r

Indira Gandhi
National Open University
DHNE-3
~ , School of Continuing Education Nutrition and Health
Education

Block

2
THEMES AND MESSAGES IN NUTRITION AND
REALm EDUCATION
UNIT 4
Themes in Nutrition Education 5
UNIT 5
Themes in Health Education 43
~------------------------
UNIT 6
Messages in Nutrition and Health Education 57
 Course Design
Prof. v.c. Kulandai Swamy Prof. H.P. Dikshit Prof. A.B. Bose
Vice-Chancellor Pro Vice-Chancellor Director
IGNOU IGNOU School of Continuing Education
IGNOU

Prof. P.R. Reddy Dr. Mehtab Bamji Prof. B.N. Koul

Vice-Chancellor NationalInstitute of Executive Director
Sri Padmavathi Mahila Nutrition S1RIDE
Vishwa Vidyalayanl Hyderabad New Delhi
Tirupati
Mrs. Arvind Wadhwa Dr. Prabha Chawla
Mrs. Mary Mammen Lady lrwin College School of Continuing Education
CMC Hospital New Delhi IGNOU
Vellore New Delhi
Ms. Annu 1. Thomas
Dr Mrs. S.R. Mudambi School of Continuing Ms. Deeksha Kapur
W-163 'A', 'S' Block Education School of Continuing Education
MIDC Pimpri, Bhosari IGNOU IGNOU
Pune . .New Delhi New Delhi

Project Design.
Prof. K. Chandralekha (Urit 4) Block Coordinator
Sri Padmavathi Mahila Vishwa Deeksha Kapur
Vidyalayam School of Continuing Education IGNOU
Tirupati New Delhi
Mrs. Mary Mammen (Unit 4)
; CMC Hospital
Course Editor
Prof. PR Reddy
Vellore
Vice-Chancellor
Ms. Annu J. Thomas (Unit 5 and 6) Sri Padmavathi Mahila Vishwa
.School of Continuing Education Vidyalayam
IGNOU. New Delhi Tirupati
Course Revision
Prof. Deeksha Kapur Rajshree
Nutritional Science Kusum Bhatt
School of Continuing Education Consultant
IGNOU, New Delhi School of Continuing Education
IGNOU. New Delhi

PRINT PRODUCTION:
Mr. Rajiv Girdhar Mr. Hemant Kumar
AR(P)IGNOU 80(P) IGNOU

January, 2020 (Reprint)

© Indira Gandhi National Open University 20 I 6
ISBN: 81-7263-432-3
All rights reserved. No part of this work may be reproduced in any form. by mimeograph or any other
means, without permission in writing from the Indira Gandhi National Open University.
Further information, about the Indira Gandhi National Open University courses may be obtained from the
University's office at Maidan Garhi, New Delhi-I/O 068.
Printed and Published on behalf of the Indira Gandhi National Open University. New Delhi
by Head MPDD, IGNOU, New Delhi.
Printed at : P Square Solutions, H-25, Site-B, Industrial Area, Mathura
BLOCK INTRODUCTION
As a nutrition and health educator you would like to have a ready reference on what
to tell community groups. This block should serve this purpose.

To make it easy·to use this block, we have not used the usual structure. A question-
answer format according to different relevant themes has been employed. The block
has been organised like a handbook and consists of the following units:

Unit 4 : Themes in Nutrition Education

Unit 5 : Themes in Health Education

Unit 6 : Messages in Nutrition and Health Education

In Unit 4 we concentrate on nutrition education related to various groups in a

community So the'first three major themes deal-with nutrition and education concerns
in pregnancy, lactation, infancy and early childhood as well as the school years,
adolescence and adulthood. Theme 4 deals with diet therapy for common problems ..
encountered in the community. So you now, have information in simple ready-to-use
form!

Unit 5 deals with common themes in health education, in a similar pattrem.

Unit 6 is a compilation of a range of messages. From this you can pick and choose
those, which may be relevant in your community. Messages have been categorised
according to common problem areas, usually tackled by education programmes in
the community. Of course, YOUT community would have its own special needs. It's
important to make your own list of messages, that need to be conveyed to communities
in the area where you work. So it is likely that, you would need to modify, reword,
redesign the messages we have given.

As you would have realised by now, the idea in this block is to emphasise the way
in which, information can actually be conveyed to an individual or group. The list of
questions/topics/messages in Units 4 to 6 is by no means exhaustive. We have just
tried to show you how you can convert the information you already have into a form
understandable to the community. Feel free to adapt, modify or add to this list!
 UNIT 4 THEMES.lN NUTRITION
EDUCATION
Structure
4.1 Introduction
4.2 Objectives
4.3 Theme 1: Nutrition during Pregnancy and Lactation
4.4 Theme 2: Nutrition during Infancy and Preschool Age
4.5 Theme 3: Nutrition during School Age, Adolescence, Adulthood and Old age
4.6 Theme 4: Diet as Therap~, .
. 4.7 Summing Up: Hints on using this Marterial

4.1 INTRODUCTION·
This unit uses a question 'and answer format to raise issues of concern in relation to
nutrition and diet therapy. Read the answers as if you are talking to community
members. As part of the answer you will also sometimes find hints and guidelines for
yourself. These are given in italics as you will notice. It must be emphasised that we
have mentioned only important themes in nutrition education in this unit Some ideas
on how you can put across these themes in nutrition education are given at the end
of the unit in the form of'a box, Blocks 3,4 and 5 will give you further details.

4.2 OBJECTIVES
After going through this unit, you should be able to:

• select key themes relevant to your community; and

• list ways in which you can convey the information given in the best manner in your
conmnmity.

4.3 THEME 1: NUTRITION DURING

PREGNANCY AND LACTATION
Topics
• Vulnerability of Pregnant Women
• Weight Gain in Pregnancy
• What to Eat duriIig Pregnancy
• Influence ofVariolls Factors on Food Intake in Pregnancy
• Common Problems which affect Nutritional Status during Pregnancy
• Monitoring Health during Pregnancy
• Identification of Pregnant Mothers at Risk
• Vulnerability ofI.actating Women
5
;J'hlfmes and Messages • What to Eat during Lactation
in Nutrition and Health
7 •

Education • Influence of Various Factors on Food Intake in Lactation

• Why Breast feeding is Best
• Helping Mothers to Breastfeed Successfully
• Specific Problems during Lactation and their Solutions.

4.3.1 Why are pregnant women vulnerable?

Pregnancy is an important period in the life span of woman. This is the time when
a baby grows inside her body. To grow properly in the womb of the mother, this
unborn child (foetus) needs a healthy and well-nourished mother. The mother's
tissues grow with the baby. All the nutrients needed by the unborn baby, must be
supplied by the mother, Think of the stress on her body!

4.3.2 What is the importance of weight gain in pregnancy? .

A mother needs to gain weight during pregnancy to nourish her growing baby.
Women who do not gain enough weight, often have babies that weigh too little. A
baby that weighs less than 2.5 kg, is more likely to have both physical and mental
problems. It may not grow normally. It may suffer more from infections and malnutrition
than babies of normal weight.

A woman should gain at least 11 kg during pregnancy. The baby accounts for only
part of the weight gain. Her own body must add blood, muscle, fluids and tissue,
which are needed for the baby's development. If she gains less than 11 kg, the
baby's chances for health and survival might get affected.

If a mother is overweight, she still needs to gain weight for the baby's health. She
should not try to lose weight, while she is pregnant but should wait until after the
baby is born and after breast feeding.

When and how fast the woman gains weight, is just as important as the amount which
she gains. A pregnant woman should gain weight smoothly and steadily. Ifher weight
jumps suddenly, she should see the doctor.

During the first three months, she should expect to gain about 1-2 kg. During the last
six months, she needs to gain about 112 kg, each week. If she has already gained
11 kg after six or seven months of pregnancy, she should continue to gain moderately
until delivery. Remember, baby puts on most of its weight during those last few
months.

4.3.3 What to eat in pregnancy?

Now you are aware, how growth or changes occur during pregnancy. For this
growth to be steady and nonnaI, the pregnant woman needs to eat more food than
before- especially energy (go), body building (grow) and pn nective (glow) foods.
She also needs foods which are good sources of iron.

What are some of the good sources of iron?

Extra iron is needed for the growth of the foetus and placenta, and for the increased
red cell mass of the mother. She should eat a well-balanced diet, containing a mixture
of foods. She does not need to buy any special or costly foods for good nutrition.
.6 She can get the extra foods she needs, by eating a little more, if her 'ordinary meals
 UNIT 4 THEMES IN NUTRITION
EDUCATION
Structure
4.1 Introduction
4.2 Objectives
4.3 Theme 1: Nutrition during Pregnancy and Lactation
4.4 Theme 2: Nutrition during Infancy and Preschool Age
4.5 Theme 3: Nutrition during School Age, Adolescence, Adulthood and Old age
4.6 Theme 4: Diet as Therapy,
. 4.7 Swnming Up: Hintson using this Marterial

4.1 INTRODUC'TION,
-,
This unit uses a question arid answer format to raise issues of concern in relation to
nutrition and diet therapy. 'Read the answers as if you are talking to community
members. As part of the answer you will also sometimes find hints and guidelines for
yourself. These are given initalics as you will notice. It must be emphasised that we
have mentioned only important themes in nutrition education in this unit Some ideas
on how you can put across these themes in nutrition education are given at the end
of the unit in the form of a box. Blocks 3, 4 and 5 will give you further details.

4.2 OBJECTIVES
After going through this unit, you should be able to:

• select key themes relevant to your community; and

• list ways in which you can convey the information given in the best manner in your
COO1IJ1lDlity.

4.3 THEME 1: NUTRITION DURING

PREGNANCY AND LACTATION
Topics
• Vulnerability of Pregnant Women
• Weight Gain in Pregnancy
• What to Eat during Pregnancy
• Influence OfVariollS Factors on Food Intake in Pregnancy
• Common Problems which affect Nutritional Status during Pregnancy
• Monitoring Health during Pregnancy
• Identification of Pregnant Mothers at Risk
• Vulnerability ofI.actating Women
s
 Themes in NutritIOn
are good and well balanced. The extra food does not have to be eaten at every meal EdUal~
during the day. She can increase the amount of nourishment she gets, at one or two
meals. The best way, .however, is to eat substantial snacks during midmorning or
midaftemoon.

4.3.4 Which factors influence foodintake?

Food intake of a pregnant woman, may be affected by food availability, economics,
acceptability, psychological and personal factors. Any combination of these factors
might adversely affect the choice of foods, and in turn the food intake of the pregnant
woman. Some examples are illustrated here. Women belonging to the low income
group will have less choice of foods due to economic reasons. A woman who can
afford to have a better diet, also may have less choice of foods due to a value system
i.e. having less value towards food, compared to other things like gold, property etc.
Amongst many families, certain foods like egg, banana, gingeUy seeds etc. are being
restricted during pregnancy due to cultural factors. In most of the Indian families,
social practices like woman eating leftover foods (both in quality and quantity) after
everybody eats are still prevalent.

(It s important for you to identify which factors are specific to your community
and then deal about them in detail).

In addition to these factors, certain physiological factors also restrict the intake of
food. For example, the pregnant mother suffers from nausea and vomiting during
early pregnancy and thus she cannot eat enough food. Early age at pregnancy when
the girl is still growing, means additional amounts of food to meet requirements for
the growth of both mother and baby.

4.3.5 How can we deal with common problems during

pregnancy?
Morning sickness, heart burn and constipation are some of the problems. These
problems affect the intake of food. This might lead to or aggravate nutritional
deficiencies. What should be done to control these problems?

Problem How to deal with it?

Morning sickness
(Nausea, vomiting)
• Eating a light meal before going to bed at
night e.g. a glass of milk and fruit.
• Have something soon after getting out of
bed e.g. milk .and something dry in the
morning.
• Frequent feeding with small quantities (eat
5-6 meals a day).
• Avoid greasy foods.
Heartburn • Avoid foods known to cause discomfort.
• Sucking hard candy.
• Use tablet only if it is a must, and do not
take along with iron pill.
• Do not take tea or coffee along with any
non supplement.
Ir. Sleeping with chest and head lifted up.
• Frequent feeding with small amounts.
".!~emes and Messages
Jq Nutrition and Health Constipation • Drink plenty of fluids. Take liquids before
F~tion eating anything in the morning.
• Eat fiuits and foods with fibre e.g. unsieved
wheat flour.
• Exercise regularly.

