Nutrition education programme

EFFECTS OF SCHOOL BASED NUTRITION EDUCATION PROGRAM ON ADOLESCENT’S NUTRITION RELATED KNOWLEDGE, ATTITUDE AND EATING BEHAVIOUR: A CASE STUDY OF NSUKKA LGA ENUGU STATE.

Overweight and obesity are, globally, the fifth leading risks for mortality. At least 2.8 million adults die each year as a result of being overweight or obese. In addition, 44 % of the diabetes burden, 23 % of the ischaemic heart disease burden, and between 7 and 41 % of certain cancer burdens are attributable to overweight and obesity. While many nutrition-related chronic diseases such as cardiovascular disease (CVD), non-insulin-dependent diabetes mellitus (NIDDM) and certain types of cancer may only appear in adult life, they are associated with dietary and lifestyle risk factors developed during childhood and adolescence, many of which are associated with obesity. Studies suggest that obesity tracks into adulthood if it is present in adolescence

Nutrition education alters undesirable food attitudes and nutrition-related practices which are often based on insufficient knowledge, traditions, and taboos or poor understanding of the relationship between diet and health (Food Agricultural Organization–FAO, 1998). The goal of nutrition education is to reinforce specific nutrition –related practices or behaviours to change habits that contribute to poor health. This is done by motivating people to establish desirable food and nutrition behaviour for the promotion and protection of good health. People are given help to learn new information about nutrition and to develop the attitudes, skills and confidence that they need to improve their nutrition practices (Stuart and Achterbergh, 2004).

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National food and nutrition policy in developed and developing countries emphasize the improvement of the quality of its citizens. It does this by striving to: stimulate and sustain the production and consumption of more nutritious foods, promote proper food habits and healthy life-styles, reduce the prevalence of protein energy malnutrition–(PEM), reduce the prevalence of micronutrient deficiency particularly vitamin A, iron and iodine among vulnerable groups, reduce over-consumption of certain nutrients, particularly fat, sodium, and alcohol (Stuart and Achterbergh, 2004). With this policy, nutrition education programmes are now recognized as a primary form of intervention in national food and nutrition programme.

The ultimate goal of nutrition education, according to Leverton (1974), is to aid individuals in effectively applying their nutritional knowledge, attitudes, beliefs and practices and modifying their diets to attain optimal nutritional status. In line with the above assertion, Lewis (1976) posited that the goal of nutrition education is to produce nutritionally sound decision makers who are motivated, knowledgeable, skilled and willing to choose proper nutrition alternatives. A well planned and well delivered nutrition education programme may help to produce women who are motivated, knowledgeable and skilled; and who can be empowered to make informed decisions on nutritional issues.

Nutrition education is one of the effective intervention strategies for bringing about knowledge, attitudinal and behavioural change in the individual. In other words, nutrition education is one of the effective means of alerting adolescents and communities of the need for nutrition improvement. It is the first step towards improving food habits (Devadas, Chandrasekhar and Vasanthanmani, 1975).

A well designed nutrition education programme when handled by a competent health educator would enable adolescents to make effective and well informed decisions that can improve their live and environment (Ezealigo, 2000). When nutrition education is poorly designed or developed and handled by incompetent health educators, it may not alter nor modify negative nutritional attitudes, beliefs and practices. Where negative nutritional attitudes, beliefs and practices manifest, the resultant effect is poor nutritional life-style which may eventually predispose children to nutritional disorders such as protein energy malnutrition (PEM) and Microcronutrient nutritional disorders (MNND) while adults may be predisposed to obesity and overweight.

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Gove (1993) conceived programme as a plan of procedure or schedule under which action may be taken toward a desired goal. Brown (1993) perceived programme as a course of study in its order of occurrence. He further added that it is a planned series of activities, events or scenes intended to be carried out. Read (2003) described programme as any prearranged plan or course of proceedings. When nutrition relates to education as in the present study, it is termed nutrition education. Powers (1980) perceived nutrition education programme as the process of developing knowledge, skills and desirable attitudes in the proper composition and use of food. According to her, these processes are to empower learners to utilize, to their wellbeing, experience and information about food and its use.

Caliendo (1981) described nutrition education programme as the process by which beliefs, attitudes and environmental factors that negatively influence nutrition are positively altered. United Nation Education Scientific Cultural Organisation –UNESCO (1983) conceptualized nutrition education programme as that which is concerned with teaching and learning about knowledge, attitudes and practices related to food and the way it is used by the human body for energy, growth and development. Samuel (2000) viewed nutrition education programme as the planned use of educational process to modify food and nutritional behaviour in the pursuit of health. In this study, nutrition education programme was used to mean a process by which people are taught nutritional facts so as to promote positive nutritional knowledge, attitudes, beliefs and practices in the pursuit of health.

Caliendo (1981) asserted that nutrition education motivates people to adopt healthful nutritional practices and provides consumers with information about the current state of nutrition knowledge so that they will be able to make wise food choices. This may aid in the promotion of nutritional status of consumers. Regrettably, as laudable as nutrition education is, Nigeria still seems to portray lukewarm attitude toward it (Rosso, 1999). This may have resulted to poor knowledge of nutrition leading to harmful nutritional attitudes, beliefs and practices among adolescents which ultimately usher in nutritional disorders such as micronutrient nutritional disorders –MNND and protein-energy malnutrition (PEM) (English & Badcock 1991-93). No wonder then the Government of Nigeria (2004) reported that the problems of hunger and malnutrition among Nigeria adolescents are more widespread than ever. It further stated that it had been estimated that the percentage of Nigerian  households that are food insecure had risen from 18 per cent in 1968 to over 40 per cent in 1998, and over 70 per cent in 2003

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Gillespie, Mason and Martorell (1993) had earlier stated that government that invests in adolescents nutrition education and welfare of its citizens can thus anticipate benefits in both nutrition education and economic productivity. Kaine (1989) submitted that a nation’s health condition is insured in the excellent nutritional status of its citizens. This assertion could be achieved through a sound and well designed nutrition education programme packaged and delivered to women in particular and the populace in general.

