71

Agenda 2:

Group 4 country presentation

• Observation regarding prevalence estimates:

– different growth reference used (NCHS vs local

reference)

– different cutoffs/criteria

– Different indicators for the same problem, e.g.,

IDD – may be by TGR or UIE

• Need harmonization reference/criteria for

comparability

Appendix VIII

** Urban:

1o

= 4.2

2o

= 10.6

highsch =8.2

Urban:

1o

= 6

2o

= 9.9 high

sch = 14.2

Urban:

1o

=12.2

2o

= 6, high

sch=6.6

% school-age children affected

8.3 %

7.5%

2%

5.4%

Thailan

d*

** Rural:

2o

= 32.8

highsch=15.4

Rural:

1o

=27.8

2o

= 30.4

highsch= 37.7

Rural:

2o

= 0.3

Highsch= 0.3

Vietnam*

Luangnamtha

B=42.5%, G=35.4%

Sekong: B 51.3%,

G 44%

underweight

Luangnamtha

B=74.5%, G=73.6%

Sekong: B 62.2%,

G 62.7%

stunting

NAoverweight

NAobesity

Laos

* National survey ** wasting

Nutrition Situation

0

2

4

6

8

10

12

6-12 yr 13-18 yrs 13 yrs, 2005 6-14yrs, NNS

obesity

overwt

stunting

underwt

Nat’l, 20012003, Bkk

urban,

Nat’l

Trends of nutritional status in Thailand

Test DQ IQ

1-2 y Capute 102.5

3-5 y Draw-a-Person 113.6

Gesell 94.7

6-12 y TONI-3 91.2

13-18 y TONI-3 89.9

72

Rural:

2o

= 26.4

High sch= 13.4

1o

sch:

TGR = 6.1%

Rural:

2o

= 5.8

High sch= 2.03

Vietnam

Anemia =

30.6%

Sekong province

only:

12-14 yrs = 33.3%

15-19 yrs = 37.5

Iron deficiency

anemia *

UIE < 50 mcg/L

= 33.9%

26.9% by UIE <100

mcg/L (8-12 yrs)

Iodine

deficiency

S. Retinol <

1.05 =20%

NAVitamin A

deficiency

Thailand* Laos

% school-age children affected

* Likely to be anemia, not verified if iron deficiency

Micronutrient status

96.9 per 1000*NANAHIV/AIDS

99.5/100,000*NANADengue fever

NA

Rural:

1o

sch =96.6

2o

sch = 45-97

High sch= 40-97

5.4

Vietnam

1719/100,000*Sekong =39.6

Luangnamtha = 14.8

Diarrhea

Hook worm =

11.4%

Liver fluke=9.6

(2001)

62Parasites

0.64 per 1000*Sekong =50.7

Luangnamtha = 34

Malaria

Thailand Laos

% school-age children affected

Health status

*Incidence rate (2003), Thailand H profile, 2004

15.4NANAHigh intakes:

sugary foods

25.1NANAHigh intake

fatty fds

NA

NA

NA

Vietnam

Veg/fruits

combined *:

M = 80%

F= 76%NA

Low veg

intakes

NALow fruit

intakes

Drinking

water = 94%

Toilet use:

99%

NAHygeine &

sanitation

Thailand* Laos

% school-age children affected

* For age 15+ yrs old, % of pop consumed < recommended daily intakes, 400 g

• snack & beverage consumption (11-13 yrs old)

• high sugary, fatty foods/snacks

• > 165 kcal/d = 66.6%

• > 330 kcal/d = 40%

• high intake of soft drinks:

• > 12 oz/d = 40.7 %

• > 24 oz/d = 17 %

Undesirable eating habits: Thailand

Time spent watching TV (hr/d)

Weekend 4.9 + 2.9Week day 3.3 +2.9 13-18 y

Weekend 4.2 + 2.4Week day 2.5 + 1.36-12 y

73

Factors influencing children’s food intakes

and nutrition practices

1. Economic status – low purchasing

power, esp. in urban areas, cash

cropping in rural areas (Thailand)

2. Advertisement and marketing of foods

3. Lack of awareness on good quality foods

4. More accessible to cheap foods

5. Poverty underlying some population

groups

Health and Nutrition Services in Laos

• Currently implemented:

- Providing supplementary food and creating a school

feeding in three northern provinces

- National Policy on nutrition is about to draft

- De-worming for primary school students nationwide

– Major achievements:

- School feeding project is fully conducted in three

northern provinces where many ethnic children attend

school

- De-worming covered already all primary school age

- Enrolment rate is increased.

