Nutrition Curriculum For Asia & The South Pacific

Heifer International Nutrition Curriculum:
Asia and the South Pacific
Introduction to Nutrition Training
utrition is the daily intake and utilization of food to support body processes and daily activity. Good nutrition, resulting from an adequate and diverse diet, is the foundation of good health. Poor nutrition results in impaired mental and physical development, reduced ability to fight off disease, increased susceptibility to illness and infections and reduced productivity. Malnutrition is not simply the lack of adequate food intake for the energy requirements for daily activity; it also results from a lack of information about key nutrients and a lack of access to those key nutrients in the diet. Promotion of good nutrition is directly related to Heifers goal of ending hunger and poverty, through Heifers Cornerstone of Nutrition and Income. To increase the impact of Heifers projects in the Asia/South Pacific area, this curriculum was created to: Promote intentional diversification of food production and intake. Increase the intake of food and essential nutrients for children from conception to two years of age, during which appropriate nutrition is critical for cognitive and physical development. Deepen the understanding of basic nutrients and their benefits. Improve safe, hygienic preparation of food items. Nutrition Curriculum 2
Heifer International
Description of the Program

The purpose of this training manual is to provide a foundation for nutrition information to trainers who will share this information with participants in the projects in their specific area. The enhanced knowledge of nutrition intensifies the impact our projects have on the nutrition of the families in the communities we serve in eight countries in Asia and the South Pacific. This nutrition training manual creates a foundation in basic nutrients, maternal and infant nutrition, and safe handling of foods so that members of the Self-Help groups can improve the health of their families and communities. It should be noted that most countries have Food Based Dietary Guidelines which are set by the Ministry/ Department of Health. These guidelines take into consideration the countrys specific priorities and issues related to nutrition. Additionally, the Ministry/Department of Health can often provide additional resources that can support this Nutrition Training Curriculum. Within this manual are suggested agendas for trainings of a variety of lengths and areas of emphasis. Reference information and sample activities are also included for each topic listed in the agendas.
Objectives
Project participants/members of Self-Help groups will: Describe nutrients and diverse sources of nutrients. Examine/describe how to prepare a safe and nutritious meal for improving and/or maintaining good health. Discuss general nutrition requirements for good health. Additional emphasis may be made on the following groups: Sick/recovering children and adults. Individuals with HIV/AIDS. Pregnant and breastfeeding women. Adolescent girls and women of childbearing age. Infants from birth to two years of age.
Tips for Trainers

1) When training adults, be sure to consider that each individual and group of individuals may have different reasons to participate in the training. In order to make your training most effective, consider the following: Motivation Need Interest Perception Desire
Nutrition Curriculum
You might choose to ask about these things prior to the training to help you prepare. You may alternately choose to begin your training by asking participants why they chose to participate. 2) It is important to give participants the opportunity to apply their knowledge. Present the basic information and then allow the participants to engage in activities that use and practice the information that was presented. This also allows them to use knowledge they have gained through life experiences. 3) You will find the most success in changing the behavior of the participants if you emphasize a relationship between knowledge and behavior. For example, when talking about the importance of calcium for strengthening bones and teeth, it is good to describe the benefits for the body (knowledge). It becomes more effective if you say, Consume milk or dairy products three times a day (behavior) to strengthen your bones and teeth. 4) Adults will learn best when you give plenty of opportunities for them to interact with their peers and engage with the information. Active participation prevents boredom and encourages stronger retention of the information. You might consider using the following techniques: Use colorful visual materials. You may find posters and other visual materials through government offices, Ministry of Health or other nutrition-focused NGOs in your area. Use images to show examples of foods or proper washing and cooking procedures. Play games. Create games for your participants to play. Perhaps the participants would like to play a game of charades to demonstrate cooking techniques or how nutritional deficiencies might affect the body. Create teams with participants and challenge them to think of as many green or orange or blue vegetables and fruits as possible. Be creative. Challenge small groups of participants to create and perform short skits to demonstrate how to feed a two-year-old child or a sick family member. Or allow them to create and perform songs about the benefits of iodine and folic acid for pregnant women. If you have supplies for drawing, participants can create posters about how to choose foods for their families or how many servings of each food group should be consumed. Cook together. Plan and arrange for group cooking sessions so that participants can apply and practice skills in safe food preparation. Participants can cook together in pairs or small groups; you may also choose to have a cooking demonstration. If you have time, you can expand this activity to include a trip to the market to select foods, or you may ask each participant to bring a particular food item to the training.
5) You may find that the participants in your training have misconceptions about nutrition. Correct errors respectfully and provide accurate information. It may take time for adults to accept new information if it contradicts something they previously assumed to be correct. Restate information as needed and provide real-life examples when possible. 6) Your training will be much more effective if you allow participants to reflect on the information and how it relates to their particular situation. It is important to create action plans so that participants can begin to practice and use the new information and skills they have gained.
Sn
1.
Major contents
Program review
Time
15-20 min.
Methods
Presentation 1. to group
Materials
Goals/ objectives written on flip chart Agenda of meeting on flip chart Flip chart or whiteboard Markers
Major activities/ process

Welcome group. Review the objectives & agenda.
Notes for the facilitators

If observers or facilitators are present, introduce them to the group.
2.
2. Introductory activity 45 min.
Discussion
3.
4.
Participants share a typical meal that their family eats. Facilitator records food examples on a flip chart & refers to this list later in the training. Introduce role of nutrients for good health, intelligence & a successful future. Show comparative drawings of healthy vs. unhealthy people for each nutrient. Show photos of nutrient-rich foods. Post comparative drawings and foods for each nutrient on wall. Facilitator briefly refers back to list of meals from the introductory activity and compares food visuals on the wall from the previous activity. Facilitator reviews the importance of having a rainbow plate with a diverse selection of foods in each meal and shows examples. Small groups create/ present healthy rainbow plates that include foods from the main categories. Small groups present rainbow plates to large group.
If possible, have every person share what their familys meal would be.
3. Food groups Role of food groups/ specific nutrients in a persons life 1.5-2 hrs
Interactive 5. presentation Discussion questions 6.
Drawings of healthy vs. unhealthy people Photos/ drawings of foods Tape Wall for taping drawings Flip chart with list of foods
Refer to Important Nutrient document and chart for examples of foods. Optional discussion questions are provided if needed.
7. 8.
4.
Specific foods high in important nutrients
1.5-2 hrs
Group presentations Game
9.
Food for rainbow plates should be appropriate for season. If possible, facilitator could prepare a rainbow plate with real food for the group at the end.
Importance of diversification in food production & intake
10. Visuals of rainbow plates 11. Blank rainbow plate templates 12. Markers 13. Photos or drawings of foods to glue to plates (if available)
5.
Cases that require special attention to nutrition
30 min.
Facilitated discussion and presentation of information
14. Discussion questions
Nutrition during illness and HIV/AIDS Nutrition for pregnant women & women who are nursing 6. Importance of improving nutrition for children, birth to 2 years 1 hr Presentation/ timeline
Ask discussion questions to the group. Encourage discus15. Nutrient sion among group. chart for Summarize and people with present information illness or HIV/ from supporting AIDS and documents. pregnant women
Dont forget to remind the group that nutrition during illness is similar to nutrition during pregnancy. Remind group that rainbow plate has these nutrients.
1. Timeline to be made (see example in manual) 2. Tape
Facilitator briefly presents a few statistics and important facts about nutrition for young children using visuals. More specific information about nutrition is presented in a timeline. The timeline starts with a pregnant woman and goes through the 2nd year of her childs life. Examine issues/ challenges around nutrition (access to junk food, gender inequalities, etc.). Discuss ways to overcome these challenges. Facilitator can use 5 Ways document. Facilitator presents information on how to prepare a safe and clean environment for cooking and storing food. Facilitator demonstrates tips on how to properly prepare and cook foods. Participants observe and participate in process.
An example of how to create the timeline is included in manual.
7.
Obstacles connected to nutrition How to overcome obstacles
30 min.-1 hr
Case studies/ discussion
1.
5 Ways to Overcome Obstacles document 5 case studies
2.
Facilitator should find case studies or other documents about local challenges or obstacles to nutrition.
8.
Hygiene and proper food safety
1-2 hrs Presentation demonstration
1.
5 Keys to Safer Food chart Food items Containers
2. 3. 4. 5. 6.
Facilitator can use information from the supporting resources to present information. Consider local food preservation issues when presenting information.
Soap Water Space for cooking
9.
Take action/ reflection
45 min.1.5 hrs
Prepare action plans Brainstorming Discussion
1. 2.
Action plan Nutrition information sheet
Facilitator encourages participants to create individual action plans on what they have learned. They share their plans with the large group. Take-home nutrition information is given to participants.
For another activity, the facilitator could have the individuals in the group create meal plans.
NOTE: This is a tentative schedule for the Nutrition Training. Weve proposed a variety of interactive activities and presentations that will help participants understand nutrition.
We also include a packet of nutrition background information for facilitators to review. This packet will focus on specific topics in more detail and can be used to expand trainings.
O verview of Important Nutrients

