An Observational Study of the School Health and Nutrition Programme in State Schools in Lusaka District, Zambia

Background: School health and nutrition programmes improve the health and nutritional status of learners, yet their implementation status in Zambia remains unknown. This study aimed to explore the implementation of school health and nutrition programme in one of the districts in Zambia.Methods: This was a descriptive, cross-sectional study conducted in Lusaka district, in 2015. The participating schools, including only state schools in Lusaka district were selected using stratified sampling method. Community and privately owned schools were not included. Herein, 40 school health and nutrition programme coordinators completed a questionnaire based on the guidelines provided by the Ministry of Education. Quantitative data were analysed via Microsoft Excel and Stata. The data obtained from open-ended questions were subjected to content analysis with prominent themes generated.Results: A School health and nutrition programme was observed in 42.5% (n=17) of the schools, but with no significant differences (P=0.601) between the urban and peri-urban ones. Due to insufficient funds and lack of supervision, only some of the recommended activities were implemented, such as school gardens, deworming, vitamin A and iron supplementation, and health education. The schools implementing school health and nutrition activities noted positive changes such as improvement in school attendance, pass rate, and a reduction in diarrhoea and bilharzia among their learners.Conclusion: School health and nutrition programme was implemented by less than half of the schools, still only partially. The effective implementation of the school health and nutrition programme is crucial to improve the health and nutritional status of learners. This necessitates that the Ministry of Education consistently follow up on school health and nutrition implementation

Effects of agricultural biodiversity and seasonal rain on dietary adequacy and household food security in rural areas of Kenya

Abstract Background Kenya has a high prevalence of underweight and stunting in children. It is believed that both agricultural biodiversity and seasonal rainfall influences household food security and dietary intake. In the present study we aimed to study the effects of agricultural biodiversity and seasonal rains on dietary adequacy and household food security of preschool Kenyan children, and to identify significant relationships between these variables. Methods Two cross-sectional studies were undertaken in resource-poor households in rural Kenya approximately 6 months apart. Interviews were done with mothers/caregivers to collect data from randomly selected households (N = 525). A repeated 24-hour recall was used to calculate dietary intake in each phase while household food security was measured using the Household Food Insecurity Access Scale (HFIAS). A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended nutrient intake (RNI) for that nutrient. A mean adequacy ratio (MAR) was calculated as the mean of the NARs. Agricultural biodiversity was calculated for each household by counting the number of different crops and animals eaten either from domestic sources or from the wild. Results Dietary intake was low with the majority of households not meeting the RNIs for many nutrients. However intake of energy (p < 0.001), protein (p < 0.01), iron (p < 0.01), zinc (p < 0.05), calcium (p < 0.05), and folate (p < 0.01) improved significantly from the dry to the rainy season. Household food security also increased significantly (p < 0.001) from the dry (13.1 SD 6.91) to the rainy season (10.9 SD 7.42). Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Agricultural biodiversity was positively and significantly related to all NARs (Spearman, p < 0.05) and MAR (Spearman, p < 0.001) indicating a significant positive relationship between agricultural biodiversity of the household with dietary adequacy of the child’s diet. Conclusion Important significant relationships were found in this study: between agricultural biodiversity and dietary adequacy; between agricultural biodiversity and household food security and between dietary adequacy and household food security. Furthermore, the effect of seasonality on household food security and nutrient intake was illustrated

Conflict of interest in nutrition conference financing: Moving towards solutions after IUNS 2022

Making contributions to reducing malnutrition entails sharing evidence and approaches among the research and practice communities, including through conferences. But who is involved in these processes, including who pays, matters both in terms of actions and optics. This paper was motivated by observations – in 2022 and historically – that the International Union of Nutritional Sciences (IUNS), in putting on its flagship International Congress of Nutrition (ICN), was leaving itself – and, by extension, participating scientists – open to conflicts of interest (COI). With contemporary scholarship on the commercial determinants of health making clear the ways in which this kind of sponsorship represents both a conflict of interest for nutrition events and a negative force in broader food system drivers of nutrition, this paper aims to document the issues surrounding the 2022 IUNS-ICN conference as historical record; draw on academic literature on conflict of interest to better understand the issue; and suggest some practical options moving towards COI-free nutrition events in the future.

Capacity-building for a strong public health nutrition workforce in lowresource countries

Neglected for several decades, nutrition is now firmly on the development agenda. Important landmarks are the initiation of the Scaling Up Nutrition movement in 2010; the adoption by the World Health Assembly of the Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition in 2014; and the World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases for 2013–2020. Public health nutrition has to meet multiple new challenges, including the shift from the millennium development goals to the sustainable development goals (SDGs), together with growing issues such as climate change, globalization, urbanization, socioeconomic disparities, migration and wars.