• Major gaps:

- Poor health-check for nutrition in primary school students

- School canteens are not regularly controlled

- No healthy eating guidelines, no ban on fd/drink in school

School-based program: Vietnam

• School feeding in some schools only:

policy/program drafted, but not materialized

• Nutrition education in curriculum – very brief

information, part of health ed

• Deworming- not national

• Weekly iron supplementation in 3 provinces

(WHO)

• NIN + Med – cleaning hand campaign

• Sex education in schhol: Hanoi and HMC

Barriers:

• No recognition that school can be a good

entry point for nutrition education

• Gov’t budget allocated for lunch for all schools

under the Office of Basic Education

Commission, for 30% of children at 10 B/p/d

• Border Patrol Police schools, all children at

10 B/p/day

• Bangkok Metropolitan Administration, for all

children

Subsidies for school lunch

School milk:

• Free for all primary sch children, 200 ml/d,

for 200 d/sch yr

Program in Thailand

74

Guidelines for healthy eating: Thailand

• Food-based dietary guidelines and nutrition flag

• Guidelines for school lunch (INMU & NHF)

• Guidelines for obesity prevention in school

• Smart snacks for children

• School lunch

• Physical activity and exercise

• Healthy environment:

• clean drinking water

• safe school canteen

• no soft drink and snack advertisement

& support from these industries

75

Appendix IX

Agenda Item 5: Group work

Review of ongoing country school health and nutrition programmes (as presented under

agenda item 2); four working groups

DISCUSSION TOPICS

Working from the needs and issues identified in the country presentations (Agenda item 2),

groups review the ongoing health and nutrition programmes in their countries in various

aspects, identifying strengths, priority needs, opportunities and challenges.

Working Group 1: Curriculum content: what should be learned?

Review ongoing school health and nutrition programmes in your countries from the point of

view of curriculum content

Working from the situation and issues identified in the country presentations,

- outline the principles on which curriculum content for nutrition education should be

decided (e.g. priority needs, general knowledge, local conditions?)

- suggest what kinds of learning objectives should be given priority (knowledge,

attitudes, practical skills, behaviour, all four?)

- indicate what areas are well covered by existing programmes and which areas need

further development.

Working Group 2: Curriculum implementation: how can NE be integrated?

Review on-going school health and nutrition programmes in your countries from the point of

view of curriculum implementation

Working from the situation and issues identified in the country presentations,

- describe existing processes for curriculum review at local or national level and

attendant challenges

- suggest the most effective ways of establishing new curriculum in nutrition education

(What sectors should be involved? What stakeholders should be consulted and how?

What approval procedures are necessary? What kind of needs analysis is indicated?)

- suggest how new nutrition education topics can best be integrated into the existing

curriculum (a cross-cutting issue across the curriculum, local/national action, formal

vs informal options, stand-alone or integrated into other subjects) and what obstacles

present themselves

- say if nutrition education should/could be incorporated into existing

examination/certification structures.

Working Group 3: The tripartite approach: how can it be implemented?

Review on-going school health and nutrition programmes in your countries from the point of

view of implementing the tripartite approach

Working from the situation and issues identified in the country presentations, indicate how

far the tripartite approach is already implemented, how amenable the education system is to

this strategy, what areas most need improvement and what strategies might be most effective.

Take each element in turn:

76

- the whole-school approach: individual school health and nutrition policy and mission

statement; staff development and awareness of their status as role-models; hygiene

and sanitation measures in school grounds; establishment of school gardens and their

use in nutrition education; integration of nutrition education with direct health and

nutrition interventions such as school feeding, deworming, vitamin supplements;

approaches to snacks and snack vendors

- involvement of the family – as a resource and support, as a source of information for

children and for the school, as receivers of messages, as helpers with homework

- involvement of the community – as a resource and support, as a source of information

and as an object of study.