M
icronutrients are important in the diet. They help the body create enzymes, hormones and other substances that are vital for growth and development. When a diet lacks the proper micronutrients, the consequences are serious. Iodine, vitamin A and iron are the three most vital micronutrients in terms of global health issues. These micronutrients greatly affect children and pregnant women in low-income countries around the world. Iron deficiency is the most common nutritional disorder in the world. Between four and five billion people suffer from iron deficiency. When a persons diet lacks the proper amount of iron, physical and mental development is severely stunted. As a result, whole populations of people are greatly held back. Iron deficiency is hidden in many ways. When an individual is iron deficient, they have lower energy, lower resistance to infections and a harder time focusing due to impaired motor development. This may look like laziness or confusion to an outsider. A person suffering from iron deficiency may feel tired all the time and is unaware of the reasons why. This is easy to treat though! Families just need to modify their diets to Heifer International Nutrition Curriculum 8
Iron
In developing countries, one in two pregnant woman and about 40 percent of preschool children are estimated to be anemic. In many developing countries, iron deficiency anemia is aggravated by worm infections, malaria and other infectious diseases such as HIV and tuberculosis. Major health consequences include poor pregnancy outcome, impaired physical and cognitive development, increased risk of morbidity in children and reduced work productivity in adults. Anemia contributes to 20 percent of all maternal deaths.
http://www.who.int/nutrition/topics/ida/en/ index.html
Vitamin A
An estimated 250 million preschool children are vitamin A deficient and it is likely that in vitamin A-deficient areas, a substantial proportion of pregnant women are vitamin A deficient. An estimated 250,000 to 500,000 vitamin A-deficient children go blind every year, half of them dying within 12 months of losing
include iron- rich foods. Meat is a great source of iron. Fish, red meat and poultry are all solid choices. Green leafy vegetables such as collard greens and spinach are also iron-rich foods. In addition, eggs, beans, whole grains, nuts, sesame seeds, egg noodles and rice are all rich in iron. Vitamin A deficiency (VAD) is a serious issue in low-income areas around the world. Pregnant women and young children suffer the most. The United Nations estimates that over 100 million children under the age of five suffer from VAD. The results of vitamin A deficiency are severe and sometimes deadly.
When someones diet is severely lacking in vitamin A, this can lead to serious visual impairments such as blurred vision, tunnel their sight. vision, night blindness and total blindness. The leading cause of http://www.who.int/nutrition/topics/vad/ preventable blindness in children is VAD. An estimated 250,000 to en/ 500,000 vitamin A-deficient children go blind every year, half of them dying within 12 months of losing their sight. In addition to vision impairment, vitamin A deficiency increases the risk of disease in children. As a result of vitamin A deficiency, common infections in children, such as diarrheal disease and measles, can lead to death. In order to prevent vitamin A deficiency, families should grow proper fruits and vegetables in their home gardens and purchase certain foods at market. Yellow-orange vegetables and fruits are typically high in vitamin A. Some examples of specific fruits and vegetables that are high in vitamin A include carrots, pumpkins, mangoes, apricots, summer squash, cantaloupe, peaches, sweet potatoes and yams. Many green leafy vegetables are also high in vitamin A. These include lettuce, spinach, kale and broccoli. Additionally, red peppers, asparagus, turnips, milk, liver, cheese, fish, eggs, chicken, pork and beef are all high in vitamin A. Nursing mothers should keep in mind that breast milk is a natural source of vitamin A. Iodine deficiency is the main cause of impaired cognitive development in children around the world. This deficiency can start when children are born and can threaten their mental health and often their survival. When a pregnant womans diet severely lacks iodine, stillbirth or inherited abnormalities such as mental disability can result. Less visible signs of iodine deficiency include extreme fatigue and affect the day-to-day activities at home, school or work. Goiters are also caused by iodine deficiency. When theres a low amount of iodine in the diet, high levels of TSH (thyroid stimulating hormones) are produced. This overstimulates the thyroid gland and leads to swelling in the neck known as goiters. One way to treat iodine deficiency is by adding iodized salt to the diet. Families are encouraged to use iodized salt when cooking their meals. Direct use of iodized salt is the best solution. Foods from the sea, especially seaweed and saltwater fish, contain high amounts of iodine. Egg and dairy products are also good resources. In addition to iodine, iron and vitamin A, individuals should
Iodine
Iodine deficiency is one of the main causes of impaired cognitive development in children. The number of countries where iodine deficiency is a public health problem has halved over the past decade, according to a new global report on iodine status. However, 54 countries are still iodine-deficient.
http://www.who.int/nutrition/ topics/idd/en/index.html
also make sure their diets have plenty of protein and calcium. Protein is a nutrient that is vital for human growth and for the maintenance of tissues and muscles in the body. Nuts, meat, cheese, seeds, eggs, beans and seafood are all high in protein. Calcium is an important mineral that affects our bones. When a diet lacks the proper amount of calcium, frequent bone fractures and bone deformities can result. Dairy products such as milk and cheese are the best sources for calcium. Many suffer from lactose intolerance and therefore have to avoid dairy, but there are other good sources of calcium out there. These include seaweed, nuts, okra, broccoli, kale, soy milk, cabbage, cauliflower and figs. A healthy diet includes a variety of foods rich in the proper nutrients. It is important to focus on foods that have plenty of iron, vitamin A, iodine, protein and calcium. This may seem overwhelming at first, but, as individuals work to create rainbow plates with a diverse arrangement of colors and textures on their plates, reaching a healthy diet will become easier over time. (Note: Provide visual examples of a rainbow plate through Internet searches for foods that are common in the particular regions of the training. You may also find that local nutrition organizations or government agencies can provide these visual resources. The trainer may also be able to gather statistics and facts regarding regional nutrient deficiencies from these same organizations. )
SOURCES: WHO www.who.int/
USDA www.usda.gov/
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N utrition for Women and Girls
ood nutrition affects health status in childhood and beyond. Nutrition and well being of young women and children are particularly important because of their future reproductive roles. Good maternal health is dependent on good nutrition before conception, even during childhood. The health and development potential of future generations can be affected negatively or positively through the nutritional health of their mothers. Male and female children have the same nutritional needs throughout most of their childhood. (For specific information about feeding and nutrition for children from birth to age two, please see section four of this training manual, Infant Nutrition). It is important that girls and boys receive a varied diet that includes protein, fruits and vegetables, grains, milk and dairy products and healthy oils. Adolescent girls who have good nutrition can expect a period of good growth and development. Increased nutritional needs at this juncture relate to the fact that adolescents gain up to 50 percent of their adult weight, more than 20 percent of their adult height and 50 percent of their adult skeletal mass during this period1. However, lacking the appropriate nutrients can have negative consequences. Adolescent girls who do not receive the proper nutrition often experience stunted growth. Stunting is a known obstetric risk factor, which increases the chances of
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Malnutrition poses a variety of threats to women. It weakens womens ability to survive childbirth, makes them more susceptible to infections and leaves them with fewer reserves to recover from illness. HIV-infected mothers who are malnourished may be more likely to transmit the virus to their infants and to experience a more rapid transition from HIV to fullblown AIDS. Malnutrition undermines womens productivity, capacity to generate income and ability to care for their families.
www.prb.org/Articles/2003/NutritionofWomenandAdolescentGirlsWhyItMatters.aspx
needing medical interventions during labor. This may lead to injury or death for the mother or her baby. Adolescent girls need protein, iron and other micronutrients to support the adolescent growth spurt and meet the bodys increased demand for iron during menstruation. It is particularly important that adolescent girls and women of childbearing age should receive adequate levels of iodine and folic acid before pregnancy to ensure proper development of their future children. Women who do not receive enough healthy food will find themselves with low energy and an increased likeliness of becoming ill. Women who do not receive proper nutrition may experience hair loss, loss of menstruation and increased risk of miscarriage. It is possible to reverse these things with good nutrition, but long-term consequences may persist. (For more information about the specific nutritional needs of women who are pregnant or breastfeeding, please see section three of this training manual, Nutrition for Special Cases.)
1https://apps.who.int/nut/ado.htm
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W ater
Health Benefits of Water
Water is your bodys principal chemical component and makes up about 60 percent of your body weight. Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues. Lack of water can lead to dehydration, a condition that occurs when you do not have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired.
How Much Water Do You Need?

Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply. So how much water does the average adult need? In general, doctors recommend eight or nine cups a day.
Factors That Influence Water Needs

Exercise. If you engage in any activity that makes you sweat, you need to drink extra water to compensate for the fluid loss. Environment. Hot or humid weather can make you sweat and requires additional intake of fluid. Nutrition Curriculum 13
Illnesses or health conditions. When you have fever, vomiting or diarrhea, your body loses additional fluids. In these cases, you should drink more water. Pregnancy or breastfeeding. Women who are expecting or breastfeeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing.
SOURCE: http://www.mayoclinic.com/health/water/NU00283
Dehydration
Dehydration occurs when you lose more fluid than you take in, and your body does not have enough water and other fluids to carry out its normal functions. If you do not replace lost fluids, you may get dehydrated. Common causes of dehydration include intense diarrhea, vomiting, fever or excessive sweating. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk. You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment.
Symptoms
Mild to moderate dehydration is likely to cause: Dry, sticky mouth; sleepiness or tiredness; thirst; decreased urine output no wet diapers for three hours for infants and eight hours or more without urination for older children and teens; few or no tears when crying; dry skin; headache; constipation; dizziness or lightheadedness. Severe dehydration, a medical emergency, can cause: Extreme thirst; extreme fussiness or sleepiness in infants and children; irritability and confusion in adults; very dry mouth, skin and mucous membranes; lack of perspiration; little to no urination any urine that is produced will be dark yellow or amber; sunken eyes; shriveled and dry skin that lacks elasticity and doesnt bounce back when pinched into a fold; in infants, sunken fontanels the soft spots on the top of a babys head; low blood pressure; rapid heartbeat; rapid breathing; no tears when crying; fever; in the most serious cases, delirium or unconsciousness.
http://www.mayoclinic.com/health/dehydration/DS00561
Unclean water and poor sanitation is the worlds second biggest killer of children.
http://hdr.undp.org/en/media/HDR06-complete.pdf
Storage of Drinking Water

Keep drinking water in a covered container that is cleaned at least once a week. Do not dip hands or cups into the container. The best container is one with a tap.
http://www.fao.org/docrep/005/y4168e/y4168e20.htm#P324_4726
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About 884 million people do not have access to safe water.