4.3.6 What happens if a pregnant woman becomes anaemic?

If the dietary intake is inadequate, the foetus still has priority and the mother can
become severely anaemic. How can this be detected by us? Some women feel weak.
and tired when they are pregnant. They are unable to perform the daily activities.
This is an early indicator of anaemia. Poor weight gain can also be taken as another
indicator, i.e. no steady weight gain being 'observed. From this, you may conclude
that they are anaemic.

If the pregnant woman is anaemic, the consequences are:

• They may have difficulty in pregnancy and child birth.

• Babies ofanaemic mothers may be born without the 3 to 6 months supply of iron
that a normal, healthy, full-term baby should have.
• Small for date and weaker babies may be born.
• Mother's breast milk may not have enough iron.

4.3.7 How can iron deficiency anaemia be prevented?

A pregnant woman should have enough iron to keep herself and her baby healthy.
She should eat foods that have plenty of iron everyday. Citrus fruit (for e.g. orange)
or amla with a meal helps the body to utilise the iron well (mention iron rich food
sources).

4.3.8 How can you tell, if a woman is anaemic?

It is hard to be really sure, unless the blood is checked. If you look at the inside of
the lips or lower eye-lids, they may be pale, light pink or white. These parts should
normally look bright pink. The fmger nails also normally look pink, but not pale or
white. With the help of anyone or two of these indicators, you can diagnose iron
deficiency anaemia. Tiredness and exhaustion are important indicators. Anaemia can
be corrected or prevented through consuming iron-rich foods and supplements of
iron in the form of tablets/capsules/syrups.

4.3.9 What advice to give about iron tablets?

Close monitoring of health and growth is essential during pregnancy. Pregnant women
should visit the doctor clinic at least once a month. At the clinic, the pregnant
woman's blood will be checked. She will be given iron tablets or tablets which
contain both iron and folate to build "strong blood" for her and her baby. Remind
the mother to follow directions for taking the iron tablets. It is a good idea for her
to take the tablets, ri ght after a main meal.

She should not take the iron tablets with tea or coffee. This prevent the body from
using the iron properly. Milk provides good nourishment for a pregnant or breast
feeding woman; so it is a good drink. But, ironically Indian women consider milk as
8 food for the children. There is a need to change this attitude in the interest of their
health during pregnancy and lactation, in particular..
 Sometimes pregnant women complain about iron tablets. They upset her or cause Themes in Nutt'ti'~D
side effects. (Encourage her to take the problem over to her A.N.M (nurse) or Educ3don
doctor or health worker. They may give her another type of iron. Advise her
not to stop taking the iron as her body needs it especially during pregnancy.)

Remember
It costs very little to provide the extra food needed during pregnancy than to
cure anaemia.

If the mother is already eating well, she should just eat a little more of the foods
she enjoys such as:
• Chapatis

• Ragi sankati (rice and ragi combination).

• Snack with gingelly 'seeds and jaggery along with any citrus fruits.
• Any preparation made of dark green leafy vegetables with germinated pulse.

4.3.10 How can we,identify pregnant women at risk?

The following hints need to be considered, to identify pregnant women who need
special attention:

• Women from poor families who are unemployed withno land etc.

• Women who are 'widows or have been deserted by their partners and don't have
' any type of family support.

• Mothers who have given birth to many babies over a short time.

• Women who are ill from diseases like tuberculosis.

• Women who look thin and depressed.

• Mothers whose previous babies have been small anti malnourished.

• Teenagers who are pregnant.

• Women with babies dying in their first year oflife.

• Mothers who are overburdened with work inside and/or outside the home.

• ,Women who are very worried about becoming a mother, particularly for the first
time.

All these women need extra help. This is what you can do.

• Visit them often.

• Encourage them to eat as good a mixture of foods as they can.

• Let them be the first ones to receive iron or food supplements when available.
• Help them to get immunised against tetanus.
,
• Let them check their weight regularly.

• Encourage them to be clean and tidy.

9
Themes and Messages
• Encourage other membersof the household to do some of the house and field work
in Nutrition and Health
Educatiori and lessen the burden of work on the pregnant woman.

4.3.11 Why are lactating women vulnerable?

In lactation, the nutrients present in breast milk come from the mother. This puts a
heavy strain on the body, in addition to recovering from the physiological stress
caused by pregnancy and delivery. So, if enough food is not provided, the lactating
woman can become malnourished.

Once the pregnant woman delivers a child, the lactation period starts. A common
practice observed is to neglect the care of the mother, once the child is born. This
is due to the belief that breast feeding does not increase food needs, compared to
the growing foetus. Is this true?

As you are aware, the new-born baby depends solely on breast milk for its nourishment
during lactation. Herce, whether the baby is outside or inside the womb of the
mother, it gets its nourishment from the mother. Hence, the lactating woman also
needs extra food like the pregnant woman. For proper breast feeding in terms of
quality and quantity, lactating mothers need to eat more foods-especially energy (go),
body building (grow) and protective (glow) foods. They need foods which are good
sources of vitamin A and calcium. Do mothers in your area eat well? If not, what
foods are generally lacking in their diets?

You must be aware of what are 'go', 'grow' and glow 'foods and what are the
rich sources of calcium and vitamin A?

4.3.12 What influences food intake in lactation?

The suggested dietary modifications are not taken care of due to influence of various
factors described in the answer to question 4, this is observed during pregnancy and
more so during lactation. This is because the dietary care is being neglected after the
baby is born and many foods are restricted because ofthe belief that child's health
will be affected e.g. foods causing diarrhoea, cough. Thus, multiple factors influence
the food intake of'women drastically and result in nutritional deficiencies. This, in turn
affects the secretion of breast milk and then the low production of breast milk, affects
the health of the baby.

4.3.13 Why is breast feeding the best?

Milk comes from the breast even before the baby is born. When baby suckles at
the nipple, this causes the milk to come into the breast and continue to flow.

If all babies are to be .iealthy and grow well, they must be fed with breast milk.
Breast milk contains all the nourishment a healthy baby needs. It is a food produced
by the mother especiall y for the baby. It also has substances which protects the baby
from getting running belly or other infections which make the baby sick.
10
 Themes in Nutrition
When the mother breastfeeds and holds her baby close, she gives warmth and Education
security as well as food. This makes mother and baby to get close and loving. Breast
feeding often and without giving baby any other kind of milk can prevent a woman
from getting pregnant. To be fully protected, the couple should use family planning
methods. which do not affect breast-feeding.

In addition, breast milk goes straight from the mother breast to the baby and never
gets too hot or too cold. If a mother breast-feeds, she loses the weight put on during
pregnancy more quickly than if she does not. The womb will get small faster when
a mother breastfeeds.

The mother who breast feeds, will not have to use
milk formulae. It costs much less for the mother,
special foods for the baby. Eating extra food gives
breast milk. Breast feeding also saves her time, as
baby feeds and to sterile the utensils.
a feeding bottle or buy artificial
to eat a little more than to buy
her energy to produce adequate
the mother will not have to mix

Remember why breastfeeding is best

For the child For the mother

• It contains exactly what the • Tt is very cheap.
baby needs. • It is convenient.
• It contains no microorganisms. • It helps mothers to lose weight put
• It develops a good emotional bond on during pregnancy.
with the mother. • It is simple and quick, even during
• It protects the baby from infections. travel.
• It is the natural way that promotes
growth of the baby.
• It is safe, simple and quick.

4.3.14 What advice can be given to mothers on successful

breast feeding?
Breast feeding is the natural way for a mother to feed her baby. She must be relaxed,
contented and well prepared to feed her baby.

Before baby is born: When the mother is pregnant, her breasts get bigger. She
should support them with a well fitting, sturdy bra, made of cotton.

Taking care of the breasts: She should wash her breasts every day and make sure
she dries them well. She should rub the nipples gently to keep them soft. She' should .
also pull the nipples out a few times, so that they stand out. If the mother does this
every day, her nipples will not become sore when she is breast feeding the baby. A
good time to do this is, when she is taking her daily bath.

Colostrum: A pregnant woman may notice a thin yellowish fluid coming from the
nipples. This is called colostrum. At about six weeks before the baby is due, she
should squeeze some of this from her breasts everyday. This will help her milk flow
more easily after the baby is born.

When baby is born: A new born baby should be put to the mother's breast as soon
as possible. Baby should suck on each breast for 3-4 minutes. The baby will swallow
some of the colostrum and this will nourish the baby until the mature milk comes in.
11
r
Themes and Messages
The colostrum will also protect the baby from infections. Colostrum is the baby's first
il!,~utrition and Health
Education
food; that is all the new born baby needs.

How to breast feed baby: When the mother is breast feeding she should be
comfortable. The baby's head and back should be supported with her arm. The
nipple, and as much as possible of the dark area around it, should be put into the
baby's mouth. If the baby sucks on the nipple alone, he will not get enough milk and
the nipple may become sore.

The breast must be held from the baby's nose with the second or third finger of his
mother's hand. lfthe breast rests on the baby's nose, he will not be able to breathe
properly. Baby she uld feed for 10-15 minutes on each breast.

If the baby falls asleep before; he/she has finished feeding. the mother should flick
the soles ofhis/her feet or tap hislher chin so that he/she sucks again. The more the
baby sucks, the more milk is produced. After baby has finished breast feeding, both
breasts should be empty. If they still feel full after feeding, the mother should squeeze
some milk from the breasts.

When the baby has finished feeding, she should press the breast away from the
baby's mouth and gently remove the baby from the breast. The baby can now be
'burped' by rubbing him gently on the back. A baby should be fed, whenever he is
hungry. All babies should settle down into their own feeding times.

A mother who is relaxed and contented, will be able to breast feed her baby better
than one who is worried and tense. Any kind of worry can slow down the flow of
milk. Family members can help in household work or in caring for younger children,
so that she can relax and the baby can get plenty of milk from the breast.

Remember
A mother may find it hard to breast feed, if she
• has never breastfed before.
• has no friends or relatives to encourage and help her.
• has other young children.
• is expected to work soon after the baby is born.

4.3.15 What are some of the specific problems in lactation?

There are different situations, where mother needs special attention to maintain her
health and the hea lth of the baby. A few such situations are illustrated here:

First Pregnancy: The woman who is pregnant for the first time needs special
counselling. She needs help to breast feed successfully and to enjoy it. Experienced
mothers, health workers and family members can all help. Sometimes, a mother may
feel that she will not be able to breast feed. Health workers should help her by
discussing her problems.

Undernourished Mother: Most mothers who are poorly nourished produce rich
breast milk to feed the baby. They may produce slightly less milk than well nourished
mothers; but the milk will be just as nourishing and good. This milk will help to ensure
that, the baby develops and keeps healthy during the first few months of life.
12
 Themes in Nutrition:
However. it is important that mother gets·enough Eduaitibd
to eat, while she is pregnant and while she is breast feeding.

She should eat local foods that she knows well, that are nourishing, easy to get and
not too expensive. The health worker should also advise her about what to eat and
show her how she can get the extra foods she needs.

If the mother is not well, the health worker should find out why? It may be due to
the fact that she really does not know what she.should eat. Once the health worker
knows what is wrong, she or he should guide the mother on practical ways of getting
a good diet.

There are different ways of helping the mother and family to get extra food. One way
is to help them to work together, raising small kitchen gardens with vegetable plants
and fruit trees, and maintaining dairy animals and poultry on a very small scale. This
does not require much extra money and does help to provide extra food and
income to the family. If the mother does less work, particularly during pregnancy and
breast feeding, she will be able to save energy to maintain her and her child's health
properly.

Extra food to be' taken

• One or two amlas everyday (during season).
• Local preparation recoriunended for lactation such as tilladdoos (gingelly
andjaggery sweet) or panjiri every day, if possible or on alternative days.
• Greens preparation on alternate days:
• Papaya about 100 g everyday (available in rural areas).
• Ragi sankati once a day, atleast (common practice in parts of South India).

Mothers who have a difficult delivery: After a difficult long labour, the mother
may be too tired to breast feed, right away. But remember, the sooner the baby
suckles her breast after birth, the sooner the milk will flow and breast feeding begins.
Breast feeding should begin within the first half an hour or as soon as possible after
delivery.

Babies that have difficulty in sucking: Some babies find it difficult to feed from
the breast at first. Such babies are those who are tiny at birth, those born before they
are due or those who have deformed lips or mouth. Whatever the baby's condition,
breast feeding is to be tried. If not possible, breast milk can be expressed into a
clean cup initially and the baby can be fed with a clean spoon. The breast milk should
be given to the baby right away, and should not be stored for more than two hours.

Breast problems: When the mother suffers from any problem related to the breast,
she can consult the ANM or doctor or health worker immediately and get the
appropriate help. Problems should never be neglected and the child should not be
deprived of breast milk.

