci l meetings. Such problems as lack of space, lack o f p lan t ing materials, lack o f water, insects and disease, stray animals, lack o f time, the f t and others must be considered so that possible solutions can be developed.

8. Before establishing a home garden, certain condit ions need to be considered:

a) ava i lab i l i t y o f water, especially du r ing dry season

b) ava i lab i l i t y o f space and tools c) tk.e nature and condi t ion o f the soi l d) the topography o f the l and e) the common insects, pests and

diseases in the environment f) marke tab i l i t y o f the surplus produce g) var ie ty of plants f o r nu t r i t i ona l

value

7.1 Visit the school f a r m or any home garden in the communi ty and describe i t s strongest characteristics in terms o f i t s nu t r i t i ona l goals, and i d e n t i f y what you fee l as i t s least desirable characteristic.

8.1 Discuss w i t h a home-gardener some o f his problems and describe his problem-solving activit ies.

8.2 Describe where or who are the major sources o f the gardeners’ p lant materials.

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9. Pa Bagolay has a f a r m at Boama vi l lage in Kimmi lands. In his backyard f a r m o f about 600 square meters he grows cassava (cassada), garden eggs (kobokobo), b i t te r balls (yakato), okra, beans, pineapple, water spinach, k r a i n krain, sweet potato, coconut, oranges, mangoes, tomatoes, and onions. H e can harvest h i s crops throughout the d i f f e ren t seasons o f the year, and even sel ls h i s crops.

10. Companion p lant ing o f crops tha t complement each other i s the foundat ion o f a mixed garden. This system uses every i n c h o f avai lable space f o r crop production. I t i s intensively cropped ver t ica l ly as we l l as hor izon tally. To produce continuously, i t rare ly depends upon outside resources once i t has been established, regenerating i t s e l f in order to survive. There should be: a) mul t i -s tory t ree crops: top layer,

m idd le layer, lower level, ed ib le vines, lowest l e v e l

b) c l imb ing legumes o n stakes or untrimmed bamboo sticks

c) p lan t ing in a circle d) water canal f r o m k i tchen/and or

e) t r e l l i s over an i r r i ga t i on canal or

f) t r e l l i s over l ivestock pen f o r pigs

water pumps

drainage

and/or chickens

9.1 Make a table w i t h the name o f crops, and classified as follows, the approximate number o f plants to raise, and the p lan t ing season w i t h i n a 500 sq. m. p lo t that wou ld f e e d th ree adults per year.

Fo r example:

P lant ing No. o f CroD Season Plants

Fruit /Vegetable (okra, etc.) A 24

Roots and tubers 24 Legumes - - Lea fy vegetables (and so on) -

(Planting Season: A, anytime, D, beginning o f dry season; W, beginning o f the wet season.)

9.2

10.1

10.2

10.3

Which o f these crops above are sown d i rect ly on the f ield and wh ich are nursed in seed beds and later transplanted?

Identify a group o f crops that can be grown according to the l i s t o f combinations w i t h i n a home garden.

Make a l i s t o f fruit trees that have a ma tu r i t y o f th ree years, and f i v e years

What fruit intercrops w i th shorter ma tu r i t y can be grown in a home garden?

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11.

g) c l imb ing vines o n a palm-leaf

h) mushrooms growing inside a hill o f house with or w i thout t re l l is

bananas

Fruits and vegetables have d is t inct ly d i f fe ren t stages o f matur i ty , and this fac t must be considered before harvesting. Some fruits and vegetables w i l l cont inue to r ipen a f te r harvesting; others stop once they are picked. Some lea fy vegetables and fruits can be harvested continual ly. Generally, as a fruit o r vegetable matures, the v i t a m i n C content decreases; however, there i s a corresponding increase in v i t a m i n A.

12. In general, i t i s best to harvest leaf vegetables, fruits vegetables and tree fruits in the ear ly morn ing and root crops in the later afternoon. However, the best course i s t o p i c k the p lant just before the meal. This w i l l he lp increase v i t a m i n retent ion and thus a i d the family’s nut r i t ion. Remember that:

a) Fat-soluble p lan t v i tamins A found in green lea fy vegetables are lost during frying.

b) Water-soluble v i tamins (B complex a n d C) f o u n d in green lea fy vegetables are reduced during prolonged water soaking, bo i l ing and oxidation, ear ly preparat ion and long periods before cooking o r serving.

c) Vegetables should be cooked f o r j u s t a f e w minutes a n d served w i th the cooking water to re ta in nutrients.