Working Group 4: Methodology and materials:

Review on-going school health and nutrition programmes in your countries from the point of

view of teaching methodology and teaching materials

Working from the situation and issues identified in the country presentations,

- describe the methodological approach which is likely to be most effective in nutrition

education

- identify essential and desirable elements in learning/teaching materials for nutrition

education, including the role of learning materials in teacher development

- identify the strengths of present teaching staff and materials writers and suggest in

what areas capacity needs to be developed

- identify appropriate institutional frameworks for such capacity-building (e.g. pre-

service and in-service education, certification for teachers, organizations and

conferences, writing workshops), including the establishment of regional networks for

capacity building.

77

Curriculum content: What

should be learned?

Group 1

Nepal. Bangladesh and Sri Lanka

Appendix X

Principles on curriculum

content

Basics of food, nutrition and health

Emphasis on food based approach

(Local foods)

Address the emerging nutritional issues

in country context

Applied nutrition knowledge

supplemented with practical

Grips with real life situation (behavior

change)

Priority learning methods

Comprehensive approach

Information

Practical skills

Attitudes

Behavior change

Self efficacy

Learning objectives

Identify basic food groups - nutritious

and healthy foods

Describe functions of foods for growth,

development and health

Learn the importance of food hygiene

and sanitation

Aware of eating habits, cultural and

social influences on the country context

Learn school/ home gardening

techniques

78

Learning objectives

Age group 6 -7

Identify different food items on your

plate

Understand your body and food need

Identify different fruits and vegetables in

your school/ home garden

Learn to maintain personal cleanliness

Learning objectives

Age groups 8 -10

Recognize various food groups

Recognize different nutrients

Explain the effect of over/ under eating

Select appropriate fruits and vegetables

for the school garden

Learn the causes of illnesses- due to

food habits

Learning objectives

Age groups 11- 13

Link food and nutrients with growth and

development of the body

Plan a balanced diet with local foods

Hygienic food preparation and handling

Plan/ design home garden

Learning objectives

Age groups 14- 16

Select healthy food

Plan and prepare balanced diet

Identify prevalent nutrient deficiency

diseases

Plan to use school garden produce in

the market/ tuck-shop

79

Existing programmes & Suggestions

Current curriculum is knowledge based

Suggestions for the improvement

� Life skill based

� Consider local needs and resources

� Community participation

� Inter sectoral coordination

� Appropriate teaching materials

� Training for teachers

81

India & Philippines

Appendix XI

Curriculum review is

done periodically

Philippines

� Situational Analysis –

Diagnostics/Achievement

Tests

� National Consultation

� Creation of National

Technical Working Group

� Actual Review & Evaluation

based on agreed set of

indicators

� Curr development

� Presentation/Consultation

to stakeholdres

� Revision if necessary

India

� Central Advisory

Boards on Education

� Nat’l Council on Educ’l

Research & Trng

� National Curr

Framework

� 21 Focus Groups

(1 on Health & PE;

nothing on Nutrition)

Philippines

Curriculum Parameters

OBJECTIVES

-Competencies

(knowledge,

skills,

Attitudes)

CONTENT/

PROCESS

SKILLS

MATERIALS/

RESOURCES

-Textbooks

ICT

Community

TEACHER-

LEARNING

PROCESS

EVALUATION

FEEDBACK

Philippines

� Stakeholder participation

� Limited resources for

situational analysis

� “one-size-fits-all”

approach vs. needs-

specifics

� Top-to-bottom rather

than bottom-up

approach

� Overcrowded curriculum

India

� CBE would need to be

sensitized to include

NE

82

Philippines

� Advocacy targeted to

Exec & Legislative bodies

for policy formulation &

legislations (NNC &

DepED as lead)

� Inclusion in the Phil. Plan

of Action for Nutrition

(PPAN)

� Sectors: Health,

Agriculture, all levels of

education, NGOs

India

� Nodal Ministry for

Nutrition approaches the

Education Ministry at the

highest level

� Advocacy/sensitization

activities

� Sectors:Nutrition, Health,

Agriculture, Education &

Academe (Home Science

Colleges & NIN)

Philippines India

National Legislative (for policy

formulation)

Secretary of Ed (for curriculum

revision)

National Framework

Local None State Council of Educational

Research & Trng

3. APPROVAL PROCESS

Philippines India

Needs Analysis Benchmarking of extent & how of

nutn eucation is integrated in the

existing curr

What are the gaps in knowledge,

attitudes & skills among school

children to promote healthy food

choices & lifestyles?

