The FMFH initiative is based on the assumption that food security can be increased through education. Although this has still to be proven with empirical evidence,11 the outcome of the Indian initiative indicates that FMFH materials can be successfully used to make school children aware of hunger and food security issues.
It also showed that school children can provide a link for reaching out and educating other sections of the community. The results reported by the teams highlight that: (j)children can be key agents of change (ii) FMFH materials can provide a platform for addressing other important public health issues (iii) FMFH materials can be used to start food-based interventions and (iv) teachers have a key role in the successful delivery of FMFH messages
According to the WHO (World Health Organization) Expert Committee,12 children are a nation’s most important resource and promoting their health through schools can both reduce common health problems and make the education system more efficient, leading to economic development. The Indian FMFH initiative shows that it is certainly possible to make children aware of broader public health issues such as food security.
The Mumbai team (St Gregorius School) demonstrated that it is not only possible to do this, but also to encourage children to act on this knowledge as was shown by the school children reaching out to children of migrant construction workers. Perez-Rodrigo and Javier13 observe that schools provide the most effective way to reach out to large sections of the wider community, including young people and their families.
However, the experience of the Kolkata team suggests that more intense efforts may be needed to make primary school children understand the role of children in tackling food insecurity. The FMFH initiative may thus need to be further adapted in keeping with the children’s age, level of understanding as well as their socio-cultural environment.
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Children attributed hunger and malnutrition to poverty and had a clear understanding of the social factors responsible. |
Connell et al.14 found that children with cognitive ability can sense when there is a shortage of food in their household. They observed that such children were aware not only of their parent’s attempts to ensure adequate food for the family, but also that their parents were concerned about their inability to ensure food security to the family. Both rural and urban children could identify behaviour associated with food insecurity.
The experience of the five teams confirms Connell’s observations. All teams reported that children attributed hunger and malnutrition to poverty and had a clear understanding of the social factors responsible.
At the end of the initiative, the children identified segments of society vulnerable to food insecurity. The DCT, Hyderabad team found that rural children identified landless families, orphans, destitute, the unemployed, child labourers, illiterates and victims of crop failure or war as prone to hunger. The children could easily list the food items that were not available to rural people in their region leading to food insecurity.
All five teams used the FMFH lessons to educate children about nutrients and their functions as well as the importance of a balanced diet. The teams in Mumbai and Delhi also observed inappropriate dietary patterns among the school children. While implementing the FMFH initiative, these teams were able to change the children’s knowledge of the nutritional value of various kinds of food.
They also made the children realize the disadvantages of fast food and soft drinks. The children learned about the harmful effects of eating too much fast food, energy-dense oily preparations and skipping meals, especially breakfast.
Promoting this knowledge at an early age is particularly relevant as developing countries undergo a nutritional transition with more and more consumption of pre-processed food rich in sugar and fat. Often accompanied by sedentary lifestyles, this is resulting in an epidemiological shift from endemic undernutrition to a growing incidence of chronic ailments such as obesity, cardiovascular disease, diabetes mellitus and cancer. The reported increase in childhood and adolescent obesity has made this is as important a public health issue as hunger and undernutrition.
A number of studies on nutrition education for children of school age have been conducted, most of them mainly in a school setting. Most researchers have used one of two approaches. The first aims to improve the knowledge, skills and attitudes of children to understand food and nutrition issues so they can choose a healthy diet. Programmes based on this approach rely on nutritional science and aim to change knowledge, attitudes and/or dietary intake.
The second approach began in the 1980s with evidence increasing of the link between diet and chronic diseases. Programmes based on this approach aimed at reducing risk factors among children through school-based education. Carrell et al.15 observed that nutrition education and exercise could reduce hyperinsulinemia in obese children. Similarly Ryan, Anderson and Sherman16 reported how a nutrition education programme by a team of the Colorado State University Cooperative Extension faculty and students for school children aged 5-11 years, improved fruit and vegetable consumption. Other researchers have noted the positive effect of nutrition education on children’s nutritional knowledge.17
Devine, Olson and Frongillo18 observed that a state-wide nutrition education curriculum in a natural, non-research setting had a significant impact on eating behaviour in terms of breakfast and consumption of different kinds of food such as whole grains, fatty food, fruits and vegetables, and dairy products. Kelder et al.19 found on the basis of community trials that nutrition education can be used as an effective tool for developing suitable nutritional practices.
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Students taking part in nutrition and gardening activities showed a 33percent improvement in their knowledge of FMFH topics. |
The Indian FMFH initiative’s effectiveness is reflected in the improved scores observed by the NIN team even two months after providing the educational inputs.20 The NIN study indicates that FMFH classroom lessons can be effective in promoting children’s awareness of the “who, what, why and how” of hunger.21
With support from teachers and school authorities, the DCT, Hyderabad team developed kitchen gardens, which were maintained by the school children. This also enriched the children’s learning experience.