Mothers who do not have enough milk: Too little milk is a common reason
mothers give for not breast feeding or stopping breast feeding early. In fact, the milk
the mother produces is usually enough for the baby during the first 6 months of life.
She needs to be counselled that she can produce enough milk. Also the mother who
thinks that she is not producing enough milk, during the first week also needs strong
13
'fbe,mes and Messages encouragement to feed the baby very often. Frequent sucking at the breast, will help
i.1JN.utrition and Health
Education
stimulate the flow of milk. It will also help the mother gain confidence and get used
to breast feeding.

Community workers should remember that the mother needs

support or special advice to manage these situations and to
continue breast feeding.

4.4 THEME 2: NUTRITION DURING

INFAN(~Y AND PRESCHOOL AGE
Topics
• Feeding Young Children
• Supplementary Feeding for Young Children
.• Feeding the YOWlgChild When Sick
• Preschool Age-·· A Critical Period
• What is Good Nutrition for Preschoolers?
• Growth Monitoring
• Common Nutritional Problems in Preschoolers and their Solutions

4.4.1 . How, should we feed young children?

You have learnt in Theme 1 about how you can advise mothers on successfully
breast feeding their' babies, to improve and maintain the health of the babies.
You would have also got ideas on, how to communicate the importance of
breast feeding for infants. Now, we summarise the discussion you can have in
the community regarding complementary feeding.

What is complementary Feeding?

A ·baby's first food is breast milk, which is an excellent food. Breast milk alone
satisfies the baby for the first six months of life. After six months, breast milk alone
is not enough to make the baby grow well. Other foods need to be given, in addition
to breast milk. When new foods are introduced to the baby other than mother's milk,
the elimination of breast milk is gradually accomplished.

We prefer to use the term complementary feeding now. In other words, giving foods
in addition to breast milk. These foods or supplements may be liquid, semi-solid or
solid. In poor communities, this concept should be encouraged, rather than stopping
breast milk totally which is a common practice.

When to Start?
It is suggested that complementary feeding should begin after six months oflife of the
baby. Why should we start complementary feeding only during that period? Here's
a list of reasons.

• Baby can eat and swallow foods other than liquids by sucking.
• Baby begins to get interested in surroundings-that makes feeding easier.

1~ • Stored nutrients like iron etc. begin to get exhausted.

 Themes in Nutrition
• Baby requires more energy,protein and other nutrients than breast milk alone Education
can supply,
• Early (before six month) cessation of breast milk may cause disadvantages.
• After sixth month breast milk is not sufficient to meet the growth demands.

What to feed?
Once weaning has begun, it is·important to introduce new foods in the diet as soon
as possible. The best foods for children, who .are being weaned are:

• High energy foods: Young children need energy. Staple cereals are good sources
of energy. Fat, oil and sugar are also good sources of energy but should be used in
limitedquantities.

• Foods rich in protein, vitamin A. vitamin C, iron and calcium: These are key
nutrients in the baby's diet. Vitamin C and iron are notprovided by milk in enough
amounts.so we must' concentrate on these.

• Easy to digest: The first new foods that babies eat, should be very soft and easy
to digest. For example, idli, pongal, khichri etc. Later, as teeth develop and as
the digestive system develops, more solid foods should be added gradually.

• Pure and clean: Baby's food should be as fresh as possible. In homes, where
. foods cannot be kept cold very easily, baby's food must be cooked before each
meal.

• Inexpensive and easy to prepare: Many families do not have much money to
spend on food. Taking out baby's share of food from the main meal cooked for
the family, before adding spices does not cost more or take more time.

• Varietyoffoods: Increasing variety in the diet of the young child, leads to a well
balanced diet as well as stimulates the acceptance of new foods. Keeping the
infant on a monotonous single grain diet has been shown to cause growth retardation
and a loss of interest in food. Enough of combinations of foods, like more than
one cereal and pulse, more than one pulse in a recipe, will provide the nutrients
the young child needs, for proper growth and development.

4.4.2 What points should be kept in mind during complementary

j
feeding?
There is a need to educate the mother. to make better use of available resources.
This solution has obvious attractions. In most areas, combinations like two cereals!
pulses, cereal and pulse, cereal with vegetable, pulse with vegetable, two or three
vegetables etc., would ensure more nutritious and balanced complementary foods.

