The 2012 Global Hunger Index estimates that South Africa is ranked 9th in the world for highest

hunger levels.[1] 15% of South African infants are born with a low birth weight.[2] 5% of South African children are so underweight they are considered to be wasted.[2] Since the 1990s South Africa's malnutrition problem has remained fairly stable.[2] It is estimated that South Africa loses about US$1.1 billion every year in GDP to vitamin and mineral deficiencies arising from malnutrition, although it would only cost an estimated US$55 million to alleviate this problem through micronutrient nutrition interventions.[2] The prevalence of malnutrition in South Africa varies across different geographical areas and socio-economic groups.[2] There are certain factors, like a lowprotein diet or a reluctance to breastfeed, that make certain South African individuals more susceptible to malnutrition than others.[3][4] Malnutrition can cause several different health problems, like anemia and pellagra.[5][6] The specific consequences of malnutrition vary depending on the individual and the specific nutrients the individual's diet is lacking. Malnutrition has developed to a large extent as a result of the widespread poverty and inequality caused by the period of apartheid in South Africa. South Africa's Department of Health has established various special programs and initiatives, like the Integrated Nutrition Program, to combat the detrimental effects of malnutrition.[7] All programs and initiatives have faced copious challenges and their individual success rates vastly vary as a result. Prevalence of Malnutrition in South Africa The article Agreement on Defining Malnutrition defines malnutrition as affecting individuals whom "food and nutrient intake is consistently inadequate to meet individual requirements."[8] By the standards of this definition, malnutrition is a prevalent problem in South Africa. In the year 2000, 39% of the country's population suffered from malnutrition.[5] Children are the most affected by this problem, especially young children. South Africa's problem of malnutrition is unique to other countries' malnutrition problems because South Africa is a primarily young country, with one third of the population being under the age of 15.[9] Thus, the fact that 25% of pre-school children and 20% of primary school children in South Africa suffered from malnutrition in the year 2000 means that the future population of South Africa is being endangered by the problems of malnutrition[5] The problem of malnutrition in South Africa can be individually assessed through the deviation of weight of each child from the average weight for their age. According to the World Health Organization, the deviation from the average weight of children under age five in South Africa has dropped from 31.5% to 8.7% from 1994 to 2008.[10] Malnutrition can also be individually assessed through the deviation of height of each child from the average height for their age. This is because malnutrition stunts growth.[11] The World Health Organization showed that over the span of thirteen years (1995 to 2008), the deviation from the average height of children under age five in South Africa has slightly decreased from 28.7% to 23.9%.[12] These decreases in deviation show that the problem of malnutrition in South Africa has decreased over recent years. However, it remains a prevalent problem, notably in the regions of Eastern Cape and the Limpopo Province. These two areas are especially poor and rural as compared to the rest of South Africa. According to UNICEF, although 84.5% of South Africans have access to piped water, only 62.4% of Eastern Cape residents have access to piped water.[13] Also, although only 13.6% of South African households have no toilet facilities, 30% of Eastern Cape residents lack toilet facilities.[13] Similar statistics are true for the rural areas of the Limpopo Province in northern South Africa. The prevalence of malnutrition in Limpopo is so vast that 48% percent of children in the Limpopo Province evaluated in a 2005 study were shown to have stunted growth.[14] Thus, the high levels of poverty and the rural state of these two areas reflect back through high levels of malnutrition. Development of Malnutrition in a South African Individual An individual in South Africa may develop malnutrition because of several factors, not all of them necessarily having to do with diet. According to UNICEF, factors that can cause malnutrition include but are not limited to stress, trauma, poor psychological care, neglect, and abuse.[15] For example, a woman with psychological problems may not have the cognitive abilities to recognize that she needs to feed her children, and thus may neglect to do so, causing her children not to obtain the sufficient nutrients they need to thrive. However, even mothers with full cognitive abilities may still cause their children to suffer from malnutrition by not partaking in breastfeeding. Breastfeeding and Malnutrition Breast milk contains many vital nutrients and minerals that protect against infant mortality.[16] Many infants in Africa suffer from malnutrition because their mothers do not breastfeed them. The mothers in South Africa that do not breast feed their children do not do it mainly to try to avoid the possibility that in doing so, their children may contract AIDS.[3] The 2010 South Africa Department of Health Study found that 30.2% of pregnant women in South Africa have AIDs.[17] Thus, these women pose a huge risk to their infants because infants drinking breast milk infected with the HIV virus may contract the virus as well.[3] Infants with the HIV virus are more likely to pass away if they are breast fed than if they are formula-fed.[3] A study published in the Journal of the International AIDS Society found that the mortality for infected infants was 19% for exclusively breast-fed infants, 13% for mixed-fed infants, and 0% for formula-fed infants.[3] Thus, many conflicted South African mothers are faced with the morally difficult decision of whether to prevent malnutrition in their children by breastfeeding them at the risk of them contracting HIV, or preventing HIV in their children at the risk of them not being properly nourished. Because the health cost of not breastfeeding a child is not widely known, most South African women chose the latter option and turn to baby formula to replace breast milk as the main nutritional source for their infants. In fact, according to the South African Demographic Health Service, out of all 3-month-old babies in South Africa, only 10% were exclusively breast-fed and 48.3% were bottle-fed.[15] The formula readily available to the average South African woman does not provide the sufficient nutrients necessary to sustain an infant when utilized by itself. Thus, many infants are not provided with the necessary nutrients they need to thrive, and this can lead to severe cases of malnutrition. The first two years of a person's life constitutes the most vulnerable period for malnutrition, making this lack of nutrients especially detrimental to an infant's health.[18] However, the problem of malnutrition isn't simply solved by a mother choosing to breastfeed her child. Many infants who are breastfed have mothers who are severely undernourished themselves. If a mother doesn't have sufficient nutrients for herself, she is much less likely to have sufficient nutrients in her breast milk. Thus, breast milk from undernourished women is often lacking sufficient quantities of several vital vitamins and minerals like vitamin B6 and folic acid.[19] This lack of nutrients can lead to a nutritional deficiency in the child being breastfed as well. Additional Factors Malnutrition may also be caused by physical and psychological trauma.[20] These types of trauma are often brought on by personal, political, economical and social unrest, which is not uncommon to South Africa.[20] Trauma increases the body's need for certain nutrients. (i.e. Vitamin C)[20] It can also cause the body difficulties in digesting food properly.[20] In addition to that, it may have a detrimental effect on the immune system.[20]

Another main determinant of malnutrition is culture and lifestyle.[4] Various rural South African groups lead agricultural cultivation-based lifestyles that only allow them to live on the very limited amount of resources given to them by their land. The food resources they have access to lack several vital nutrients, making malnutrition among these people more prevalent than among pastoral people and other people with more animal-based diets. In comparison to the average American diet, rural South African groups like the South African Bantu consume a diet with less than half of the fat content.[21] A lack of fat often accompanies a lack of protein. A lack of protein in a South African's diet can lead to a form of severe malnutrition know as "kwashiorkor."[22] Research was done to compare the frequency of kwashiorkor among five African groups: the Maasai, the Kikuyu, the Batussi, the Bahutu, the Pieraerts, and the Wakamba.[22] The Masai are pastoral people who consume milk and on occasion, meat. The Wakamba, Kikuyu, and Bahutu are non-pastoral agricultural people who cultivate the foods that they eat. The Batussi people are livestock raisers who consume large amounts of curdled milk. The Pieraert people are lake-side dwellers who consume fresh fish and dried fish. The research found no incidences of kwashiorkor among the Masai, Batussi, the Pieraert, and a small part of the Bahutu who in addition to vegetables and grains, also cultivate beans.[22] However, numerous incidences of kwashiorkor were found among the Wakamba, Kiyuku, and solely grain and vegetable-consuming Bahutu.[22] This shows that South African people who have an agricultural cultivation-based lifestyle are at high risk for malnutrition. In addition to those living in desolate, rural areas, those living in South African slums and other poverty-stricken conditions also only have access to a high-starch, low protein diet.[21] The typical undernourishing South African diet is based on the main staples of rice, porridge, and maize.[21] Malnutrition and Poverty Malnutrition is an underlying cause of severe poverty.[4] According to statistics from the year 2000, 50% of the South African population is under the poverty line.[40] South Africa's per capita GDP is only $11000 dollars, and 21% of people live on a dollar or less a day. In 2008, 27.9% of youth between ages fifteen and twenty-four were unemployed, and the amount of overall unemployment was even higher (33.2%).[41] The unemployment rate partly stems from South Africa's unstable macroeconomic status that regardless of modern attempts, is yet to be effectively controlled. The nation-wide economic instability causes income instability for many Africans, which is reflected in a drop of food and beverage purchases. Statistics have shown the percentage of South African incomes being spent on food and beverage purchases have dropped drastically from 27.4% in the year 2000 to 16.6% in the year 2005.[42] These statistics are reflected in poverty-stricken South African households, where the main food providers have to change their food consumption patterns to cope with economic instability. [4][43] This is a detrimental change that compromises nutrition.[4][43] Apartheid: A Brief History of Poverty and Inequality in South Africa According to 2008 statistics, South Africa has the third most unequal economy in the world.[44] The widespread poverty in Africa can be traced to many factors, one of the most prominent being Apartheid. UNICEF states that the main causes of malnutrition are household fo od insecurity, inadequate care for the vulnerable groups such as maternal and childcare, insufficient essential human services including health, education, water and environmental sanitation and housing.[4][45] According to the effects of South African Apartheid listed in the World Fact Book, Apartheid has helped create many of these issues, especially housing, healthcare, and education. Issues like education (i.e. poor performance in school, poor cognitive development) are directly connected to malnutrition in children.[43] South Africa is unique from other African countries in its particular experience with Apartheid and colonialism.[40] South Africa has numerous rich natural resources like diamonds and gold, yet it has the number one highest death rate in the world (17.23 out of 1000 people die annually).[46] When diamonds and gold were discovered in 1867 and 1886, instead of causing widespread richness for the African people, it caused widespread subjugation to the Boers (Dutch Settlers).[47] Upon their arrival, the Dutch forced black farmers to either abandon their land, become share-croppers, or become farm laborers.[40] Subjugation from non-native groups continued until South Africa became a Republic. This long period of subjugation eventually lead to the establishment of Apartheid in South Africa in 1948 by the National Party ( the ruling political party of the time).[43] In the 1960's, the Apartheid-centered government created African reserves where blacks could live and have a chance at "separate development."[40] Although the majority of South Africans were (and continue to be) black, the reserves compromised a disproportionally small amount of land (13% of South Africa).[40] The reserves were geographically isolated and had poor healthcare, infrastructure and irrigation.[40] Although the first multiracial election in 1994 brought an immediate end to Apartheid, the detrimental effects of Apartheid in South Africa continue to be felt today.[47] The poorest South African provinces today are those that encompass former African reserves. ( Eastern Cape, Limpopo Province, and Kwazulu-Natal).[40] These places are especially known for their higher rates of malnutrition as compared to the already high rates of South Africa. While 72% of the South African population considered poor live in rural areas, 86.9% of the chronically poor in Kwazulu-Natal live in rural areas.[40][48] Whereas people in wealthy urban areas tend to have a better nutritional status, rural and agriculturally-based people in South Africa tend to have the most inadequate diet.[4][43] This is because while wealthy urban residents have access to better education and food, their rural, chronically poor counterparts are less educated, have lower literacy levels, and have limited food access.[4][40] In 1997, 900,000 households that were located in formal reserves had no arable land access, 1.4 million had no access to any livestock besides chickens, and 770,000 households had access to neither arable land or other livestock.[49] Unfortunately, many of the rural households that did have access to livestock had to sell the livestock in order to alleviate poverty.[50] All this results in a severe shortage of food among the rural poor, thereby leading to a shortage of nutrients.[4] Combating Malnutrition: Efforts and Challenges Since the 1990s, the first Millenium Development Goal of the United Nations has been to eradicate world hunger and malnutrition. According to the United Nations, there are certain steps that could be especially beneficial in combating malnutrition.[4] It is estimated that by simply increasing Vitamin A and C intake along with improving breastfeeding methods, the lives of 2.4 million children throughout the world could be saved annually.[51] Various programs in South Africa have been established since then to help achieve this, all with different success rates. The Integrated Nutrition Program In accordance with the goal of the United Nations, the South Africa Department of Health established the Integrated Nutrition Program in 1995.[7] The INP aims to mainly help the people most prevalently at risk for malnutrition: children six years old and under, pregnant women, and lactating women. The main foci of the INP are breastfeeding promotion, growth monitoring and promotion, food fortification, micronutrient supplementation, hospital-based management

of severe malnutrition, nutrition rehabilitation in communities, and nutrition management during illness.[7] The INP addresses these foci through nutritional education, nutrition counseling services and support for specific ailments, and indirect provision of healthcare services.[7] Since the establishment of the INP in 1995, South Africa has adopted the International Code of Marketing of Breast-milk Substitutes to promote breastfeeding.[52] The code was cofounded by the World Health Organization and UNICEF during the thirty-third World Health Assembly.[53] It aims to provide nutrition to malnourished infants through the facilitation of breast-feeding and proper use of breast-feeding substitutes only when absolutely necessary. Unfortunately, there has been a delay in the legislation of the code. If it does get passed, it will need to promote intensive training that follows along the national breastfeeding guidelines for health workers, so that they can reach out to individuals that are doubtful of the benefits of breastfeeding their children.[7] It will also need to promote the extension of maternity leave benefits to give working South African mothers sufficient time and resources to breastfeed.[54] The INP has implemented growth monitoring in South Africa through the following measures: the provision of growth cards to all caretakers of children under two years old, the constant monitoring of growth and detection of malnutrition, the provision of counsel to caretakers, and the promotion of growth.[52] However, there are various shortcomings in Africa's approach to growth monitoring and promotion. These include inaccurate weight assessment, lack of weight plotting, nurses not trained sufficiently to detect malnutrition, inability to supply growth cards to all infants, and lack of sufficient communication with caretakers.[55] In order to directly address nutrient deficiencies, the INP established a mandatory food fortification program in 2003, which is interrelated to the micronutrient supplementation program.[52] However, the programs have not reached their anticipated success rates.[52] The food fortification program has created a food fortification mix imbedded in maize meal and other complementary foods. The mix's high Folate content seems to have eradicated Folate deficiencies.[52] The food fortification program also made the iodization of salt mandatory since 1995.[52] This seems to have halted incidences of iodine deficiencies.[52] However, any micronutrients lacking in the food fortification mix can still cause malnutrition. Unfortunately, it has been difficult for the micronutrient supplementation program to provide all the lacking micronutrients to those in need. The program faces various limitations in the forms of supply, supplement quality, bio-availability, outreach, and compliance.[52] For example, the Vitamin A supplementation program has been criticized for its struggles with reaching its most vulnerable target: children and post-partum women.[52] The INP has not failed to recognize the challenges that arise in the hospital-based management of severe malnutrition. South African hospitals admit numerous children for severe malnutrition, yet many of these children end up suffering easily-avoidable deaths.[56] Even after the 2006 South African amendment of the District Health Information System, which was supposed to provide the case fatality rates of severe malnourishment among children in hospitals, the lack of identification of malnutrition-related deaths remains high.[52] However, there has been a notable drop of malnutrition-related deaths among hospitals due to training and capacity development geared at the hospital staff.[52] In order to address the problem of nutrient supplementation on a community-wide level, the INP helped establish the short-term program "Nutrition Supplementation Program" (previously known as the PEM Scheme).[52] This program has been fairly effective because of the well-trained nutritionists that assist it.[52] However, various shortcomings remain. The program has struggled with community based interventions and with properly reaching out to and enrolling all malnourished children without misusing resources on children that are not truly malnourished.[55] If the Child Support Grant was extended to apply to all families of malnourished children, all at risk children could be reached and enrolled at hospitals, clinics, and other places that participate in growth monitoring.[52] Nutrition management during disease is an another method used by the INP to prevent malnutrition. South Africa's Department of Health adapted the Integrated Management of Childhood Illness to encourage proper nutrition management.[52] UNICEF, in conjunction with the World Health Organization, established the IMCI to increase child survival in areas with poor resources.[57] IMCI aims to achieve this through a combination of improved management of common childhood diseases and proper nutrition and immunization.[58] However, there are various vague generalities in IMCI's guidelines that make it difficult for South African health providers to know exactly how to train mothers to provide food for their children.[59] This presents a problem because most ill South African children are never seen by a nutritionist so they have no other way of learning how to have a proper nutrition. South Africas Food for All Campaign: A promising new plan to tackle hunger and malnutrition? South Africa recently launched a new social protection initiative the Food for All Campaign inspired by Brazils Zero Hunger strategy. The Campaign intends to tackle some of South Africas most pressing social ills linked to hunger and malnutrition, especially affecting woman and children. 1 February 2012 Hunger and malnutrition have become an increasingly worrying concern throughout South Africa. Also, high unemployment rates, the rippling effects of HIV/AIDS and gender inequality have aggravated the problem. Additionally, more and more South Africans, especially woman and children have become the central victims of this socially and economically debilitating issue. According to the Human Science Research Council of South Africa (HSRC), South Africa ranks among the countries with the highest rate of income inequality on the globe, in comparison to other middle income countries. Further, South Africa has resounding high levels of absolute poverty. Data shows that approximately 21.9 % of South African households have insufficient or severely insufficient access to food. Additionally, roughly 14 million South Africans are vulnerable to food insecurity. These are startling statistics, but what does this exactly imply for the most vulnerable segments of society? Vulnerability to food insecurity signifies that millions of South Africans, especially woman and children do not know when and where their next meal will come. It can be argued that the countrys children bear the biggest brunt. Not feeding a child the appropriate amount of food coupled with the correct dosage of nutritional intake in their pivotal stages of growth, is a recipe for human developmental disaster. According the Medical Research Council of South Africa(MRC), 33% (1,8 million) of children under six years of age suffer from vitamin A deficiency, while 21% (1,2 million) are anaemic. Further, 27% of preschool children and 34% of primary school children in a rural community in KwaZulu-Natal are zinc deficient. The impact of vitamin deficiencies such as vitamin A, iron, zinc result in learning disabilities, mental retardation, poor health, low work capacity, blindness including a slow immune response and premature death. The gloomy state of hunger and malnutrition in South Africa makes the future of the country all the more worrying. Nonetheless, South Africas ministry of Social Development is now forcefully gearing up to address this critical situation.

South Africas new plan South Africa recently launched a new social protection initiative called the Food for All Campaign under its umbrella Zero Hunger strategy, inspired by Brazils successful Zero Hunger strategy The campaign intends to complement other existing poverty and hunger programmes. At the launch of the campaign, the minister of Social Development, Mrs. Bathabile Olive Dlamini stated that: Today we are launching the Food for All Campaign as a measure to address incidents of extreme hunger and malnutrition also in order to restore dignity of many South Africans, including children who experience hunger. Dignity has become a key word often used in South African post-apartheid rhetoric. Dignity in South Africa has been restored in a number of areas, especially in the political and public sphere. Nevertheless; dignity has yet to fully materialize on the ground and beyond the written cornerstones of South Africas democracy the Constitution and the Freedom Charter. The intergenerational cycle of hunger and malnutrition in South Africa must be broken if dignity is to be effectively restored in the lives of every South African. South Africas Food for All Campaign is still in its initial stages. There will undoubtedly be a range of setbacks as the c ountry grapples with various underlining socio economic ills, but hopefully those setbacks and underlining issues will provide South Africa greater incentives and lessons in galvanizing the campaign. Further, the campaign opens doors to greater collaboration and dialogue sharing with Brazil on anti hunger and poverty programmes. Based on these reasons South Africas new plan to steadily address hunger and malnutrition certainly sounds promising. By: Charlotte Lazarus* Ms. Patricia Vieira da Costa from the Brazilian Ministry of Social Development and Fight against Hunger (MDS), spoke to IPC-IG Communications about some of the key issues concerning Bolsa Familia, one of the many initiatives linked to Brazils Zero Hunger strategy: Brazils Zero Hunger Programme Zero Hunger is Brazils national strategy on food and nutritional security consisting of more than 20 initiatives in four areas of intervention: Food Access Strengthening of Family Agriculture Income Generation Articulation, mobilization, and social control The Zero Hunger initiative introduced major programmes such as the Bolsa Famlia, a conditional cash transfer scheme, and it incorporated a range of existing initiatives in an effort to put together a multi-sector array of public interventions to tackle hunger and guarantee universal access to quality food. Bolsa Famlia has the largest budget within Zero Hunger, equivalent to over $8 billion USD in 2010, followed by two other programmes: the National Programme for Strengthening Family Farming (PRONAF) and the National School Feeding Programme (PNAE). The scale of Bolsa Famlia in recent years, in terms of budget and visibility, could be interpreted as a shift in focus from food and nutritional security to poverty reduction. The maintenance of Zero Hunger itself as a long-term framework for public action brings uncertainties. This is aggravated by the new presidential term that started in January 2010, when President Lula, whose two consecutive terms were Zero Hungers implement ation period, will be terminated. Brazils new anti- poverty and hunger strategy In June 2011, President Dilma Rousseff launched a flagship initiative : Brasil Sem Misria (Brazil Without Extreme Poverty). Brazil Without Extreme Poverty is a new multibillion-dollar anti-poverty plan that would focus on 16.2m people still living in extreme poverty by expanding the governments Bolsa Familia family stipend scheme which have helped lift 26 million people out of poverty and other benefits for small farmers, garbage pickers and others. The government planned to spend R$20bn ($13bn) annually over the next four years. Malnutrition Child and camels by a river, Africa Malnutrition is estimated to contribute to more than one third of all child deaths, although it is rarely listed as the direct cause. Lack of access to highly nutritious foods, especially in the present context of rising food prices, is a common cause of malnutrition. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition. Infection particularly frequent or persistent diarrhoea, pneumonia, measles and malaria also undermines a child's nutritional status. A recently developed home-based treatment for severe acute malnutrition is improving the lives of hundreds of thousands of children a year. Ready-to-use Therapeutic Food (RUTF) has revolutionized the treatment of severe malnutrition providing foods that are safe to use at home and ensure rapid weight gain in severely malnourished children. The advantage of RUTF is that it is a ready-to-use paste which does not need to be mixed with water, thereby avoiding the risk of bacterial proliferation in case of accidental contamination. The product, which is based on peanut butter mixed with dried skimmed milk and vitamins and minerals, can be consumed directly by the child and provides sufficient nutrient intake for complete recovery. It can be stored for three to four months without refrigeration, even at tropical temperatures. Local production of RUTF paste is already under way in several countries including Congo, Ethiopia, Malawi and Niger. Following the consensus on community-based management for severe malnutrition reached in a informal consultation in 2005, WHO has worked with UNICEF on the development of a field manual on community-based management of severe malnutrition, and the IMCI guidelines have been revised to take account of the new home-based treatment. Developing effective food and nutrition policies and programmes The challenge Eliminating hunger and malnutrition is technically feasible. The means are there. The challenge lies in generating the requisite political will, developing realistic policies and taking concerted actions nationally and internationally.

During the last decade, there has been a number of attempts to set specific goals and targets for eliminating or reducing various kinds of food and nutrition insecurity and all the major forms of malnutrition. However, progress towards these targets has been lagging far behind of what was intended and a continuation of present trends would leave millions of people undernourished and suffering from all the major forms of malnutrition in the next millennium. The response Building on a series of global conferences in the 1990s especially the 1992 International Conference on Nutrition and the 1996 World Food Summit countries have developed national nutrition plans and policies in nine major strategic action areas that: mainstream nutrition goals into development policies and programmes, improve household food and nutrition security, protect consumers through improved food quality and safety, prevent and manage infectious diseases, promote breastfeeding, care for the socioeconomically deprived and nutritionally vulnerable, prevent and control specific micronutrient deficiencies, promote appropriate diets and healthy lifestyles, and assess, analyse and monitor nutrition situations. As evidence of the higher priority that governments are giving to nutrition, as of July 2000, 149 (78%) of WHOs Member State s had given effect to their commitments while another 17 (9%) had plans and policies under preparation. Through this globe-spanning initiative, WHO is providing technical and financial support for the development and implementation of national policies and programmes that effectively address food and nutrition problems that are influenced by rapid change in todays world and successfully meet tomorrows nutrition challenge. Improving household food and nutrition security for the vulnerable: A WHO multicountry study WHO sees household food and nutrition security as a basic human right. Since 1995, NHD has been undertaking a multicountry study in China, Egypt, Indonesia, Ghana, Myanmar and South Africa. Bringing together experts from fields as diverse as nutrition, anthropology, sociology, psychology, agricultural economics, economic geography, communication and education, this study is examining malnutritions main causal factors. On this basis, guiding principles will be prepared for protecting the nutritional needs of the most vulnerable and enhancing understanding of womens productiv e, reproductive, nurturing, educational and economic roles. The five keys to safer food training course Train The Trainer course - Module 1: Directed to Women Five keys Introduction to the course pdf, 105kb Training Course pdf, 5.02Mb In response to the increasing number of requests from countries to assist in strengthening their food safety education programmes for the prevention of foodborne diseases, WHO has developed a Train the Trainer course on the Five Keys to Safer Food which provides guidance on how to both educate and promote the adoption of safe food handling behaviours. The first module was designed to target women as women play an important role in the production and the preparation of safe food (women produce between 60% and 80% of the food in most developing countries and are responsible for half of the worlds food production [FAO Focus, 19 March 2009]). This training course was also developed in response to the WHO Director-General's priorities to promote the health of women, particularly in developing countries (Women and health: today's evidence tomorrow's agenda [WHO global report 2009]). The Five Keys to Safer Food Train The Trainer course complements the package of the Five Keys to Safer Food Poster and Manual. WHO plans to extend the adaptation of this training to other settings, including school children, health workers working in rural settings and immunocompromised people. This training course builds upon the concepts of Communications for Behavioural Impact (COMBI),a communication method developed by WHO, and is designed to go beyond education and foster the adoption of safe food handling behaviours. Special thanks are given to the Food and Drug Administration of the United States, Office of Women and Health, for their support in the development of the materials and to the governements of Belize, South Africa and Tunisia which piloted the training. South Africa: Outcome of the first pilot session organized in September 2007 Participants in the first pilot session of the Train the Trainer Programme, South Africa The Department of health of South Africa adopted the Train the Trainer course to train food handlers in preparation of the 2010 FIFA World Cup. In February 2009, the Tswhane University of Technology presented the training sessions to lecturers from 6 universities of technology situated in Cape Town, Port Elizabeth, Bloemfontein, Durban, Johannesburg and Pretoria who are responsible for the training of Environmental Health Practitioners in Food Hygiene and Community Development. All the candidates indicated afterwards that they are in a position to continue with the roll-out of the course through their respective institutions.

The 5 Keys poster is already available in Zulu and Tshwana and translations in Tsonga, Swazi, Afrikaans, Venda, Ndebele, Sotho, Xhosa and Pedi are in process to cover all the local South African languages and to reach the entire community. Participants in the second pilot session of the Train the Trainer Programme, Tunisia Tunisia: Outcome of the second pilot session organized in January 2008 In January 2008, l'Agence Nationale de Contrle Sanitaire et Environmental des Produits (ANCSEP) organized the second pilot session of the Train the Trainer course targeted to women. As part of its strategy to encourage the implementation of the Training course in the various educational sectors, ANCSEP asked the participants to propose a training project. The best projects will be selected by ANCSEP and ANCSEP and will support their implementation in collaboration with WHO. Belize: Outcome of the third pilot session organized in February 2009 Participants in the third pilot session of the Train the Trainers Programme, Belize Discussion group, Belize training The Ministry of Health, Belize, is now considering to include the Train the Trainer course on Five Keys targeted to women in the training of food inspectors and health educators. WHO also piloted in Belize for the first time the second module targeted to health educators working in rural communities. The participants concluded that the Five Keys model would be relevant for rural settings and further development of Module 2 is now under consideration.