http://www.childinfo.org/files/WatSan_JMP_report_2010.pdf
All water that people drink and use should come from a safe source or be purified. Families have fewer illnesses when they have an adequate supply of safe water and know how to keep it clean and free from germs. If the water is not clean, it can be purified using low-cost solutions at home. It can be: (1) Boiled (2) Cleaned through a filter (3) Purified with chlorine (4) Disinfected with sunlight or other simple measures Other home-based water treatment measures include keeping water in clear plastic bottles in strong sunlight for six hours. Water should be safely stored in a covered container that is clean on the inside and outside. Families and communities can protect their water supply by: lining and covering open wells, installing a hand pump and protecting the immediate area from animals and vandalism; disposing of feces and waste water well away from any water source used for cooking, drinking or washing; building latrines at least 15 meters away and downhill from a water source; keeping jars used to collect and store water as clean as possible by storing them in a clean place, off the ground and away from animals; keeping all animals away from drinking water sources and family living areas; and avoiding the use of pesticides or chemicals anywhere near a water source.
http://www.unicefusa.org/assets/pdf/factsforlife-en-full.pdf
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Nutrient Iron

Benefits
Necessary in red blood cell formation and function Maintains immune system Energy-producing
Deficiency Symptoms
Stunted physical development Stunted mental development Low energy Hard to focus Lower resistance to infections Pregnancy complications Anemia Visual impairments (ex., blurred vision, tunnel vision, night blindness) Increased risk of disease in children
Foods
Meats (red meat, fish, poultry, pork, etc.) Green leafy vegetables (kale, spinach, collard greens, etc.) Eggs, beans, nuts, seeds Whole grains, rice, egg noodles
Vitamin A
Maintenance of normal vision Essential for immune systems Necessary for growth
Yellow-orange fruits and vegetables (ex., carrots, pumpkins, mangoes, summer squash, peaches, sweet potatoes, yams) Green leafy vegetables (spinach, kale, lettuce) Red peppers, asparagus, broccoli Meats (liver, chicken, fish, pork, beef) Milk, cheese, eggs Fresh fruits, especially citrus fruits, Fresh vegetables including lettuce, cabbage, peas and asparagus
Vitamin C
Essential to metabolism, immune systems
Scurvy: fragile connective tissue in body, poor wound healing, bleeding from gums and deeper tissues, changes in brain and nerve function Rickets in children Osteomalacia in adults (both bone disorders) Impaired cognitive development in children Pregnancy complications (ex., stillbirths, inherited abnormalities) Fatigue, mental slowness Goiters
Vitamin D
Regulates calcium, metabolism Important part of thyroid hormones that help with metabolism Helps regulate thyroid glands production of energy
Does not occur in many foods Sunlight exposure Direct iodized salt for cooking and flavoring Foods from the sea (ex., seaweed, saltwater fish) Eggs and dairy products
Iodine
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Niacin
Niacin is a watersoluble vitamin essential in aiding the digestive system, the skin and the nervous system. Helps convert food to energy and reduced cholesterol Vital for human growth Maintenance of tissues and muscles
Pellagra dermatitis in sun-exposed skin, diarrhea, dementia, general weakness, loss of appetite, indigestion
Lean meats, poultry, fish, organ meats Brewers yeast, milk, nuts, legumes, ground nuts
Protein
Fatigue Muscle wasting; muscle cramping Bleeding gums Kwashiorkor (swelling of feet, enlarged liver, thinning hair, loss of teeth, irritability) Inflammation and cracking of lips and corners of mouth Frequent bone fractures Bone deformities Muscle pains, spasms Numbness in hands and feet Bone growth retardation in children Tooth loss
Meats (chicken, pork, turkey, red meats, lamb) Fish, shrimp, clams, oysters Lentils, soybeans, chickpeas, black beans Nuts, cheese, eggs, tofu, soy milk Liver, milk and dairy products Dairy products (ex. milk, cheese, yogurt) Seaweed, nuts, okra (lady finger), broccoli, kale, soy milk, cabbage, figs
Riboflavin (Vitamin B2)
Vital to metabolic processes Development and maintenance of healthy bones and teeth Assists in blood clotting, muscle contraction and nerve transmission Involved in production of energy & maintenance of immune system Immune system support Wound healing Growth and vision
Calcium

Zinc
Growth failure. Weakened immunity Higher risk of diarrhea and pneumonia
Lean meats, liver, eggs and seafood Whole grain breads, cereals
In severe cases of malnutrition, seek care from a doctor or community health clinic. An individuals requirement for different micronutrients depends on age and sex. There are also key periods when micronutrient requirements increase: pregnancy and lactation, early infant and child growth and during certain illnesses. There is a risk of toxicity with excessive intakes of some micronutrients; a high intake of vitamin A, for example, is especially dangerous for pregnant women as damage to the growing baby can occur.
You can navigate to the following from here: Recommended Nutrient Intakes - RNI Minerals & Vitamins [WHO/FAO - 2002].
Supplementary Feeding
There are situations in which the World Health Organization (WHO) recommends supplementation of nutrients through the form of fortified powders and liquids or vitamin pills. Some supplementation may also be accomplished through injections. Some scenarios that require supplementation include: acute malnutrition, pregnancy, infancy and during certain illnesses (TB, diarrhea, HIV/AIDS, respiratory infections). Heifer International Nutrition Curriculum 17
It should be noted that the decision to supplement nutrition beyond foods included in the daily diet should be made with assistance from medical care providers. Correct dosage is necessary and caregivers should follow instructions regarding the administration of these supplements. Such supplements can often be obtained from medical clinics, government health departments or non-governmental health agencies.
Basic Nutrients Discussion Questions

1. 2. What are the favorite vegetables, fruits and meats that your family eats? Which foods that we discussed are easiest to grow and/or get at the market? Which are the hardest to find? Why? What are common illnesses that weve discussed in your own family and community? What do you currently feed your family? What does a week of meals look like? Who gets the healthiest foods in your family? Who gets the least? Why?
3. 4. 5.
Image Examples for Non-Healthy Versus Healthy People: Iron
Protein
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Calcium
Iodine Deficiency
Vitamin A Deficiency
Nutrition for Special Cases Nutrition When Sick

Nutrition for Sick Infants (6 months to 24 months) Children who are sick or are recovering from a recent illness have specific nutritional needs. During illness, continue to feed children and offer fluids more frequently. Breastfeeding infants (under 6 months old) should feed more frequently and for longer periods of time. Their mothers milk provides antibodies and strengthens the immune system. Additionally, it helps to replenish fluids and nutrients lost through diarrhea or vomiting and to prevent dehydration. If an infant is too weak to nurse, pumped breast milk can be given with a spoon or small cup.
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Daily Physical Activity and Food
Older infants (6-24 months old) should also breastfeed more frequently and for longer periods of time. In addition, the child should be offered small meals frequently throughout the day. These meals should offer a variety of food and nutrients, as well as the childs favorite foods. Soft or mashed foods are appropriate for a child who may have difficulty swallowing, but do not dilute the foods or milk with water. The child may need to eat slowly. Do not force eating. Do not withhold foods or liquids. A sick child should be given liquids frequently, at least every one to two hours. For exclusively breastfed infants, breast milk is sufficient at these intervals. For children over the age of six months, other nutritious fluids such as boiled water, soups, yogurt drinks, coconut or rice water and fruit juices should be offered. Do not offer artificially sweetened fruit drinks or sodas. Do not feed a sick child while he or she is lying down. This can cause choking. Hold the child in your lap or in your arms if he or she is too weak to sit. Nutrition for Sick Children and Adults Similar nutrition practices apply for older children and adults who are suffering from illness. A variety of foods should be offered to ensure intake of a variety of nutrients. Food may need to be mashed or soft food may be more appropriate for someone who is having difficulty swallowing. Small but frequent meals Heifer International
Safety Considerations for Feeding Sick Individuals

Respiratory infections can cause a stuffy nose, which may make eating dicult. This is especially the case for breastfeeding infants. Feedings should be slow and the feeder should be very patient and very encouraging. Bottles can be dicult to clean and can harbor harmful bacteria. Feedings should be offered from clean spoons or clean cups, even for infants. (Breastfeeding is still appropriate, even from a sick mother). Do not feed someone who is lying down. This can cause choking. If the sick child or adult cannot sit, hold him or her in your arms or lap. Water used in preparing foods should be boiled or from a source free of contaminants.
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are easier for someone who is sick. Additionally, nutritious fluids should be offered very frequently. This includes boiled water, yogurt drinks, coconut or rice water, soups and fruit juices, but not sodas or artificially sweetened fruit drinks.
No food or liquids should be withheld from someone who is sick.

During Recovery from Illness After illness, it is important to resume a complete diet as soon as possible. Children, especially, may seem more hungry than usual. It is appropriate to feed an additional meal or additional snacks between meals during the recuperation period to help regain weight that was lost during illness. This increased appetite may persist up to two weeks after illness. Adults and children six months of age and older require foods that are rich in nutrition and energy during and after illness to regain strength. These foods include meat, poultry, fish, eggs and milk, when possible, as well as a variety of vegetables and fruits.
Additional resources:
http://www.linkagesproject.org/media/publications/Facts-for-Feeding-Illness_11-21-06.pdf http://www.unicef.org/nutrition/files/Key_Messages_Booklet_for_counselling_cards.pdf
Nutrition and HIV/AIDS

Good nutrition is crucial to maintaining the health and quality of life of individuals with HIV/AIDS. HIV infection lowers the bodys immune system, increasing the likelihood of fever, diarrhea and other infections such as tuberculosis, sore throats and pneumonia. These infections can lower appetites and also interfere with the bodys absorption of nutrients from food. Thus, it is necessary to maintain high-quality nutrition to avoid malnutrition, weight loss and weakness in fighting subsequent infections. HIV/AIDS often results in reduced food intake for a number of reasons1: The disease or the treatments result in lowered appetite Symptoms such as sore mouth and throat, nausea and vomiting make it difficult to eat Isolation and lowered energy make it difficult to prepare healthy foods Less money to purchase food due to money spent on medications or due to inability to work
There are two goals in relation to food intake for people with HIV/AIDS: Maintaining/regaining weight Meeting increased nutrient needs
Tips for maintaining/regaining weight for older children and adults with HIV/AIDS1: Eat staple foods at every meal Increase intake of proteins (meat, poultry, fish, eggs)
1 http://www.fao.org/docrep/005/y4168e/y4168e06.htm#P241_35066
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Increase intake of legumes, nuts and seeds Increase dairy intake (whole fat milk, yogurts, cheeses) Gradually increase fat content of foods with additional fats and oils Add honey, jams and other sweet foods
Important Vitamins and Minerals for People Living with HIV/AIDS