Early morning . Breast milk

Breakfast Fruit juice or mashed fruit
Mid-morning Porridge
Lunch Breast milk
Evening Porridge
Bedtime Breast milk
 ~~~~~~~~- -- ~

'ftleQleS and,IMessages
Feeding Infants (12 Months)
,illt~IJQition and Health
Education 1) Breast feed
2) Give porridge and fruit juice or mashed fruit,

3) Give idli or pongal or soft chapatis

4) Give the same food as the rest of the family with slight modifications. For example,
rice can be mashed and can be given to the child with a little plain dal.

Balanced diet for baby

The family's diet shou.d contain food from the three different food groups: energy
giving, body-building and protective. Remember, this is called a balanced diet.
Baby's meals must also be balanced. We mix foods together from different groups
to make these meals.

TWO FOOD COMBINATIONS THREE FOOD COMBINATIONS

Rice + Dal Rice + Ragi + Chicken
Bread + Egg Rice + Dat + Greens
Rice + Fish Rice + Cabbage + Carrots
Chapati +- Beans Rice +- Ragi + Peas

FOUR FOOD COMBINATIONS

Rice + Green gram dal + Groundnuts + Banana
Rice + Ragi + Fish + Lady's finger
Rice +- Wheat + Carrot + Guava
Rice + Green gram dal + Coconut + Brinjal

How to modify the family s diet for the baby?

Here are some tips:

• Take out the baby's food before adding chilli or any other strong seasoning.
• Mash the food with a clean wooden spoon and soften it with ghee.
• When giving fish or lUeatto the baby, cut it into small pieces and take out all the bones.

I Always feed 'baby, using a clean cup and spoon. I

Guide 10 feeding a 7 ·12 month old baby

Early morning BreastmiIk

Breakfast Idli, sambhar

Mid-morning Biscuits and milk/fruit juice
Lunch Mashed, rice + dal/rasam + ghee + vegetable
Evening Egg pudding + milk
16~
 Dinner
Mashed rice + daVrasam + ghee + fruit Themes in Nutrition
Bedtime Educadoo
Breastmilk .

Feeding the Young Child (One Year and Above)

By the time baby is one year old he should be eating all kinds of food. He needs
three main meals every day- breakfast, lunch and dinner. Between these meals, hel
she also needs other foods because he/she is growing fast. Hence, he/she can eat
snacks and milk or fruit.

Help the child to feed himself. Make sure that, he does not waste the food or he
will not get an he needs. He or she should eat with the rest of the family.

Guide to feedinga child one year and over

This guide is suitable inSouth India. For the North and other regions, you can make
a similar one based on Unit 9, Block 3, Course I.
Early morning Milk
Breakfast
PongalJidli with sambar
Mid morning
Snack + fruit juice
Lunch
Rice/sankati + plain dal + vegetable + curd
Evening
Snack + milk
Dinner
Rice + dal rasam + vegetable + curds
Bedtime Fruit + milk

4.4.3 How should we feed the sick child?

Feeding the young child when sick

When a child is sick or has an infection, he/she needs more food than usual. The
food must be more nourishing than usual so that the body can fight the illness.
Encourage the mother not to stop giving certain foods during illness.

Milk is good food for sick children. Breast milk is the best food for sick babies.

A mother'should never stop breast feeding, when baby is sick.

j
Guide to Feed the Child Who has Diarrhoea
• Give him plenty offluids.

• Oral rehydration solution (ORS) need to be given as many times as possible.

How to prepare oral rehydration solution?

• Take a glass of water,

• Add one teaspoon of sugar,

• Add a small pinch of salt,

• Mix and taste (It should taste like tears, not so sweet or saltish).
1'7
Themes and Messages
Sometimes, the sick child may not want to eat. The m~ther should try very hard to
in Nutrition and Health
Education get him to eat She should give foods, which are easy to swallow like thick porridge
or bread soaked in milk. She should give some yellow and orange vegetables cooked
and fruit like papaya and mango and plenty of fluids. Sick children need plenty of
tender loving care. They need coaxing to eat. .

When children have infections, they need good nourishing food.

rRemember, malnutrition makes infectionworse ..

. and infection makes malnutrition worsen' further! '

When the child is better, feed him extra food. He should takeenough extra food after
his illness, also to make up for the food he didn't eat when he was sick. If he is
hungry, feed him, adequately with care.

4.4.4 Why is the preschool age called a critical period in

development of food habits?
It is observed that, preschool children are not growing as fast as they did during the
first year of life. However, the child grows continuously. In addition, the preschool
child is very active- nmning, jumping, climbing.

This is the age, when active movement increases in preschoolers, They have increasing
imagination and curiosity. They start imitating adults. Parents rieed to be careful,
during their family meal-times because, children imitate their parents: These children
are beginning to form definite responses to various foods. Further, multiple factors
like social and cultural factors, availability,economics, mother's nutritional knowledge
play a crucial role in forming life time food habits of children. Therefore, preschool
age is considered a critical period, in development of food habits. This is only to
caution the mothers, who are essentially responsible for feeding their children.

4.4.5 What is good nutrition in preschoolers ?

All parents want their babies to be healthy and well nourished. A child who is healthy
and getting enough of the right kinds offood isalert, vigorous and active.

Signs of good nutrition

• Posture is good.
• Weight is in proportion to height and age.
• Skin is clean, smooth and soft.
• Eyes are bright and clear with the inside lowest eye lid, and mouth bright pink.
• Tongue is pink, uncoated and moist.
• Fingernails are pink.
• Teeth are clean, well formed and free from cavities.
• Muscles are firm and well developed:
• Breath is fresh:

18
,-
Themes in Nutrition
4.4.6 How can we monitor the growth of a child? Education
Healthy children must grow steadily. In order to grow, they must have enough of the
right kinds of foods. As you are aware, many children in our country are not being
fed properly due to various factors.

When the children do not get enough food or when they get the wrong kinds of food,
they become malnourished. When a child is well nourished, he will grow well. We
can tell that, he is well nourished and growing when he puts on weight.

The infant's weight should increase to 3 times

the birth weight at one year of age.

To know if a child is putting on weight, we must weigh him regularly for the first three
years of his life and record the weight on a growth chart.

Get the help of an Anganwadi worker for recording growth.

Growth monitoring

The growth ofa young child can' be monitored at anganwadi centers (AWC), which
are established all over the county. At AWe, mothers can weigh their children and
can get the weights plotted on growth charts. This chart will help the mother to
realise how the child is growing and how healthy he/she is? This gives an indication
of whether or nor they are eating the right foods in the ri!?htamounts.

Watch the direction of the growth curve (line) showing

the child's growth.

To check whether. the child is growing properly or not, watch the direction of the
growth line (curve). Emphasis is always on the direction of the child's growth curve.

I) Ifit is going up parallel and close to the lines for normal children, this is alright.

2) If the curve is flattened, the child is not growing (danger).

3) If the curve is going down parallel to the lines, the child is losing weight (very
dangerous).

If the child is in the second category, find out why? The child may not be getting
enough of food. Check the number of meals the child is receiving. Most children
need 4-5 meals a day. If the child is in the third category, find out why? The child
may be falling sick quite often=-diarrhoea, measles and other infections.

Let us now learn, what happens when the child is not being fed a balanced diet for
a long period and when the child is not growing properly. Being underweight forage
is a common form of malnutrition in young children. The underweight child becomes
severely malnourished. He may get infections easily. He may not grow and develop
well into a healthy and productive adult, in future.

4.4.7 What are some common nutritional problems in

preschoolers?
There are different kinds of nutritional problems which affect the child. The most
common forms of malnutrition are:
19
Themes and Messages 1) MarasmusIK washiorkor (Protein Energy Malnutrition)
in Nutrition and Health
Education 2) Anaemia (Iron deficiency)

3) Xerophthalmia (Vitamin A deficiency).

Protem_En~rgy M;llinutrition (PEM)

Being underweight for age is a common form of malnutrition in young children. This
is the first sign of any type of malnutrition, but for marasmus/kwashiorkor, in particular.
The underweight child could become severely malnourished. Such a child may get
infections easily.

Thefirst sign of both types of PE M is growth failure. The child is thinner or shorter
than normal. Growth failure can be seen most clearly on a child's growth chart.
Weeks or months before a child looks like a case of malnutrition, he must have
stopped growing.

Therefore, the mothers need to be helped by community worker [Anganwadi

worker/health worker (ANM)] to maintain growth charts of their children. This
helps them to detect malnutrition at a very early stage. Remember to guide the
mothers along these lines. This means, you are doing a lot to help the community,
to maintain its health status.

A community worker should be able to identify children with malnutrition at the

earliest possible stage, in order to cure them more effectively.

The severe forms of PEM are described here. There are two main types of severe
PEM:

• Marasmus

• Kwashiorkor

Some children have features of both types ofPEM. These children have marasmic
kwashiorkor.

Marasmus
Children get marasmus when they do not eat as much food as they need.

Children with marasmus:

• 'have stopped growing.
• are very skinny/thin with no fat.

• are all skin and bones and are very much underweight.

• have an "old person's" face.

• are always hungry.

• have pot belly.

Many children get marasmus between the age of 6-14 months, during the weaning
period. From the age of 4 - 6 months, all babies need more food, in addition to
breast milk.

20
 Themes in Nutrition
Kwashiorkor Education

Kwashiorkor may start at a later age than marasmus. Often/it starts between the age
of 18 and 48 months. It is a serious sickness especially when there are the added
complications of infection. It needs immediate and urgent medical care.

Children with kwashiorkor:

• have stopped growing.
• show body swelling (oedema), especially on the legs and feet and sometimes
on the face (moon face).
• have thin upper arms.
• have soft, flabby muscles.
• have cracked and peeling skin.
• have thin reddish hair.
• are Wlhappy and ~ften peevish and may not want to eat (miserable looking).

Children who are likely to become malnourished

There are a number of factors playing a role in causing PEM in childhood. Let us
examine the most common and important ones. These are:

1) Under feeding during 6 months to 4 years, which is a fast growing period ..

2) Large family size, sex and birth order result in inadequate food distribution.

3) Close spacing between children and working mother, cause poor attention of the
mother in feeding young children.

4) Repeated pregnancies result in poor maternal health, leading to inadequate secretion

of breast milk.

5) Babies who are born small (less than 2 kg).

6) Babies who do not get enough breast milk for various reasons.

7) Improper weaning practices and weaning foods.

8) Sex differentiation in feeding results in female child suffering.

9) Repeated attacks of infections during childhood.

10) Poor families often cannot afford to buy or grow enough food for everyone in
the family. Culturally, younger ones get affected more.

11) Seasonal variation in food availability results in limited variety of foods in the diet.

12) If the family or community does not know how to feed young children, the result
often is improper food choice in terms of quality and quantity.

In view of the situations existing in a majority of the countries and particularly in

I
India, preschool age is considered as a critical period.

:!l
 Themes and Messages
in Nutrition and Health Preschool age is a critical period.
Education
The children who are likely to become malnourished and children who are border
line cases of malnutrition can get help from the community worker. Children who
have serious malnutrition and often associated' with repeated infectious diseases need
special care. Therefore, they need to be referred to a doctor. Examples of these are:
very thin children with marasmus and children with kwashiorkor who don't eat.

4.4.8 How can we prevent malnutrition?

Some practical hints to the mothers:

• Breast feed the c hiId as long as possible.

• From sixth month onwards give the child a mixed diet, which includes cereal, pulse,
flesh foods, vegetables, etc. This will help a malnourished child to get better quickly,
• Have variety in the diet from different food groups, which helps to balance the diet
of the child.

• Feed frequently. This is a good way of giving more food. A child with malnutrition
needs six meals per day. He should get good quantities of food, not just snacks.
• Add fat to the meals; use cooking oilsto add more energy and to make the diet
tasty, so that the child eats more.

If a child's growth curve falls between the lower

solid line and the dotted line, the child is moderately
nourished. If the curve falls below the dotted line, the
child is severely malnourished.

(Show a growth chart while explaining this.)

4.4.9 What should we know about Anaemia?

This is another type of malnutrition commonly seen among young children. You must
have heard of this name.

Anaemia is a condition when the blood has too few red blood cells or too little of
the red pigment hae rnoglobin. As you are aware, haemoglobin carries oxygen to all
parts of the body for their normal functioning. Anaemia is also referred to as having
'weak' or 'thin' blood.

Haw can ~'\.'e detect an anaemic child? The best way is to get the blood checked
at the clinic.

Some observable symptoms are:

• Pale and transparent skin.

• Child may be less active than normal.

• Child may have infections often.

• Inside of the lips, gums and lower eyelids are light pink or whitish instead ofbright
pink.
22
 Themes in Nutrition
Educatioo
• Shiny smooth tongue.
• Eyes look pale and dull (good indicator).
• Pale pink and sometimes spoon shaped finger nails.

• Swollen face and feet.

• Rapid heart beat.

• Feel like eating mud, dirt, chalk etc.

• Shortness of breath.
A good time to observe the child is when he is feeding at the breast. Always look
at a malnourished child to check for signs of anaemia.

What are the possible causes of anaemia?

1) Inadequate intake of iron rich foods: If the child's main diet after 6 months is
milk, which contains very little iron, he may get anaemia. If the foods rich in iron
such as greens are not given to a young child regularly, he may get anaemia. The
body cannot make enough red blood if it does not have enough iron. The child who
is growing very fast, needs more iron to make blood.

2) Maternal malnutrition: Ifthe mother was anaemic during pregnancy, the baby
may start life with too small stores of iron.

3) Premature birth: Ifthe child was born before the full term (270 days) i.e. too
early, he/she may start life with too small stores of iron.

4) Worm infestation: Losing blood inside the body, through worms such as hook
worm or tape worm may cause anaemia.

Children who are likely to become anaemic?

Children who are

• born too early
• born to anaemic mothers
• fed too long only on milk
• infested with parasites such as hook worm or tape worm
• not eating a mixed diet which contains iron-rich foods

Treating a child with anaemia

• Give plenty of iron-rich foods

• Give an iron tonic

• Give iron tonic after a meal, so that it doesn't upset the child.

The child's bowel movements may be black in colour, ifhe is taking iron. This is
