10. Nutrition education
10.1 General community nutrition programmes
10.2 Mass media nutrition education
10.3 School-based nutrition education
10.4 Car tyres and getting to school
Note vitamin A promotion programmes are contained in the section on eye health promotion
on the link for details of the Leeds Health
Education Database Project, a complete listing of
papers included and a listing of papers on family
planning reviewed but not included in the database
10.1 General community nutrition programmes
Brown, L.V., Zeitlin, M.F., Weld, L.H., Rogers, B.L., Peterson, K.E., Huq, N. and Gershoff, S.N. (1994) Evaluation of the impact of messages to improve the diets of lactating rural Bangladeshi women on their dietary practices and the growth of their breast-fed infants. Food and Nutrition Bulletin 15, 320-334. Ref ID : 6549.
Target Group/Country Lactating rural Bangladeshi women
Intervention Methodology Nutrition messages were designed for the Bangladesh's Rural Advancement's Child Survival programme to improve lactating women's diets. Preliminary messages were developed by village workers to encourage lactating mother to eat an extra serving of all foods she normally ate at each meal, consume adequate fluids, was hands and utensils before eating and offer both breasts to the baby when breast feeding, The messages were disseminated by paid 8 volunteer mothers to other lactating mothers, tested and revised on the basis of observations and outcomes during the intervention. The home-based approach to teaching was participatory and family oriented , involving the mother, her husband and her mother-in-law. Following cultural norms, male village workers met with and taught the male household members. Little information is presented on the content, methods and timing of the health education
Evaluation Method 78 lactating mothers and their breast-fed infants (48 treatment and 30 controls were followed for eight months. The infant's ages ranted from 0 to 11 months at baseline and 8-18 months at final measure. Baseline anthropometric, dietary and socio-economic data were collected on all sample households (February-March 1987) and anthropometric, dietary and child morbidity data (recalled by mother) were collected monthly except for 2 months when there was severe flooding. Post-test 1 was in May-June 1987 (t=3 mo.) and Post-test 2 was in October-November (t=8 mo)
Impact Achieved The energy adequacy of the women's diets and of 30 comparable controls averaged 65▒14% of the FAO/WHO/UNU requirement at base-line and declined to 55▒7% immediately after the education (Post1) and to 52▒6% after 8 months of study (Post2). This decline was probably a seasonal effect resulting from lower food availability at Post1 and Post2. The adjusted diets declined in adequacy of treatments and controls did not differ at Post1 when behavioural changes were expected. Adjusted declines from base-line to Post2 were significantly less for treatments than for controls, but results may have been influenced by flooding that affected food distribution and production. Arm circumferences of both groups remained along the 5th percentile of the international reference. No significant differences were found between the average weight for age of arm circumference of the breast-fed children in the 2 groups, although a greater percentage of control children became severely malnourished. The lack of impact of nutrition education led the authors to conclude that nutrition education cannot improve the health of lactating mothers unless accompanied by measures to increase the availability of the necessary foods. Note that a parallel study by the same group found that nutrition education on weaning could have an impact on the health of infants without any accompanying economic measures. A weakness of this study is the lack of information on the quantity and quality of nutrition education - i.e. would a better designed and implemented nutrition education programme have had an impact?
Brown, L.V., Zeitlin, M.F., Peterson, K.E., Chowdhury, A.M., Rogers, B.L., Weld, L.H., and Gershoff, S.N. Evaluation of the impact of weaning food messages on infant feeding practices and child growth in rural Bangladesh. American Journal of Clinical Nutrition 56(6):994-1003, 1992. Ref ID : 2468
Target Group/Country Families of infants in rural Bangladesh
Intervention Methodology A community-based weaning intervention used volunteers to teach complementary feeding to families. The preliminary messages were developed by the village level workers and technical staff and included in-home demonstrations of snack-type recipes and instructions for enriching meals with energy, protein and other nutrients by adding oil, molasses, milk, fish and lentil flour to foods or by offering vegetables or seasonal fruits, The messages also encouraged continued breast-feeding in addition to frequent and persistent feeding of new foods. A message on hygiene discussed proper food storage and the need to wash hands and utensils adequately before cooking and feeding. Very little information is provided on the educational programme including number of educational sessions and methods.