11.1 Make a l i s t o f f r u i t s a n d vegetables w h i c h cont inue to r i p e n a f te r harvesting.

11.2 Make a l i s t o f crops w h i c h should no t be harvested before they reach matur i ty .

12.1 Comment o n the cooking practices in your household and describe h o w nutrient losses o r re tent ion takes place.

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13. Fo r the successful product ion o f crops, the gardener should be prepared to carry out par t icu lar cu l tu ra l practices required f o r specific group cult ivat ion, such as:

a) mu lch ing h) topping b) water ing i) prun ing c) staking j) shading d) weeding k) manure application e) nurs ing 1) d igg ing/cu l t ivat ion f) transplanting m) pest and disease g) harvesting contro l

14. When no t a l l the garden products are consumed or sold immediately a f te r harvest, storage and preservation o f fruits and vegetables need to be undertaken:

a) Home preservation - root crops, wax gourds and pumpkins can be stored on a s h e l f f o r three months. Legumes can be stored f o r longer periods o f time.

b) Dehydra t ion o f root crops and fruits: crops h i g h in starch- sweet potatoes, yams, cassava, taro and arrowroot (ginger) are easily processed. Some fruits l i k e mango, pineapple and the cooking var ie ty o f banana, when sliced and placed in trays to d r y in the sun f o r 3 days can be sealed and stored up to six months.

13.1 V is i t the school f a r m or a home garden and

a) i d e n t i f y the crops and the cu l tu ra l managements practices that are used.

b) discuss the ways b y wh ich cu l t i va t ion can be improved.

c) l i s t the d i f f e r e n t types o f tools used f o r gardening.

d) describe the means b y wh ich seeds can be stored.

e) show that an insect repellant can be made f r o m soap, kerosene and water.

14.1 Demonstrate how a dried produce, i.e., sweet potato or cassava i s dried, and ground i n t o a powder and stored f o r future use.

14.2 Compare the sun d ry ing o f root crops w i t h the ways fruits are dried.

14.3 Prepare boi led p i ck l i ng solut ion and bott le separately green cucumber, shredded green papaya or green tomatoes, f o r a t least 48 hours. L e t some mothers sample and get the i r reaction. L e t them suggest how to improve the taste, i.e. adding pepper or garlic, or make attractive, i.e. m i x i n g grated carrots w i t h the papaya f o r color, or s t r i p s o f green pepper. When i s i t necessary to p ick le f reshly harvested vegetables?

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THINGS TO REMEMBER

1. Mixed home gardens have nutritional, economic and other bene fits.

2. Mixed home gardens provide crops for harvest1 throughout the year.

3. Companion planting increases crop production efficiency.

4. Labor requirements are minimal and do not inter fere with major income activity.

IV. Community Par t ic ipat ion Activi t ies

1. Through the CDC and PTA, organize meetings to in t roduce and establish home gardens a) c i t ing i t s nu t r i t i ona l benefi ts and potent ia l economic advantages, b) i d e n t i f y i n g areas f o r possible cu l t i va t ion and c) c l a r i f y i n g the ro le o f the schools as nursery and source of technology. P lan a model f o r a m ixed garden.

2. In Mothers’ workshops, i l lus t ra te how nu t r i t i ona l needs are met in home gardens.

3. Where home gardens are no t possible because o f the t i gh t l y clustered houses, consider a communi ty plot, under the auspices o f the C.D.C. - and identify roles and responsibil i t ies f o r care and maintenance o f assigned areas.

4. Demonstrate the use o f o ld baskets lined w i t h per forated plastic f o r growing vegetables or vines in the veranda.

5. Establish w i t h CDC a communi ty nursery.

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MODULE 8

WATER, H E A L T H A N D S A N I T A T I O N

I. Overview

Clean, pure water i s essential t o human l i fe . I t i s possible t o l i v e longer w i thout food than w i t h o u t water. In fact, over h a l f o f the body, (60%) i s made up o f water. Water in the communi ty i s collected f r o m natura l sources, such as springs, rivers, swamps o r stored r a i n water. I t can also be obtained f r o m wells dug t o tap the ground water. Heal thy fami l ies make water safe t o drink, use enough water f o r personal hygiene and prevent contaminat ion o f foods and water through the use o f latrines.

This module i s concerned w i th the f o l l o w i n g ideas:

1. Water sources must be made safe t o drink.

2. Water-borne diseases are t ransmit ted by use o f contaminated water.

3. Water-washed diseases are spread when people do no t use enough water f o r personal cleanliness.

4. Water-site related diseases are those spread by organisms that breed in o r near the water.

5. Water i s a heal ing agent.

6. Envi ronmenta l sanitat ion prevents diseases that are water-related.

II. Objectives

'I 1.

2.

3.

4.

5.

6.

7.

8.

By the end o f this t ra in ing module the learner should be able to:

Describe the ways in wh ich sources o f water are contaminated.

Trace the route o f transmission f o r water-borne diseases.

I d e n t i f y diseases that are spread by poor sani tat ion and lack o f personal hygiene.

I d e n t i f y some water-site related diseases and show h o w they are transmitted.

I l lustrate the ways by wh ich the transmission cycle o f water-related diseases can be broken.

Describe the processes o f mak ing water safe f o r dr ink ing.

Demonstrate the use o f water f o r diarrhea.

Show h o w water can be used f o r healing.