Ruel and Levin22 note that significant progress has been made in the last decade in food-based approaches to problem of micronutrient malnutrition. Home gardens have been effective, especially when combined with promotional and educational interventions, in improving vitamin A intake and nutrition.23, 24
This highlights the need for food-based interventions to combat micronutrient deficiencies. However, these have so far been largely overlooked in favour of clinical approaches such as capsule distribution and food fortification programmes
The use of the kitchen garden for nutritional education of children in grades four to six was demonstrated by Morris, Briggs and Zidenberg-Cherr.25 Students taking part in nutrition and gardening activities showed a 33 percent improvement in their knowledge of topics included in the FMFH intervention. Although only one of the five teams tried the kitchen garden approach to nutrition education, it would be worthwhile considering the incorporation of such activities in the FMFH modules, especially in rural areas.
Teachers have a key role in determining the success of the FMFH intervention. The Lady Irwin College team observed a lower improvement in scores of children in government schools because of the lack of enthusiasm on the part of their teachers and the limited availability of supplementary teaching materials. In all other schools, there was enthusiastic participation by the teachers.
Although all teams did not measure the pre- and post-intervention knowledge of the teachers, the teams from NIN, Hyderabad and Lady Irwin College, Delhi found considerable improvement in the teachers’ scores after their training.
Teacher orientation is a necessary part of nutrition education interventions. Most studies on nutrition education have included teacher orientation. However, only a few studies have actually examined whether teachers’ preparation for nutrition education makes a difference in providing such education to children. Penner and Kolasa26 found that teachers participating in nutrition courses had better knowledge of nutrition, a more favourable attitude towards teaching nutrition and spent more classroom time on this.
Brown and Park27 observed that school teachers with nutrition training made more use of community resources and supplementary materials. They also noted a significant increase in the post-intervention knowledge scores of students of teachers who had participated in nutrition training.
In the "Team Nutrition" educational initiative of the U.S. Department of Agriculture to change children’s eating behaviour, Levine et al.28 reported that although nutrition education is offered in schools, its actual implementation is often left to the discretion of individual districts, schools or teachers.
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Brown and Park27 observed that school teachers with nutrition training made more use of community resources and supplementary materials. They also noted a significant increase in the post-intervention knowledge scores of students of teachers who had participated in nutrition training. |
The FMFH evaluation found that teachers needed training and/or background information on nutrition, particularly if they had not taught it before. Since time constraints were a concern; team building and sharing of responsibilities was a key strategy.
This was evident from the experience of the DCT, Hyderabad team, where in one of the schools, only a single teacher was responsible for the FMFH lessons. The involvement of parents was suggested to support the teachers.
However, there was significant parental involvement only in Kolkata. Studies suggest that parental involvement can make classroom teaching more effective, especially with younger children.29, 30, 31
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FMFH lessons can be easily adapted to different socio-cultural settings and used to reach out to other members of the community In Hyderabad; the FMFH team was approached by other private schools to start similar programmes. |
The experience of the five teams shows that the FMFH initiative can be extremely useful in creating awareness among school children. The lessons can be easily modified and adapted to regional conditions and different socio-cultural settings. They can be used to reach out to other members of the community or start activities such as kitchen gardens and increase community involvement. The experience of DCT, Hyderabad was positive with other private schools approaching the Trust to start similar programmes.
The FMFH initiative also indicates that local administration should be taken into confidence and school authorities and teachers must be convinced that the FMFH programme will not add to their work burden. This calls for innovation and creativity on the part of implementers so that the FMFH lessons can be added in a meaningful way to existing school curricula.
It seems worthwhile to offer FMFH materials on a large scale to schools. However, orientation workshops will be needed for administrators and school authorities to develop workable strategies which do not significantly add to the work burden of teachers and sacrifice creativity.
11Keenan, D.P., Olson, C., Hersey, J.C. & Parmer, S.M. 2001. Measures of food insecurity/security. J Nutr Edu., S49-S58.
12WHO. 1995. WHO Expert Committee Report – Comprehensive School Health Education and Promotion. Geneva, World Health Organization,
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14Connell, C.L., Lofton, K.L., Yadrick, K. & Rehner, T.A. 2005. Children’s experiences of food insecurity can assist in understanding its effect on their wellbeing. J Nutr., 135:1683-90.
15Carrel, A., Manen, A., Garry, C. & Storandt, R. 2005. Effects of nutrition education and exercise in obese children: The Ho-chunk Youth fitness program. Wisc Med J., 104:44-47.
16Ryan, L., Anderson, J. & Sherman, B.M. 1995. The effect of nutrition education on improving fruit and vegetable consumption of youth. (available at http://www.joe.org/joe/1995October/93.html)
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19Kelder, S.H., Perry, C.L., Lytle, L.A. & Klepp, K.L. 1995. Community-wide youth education: Long term outcomes of the Minnesota Heart Health Program. Health Educ Res., 10: 119 – 31.
20It has been indicated that educational programmes can have a positive impact where the effect of size (Cohen’s d) is 0.2 or more.
21Rao, G.M.S., Rao, D.R., Venkaiah, K., Dube, A.K. & Sarma, K.V.R. 2004. Evaluation of FAO’s global school-based nutrition education initiative Feeding Minds, Fighting Hunger (FMFH) in schools of Hyderabad. (Project Report submitted to FAO)
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23Talukder, A., Kiess, L., Huq, N., de Pee, S., Darnton-Hill, J. & Bloem, M.W. 2000. Increasing production and consumption of vitamin A-rich fruits and vegetables: lessons learned in taking the Bangladesh homestead gardening program to national scale. Food Nutr Bull., 21:165-172.
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