normal. Keep iron and other medicines out of children's reach.
23
r

Themes and Messages

in Nutrition and Health
4.4.10 How can we prevent anaemia in young children?
EdUOltion
1) Pregnant woman should eat different kinds of food, especially those with plenty of
greens, liver,jaggery, whole grain cereals and pulses. .
2) Pregnant women need iron tablets for better availability of iron in the body, compared
to dietary iron.
3) Babies born too early (premature), need small doses of extra iron in the first 3
months of life. These are given at PHCs.
4) After about 6 months, babies should have a mixed diet, which contains good food
sources of iron.
5) Babies should not be fed with tea because it slows down the use of iron by the
body.
6) Fruit juices which taste sour, like oranges or grapes help the body use the iron better
from foods. They should be taken with meals which contain plenty of iron.
7) Children should live in clean surroundings, use clean toilet and wear chappals where
possible to prevent worm infestations .:

4.4.11. What happens in vitamin A deficiency and what can be

done to prevent it ?
Vitamins are substances (nutrients) essential for keeping good health: Vitamin A is
particularly essential for normal health and survival. Vitamin A is also necessary for
normal skin as well as vision.

Mild deficiency of vitamin A in a child for a long period makes the child more prone
to infections and thus infectious diseases occur again and again. When the deficiency
is severe, the eye sigbt will get affected. Initially, inability to see in dim light may
occur. Some children take a long time to adjust their sight when they suddenly come
into a dark room. In a very severe deficiency condition, the eyes undergo some
changes. Gradually the white part of the eyeball loses its sheen and becomes wrinkled,
dull and dry. Some spots may develop in the eye. Finally blindness sets in. You must
be aware of these serious consequences of vitamin A deficiency. This helps you also
to detect vitamin A deficiency.

Less deficient but chronic

Increased morbidity- mortality
Inability to see in the dark
Takes time to adjust sight to sudden changes in light
Severe deficiency •.
White part of eye loses its sheen and looks wrinkled
Cornea becomes dull and dry
Blindness
Vitamin A deficiency is generally seen in children particularly under the age of five.
It does not appear to be so serious in adults.'

24
 Themes in Nutrition
What is the reason?
Education

• Children are not fed with colostrum which is rich in vitaminA and other substances
which give resistance to infection.

• Artificially fed children are more likely to develop vitamin A deficiency.

• If pregnant woman's diet is deficient in vitamin A, the new born baby will have less
vitamin A stores.

• If the child's diet is not supplemented with vitamin A during weaning time.

How to avoid dangerous consequences of vitamin A deficiency?

It is not difficult to avoid blindness due to vitamin A deficiency. Vitamin A has a

special feature. When this vitamin is consumed in large quantities, the excess quantity
is stored in the body for future use. Hence, the following guide is suggested to
improve vitamin A status in the body and thus, avoid dangers.

Guide to improve vitamin A status

• New born should be put to the breast soon after birth, so that the infant can get
enough vitamin A stores.

• Weaning or supplementary foods should contain rich sources of vitamin A- milk,

egg yolk, greens, carrot, papaya.

• Pregnant and lactating mothers should consume plenty of vitamin A rich foods, to
i improve the' vitamin A stores of the child.
s
l
• Large doses of vitam in A are suggested to be given to children in a country like
India, keeping the large majority i.e. low income group in mind.

Recently the following benefits have been observed due to improvement in vitamin
A status in children.

• Vitamin A deficiency increases mortality among 1to 6 year old children. Improving
the vitamin A status of deficient children increases their chance of survival.

• Improving vitamin A status before and after the onset of measles, reduces the severity
of complications and associated mortality.

• Improvement of vitamin A status reduces the severity of infectious episodes e.g.

diarrhoea, pneumonia.

Hence, the pregnant and lactating mother must:

J) Try to encourage the child to consume plenty of foods rich in vitamin

J
-..- A, whenever possible to help the child get enough of vitamin A.
-
2 Now, you must be aware of the major and common problems of malnutrition among
;,
children in our communities. Remember. to emphasise the preventive measures to
overcome malnutrition of any kind- marasmus, kwashiorkor, anaemia, night
~
)
blindness. Also rehabilitate the children who are already malnourished.
)
5
) Guide to overcome malnutrition in children
)

J
p
25
)
Themes and Messages
It is essential to include the following in the diet
in Nutrition and Health
Education
• dark green leafy vegetables
• milk, fish, eggs, meat (ifthey can)
• seasonal fruits
• seasonal vegetables
• cereals (ragi, rice, wheat etc.), pulses, oils.

You may help mothers realise that they can fight against malnutrition, by eating
differently, using foods they can easily provide to their families and thus promote
community nutrition and health.

4.5 THEME 3: NUTRITION DURING SCHOOL

AGE, AI)OLESCENCE, ADULTHOOD AND
OLD AGE
Topics
• Growth Pattern in School Children
• Planning Meals and Feeding School Children
• Some Nutritional Problems and Management in School Children
• Growth Pattern in Adolescence
• Good Meals and Eating Habits for Adolescents
• Adolescents who need Special Attention
• Problems Which Atfect Dietary Intake in Old Age
• Nutritional Problems during Old Age

4.5.1 What is the growth pattern in the school years? Are

Nutrition and Learning related?
School age children are still growing, although not as fast as their younger brothers
and sisters. Growth rates vary widely between sexes. Girls usually out distance boys.
Children from both sexes are usually very active and use up plenty of energy everyday.
. Psychologically, they begin moving from a dependence on parental standards to
those of peers. This is the step in preparing for coming maturity and self growth.
Pressures are generated for self control of the growing body.

There is a close relation of sound nutrition and child learning. Breakfast is particularly
important for a school child. It breaks the fast of the sleep hours and prepares the
child for attention in the learning hours at school. Further, likes.and dislikes of foods
are common among cnildren of this age.

In this situation, if the children do not eat properly, they will not be healthy and will
not grow and develop as they should. School children who don't get enough food,
or enough of the rightkinds of food, cannot pay attention in school. Hungry children

26
 Themes in Nutrition
get bored easily, and do not do their lessons well. They may fall sick quite often. As Education
a result, they may not be regular at school, as they may have neither the energy nor
the interest to go to school. This may be an early symptom of iron deficiency anaemia
in school children. The majority of school children, do suffer from different degrees
of anaemia. You should be able to recognise this anaemia in school children at a very
early stage, so that preventive measures can be taken. The ideal preventive measure
is proper food and feeding for school going children.

4.5.2 What should we keep in mind while planning meals for

school children?
School children need mixtures/combinations of foods from the three food groups.
Every day at least three meals containing enough foods from all the food groups, will
help children to develop properly, stay healthy and learn well. Their diet should also
contain foods rich in iron, since children tend to become anaemic.

In order to help the children enjoy their meals, parents should make foods appetising.
Foods that are crisp, in small portions, easy to handle and with a good blend of
colours will encourage children to eat.

Breakfast: A good breakfast is very important for school children. If a school child
does not have breakfast before leaving home, he will not be able to pay attention
to the lessons in the classroom. He/she may get exhausted.

Simple foods are given for breakfast:

1) Chapati + Cnana preparation + Seasonal fiuit + Milk

2) Pongal + Coconut chutney + Seasonal fruit + Milk

3) Idli + Groundnut chutney + Seasonal fruit + Milk .

Just a drink of tea/coffee/milk with or without fruit does not provide enough
nourislunent

Lunch: School children generally carry a packed lunch to school or eat the school
lunch. There should be enough food provided to make the child satisfied. There
should not be too many items because the child has to carry his lunch. It should also
be appetizing. At the same time, food requirements have to be met.

In order to meet all these conditions, it is better to plan and prepare mixed diets.
Thus, the lunch will have less number of items and will be nutritious. colourful and
easy to carry and eat.

• Mixed rice (rice + dal + vegetable)

• crispy items (chips with potato/yanvbanana)

• curd rice (rice + curd + greens/carrots)

• fruit/sweet dish.

Variety in model lunch, can be brought by altering the kind of dal, vegetable, fruit etc.
in the diet. Parents and children, need to be educated about the fact that sweets,
snacks, icecreams alone do not make a nourishing lunch. It is
often cheaper to
27
Themes and Messages
provide packed lunch than to allow the children to choose from the eatables available
in Nutrition and Health
Education for sale outside the school.

Generally, children enjoy lunch because they eat along with their friends. They start
sharing with each other. This may help children to get introduced to new foods.
Working mothers should provide proper foods for their school age children to eat
when they come from school. Foods like snacks (cereal + pulse + oil), fruit, fruit
juices, groundnuts are nourishing. They will also encourage good eating habits.

Some examples of snacks are- muruku mixture, pakoda, fried whole pulses-bengal
gram, peas, green gram etc.; diamond cuts sweet with oil seeds and jaggery etc. One
snack can also be carried along with packed lunch. This helps children to get
interested in the lunch. Children like snacks and these can be both nourishing and
cheap.

Dinner; Dinner may be the one meal, which the child can eat without rushing.
Mothers should encourage the child to eat. They should pay full attention to eating,
so there should be no distractions around. Like other meals, dinner should be based
on good nourishing mixtures of foods from the three food groups.

An example of a good dinner is :

• chapatillimerice

• dallfish, egg or meat preparation

• vegetable preparation especially green leafy vegetables

• seasonal fruit

• curd (if possible)

4.5.3 Which nutritional problems are common in school

children and how can they be managed?
Common nutritional problems observed in school children are anaemia (Iron
deficiency), riboflavin deficiency. Sometimes vitamin C deficiency is also observed.

Iron deficiency anaemia: This is often present, but symptoms may not appear.
Parents must become alert and feed the children with foods rich in iron. You must
be able to recognise the deficiency in children easily, and treat them.

Riboflavin deficiency: This is also observed in children belonging to low and

middle income groups. The common symptoms of the deficiencyare cheilosis,glossitis,
angular stomatitis, f ssures and ulcers in the tongue and mouth. . .

The diets of these ch.ldren are generally, lacking in animal foods and milk. But, it can
also be managed by providing whole grain cereals and whole pulses and milk in the
diets ofvegetarians ..Animal foods like meat, fish etc. are not a must in the diet to
overcome riboflavin deficiency.Snacks like 'sundal' with whole pulses can be prepared
and served to the eh:ldren. Germinated whole grains (cereals) can also be included
in the diet in whatever form it is relished by people. Here's an example of a snack
from South India made from bengal gram (chana).
28
 Themes in Nutrition
Preparation of snacks with whole pulses
Education
The whole gram has to be soaked in water overnight and it should be cooked in
water and seasoned as per your desire. This is called 'sundal' in South India. The
soaked whole gram should be drained for sometime and this can also be deep fried
and salt and chilli can be added to taste.

Vitamin C deficiency: This is also seen among school children. The common
symptoms are bleeding gums which bleed profusely on touch. In chronic cases, the
teeth may become loose and fall out. It might generally result when the diet is lacking
mostly fresh fruits and vegetables. People who eat salads, need not be worried
much. Those who do not eat vegetables or fruits for various reasons, usually have
diets deficient in vitamin C. This can be managed to a great extent, by providing
amla and guava in the diet of children. Germinated whole grain cereals and pulses,
can also be included in the diet. This does not cost much. You are aware that vitamin
C is necessary to help the body to utilise the iron provided through the diet.
.
Try to be observant to recognise children with these
problems in your community and offer relevant advice
. both to the parents and children.

4.5.4 What is .the growth pattern in Adolescence?

Physical growth during adolescence plays a considerable role in deciding food
requirements. Adolescents undergo a second large growth spurt before reaching
adulthood. Tliis rapid growth is accompanied by sexual maturation. It is observed
that increased food needs are easier for boys to achieve than for girls. This may be
due to sex discrimination in the Indian context.

The remarkable body changes in the adolescent period occur from hormonal effects
regulating the development of sex characteristics. The rate at which these changes
occur varies and shows up in the growth patterns of boys and girls. In girls, the
amount of fat deposit increases particularly in the abdominal area. The hip breadth
increases and the bony pelvis widens in preparation for reproduction. The pelvic girth
of fat also appears. This is often a source of anxiety for many young girls. In
adolescent boys physical growth is manifested more by an increased muscle mass
and long bone growth. The boy's growth spurt is slower than that of the girl initially
but soon he becomes heavier and taller.

4.5.5 What are the major problems regarding eating habits

of Adolescents?
In order to meet the rapid growth of adolescents, increased demands of' go', 'grow'
and 'glow' foods result. But, the psychological (due to rapid body changes) and
social (peer influence) pressure may affect food intake. This is observed more among
girls than among boys.
. .
Adolescent girls often try to follow their own or their friend's eating habits. They may
skip meals: eat snacks/fast foods instead of major meals even.durips lunch or dinner
times. They are likely to eat any type of food at any time of the da:Y.But in the Indian
middle and low income families, the major share of snacks generally goes to boys.
As a result, female children suffer by not getting enough share of snacks and by not
eating major meals. Some girls who want to look slim, may start dieting .notknowing
its serious consequences on health. These practices may be bad for their health. They
29
 Themes and Messages
may become undernourished and even seriously ill if they do not eat a proper
. in Nutrition and Health
Education
nourishing diet.

Pregnancy in adolescence imposes additional strain and this undernutrition continues

and underweight chi dren will be born. The vicious cycle of malnutrition continues.
Hence there is a need to prevent this during the adolescent period itself.

4.5.6 What advice can be given for promoting good eating

habits in Adolescents?
Adolescents of both sexes should have three regular meals based on a variety of
foods. Use the three food groups as a guide to select foods. This is the only sure
way by which they can get all the necessary nourishment each day. Good mixtures
of foods should be eaten at breakfast, lunch and dinner.

Breakfast: This coul d be breadlidlildosa/chapatilupma+coconut/groundnut chutney

