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eveloping a Nutrition and Health Education Programor Primary Schools in Zambia

ane Sherman, MA, BPhil1; Ellen Muehlhoff, BSc, MSc2

BSTRACT

School-based health and nutrition interventions in developing countries aim at improvingchildren’s nutrition and learning ability. In addition to the food and health inputs, children needaccess to education that is relevant to their lives, of good quality, and effective in its approach. Basedon evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this articleexamines whether and to what extent school-based health and nutrition education can contributedirectly to improving the health and nutrition behaviors of school children. Initial results suggestthat gains in awareness, knowledge and behavior can be achieved among children and their familieswith an actively implemented classroom program backed by teacher training and parent involve-ment, even in the absence of school-based nutrition and health services.

Key Words: nutrition and health education, behavior change, basic schools, Zambia, curriculumdevelopment, learner-centered

(J Nutr Educ Behav. 2007;39:335-342)

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NTRODUCTION

hronic malnutrition is widespread among school childrenn many developing countries. The few available data onow-income countries show that the nutritional and healthtatus of school children reflects that of preschool children.1

ndernutrition and micronutrient deficiencies continue tompede the growth of children when they reach school,educe their capacity and motivation to learn, and leadhem to drop out of school early.2 The main nutritionalroblems are stunting, underweight, and wasting, resultingrom poor nutrition in utero and from inadequate dietaryntake and infectious diseases during early childhood. Mi-ronutrient deficiencies, particularly of iron, iodine, and

FAO Education Consultant, Rome, ItalyNutrition and Consumer Protection Division, Food and Agriculture Organization ofhe United Nations, Rome, Italyhe Nutrition Education in Basic Schools project was funded from 2000 to 2002 by

he FAO Technical Cooperation Programme under project TCP/ZAM/8923, “Nu-rition Education in Primary Schools,” and from 2002 to 2007 by the Belgianurvival Fund through FAO’s Trust Fund project GCP/ZAM/059/BEL, “Luapulaood Security, Nutrition Action and Communication.”he views expressed in this publication are those of the authors and do notecessarily reflect the views of the Food and Agriculture Organization of the Unitedations.upplementary data associated with this article can be found in the online version atww.jneb.org under the label “Add-ons” within the online version of the article.

ddress for correspondence: Ellen Muehlhoff, BSc, MSc, Senior Officer (Nutritionducation), Nutrition and Consumer Protection Division, Food and Agriculturerganization of the United Nations (FAO), Viale delle Terme di Caracalla, 00153ome, Italy; Phone: �39 06 5705 4113; Fax: �39 06 5705 4593; E-mail:llen.Muehlhoff@fao.org2007 FOOD AND AGRICULTURE ORGANIZATION OF THE UNITEDATIONS. PUBLISHED BY ELSEVIER INC. ON BEHALF OF THE SOCI-

rTY FOR NUTRITION EDUCATIONoi: 10.1016/j.jneb.2007.07.011

itamin A, slow children’s growth and mental developmentnd increase susceptibility to infection. Overweight andbesity are also becoming serious problems for children inountries experiencing the “nutrition transition.”3

Following a series of international commitments andnitiatives,4,5 there have been large-scale efforts to provideimple and cost-effective health and nutrition interven-ions in schools in low-income countries.1,6,7 However, di-ect interventions, such as school feeding, micronutrientupplementation, and treatment for worms, tend to pre-ominate over health education, while health educationredominates over nutrition education.6 The question isherefore whether and to what extent nutrition and healthducation in schools in developing countries can contributeirectly to improving the health and nutrition behaviors ofhildren and, in the long term, to the health of the popu-ation as a whole.