Micronutrient Vitamin A Role
Makes white blood cells essential for vision, healthy skin, mucosa and teeth and bone development. Protects against infection associated with accelerated HIV progression, increased adult mortality, increased mother to child transmission, higher infant mortality and child growth failure. Important for energy metabolism; supports appetite and nervous system functions. Important for energy metabolism; supports normal vision and health and integrity of skin. Essential for energy metabolism; supports health and integrity of skin, as well as nervous and digestive systems. Facilitates metabolism and absorption of fats and proteins; helps to make red blood cells.
Source
All yellow and orange fruits and vegetables, dark green leafy vegetables, alfalfa, liver, oily fish, dairy products and egg yolks.
Thiamine Vitamin B1 Riboflavin Vitamin B2 Niacin Vitamin B3 Vitamin B6
Whole-grain cereals, beans, meat, poultry and fish. Milk, yogurt, meat, green leaves and wholegrain cereals. Milk, fish, eggs, meat, poultry, peanuts and whole-grain cereals. Sweet potatoes, white beans, maize, cabbage, whole-grain cereals, seeds, eggs, leafy green vegetables, alfalfa, bananas, legumes, meat and fish.
Folate
Required for building new cells, especially Liver, red meat, green leafy vegetables, fish, red blood cells and gastrointestinal cells. oysters, legumes, groundnuts, oilseeds, whole-grain cereals and egg yolks. Important for new cell development and maintenance of the nerve cells. Helps the body to use calcium and other nutrients to build bones and blood vessel walls. Increases non-haem iron absorption. Increases resistance to infection and acts as an antioxidant. Important for protein metabolism. Protects cell structure and facilitates resistance to disease. Builds strong teeth and bones. Aids heart and muscle functions, blood clotting and pressure and immune defenses. Ensures the development and proper functioning of the brain and the nervous system. Red meat, fish, poultry, seafood, sardines, cheese, eggs, milk, whole-grain cereals and seaweed. Citrus fruits (such as pomelo, oranges and lemons), cabbage, green leaves, tomatoes, sweet peppers, potatoes and yams. Vitamin C is lost when food is cut up, reheated or left standing after cooking. Leafy vegetables, vegetable oils, peanuts, egg yolks, dark green vegetables, nuts and seeds and whole-grain cereals. Milk, green leaves, shrimp, dried fish (with bones), nuts, beans and peas. Fish, seafood, milk and salt with iodine.
Vitamin B12
Vitamin C
Vitamin E
Calcium
Iodine
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Iron
Transports oxygen to the blood, eliminates old red blood cells and builds new cells.
Red meat, poultry, liver, fish, seafood, eggs, peanuts, beans, some cereals, green leafy vegetables, seeds, whole-grain cereals, dried fruit and alfalfa.
Magnesium
Strengthens the muscles and is important Cereals, dark green vegetables, seafood, nuts for proper functioning of the nervous and legumes. system. Involved in bone development and teeth maintenance. Prevents impairment of the heart muscle. Seafood, liver, meat, carrots, onions, milk, garlic, alfalfa, mushrooms and whole-grain cereals. Meat, chicken, fish, cereals, leafy green vegetables, seafood, oysters, nuts, pumpkin seeds, milk, liver, whole-grain cereals, egg yolks, garlic and legumes.
Selenium
Zinc
Reinforces the immune system, facilitates digestion and transports vitamin A.
SOURCE:
http://www.fao.org/docrep/005/y4168e/y4168e13.htm#P856_100499
Additional Resources:
Breastfeeding and HIV/AIDS: http://www.linkagesproject.org/media/publications/FAQ_HIV_Eng_Update_10-06.pdf http://www.unicef.org/nutrition/index_24827.html
Nutrition for Pregnant and Breastfeeding Mothers

Poor nutrition for pregnant and nursing moms can have consequences on the mothers health as well as the birth weight and early development of her children. Children who are born with low birth weights often face serious short- and long-term health conditions. Low birthweight rates are as high as 30 percent in many developing countries2 . The nutritional care of mothers during the prenatal and postpartum phases is vital for both the children and the mothers. Women should increase their food intake during pregnancy and breastfeeding phases by eating extra snacks in between meals. Women who are underweight before getting pregnant should gain anywhere from 13 to 18kg throughout pregnancy. Overall, women should make sure theyre getting enough calories, proper nutrients and plenty of fluids throughout the pregnancy and breastfeeding phases. There is more demand on their bodies during this time and caring for their own bodies is the best way to care for their children. Women need many nutrients throughout this time in their lives: Vitamin A helps with proper bone and teeth growth for children. Women can get vitamin A from milk, eggs, carrots, spinach, green and yellow vegetables, broccoli, potatoes, pumpkin, yellow fruits and papaya. Vitamin D helps the body use calcium and phosphorus. It also promotes strong teeth and bones. Women can get vitamin D from drinking milk, eating fatty fish and getting plenty of sunshine. Vitamin E helps the body form and use red blood cells and muscles. Women can get vitamin E from vegetable oil, wheat germ, nuts, spinach and fortified cereals. Vitamin C is an antioxidant that protects tissues from damage and helps the body build a healthy immune system. Women can get vitamin C from citrus fruits, bell peppers, green beans, strawberries, papaya, potatoes, broccoli and tomatoes.
2 http://www.who.int/nutrition/topics/feto_maternal/en/index.html
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B vitamins increase energy levels, regulate the nervous system, maintain good eyesight and healthy skin, promote healthy nerves and digestion and help form red blood cells. B vitamins can be found in whole grains, eggs, rice, berries, nuts, legumes, meats, fish, dairy products, soybeans and sunflower seeds. Folic acid helps support the placenta and prevents spina bifida and other neural tube defects. Women can get folic acid from oranges, strawberries, green leafy vegetables, beets, broccoli, cauliflower, fortified cereals, peas, pasta, beans and nuts. Calcium creates strong bones and teeth and helps muscles and nerves function. Women can get calcium from yogurt, milk, cheese, soymilk, juices, breads, cereals and dark green leafy vegetables. Iron helps to prevent anemia, low birth weight and premature delivery. Women can get iron from beef, pork, dried beans, spinach, dried fruits, wheat germ and oats. Protein helps to repair cells and to provide support for muscle growth and development. Women can get protein from red meat, poultry, eggs, dairy products, beans, legumes, fish and nuts.
In addition to foods that pregnant women should take in, there are some foods that they should stay away from: High-sugary foods and drinks provide empty calories that are not helpful for the growth of the baby and the health of the mother. Alcohol should be avoided. When a mother drinks alcohol, it moves quickly through the bloodstream, across the placenta and to the baby. This can increase the risk of miscarriage and stillbirths. The risk of low birth weights also increases. Fetal Alcohol Syndrome occurs when a child is exposed to too much alcohol before birth. This can lead to a life of poor growth and damage to the central nervous system. In addition, they should avoid raw fish and undercooked meat, poultry and eggs.
The best way for a mother to care for her child early on is by caring for herself first. Proper nutrition during the pregnancy and breastfeeding phases is vital for proper growth and development.
Additional Information:
Unicef
www.unicef.org
Mayo Clinic
www.mayoclinic.com
USDA
www.usda.gov/
American Pregnancy Association

www.americanpregnancy.org/
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Nutrients for Pregnant Women and Breastfeeding Women

Nutrient Vitamin A Benefits
Bone & teeth growth for children Maintenance of normal vision
Foods
Yellow-orange fruits and vegetables (ex. carrots, pumpkins, mangoes, summer squash, sweet potatoes, yams) Green leafy vegetables (spinach, lettuce, kale) Red peppers, asparagus, broccoli, turnips Meats (chicken, fish, pork, beef) Milk, cheese, eggs Dairy products (cheese, milk) Fatty fish Getting plenty of sunshine Vegetable oil Wheat germ, nuts, fortified cereals Green leafy vegetables Citrus fruits Bell peppers, green beans, potatoes Broccoli, tomatoes Whole grains, nuts, legumes, soybeans Eggs, meats, fish Berries, sunflower seeds Dairy products Oranges Green leafy vegetables Broccoli, cauliflower, peas Beans, nuts, noodles, fortified cereals Yogurt, milk, cheese Soymilk, juices Breads, cereals Dark leafy vegetables Meat (beef, pork, chicken) Beans, wheat germ, oats Dried fruits Dark leafy vegetables, bitter gourd Red meats, poultry, fish Eggs, nuts, beans, legumes Dairy products
Vitamin D
Helps the body use calcium and phosphorus Promotes strong teeth and bones Forms and uses red blood cells and muscles
Vitamin E
Vitamin C
Antioxidant helps body build healthy immune system Protects tissues from damage Increase energy levels Regulate nervous system Maintain good eyesight and healthy skin Promotes healthy nerves and red blood cells Supports the placenta. Prevents spina bifida and other neural tube defects
B Vitamins
Folic Acid
Calcium
Creates strong bones and teeth Helps muscle and nerve function
Iron
Prevents anemia Prevents low birth weight Prevents premature delivery Repairs cells Provides support for muscle growth and development
Protein
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A few questions to ask in order to start the conversation about special cases where nutrition definitely needs to be addressed: What are some special cases you can think of where a person may need extra care with their nutrition? Are there any illnesses that are common in your community where you think someone may need to improve their nutrition? Do you think that pregnant or nursing mothers would need to pay more attention to their nutrition? Why would this need to be addressed?
Pregnant Women/Breastfeeding Women Nutrition Discussion Questions 1. 2. 3. What are some common birth defects that youve seen in your community? What are some obstacles that breastfeeding mothers and pregnant mothers face when trying to eat healthy? What is a common diet for a pregnant woman? A breastfeeding woman?
Nutritional Guidelines for Infants (Birth Through Two Years)