10 3

III. Concept Development and Learn ing Activi t ies

1. Water goes around in a cycle (circle). I t fa l l s as r a i n or h a i l or snow. Some o f this r a i n j s n o w l h a i l w i l l run o f f t h i s l a n d i n t o rivers, streams, swamps, lakes and some w i l l eventual ly reach the sea. Some o f the water w i l l sink i n t o the ground, i n t o an aauifer. An aqu i fe r i s an underground area where water collects. ( I t i s also called ground water). When the w i n d or the sun dries the water f r o m the ponds, swamps, or wet clothes, the water changes i n t o vapor and goes i n t o the air. I t collects i n t o the a i r and clouds. In the clouds, the vapour changes back i n t o liquid and fa l ls as rain.

2. Surface water i s o f ten used f o r d r i n k i n g because i t i s easy f o r people and animals to obtain. I t i s also easy f o r people and animals to contaminate them. U n l e s s great care i s g iven to prevent water f r o m contamination, i t may be a source o f disease.

3. Many diseases and infections in the communi ty are caused by unclean water and/or poor sanitation. Water-borne diseases are transmitted through the faecal-oral route. This means that diseases are spread when the feaces o f a sick person contaminates water. The feaces f r o m the person w i t h a stomach i l l n e s s conta ins germs (micro- organisms) wh ich can make other people sick f r o m the use o f t he contaminated water. Diseases wh ich may be transmitted i n t o this way are: Cholera, diarrhea, typhoid, anaemia, dysentry, polio, and hepati t is A.

1.1 Exp la in where the r a i n that fa l l s f r o m the sky comes from.

1.2 Make a sketch to i l lus t ra te the cycle.

2.1 Identify the na tu ra l water source in the community.

2.2 Based on your experience, describe how people use this water source.

2.3 Estimate the distance o f t h i s source f r o m the woman’s vi l lage or compound. H o w much time i s used to collect t h i s water?

3.1 Describe the several ways that faeces (excreta) can get i n to the water source.

3.2 Exp la in w h y a mother caring f o r a ch i ld w i t h diarrhea needs to wash her hands before prepar ing food for the family.

3.3 Trace the manner in wh ich f l i es can spread diseases through the faeces ora l route.

10 4

10 5

4. Diseases can also be spread f r o m a la t r ine too close to a water source, be i t a we l l or a spring, o r stream or pond wh ich enable micro-organisms to seep i n t o the liquids f r o m the la t r ine and i n t o the water supply.

5. Some diseases are caused when people do no t use enough water to:

a) Bathe frequently. b) Wash hands before meals and a f te r

defecation. c) Wash clothes and household utensils. d) Wash fruits and vegetables before

eating.

6. Water-site related diseases are those wh ich are spread by organisms that breed in or near water. Transmission occurs when an insect becomes in fected f r o m b i t i ng an in fec ted person. Examples o f diseases spread t h i s way are: Malaria, yel low fever, dengue fever and river blindness. People coming to get water a t a s i t e where mosquito o r f l i e s breed, can get these diseases f r o m the b i tes o f in fected insects.

4.1 Go through the area surrounding your house and expla in how t h e water supply i s kept safe f r o m contamination.

4.2 In what way can we l l water be po l lu ted by people using the well?

4.3 Show that vegetables growing near a la t r ine can be a source o f infect ion.

5.1 Exp la in the two ways in wh ich w a t e r - w a s h e d d iseases a r e transmit ted.

5.2 Identify the water-washed diseases.

5.3 L i s t ru les o f personal hygiene that contr ibute to good health.

6.1 Exp la in why skin in fect ions and sources are common du r ing the d ry season.

6.2 Show that diarrhoea can be common in both wet and d r y seasons.

10 6

WATER - SITE DISEASES

- BLOOD ---- -FLUKE

10 7

WATER-WASHED DISEASES

,rj J I .

// '

10 8

7. Schistosomiasis i s a parasite that needs a snai l in a r ice paddy or d i tch to complete i t s l i f e cycle. A person w i t h schistosomiasis urinates or defecates i n to a water source, a muddy seed bed or watery ditch. The eggs that are found in the urine or excreta are released i n t o the water and as larvae, gets i n t o snails. The young worms leave the snails and go i n t o the t issue or skin o f another person. In this way, someone who wades in this r ice paddy or washes and swims in the water where a n in fec ted person has urinated, also becomes infected. Another name f o r t h i s in fec t ion common in Af r i ca , Middle East and parts o f L a t i n America and Asia i s bilharzia.

8. To help the body f i g h t o f f or overcome a sickness, ind iv iduals need to keeP

clean, eat we l l and get d e n t v o f rest. Where medicine may be needed i t i s s t i l l the body that must overcome the disease. G i v i n g lots o f liquids to a ch i l d with d iar rhea i s more impor tant than any medicine. Dehydrat ion can take place a f e w hours a f te r a severe diarrhea and o f ten be prevented or corrected by d r i n k i n g a rehydrat ion drink.

9. Below are a f e w examples to show that when water i s used correctly, often, medicines are no t needed:

7.1 Make a sketch to i l lus t ra te the cycle o f transmission o f the blood f luke. How does one prevent schistosomiasis?

8.1 L i s t rules o f communal hygiene that cont r ibute to good health.

8.2 Demonstrate the preparation o f o ra l rehydrat ion solution. L i s t the ingredients and i t s proportions.

9.1 R e f e r to p. 47, o f D a v i d Werner, Where There i s N o Doctor and make your own visuals to i l lus t ra te the messages.

