A case for integrated nutrition messaging for schoolchildren
"My daughter is counting the different types of food she has during meals. Now she can say 'I eat so-and-so groups of food daily'. My husband also learned the functions of food and tried buying varieties of vegetables for us. But not all food is always available in our area," said Sharifa, a resident of Parbatipur, Dinajpur.
Rabeya from Badarganj, Rangpur shared how her son had started wearing shoes: "He always loved to be barefoot. But now, he has learnt to wear shoes, even when he plays."
These are just a few of the stories that came up during a study on the importance of developing integrated nutrition messages for schoolchildren. The study was conducted by a research team of BRAC James P Grant School of Public Health (JPSGH) between August 2020 and February 2021 under the supervision of the Ministry of Food, supported by the Food and Agriculture Organization (FAO) and funded by the European Union. Many other parents also told us how their children had started recalling food groups, washing hands before meals and brushing their teeth after meals.
The study found out that diet and nutrition related knowledge and behaviour change messages, such as having at least five out of 10 food groups daily and the functions of these food items, and motivated parents to add a variety of food groups to their regular diets—an example of healthy practices that help improve one's nutritional status. There are many other important solutions we may adopt in our daily life, such as having a diverse variety of food items, drinking adequate water, washing hands with soap after defecation and before having meals, etc. These simple practices begin in the family, but due to a lack of knowledge, school-aged children may become vulnerable at a time that is most critical for their development.
When schoolchildren suffer from undernutrition and micronutrient deficiencies, it can have an immediate bearing on their health and development. Physical growth and development of children require not only food and nutrition, but also good immunity, safe water and sanitation, a healthy lifestyle and safe environment. Malnutrition and micronutrient deficiencies expose children to poor school performance, which may lead to them dropping out, hindering their future productivity and compromising the country's socioeconomic development.
According to the Bangladesh Bureau of Statistics 2011, over one-fourth of our population are children aged five to 16 years. Among them, one in five school-aged children is anaemic. Moreover, 20 to 40 percent of these age cohorts suffer from Vitamin A, Vitamin D, calcium and iodine deficiencies. Conversely, overweight and obesity are an emerging issue among school-aged children. We also observe an increasing trend of overweight and obesity among children ranging from one percent to 17 percent, with children in urban areas being more at risk. This is a huge challenge as obesity in an early age increases the risks of disease and death.
How do we develop interventions for these population cohorts to improve their knowledge and practices related to nutrition, healthy habits and lifestyle? There is ample evidence of good practices in countries like China, Malaysia, Cambodia, Indonesia and Lao PDR. It is reported that several forms of nutrition education—school-based education programmes, web-based education, lectures and supplement provisions—could improve dietary patterns and lifestyles of schoolchildren. In the context of Bangladesh, schools could be the best platform to reach out to a large population for influencing healthy food behaviour and practices.
Providing succinct, integrated messages covering food, nutrition, immunity, sanitation and hygiene, physical exercise, lifestyle and environment is critical for the physical and cognitive development of schoolchildren, and the best way to amplify their reach and coverage is to target the children via school textbooks. In the aforementioned study, BRAC JPGSPH reviewed school textbooks and curricula and found that although there were plenty of texts on food, nutrition, hygiene, sanitation, environment, and physical exercise, they were not adequately reaching school children because they are scattered in different chapters across different textbooks.
The idea was to construct simple and culturally-appropriate integrated nutrition messages that schoolchildren could easily access—being visible on one or two pages of text, in both pictorial and narrative forms. Also included were the FAO-recommended ten food groups in a plate, with narratives such as, "I eat at least five food groups daily", "I do not take junk food", etc. Similarly, pictures were displayed of hand washing with soap and running water, wearing sandals, physical activity and tree plantation and many such simple practices.
However, it must be noted that while integrated nutrition messages among schoolchildren can create practices and habits that can improve child nutrition through simple means, that alone is not enough. The study also found that practicing intake of food with the minimum dietary diversity among children is difficult due to several reasons, including lack of purchasing capacity of their parents, challenge of shifting existing food habits within short time periods, unavailability of food items in local markets, etc. However, regardless of the obstacles, many school students were still seen to adopt various good practices, showing that such integrated messages are likely to bring quick and easy changes.
The strength of integrated nutrition messaging is that the same messages are developed for all age groups of children and are simple and feasible to practice. Furthermore, it is crucial that the messages are sensitive to the context and purchasing capacity of families. We must also remember that although presenting integrated nutrition messages in school textbooks leads to easy accessibility for students, parents and teachers, this has been hampered by Covid-19 and extended school closures. So we need to focus on making these messages accessible to students beyond textbooks, through web-based platforms or alternate media.
It is urgent now for the policymakers to translate existing knowledge into actions by incorporating integrated nutrition messages into school textbooks and other easily accessible platforms. The Ministry of Food has already been in discussion with the Ministry of Education, and BRAC JPGSPH along with the FAO have drawn the attention of the National Curriculum and Textbook Board to this issue. The country must act to reinforce healthy behaviour and practices of schoolchildren and invest in communicating integrated nutrition messages quickly and creatively for the health of the future generations.
Saira Parveen Jolly is a Senior Research Fellow at BRAC James P Grant School of Public Health, BRAC University. The Principal Investigator of the project mentioned is Professor Dr Kaosar Afsana. The contents of this report are the sole responsibility of the author and do not necessarily reflect the views or policies of the Ministry of Food, FAO and EU.