The approach used in nutrition education has changedonsiderably to adapt to urgent health challenges withegard to learning models and the scope or reach of itsctivities.8-10 A main movement has been from a knowledgerientation to a behavioral orientation,11,12 following fromesearch evidence that gains in knowledge and attitudes doot usually or necessarily result in changes in practice,10-12

nd that aiming for specific dietary behavior appears toaximize the chance of achieving it.8,10 This reorientation

epresents a radical change for conventional educationystems.9,13-15

The profile of nutrition education in school curriculacross the world is still low, the time dedicated is small, androgress is slow, partly resulting from lengthy curriculum

evision processes, pressure on school timetables, and con-

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336 Sherman & Muehlhoff/NUTRITION AND HEALTH EDUCATION IN PRIMARY SCHOOLS IN ZAMBIA

eptual innovations.12,15-18 Of the various curriculum op-ions, the most favored is integration into existing sub-ects9,19-21; in this case the academic status of the hostubject(s) may be a prime consideration.15

ackground

ambia is a large, landlocked country in southern Africaith a population of 11.6 million. Agriculture accounts forbout 22% of gross domestic product.22 The country isndowed with abundant natural, agricultural, and mineralesources; copper accounts for the bulk of export earnings.he HIV/AIDS pandemic is draining the country of human

esources and undermining the economy. The loss of lifeas affected every aspect of society and has resulted in largeumbers of orphaned children. Undernutrition is a seriousroblem, resulting from high levels of disease (eg, diarrhea,alaria), lack of adequate dietary intake, and poor educa-

ion and care. About half the children under the age of 5re chronically undernourished or stunted (ie, short forheir age).23

Luapula Province is one of the poorest and most ne-lected provinces in Zambia in terms of agriculture, infra-tructure, and community development. About half theouseholds are chronically food insecure. Although com-rehensive data do not exist for the school-aged population,he indications are that undernutrition and micronutrienteficiencies continue to impede the growth and develop-ent of children when they reach school, while also reduc-

ng their capacity and motivation to learn. In the absencef school meals and health interventions, the question is tohat extent school-based nutrition education can make aifference in children’s health and food practices.

This paper reports on a project in Luapula Province,ambia to develop nutrition education materials for pri-ary schools. The institutional framework, objectives, and

urricular concept of the project are described. The meth-dology section discusses the situation analysis and curric-lum development processes, production of the materialsnd their field testing and publication. The findings of theeld testing are then presented and discussed, and tentativeonclusions are drawn. The theoretical framework thatormed the basis for curriculum decisions is available asupplementary material in “Theoretical framework forchool-based nutrition education” at http://www.jneb.org.

HE PROJECThe Institutional Framework

rom March 2000 to the present, the project, “Nutritionducation in Basic Schools” (NEBS), originally mountednder the Technical Cooperation Programme of the Foodnd Agriculture Organization of the United NationsFAO), has assisted the Zambian Ministry of Education ineveloping a nutrition education program for basic schools.

ocated within the Basic Education Sub-Sector Investment L

rogramme, the project is led by the Zambian Ministry ofducation in close collaboration with the National Foodnd Nutrition Commission and has been incorporated intoAO’s Luapula Food Security, Nutrition Action and Com-unication project. The province of Luapula in northernambia was selected for piloting the materials; thus theroject has had both a national and a local focus.

Project activities are not yet complete, so this article isreport on work in progress.

bjectives

he project objectives were to contribute to improving theealth and nutritional status of Zambian schoolchildrenged 7-13 years, and to improve the relevance and qualityf education24 by

–integrating food and nutrition topics into primaryschool curricula in Zambia;

–developing appropriate teaching and learning materials(at grades 2, 4, and 6); and

–developing an in-service training program for teachertrainers, education officials, and primary schoolteachers.

he Curriculum Concept and Learningpproach

he concept of nutrition education adopted by the projects embodied in the FAO Guide for Planning Nutritionducation Curricula (the “Planning Guide”),25 which ex-ends to nutrition education the World Health Organiza-ion concept of the health-promoting school.16,26 This con-ept assumes that health and diet are, above all, a way ofife, centered on the child and learned in all the contexts ofchild’s life. To be effective, nutrition education should beart of a “whole-school” approach, where classroom learn-ng is linked with practical action, backed up by improve-ents in the school environment and family and commu-ity participation. It should have a considerable focus onehavior and an active, learner-centered methodology.