Ozoro (1980) attested that nutrition education initiates changes of undesirable nutritional knowledge, and promotes positive nutritional attitudes, beliefs, and practices. Nigerian’s undesirable nutritional attitudes, beliefs and practices in general and Nsukka LGA in particular may not have adopted such changes as a result of lack of exposure to nutrition education. This therefore suggests the need for people especially adolescents to possess high knowledge and at the same time apply such knowledge on nutritional issues.

It takes knowledge of nutrition for one to choose foods that contain the right nutrients required by the body. Knowledge, which is one of the concepts used in this study is described by Bloom (1956) as a factual information that is learnt initially and then remembered. Comforth (1956) viewed knowledge as the sum of conceptions, views and propositions, which have been established and tested as correct reflections as far as they are of objective reality. Rowntree (1981) submitted that knowledge is the body of information and understanding, which individuals acquire through life experience and through education. Sinclair (1992) conceptualized knowledge as information and understanding about a subject, which someone has in his or her mind. Applied to this study, knowledge is defined to mean the ability to comprehend, apply, analyse, synthesize and evaluate what are known facts, concepts, views, propositions and principles related to nutrition. When knowledge relates to nutrition, it is termed nutritional knowledge.

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Nutritional knowledge is defined by Gudam (2002) as the ability to recall, comprehend and analyse facts, information and experience on nutrients, sources of nutrients, and handling as it affects the general body processes and health of individuals. This study discussed knowledge under the dimensions of comprehension and application of nutrition. Grunlund (1985) described comprehension as the ability to grasp the meaning of material. He further stressed that this may be shown in translating materials from one form to another. According to him, comprehension outcomes go one step beyond the simple remembering of material. Applied to this study, comprehension has to do with grasping nutritional facts and principles. Grasping nutritional facts and principles as far as this study is concerned, is not the main objective of knowledge. The main focused is grasping the nutritional facts and principles and applying them. Grunlund (1985) conceptualized application as the use of information and ideas in new situations. As in the case of nutrition, this has to do with application of nutrition concepts, principles, laws and theories.

Generally, education serves to raise one’s understanding of knowledge and provides background for one to seek application on other nonspecific skills such as nutrition (Foley, Voden & Dayton, 1993; Falusi, 1985; Harper, 1986). Foley et al., further reported that educational attainment was positively correlated with the level of nutritional knowledge. Devadas (1970) attested that lack of knowledge of the simplest facts of nutrition is the root of high proportion of causes of malnutrition. According to him, even the affluent societies of the so-called developed nations may suffer from malnutrition in the midst of abundance.

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Knowledge of nutrition acquired by school based adolescents through nutrition education programme can help them adapt easily the desired changes (Ezealigo, 2000). Nutrition education helps women to acquire adequate knowledge and value of different foodstuffs. This knowledge according to her, would build confidence, skills in dieting and optimism among adolescents. Proper application of nutritional knowledge may lead to positive nutritional attitudes.

Allport (1995) described attitude as a mental or neutral state of readiness organized through experience, exerting a directive or dynamic influence upon the individual’s responses to all objects and situations with which it is related. Pollock and Oberteuffer (1974) submitted that attitude about health and health behaviour helps in a given situation. When attitude relates to nutrition, it is termed nutritional attitude. The term nutritional attitude is used in this study to mean mind set to feelings and thoughts and internal readiness to behave or act towards food and nutrition. Rosso (1990) submitted that nutrition is one of the fields of human endeavour in which the population cannot survive without. He regretted that people have learnt bad nutrition behaviours which inhibit positive nutritional attitudes and practices.

For the purpose of this study, eating behavior shall entail the following nutrition dimensions of nutritional attitudes: eating between meals, skipping breakfast, consumption of sugary foods, consumption of alcohol, food fads, consumption of high saturated fats, food preference and dieting to maintain weight. Sigman–Grant (1996) submitted that conclusion of a comprehensive review of nutrition education suggests that nutrition education is a significant factor in improving dietary practices when behaviour is set as the goal and the educational strategies employed are designed with that as a purpose. Implicit in the delivery of nutrition education according to Sigman –Grant, is the need for behaviour change. He further stressed that in the process of behaviour change, the individual must change in awareness, motivation, attitudes and practices about the role of nutrition in both health and disease, change the kinds, types and amounts of foods eaten, change food preparation, methods and change sensory perception.

In general, UNICEF (1998) attested that lack of access to nutrition education and correct information leads to malnutrition. According to UNICEF, without nutrition information strategies, better and more accessible nutrition programmes, knowledge, skills and behaviours needed to combat malnutrition cannot be developed. Further, studies also indicate that adolescents are a nutritionally vulnerable group for a number of reasons, including their high nutrition requirements for growth, their eating patterns and lifestyles, their risk-taking behaviours and their susceptibility to environmental influences. Therefore, the promotion of nutrition from adolescence plays a vital long-term role in maintaining lifelong health.

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