Evaluation Method 62 breastfed infants aged 6-12 months were followed up and compared with 55 controls. Children were weighed and infant intakes of energy, protein, fat, vitamin A and iron from complementary foods were computed from 24 hour dietary recalls.
Impact Achieved Over 5 months, treatment children gained on average 0.45 SD (approx. 460 g) more in weight-for-age (WAZ) than the 55 control subjects, and were approx. 0.5 kg heavier at the final measure. The differences were statistically significant (p<0.001). The percent median weight-for-age (WAPM) of treatment children held steady at 76% of the National Centre for Health Statistics' reference, whereas the WAPM of control subjects dropped from 78% to 72%. The increase in percentage points of severe malnutrition (below -3 WAZ) was only 5% in the treatment group compared with 26% in the control subjects. Treatment children consumed a significantly greater percentage of their energy and protein requirements from complementary foods than did control subjects. The affordable complementary foods consisted mainly of cereal porridge with oil and brown sugar. These findings suggest that educational interventions teaching families to feed hygienic, simple, cheap, energy-enriched complementary foods to breastfed infants after 5-6 months can improve child growth, even under impoverished conditions.
Can,G., Íkten,A. and Green,J. (2012) The role of local mass media in promoting the consumption of iodized table salt. Health Educ. Res. 16, 603-607. Ref ID: 8940
Target Group/Country Married Women >19yrs in Trabzon
region of Turkey
Intervention Methodology During the period between February
and May 1999 there were 2 TV programmes, each running for 3hrs in the late evening
between 21.00 and 24.00, and one live morning radio broadcast, which was transmitted
from 10.00 to 12.00. The programme used a pnone-in format and were subsequently
repeated twice at prime time between 20.00 and 23.00. The key messages about
Iodine deficiency disorder, its control and the role of iodized salt were reinforced
by the researchers 3 and 4 times during subsequent day-time slots scheduled
to run at various times of day. These daytime slots each lasted 2-3 hrs
Evaluation Method Face to face interviewing using a structured
questionnaire of a sample of 672 married women >19 yrs in February 1999 before
the campaign and 768 women in May 1999 after the campaign. There were no controls.
The sample obtained through a two stage random sample method - the first stage
being the identification of provincial family centers and the second that of
women from families registered at those centres. There were no controls.
Impact Achieved Prior to the intervention, the prevalence
of reported iodized salt consumption was 54.5%. Following the 3-month education
program it increased to 62.4% (p = 0.00237). Those who were aware of campaign
(not stated how 'awareness' was verified) were more likely to use iodized salt
(p=0.1324). Women of higher educational level were more likely to use iodized
salt (p=0.022) It is disappointing that no information is provided on the actual
availability of iodized salt in the community. Also it is not clear whether
any checks were carried out to determine the validity of self-reported use of
iodized salt e.g. observed presence in the home
Guldan, G.S., Zhang, Y., Huang, Y., Yang, X., and Zeng, G. Effectiveness of a worksite nutrition education activity in a factory in China. Asia.Pac.J.Public Health 6(2):8-14, 1993. Ref ID : 2160
Target Group/Country Workers in Tube Processing and Forging Divisions of Chengdu Seamless Steel Tube Plant in Sichuan province in China
Intervention Methodology Nutritionists carried out of a health and nutrition education promotion program They had earlier discussed health promotion with trade union and work team leaders
Evaluation Method A pre-test survey was conducted with 120 randomly selected employees from each of the two divisions. Two to four weeks after the lessons, an additional 120 workers from each of the two divisions were selected randomly for the post-test . The intervention group had attended the lectures but had not received the pre-test. The controls were selected randomly from persons who had not attended the sessions and had not received the pre-test. Very little information is provided on the data-collection instrument
Impact Achieved The post-test mean nutrition knowledge score of the education group was much higher than the pre-test and post-test score of the control group and the education group's pre-test score (posttest:16.5 vs 12.7, 12.4, and 14.2, respectively; p < .05). The education group also had a higher post-test mean nutrition attitude score than the other 3 groups (5.9 vs. 5, 5, and 5.1, respectively; p < .05). Fewer education group members reported eating pork liver and blood products seldom/never after the nutrition workshop than prior to it (0 members vs. 12 members; p < .001), suggesting that the workshop motivated education group members to consume these promoted food items more frequently after the workshop. Similarly, they were less likely to report consuming dairy products (promoted food products) seldom/never after the nutrition workshop than prior to it (5 vs. 26; p < .001), again indicating a tendency to consume them more frequently. A strong increases in post-test knowledge and attitude scores occurred in 19 of the 31 questions. Yet the mean post-test knowledge score for the education group represented only around 61% correct answers. Possible factors limiting the program's effectiveness were less than ideal classroom conditions, too many open-ended questions, cultural/psychological resistance, and lack of message reinforcement in the surrounding community. Note while demonstrating a change in self-reporting behaviour, the appropriateness of some of the desired behaviour changes is questionable.