ETHODOLOGY

roject activities were organized by a project task force,onsisting of government officers from the Ministry of Ed-cation and the National Food and Nutrition Commission,n collaboration with the education authorities in Luapula,ocal nutritionists, and the Teacher’s College of Educationn Mansa, and calling on technical support from FAO andhe National Food and Nutrition Commission.

ituation Analysis

situation analysis was carried out in 15 basic schools in

uapula Province in August 2000.27 It revealed that primary

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Journal of Nutrition Education and Behavior ● Volume 39, Number 6, November/December 2007 337

chool children’s general health was poor, there was a highrevalence of stunting (ie, 58% of children under 6 yearsld were moderately to severely stunted),28 and their dietacked variety and was lacking in important micronutrients.arents did not perceive children’s health problems as

inked to diet. There were no school meals. Children ate 1r 2 meals a day, seldom had breakfast, and did not takenacks to school. Findings for the wider population sug-ested that vitamin A deficiency and anemia were preva-ent and that children’s nutritional status was exacerbatedy infections, including worms, malaria, and diarrhealiseases.28-30 In the school environment, water supply andanitation were generally inadequate; most schools hadardens, but these were seldom associated with education orutrition.

Nutrition topics were not well integrated into educa-ional materials, and the health and nutrition curriculum,eaching materials, and teacher education provision ur-ently needed reviewing and updating. On this basis, theroject task force decided that rather than plugging gaps inxisting school materials, it would be best to develop newearning modules based on the specific needs identified.

urriculum Development

sing the Planning Guide,25 which includes a curriculumhart, a participatory curriculum development meeting waseld in Luapula in March 2001 facilitated by the projectask force.31,32 Participants were teachers, head teachers,eacher trainers, writers, local nutritionists, and doctors;choolchildren and their parents were consulted. Recogniz-ng the interdependence of health and nutrition issues, theorkshop identified 7 priority topics to be addressed in the

earning materials—undernutrition, vitamin A deficiency,ron deficiency anemia, personal diet, malaria, diarrhea, andersonal and environmental health and hygiene—and rec-mmended related learning objectives. These objectivesere approved by the Sub-Committee on Curriculum De-elopment of the Zambian Curriculum Development Cen-re, and the recommendations were carried forward by theroject task force to the ongoing national curriculum revi-ion process. Doing so ensured extensive coverage of nutri-ion education objectives in the new national curriculum.

The recommended objectives were the basis of therade 2 and grade 4 materials. Grade 4 included morexploration of local food and a lesson on the feeding andare of the chronically sick. The content of grade 6 waseshaped by input from the project task force and a partic-patory consultation to include a focus on food-relatedivelihoods and food production, care, and diet for peopleho are living with or affected by HIV/AIDS, preventionnd treatment of parasites, and ensuring clean, safe water.

roduction of Materials

he learning materials were written by Zambian writers

n line with the given learning objectives and a meth-

dological brief, which included targeting behavior andttitudes as well as knowledge; aiming at active experi-ntial learning; involving families, the community, andhe school environment; building in technical and meth-dological briefing for teachers; and ensuring good infor-ation flow from children/parents to teachers/school, asell as vice versa. A provincial advisory team was set up

o advise on Luapula conditions and practices and tovaluate materials for local applicability. The writingrocess was, however, hampered by communication dif-culties between the writers, the project task force, theuapula advisory team, and the project coordinator; by

ack of access to technical information and informationechnology; and by writers’ unfamiliarity with the pro-osed methodology. Both writers and the project taskorce agreed that the resulting first draft of the materialsor both grade 2 and grade 4 did not fulfill the method-logical brief, particularly with regard to strategies forehavior change in dietary and health practices. Morerecise guidelines and a standard format for both theupil’s Book and the Teacher’s Book were worked out forrade 2 and later developed for grades 4 and 6, as follows.

he Pupil’s Book. Each chapter in the Pupil’s Bookegins with simplified objectives for the chapter (grades 2nd 4). In grade 6, the lesson objectives are expressed asuestions addressed to the learner at the beginning of theesson. Each lesson in the Pupil’s Book contains

–1 to 3 activities accompanied by pictures featuring localscenes and recurring child characters. Grades 4 and 6also include tables, diagrams, and other visuals;