Conflicts of interest are harming maternal and child health : time for scientific journals to end relationships with manufacturers of breast-milk substitutes

► Forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes, inappropriate marketing of breast-milk substitutes persists and puts infants and young chil- dren at risk of malnutrition, illness and death. ► The formula industry is large and powerful and has used various ‘medical marketing’ strategies to influ- ence scientists and health professionals as to the purported benefit of breast-milk substitutes. ► The examples provided in this commentary show how a manufacturer is using a leading scientific journal to market breast-milk substitutes through paid advertisements and advertisement features. ► By receiving funding from breast-milk substitute manufacturers, journals create a conflict of interest, whereby the publisher and readers of the journal may favour corporations consciously or unconsciously in ways that undermine scientific integrity, editorial in- dependence and clinical judgement. ► Conflicts of interest have previously been identified in infant and young child nutrition science and in journal advertising policies and have been criticised by public health experts, yet the practice continues. ► All scientific journals and publishers should stop ac- cepting funding from manufacturers and distributors of breast-milk substitutes, in accordance with global public health guidance. Public health must come be- fore profit.The DSI/NRF Centre of Excellence in Food Security.https://gh.bmj.comhj2022Paediatrics and Child Healt

Computer-based learning for the enhancement of breastfeeding training for South African undergraduate dietetic students

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2007.Introduction In order to address poor breastfeeding rates, both nationally and internationally, there is a great need for ongoing breastfeeding training for students of health care professions and health care workers (HCWs). Despite the availability of courses, there is a need for new approaches to ensure greater and more effective coverage in breastfeeding training. The students of today relate well to the use of computers in the learning environment. It was therefore deemed appropriate to explore this training method as a means to enhance the breastfeeding learning experience for students of health care professions and, more specifically, for undergraduate dietetic students. This study was aimed at adapting and validating an Indian computer-based undergraduate breastfeeding training module, intended for use by South African (SA) undergraduate dietetic students, in order to assess whether computer-based learning in breastfeeding training could address the relevancy of the topic, assess how students view the learning experience and determine whether it could contribute to a gain in knowledge of the subject. Methods An Indian computer-based undergraduate breastfeeding training module in PowerPoint format was adapted to suit the SA scenario. It was converted into web-based interactive material using the Virtual Training Studio (VTS) software tool. The adapted module was assessed for face and content validity by 19 peer reviewers and 17 third year Stellenbosch University (SU) dietetic students, by means of a self-administered questionnaire. A focus group discussion was also conducted with the third year students. The impact of the adapted module on knowledge was evaluated by means of a pre- and post-knowledge test on a total of 29 second year SU (n=14) and University of the Western Cape (UWC, n=15) dietetic students. Results All of the peer reviewers and students were of the opinion that their information technology (IT) skills were sufficient to complete the adapted module. The majority of the peer reviewers (94%, n=17) also indicated that they had adequate IT facilities and that it was feasible to administer the module. Peer reviewers and students enjoyed the presentation and delivery mode of the adapted module. Third year students indicated that computer-based learning (CBL) was a “nice way of learning”, but pleaded that it should not be used as the sole source of instruction. The majority of the peer reviewers and students (53%, n=19) rated the mode of learning to be equally effective compared to conventional lectures, 35% rated it as being more effective and 11% as less effective. Eighty six percent of peer reviewers and students felt that the information in the adapted module was sufficient to enable the students to take the necessary preventive- or treatment action. The majority (91%) were of the opinion that the information in the adapted module was appropriate for the specific needs and cultural context in SA. There was a significant increase in the knowledge test scores for second year students at SU and UWC. Conclusion The SA VTS breastfeeding training module can be integrated effectively as part of multi-media methods to increase knowledge and enhance breastfeeding training for undergraduate dietetic students, as well as other students of health care professions and, possibly, HCWs in institutions striving to become Baby Friendly

Development and Field-Testing of Proposed Food-Based Dietary Guideline Messages and Images amongst Consumers in Tanzania