Guldan, G.S., Fan,H.C., Ma,X., Ni,Z.Z., Xiang,X., & Tang,M.-Z. 2011, Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan, China. Journal of Nutrition, 130 1204-1211.Ref ID: 9070, Borderline for inclusion in the database
Target Group/Country Pregnant women in four townships in rural Sichuan County, China
Intervention Methodology After a 1990 survey confirmed that poor infant feeding practices rather than inadequate household food resources were responsible for the growth faltering, a year-long community-based pilot nutrition education intervention was undertaken in four townships. The goal was to improve infant growth by improving infant feeding practices in particular the importance of complementary feeding of children above six months along side the breast-feeding. Local seasonably available foods were recommended. Nutrition educators were recruited, trained and mobilized from among the local Women's Affairs Officials and Village Doctors. Three training sessions were provided of between one-half to 1 d each. Beginning September 1994 and for 1 year , the trained nutrition educators made monthly growth monitoring and counseling visits to the households of all pregnant women and infants up to 1-y-old in the study villages.
Evaluation Method 250 infants each in Education and Control groups. There was no base-line. The study relied on the 1990 survey to provide background information for planning the intervention. The caregivers were questioned about their infants current diet, their infant's weights and lengths were measured.
Impact Achieved After
1 y, the Education group mothers showed significantly higher nutrition knowledge
and better reported infant feeding practices than their Control group counterparts.
Also, the Education group infants were significantly heavier and longer, but
only at 12 mo (weight-for-age -1.17 vs. -1.93; P = 0.004; height-for-age -1.32
vs. -1.96; P = 0.022), had higher breast-feeding rates overall (83% vs. 75%;
P = 0.034) and lower anemia rates (22% vs. 32%; P = 0.008) than the Control
group infants. The authors provide a thoughtful discussion of their intervention
which they conclude would make a suitable low-cost model and, not withstanding
the apparent benefits of the intervention, they make many suggestions for improvement.
They commented on the desirability of following up for a longer period than
one year, the need to address the belief of women that their infants were too
small to digest solid food, on the need for the nutrition educators to be provided
training and support to move from their didactic approach towards education
towards a more counseling approach and the need for stronger supervision of
the village educators. The lack of a baseline, omitted because of the costs
involved, is a disappointing feature of this study especially as the intervention
group had a slightly higher (8 months) level of education and a lower proportion
of the respondents working as farmers.
Guptill, K.S., Esrey, S.A., Oni, G.A., and Brown, K.H. Evaluation of a face-to-face weaning food intervention in Kwara State, Nigeria: knowledge, trial, and adoption of a home-prepared weaning food. Social Science & Medicine 36(5):665-672, 1993. Ref ID : 2970
Target Group/Country 11 rural communities in Kwara State, Nigeria
Intervention Methodology A pilot intervention carried out from June to August, 1988 to introduce a fortified, home-prepared weaning food (eko ilera, or 'pap for health') in 12 communities in Kwara State, Nigeria,. The recipe added toasted cowpea flour, red palm oil, and sugar to increase the energy and protein density of the traditional maize or sorghum starch porridge used for weaning from 38 to 85 kcal and 0.8 to 2.0 g protein per 100g. Local leaders and health workers from each community selected and trained 10 mothers (older respected female leaders) to introduce eko ilera to their neighbours with children aged 4-24 mo.
Evaluation Method A stratified, random sample of participating (n = 295) and non- participating (n = 301) mothers from the same communities were interviewed from 2 to 8 weeks following the completion of the intervention, and their rates of knowledge, trial, and adoption of eko ilera were evaluated.