–an “Ask Yourself” question (grades 2 and 4)—a self-check on personal knowledge, attitude, or behavior,with a box in which children keep a brief writtenrecord of their answers, building up a personal profilefrom lesson to lesson. In grade 6 the equivalent“Think and Talk” section airs personal or social con-cerns and issues;

–a “Remember” slogan (grades 2 and 4) summarizing themain message of the lesson and calling on learners togive examples; some are “take-home messages,”which are also given in the local language at the backof the book. In the grade 6 “Share It” section, learnersdecide how to pass on the message and to whom;

–a short text recapitulating the main points of the lessonto serve as a reference;

–homework in which learners find out about food, askquestions at home, carry out actions, and report backin class. Grade 4 also has a small written homeworkassignment, which is expanded in grade 6 to form abasis for portfolio work and continuous assessment;

–(grade 6 only) an interview option on the lesson topicwith a member of the community selected by thelearner. Learners carry out one interview, in pairs, for

each chapter.

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338 Sherman & Muehlhoff/NUTRITION AND HEALTH EDUCATION IN PRIMARY SCHOOLS IN ZAMBIA

Review of the content of each chapter (Grades 2 and 4)onsists of learners recalling the “Remember” messages andiving examples; in Grade 6 the lesson objective questionsre recycled in group discussions.

he Teacher’s Book. This resource guides teachers inheir handling of the lessons, trains teachers in nutrition,nd suggests outreach activities and evaluation procedures.he Introduction outlines the Zambian situation and theethodology and suggests how to involve parents. To re-

nforce the methodology, the grade 4 materials include ahecklist to help teachers make decisions about classroomtrategies. An appendix gives questions and criteria forefore-and-after focus group discussions with pupils to as-ess group learning, and each chapter in grade 6 has a small,ormal exit test as well. Lesson notes for each lesson contain

–a background briefing explaining the situation in Zam-bia, expanding the technical information and sug-gesting potential learning challenges;

–detailed suggestions for carrying out the lessonactivities;

–suggestions for in-class assessment of learning and re-medial work (required by the Zambian CurriculumDevelopment Centre);

–the “event track”: suggestions to the teacher (grades 2and 4) for displays, presentations, projects, and showsthat can reinforce and publicize pupils’ learning atOpen Days and other events. For grade 6 this be-comes a listing of project outlines for class or groups.

The materials for grades 2 and 4 were rewritten in lineith the revised framework above, revised again, reviewedy the Luapula advisory group, revised again, and finallyllustrated.

ield Testing and Evaluation of Grade 2 andrade 4 Materials

rade 2 materials were field tested in 8 schools, urban andural, from 2 Luapula districts, and grade 4 materials in 12chools from 4 Luapula districts. The aims were to establishow teachable the materials were; how well they weredapted to children’s level and cultural expectations;hether they produced observable results in understanding,ttitude, and behavior; and whether the approaches wereppreciated by teachers, parents, and pupils. The findingsre summarized below.

ublication and Launching

fter field testing, both sets of materials were again revised,hen copyedited. The grade 2 Pupil’s Book was translatednto Icibemba (the local language), in line with the Zambia

inistry of Education policy on the use of the home lan- a

uage in schools. The grade 2 materials were submitted forvaluation by the Curriculum Development Centre, revisedgain, approved for use in Zambia, published with thenancial support of the United Nations Children’s FundUNICEF) in Zambia, and launched for use in the whole ofuapula Province. Grade 4 materials have finally beenpproved by the Curriculum Development Centre, and it isoped to launch them in 2007. Grade 6 materials are stilleing developed.

INDINGS OF THE FIELD TESTING OF GRADEAND GRADE 4 MATERIALS

he field testing for grades 2 and 4 was initiated with a-week orientation and training workshop involving teach-rs, head teachers, parent representatives, teacher educa-ors, and education standards officers, to introduce thessues and the materials. The teaching units were thenivided between the participating schools. Field testingrocedures consisted of

–monitoring visits by school inspectors and checks byhead teachers;

–logs kept by teachers (checked by head teachers andmonitors);

–evaluation forms completed by teachers for each lesson(supplemented by monitors’ comments, collected andanalyzed at completion of the field testing);

–focus group discussions with learners and parents beforeand after the lesson program (preprogram and post-program results compared at completion of the fieldtesting);

–a final evaluation meeting of all participants (com-ments recorded).

