Tackling the drivers of child undernutrition in developing countries : What works and how should interventions be designed?

OBJECTIVE: The present paper presents a synthesis of available evidence to support action on the interventions that can effectively address the main drivers of child undernutrition in developing countries. It also discusses how interventions should be designed and identifies policy-relevant areas for further research. DESIGN: A structured literature review of fifty-eight controlled evaluations and studies in developing countries were selected because they are methodologically sound, recent (reported within the past 10 years), report on nutritional status, cover a wide range of interventions and are implemented by a range of different agencies. SETTING: Indirect interventions in developing countries, which address the underlying and basic causes of child undernutrition and can potentially be implemented in the short to medium term. SUBJECTS: Children under 5 years of age and their mothers across a range of developing countries. RESULTS: Evidence has now accumulated to guide action on a range of indirect interventions that can reduce child undernutrition, but for all these interventions context is all-important. There is less evidence on how these interventions can be effectively implemented on a large scale. CONCLUSIONS: Efforts should be directed towards improving implementation of effective interventions on a large scale. Donors need to keep commitments both in dollar terms and in terms of the Paris Declaration so that the push for improved nutrition does not become donor driven. At the country level, there is a need for enabling governance structures, institutions and evidence-based decision making. Within countries there is a need for well-trained personnel with delegated authority, accountable to local people. It is essential for chains of accountability to be transparent and for active involvement of households in decision-making processes

Children as health educators : the child-to-child approach

This study explores the Child-to-Child approach to health education. Child-to-Child claims that children can be effective promoters of health. The thesis provides an analysis and criticism of Child-to-Child, comparing theory with practice in the Little Teacher Programme in Botswana. It examines how Child-to-Child has sought to keep abreast of new thinking and to respond to experience and considers the extent to which its ideas have been implemented. It explores whether primary school children can be effective health educators and seeks to identify factors enabling or inhibiting their effectiveness. Research questions are focused in three main areas. First, what is meant by the Child-to-Child approach to health education? What does Child-to- Child mean theoretically? To what extent has current thinking departed from the original conceptualization of the approach? What does Child-to-Child mean to the practitioners of the Little Teacher Programme in Botswana and how successfully have they applied its ideas and methods?\ud Second, how effective can children be as health educators using the Child-to-Child approach? A field study of the Little Teacher Programme is included to test the hypothesis that child educators can raise the knowledge level of preschool children and that performing their role can increase their own knowledge level. An extension of the main field study addresses a further question, what is the influence of the poor urban environment and of ethnicity on the effectiveness of children as health educators?\ud Third, how can children be effective health educators and what factors enable or impede their effectiveness? The study considers how social, cultural and environmental factors may influence health behaviours.\ud The study concludes that children can be effective health educators at the level of knowledge change but raises serious questions about the failure of Child-to-Child to take account of traditional resistance to some of its central ideas. \u

Evaluating the provision of flexible learning for children at risk of primary school dropout in Malawi

Communities in Malawi selected 15 children deemed "at-risk" - predominantly orphans - in Class 6 of each of 20 intervention schools to receive learning materials, support from the community and a school "buddy." An experimental evaluation found that dropout was reduced by 45% across intervention schools compared to 20 control schools. The program had spillover effects, indirectly reducing dropout among older pupils in the class not deemed at-risk. These findings imply that age, and not orphanhood, was the main indicator of dropout risk and that when targeting criteria are considered carefully, flexible learning programs can reduce dropout substantially among vulnerable children. (C) 2014 Elsevier Ltd. All rights reserved

Promoting the spiritual development of sick children

This paper considers whether there are aspects of spiritual pedagogy specific to the education of children who are sick and asks how these concerns are to be addressed. The context of the enquiry is England and Wales where the promotion of the spiritual development of children is a legislative requirement. The focus of the study is on sick children whose treatment requires extended stay in hospital. Such children have hardly been noticed in the continuing debate about spiritual education. Our enquiry has involved analysing literature published in English in the UK and North America. We have supplemented this analysis with primary data from semi-structured interviews with three hospital schoolteachers, two hospital chaplains and the founder of a hospice for children and a 'respice' for young people. We argue that what emerges as important in the spiritual education of the sick child has significant implications for the spiritual education of all children

Reaching and teaching marginalised children in Malawi and Lesotho: the importance of stakeholders sharing common values and attitudes

This chapter reports on a study in Malawi and Lesotho that aimed to improve student retention and progression rates by intervening to complement conventional schooling with self-study learner-guides and additional support for learning and for life and to change exclusionary school policies and practices. The findings showed that that there can be problems when stakeholders do not share common values, attitudes and purposes towards education. National education policy on inclusive education was being undermined by the actions of some head-teachers and teachers who excluded children who could not afford uniform or shoes, who arrived late or who attended irregularly. When a child dropped out they considered the child to be the problem rather than the school. Although attitudes and values of family members in Malawi were generally positive towards primary schooling, grade repetition significantly increased the likelihood of a child dropping out. In Lesotho many secondary school-aged children and their families did not value schooling due to perceived low quality. Implementing a more open, flexible and holistic model of schooling and helping to align the values, attitudes and purposes of all stakeholders towards inclusive education was found to help reduce school drop-out and produce additional benefits for the students