+ milk + seasonal fruit. A good breakfast will help the adolescent to do well at
lessons and sports/games at school.

Lunch: If an adolescent is in school, a good lunch should be provided every day.

It should include a good mixture of foods following the principle ofa balanced diet.
A well planned packed lunch is cheaper, clean and more nourishing than the snack
foods sold at school. A good cooked lunch for an adolescent could consist of rice:
chapati/ mixed rice .- dal with green leafy vegetable /meat/fish curry + vegetable
either cooked or raw + curd + fruit (seasonal).

. Dinner: The pattern can be the same as for lunch. Curd can be substituted for milk ..
Special care should he taken to include foods with plenty of iron and calcium.

Snacks: Nourishing snacks are groundnuts, gingelly seeds or groundnut andjaggery

sweet, mixture, muruku (rice + dal deep fiied item), fiuit salad, fiuit custard, pakoda,
samosa etc. Popular snacks can easily be modified to make them more nutritious.
These snacks should be eaten in between not instead of regular meals.

Why Iron is important: Adolescents should eat many different kinds of nutritious
foods every day. They should pay special attention to foods with plenty of iron. As
you are aware, foods rich in iron are meat, liver, whole pulses, dark green leaves
particularly drumstick leaves, jaggery. To help the body use iron well from foods
adolescents should eat fiuits like oranges/guava/amla along with main meals. These
fiuits rich in vitamin C are especially good for this purpose.

Iron is especially important-for adolescent girls who are menstruating.

When there is not enough iron in the diet or when the body cannot use the iron in
the diet well, an adolescent girl may become anaemic. Some boys also lose iron
when they are active in spOI1Sand sweat a lot. Some adolescents who are on
vegetarian diets may be anaemic because they lack iron as well as other nourishing
substances.

4.5.7 Who are the Adolescents who need special attention?

1) Adolescent who does not consume milk: There are different types of vegetarian
diets.A very strict vegetarian diet in low income families may include no foods from
animals including milk and milk products. Adolescents from the low income group,
30
 who follow such a limited vegetarian diet may become malnourished if their diets Themes in Nutrition
Education
do not include careful blends of pulses, groundnuts, cereals, fruits and vegetables.
Hot tea/coffee taken shortly before taking foods rich in iron interferes with iron and
calcium absorption,

2) Pregnant Adolescent: An adolescent girl who becomes pregnant needs plenty

of extra nourishment. This is because she is still growing and is at the same time
nourishing a growing baby. Pregnant adolescents who do not eat properly will
have babies who weigh very little at birth or may die soon after they are born.
These mothers may have a difficult time during pregnancy and delivery. They may
not be able to breast-feed properly. Special attention should be paid to the very
young pregnant adolescent. She is still a child herself and at the same time has
a child growing inside her who needs nourishment to develop properly. She
should get plenty of nourishing foods for herself and her growing baby.

3) An adolescent with a disease related to nutrition: Adolescents with diabetes,

.hypertension or 'heart disease in their family must watch their diets carefully.
Those who are suffering from these diseases should follow their special diet.
Snacks should be .nourishing and eaten in small portions. Foods which are highly
salted and are high in sugar and fat should be avoided.

Adolescents should be dealt with carefully. They are sensitive and

they like to be-independent.

4.5.8 How does ageing influence nutritional requirements?

Ageing starts at conception and ends at death. It encompasses the whole of life, not
merely its later stages, Indeed, every stage has its unique potential and fulfilment and
the periods of adulthood=- young, middle and older- are no exception.

Dietary requirements do not differ greatly in old age from those of younger and
middle adults except in the case of energy. There is a reduced.need for energy as
energy expenditure declines. Usually, old people are less active and use less energy.
They do not need as many calories as younger people. Further dietary intakein the
elderly is influenced by a range of physical, social and psychological problems.

4.5.9 What are the problems which affect dietary intake?

Physical

• Disability
• Knee pains/joint pains
• Loss of teeth

Social

• Loneliness
• Social isolation
• Lack of income

Psychological

• Loss of partner
31
ThemH and Messages • Food faddism and superstitions
in Nutrition and Health
EducatiOn
Therefore, when people get older, they still have special needs for nourishing food.

4.5.10 How can we manage the problems faced during old

age?
Food for the elderly has to be carefully chosen and properly prepared. Make sure
meals are balanced.

Reduced activity: There is a need to cut down on calories. They should reduce
intake of fats and sugar in particular.

Loss of teeth: Diet consistency needs to be looked into.

• Crush or mash the foods and also cut food into small pieces.
• Add gravy or other liquid foods to make the food soft and thus make chewing
easier.
• Be sure to give nourishing foods, which need a little chewing and are easy to digest,
c.g. thick soups, sweets like payasam/halwa, milk, drinks, fruit salad/fruit custard.

Loss of appetite: This might result in problems due to social and psychological
factors like loneliness, social isolation, loss of partner etc. To overcome this problem
the following may help:

• Show concern for the elderly.

• Prepare colourful and tasty meals according to taste and balanced diet principles.
• Serve frequent small nourishing meals often.
• Serve meals in pleasant surroundings and allow enough time for eating slowly.

Poor digestion and constipation: Poor digestion might occur as a result of not
making any alterations in the diet though the activity has reduced and there is loss
of teeth. Constipation might result due to less physical activity.

To overcome these problems:

• cereals and oils and fried foods have to be reduced to balance with the
reduced physical activity.
• serve fresh fruits and soft vegetables which do not cause irritation in the
stomach.
• serve cooked vegetables and mashed fruit/fruit juices to control indigestion.
• include millets such as ragi, maize, bajra etc. in the diet.

Low Income: This might cause psychological tension and worry. To overcome these
problems: . .

• offer psychologica Isupport mainly to build confidence.

• plan and prepare balanced diet by choosing low-cost, locally produced foods.

32
 Loneliness and social isolation: These feelings might be only due to retirement Themes inNutrition
Education
and not having scheduled work. Friends may not visit due to their work pressure.
Similarlymembers in the family also might be busy with their work This, in combination
with their feeling of insecurity, may create feelings of loneliness and social isolation
in the elderly.

In order to overcome these problems:

• Family and friends should spare some time for the elderly, especially at meal times.
This will encourage them to eat well and regularly. .

• Help them to feel a part of family and community life by giving them a part to play.
For example, family members could discuss important issues with them. They could
help to care for young children in the family,if they are able. This act will be satisfying
for both children as well as the elderly. They could look after a kitchen garden and
animals. This willthen be a useful exercise and make them feel they are making a
contribution to the family. Being involved in what is going on is the best solution to
all the problems including dietary problems.

4.5.11 What are the nutritional problems during old age?

The nutrients most likely to be deficient in the diet of an elderly person are vitamins
C, B complex and iron. These deficiencies at the sub-clinical level are common
among elderly. Hence, there is a need to take particular care to include foods rich
in these nutrients in the diet.
i

Guide to the care of malnourished elderly: Any malnourished adult-s- young,

middle or older-needs much personal care and support to build improved habits.
Helpful attitudes and actions of the people, who care for the elderly should be based
on an understanding and realistic approach.

1) Analyse food habits carefully: Try to find out the patient's personal altitudes, the
precise living situation, and its limitations or available options. Nutritional needs can
be met with a variety of foods, so suggestions can be adopted to fit particular needs
and personal situations. Offer suggestions in a practical, realistic and supportive
manner.

2) Never moralise: The statement, "Eat this because it S good for you" is what
people generally say to the elderly. It has little value for anyone, much less to an
elderly person, who may be facing economic, social and psychological problems.

'3) Encourage variety infoods consumed.·An unattractive bland diet is thought by

many, to be necessary for all elderly persons. It is not, a variety of foods and new
recipes with new foods, tastes and seasonings, often prove to be the needed stimuli
for poor appetite and lack of interest in eating. A decreased taste sensitivity in
ageing, needs all the help it can get. Sometimes, smaller amounts of foods andmore
frequent mini-meals are helpful.

The elderly person with a disease related to nutrition

If the older person has or develops a disease or condition that requires special foods,
get help from a doctor, dietitian or nutritionist. The patient must understand and
follow the dietary advice. This is especially important for old people with diabetes,
high blood pressure, overweight and heart disease. .
33
Themes and Messages Based on the issues discussed so far, the most nutritionally supportive environment
in Nutrition and Health
for the elderly is ope in which they-
Education

1) have company for meals, congregate at meal sites; have family support and friends.
2) have foods with pleasant but distinctive taste and flavours.
3) consume meals that are low in cereals, protein foods like daIs or meat etc., and
foods that are high in fibre such as a variety offresh fruits and vegetables and
calcium from animal and plant foods.

4) avoid excess supplements, especially of vitamin A.

5) avoid unnecessary drugs and be informed about the action of each drug they do
take.

6) have access to subsidised old age homes. They provide some financial, emotional
and nutritional support to deserted elderly people.

Sample diet for the elderly:

Morning Coffee/tea

Breakfast Upma/idli/pongal/dosa
. Coconut/groundnut chutney
Milk/coffee
.
Lunch Rice and ragi bath (sankati) +
Dal with greens/egg/meat/curry vegetable
Curd/butter milk
Fruit

Evening Snack (Fruit salad/any sweet or hot snack)

Dinner Rice/chapati
Dal with greens
Vegetable, Milk or milk based preparation

As you can see, this diet is suitable for parts of South India. You can make suitable
modifications for your own region.

4.6 tHEME 4: DIET AS THERAPY

Proper nutrition is necessary for maintaining good health and for building good health
during and after an illness. Using diet to care for or control disease is called diet
therapy. Diet therapy means modifying or changing the normal diet, in order to meet
requirements created by disease or injury. Such diets are called therapeutic diets.

4.6.1 How is a normal diet modified for therapeutic

purposes?
The normal well balanced diet is the basis for all dietary prescriptions. Modifications
of the normal diet may be made as necessary to meet the needs of the patient in
relation to the disease.
34
 Themes in Nutrition
Dietary modifications for therapeutic purposes may be as follows:
Education

i) .Calories niay be increased or decreased. For example, in fever, the calories are
increased and for obesity the calories have to be decreased.

il) Modifications may be made in the balance of nutrients, such as high or low protein,
carbohydrate, fat, minerals or vitamins.

ill) Certain foods may be omitted, as in cases of allergy .

. iv) Modifications of normal diet in terms of consistency, can be made such as liquid
and soft diets.

v) . Modification of the normal diet, could be in the rearrangement ofthe number and
frequency of meals as for peptic ulcer.

In certain circumstances, considerable modifications are necessary but for the majority
of sick people, meals should be based on normal dietary requirements.

4.6.2 What special considerations should we Keep in mind in

planning therapeutic diets?
It is often difficult to get the patient to eat meals based on a therapeutic diet. This
is because, people are often reluctant to eat new foods or familiar foods prepared .
in unfamiliar ways, especially when they are ill. Weakness, exhaustion, illness, loneliness
arid self pity also discourage appetites. When planning meals for the sick, the following
points need special consideration:

i) Most people prefer food to be cooked simply. The digestive capability of the patient
is an important factor.

it) Meals should look attractive when presented. A small flower or a colourful dish
cheers the patient and makes him or her feel more like eating.

fu) All serving dishes and equipment should be sparkling and clean .

.iv) Servings should not be too large, because large servings are not so attractive as
smaller portions, and they tend to discourage a patient, especially ifhe or she has
no appetite.

v) In order to appeal to the patient, hot foods must be served hot and cold foods cold.

iv) The attitude of the person serving the meal can be an effective means of encouraging
the patient to eat. Cheerfulness can improve the patient's attitude and appetite. At
times. your explanation as to the value of.the diet may motivate the patient to
eat. Thepatient should be encouraged to overcome superstitions and prejudices
about certain foods.

Diets should be individualised as far as possible, keeping in mind food habits and
preferences, socio-economic background, effect of
illness on appetite, digestive
capability and nutrient requirements. .

4.6.3 What are Liquid Diets?

Liquid diets are used for patients unable to tolerate solid food. This diet includes
foods which are liquid or liquefy at room temperature, Liquid diets are subdivided
into two types- the clear fluid diet and the full fluid diet. 35
 Themes and Messages
Clear fluid (or clear liquid)
in Nutrition and Health
Education
This consists of liquids that do not irritate the gastrointestinal tract, cause flatulence
(gas) or stimulate peristalsis. The clear liquid diet is used in acute illness, after surgery
or after acute vomiting or diarrhoea. The clear liquid diet is composed, mainly of
water and carbohydrate. It is nutritionally inadequate and should be used only for a
brief period of time. Primary purpose of the clear liquid diet, is to relieve thirst and
to help maintain water and electrolyte balance.

Foods permitted:

Clear tea, weak black coffee, clear vegetable broth, strained fruit juices,
soda water. Sugar/glucose/salt could be added to these as per their taste.

Small amounts. of fluids are offered at frequent intervals (50-100 ml every

hour or two).

Full fluid (or full liquid)

The full fluid diet contains all foods in the clear liquid diet but includes more nutritious
foods

Foods Allowed - All clear liquids

.Fruit and vegetable juices
Soups
Cereal Porridges
Milk, curds, egg flip, ice cream
Commercial supplements like complan, horlicks, casilin, syu etc.

The full liquid diet is given to patients unable to swallow or tolerate solid food. It is
free from cellulose and irritating condiments. Six or more feedings must be given
daily. The protein content of the diet can be increased by adding egg, skimmed milk
powder, or pureed meat to soups. The calorie value of the diet can be increased by
adding cream, butter or oil to porridges and soups. Glucose can be used instead of
sugar, as it is less sweet and can be used in larger quantities. The fuUliquid diet can
be nutritionally adequate.

Sample Menu for a Full Liquid Diet