Field testing conditions were not perfect. Learners wereto a book, and the native-language version of the Pupil’sook for grade 2 was not yet available. In some classes,

here were not enough seats or desks, and children had toneel on the floor.

The reports on both grades concluded that the content,ethods, and approaches of the materials were widely ap-

reciated by teaching staff, head teachers, parents, andupils and were generally suitable for the children’s levelnd culture. Teachers found their lesson briefings “rich” andnformative on nutrition and health issues. The lessons hadaised awareness, improved knowledge, and influencedany behaviors for better nutrition and health within the

chool and at home, not only among children, but also inamilies.

earners

eachers, head teachers, and monitors commented thatearners participated actively in the lessons and freely

sked questions. They noted an increase in confidence,

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Journal of Nutrition Education and Behavior ● Volume 39, Number 6, November/December 2007 339

lertness, and motivation, and improved attendance inome schools. Results of the preprogram and postprogramocus group discussions with children and parents re-ealed that learners were more aware of the importancef variety in the diet; regular consumption of vegetablesnd fruits, beans, groundnuts (peanuts) and fish, redalm oil (a good local source of provitamin A); andreater frequency of meals, including breakfast andnacks. Many more were eating breakfast before comingo school, bringing food to school, and eating moreegetables. However, children reported that the foodtems that were recommended to accompany the staplessuch as beans, groundnuts, and/or fish) were not alwaysvailable or affordable. These are the main high-proteinood items in the local diet that also contain significantmounts of vitamins and minerals. However, they arerequently sold for cash, leaving poorer families withoutufficient stocks for home consumption for half the year.

The preprogram and postprogram focus group discus-ions made it clear that more children understood theature and importance of dirt and hygiene and how tovoid diarrheal diseases. Standards had risen with respecto washing hands and cleaning up. However, in somechools the facilities for proper hand washing were notvailable. There was a noticeable improvement at gradein understanding the causes of malaria, which before

he lessons was attributed variously to washing in coldater or in the lake, not washing, or playing in the rain,s well as to mosquito bites. There was no objectiveheck on the standard of children’s reading and writing,ut both teachers and parents noted that it hadmproved.

amilies

eachers, parents, and head teachers commented in thenal evaluation workshop that links between family andchool had strengthened and that the homework approachncouraged parents’ active participation. Two schools re-orted that parents’ response had been “overwhelming.”arents were providing food to take to school, encouragingand washing, digging rubbish pits, and even building la-rines. Particularly influential were the “Remember” mes-ages, which were often pinned up in homes, becoming aopic of discussion with neighbors and enabling children toemonstrate knowledge and reading skills (the course bookshemselves were not taken home).

Parents said they appreciated the lessons becauseomework kept children busy, children’s reading andriting improved, they were motivated to go to school,

hey now willingly ate vegetables, and other family mem-ers learned through pupils’ homework and the Remem-er messages. Moreover, learners were now more activen household tasks, cleaning the house, covering food,ashing their hands often, and encouraging other chil-

ren to do so. p

ISCUSSIONducational Theory and Practice

he project emphasis on behavior change, learner-enteredness and the holistic idea of nutrition educationet challenges at all stages and from every side.

earning objectives. Objectives were initially de-ived by mapping the needs identified in the situationnalysis onto the classroom curriculum chart in the FAOlanning Guide.25 However, these objectives were too gen-ral to act as blueprints for single lessons (eg, “to be awaref the need of food for growth, health, and activity”). Moreetailed information on beliefs and practices, especiallyarmful ones, in the situation analysis would have led moreaturally into the development of specific behavioral andttitudinal objectives.

It was easy to locate priority needs on the FAO topic-ased curriculum chart, but needs cut across topics, beingoth narrower and more eclectic (eg, enhancing the dietith vitamin-A–rich food items drew on most topics, in-luding food preferences, eating habits, personal health,nd meal preparation). This situation presented no prob-ems for the development of the materials, but it suggestsome structural issues in integrating priority needs in aopic-based curriculum.

