Tawana project-school nutrition program in Pakistan - its success, bottlenecks and lessons learned

Tawana Pakistan Project, a multifaceted pilot project (Sept. 2002 to June 2005) was funded by the Government of Pakistan to address poor nutritional status and school enrolment of primary school age girls. The core strategy was to create safe environment empowering village women to take collective decisions. Through reflective learning process women learnt to plan balanced menus, purchase food, prepare and serve a noon meal at school from locally available foods at nominal costs (USD 0.12/child). Aga Khan University partnered the government for the design, management, monitoring and evaluation of the project, 11 NGO\u27s facilitated implementation in 4035 rural government girls\u27 schools. Training was provided to 663 field workers, 4383 community organizers, 4336 school teachers and around 95 thousand rural women. Height and weight were recorded at baseline and every 6 months thereafter. Wasting, underweight and stunting decreased by 45%, 22% and 6% respectively. Enrolment increased by 40%. Women\u27s\u27 ability to plan balanced meals improved and \u3e 76% of all meals provided the basic three food groups by end of project. Government bureaucracy issues, especially at the district level proved to be the most challenging bottlenecks. Success can be attributed to synergies gained by dealing with nutrition, education and empowerment issues simultaneously

Community-based approaches to combating malnutrition and poor education among girls in resource-poor settings: report of a large scale intervention in Pakistan.

Introduction: Malnutrition and low levels of education continue to be major problems in many developing countries, especially for female children. Methods: In Pakistan, a large-scale school lunch program was implemented in 29 of the poorest rural districts through a public-private partnership. The project provided freshly prepared meals in 4035 government primary girls\u27 schools over a 2 year period. The primary strategy was empowerment of women in the community who volunteered to plan the meals, purchase the food, and cook and serve the meals. The project collected data from growth monitoring, attendance records, pre- and post-intervention community based surveys, focus group discussions, and the use of other ethnographic methods. A study on changes in the levels of malnutrition was based on an analytical sample of 203,116 girls who received at least two sets of body measurements at least 6 months apart. Results: Over the intervention period, wasting declined by almost half and school enrolment increased by 40%. Girls who entered the program early were found to have similar levels of malnutrition to girls who entered late, suggesting that factors external to the program were not associated with the decrease in malnutrition. Conclusion: This study demonstrates the potential success and scalability of school feeding programs in Pakistan. Lessons learned include that synergies are found when working across sectors (health, education, and empowerment) and that there are challenges to intersectoral projects. Globalization may undermine this successful model as Pakistan considers expanded school feeding programs

Incubator poster presentations

Objective: Antibiotics are a class of medication which can be challenging for medical students to learn, as microbiology and pharmacology must be learned in addition to the diagnostic component of infectious disease content. A learning need was identified by pre-clerkship medical students for supplemental learning material on antibiotics to complement didactic lectures in the pre-clerkship curriculum. Methods: A module covering common antibiotic classes was created to assist pre-clerkship medical student learning. Objectives were developed to guide student learning. They include recalling spectrum of activity, mechanism of action, and adverse reactions of antibiotic classes covered, as well as selecting treatment on a case-by-case basis, based on patientspecific factors. The module was designed to optimize recall of information through the use of mnemonics, questions, cases and a historical description of antibiotic design as it pertains to spectrum of activity for β-lactam antibiotics. A post-module evaluation was conducted to determine the opinion of twentyfive pre-clerkship medical students. Eight questions used a 1–5 Likert scale and two questions assessed student opinion on module strengths and areas for improvement. Results: Responses to quantitative questions ranged from 4.3 to 4.6, with “amount of detail” scoring lowest and “recommending module to others” scoring highest. Areas for improvement included adding more cases to provide a broader range of difficulty and including more information on certain classes. Strengths included mnemonics, simplified spectrum of activity, and review questions and cases. Conclusion: The module received positive feedback and evaluation results were used to make changes to improve the module for future students. Additions include more clinical cases, more information on certain antibiotics, and appendices to summarize module topics. The module is available to undergraduate medical students online to be used as a supplemental learning tool