In this paper we report on the development and field-testing of proposed food-based dietary guideline (FBDG) messages among Tanzanian consumers. The messages were tested for cultural appropriateness, consumer understanding, acceptability, and feasibility. In addition, comprehension of the messages was assessed using culturally representative images for low literacy audiences. Focus group discussions were used as method for data collection. Results indicate that the core meaning of the proposed FBDG messages and images were understood and acceptable to the general population. However, participants felt that nutrition education would be required for improved comprehension. Feasibility was affected by some cultural differences, lack of nutrition knowledge, time constraints, and poverty. Suggestions were made for some rewording of certain messages and editing of certain images. It is recommended that the field-tested messages and images, incorporating the suggested changes, should be adopted. Once adopted, the FBDGs can be used to inform and engage various stakeholders, including parents, caregivers, healthcare providers and educators on appropriate nutritional practices for children and adults. They can also be used to guide implementation of relevant policies and programmes to contribute towards the achievement of sustainable healthy diets and healthy dietary patterns

Exploring stakeholder commitment and capacity to address infant and young child nutrition in the capital of the Breede Valley, Western Cape Province, South Africa

Thesis (PhD)--Stellenbosch University, 2018.ENGLISH SUMMARY: There is experience with - and documented evidence on multi-stakeholder processes (MSPs) on a global - and national level and on how to build and assess commitment and capacity to address infant and young child nutrition (IYCN) at these levels. Little experience and documented evidence, however, exist for such processes at local level. In countries with a decentralised government system, part of the lack of experience and evidence on MSPs lies in the challenge of building commitment and capacity at various political and bureaucratic levels. There is, thus, a need to build an evidence-base of how to engage stakeholders at implementation level and to assess and advance their commitment and capacity to implement responses to address IYCN. There is also a call to better define enabling environments for successful action in this field. In this research, a qualitative study design and selected participatory research methods were used to explore a diversity of perceptions, willingness, abilities, relationships and powers of key stakeholders to address IYCN at sub-district level in the Breede Valley, Western Cape Province, South Africa. The study built on baseline research in the Community-based Nutrition Security Project (CNSP), which provided insight into maternal and child nutrition challenges in the Breede Valley. Stakeholders were identified and categorised during a focus group discussion (FGD) with individuals who knew the sub-district well. Subsequently, the researcher conducted semi-structured interviews with twenty seven key stakeholders to explore their perspectives, commitment and capacity concerning IYCN. Hereafter, they were invited to participate in a workshop to map stakeholder relationships and power related to IYCN governance. Lastly, FGDs were held to reflect on the research process and to explore elements of an enabling environment conducive to action on IYCN at implementation level. Main themes from the overall research findings include: the value of local knowledge and information; the appeal of the 1000 days message and its link to development; the urgent need for IYCN advocacy; the value of stakeholder engagement and seeing the broad IYCN stakeholder landscape; the need for multi-sectoral work, while recognising the difficulty in functioning across sectors; realising the capacity inherent in “people” as a resource, the need for a “whole of society approach” in advancing the IYCN agenda and the importance of strategic capacity in local forums, combined with national legislation, to advance action for IYCN. The study provides insight into the elusive concepts of commitment and capacity in relation to IYCN governance at local level. The personal and professional perspectives of key stakeholders involved at this level offered distinct information about the unique challenges they experienced as well as practical responses required to ensure action. The barriers to multi-sectoral work at the sub-district level hinged on narrow sector-specific focus areas, mandates and budgets leading to poor integration around the social determinants of health, lack of resources and lack of targeted advocacy. The core conclusion of the study is that a detailed exploration of initial stages of an MSP is a valuable practice - and research model to create awareness of IYCN as a development issue of crosscutting importance at implementation level. This process, though time and resource intensive, has supported the development of commitment and revealed collective capacity that could