Impact Achieved Of the participating mothers, 57% (95% CI: 51%, 63%) knew the modified recipe, 48% (43%, 54%) tried it, and 17% (12%, 21%) adopted it with the intention of using it in the future. Only 2% (1%, 7%) of non-participating mothers knew about the recipe. Multivariate analyses indicated that the mothers' level of education and their perception of the cost and length of preparation time of the recipe were significantly associated with its adoption. Mothers who rated the cost of the recipe as cheap were 7.3 times (CI12.0, 56.8) as likely to have tried it as those who rated it as expensive Of mothers who tried the recipe, only 25% of those who rated recipe cost as expensive became adopters compared to 57% of those how rated it as cheap. The intervention was considered successful in using face-to-face nutrition education methods to introduce eko ilera to mothers in this region of Nigeria and to encourage its trial and adoption. It would have been of interest to have had some observational data on the quality of the nutrition education activities carried out by the women volunteers.
Jacoby, E.R., Benavides, B.M., Bartlett, J.C., and Figueroa, D. Effectiveness of two methods of advising mothers on infant feeding and dietetic management of diarrhoea Peru. Journal of Diarrhoeal Diseases Research 12(1):59-64, 1994. Ref ID : 6372
Target Group/Country Mothers of small children attending a hospital's Oral Rehydration Unit in Peru
Intervention Methodology The intervention was carried out in a room adjacent to an oral rehydration unit. The first intervention group received oral counselling and a recipe pamphlet. The nutritionist gave each mother a 5 min. explanation of infant feeding practices making three general recommendations: 1) a puree is the best food for infants instead of customary soups and broths; 2) additional oil/;butter is necessary to "strengthen" weaning foods; 3) the recipe should be used regularly and also when the infant has diarrhoea The nutritionist described how to prepare one of the recipes and used two posters as a visual aid and gave a pamphlet of recipes that had been designed and pre-tested for that specific community. The second intervention group received the same counselling and recipe book but also observed a cooking demonstration which lasted about 20 minutes.
Evaluation Method 74 mothers were in the oral Mothers of infants aged 5-15 months who had initiated weaning, were fully rehydrated and resided in one of 11 poor districts of Lima. Once the mother child pair was recruited the educational intervention was random assigned and the nutritionist in charge of it was selected by lottery. There were 74 mothers in the group receiving oral counselling plus pamphlet and 70 in the group receiving the additional cooking demonstration. Each mother was interviewed prior to the intervention, 48 hr post intervention and 30 days post intervention during home visits. Mothers were asked to recall all the food preparations and main ingredients given to the child during the previous day. Mother's recall as also used to determine the consistency of the food which was used as a proxy for energy density. To avoid bias from the interviewers preferences for particular educational methods, they were kept blind to the study objectives, Also the interviewer presented her visits as part of a comprehensive infant health evaluation and not as an evaluation of the infant feeding education. There were no controls.
Impact Achieved Both interventions had a statistically significant (p < 0.05) impact on maternal knowledge and practices; differences between the impact of the two practices were negligible. After merging both groups into a single sample, it was observed that changes over time were significantly large (p < 0.05). Knowledge rates were 27.6% before the intervention, 73.7% 2 days later and 75% 30 days later. The corresponding figures for practices were 2.6%, 58.3% and 37.5% respectively. We conclude that when place, time and message are adequately chosen, a simple method may be an effective way of good communication. There were no controls, however given that the practices being introduced were new, this is not a major shortcoming. The demonstration that a simple educational method is as effective as a more complex one has useful practical implications.
Mantra, I.B., Manoff, R.K., and Griffiths, M. Indonesia: an effective nutrition comunications programme involving the community. Education for Health 1:11-29, 1985. Ref ID : 5824 (Borderline for inclusion in database)
Target Group/Country Pregnant mothers and children in rural Indonesia
Intervention Methodology In the Indonesian Nutrition Improvement Programme intersectoral teams were established and 2011 volunteer nutrition workers Kaders) were selected by their communities, trained and provided equipment to carry out monthly weighing programme which covered more than 52,000 children. This was accompanied by a communication programme using radio. The development of the programme is described in very good detail.