9.2 Give addi t ional ways to use water f o r healing.

10 9

HEALING WITH WATER

110

Use o f Water Purpose

B o i l d r i n k i n g water, wash hands Bathe o f ten Wash wounds we l l w i th soap and water Drink plenty o f liquids

Soak body w i t h cold water Drink a lo t o f water and breathe hot water vapours Scrub w i t h soap and water

U s e hot soaks or compresses H o l d in cold water Gargle ho t water w i t h some salt U s e cold compresses

to prevent diarrhea, worms, guts infect ions to prevent skin infect ions

to prevent in fected wounds and tetanus to treat diarrhea, dehydration, m ino r u r i n a r y infections, i l l nesses w i t h fever to treat h i g h fever

f o r cough and asthma to treat sores, impetigo, r i n g worm, cradle cap f o r in fected wounds burns f o r sore throat, tendergums f o r i tching, burning, weeping i r r i ta t ions o f the skin

1 o.

11.

Water can be made safe f o r human use 10.1 I l lus t ra te a home f i l t r a t i o n unit. by the fo l low ing ways: a) B o i l i n g f o r (Use a poster showing i t s 5-7 minutes b) U s e o f chemicals components.) (steri l izat ion) by adding two drops of chlor ine or iod ine to p u r i f y 1 l i t r e o f water and c) Storage b y the 3-pot system. I f water i s al lowed to stand, many o f the micro-organisms which are in i t w i l l d i e because they cannot l i ve in water f o r a long time d) Fi l t rat ion, combines the storage system - b y le t t ing the d r i n k i n g water go through a f i l t r a t i o n unit, then cover and l e t i t stand f o r 24 hours before i t i s used.

In the storage - 3 pot system, two b i g 11.1 Demonstrate the use o f 3 pot water pots are used f o r col lect ing water on storage system. (See poster, same alternate days. The f i r s t pot i s as above.) al lowed to stand f o r 24 hours. Then the clear top water i s carefu l ly poured in to another smaller pot f o r d r i n k i n g and remaining water used f o r washing. When the f i r s t pot i s empty i t i s cleaned and r e f i l l e d and al lowed to stand f o r 24 hours, again wh i le the second b i g pot i s used in the same way as the f i r s t . In this way, each day’s water has been standing f o r 24 hours before i t i s used.

111

a) Three (3) pot storage system

b) Hcsne f i l t r a t i o n uni t

112

THINGS TO REMEMBER

1. The main cause of water-washed disease i s a lack o f water.

2. The main cause of water-borne disease i s d i r tv water.

3. Insects and parasites transmit water-site disease.

4. Personal hygiene concerns cleanliness of the body, of your food and your water.

5. Correct use of water prevents and cures some illnesses.

IV. Community Par t ic ipat ion Activi t ies

1. Make a survey o f the common illnesses in your community. Classi fy i t as either water-borne, water washed or water-site related diseases. Wi th the CDC, conduct a heal th session to i d e n t i f y the possible sources, o r causes.

2. I n v i t e the v i l lage elders t o a) discuss the importance o f latr ines a n d i t s correct placement in re la t ion t o water sources, and b) i d e n t i f y households as potent ia l constructors o f latrines.

3. Conduct a workshop o f the vi l lage mothers to a) demonstrate the preparat ion o f ORS o r b) show that water can be used f o r healing.

4. I f there i s a water well, b r i n g the ch i ldren in the communi ty t o the we l l site and discuss proper we l l maintenance and care.

5. Organize a youth heal th br igade to promote communal sani tat ion as par t of communi ty heal th action.

113

REFERENCES

1.

2.

3.

4.

5.

6.

7.

8.

9.

1 o.

11.

12.

13.

14.

15.

16.

Ariyadasa, K.D. Schools and Pr imarv Heal th Care. N.S. 19. Unit f o r Cooperation w i th U N I C E F and WFP. UNESCO, Paris, 1979.

Durana, Ines. a. d. Teaching Strategies f o r Pr imarv Hea l th Care. The Rockefel ler Foundation, New York, 1980.

Hollensteiner, Mary. Understanding People's Part icipation. N.S. 1 19, Unit f o r Cooperation w i t h U N I C E F and WFP, UNESCO, Paris, 1982.

Jabre, Bushra. Educat ion and Pr imarv Hea l th Care. Digest No. XVII, Unit f o r Cooperation wi th U N I C E F and- WFP, UNESCO, Paris.

K ing , M.H. a. d. Nutrition f o r DeveloPinn Countries. O x f o r d Un ive rs i t y Press and the Engl ish Language Book Society, London, 1978.

Morley, David, et. al. Mobi l iz inP Educat ion to Reinforce Pr imarv Hea l th Care. Digest No., Unit for Cooperation w i t h U N I C E F and WFP, UNESCO, Paris

Pampiglioni, Silvio. Handbook f o r Hea l th Workers in Afr ica. Inst i tu to I ta lo - Afr icano, Roma, 1987.