Early morning Milk or Fruit juice

Breakfast Porridge with cream and sugar
Fruit juice
Mid-morning Egg flip
Lunch Soup
Porridge with ~ream and sugar
Custard
Mid afternoon Fruit juice
Ice cream
Dinner Soup
Porridge with cream and sugar
;36 Bedtime Milk with complan or horlicks
 Themes in Nutrition
4.6:4 What is Soft Diet? Education
The soft diet usually follows a full liquid diet. It may be ordered for postoperative
cases, for patients with acute infections, gastrointestinal conditions or chewing problems.
The soft diet is very similar to the normal diet, except the texture of the foods has
been modified,

The diet includes liquids and foods that have a soft texture and are easy to digest.
The foods allowed are those that contain very little indigestible carbohydrate and no
tough connective tissue. Generally, foods in the soft diet are mildly flavoured, slightly
seasoned and are prepared in easily digestible forms. Small portions should be given
at the main meals with snacks in-between. -

Foods allowed in Soft Diet
Milk, cream, butter, curds, 'coffee, cottage
cheese, eggs except fried, tender meats or fish.
Soft cooked vegetables, cooked fruits, banana,
papaya, etc.
Cooked refined cereals- rice, bread, porridges.
Soups, fruit juices, tea, coffee, etc.

Foods to be avoided. Skin and seeds of vegetables and fruits.

Rich pastries and desserts. Fried foods and nuts.
Raw vegetables. Coarse cereals. Heavily spiced
foods ..

The mechanical soft diet is a modification of the soft diet. In that all foods must be
very soft or ground. This is used when for various reasons, a patient cannot chew
or Use the facial muscles (muscles of the face).

Sample Menu fora Soft Diet

Breakfast Toast with butter and jam; Half boiled egg/cottage cheese;
Coffee/milk; fruit juice; Banana
Midmoming Fruit juice/milk shake
Lunch Well cooked rice with butter; Soft minced chicken or meat;
Cooked carrot; Curds (or dal preparation)
Evening Milkffea/Coffee
Plain cake or biscuits
Dinner Bread with butter
Soup
Mashed potato
Custard/fruit mix
Bedtime . Milk or Milk based beverage

4.6.5 What is Fever?

'Fever' is an elevation of body temperature above the normal. The body is usually
maintained at a normal temperature of 98.6°F or 37°C. Fever is the body's response
to infection by microorganisms, inflammation, physiologic stress or unknown causes.

Fevers may be classified as:

ACUTE such as tonsillitis, influenza, typhoid, measles, chicken pox, etc. 37

Themes and Messages
CHRONIC such as tuberculosis.
in Nutrition and Healtb
Education
INTERMITIENT such as malaria.

In acute fevers, the onset is sudden and severe and the duration is short. For chronic
fevers the onset is usually slow and duration is long. In intermittent fevers, the
symptoms appear at intervals.

4.6.6 How can we use the diet to manage short term fevers?
Many fevers are short.lived or are brought under control in a matter of days by giving
drugs. During the febrile period, in the case of the more serious infections such as
pneumonia, the energy requirement may be increased by as much as 50 per cent.
But, it is not always possible to meet these needs from the diet and the main
considerations are, the replacement of fluid and the provision of energy, protein and
other essential nutrients, in amounts which can be tolerated and which cause the
minimum discomfort to the patient.

A liquid diet is used initially for fevers with progression to a soft diet and then a
regular diet as the appetite improves. When the liquid diet is used, vitamin supplements
will be needed.

Foods in the soft diet, should be bland, easily digested and of a soft consistency.

Small quantities of feeding at intervals of2-3 hours will permit adequate nutrition
without overtaxing the digestive system at anyone time.

The diet should consist, principally of fluids, and soft semi-solids given at frequent
intervals. Fluids mainly consist of milk, soups, fruit juices, egg flip and jelly. Soft
foods like custard, porridge, pureed vegetables, toast, double boiled rice, curds,
etc., could be introduced as tolerated. Glucose could be added to fruit juices, to
increase energy intake, as it is less sweet than sugar. Butter or cream could be added
to porridge and soups, to increase calorie intake.

Constant encouragement and assistance are necessary, as the patient may be too ill
to take an interest in food and drink. The mouth should be kept clean and fresh. A
few sips of water before and after food is helpful.

As improvement takes place, the appetite returns and the patient may be able to
progress to a normal balanced diet.

4.6.7 What are the main principles in dietary management of

prolonged fevers?
When the response 1:0 treatment is delayed and the period of fever is prolonged, it
is important to maintain an adequate standard of nutrition:

1) The diet should he high in energy value. The patient should not be forced to take
food, but all attempts should be made to ensure an intake of2000 to 2500 Kcal
per day.

2) Protein intake sl:.ouldbe high, to prevent body tissue breakdown. Milk and eggs
provide protein in a bland, easily digested and palatable form. They may be given
as soup, custards, etc. Milk could be fortified with supplements like proteinex,
38 complan, etc.
3) A liberal intake of carbohydrate will provide energy in an easily tolerated fonn and Themes in Nutrition
Education
has a protein sparing action. Glucose should be used freely as it is readily soluble
and not so sweet as sugar. Fruit juices and jellies could be encouraged.

4) Fat, can be introduced in the form of cream, butter or oil added to soups and
porridges, making a valuable contribution to the energy requirement.

5) Feeds should be frequent and small in amount and should consist offoods which
are easily digested and require the minimum of mastication (chewing).

6) A fluid intake of at least 2500 to 3000 ml daily, should be provided to facilitate

excretion of wastes .and prevent dehydration.

Ifthe intestinal tract is inflamed asin typhoid, the diet should be bland, soft and low
in roughage or fibre.

As improvement takes place, a more norma] type of diet is given. A high protein and
high energy intake, however, has to be ensured.

Sample Dlet for Fever

(2000 Kcal, 70-S0g Protein)

6A.M. Milk 200 ml with 1 teaspoon supplement

SA.M. Cereal porridge with cream or butter
Milk 100 ml.
Halfboiled egg
'OA.M. Fruit juice
Lunch Bread 2 slices.. ,
Butter
Soup with meat in paste or ground form
Custard
3 P.M. Jelly
Fruit juice
5 P.M. Soup or Ice Cream
7P.M. Cereal porridge with milk 100 ml, cream or butter, Bread Pudding
9 P.M. Milk 200 ml with 1 teaspoon supplement

Glucose for the day: 100 - 150g.

Protein supplement: 20 - 30g (e.g. Casilan or Syu)

4.6.8 What is Diarrhoea? What causes Diarrhoea?

Diarrhoea is the passage of frequent liquid stools. The passage of food through the
intestines is abnormally rapid and impairs complete digestion and absorption.

There.are many causes of diarrhoea. Infections in children and adults may bring
about diarrhoea. Over eating, or eating wrong foods and incomplete digestion may
cause diarrhoea. During periods of stress, strain or excitement, children and adults
may have diarrhoea. Inchildren, even fear may cause diarrhoea. Food poisoning is
a common culprit. In hot weather, diarrhoea occurs frequently. Diarrhoea may
39
Themes and Messages accompany certain diseases such as tuberculosis, amoebic dysentery and typhoid
in Nutrition and H~altb
Education
fever.

4.6.9 How are Diarrhoea and Malnutrition related to each

other?
Diarrhoea is more common and more dangerous in young children, who are poorly
nourished, Although diarrhoea has many different causes, the most common are
infections and poor nutrition, Infection in children, is essentially due to the poor
environmental hygiene and poor sanitation with special reference to the families of
lower income groups in rural areas and urban slums. With good hygiene and good
food, most diarrhoeas could be prevented in children. When the child is well nourished,
he is less likely to get diarrhoea and even if he gets it, he will get well quickly. On
the other hand, a poorly nourished child becomes a victim of diarrhoea often. There
is a greater chance for him to die of it. Thus, malnutrition and diarthoea, each makes
the other worse and situation continues.

• Prevent diarrhoea bypreventing malnutrition

• Prevent malnutrition by preventing diarrhoea

As has been mentioned earlier, when the child is well nourished he is less likely to
get diarrhoea, as against a child who is ill nourished. Diarrhoea causes malnutrition
. by preventing food from being digested and absorbed properly. Thus, diarrhoea
causes malnutrition and malnutrition causes diarrhoea.

4.6.10 What is Dehydration?

When a child gets diarrhoea his body loses water. When a child has lost water in
this way for a long period, we say, he is dehydrated. A child Jl!ay die even in hours
from acute dehydration. .

Dehydration develops more quickly and is most dangerous in small children. It is

important that every one, especially mothers know the signs of dehydration and how
to prevent and treat it early. '

What are the signs of dehydration?

• Little or no urine.
•. Dry mouth and sunken eyes.
• Loss of elasticity of the skin.
• Very severe dehydration may cause rapid and weak pulse. fast deep breathing,
fever and convulsions.
,
4.6.11 How can we prevent and treat Dehydration?
Following are the important guidelines, while treating diarrhoea;

• Medication is not needed for most cases of diarrhoea.

• Dehydration is the biggest danger in diarrhoea. When the diarrhoea lasts for a long
time. it leads to malnutrition. Enough liquids and goodfood are the two important
.things needed in preventing dehydration.
40
 Themes in Nutrition
Oral rehydratiqn solution is the life saving device for children. It is nothing but a
Education
mixture of salt and sugar solution. Oral rehydration solution, can be easily prepared
by the mother at home using the following ingredients.

Water 1 cup 200 ml, (boiled and cooled)

Salt 1 pinch

Sugar 4 pinches

Mix them all together. The mixture should not taste saltier than tears. Remember too
salty a solution can harm the child! Keep giving oral rehydration solution in quantities
tolerated by the child. Even if the child vomits, the mother should give oral rehydration
solution. Only when the child is not able to tolerate anything orally, the nearby
medical facilities should be availed, to give a drip to correct the dehydration. Many
mothers bring the children to the hospital when the dehydration is vel)' vel)' bad and
even a drip cannot save the child. Hence, we have to teach every mother, to give
her child salt and sugar water as soon as the child has a few loose motions and starts
to get diarrhoea. If this is done, then many children need not go to the hospital for
correction of diarrhoea and almost none would die from diarrhoea.

Medicines can be given as per medical advice to correct diarrhoea. Keep giving
breast milk, when the baby has diarrhoea. This facilitates easy recovery.

When an adult man gets diarrhoea in the acute stage, he can be on a liquid diet of
rice kanji, beverages like tea and oral rehydration drink. Gradually a soft diet with
low fibre content can be given. Fatty foods, rich and highly seasoned foods should
be avoided. Porridge made out of sago and arrowroot given with salt and butter
milk, will help.

4.7 SUMMING UP: HINTS ON USING THIS

MATERIAL
The answers to the questions are given exactly as if YOU were speaking to the
COMMUNITY Depending on the needs of the community you work with, this
material can be modified or adapted. In addition, you may like to raise other issues
which are relevant in that particular culture/geographical area.

Remember, that this unit does not cover all the areas you may be interested in.
However, you already have all the information you need in Courses 1 and 2. You
would just need to express this information, in as simple a manner as possible.
Dealing with local superstitions and beliefs is important.
..
The specific approaches, strategies and methods you can use to convey information
and simple messages are discussed in Blocks 3 to 5 of this course.

41
 UNIT 5 TIIEMES IN HEALTH
EDUCATION
Structure
5.1 Introduction
5.2 Objectives
5.3 Theme 1 : Infectious and Non-Infectious Diseases
5.3.1 What are Infectious Diseases'? How are they Caused?
5.3.2 What are Non-infectious Diseases?
5.3.3 How do Parasites Harm us '?
5.3.4 How can we Prevent the Spread of Infectious Disease?
5.3.5 Can Lifestyle and other Personal Factors Cause Disease?
5.4. Theme 2: Preventing and Treating Common Sicknesses and Problems
5.4.1 How can we Prevent Damage to the Eyes?
5.4.2 What sho.ild we do to Keep Teeth and Gums Healthy?
5.4.3 What are the most Frequent Signs of Tuberculosis? How can it be Treated and
Prevented?
5.4.4 Can we Prevent Tetanus?
5.4.5 How can we Avoid Malaria?
5.4.6 What are the Steps which can be taken to Prevent Typhoid?
5.4.7 What are the General Guidelines for Cleanliness and Hygiene?
5.4.8 How should we Deal with Fever in Small Children?
5.4.9 What is the Best way to Prevent Hookworm Infestations?
5.4.10 How can Worm Infestations in General be Prevented?
5.4.11 What are the General Principles of Treatment of the Infectious Diseases of
Childhood?
5.4.12 How can we Prevent Degenerative Diseases in Old Age?
5.4.13 What can we do to Treat Burns?
5.4.14 How can we Prevent Cases of Poisoning? What should we do if we Suspect
Poisoning?
5.5 Theme 3 : Using Medicines
5.5.1 "Medicines are Always Necessary." True or False?
5.5.2 "Injections are Always Better." True or False?
5.5.3 When Symptoms Disappear, should we stop Taking Medicines?
5.5.4 Can Antibiotics be Dangerous?
5.5.5 How do we Measure the Amount of a Medicine ?
5.5.6 How often should a Medicine be taken?
5.5.7 Can we take medicines with food?
5.6 Summing Up: Hints on Using this Material

5.1 INTRODUCTION
In the last unit, we discussed how information can be provided to the community,
using simple language. The focus was on some major themes in nutrition education.
Now, this unit concentrates on themes in health education. The material is organised
in question and answer form. Again you are free to add, delete or modify, according
to the needs of the community, you are working with.

5.2 OBJECTIVES
After going through this unit, you should be able to:
42
 Themes in Health
• select themes and issues appropriate for your community; and
Education

• make modifications in order to improve the effectiveness of the teaching process.

5.3 THEME 1: INFECTIOUS AND NON-

, INFECTIOUS DISEASES
Topics
Infectious Diseases and their Causation
Types of Non-infectious Diseases
Problems Caused by Parasitic Infestations
Preventing Spread of Infectious Diseases
Relationship of Lifestyle and other Factors with Disease

5.3.1 What are infectious diseases? How are they caused?

Infectious diseases spread from one person to another by:

• touching • dirt on wounds

• through air, water or food • dirty fingers .
• sexual contact • contact with dirty things
• contact with dirty clothing • infected blood transfusion
• insect or animal bites • unsteriled syringes and needle

. These diseases are generally caused by germs, we cannot see with our eyes such as
bacteria or viruses. Viruses are even smaller than bacteria. Fungi can also cause
infections. The following table lists some of the sicknesses caused by bacteria, viruses
and fungi.

Organism Causing Name of Diseases

Disease
Bacteria Tuberculosis, tetanus, some diarrhoeas, pneumonia,
gonorrhoea and syphilis
J
VIruses Colds, flu, mumps, chickenpox, some diarrhoeas,
rabies, AIDS
Fungi Ringworm, athlete's foot, some types of itching

5.3.2 What are Non-infectious diseases?

Non-infectious diseases do not spread from person to person. You cannot "catch"
a non infectious disease; you can "catch" an infectious disease.

Examples of non-infectious diseases are many such as those listed here;

I) Problems caused by something that wears out or goes wrong within the
body
43
Themes and Messages Rheumatism
in Nutrition and Health
Education Heart attack
Epileptic fits
Stroke
Migraines
Cataract
Cancer

ll) Problems caused by something, from outside that harms or troubles the
body -

Allergies
Asthma
. Poisoning
Snakebite
Smoker's Cough