Evaluation Method 1000 households with either a nursing mother or a child less than 24 months (600 in project area and 400 in comparison area). The evaluation looked at mothers' participation in nutrition activities, their nutrition knowledge, the mothers' and children's consumption of key foods, their dietary intake of calories and protein and the infants' nutritional status as measured by weight-for-age and height for age. Details of the sampling and data collection instruments are not provided.
Impact Achieved Children in the nutrition education sample grew better in than in the comparison groups with differences significant (p<0.05) at 2-3 mo., 7-8 mo. and 14 mo. Children in the nutrition education group received more foods identified in the messages than children in controls and mothers who were breast-feeding and children in the nutrition education villages had higher protein and calorie intakes than comparison mothers and children. While histograms and charts of results showing comparisons are provided the raw data upon which they were based and significance tests are not provided for claimed differences in nutrient intakes. Given the richness of insights on the intervention process provided in the text the lack of detail on the data collection and data generated/significance testing is disappointing. (note that a descriptive account of this intervention is also available at Griffiths, M. Using anthropological techniques in program design: successful nutrition education in Indonesia. In: Anthropology and primary health care, edited by Coreil, J. and Mull, J.D.Boulder S.F and Oxford:Westview Press, 1990 Ref ID : 1146
Monte, C.M.G., Ashworth, A., Nations, M.K., Lima, A.A., Barreto, A., and Huttly, S.R.A. Designing educational messages to improve weaning food hygiene practices of families living in poverty. Social Science and Medicine 44(10):1453-1464, 1997. Ref ID : 5829
Target Group/Country Urban slum dwellers in Ceara State, North East Brazil
Intervention Methodology Educational messages to promote specific behavioural changes were defined and tested by utilizing a combination of ethnographic, survey and observational methods, and integrating viewpoints and suggestions of mothers and caretakers into the decision-making process. The trial involved a singly visit to explain desired behaviour changes.
Evaluation Method A household trial in which five groups, each of 15 non-practising mothers. were invited to adopt defined behaviours (handwashing before and after defined events, boiling water for reconstituting powdered milk, feeding gruel by spoon rather than bottlefeeding, not storing gruels and milks, and all four together). Following the initial educational visit there were three follow-up visits one week apart to determine message recall, adoption of practice and opinion of the intervention. There were no controls
Impact Achieved All initiated the advocated behaviour and most (53-80%) sustained the new behaviours and practised them every time during a one-month period. Of the four advocated behaviours, spoon-feeding was the most difficult to adopt wholly.This is an example of an ethnographic approach to evaluation. Rich insights are included on change processes and triangualation of methods are used to ascribe validity in the absence of statistical analysis of data.This is an example of an ethnographic approach to evaluation. rich insights are included on change processes and triangualation of methods are used to ascribe validity in the absence of statistical analysis of data. A disappointing feature is that it is not clear how the ethnographic data was recorded or analysed.
Paramjit, Chawla,K. and Puri,R. (1996)
Impact of nutrition education on food and nutrient intake of pregnant women.
Indian Journal of Maternal and Child Health 7, 11-15. Ref ID 8681
Target Group/Country Low socio-economic pregnant women were selected from two hospitals and two urban family welfare centers in Ludhiana city, India.
Intervention Methodology Nutrition education was carried out through 10 group contacts and three individual contacts over 13 weeks. The woman came to an urban family welfare center once a week from 9.30 to 12 noon during which period were taught about nutrition for 45 minutes in groups of 7 to 10 women. Teaching was carried out through in local language Punjabi using lectures, discussions and demonstrations. Charts, posters and actual foods were used as visual aids. Content of the nutrition education included: functions of food, balanced diet during ping pregnancy, anaemia and its eradication, methods of improving nutritive value of diets, breast feeding and weaning.
Evaluation Method Researchers compared data on 33 pregnant women attending nutrition education classes regularly over a 13-week period (nutrition education group) with data on 33 other pregnant women who did not receive such education (controls). A dietary survey was conducted at 20 weeks gestation and again at 36 weeks gestation.