Birth to Six Months of Age: The World Health Organization and UNICEF recommendations on breastfeeding are as follows: initiation of breastfeeding within the first hour after the birth; exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, nutritionally adequate, age-appropriate, responsive, complementary feeding starting in the sixth month. Benefits of breastfeeding3: Breast milk provides all of the nutrients, vitamins and minerals an infant needs for growth for the first six months; no other liquids or food are needed. In addition, breast milk carries antibodies from the mother that help combat disease. The act of breastfeeding itself stimulates proper growth of the mouth and jaw and secretion of hormones for digestion and satiety. Breastfeeding creates a special bond between mother and baby, and the interaction between the mother and child during breastfeeding has positive repercussions for life in terms of stimulation, behavior, speech, sense of well-being and security, and how the child relates to other people. Breastfeeding also lowers the risk of chronic conditions later in life, such as obesity, high cholesterol, high blood pressure, diabetes, childhood asthma and childhood leukemia. Studies have shown that breastfed infants do better on intelligence and behavior tests into adulthood than formula-fed babies.
3 http://www.unicef.org/nutrition/index_24824.html
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Ideal breastfeeding practices4: Initiate breastfeeding within an hour of birth Exclusive breastfeeding for the first six months (the infant only receives breast milk, not other foods or liquids, even water) Breastfeeding on demand (as frequently as and for the duration the child wants, with the second breast offered after the child releases the first breast) Avoid the use of bottles, teats and pacifiers (to encourage breastfeeding and to avoid infections caused by contaminated bottles, teats and pacifiers) Continue breastfeeding if mother or child becomes sick (breastfeeding protects the infant from illness and does not pass cold, flu or diarrhea germs from mother to child)
Additional information is available:

http://www.linkagesproject.org/media/publications/facts%20for%20feeding//FactsForFeeding0-6months_eng.PDF http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/index.htmlInfant
Formula Feeding (0-6 months)

It is important to promote breastfeeding as the optimum feeding practice for infants. However, there are occasions when breastfeeding is not available, the mother cannot breastfeed or the mother has made an informed choice not to breastfeed (for example, the mother is taking certain medications that are not compatible with breastfeeding, or in the case of HIV/AIDS status of the mother). Some infants are unable to breastfeed (low birth weight, premature birth, birth defects or illness). In this case, if expressed breast milk is not available or is not sufficient in quantity, prepared infant formula is an option.
Risks associated with formula feeding:

Prepared infant formula feeding is expensive. Formula feeding does not provide the same protections from illness and infection as breast milk. In areas where safe, clean water is not available, powdered infant formula feeding puts the infant at risk for waterborne infections. If powdered formula is not prepared with the proper water-to-formula ratios or if quantities of formula are not sufficient, the infant is at risk of severe malnutrition. Feeding utensils that are not properly cleaned put the child at risk for a number of infections. This is especially the case for bottles, which are difficult to sufficiently clean and can harbor dangerous bacteria.
Safe practices for formula feeding: Keep Clean

Wash your hands with soap and water before preparing formula or food, before feeding your child and after going to the toilet. Wash your childs cup or bowl thoroughly with soap and water or boil it. Keep food preparation surfaces clean using water and soap or detergent to clean them every day.
4 http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html
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Use Safe Water

Boil water vigorously for one to two seconds. Then allow to cool before mixing the formula and feeding it to the baby. If the baby does not finish a feeding, give unfinished formula to an older child, drink it yourself or add it to cooked food. Do not keep it until the next feeding. If the formula has not been given to a child, refrigerate prepared formula promptly (preferably below 5C).
Keep Formula and Food at Safe Temperatures:

This information and additional information on formula feeding can be found at:
http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf
Children Six Months to 24 Months of Age:

Breast milk changes in composition, as the child gets older, to accommodate the changing nutritional needs of an older infant. As a child grows, breast milk remains an important, high-quality source of protein, carbohydrates (energy), fatty acids and essential vitamins and minerals. After a child reaches six months of age, it is appropriate to start introducing additional foods to his or her diet. The transition from breastfeeding is called complementary feeding. It generally occurs between the ages of six months to 24 months, though breastfeeding may last longer. This period of time is critical for proper nutrition. Children of this age are especially vulnerable to the effects of malnutrition. The effects of malnourishment at this age are rarely reversed, leaving children unable to meet their potential physically and mentally. Ideal complementary feeding practices5: Continue breastfeeding on demand, even during the night Introduce foods beginning at six months of age Increase amounts and frequency of foods as the child ages, while still breastfeeding (see chart below) Increase food texture and variety as the child grows, being responsive to the childs needs (see chart below) Feed a wide variety of foods to increase micronutrient intake Practice responsive feeding Practice good hygiene
Responsive feeding practices allow parents to nurture their children and to help teach good nutrition practices. Caretakers should help feed infants and should provide assistance to children until they are able to feed themselves independently. Children eat more slowly than adults, so they should be allowed time to eat, without being forced. Adults should talk with children during mealtimes, but should minimize other distractions. Children should be encouraged to try different foods, in different combinations and with different preparations. Good hygiene should always be practiced around meals. Adults and children should wash their hands before
5 http://www.linkagesproject.org/media/publications/FactsForFeeding_6-24months_eng.pdf
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preparing food and before eating. Clean utensils, bowls and plates should be used for serving food. Feeding bottles are difficult to clean adequately and can harbor germs. Infants can be fed with spoons and cups. Food should be served immediately after it is prepared and stored safely afterward to avoid contamination.
Amounts of foods to offer during complementary feeding:

Age Texture
Start with thick porridge, well-mashed foods. Continue with mashed family foods. Finely chopped or mashed foods, and foods that baby can pick up.
Frequency
2-3 meals per day plus frequent breastfeeds. Depending on the childs appetite, 1-2 snacks may be offered. 3-4 meals per day, plus breastfeeds. Depending on the childs appetite, 1-2 snacks may be offered. 3-4 meals per day, plus breastfeeds. Depending on the childs appetite, 1-2 snacks may be offered.
Amount at Each Meala

Start with 2-3 tablespoons per feed, increasing gradually to of a 250 mL cup.
6-8 months
9-11 months
of a 250 mL cup/bowl.
12-23 months
Family foods chopped or mashed if necessary.
to full 250 mL cup/bowl.
Note: If baby is not breastfed, give in addition: 1-2 cups of milk per day, and 1-2 extra meals per day.
Source: http://www.who.int/features/qa/21/en/index.html
Additional resources:
http://www.linkagesproject.org/media/publications/FactsForFeeding_6-24months_eng.pdf http://www.unicef.org/nutrition/index_24826.html http://www.who.int/features/factfiles/nutrition/en/index.html WHO document: Guiding Principles for Complementary Feeding of the Breastfed Child, http://whqlibdoc.who.int/paho/2003/a85622.pdf
Cup feeding as an alternative to bottle-feeding for infants:

Using cups for feeding babies is better than using bottles if they are receiving formula or animal milk, for several reasons: Bottles are harder to clean, so they can be easily contaminated with germs that can make your baby sick. Ear infections are more common with bottle-feeding. Bottles may be propped for babies to feed themselves or given to a young sibling to feed the baby, so babies get less adult attention and social contact when bottle-fed. Cup feeding ensures social contact during feeding.
Steps for cup feeding6:

6 http://whqlibdoc.who.int/publications/2005/9241592494.pdf Card 10
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Clean the cup with soap and water before filling it with milk or formula. Make sure that your baby is awake. Hold him/her sitting upright or semi-upright on your lap. Put a cloth underneath his/her chin to catch any dribble. Hold the cup to the babys lips and tilt it just enough so that the milk touches the lips. The cup rests lightly on the babys lower lip, and the edges of the cup touch the outer part of the babys upper lip. Keep the cup tilted so that he/she can sip the milk. Do not pour the milk or push on the babys lower lip. Let the baby take the milk at his/her own speed. A low birth weight baby starts to take the milk into his mouth with his/her tongue. A full-term or older baby sucks the milk, spilling some of it. You will know the baby has had enough when he/she closes his/her mouth and does not take any more. If the baby does not drink very much, offer him/her more at the next feeding or feed him/her earlier than usual. Look into your babys eyes and talk to him/her to show your love.
Nutrition for Infants Discussion Questions

1. 2. 3. Do you breastfeed? How often? How long in your childs life? Do you offer food to your child at six months? What kinds of food? What are challenges that you face in meeting the needs of infant children?
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Infant Nutrition Timeline

Breast milk Breast milk Thick porridges and well-mashed foods Continue with mashed family foods Breast milk Finely chopped or mashed foods Foods the baby can pick up Breast milk Family foods, chopped or mashed if necessary
BIRTH TO 6 MONTHS
6 TO 8 MONTHS
9 TO 11 MONTHS
12 TO 23 MONTHS
Upon demand (8-12 times in a 24-hour period.) Infants should continue feeding until they release the breast, and then the 2nd breast should be offered to the child.
Breastfeed frequently 2-3 meals and 1-2 snacks daily Initially start with 2-3 tablespoons per meal and gradually increase to approximately 125mL per meal Breastfeed frequently 3-4 meals per day and 1-2 snacks daily 125 mL per meal Breastfeed frequently 3-4 meals and 1-2 snacks daily 200-250 mL per meal
NOTE: After 6 months of age, if a baby is not breastfed, he or she should additionally receive 1-2 cups of milk per day and 1-2 extra meals per day.
Common Obstacles to Good Nutrition

