In a very broad sense, inadequate education is one of the ‘basic’ causes of undernutrition at the national, community and individual level as lower levels of education are associated with fewer economic opportunities. More specifically, nutrition education can play a role in reducing undernutrition at each level. As educators, we have developed nutrition coursework and curricula for both economically developed and developing countries at the post-secondary level. For the latter, the goal is to increase capacity such that nutrition issues, including programming, monitoring and evaluation, can be handled by well-trained nationals reducing the need for external consultants. The current reality is that many of the countries with the highest levels of malnutrition, including chronic and acute undernutrition, and micronutrient deficiencies, have no post-secondary nutrition education.
Communications – Our team has developed behaviour change communication strategies and materials to ensure effective communication and social mobilization for programmes in multiple countries. We have extensive experience designing country-specific artwork and messaging for print materials and media for programme promotion. We recognize that communication and social mobilization are critical elements of nutrition and health programmes, particularly communicating with families and communities to introduce and promote new interventions. To accomplish this, we aim to deliver culturally adapted materials that align with national identity and policy.
A) Post-Secondary Nutrition Education
Rwanda – In post-genocide Rwanda there were no nutrition educators and an urgent need for well-designed, evidence-based nutrition and food security interventions. The majority of nutrition programming was done with the support of international consultants. At the request of a CIDA funded initiative, we developed and taught an Applied Nutrition course at the Institute of Agriculture and Technology and Education in Kibungo (INATEK), Rwanda. The course was taught in English and French in the Faculty of Rural Development and after two years, all materials were left for others to teach. (Supported by the University of British Columbia).
Mongolia – In collaboration with the Minister of Education and the support of the World Health Organization and the Asian Development Bank our team developed a curriculum for an integrated nutrition training programme for medical personnel (doctors and nurses) at the University of Health Sciences in Ulaanbaatar. Mongolia is experiencing the double burden of over and undernutrition that is common with economic development and there is an urgent need for professionals to be trained in the prevention, diagnosis, and treatment of all forms of malnutrition.
The importance of educating Mongolian health professionals in nutrition is important for the self-sufficiency and development of the country’s nutrition and health programs and ultimately to the long-term effectiveness of nutrition interventions. Therefore, the ultimate goal of the Public Health Nutrition education programme is to build capacity in nutrition at all levels from the community to policy level through education in a sustainable manner. Our support enabled a nutrition training curriculum to be adopted within undergraduate medical training for general practitioners.
Cambodia – Currently, there is a lack of qualified nutrition professionals in Cambodia and a well-demonstrated need. Malnutrition is recognised as the underlying cause of over 50% of childhood deaths, yet it goes largely untreated, at least in part due to a lack of knowledge regarding prevention, assessment, and treatment. The benefits of having Cambodian nationals educated and working in nutrition is important to the self-sufficiency and development of the country’s nutrition and health programmes, and ultimately to the long-term effectiveness of nutrition interventions.
Accordingly, with support from the World Health Organization, our team developed the first Master of Science in Nutrition programme to build capacity in nutrition at all levels from community to policy through education in a sustainable manner.
Lao PDR - Although Lao PDR has made significant progress in the area of child and maternal mortality reduction, a high prevalence of undernutrition remains one of the biggest challenges for the country and presents an area where accelerated efforts are required if the country is to graduate from its Least Developed Country status.
There is an urgent need for comprehensive and in-depth training on topics such as the principles of nutrition and nutrition assessment to strengthen nutrition knowledge of health professionals working in the National Institute of Public Health, National Nutrition Centre of Ministry of Health as well as organizations working in nutrition-related activities.
The importance of having professional, locally trained medical personnel overseeing nutrition programs and interventions is manifold. Locally trained medical practitioners have an inherent knowledge of cultural preferences and constraints, language skills, and are more likely to remain in the country and continue contributing to the health care system throughout their working life. Hence, they will build the capacity of their colleagues through their training and experience.
Medical personnel need to be equipped with appropriate knowledge and skills to implement nutrition activities in the most effective and efficient ways. They need and want more formal training to allow them to gain the required knowledge and skills to address the current nutrition needs in Lao PDR and to continue their work without long periods of disruption attending programs outside the country. The Nutritional Training Curriculum was designed by our team with the support of the World Health Organization to fill the current systemic gaps in nutrition education.
Within Canada, at the University of British Columbia, we developed a range of courses to increase the knowledge and awareness of the general student population regarding the causes, consequences and current solution for common undernutrition and food insecurity issues. The courses provided a unique foundation for those interested in careers in international nutrition, health and development, and are a first in Canada for undergraduates. They included International Nutrition, Nutrition in Emergencies, Applied International Nutrition and an International Nutrition Field Placement course. In addition we designed and conducted workshops for medical and graduate students who were doing international health placements to increase their understanding of current issues and interventions recommended by the WHO and UNICEF.
B) Community-based Nutrition Education
At the community level, we work with international, national, and local organizations to develop culturally contextualized materials for use within community-based education models such as mother-support-groups and cascade trainings for health workers and caregivers. This follows a process that includes an in-depth situation analysis and formative research with caregivers and community leaders whose beliefs, practices and knowledge guide the content and type of materials that are deemed most acceptable for the setting and beneficiaries. Materials are pre-tested and undergo ongoing revision following responsive monitoring of their effectiveness. Our work developing Information, Education and Communications Materials and Social and Behaviour Change Communication strategies is guided by a comprehensive ecological theory that incorporates both individual level change and change at broader environmental and structural levels.
Key Definitions:
Information, Education and Communication (IEC) – IEC is a process of working with individuals, communities and societies to develop communication strategies to promote positive behaviours which are appropriate to their settings. Experience has shown that providing people with information and telling them how they should behave (“teaching” them) is not enough to bring about behaviour change. Behaviour change also requires a supportive environment from community and society.
Social and Behaviour Change Communication (SBCC) – SBCC builds on IEC. It involves a consultative interactive research process that uses communication to promote and facilitate behaviour change and support the requisite social change for the purpose of improving health outcomes. The core elements of SBCC include:
- Communication using channels and themes that fit an intended audience's needs and preferences.
- Behaviour change through efforts to make specific health actions easier, feasible, and closer to an ideal that will protect or improve health outcomes.
- Social change to achieve shifts in the definition of an issue, people’s participation and engagement, policies, and gender norms and relations.
Some examples of our IEC/SBCC work include:
Rwanda – Working with the international NGO World Relief, and the Rwandan Ministry of Health, we designed and tested a model known as ‘Nutrition Weeks’, which incorporated the Essential Nutrition Actions into interactive training sessions following community based formative research. The focus was on improving complementary feeding practices using locally grown ingredients and integrating a protocol for improving sanitation and hygiene. The overall goal was to reduce morbidity, mortality and underlying undernutrition of children under five and pregnant women in Nyamagabe District. The project was funded for four years through USAID’s Child Survival and Health Grants Program - Innovation Grant.
Cambodia – Working with the Maddox-Jolie-Pitt (MJP) Foundation and National Nutrition Programme in the Ministry of Health, we incorporated a mother-support-group model, the ‘Baby Friendly Community Initiative (BFCI)’, into a package of community development interventions. The final design followed an analysis of the results from a food security and nutrition survey conducted among caregivers of young children in Samlaut, and a comprehensive situation analysis. The BFCI included modules on complementary feeding, maternal nutrition, exclusive breastfeeding, and food safety. Interactive demonstrations on how to prepare more nutritious ‘borbor’, a porridge fortified with local ingredients, was central to the messages of providing a variety of foods from different food groups from 6 months of age on.