Many of the knowledge objectives originally formulatedy writers for individual lessons were verbal, requiringearners to mention/state/name/explain. This widespread as-umption that knowledge is best or mainly learned andemonstrated verbatim needed to be enlarged to otherorms of demonstration. At the same time, verbal accom-lishments such as giving reasons and discussing food pur-hases with vendors needed to become objectives in theirwn right.

eveloping and using the materials. The firstrafts of the materials showed a negative clinical emphasisn disease rather than a positive emphasis on food andating and leaned toward information delivery. Learners’ctivities were generally limited to listening to the teacher,eading aloud, and answering right/wrong questions. Writ-rs did not at first suggest ways of involving family andommunity and were concerned that parents, if asked ques-ions, might give wrong answers. There was some objectiono making lesson objectives explicit to learners. The pur-ose of the reflective “Ask Yourself” activity was queried.hanges were achieved by developing more specific learn-

ng objectives oriented to food behavior; calling on chil-ren’s own ideas and reactions more extensively; using aider range of more exploratory, active, dramatic, andultisensory activities; building in take-home messages andomework that involved families; and incorporating lessonbjectives in the course books.

In class, some lesson elements did not function as

lanned. Reading as an exploration or interactive engage-

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ent with the text tended to be replaced by reading alouddecoding letters into sounds), an approach seemingly ap-roved by writers, teachers, school inspectors, head teach-rs, and parents.33 The “Ask Yourself” activity tended tourn into a class question-and-answer session with no ele-ents of personal reflection or record keeping. An element

f situation analysis was built into the homework feedbackeg, questions on what is done at home), but it was notlear that teachers used this feedback to shape lesson con-ent or saw themselves as learning from learners rather thanimply approving what they had done.

Over the years there has been give-and-take on bothides. Zambian teaching approaches have a lot to contrib-te. More learner-centered and behavior-oriented activitiesave gradually established their own orthodoxy, but it hasaken time.

aterials-led Training

earning effects are more sustainable and cost-effectivehen comprehensive, self-explanatory, procedure-basedaterials are in place. Such “materials-led training” had the

otential of operating at several levels:

–The nutrition briefings in the Teacher’s Book acted asongoing in-service teacher training, while the lessonnotes guided teachers on classroom approaches. How-ever, training in the use of the materials is critical,since teachers tend to ignore activities that do not fittheir habitual practices.

–The FAO Planning Guide was employed not only todevelop the curriculum, but later as an instrument inpreservice teacher training at the College of Educa-tion and for the training of trainers in the basicprinciples of nutrition education and the use of grade2 and grade 4 materials.

–Teacher training manuals can also serve both for train-ing teachers and for more effective training of train-ers, and it is hoped that such a manual for the grade6 teacher training will be produced.

–Children’s course books too were intended to havemore than 1 audience. If they had been taken homeas intended, they would have had much greater im-pact on families, as well as on children. Zambianschools are, however, deeply reluctant to let booksleave the premises, and there are generally notenough books for all the children. As a result, muchclass time was taken up by both teachers and childrencopying out homework and “Remember” messages.After several years of trying to reach agreement onthis issue, it has been concluded that this may besomething which cannot be achieved in the near

future. d

nexpected Spin-offs

ome of the findings mentioned above were unpredicted.arents’ appreciation of improvements in children’s readingnd writing suggested that visible tokens of scholasticchievement quite unrelated to nutrition and health mightlay an important role in gaining family approval. Anothernexpected benefit was children’s help in the home, whicheduced the burden on parents. Involving parents shouldntail some exploration of parents’ motivations as well ashose of children.