Mothers around the world face many of the same challenges when trying to provide healthy nutrition for themselves and for their families. Some are simply unaware of the right foods to feed their families. Many face the challenge of unequal distribution within their communities and within their own families. Some run into the temptations of junk foods that are easy and cheap to offer their children, while others may not be aware of ways to fulfill their familys needs at home through simple steps like kitchen gardens. There are ways to overcome these obstacles. The first step is addressing the specific obstacles that exist within different communities, and the next step is coming up with community-based solutions. Below are some tips from the FAO that encourage good nutrition and ways to overcome common challenges: Improving nutritional knowledge: Lack of knowledge is an important cause of malnutrition. Nutrition knowledge can, for example, be improved by: Trainings, classes, community meetings Distribution of resources such as pamphlets and posters on nutrition facts Demonstration of proper preparation and cooking of food Encouraging nutritionally good, traditional food habits and discouraging bad ones Teaching mothers practical skills Nutrition Curriculum 31
Improving and increasing food production: Increasing and improving food production is mainly an agricultural problem. The aim should be: Creating plans for having enough food available for all seasons of the year Promoting home gardens with a variety of vegetables and fruits that are high in necessary vitamins and minerals; encouraging the growth of leafy greens, yellow and orange vegetables, fruit trees, etc. Encouraging the increase and improvement of the production and consumption of animal foods by all family members Where appropriate, increasing and improving methods for catching and preserving fish
Improving food distribution: Food should be equitably distributed. More equitable distribution can be achieved by: Working on ways to improve communication between different parts of the community to ensure that excess stock in one area reaches another area that is lacking Encouraging better trading facilities and systems within markets, shops, homes, etc. Promoting equitable distribution within the family to ensure a fair share of food, especially nutritious food, for children and increased supplies of food for pregnant and lactating women Encouraging children to take food to school
Improving food and crop storage: In some developing countries, an estimated 25 percent of all food produced is never consumed by humans. Instead, it spoils or is eaten by insects, rats and other pests. Measures to correct this situation can be taken in fields, households, shops and warehouses. These may include: Controlling pests by using traps and better food storage containers Controlling food rot by storing food in dry, air-tight containers Providing education on safe and hygienic food storage at home
Improving food processing and safety: Proper food processing can ensure that nutrient values of food are maintained at the highest possible levels, that food surpluses are utilized and that food is safe. Suitable measures are: Teaching methods of food preservation in the home and the village (ex. drying/smoking meat and fish, preserving fruits and vegetables, producing cheese) Promoting better cooking methods (ex. less prolonged boiling of vegetables, use of safe water for cooking) Incorporating iodized salt into cooking Providing trainings on food hygiene for households
http://www.fao.org/DOCREP/W0073e/w0073e07.htm#P9622_1151598
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Obstacles to Good Nutrition Discussion Questions

1. 2. 3. 4. 5. What are common obstacles to good nutrition in your community? Do you feel like you know the healthy foods to feed your family? What are challenges for growing a healthy garden at home? Is food distributed equitably in your home? Why? Why not? Do you have challenges of some foods going to waste? Why?
C ase Studies
Not having access to knowledge about proper nutrition Temptation of junk food that is sold at market Nutrition Curriculum 33
elow you will find two examples of case studies that the facilitator can use to discuss common obstacles that participants face with nutrition. The facilitator can make additional case studies of similar lengths based on various obstacles that are common in each particular community. Some obstacles that may be discussed in case studies are:
Challenges of growing healthy gardens Inequitable sharing of nutritional foods within families Pests that get into food and food decay issues Financial struggles that prevent good nutrition
Case Study #1:

Bilkani Sangha was not allowed to breastfeed her son for almost two days until all the colostrum could be squeezed from her breasts and discarded. Instead, Bilkani fed her baby by dipping a cloth into warm goats milk mixed with honey and jungle herbs, then slowly dripped the concoction into her childs mouth. And, as a new mother, she wasnt given any food to eat for three days, just turmeric water, as she went through narak upvas or hell fasting, a purification ritual that left her almost too weak to finally start breastfeeding. Once her fasting was complete, as the youngest daughter-in-law of her family, Bilkani was only allowed to eat after all other family members had taken their portions. Therefore, the only food left was a small amount of rice and cup of lentil soup. When her newborn lost weight, started to kai (vomit) and had paikhana (diarrhea), her family blamed bad luck, not the traditional feeding practices. This was the beginning of a downward spiral into malnutrition for the newborn as he began to fall below the ideal growth norms. However, Bilkani recently joined a Heifer SHG and underwent Cornerstones training and nutrition training. At these trainings, Bilkani realized the importance of breastfeeding and maternal health/nutrition for the overall health of her baby. Her husband also attended Gender Justice training where he learned to value his wife and realize the importance of supporting her nutrition and the nutrition of his daughters. With the support of her family, Bilkani has now begun to get the nutrition she needs as a nursing mother to improve the health of her baby. She has learned the importance and long-lasting effects of proper nutrition for young children and will continue to support the growth of her own kids by working to give them the nutrition they need to grow and succeed.
Case Study #2:

Nguyen Thuy Luong has four children living with him and his wife in Ben Tre, Vietnam. Luong has .25 hectare of land on which his family grows only coffee plants. Immediately after the coffee harvest, Luong spends most of his money on rice for his family and some other basic food products. Rarely could he afford to purchase fruits, varied vegetables, milk or proteins. Additionally, in the off-season when he does not have coffee to sell, Luong must go in search of daily labor, making his income during that time sporadic and uncertain. During those times, meals are usually only once a day and consist of only rice, a small amount of cabbage and fish sauce. Luong is also concerned because his children are small for their age and tend to get sick easily. He is not sure why their health is poor and cannot afford medical fees to diagnose the problem. Luong wanted to provide a better life for his children, but did not know how with his limited resources. Two years ago, Luongs wife joined a Heifer SHG. After the nutrition training provided by Heifer and its project partners, Luongs wife told her husband that in order for their four children to grow strong, smart and successful in their lives, it was critical that they get nutrition from diverse sources while they were still young. For that reason, she asked if she could use a portion of their land for growing a small kitchen garden. Luong was skeptical and reluctant to give up a portion of his coffee land, but allowed his wife to do this since he was grateful for the pigs and chickens that the family had received due to her involvement with the Heifer project. After a few months, the family had begun to grow a variety of vegetables for their own consumption during each different season. The family also
34
now had a regular supply of eggs from their chickens and, occasionally, pork. After several months of eating these diverse, nutrient-dense foods, Luong began to notice a change in his children: their complexion was improved, they had increased energy and ability to concentrate, and they began to grow stronger and more resistant to illness. This self-production also allowed the family to decrease their expenditure on food and use their income for other things such as school supplies and health services for their children. The family is also able to take their extra vegetables and eggs to the local market and gain a small supplementary, steady income year-round on top of what they are earning from their pig and chicken production.
and Proper Cooking
H ygiene, Food Preparation
roper food preparation and cooking involves awareness of the overall hygiene of a home. The most threatened family members are children when it comes to a lack of cleanliness and sanitation. As a result of poor hygiene, they often suffer from diarrheal diseases. Simple actions such as washing hands with soap can cut the risk of diarrheal diseases in half. Families should be aware of proper ways to keep their latrines, sleeping areas, living areas and cooking areas safe and clean. Simple measures taken at home can prevent many illnesses and can lead to an overall improved livelihood for families. Nutrition Curriculum 35
According to the FAO, there are some simple steps that families can take with food preparation and hygiene:
Keep the Home Free from Feces

Use a latrine and keep it clean and free from flies Keep the surroundings clean Wash clothes, bedding and surfaces that might have been contaminated with feces in hot water with soap
Personal Hygiene
Always wash hands with clean water and soap or ashes before, during and after preparing food or eating, and after visiting the toilet Cover all wounds to prevent contamination of food during preparation and handling Use safe, clean water from protected sources. If the water is not from a protected source, it should be boiled for 10 minutes or filtered
Storage of Drinking Water

Keep drinking water in a covered container that is cleaned at least once a week Do not dip hands or cups into the container The best container is one with a tap
Hygiene in the Kitchen

Keep all food preparation surfaces clean. Use clean dishes and utensils to store, prepare, serve and eat food Wash vegetables and fruit with clean water Cover food to keep flies and dust away Keep rubbish in a covered bin and empty regularly
Cooking and Storage of Food

Cover and store food in containers away from insects Throw away any food that has gone bad, or is well past its sell-by date Cook food thoroughly, but do not overcook vegetables Serve food immediately after cooking Store fresh food in a cool place or refrigerator Do not store raw food, especially meat, close to cooked food Avoid storing leftovers unless they can be kept in a cool place or refrigerator. Always reheat them at a high temperature.
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Meat, Poultry and Fish