Pisharoti, K.A. Guide to the Integrat ion o f Hea l th Educat ion in Envi ronmenta l Hea l th Programmes. WHO, 1975.

Sierra Leone Nat iona l N u t r i t i o n Survev. O f f i c e on N u t r i t i o n Development Support Bureau. AID, Washington, 1978.

Svllabus f o r Pr imarv Hea l th Education. Bunumbu Teachers College, 1980. (Mimeographed).

Svllabus f o r Pr imarv Home Economics. Bunumbu Teachers College, 1979. (Mimeographed).

Svllabus f o r Home Economics. (H.T.C. - harmonized), Inst i tu te o f Education, June, 1987. (Mimeographed).

Teachers Cer t i f icate Curriculum, Bunumbu Teachers College, Sierra Leone, (3rd Ed. 1984. Mimeographed).

Turner, Sheila A and R ichard B. Ingle (Eds.) New Develomnents in N u t r i t i o n Education, UNESCO, 1985.

Unit f o r Cooperation w i t h U N I C E F and WFP. Some Guidelines f o r Hea l th and N u t r i t i o n Education, N.S. 81. UNESCO, Paris, 1981.

Van der Vynckt , Susan. N u t r i t i o n Educat ion in the '80s. N.S. 175. Unit f o r Cooperation wi th U N I C E F and WFP, UNESCO, Paris, 1987.

115

17. Werner, David. Where There i s N o Doctor. The Hesperian Foundation, California: 1982.

18. Werner, D a v i d and Bill Bower. HelDing Health Workers Learn. The Hesperian Foundation, California: 1984.

19. WHO, Guidelines for Training Community Health Workers in Nutrit ion, Geneva, 1987.

116

A p p e n d i x 1 Community Nutr i t ion S u r v e y

Name o f I n te rv iewer Primary School Date

Household number Name o f Household Head: V i l l a g e Age : Occupation: Chief dom: T o t a l number i n household: (persons e a t i n g from t h e same p o t ) Number o f wives: - Number o f c h i l d r e n t o age 5: - Number o f c h i l d r e n 6 - 12: - Number o f c h i l d r e n 1 3 and above -

(Check t h e corresponding answer)

Pa r t I - In fo rma t ion on Dwel l inq

Condit ion o f house: Walls: M u d Cement Wood Floors: Mud Cement Wood Roof: Palm branch Zinc/galvanized i r o n La t r i ne : - None - Poor c o n d i t i o n - good c o n d i t i o n Ki tchen: open outdoor shed I n s i d e house

General home san i ta t i on : poor f a i r good Water source: swamp sp r ing p ipes w e l l

Pa r t II - N u t r i t i o n and Hea l th Prac t ices

1.

2.

3 .

4 .

5.

6 .

7. 8 .

Respondent: Mother Caretaker o f c h i l d Tr ibe o f mother R e l i g i o n

When d id you s t a r t b reas t feeding? Immediately a f t e r b i r t h within f i r s t two days W i t h i n t h e f i r s t week a f t e r t h e f i r s t week Not a t a l l Reason Give t h e age when o ther foods are g iven t o t h e c h i l d apa r t from breas t m i l k : (Speci fy t h e food) Age i n months food Age i n months food Age i n months food A t what age d id you ( o r w i l l you) s top b reas t feeding t h e c h i l d ? Why? Chi ld ’s age new pregnancy

I have bad m i l k no m i l k produced I l l n e s s o f mother ~~~~ ~

Do you b reas t feed now? Age o f c h i l d What foods d id you g i v e yesterday t o t h e c h i l d ? What d id t h e c h i l d r e n below f i v e ( 5 ) e a t yesterday? breas t m i l k cassava/gari palm o i l r i c e pap p l a n t a i n f r u i t ( spec i f y ) cooked r i c e Yam/sweet po ta to bread f i s h beef eggs How many t imes d id your c h i l d / c h i l d r e n ea t meals yesterday? Once tw ice th ree o r more What do they ea t between meals? Foods g iven t o c h i l d s i c k w i t h d iar rhoea

117

9. I s the re any food you should n o t g i v e t o your c h i l d ? ( food taboo) Food I tem Reason

10. Have you brought c h i l d r e n t o any c l i n i c ? Yes No Age W h y Age W h y Age Why

11. Has any c h i l d been s i c k f o r more than 1 week cont inuously?

12. What i s t h e f requent i l l n e s s o f t h e c h i l d r e n i n your household? (may r e f e r t o one o r more ch i l d ren ) Diarrhoea: - once month - twice/month - every week Malaria/Fever: once/month twice/month

Respi ratory : once monthly twice/month

P a r a s i t i c worms: pas t p resent ly U n i d e n t i f i e d fever: once monthly twice/month

Ulcers, b o i l s , scabies: pas t present ( e n c i r c l e o r under l ine)

1 3 . Where do you g e t t reatment f o r i l l n e s s o f t h e ch i l d ren? Home treatment t r a d i t i o n a l hea le r c l i n i c

1 4 . Describe home/ t rad i t ional remedies you apply? d iar rhoea fever ma la r ia u lcers , scabies

Yes No Age Type o f i l l n e s s

Once i n 3 months When was l a s t i l l n e s s none

Once i n 3 months none

once i n th ree months none

r e s p i r a t o r y p a r a s i t i c worms 15. Any c h i l d r e n who are deceased? (age 1 2 o r below)

Age cause o f death Age cause o f death

Age cause o f death

n u t r i t i o n ? on sani tat ion/hygiene? c h i l d care?