Impact Achieved At 20 weeks, the two groups were not statistically different. In both the nutrition education group and the control group, nutrient intake was higher at 36 weeks than at 20 weeks due to the increased food requirements of pregnancy. Women in the nutrition education group were more likely than the control group to consume more protein, vitamin A, thiamine, folic acid, and vitamin C (p<0.01). This likely reflects a higher consumption of pulses, milk and milk products, fruits, and vegetables as well as adopting favorable nutritional practices (e.g., use of sprouted grains). Nevertheless, intake was below RDIs for many nutrients, even for women in the nutrition education group. These findings suggest that nutrition education for pregnant women does improve nutrient intake but also that more needs to be done to bring intake levels up even higher
India Sachdeva, R. and Mann, S.K. (1993) Impact of nutrition education and medical supervision on pregnancy outcome. Indian Pediatr. 30, 1309-1314. Ref ID : 6572
Target Group/Country Punjabi women from low and lower middle income groups from villages of the Ludhiana district, Indiz
Intervention Methodology Supplements of iron, folic acid and calcium (Folifer and Calcium Sandoz tablets) were supplied regularly to the experimental (E) group (n=30) from the second trimester onwards. A pamphlet about diet during pregnancy was distributed to E. Moreover, 4 individual and 3 group contacts were made during the second half of pregnancy to reinforce the nutrition education provided by the pamphlet. The control (C) group (n=30) received iron and folate supplements
Evaluation Method 30 in experimental group and 30 in control. Body height, weight, mid-upper arm circumference (MUA) and skinfold thickness were recorded. Weight gained during pregnancy and post-partum weight were also recorded and body mass index was calculated. Crown heel length (CHL), birth weight (BW), skinfold thickness, MUA, head circumference, chest circumference and ponderal index (PI) of neonates were recorded within 8 h of birth. control.
Impact Achieved Weight gain during pregnancy was 6.30 and 5.7 kg in E and C groups, respectively (p<0.01). Body weight, crownheel length, skinfold thickness and ponderal index of the neonates were greater in E than C (P<0.01). Mean body weight of neonates in E and C groups was 2700 and 2300 g, respectively. Weight gain during pregnancy was correlated with MUA, BW and skinfold thickness of the neonate (P<0.05). It would have been helpful to have had some supporting information on any change in dietary practices/total food intake to support the information provided.
Vijayaraghavan, K., Hanumantha Rao, D., and Swaminathan, M.C. India Population Project, Karnataka. Evaluation of nutrition education activities. Hygie 1(3-4):9-14, 1982.Ref ID : 541
Target Group/Country Rural mothers in Kanataka State, India
Intervention Methodology Educational activities were carried out in 2 primary health care centers where supplementary feeding for pregnant women (last trimester), nursing mothers during the 1st 6 months of lactation, and children between 6 and 24 months had been introduced. They consisted of group talks, cooking demonstrations, mobile nutrition exhibitions, and films on nutrition and other health matters. Topics included: Importance of supplementary food for women during pregnancy and lactation, prevention of vitamin A deficiency and nutritional anaemias and the need for childhood immunisations. Intervention villages had participated in the educational activities at least six or more times during the five year period of IPP programme.
Evaluation Method 12 villages where group talks or cooking demonstrations had taken place 6 or more times over the 5-year period were surveyed, generally through interviews with mothers; personnel involved in educational activities were also interviewed. Pre tested questionnaires of intervention households (n=120) and controls households (n=145).
Impact Achieved Intervention householders were more likely than controls to know that greater amounts of food should be consumed by pregnant women (P<0.001). More intervention households could recall the major ingredients demonstrated in recipes than controls (P<0.01). More intervention women prepared the demonstrated recipes at home compared to controls (P<0.001). Significantly more intervention women were aware of and received iron and folate tablets (P<0.01). There was also increased awareness of immunisation (P<0.001) and the need for prophylactic Vit. A among the intervention households (P<0.001). Where food supplementation was recognized as a need (p<0.01), lack of resources made it difficult for villagers to provide it
10.2 Nutrition Education using Mass Media
Cerqueira, M.T. and et al A comparison of mass media techniques and a direct method for nutrition education in rural Mexico. J Nutr Ed 11:133-137, 1979. Ref ID : 907
Target Group/Country Communities in Rural Mexico
Intervention Methodology Three different geographical areas were chosen: in one area mass media techniques including radio, posters and leaflets were used; in a second area teachers used a direct method of nutrition education involving six two hours sessions over three weeks of theory alternating with demonstrations sessions. The educational sessions were deliberately kept didactic with little interaction; and the third served as a control group. Note the control group were in a position to receive the radio spots (but did not have leaflets or posters. It is not clear whether the face-to-face education group were in a position to receive radio broadcasts.