(competencies)

Review of existing health

& PE as part of general

sciences

� Preferably as a stand-alone subject (India &

Phil), but if not possible, can be integrated

into existing learning areas by enriching the

competencies presently integrated (Phil)

� As a stand-alone subject:

-Congested curriculum (I & P)

- Existing laws on teaching & nutrition practice

(P)

- Limited resources i.e., workbooks (P)

- If school gardens are part of NE, lack of space

& agriculture teachers, esp. in urban areas

83

� Development of school policy on NE

& legislative acts (P)

� NE should be incorporated into existing

exam/cert structures for teachers. For

pupils, include questions on nutrition as part

of the examination (P & I)

85

Classroom, school environment,

parents and community

How can it be implemented?

Appendix XII

1. The whole-school approach

• There are national policies but not school-level

policies

– Recommend that schools have their own policies

• Staff are not trained in nutrition and don’t see

themselves as role-models

– Recommend nutrition training for in-service and

teacher training

• Good in urban areas but not in rural or remote

areas

– Recommend that the government supports

community to provide clean toilets and good water

supply to rural and remote schools

1 Continued

• Schools in rural areas in China have vegetable

gardens, in Indonesia mostly flower gardens

– Recommend having gardens where the local context

is appropriate (eg space) and training can be

provided

• Nutrition education is provided before vitamin

supplements are distributed in China (not very

often)

– Recommend more regular nutrition education

– Recommend that nutrition education come under the

banner of Health (so that schools don’t have too

many programs)

1 Continued

• All countries have vendors inside and

outside schools. Inside ones can be

controlled, outside ones are harder to

control

– Recommend guidelines for inside vendors

and local government regulations to control

outside vendors

86

2. Community and Family

• Families do provide resources and support and

are sometimes sources of information for

preschools but less support for primary and

secondary schools

– Recommend targeting parents of preschool children

for nutrition education

• In China some schools have nutrition education

classes for parents

– Recommend providing brief, practical nutrition advice

to parents at the start of the school year, with follow-

up advice

2. Community and Family

• Companies like McDonalds and Unilever

are good at supporting schools with

resources (eg basketball rings in

Indonesia from McDonalds and toothpaste

from Unilever)

– Recommend that we learn to use the same

strategies to promote nutrition education and

health

87

Group 4

Team:

1. Laos PDR

2. Thailand

3. Vietnam

Appendix XIIIEffective methodological approach to

nutrition education

X

X

7

exper

iment

X

X

X

6

Disc

over

y/

proje

ct

X

X

8

song

s

X

X

5

Role

play/

story

X

4

Demo

nstrat

ion

X

X

X

3

Grp

work

2

lectu

re

1

Lear

ning

by

doin

g

Learning

method

Age grp

XEarly primary

High school

XLower secondary

Late primary

XPreschool:

kindergarten

Essential elements in

learning/teaching materials

Manuals/Text books

Test kitsSong/Story book

Cooking utensilsFlash cards

TVPicture cards

Computer gameFood models/real food

VCDPoster

DesirableEssential

Strength of present teaching/material writers

and training needs

Strength

Teaching staff:

• Aware of importance

• Position exists: Health

teachers

Material writers:

• Designated unit to

develop teaching

materials in DOE,DOH

(thailand)

• Talented people to

develop materials

Training needs:

• Need nutrition

course/refresher

• Orientation/training

• Position/Job description

• Supervision

• Need nutrition training &

institutionalization

88

Institutional framework for capacity

building

• Integrate nutrition topics into teacher

training curriculum

– Pre-service

• In-service training/refresher courses

• Credit for promotion

• Accreditation/recognition for school

providing nutrition

89

Appendix XIV

NAME: ______________________

COUNTRY: ______________________

Please write 2-3 paragraphs of the nutrition situation and ICN/WFS follow up activities in the

context of MDGs of your country

(to be included into the proceedings/report)

NAME: ______________________

TITLE: ______________________

COUNTRY: ______________________

Please write 3-4 paragraphs about the lesson learned and best practice on nutrition education

in schools that you presented.

(to be included into the proceedings/report)