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: 1 o = 4.2 2 o = 10.6 highsch =8.2 Urban: 1 o = 6 2 o = 9.9 high sch = 14.2 Urban: 1 o =12.2 2 o = 6, high sch=6.6 % school-age children affected 8.3 % 7.5% 2% 5.4% Thailan d* ** Rural: 2 o = 32.8 highsch=15.4 Rural: 1 o =27.8 2 o = 30.4 highsch= 37.7 Rural: 2 o = 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 NA overweight NA obesity 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, 2001 2003, 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
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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
Maurelli
Typewritten Text
Appendix VIII
Maurelli
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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
Maurelli
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Appendix X
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
Maurelli
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Appendix XI
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
Maurelli
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Appendix XII
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