Cook meat and fish well; meat should have no red juices Wash utensils and surfaces touched by meat, poultry or fish with hot water and soap before preparing other foods Eggs should be hard-boiled. Do not eat soft-boiled eggs, raw eggs, cracked eggs or any foods containing raw eggs
http://www.fao.org/docrep/005/y4168e/y4168e20.htm#P324_47266 UNICEF also offers additional tips and important information in regard to hygiene: 1. All feces should be disposed of safely. Many illnesses, especially diarrhea, come from germs found in human feces. If the germs get into water or onto food, hands, utensils or surfaces used for preparing and serving food, they can be swallowed and cause illness. All feces, including those of babies and young children, carry germs and are dangerous. If it is not possible to use a toilet or latrine, everyone should always defecate well away from houses, paths, water sources and places where children play. The feces should then be buried immediately. Animal feces also need to be kept away from the houses, paths and areas where children play. Latrines should be kept covered and toilets should be flushed. 2. All family members need to wash their hands thoroughly with soap and water. Washing hands with soap and water removes germs. Rinsing fingers with water is not enough both hands need to be rubbed together with soap and water, and then rinsed with water. Soap and water should be placed conveniently near the latrine or toilet. It is especially important to wash the hands with soap after defecating and after cleaning the bottom of a baby who has just defecated. It is also important to wash hands after handling animals and raw foods. Hands should always be washed before preparing and serving or eating food. Children are easily infected with worms, which deplete the bodys nutrients. Worms and their eggs can be found in human and animal feces and urine, in surface water and soil, and in poorly cooked meat. Children should not play near the latrine, toilet or defecation areas. Shoes or sandals should be worn near latrines to prevent worms from entering the body through the skin of the feet.
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3. Washing the face and hands with soap and water every day helps to prevent eye infections. In some parts of the world, eye infections can lead to trachoma, which can cause blindness. Flies carry germs. A dirty face attracts flies, spreading the germs from person to person. If the eyes become sore or infected, vision may be impaired or lost. Eyes must be kept clean and healthy. If the eyes are healthy, the white part is clear, the eyes are moist and shiny and vision is sharp. If the eyes are extremely dry or very red and sore, if there is a discharge or if there is difficulty seeing, the child should be examined by a trained health worker as soon as possible. 4. All water that people drink and use should come from a safe source or be purified. Families have fewer illnesses when they have an adequate supply of safe water and know how to keep it clean and free from germs. If the water is not clean, it can be purified using low-cost solutions at home. It can be (1) boiled,(2) cleaned through a filter, (3) purified with chlorine, or (4) disinfected with sunlight or other simple measures. Other home-based water treatment measures include keeping water in clear plastic bottles in strong sunlight for six hours. Water should be safely stored in a covered container that is clean on the inside and outside. Families and communities can protect their water supply by: lining and covering open wells, installing a hand pump and protecting the immediate area from animals and vandalism; disposing of feces and waste water well away from any water source used for cooking, drinking or washing; building latrines at least 15 meters away and downhill from a water source; keeping jars used to collect and store water as clean as possible by storing them in a clean place, off the ground and away from animals; keeping all animals away from drinking water sources and family living areas; and avoiding the use of pesticides or chemicals anywhere near a water source. 5. Raw or leftover cooked food can be dangerous. Raw food should be washed or cooked. Cooking food thoroughly kills germs. Food, especially meat and poultry, should be cooked all the way through. Germs grow quickly in warm food. Food should be eaten as soon as possible after cooking so it does not have time to collect germs. If food has to be kept for more than two hours, it should be kept either very hot or very cool. If cooked food is saved for another meal, it should be covered to keep off flies and insects and then thoroughly reheated before being eaten. Raw and cooked foods should always be kept separate. Knives, chopping boards and surfaces should always be cleaned with soap and water after preparing raw food. Fruit and vegetables should be peeled or washed thoroughly with clean water, especially if they are to be eaten raw by young children. Fruits and vegetables are often treated with chemicals such as pesticides and herbicides, which can be harmful.
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6. Food, utensils and preparation surfaces should be kept clean and away from animals. Food should be stored in covered containers. Germs on food can be swallowed and cause illness. To protect food from germs: Keep food preparation surfaces clean Keep knives, cooking utensils, pots and plates clean and covered Washcloths used to clean dishes or pans thoroughly every day and dry them in the sun. Wash plates, utensils and pans immediately after eating and put them on a rack to dry. Keep food in clean, covered containers to protect it from insects and animals
http://www.unicefusa.org/assets/pdf/factsforlife-en-full.pdf
Food and Waterborne Illnesses

Food and waterborne illnesses are often preventable through using proper sanitation and cooking techniques. The combined effects of inadequate sanitation, unsafe water supply and poor personal hygiene are responsible for 88 percent of childhood deaths from diarrhea. HIV/AIDS is not a food or waterborne illness. Adequate nutrition and hydration are essential for people living with HIV/AIDS or other illnesses. (See Nutrition for Special Cases for information about nutrition and HIV/AIDs, Nutrition for the Sick and Recovering, and more.)
Common Food and Waterborne Illnesses

Name Salmonellosis Symptoms Fever, headache, nausea, vomiting, abdominal pain and diarrhea Diarrhea, fever and stomach cramps Severe abdominal pain, fever, nausea, diarrhea May lead to chronic health problems including reactive arthritis and neurological disorders Abdominal pain, vomiting, profuse watery diarrhea May lead to severe dehydration and possibly death Fever, muscle aches, flu-like symptoms Diarrhea/gastrointestinal symptoms Contaminated food (raw meat, poultry) Unpasteurized milk products Causes Caused by salmonella bacteria
Shigella
Bacteria pass stools or soiled fingers to mouth via food or water Mainly caused by foods such as raw milk, raw or undercooked poultry and drinking water
Campylobacteriosis
Cholera
Contaminated food and water, ice, under-processed seafood
Listeria
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E. Coli
Abdominal cramps and diarrhea Fever and vomiting Infection may lead to lifethreatening diseases Flu-like symptoms (fever, sweats, headaches, back pain, physical weakness) Can cause chronic symptoms including recurrent fevers, joint pain, fatigue
Undercooked ground meat products, raw milk, fecal contamination of vegetables
Brucellosis
Contact with animals or animal products (unpasteurized milk) contaminated with Brucella bacteria (affects sheep, goats, cattle, deer, elk, pigs, dogs and other animals)
Help prevent foodborne illnesses See: 5 Keys to Safer Food Chart

http://www.who.int/foodsafety/publications/consumer/5keys/en/
SOURCES:
http://www.who.int/mediacentre/factsheets/fs237/en/ http://www.cdc.gov/nczved/divisions/dfbmd/diseases/shigellosis/#catch http://www.who.int/mediacentre/factsheets/fs125/en/ http://who.int/mediacentre/factsheets/fs124/en/ http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm263158.htm ftp://ftp.fao.org/docrep/fao/007/y5740e/y5740e00.pdf
Chemical-Free Vegetable Farming:

Vegetables are important to our daily diet, as they are our major source of vitamins, minerals and dietary fiber. However, improper use of agricultural chemicals, especially the excessive use of pesticides and fungicides in growing vegetables, not only results in residue-contaminated products but also causes environmental problems. Chemical fertilizers and pesticides have the potential to cause damage to the environment and cause harm to the health of adults and children. Long-term exposures can cause immune system suppression; reproductive abnormalities, hormonal disruptions and cancers, as well as causing diminished intelligence and mental function, among other neurological complications.7 These chemicals make their way into food sources, including plantbased and animal-based foods. Further, water in lakes, rivers, streams and ground water becomes contaminated with these chemicals and may affect the growth of plant and animal life in the water sources. Although many environmental impacts are seen over a long period of time, the use of organic fertilizers and pest control methods have many benefits. There is both a proactive benefit for production of crops, as well as a remedial benefit of improving damage caused by chemical based fertilizers and pesticides. These benefits include soil, water and air quality improvements. For human health impacts, the risks caused by chemicals (see above) are reduced, as food sources are less contaminated and direct exposures to the chemicals are decreased. It is important to remember to wash fruits and vegetables, using safe water before eating. This will remove dirt, bacteria and trace pesticides from the food. It is, however, impossible to remove all pesticides from chemically treated foods.
7 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984095/
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Hygiene and Safe Food Discussion Questions

1. What are common/frequent illnesses that your family suffers from? Do you know of ways to prevent these illnesses? What is the hardest part of your home to keep clean? Latrine? Yard? Kitchen area? Why? Where do you get your water? How do you store it? Do you have storage containers for food? Where could you get proper storage containers? Does everyone in your home wash hands after using the latrine? Before mealtime? Do you have challenges getting children to wash hands? How can chemicals affect the health of your food? What are ways that you avoid the overuse of chemicals in growing your food?
2. 3. 4. 5.
6. 7.
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Create an Action Plan

A few questions to ask in order to get the group to think about their action plans:
What are some specific action steps you can take at home in order to improve your familys nutrition? What are specific foods you are going to add to your familys diet when you go home? What are new foods you may grow in your garden when you go home? As a pregnant woman or breastfeeding mother, what are some specific action steps you can take? As a mother, what are some specific steps you can take to improve the nutrition of your children? What are ways you can improve your familys hygiene and help make your food preparation safer at home? What are steps you can take in your home and community to overcome some of the common obstacles that exist? What are some ways you can support others in your community to improve overall nutrition and health? What are some things you can teach others in your community about nutrition? Nutrition Curriculum 42
Take-Home Nutrition Information

*These are suggested materials that the facilitator can collect and give to participants at the end of training. The facilitator can see what nutrition posters and resources are available in local offices (ex, government offices, local nonprofits, healthcare facilities). Types of healthy foods to include in meals with images Types of healthy foods to grow in gardens with images Timeline for Infant Nutrition Hygiene and Safe Food Preparation Tips Poster of rainbow plate example Chart that shows the proper amounts of food items to include in diet
Relating Knowledge and Behaviors

It is important to emphasize behavior change, as well as sharing information regarding healthy nutrition. The following action-oriented messages are from the FAOs Regional Consultation on Food-Based Dietary Guidelines for countries in the Asia Region8 .
Infant and Young Child Nutrition

Age group: birth to two years Early initiation of breastfeeding (within one hour of birth) Exclusive breastfeeding for first six months Continue breastfeeding for at least two years and beyond Start complementary feeding in small quantities of semi-solid food from six months of age Introduce one food at a time for at least five to seven days for a child to adjust to it Select food from all food groups for complementary feeding Use only iodized salt for cooking A one year old child should be eating a modified family diet at least three times per day The child should be eating cups of food at each meal (each country can use their own measure for portions. One cup is equivalent to approximately 200 mL) Prepare complementary food hygienically using safe drinking water
Age group: two to five years Children have to be encouraged to eat on their own At least two servings of milk and milk products should be included in their diet daily A child should be given at least three meals and two snacks daily Include green, leafy and yellow and orange vegetables and fruits daily
8 http://www.fao.org/ag/humannutrition/32037-05d2b5da1c3475eeeb7925b948108c430.pdf
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Discourage high sugar and high fat foods such as candies, sweetened drinks, chips, etc. Proper feeding will ensure desirable growth and development of the child
School Age and Adolescent Nutrition

Age group: six to 12 years Eat a variety of foods Eat three meals and two snacks daily Include green, leafy and yellow and orange vegetables and fruits daily Avoid high sugar, salt and fat foods such as candies, sweetened drinks, chips, etc. Eat clean and safe foods Avoid caffeinated beverages Promote a healthy lifestyle
Age group: 12-18 years Eat a variety of foods Eat three meals and one snack daily All children, especially girls, need iron-rich foods daily (egg yolk, fish, liver, green leafy vegetables, sprouts, beans, red meat) Include green, leafy and yellow and orange vegetables and fruits daily Avoid high sugar, salt and fat foods such as candies, sweetened drinks, chips, etc. Eat clean and safe foods Promote healthy lifestyle Avoid smoking and alcohol consumption
Adults and Females of Childbearing Age