Age cause o f death

1 6 . A r e y o u w i l l i n g t o a t t e n d (mothers’ workshops) on

118

Appendix II Nutr i t ion S t a t u s o f the C h i l d

Name o f I n te rv iewer : Primary School:

V i l l a g e : Date

( C l i p t h i s t o t h e appropr ia te household o f which he/she i s a member. Use a separate sheet f o r each household)

1. Name o f t h e c h i l d : Sex Age Arm circumference ( i f below f i v e ) cm . Height/ inches Weight Cause o f l a s t i l l n e s s When? Colour o f eye t i s s u e p a l e ye l low rosy Observed p h y s i c a l aspect o f t h e c h i l d What d id t h i s c h i l d ea t yesterday?

w e l l b o r d e r l i n e undernourished

b reas t m i l k cassava/gari palm o i l r i c e pap p l a n t a i n f ru i t ( spec i f y ) cooked r i c e yam/sweet po ta to bread f i s h beef eggs cooked green vegetables raw vegetables margarine o ther o the r

2 . Name o f t h e c h i l d Sex Age Arm circumference ( i f below f i v e ) b o r d e r l i n e w e l l

Height/ inches Weight Cause o f l a s t i l l n e s s when? Colour o f eye t i s s u e p a l e Yellow rosy Observed p h y s i c a l aspect o f t h e c h i l d What did t h i s ch i ld e a t yesterday?

b reas t m i l k cassava/gari palm o i l r i c e pap p l a n t a i n f r u i t ( spec i f y ) cooked r i c e yam/sweet po ta to bread f i s h beef eggs cooked green vegetables raw vegetables margarine o the r

b o r d e r l i n e Undernourished

119

Appendix III Mothers’ Workshop in Nu t r i t i on

Nutr i t ion, Hea l th and Environmental Sanitat ion Practices

A. Mother’s responses No. o f respondents

B. Children’s responses

(school) (class) (No. o f respondents)

1.

2.

3.

4.

5.

6.

7.

8.

9.

1 o. 11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

Y es N o

D r i n k i n g boi led and cooled water

Brushing the tee th everyday

Rinsing the mouth af ter eating sweets

Keeping the nai ls trimmed and clean

Us ing a dust bin to th row wastes

Inc lud ing raw vegetables in the diet

I nc lud ing seasonal fruits in the d ie t

Washing the f r u i t s and vegetables before eating

Eat ing a l l r a w foods w i thout washing

Buy ing foods/eatables exposed to f l i e s

Keeping the surroundings clean

Us ing the la t r ine f o r bowel movement

Washing hands af ter coming f r o m the toi let

Washing hands before hand l ing or preparing foods

Bath ing or washing body da i l y

Covering trash in the back yard

Us ing food covers to prevent f i l e s

D r y i n g clean plates or utensi ls in the sun

Hang ing clothes on a l i n e or st ick to d r y

Covering w i t h soil, faeces in the compound

Defecat ing in the bush

A backyard garden provides some food to eat

Name o f Trainer/ Interviewer

120

Appendix III (cont’d) Mothers’ Workshop in N u t r i t i o n

M o t her’s Works hop Pretest

No. o f part ic ipants Locat ion

(Read/translate the contents o f each item and w i t h a show o f hands, t a l l y the i r responses opposite t h e item. Respondent may raise the hands more than once.)

1. The most common illness that results f r o m d r i n k i n g contaminated or unsafe water is :

a) b lood poisoning

b) diarrhoea

c) fever

2. Foods tha t are no t washed very w e l l o r not cooked proper ly can be the cause of:

a) parasit ic worms

b) diarrhoea

c) fever

3. When diarrhoea does no t stop, the c h i l d o r baby

a) loses weight

b) c) m a y d ie

loses water in the body

4. Clean water can be used t o prevent o r cure illnesses such as:

a) fever

b) skin diseases - c) run-bel ly

5. Insects (flies, mosquitoes) and rats can also be carr iers o f diseases. diseases?

What are these

a) b) c)

Name o f Tra iner / In terv iewer

121

Appendix III (cont’d) Mothers’ Workshop in Nu t r i t i on

PurDose:

M a t e r ials:

Presentation:

1. R E C A L L

2. ASK

3. TELL

4. ASK

5. E X P L A I N

6. ASK

7. SH-OW

Summarize:

Puroose:

Materials:

Lesson 1 Clean Water f o r H e a l t h

To prevent diarrhoea, worms, and gut infect ions with the

T o recognize signs o f dehydration use o f bo i led water.

Posters showing bo i l ing water, f i l t r a t i o n and storage o f water bucket w i t h a cover clean piece o f wh i te mater ia l Posters showing the transmission cycle o f water-related diseases Picture o f a dehydrated ch i l d and sick persons

Greetings, prayers, introduction, recognit ion o f part icipants

The problem o f h i g h incidence o f diarrhoea. Ge t the group in te res t b y showing pictures o f sick people and ask

what they seem to be suffering.

D o you know that some o f these i l lnesses are caused by using Show poster on transmission of unclean or contaminated water?

water borne diseases.

That unboi led water can cause diarrhoea, w o r m in fect ions and many other diseases.

What happens when they have run-belly. D o they know anybody, especially a ch i ld who had died f r o m run-belly?

Dehydrat ion as an e f fec t o f diarrhoea. Show poster o f dehydrated chi ld. Compare dehydration to a dried-up plant.

Why do people need to bo i l the i r water?

The way water i s f i l t e r e d and stored. (Use bucket and piece o f cloth)

1)

2) 3) 4)

L e t the part icipants describe how improper disposal o f excreta, i.e. in rivers, in bush, etc w i l l contaminate the water. Ask w h y bo i l ing water to drink prevents diseases. What happens when ch i ldren have run-bel ly over 2 to 3 days? D o the part icipants recognize or know about dehydration?

Lesson 2 Water fo r ORS

T o demonstrate treatment o f diarhhoea and dehydrat ion by use of O r a l Rehyrat ion Solut ion (ORS)

Salt, cube sugar, teaspoon, bott le caps, boi led water Clean pint (beer) bottles, plastic bott le (Tutik bottle) Poster o f foods to give to ch i l d wi th diarrhoea Posters on faeces - disease - sanitation relationship; dehydration and

insects as vectors

122

Presentation:

1. REVIEW

2. ASK

3. SHOW

4.

5.

6.

7.

8.

9.

1 o.

11.

ASK

Greetings, prayers, introduction, recognit ion o f par t ic ipants

Why i t i s necessary to b o i l d r i n k i n g water

What are the causes o f contamination in water?

a) Poster about faeces as a source o f contamination; unprotected water and foods f r o m insects and rodents

b) Poster showing causes o f run-bel ly (f l ies o n milk bot t le or foods); dirty hands touching baby's foods; c h i l d p lay ing on soi l and touches h i s mouth with d i r t y hands)

When a ch i l d or i n f a n t has run-belly, how many bowel movements are experienced?

SHOW Poster o f foods t h e ch i l d may eat.

TELL When run-belly continues f o r 2 o r 3 days, the c h i l d may have fever , and you may need to b r i ng the c h i l d to a cl inic.

SHOW Picture o f a dehydrated c h i l d

E X P L A I N The signs o f dehydrated ch i ld

ASK Why does the ch i l d "dry up" l i k e a p lant? (Compare a p lant w i thout a water to a ch i l d losing "water in run-belly.)

SHOW The use o f ORS to prevent dehydration. Compare ORS w i t h water ing plants to prevent them f r o m d ry ing up)

D E M O N S T R A T E The preparation o f ORS SING-A-LONG the r e f r a i n on the ingredients fo r ORS

Purpose:

Materials:

Presentation:

1. ASK

Lesson 3 Healing wi th Water

T o help vi l lage mothers to learn the following:- a) That soap and clean water can be used to wash wounds, skin

infections, rashes, snake and dog b i tes b) Warm water can be used f o r bruises, insect bites, stings, etc. c) Salt and water can be used f o r mouth gargle f o r mouth b l is ter

d) I t i s necessary to always wash vegetables and fruits before

e) Inhalat ions o f warm vapours can r e l i e v e the fo l l ow ing i l lness:-

and sore throat

eating.

cough, asthma, bronchitis, and whooping cough

Flip char t titled "Healing w i t h water".

Greetings, prayers and recognit ion o f part icipants

I f anybody in the group had occasion to use water f o r healing.

123

2. REMIND The importance o f water in nutr i t ion, i.e., d r i n k i n g plenty o f clean water du r ing fevers, ORS du r ing diarrhoea, water to make soups and sauce palatable and water to wash fruits and vegetables.

3. SHOW Each p ic ture in the f l ip chart and ask them f o r the message.

4. EXPLAIN When necessary the answers to their questions.

5. EMPHASIZE T h e need to fo l l ow up with v i s i t s to the dispenser or to the health c l i n i c when the i l l ness i s no t rel ieved.

6. SUMMARIZE a) Using water f o r preventing i l lnesses b) c) Water f o r bruises, cuts and sores, coughs and sore throat and

Water f o r fevers, sore throat

f o r constipation

Lesson 4 Heal ing w i t h Water (cont’d)

PurDose: T o demonstrate the use o f water to treat h i g h feve r

Materials: Sponge or towel, container, luke warm or co ld water

Presentation: Greeting, prayers and recognit ion o f part icipants Ask them how they detect h igh fever. What do they do as a f o r m o f treatment?

1. TELL The the dangers o f h igh fever, i.e. leading to death i f the appropriate measures are no t taken immediately l i k e a t ree being burnt b y f i r e .