he Limits of Nutrition Education

he limits of classroom teaching were clearly illuminatedy the fact that children were unable to carry out some ofhe advice in lessons, in particular to eat more fish, beans,r groundnuts (because the food items were not alwaysvailable, especially for poorer households), and to washheir hands properly (because of lack of water and soap atchool). This situation raises questions about the ethics, asell as the efficacy, of teaching children to do things whichannot be done, and it sends urgent messages about actionor food security outside the school. It confirms the impor-ance of reinforcing school nutrition education messagesith appropriate school-, community-, and home-based

ood, nutrition, and health interventions to enable theesired behavior changes. It will be important to involveead teachers and Parent Teacher’s Associations, ideallyith the help of the FAO Planning Guide, to raise aware-ess of health and nutrition issues and develop a health-romoting school, with an appropriate policy and actionlans.

orking Within the Official Framework

lthough dependence on ministerial procedures sometimeslowed down activities, embedding project activities in theational institutional framework, with a task force of gov-rnment staff, some senior, had many advantages. Thistatus ensured official attention to project activities, facili-ated compliance with official requirements, and gave thentrée to other official activities, such as the nationalurriculum revision process and the establishment of a localurriculum.

The project enjoyed very positive relationships with theational Food and Nutrition Commission and with the

rovincial College of Education in Mansa. It would haveeen useful to have the time to work within the Ministry ofducation to develop other contacts, for example with theational Teacher Education Department, and with otherngoing health and nutrition initiatives, such as the Na-ional School Health and Nutrition program of the Minis-ry of Education in Zambia, and to continue to providenput. For nutrition education to make its mark on chil-

ren’s knowledge and behaviors, strong support will be

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Journal of Nutrition Education and Behavior ● Volume 39, Number 6, November/December 2007 341

eeded for nutrition education at both the national andocal levels, with people of conviction, energy, and com-itment in government positions to champion its cause.

ONCLUSIONS

here is some evidence that gains in awareness, knowledge,nd behavior can be achieved among children and theiramilies with an actively implemented classroom programacked by teacher training and parent involvement, evenn the absence of school-based nutrition and health ser-ices. Homework and specific messages taken home seem toe successful mechanisms for involving parents and fami-ies, but parents’ values and motivations also need to bexplored. The role of good materials, backed by training, isentral; in particular, pupils’ books need to be taken home.

To make projects of this kind both effective and costffective, there is a need for more specific skills-based train-ng of curriculum developers, writers, teachers, and headeachers, especially where the project philosophy does noteflect established educational practice. Above all, class-oom interventions need to be backed by improvements inousehold food security and sanitation infrastructure. It isoped that the experience here and the materials that wereeveloped can help to smooth the path for others under-aking similar projects.

Findings from the field testing were on a small scale,mpressionistic, partial, and short-term. They did not ex-lore teachers’ learning or changes in the school environ-ent. A more systematic evaluation of grade 2 materials,

aunched for use by approximately 8000 learners in 190asic schools in February 2007, will be carried out later inhe year and should extend and refine these first impressionsith more quantitative data. The full impact of the pro-ram, which it is hoped will be evaluated by National Foodnd Nutrition Commission, can only be measured once allgrade levels are in place.

CKNOWLEDGMENTS

he Nutrition Education in Basic Schools project wasunded from 2000 to 2002 by the FAO Technical Cooper-tion Programme under project TCP/ZAM/8923, “Nutri-ion Education in Primary Schools,” and from 2002 to 2007y the Belgian Survival Fund through FAO’s Trust fundroject GCP/ZAM/059/BEL, “Luapula Food Security, Nu-rition Action, and Communication.”

Thanks are due to the many people who have partici-ated in the project, including the FAO office in Lusaka,he project task force, and other officials from the Ministryf Education, the writers, teachers, parents, and children.

The grade 2 Pupil’s and Teacher’s Books can beccessed on FAO’s Nutrition Education website at:

ttp://www.fao.org/ag/agn/nutrition/education_schools_en.stm.

UPPLEMENTARY DATAupplementary data associated with this article can be found

n the online version at www.jneb.org under the label “Add-ns” within the online version of the article.

EFERENCES

1. Drake L, Maier C, Jukes M, et al. School-Age Children: Their Health andNutrition. United Nations Standing Committee on Nutrition, Work-ing Group on Nutrition of School-Age Children. SCN News. 2002;25. Available at: http://www.unsystem.org/scn. Accessed March 3,2007.

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