PRACTICAL NUTRITION
FOR FIELD WORKERS (2)
Objective
By the end of this session, field workers will be able to:
FIGURE 3.1
Home garden produce
OVERVIEW
An adequate diet must contain enough food in the right combinations for everyone, young or old, male or female. Different nationalities, groups of people and cultures have their own food habits, traditions and preferences that influence food choice, cooking methods and diet composition. Factors such as food cost and seasonal availability must also be considered when discussing food and nutritional patterns and ways of improving food choice and meal planning and preparation. During this session, participants will use their knowledge of the local culture, food production, home gardening and food habits to evaluate the nutritional adequacy of meals. They will also learn how to help people improve the nutritional value of local diets and how to encourage improvements in crop choice, land use and other home garden practices that contribute to the nutritional well-being of the community.
ACTIVITIES
The field workers should be familiar with Table 2.4, "Food quantities that meet daily energy and nutrient requirements of different household members", particularly the sections dealing with food quantities that the trainer will have converted to local household measures. A good understanding of Table 2.2, "Nutritional values of raw and processed foods commonly consumed", and Table 2.5, "Home garden crops that are rich in key nutrients", is equally useful.
Discussion of nutritionally adequate meals. After outlining the objectives of the session and explaining the activities to be undertaken, the trainer asks the participants to use the flip chart to present the types of dishes that are prepared locally, starting with main dishes. The participants then list the dishes (including their ingredients) that accompany the given main dishes (e.g. the relish). Main dishes made from a mixture of food items and considered "complete" meals needing no accompaniment or relish (e.g. West African soup or stew) should be listed separately.
The trainer then introduces the "Family mixed meal guide 1" (see Figure 1) from Information Sheet 3 and explains how it is used to plan and prepare family meals that are healthful and nutritious. Special attention should be given to essential foods and nutrients that may be lacking or in short supply due to seasonal variations in the locality. Keeping the family mixed meal guide in mind, the members of the group should decide which of the commonly consumed meals they present are nutritionally adequate and which lack essential food items, and then explain why. For those meals that are nutritionally inadequate, the field workers should be able to suggest different ways to improve them.
Using the information from Tables 2.2 and 2.5 and, where necessary, Appendix 2, "Proximate composition of foods", the trainer initiates a brainstorming session on the nutrient composition of foods that are often used to substitute one another (e.g. the energy and nutrient contents of different leafy vegetables, cooking oils, legumes, or cereal, root or tuber flours used to prepare the main dish). The participants should consider the following questions:
Note: Only 1.5 cups chopped dark green leafy vegetables, or a medium-size yellow-coloured sweet potato, or 2 teaspoons unrefined red palm oil (10 ml) or one small carrot a day will provide enough vitamin A for a child to avoid eye damage and reduce his or her risk of getting measles and other diseases. Adding a small spoonful of oil to a child's food enhances vitamin A absorption by the body.
Exercise. The trainer draws a table listing the main local foods, such as cereals, roots and tubers, oilseeds and pulses, fats and oils, fruits and vegetables, and then asks the field workers to indicate whether the nutritional values (i.e. energy and nutrient content) of each of the local foods is good (+), fair (0) or poor (-).
Snacks. The trainer defines the term "snack" (a food that is eaten between main meals) and then discusses snacks and the contribution they make to the diet, particularly to a child's diet. The trainer refers the field workers to Information Sheet 4, "Nutritious and tasty snacks for young children", as reading material.
The group makes a list of local snack foods, estimates the nutritional value for each snack food and indicates which are particularly rich in certain nutrients and how they contribute to improving daily nutrient intake.
Planning daily family meals. Using the Technical Notes section in Session 3 as a guide, the trainer initiates a discussion of why people prefer different foods (i.e. why they have food preferences). Then the participants arrange themselves in small groups and review the daily meal frequency of the local community, any seasonal variations that exist and the local conditions and factors (e.g. the mothers' many responsibilities, the fathers' working away from home, lack of fuelwood) that determine such meal patterns. They also discuss how seasonal variations in food availability affect the main dishes, the relish ingredients and the snacks given to the children.
The trainer refers to Table 2.4, "Food quantities that meet daily energy and nutrient requirements of different household members". Using the information (household measures) indicated in Table 2.4, the groups must plan family meals for one day, ensuring that the meals are nutritionally adequate (i.e. they contain the right quantity and variety of foods). The participants can refer to the family mixed meal guide in Information Sheet 3 to complete this exercise.
