Impact of a nutrition education programme on nutrition knowledge and dietary intake practices of primary school children in Boipatong

Abstract

Inadequate food intake and unhygienic practices are usually associated with poor nutrition practices. Malnutrition stems from poor quality and quantity of foods, but is also contributed to by factors of inadequate maternal and child health care, lack of education and information and insufficient health services. The first phase of this study was to assess the nutritional status and nutritional knowledge of primary school children within a peri-urban community, through the implementation of a situational analysis. Validated 24-hour (hr) recall, food frequency (FFQ), nutrition knowledge and health questionnaires were used to conduct the situational analysis of this community. Parents (n=52) representative of 400 (13.0 percent) children voluntarily agreed to participate and 45 children completed the baseline survey. Results indicated a community faced with poverty as unemployment (60.9 percent) was high, education levels amongst the parents ranging between primary (33.3 percent) and secondary school (54.9 percent). The dietary patterns of the children revealed a carbohydrate-based diet with very few (n=2) consuming a variety of fruit and vegetables. Some nutrition knowledge amongst the children was evident, with a mean 60.2 percent in correct answers for the true/false questions. The children within the community were at risk of becoming stunted, with small numbers having deficiencies in iron. Therefore, it was decided to implement a nutrition education programme (NEP) in the second phase of the study to address malnutrition amongst primary school children. The objectives of the second phase were 1) to implement a NEP amongst the primary school children to assess the impact on nutrition knowledge and dietary practice, and 2) to determine the retention of knowledge after nine months and whether any correlation occurred between knowledge and dietary practices. The school environment was chosen to ensure attendance and create a suitable learning environment to which the children were already accustomed. Two groups, namely experimental (n=82) and control (n=91), were assigned for this study. The control group received no form of nutrition education during the intervention period. The experimental group received nine 45 minute lessons over a period of nine weeks. The nutrition education tools (NETs) were made up of a text and activity book, supplemented by a card and board game. Pre- and post-nutrition intervention knowledge and 24-hr recall questionnaires were completed to assess differences in nutrition knowledge and dietary practices between the two groups. The intervention made a significant impact on the nutrition knowledge of the experimental group, with a 13 percent improvement between pre and post results. Topics which required more emphasis included the importance of variety in the diet, the functions and sources of certain nutrients, and the classification of certain food groups and the daily serving requirements. In the long-term evaluation, nutrition knowledge was retained and related to topics of the inclusion of milk and fat on a daily basis, the serving size of starch, dairy products and fruit and vegetables, and the classification of low-fat snack items. Retention of knowledge was poor for the source of vitamin C. A few changes were made in the dietary choices of the children after the intervention, with the inclusion of more carbohydrates and one fruit. During the long-term evaluation, the children included more protein sources, but carbohydrates remained dominant within the Top 20 list. The energy distribution in the long term changed towards more energy being supplied from protein (15.6 percent) and fat (34.4 percent), compared with post results of 13.7 and 25.8 percent respectively. The multivariate analysis revealed a significant correlation between the protein intake of the Top 20 list and the question relating to the number of eggs (p=0.00) to be consumed daily, as well as the link between vitamin C (p=0.00) and fruit and vegetable intake. A limitation is that a small number of children (n=27) could not complete the post test, with another 34 children not present to complete the long-term evaluation. The children had very little control of the dietary patterns as their mothers were primarily responsible for food procurement, preparation and feeding. A recommendation is to commence the intervention in the beginning of the year and to consider a co-ordinated approach with parents to encourage dietary changes.