be unlocked to address IYCN at the sub-district level in the Breede Valley. Such an approach, appropriately adapted to local conditions, could be helpful in scaling-up efforts to improve IYCN at sub-district level elsewhere in the country. The next phase of the CNSP should involve joint planning and concrete action to improve IYCN in the Breede Valley. The proposed expansion of the definition of the enabling environment and adaptation of the nutrition governance framework could be introduced into international debates and agendas for continued deliberation, research and action to improve IYCN as a global, national and local priority.AFRIKAANSE OPSOMMING: Daar is ondervinding in - en gedokumenteerde bewyse van multi-rolspeler prosesse (MRP) op ‘n globale en nasionale vlak asook hoe om toewyding en kapasiteit te bou en te ondersoek om baba-en-jong-kind voeding (BJKV) aan te spreek op hierdie vlakke. Daar is egter min ondervinding en gedokumenteerde bewyse vir sulke prosesse op ‘n plaaslike vlak. Die uitdaging om toewyding en kapasiteit op verskeie politieke en burokratiese vlakke te bou, dra by tot die gebrek aan ondervinding en bewyse oor MRP in lande met ‘n gedesentraliseerde regering-sisteem. Daar is dus ‘n behoefte om ‘n bewys-basis te bou oor hoe om rolspelers te betrek op implementeringsvlak en om hul toewyding en kapasiteit te bou en te bevorder om oplossings te implementeer om BJKV aan te spreek. Daar is ook ‘n versoek om bemagtigende omgewings vir suksesvolle aksie in die veld beter te definieer. ‘n Kwalitatiewe studie-ontwerp en geselekteerde deelnemende navorsingsmetodes was in hierdie navorsing gebruik om ‘n verskeidenheid van perspektiewe, gewilligheid, vermoëns, verhoudinge en mag van sleutelrolspelers te ondersoek om BJKV op sub-distrikvlak in die Breede Vallei, Wes-Kaap Provinsie, Suid-Afrika aan te spreek. Die studie het voortgebou op navorsing van die “Community-based Nutrition Security Project” (CNSP), wat insae verleen het in die moeder-en-kind voedinguitdagings in die Breede Vallei. Tydens ‘n fokusgroepbespreking (FGB) met individue, wat wel bekend was met die sub-distrik, was rolspelers geïndentifiseer en gekategoriseer. Gevolglik het die navorser semi gestruktureerde onderhoude gevoer met sewe en twintig sleutelrolspelers om hul persepsies, toewyding en kapasiteit ten opsigte van BJKV te ondersoek. Hierna was hul genooi om deel te neem aan ‘n werkswinkel om verhoudinge en mag tussen rolspelers, ten opsigte van BJKV-bestuur op sub-distriksvlak, uit te plot. Laastens was FGB gehou om oor die navorsingsproses te reflekteer en om gunstige elemente vir ‘n ondersteunende omgewing vir BJKV aksies op implementeringsvlak, te ondersoek. Hooftemas uit die oorkoepelende navorsingsbevindinge sluit in: die waarde van plaaslike kennis en inligting; die aantreklikheid van die 1000 dae boodskap en die verband met ontwikkeling; die dringende behoefte aan voorspraak vir BJKV; die waarde van skakeling tussen rolspelers en om ‘n breë perspektief van die BJKV rolspelerlandskap te sien; die behoefte aan multi-sektorale werk, maar ook die besef dat dit moeilik is om oor sektorgrense te funksioneer; die besef van die inherente kapasiteit van “mense” as hulpbron; die behoefte aan ‘n “omvattende gemeenskapsbenadering” om die BJKV agenda te bevorder; die belang van strategiese kapasiteit in plaaslike forums en nasionale wetgewing om aksie vir BJKV te bevorder. Die studie verskaf insig in die vae begrippe van toewyding en kapasiteit van BJKV-bestuur op plaaslike vlak. Die persoonlike en professionele perspektiewe van sleutelrolspelers betrokke by hierdie bestuursvlak, het spesifieke inligting verskaf rondom die unieke uitdagings wat hul ervaar en die praktiese response wat benodig word vir aksie. Die struikelblokke vir multi sektorale werk op sub-distriksvlak het gewentel om eng sektor-spesifieke fokusareas, mandate en begrotings wat lei to swak integrasie rondom die maatskaplike bepalings van gesondheid, tekorte aan hulpbronne en ‘n tekort aan geteikende voorspraak. Die kern gevolgtrekking van die studie is dat ‘n gedetailleerde ondersoek na aanvanklike stappe in ‘n multi-rolspeler proses, ‘n waardevolle praktyk- en navorsingsmodel is om bewustheid van BJKV as ‘n deursnit ontwikkelingskwessie op implementeringsvlak te skep. Die proses, alhoewel tyd - en hulpbron intensief, het die ontwikkeling van toewyding en kapasiteit ondersteun en gesamentlike kapasiteit blootgelê wat bevorder en ontsluit kan word om BJKV op sub-distriksvlak in die Breede Vallei aan te spreek. So ‘n aanslag, toepaslik aangepas vir plaaslike toestande, kan behulpsaam wees om die skaal van pogings te vergroot om BJKV op sub-distriksvlak elders in die land te bevorder. Die volgende fase van die CNSP behoort gesamentlike beplanning en konkrete aksies in te sluit om BJKV in die Breede Vallei te verbeter. Die moontlike uitbreiding van die definisie van die “ondersteunende omgewing” en die “voedingsbestuursraamwerk” kan voorgestel word aan die internasionale debatte en agendas vir voortgesette oorweging, navorsing en aksie vir die verbetering van BJKV as ‘n globale, nasionale en plaaslike prioriteit