Eat and enjoy a variety of foods; at least three meals a day Consume clean and safe food Achieve and maintain a healthy weight Eat plenty of vegetables and fruits every day Eat staple cereals in an unrefined form whole grain, minimally processed Consume legumes, lean meat and/or chicken and/or egg, and/or fish, and/or milk or milk products every day Use an adequate amount of fats/oils in good combination in the diet Use iodized salt Restrict the amount of sugar and salt intake Practice healthy lifestyle/exercise regularly/do not smoke, limit intake of alcoholic beverages
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Drink plenty of safe, clean and potable water
Pregnant and Lactating Women

Restrict the amount of sugar and salt intake Drink plenty of fluids Have more protein foods and more vegetables Practice healthy lifestyle/exercise regularly/do not smoke or drink alcoholic beverages Pregnant and lactating women should follow the Food-Based Dietary Guidelines with extra focus on foods of animal origin and green, leafy vegetables Breastfeeding should start immediately after delivery and should continue exclusively for six months and continue up to two years
Chronic Diseases and Diseases of the Elderly

Achieve and maintain healthy weight Include physical activity in daily routine Consume a variety of foods Restrict intake of fried foods Use vegetable oils in moderation for cooking Avoid sweetened foods Consume whole grains and legumes Consume more naturally colored fresh vegetables and fruits Use salt, sauces and monosodium glutamate sparingly Drink an adequate amount of clean water
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Sample - A Heifer International Nutrition Training ACTION PLAN Timeline Set goals/activities Starting date Completion date or continuing Means of verification/ proof of completion of activities
Individual Level
Family Level
a SHG/ Community Levels b
Name of participant(s) : Name of SHG:
Signature of participant(s): Goal set date:
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Sample - B Heifer International Nutrition Training ACTION PLAN Timeline Set goals/ activities Starting date Completion date or continuing Name of participants Signature of participants
1.
2.
3.
4.
5.
Name of SHG :
Goal set date:
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the Nutrition Curriculum

Vaccinations9
O ptional Information to Enhance
The following sections contain information that you may use to enhance the quality of your program or heighten the interest of participants.
Immunization is key to achieving the Millennium Development Goals (MDGs), especially the goal to reduce deaths among children under five years of age (MDG 4). Vaccines prevent more than 2.5 million child deaths a year. Available vaccines could prevent an additional two million deaths a year among children under five years of age. The introduction of new vaccines against pneumococcal disease and rotavirus could have a rapid impact within three to five years on reducing the high toll of sickness, disability and deaths among children under 5 years of age. Over 100 million children are immunized every year before their first birthday. Around 24 million children under the age of one nearly 20 percent of the children born every year are not being reached with vaccines.
Source: http://www.who.int/immunization/sowvi_key_messages_chapter1/en/index.html
9 http://www.who.int/immunization/sowvi_key_messages_chapter1/en/index.html
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THE BIG SIX CHILDHOOD DISEASES (all preventable with vaccines)10

Measles can spread rapidly among children who are not immunized. When it doesnt kill, measles can cause permanent disabilities, including blindness, deafness and brain damage. Pertussis, or whooping cough, is also highly contagious. It sometimes results in death but more often, in prolonged and exhausting bouts of coughing that may continue for up to three months. Tetanus is caused by naturally occurring bacteria that enter the body through open wounds. It is nearly always fatal. Diphtheria is a bacterial infection that spreads through close contact. Even with treatment, one in 10 infected people die from the disease. The infection can also damage the heart and nervous system and, in tropical environments, the skin. Tuberculosis is one of the leading causes of adult deaths worldwide. The existing vaccine is effective in preventing some of the most dangerous forms of the disease in children. Polio is a viral infection that can result in permanent paralysis.
Source: http://www.unicef.org/immunization/files/Vaccines_Care_eng.pdf
Tables with vaccine schedule:

http://www.who.int/immunization/policy/Immunization_routine_table1.pdf http://www.who.int/immunization/policy/Immunization_routine_table2.pdf
10 http://www.unicef.org/immunization/files/Vaccines_Care_eng.pdf
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Cornerstones and Nutrition Connections Cornerstone Connections to Nutrition/Possible Discussion Points

P assing on the gift Just as POG is a commitment/investment in the community, so too is nutrition a commitment and investment in the health of the community, in future generations and in childrens potential. Nutrition can be an area of focus for PSRP; community members roles in helping one another diversify food choices. Healthy feeding is a form of caring for children, sick people and vulnerable members of the community; community members roles in helping one another diversify food choices. Diversification of garden/livestock allows for diversity of income and nutrients less dependence on markets for food in diet.
A ccountability S haring and caring
S ustainability and self-reliance
I mproved animal management Animals are more productive with good nutrition and the same is true for people. Special diets/nutrients and fluids for pregnant/lactating livestock like pregnant/lactating women. Importance of diet in recovery from illness for animals and for people. N utrition and income This Cornerstone focuses on nutrition; any topics related to nutrition are relevant. Diversification of garden/livestock allows for diversity of income and nutrients. Nutrition and income are bi-directionally related: low income results in less food consumed, lower quality and less diversity of nutrients AND poor nutrition/health results in less energy/ability to work and get an education. Right to access healthy foods; needs vary from family to family and person to person. Different nutritional needs for different family members; importance of nutrition for the intellectual and physical development of children; importance of nutrition for pregnant and nursing mothers (and the baby); effects of malnutrition on children, specifically girl children. Diversification of gardens, rotation of crops results in healthier soils, as well as diverse diet for people. Important for all members of the community to learn about nutrition and commit to improving the diversity of the diet. Importance of participating in nutrition training/access to nutrition training. Foods used in celebrations, rituals.
G enuine need and justice G ender and family focus
I mproving the environment F ull participation T raining and education S pirituality
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Q uotations:
One of the first duties of the physician is to educate the masses not to take medicine. Sir William Osler Life isnt simple. But the beauty of it is, you can always start over. Itll get easier. Alacia Bessette Eat breakfast like a king, lunch like a prince and dinner like a pauper. Adelle Davis Tell me what you eat, and I will tell you what you are. Anthelme Brillat-Savarin There is no love sincerer than the love of food. George Bernard Shaw The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition. Thomas Edison Our food should be our medicine and our medicine should be our food. Hippocrates To eat is a necessity, but to eat intelligently is an art. La Rochefoucauld He that takes medicine and neglects diet wastes the skills of the physician. Chinese proverb Unfortunately, everything the experts tell us about diet is aimed at the whole population, and we are not all the same. The Scientist magazine The greatest wealth is health. Virgil Today, more than 95 percent of all chronic disease is caused by food choice, toxic food ingredients, nutritional deficiencies and lack of physical exercise. Mike Adams Those who think they have no time for healthy eating will sooner or later have to find time for illness. Edward Stanley Take care of your body. Its the only place you have to live. Jim Rohn Your body is a temple, but only if you treat it as one. Astrid Alauda Our bodies are our gardens our wills are our gardeners. William Shakespeare If hunger is not the problem, then eating is not the solution. Anonymous I saw few die of hunger; of eating, a hundred thousand. Benjamin Franklin The King who cannot rule his diet will hardly rule his realm in peace and quiet. Passage from the Rule
of Health of Salerno
The wise man should consider that health is the greatest of human blessings. Let food be your medicine. Hippocrates
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Nutrition Curriculum For Asia & The South Pacific

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Nutrition Curriculum For Asia & The South Pacific

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Heifer International Nutrition Curriculum:

Asia and the South Pacific

Introduction to Nutrition Training

Description of the Program

Tips for Trainers

Major activities/ process

Notes for the facilitators

2. Introductory activity 45 min.

Interactive 5. presentation Discussion questions 6.

Specific foods high in important nutrients

Group presentations Game

Importance of diversification in food production & intake

Cases that require special attention to nutrition

Facilitated discussion and presentation of information

14. Discussion questions

1. Timeline to be made (see example in manual) 2. Tape

An example of how to create the timeline is included in manual.

Obstacles connected to nutrition How to overcome obstacles

Case studies/ discussion

5 Ways to Overcome Obstacles document 5 case studies

Hygiene and proper food safety

1-2 hrs Presentation demonstration

5 Keys to Safer Food chart Food items Containers

Soap Water Space for cooking

Take action/ reflection

Prepare action plans Brainstorming Discussion

Action plan Nutrition information sheet

O verview of Important Nutrients

SOURCES: WHO www.who.int/

N utrition for Women and Girls

How Much Water Do You Need?

Factors That Influence Water Needs

Storage of Drinking Water

About 884 million people do not have access to safe water.

Essential to metabolism, immune systems

Riboflavin (Vitamin B2)

Growth failure. Weakened immunity Higher risk of diarrhea and pneumonia

Basic Nutrients Discussion Questions

Image Examples for Non-Healthy Versus Healthy People: Iron

Nutrition for Special Cases Nutrition When Sick

Daily Physical Activity and Food

Safety Considerations for Feeding Sick Individuals

No food or liquids should be withheld from someone who is sick.

Nutrition and HIV/AIDS

Important Vitamins and Minerals for People Living with HIV/AIDS

Thiamine Vitamin B1 Riboflavin Vitamin B2 Niacin Vitamin B3 Vitamin B6

Reinforces the immune system, facilitates digestion and transports vitamin A.

Nutrition for Pregnant and Breastfeeding Mothers

American Pregnancy Association

Nutrients for Pregnant Women and Breastfeeding Women

Nutritional Guidelines for Infants (Birth Through Two Years)

Additional information is available:

Formula Feeding (0-6 months)

Risks associated with formula feeding:

Safe practices for formula feeding: Keep Clean

Use Safe Water

Keep Formula and Food at Safe Temperatures:

Children Six Months to 24 Months of Age:

Amounts of foods to offer during complementary feeding:

Amount at Each Meala

Family foods chopped or mashed if necessary.

to full 250 mL cup/bowl.

Cup feeding as an alternative to bottle-feeding for infants: