Malnutrition teeters on education, evaluation deficiencies

CEBU, Philippines - She gave her last teaspoonful of rice porridge to her son. There was nothing left. All her children ages five, three and one were underweight, stunted and wasted. Staring out the window, she rehearsed what she was going to say to Mrs. Madrasta as she would go to do the laundry. She would advance P150 if only to buy some rice, dried fish and vegetables.

Just across the street, Mrs. Madrasta had lunch with her son. The fat boy shoveled steak, chicken and a loadful of thick mayonnaise on his plate as though it was the last meal in his life. There are now moves to prepare for nutrition in emergencies but this emergency was of a different sort. Mrs. Madrasta sighed heavily as she watched her son get down from the chair and teetered as his weight made it difficult for him to walk. The boy left the seafood and mixed vegetables untouched. Except for a slice of fruit, the boy asked for the box of ice cream. As Mrs. Madrasta told her son that he already had enough, the boy screamed and threw into tantrums and breathed heavily, with difficulty. Fearing what her son would do, she gave him the box of ice cream.

As the world readies for nutrition emergency, it’s time to get educated and evaluated. In a 2011 United Nations report on “The Need for Professional Training in Nutrition Education and Communication,” it was disclosed that food insecurity and malnutrition continue to scourge the world for lack of evaluation and education. What is affrontingly alarming is that the study identified doctors and health professionals to be the priority professional groups most in need of understanding nutrition and nutrition education and communication.

The Food and Agriculture Organization of the United Nations had carried out seven case studies in Botswana, Egypt, Ethiopia, Ghana, Malawi, Nigeria and Tanzania in 2010. While the objectives of the country case studies were to explore and assess needs relating to nutrition education and communication, and eventually develop a nutrition education and communication training curriculum, what the surveyors found were cans of worms in spoiled nutrition programs. Unusual findings from the seven countries were found to have the same kinds of worms .. err … scenarios in the Philippines.

For one, there was widespread lack of evaluation in the implementation of the nutrition programs. Yet while the evaluation and feedback lapse had become systemic and had cut through all seven countries and yes, even in the Philippines – especially in Cebu, there did not seem to be any plausible explanation for the lapse. Awareness of the lapse did not seem to translate to concrete remedial actions. In a recent technical working group meeting held in Cebu last August, the National Nutrition Council 7 owned a lapse in feedback control mechanisms when conducting monitoring and evaluation, but could not quite explain what caused the lapse.

It comes down to a scenario like this — the Ministry of Health of Botswana gave trainer workshops for the management of severe and acute malnutrition (SAM) in children and in Infant and Young Child Feeding in the context of HIV. But follow up activities were not generally evaluated. In all seven countries studied (and even in Cebu), it was impossible to estimate program effectiveness because of lack of evaluation and lack of needs assessment whether these be for training and other nutrition issues. FAO describes the widespread lack, thus, “All these would be a reflection of a weak national nutrition education and communication strategy on learning from national experience.”

The lack of evaluation spilled into other dire consequences like the lack of coordination between government and other agencies of a clear nutrition education and communication strategy and the lack of distinction made between food security and nutrition security. There was a general fragmentation of nutrition activities at community levels due to lack of coordination between non-government organizations, international organizations, local governments and nutrition workers. All seven cases reported slow social awareness of nutrition. (FREEMAN)