Information on the size of the family and the age and sex of its members has already been collected for Table 2.3. The number of family meals will depend on the outcome of earlier discussions on daily meal frequency, with two to three family meals being considered as average. Snacks for young children may be included and should be indicated. The meals may consist of some or all of the following:
During the exercise, the group members should aim at getting the best nutritional benefits as economically as possible, taking into account the current prices of food commodities. Keeping these things in mind, they should:
Information Sheet 3, "Recipes for nutritious dishes", may provide the field workers with helpful hints.
Each small group should present its example to the whole group and respond to comments. The whole group should note the most common meal suggestions and divide the meal components into:
MATERIALS REQUIRED
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The nutritional value of a food is only one factor to consider when planning meals. There are many reasons why families prefer certain foods and choose to eat them when they do
Agricultural extension workers often think of food in terms of different crops or animals. Some food crops are difficult to grow while others are relatively easy to grow. Some bring good prices at the market while others do not. Home economists think of the convenience of processing and preparing certain foods, while nutritionists and public health specialists think of the nutritional value of different foods and their effect on health in certain quantities and combinations (e.g. in preventing kwashiorkor, marasmus, night blindness, allergies, diabetes and obesity).
Families, however, consider many other things. They may choose the food they eat for a variety of reasons, including habit; tradition; convenience in processing and preparation; a preference for the food's taste, texture and colour; the food's availability depending, for example, on season, adequate storage and consumer demand; its price and its suitability for an occasion (e.g. a wedding, funeral, childbirth). Often people, particularly the elderly, feel they have not eaten properly if they have not consumed the staple, or any other familiar food, at least once a day. Field workers must take all these factors into account when exploring possible ways to assist communities in improving their eating habits and nutritional status.
Snacks from the home garden are an important source of nutrients
Snacks are eaten between meals and are often a normal part of a child's diet. They are usually foods that provide energy quickly and are eaten raw (e.g. fruits and sugar cane) or cooked. Snack foods consisting of beans and nuts can provide significant amounts of protein and fat, and those prepared from, fruits and vegetables provide important vitamins and some minerals.
Snacks can be seasonal foods, particularly in rural areas of the subhumid and semi-arid parts of Africa. Street food vendors in some parts of Africa often specialize in certain snacks (e.g. bean cakes, boiled or roasted cassava and roasted groundnuts, oilseeds or grain legumes).
Depending on the region, good snacks may include:
A home garden containing a variety of crops can provide many snacks that supply essential nutrients and contribute to the nutrition and health of all family members, particularly children.
Nutritionally balanced and tasty meals can be planned by adding nutrient-rich food items to the staple food
Family meals. Locally available staples generally form the basis of a meal, but a meal becomes nutritionally adequate and tasty only if a relish or soup (consisting of beans or groundnuts, vegetables, fats or oils, condiments and spices) and fruits are eaten with the staple. The type of relish or soup that accompanies a main dish, and the ingredients used to prepare it determine the nutritional adequacy of the meal.
Apart from animal products, most of the ingredients used to prepare a relish, West African soup or other accompaniments to a main dish come from the home garden. Where foods of animal origin (meat or fish) are not readily available, the quality of the diet can be improved by providing a variety of vegetable products at each meal (e.g. beans, lentils or groundnuts with green leafy vegetables).
Some meals are adequate from the point of view of quality while others are not. The family mixed meal guide in Information Sheet 3 provides a quick and practical way to evaluate the quality and variety of food items in a meal.
The information provided in Table 2.4 offers a practical way to plan meals and determine which food quantities meet the nutrient needs of different members of the family.
Meals for infants and young children. Starting at two years of age, children may eat foods from the family pot, but children under two years of age require special food. Their teeth are usually not developed adequately to chew tough foods, and they must adjust gradually from breastmilk to semi-solid foods, and ultimately, the food from the family pot.
During this transition period, the texture and thickness of a child's food has to be appropriate to the level of development of the child, and the food's energy and nutrient content must support rapid growth. It is also important that the processing and cooking methods required for a child's diet do not place an extra burden on the mother.
Information Sheet 5 provides useful information on weaning foods and gives some recipes for energy-dense infant feeding mixtures prepared in different parts of Africa, using locally grown foods.