2. ASK The way the group gives treatment f o r h igh fever

3. SHOW Measures taken to reduce h i g h fever e.g., bath ing the child, sponging w i th a c lo th or towel and d r i n k i n g plenty o f fluid

4. LISTEN T o the i r questions and explain the immediate d ry ing to prevent chills.

Summarize: M a i n points: (a) The temperature i f not reduced, w i l l cause the death o f the

(b) I t can be reduced by the use o f water: by sponging towel or

(c) Take ch i l d to the dispenser if the fever does no t decrease.

chi ld.

bath ing the ch i l d and d r ink ing plenty o f fluid

Lesson 5 Supplementary Foods f o r I n fan ts

Purtiose: 1. 2. 3.

T o show the importance o f weaning foods T o i l lus t ra te the foods the i n f a n t needs T o demonstrate the preparation o f weaning foods

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Materials: Posters Ingredients: (Soft rice, already cooked, groundnut paste, cooked

beans, pa lm oil, groundnut f lour , r ice powder, beniseedi, fish powder, etc.)

Measuring equipment and storage container

Presentation: Greetings and recognit ion o f participants, Review o f ORS song.

1. ASK H o w many have in fan ts 2 years and below what foods are g iven to the ch i ld? I s breast milk su f f i c ien t?

2. A C K N O W L E D G E The value o f what they do.

3. ASK I f they know the importance o f these foods.

4. SHOW The poster o f foods an i n f a n t needs. Ask: can t h e i n f a n t eat these foods? H o w can we make these foods easy to eat f o r the i n fan t?

5. BRING T o the table t h e ingredients and t h e measuring cups, etc.

6. TELL The mothers that you w i l l show three porridges that can be g iven to t h e baby.

7. SHOW The proper thickness o f the sof t cooked rice, i.e. l i k e "borongo" or "pota pota" as the ma in ingredient f o r the recipes.

8. D E M O N S T R A T E The process o f adding to the body bu i l d ing foods -- ground-nuts,

to 3 heaping (tomato paste) tins o f sof t cooked rice, add 3 heaping soup spoons o f groundnut paste ( s t i r and cook to desired warmth)

to 3 heaping tins o f sof t cooked rice, add 2 heaping tins o f mashed beans, and add 3 small spoons o f pa lm oil. (Cook wel l )

t o 3 heaping t i n s o f sof t cooked rice, add 2 soup spoons o f fish powder and 3 small spoons o f pa lm o i l (cook to desired thickness and warmth)

f i s h and beans to the soft-cooked rice. a)

b)

c)

9. ASK What do they find in "beniseed mix":

M i x : 2 cups f l o u r 1/3 cup groundnut powder 1/4 cup beniseed f l o u r (pounded f r o m seed)

Addjust before preparing f o r the in fan t : fish meal, and few drops o f pa lm o i l

Before feeding, measure 1 or 2 tomato paste tin o f t h e m i x and fish meal. Add 1/2 cup water and cook well, adding more water to the r i gh t thickness, and the pa lm o i l before spoon feeding the in fant .

10. SUMMARIZE: a) the way mothers make the i r o w n weaning foods. b) the importance o f supplementary foodsfor growth.

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Appendix I V Scope and Sequence f o r Primary Home Economics

TERM I TERM II TERM III

THEMES : A . NEEDLE WORK A. FOOD AND NUTRITION

- Introduct ion t o home - Sources of foods i n the economics wi th a r u r a l community

CLASS III - Use and care o f a needle - Foods that a re l o c a l l y work equipment s u i t a b l e avai lable i n t h e community

t h e i r uses. before eating. - Some basic s t i tches and - Caring and preparing

A. HOME MANAGEMENT AND

- Cleaning i n the home, school and environ- ment

- Taking care o f your-

- Taking care o f a baby. - Simple laundry work.

CHILD CARE

s e l f

- More basic s t i t c h e s and - Nutrients needed f o r - Planning

- Use o f simple decorat ive - Reasons for cooking. - Removal o f common CLASS. I V st i tches. - Caring and preparing stains using l o c a l - Construction o f an em- vegetables before eat ing. agents.

t h e i r s t i tches . individuals. - Laundry work a t home

broidered a r t i c l e - Simple methods o f cooking.

- Mending household and - Use, care and storage o f -

cooking. - personal c lo th ing kitchen u t e n s i l s and too ls

CLASS v - Use o f common seams. - Preparation o f foods f o r

- Construction o f a - Methods o f cooking embroidered a r t i c l e . -

Common childhood diseases w i t h p a r t i c - u l a r reference Use o f hea l th services and recognised l o c a l treatment. Ways o f improving work a t home.

CLASS V

- Crocheting an a r t i c l e . - Methods o f s tor ing l o c a l - - Character ist ics, use and raw and cooked foods.

'I care o f commonly used - Preserving o f l o c a l foods. - fabrics. - Importance o f balanced

a sewing machine.

dress.

- Simple use and care o f meals. - - Construction o f baby's

Managment of l o c a l and other resources. Learning more about a family. Special care o f preg- nancy and de l ivery .

Bunumbu Teachers College, 1979.

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