Evaluation Method The impact of the programme was compared on a sample of mothers of children under 5 yrs in the control area (n=976), face-to-face education(n=1083) and mass media (n=959). A dietary survey was carried out with the three samples of mothers to determine the dietary intake habits and frequency of food intake. A questionnaire was administered in 20 minute interviews during the initial evaluation to detect the mother's knowledge of nutrition concepts. The same questionnaire was modified to change the question order and given immediately following the educational programme, 3 months and 12months later
Impact Achieved It was found that nutrition concepts were learned equally well using the direct method of education as with mass media. The face-to-face education group showed a 53 % increase (p<0.001) in their learning scores. In this group, the mothers increased their knowledge of infant nutritional needs by more than 70%. With the mass media techniques the increment in their final learning scores was 54 % (p<0.001). The knowledge of the control group also increased but at a lower level of significance (p<0.05). An increase in the self-reported intake of fish, vegetables, and fruits was observed in both the mass media and direct education groups (p<0.001). The control group increased their consumption of popular but low nutritive value foods. It is suggested that the slight increase in knowledge of the control groups was due to their exposure to the radio spots.
Ramadasmurthy, V., Rao, D.H., Clarence, I.D., and Balasubramanian, S.C. Nutrition education and SITE telecasts. International Journal of Health Education 21(3):168-173, 1978. Ref ID : 511 (Borderline for inclusion in database)
Target Group/Country Women in four rural villages in Hyderabad District, Andhra Pradesh State, India
Intervention Methodology Television programmes were broadcasted through satellites to rural villages. The programmes investigated in this study covered "Supplementary food for babies", cooking of rice" and "importance of greens". The first telecase was between 6.20 and 7pm and a second telecast was at a later time in the evening from 8.30-9pm.
Evaluation Method Pre-test survey was carried out of all women of child-bearing age in four villages (n=373). After the first broadcasts 200 of these women could be contacted for a follow-up survey and 289 after the second broadcast.
Impact Achieved Only 29 of 220 women contacted viewed the first telecast and 7 out 289 viewed the second. Among those who did view comprehension of main points was poor. Low viewing figures for women was attributed to their high workload and cultural norms within the rural villages. This simple evaualtion study highlighted some the problems faced when introducing a new communication technology to a community without adequate initial research and pre-testing. The evaluation is very limited but it is of interest for historical reasons and for showing the problems that can occur when using new communication technologies in a community.
10.3 Nutrition education in schools
Knight, J., Grantham McGregor, S., Ismail, S., and Ashley, D. A child-to-child programme in rural Jamaica. Child Care, Health and Development 17(1):49-58, 1991. Ref ID : 1351 (Borderline for inclusion in database)
Target Group/Country Mothers and schoolchildren average age 9 years in the parish of St Thomas, rural Jamaica
Intervention Methodology Teachers were trained through 15 workshops over a school year on the Child-to-Child approach which included development of curriculum; action-oriented songs, stories, skits, jingles, games, and pictures - all based on indigenous Jamaican folk music and patois intelligible to children with low literacy levels. The content covered nutrition (including breastfeeding and weaning)., healthy environment (including causes/spread of disease, flies, mosquitoes, food handling, personal hygiene) and child development (including play).
Evaluation Method Evaluation took place in 4 intervention (423 children) and two control schools (199). At the end of the year children were given a simple knowledge quiz. Mothers were administered questionnaires pre- and post project schools. Knowledge scores were tested with a simple post-test which only required ticking.
An earlier more complex questionnaire had been used for a pre-test but when the children had difficulties completing it had to be abandoned hence there is no baseline.
Impact Achieved At the end of the year the mean knowledge scores of 82 children in intervention schools was 23.24 and control schools 13.47. which was significant at the p <0.01 level. There was no change in knowledge of parents. Lack of a baseline limits the value of this study which is one of the few published evaluations of the Child-to-Child programme
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