Stomach Ulcer
Alcoholism

Ill) Problems caused by a lack of something, the body needs

Nutritional deficiency disorders such as pellagra, PEM, anaemia, goitre, etc.

IV) Problems people are born with

Harelip.
Crossed or Wan-eyes
Other deformities
Epilepsy (some kinds)
Retardation (backward in mental ability)

V) Problems that are related to the mind

Fear that something is harmful when it is not (paranoia)

Nervous worry (anxiety)
Uncontrolled feartphobia)

5.3.3 How do parasites harm us ?

Parasites are a class of animals, which are harmful to the body. They may be internal
parasites, which live in the body. On the other hand, external parasites live on the
body. Many external parasites suck blood e.g. lice, fleas and bedbugs. If these
parasites are infected with disease organisms, they pass them on to a human being
every time they Slick blood.

Internal parasites such as worms and amoebas (which cause dysentery), pass from.
faeces to the mouth through dirty fingers or through contaminated food, water. Some
such as, the hookworm enter the body, when the larvae pierce through the skin of
the foot when a person walks barefoot over contaminated soil.

The intestinal parasites take in much of the food and nutrients in the intestinal tract,
44
making the person weak and malnourished. Some such as, the hookworm take in Themes in Health
Education
blood and therefore can cause severe anaemia. -

The malaria parasite passes from one person to another through a mosquito bite. You
probably already know this. As a mosquito infected with the parasite sucks blood,
the parasite moves into the bloodstream of the person and later causes malaria.

S.3.4 How can we prevent the spread of infectious disease?

A protected supply of water and adequate measures of hygiene and sanitation can
prevent the spread of common infectious diseases. Keeping yourself and your
surroundings clean is important.

Preventive measures may vary from one specific disease to another. However, in
general, the following 'measures are important.

• Immunize infants and children, against common infectious diseases of childhood:

• If a person has an infectious disease, do not let many people come in contact with
him or her; keep clothing, bed clothes, utensils etc. separate; clean hands every time
the person is touched .
.
• Use proper toilets, do not leave garbage exposed.
• Keep domestic animals outside the house.
• Observe rules ofpersonal hygiene e.g washing hands after bowel movement, washing
hands before every meal. Teach young children to observe rules as well.

• Try to keep house and surroundings as clean as possible.

• Do not pass stools or urine close to the supply of drinking water e.g. wells, lakes,
nvers.

• Keep wens covered.

5.3.5 Can lifestyle and other personal factors cause disease?

Yes!
. ,

A person who is sedentary i.e. does not do much exercise and' keeps sitting all the
time, develops heart diseases and diabetes more easily and early. This is particularly
so, if a person eats too much fat and sugar in addition to doing little physical exercise.

Personal habits such as smoking, drug abuse, alcoholism can severely damage health.
Smoking directly damages the lungs and heart of the smoker as well as family
members. In fact, passive smoking (inhaling smoke due to sitting close to a smoker)
has been found to be asbad, ifnot worse. Smoking increases the risk of cancer of
the lungs and lips. It also increases chances of suffering or dying from a heart disease
or stroke. Pregnant women who smokes, harm their unborn babies.

Drug abuse and alcoholism takes away the major share of family's money, leaving
little to spend on essentials such as food. They reduce the productive capacity of a
person so he earns less as well. Smoking also cost money. So these kinds-of
personal factors, can be disastrous for the family and small children, in particular.

45
r
,It. ..,
Themes and Messages
in Nutrition and Health 5.4 THEME 2: PREVENTING AND TREATING
. Education
COMM:ON SICKNESSES AND PROBLEMS
Topics
Preventing damage to the Eyes
Keeping Teeth and gums Healthy
Symptoms, Treatment and Prevention of Tuberculosis
Prevention of Tetanus
How to avoid Malaria
Prevention of Typhoid
General Guidelines for Cleanliness and Hygiene
Fevers in Small Children
Prevention of Hookworm and other Infestations
Principles ofTreatrnent of Common Infectious Diseases of, Childhood
Prevention of degenerative Diseases in Old Age
Treatment of Burns
Prevention and Treatment of Poisoning

PREVENTION IS BETTER THAN CURE! In a poor community, treatment means

spending money (i.sually too much and too late) on something which could easily'
have been avoided, if proper preventive measures had been taken.

On the other hand, it is realistic to expect many illnesses and problems. You must
know the principles of treating common illness at least Recognise your own limitations.
IF YOU FEEL YOU CANNOT HANDLE A PROBLEM, GET MEDICAL HELP
AS FAST AS POSSIBLE.

This can mean the difference between life and death.

5.4.1 How can we prevent damage to the eyes?

Eyes are extremely delicate. The following precautions and preventive measures can-
keep eyes healthy and injury free.

• Apply antibiotic:ointment for eye infections. The antibiotic should be applied on the
inside of the lower eyelid.
• Do not let a person with an eye infection come in contact with others or use the
same towel. Wash hands after touching eyes.
• Eat plenty of dark green vegetables and yellow or orange fruits and vegetables to
get enough ofthe protective nutrient, vitamin A
• Get immediate help, if any ofthe following danger signs occur:
- any wound that cuts or ruptures (goes through) the eyeball.
- a painful, greyish coloured spot on cornea (the comea is the clear layer that
covers the black ofthe eye).
- great pain inside eye.
46
 Themes in Helllth
- difference in size of pupil (the middle portion of the black of the eye that is
EdUc800n
circular and appears dark but actually lets in light).
- vision failing in one or both eyes
- any eye infection or inflammation, that does not get better after 5 or 6 days of
treatment with an antibiotic eye ointment.

• If a child shows night blindness t1d dry eyes without shine and with wrinkles, the
eyes are in danger because of vita#UnA deficiency. Look carefully at the eyes of all
sick and underweight children. Give suitable doses of vitamin A. One capsule of
vitamin A or syrup equivalent to 200, 000 I.U., should be given once every six
months to prevent deficiency. Do not give to babies under 6 months of age.

If the condition is already fairly severe, give the child a 200,000 unit/capsule
inunediately. If the cornea is dull, pitted or bulging get medical help at once.'

• Do not try to remove deep seated particles stuck in the eye; seek the help of an eye
doctor.

5.4.2 What should we do to keep teeth and gums healthy? .

We cannot chew food properly without healthy teeth and gums -' chewing is important
for proper digestion. Painful cavities (holes in the teeth caused by decay) and sore
gums, can be prevented by good care of the teeth. It is important to remember that,
rotten "teeth can lead to serious infections that may affect other parts ofthe body.

The steps we can take are:

• avoid eating too many sweets or consuming too many soft drinks.
• brush teeth well every day in the morning (you don't need a toothbrush- twig of
the neem tree or soft bark will do). Use a 'mixture of salt or soda bicarbonate, if
there is no toothpaste.
• see a dental doctor immediately, if your teeth show a high degree of sensation on
taking in cold or hot foods; do not wait till the teeth hurt a lot.
• use an antibiotic and pain reliever. if tooth infection is severe; the tooth may have to
be pulled, ifit reoccurs often.
• protect the gums by removing food that sticks between the teeth; scrape off dark
yellow crust (tartar) that forms where teeth meet gums.
• eat protective foods, rich in minerals and vitamins; eat crisp, crunchy, hard foods to
give exercise to the teeth and gums.

5.4.3 What are the most frequent signs of tuberculosis? How

can it be treated and prevented?
A person with TB usually has:

• chronic cough especially just after walking up

• mild fever in the afternoon and sweating at night
• pain in chest or upper back
• chronic loss of weight and increasing weakness. 47
Themes and Messages .
Coughing up blood; }ale, waxy skinand, a hoarse voice appear only in serious or
in Nutrition and Health
Education advanced cases.

Drugs commonly used in treatment of TB, include streptomycin injections,isoniazid

pills. Isoniazid is an "antagonist" of one of the B complex group of vitamins called
vitamin B6• So, B complex supplements would be recommended. We've already
talked about diet therapy in tuberculosis. Rest is also important.

Ifa family member has TB, the following steps should be taken.

• Start treatment immediately. Continue treatmentregularly=complete cure may take

1-2years.
• Immunize children against TB.
• Getthe whole family tested for TB.
• Do not let the person with TB eat or sleep with the children; if possible, keep a
separate room for the affected person.
• Covering the mouth while coughing and avoiding spitting on the floor; c~n prevent
the germs from spreading.

5.4.4 Can we prevent tetanus?

YES! Prevention is much easier than treating this deadly disease. Vaccinating is the
only full proof method. All pregnant women, should be immunized with tetanus
toxoid. This will prevent either the mother or baby, developing tetanus.

Deep wounds should be cleaned with medical help. Getting an injection of tetanus
antitoxin is important.

Using a sterile instrument to cut the umbilical cord of the newborn; cutting the cord
short, keeping it clean and dry and leaving it open to air, are importantprecautions.

5.4.5 How can we avoid malaria?

Avoiding malaria becomes an easy task, with the following simple steps:

• Don't let mosquitoes breed, in and around the house or in your locality. To do this
- clear all stagnant water
- drain or put a little.oil on pools or marshes
- do not leave any containers or broken pots or pits, which can collect water.
• Cooperate with malaria control workers in your area.
• Don't let mosquitoes bite you or your family members. Cover yourself with a sheet
or sleep under a mosquito net.
• Take a regular dose of chloroquine (one tablet a week usually).
• If you suspect that you have malaria, get treatment immediately. This way, you
won't be spreadir.g the disease.· .

48
 - Themes in Health
5.4.6 What are the st~~s which can be taken to prevent Education
typhoid?
The steps are :

• Avoid contamination of water and food by human faeces,

• Construct and use latrines, Latrines must not be close to the drinking water supply,

• Boil drinking water, particularly ifthere is a likelihood of typhoid appearing in the

area,

• A typhoid patient should remainin a separate room; his dishes and clothes should
be separate, His stools should be burnt or buried in deep holes, persons who care
for him should wash their hands frequently, particularly after handling the patient or
items used by the patient

f • Don't let carriers handle food, "Carriers" quite literally carry the disease and pass it
on to others, even though they themselves have no symptoms,

5.4.7 What are the general guidelines for cleanliness and

hygiene?
Cleanliness in the home
• Do not let pigs or other domestic animals into the house or places, where children
play,

• Do not letdogs lick children or climb up on beds, Dogs, too, can spread disease,

• If children or animals have a bowel movement near the house, clean it up at once,
Teach them to use a latrine,

• Hang or spread sheetslblankets in the sun often, If there are bedbugs pour boiling
water on the cots and wash the sheets and blankets all, on the same day,

• Use appropriate medicines or other means, to remove infestation by lice and fleas,

• Do not spit on the floor- spit can spread disease, When you cough or sneeze,
cover your mouth with your hand or a cloth or handkerchief

• Clean house often, fill in cracks and holes in floor or walls to prevent insects using
them as hiding places,

Cleanliness in eating and drinking

• Boil water before drinking, Keep boiled water covered in a clean place, Do not dip
hands or used glasses into the water,

• Keep food covered or in boxes or cabinets with wire screens, This protects food
. from flies and other insects, which carry disease-producing germs,

• Washfruitswell especially fruits,which have fallen on the ground, Do not let children
pick up and eat food, that has been dropped,

• Cook meat thoroughly- it must not have TaV,!parts inside, Improperly cooked
meat, especially pork can contain dangerous parasites such as tapeworm. 49
 -
Themes and Messages
Do not eat food, that is old or smells bad, it may be poisonous. Do not eat canned
in Nutrition and Health
Education
food if the can is swo.len or squirts when opened. Be especially careful with canned
.
.fish. Boil utensils used by people with infectious diseases, before they are used by
others. People with TB, flu, colds or other "infectious diseases should eat separately
from others. •

Cleanliness of surroundings and public places

• Keep wells and public water holes clean. Do not let animals go near, where people
get drinking water. If'necessary, put a fence around the place to keep animals out.
Do not pass bowel movements or throw garbage near the water hole. Take special
care to keep rivers and streams clean, upstream from any place where drinking
water is taken.

• Bum all garbage that can be burned. Garbage that cannot be burned, should be
buried in a special pit or place far away from houses and the places, where people
get drinking water. Plastic waste should be burned in an incinerator- the fumes and
smoke can be poisonous and therefore do not stand near.

• Build latrines, so that domestic animals and insects, such as flies cannot reach the
human waste. A deep hole with a little cover over it, works well.

5.4.8 How should we deal with fever in small children?

High fever can be dangerous in the case of the small child. It can cause fits or
damage the brain. To lower fever quickly, remove the dothes of the sick child, soak.
with cloth pads soaked in cool water and fan the child. Also give aspirin in the right
amounts.

Giving plenty of fluid is extremely important. Dehydration can kill a small child.

5.4.9 What is the best way to prevent hookworm

infestations?
Hookworm larvae enter the body, by piercing the skin of the feet. It is important not
to walk barefoot. Ir addition, observe the guidelines for cleanliness and proper
disposal of human wastes.

5.4.10 How can worm infestations in general be prevented?

The precautions to be observed are the following:

• Observing rules 0 fhygiene

• Using latrines

.• Using shoes or other footwear- never going barefoot

• Cooking meat thoroughly, particularly ensuring that bigger pieces have no raw parts
inside

• Drinking only boiled/pure water.

5.4.11 What are the general principles of treatment of the

infectious diseases of childhood?
50 . The infectious diseases of childhood range from chickenpox and mumps, which are
 Themes in Health
generally not serious, to measles, whooping cough, diphtheria and polio which can Education
have very severe effects. It is best, to get prompt medical attention for the latter.

The following table summarises the treatment of the common infectious diseases of
childhood.

Disease Treatment/measures to reduce discomfort

Chickenpox • Bathe child daily with soap and warm water

• Apply a cool cloth soaked in water
• Cut fingernails short
• Use antibiotic ointment for scabs (scabs are
blisters which have burst)

Measles • Give aspirin for bringing down fever and

reducing discomfort
• Get medical help if signs of pneumonia,
meningitis or severe pain in the ear or stomach
develops.
.• Keep the child under bed rest (i.e. child should
stay in bed)
• Give plenty of fluids and nutritious food, if the
baby cannot breast feed; give breast milk in a
spoon

Mumps • Bring down fever and relieve pain, using aspirin

• Give the child soft, nutritious foods
• Keep the child's mouth clean

Whooping cough • Get medical help in the early stages; treat using
antibiotics, before the '<Whoop" begins.
• Don '.t wait, if you suspect whooping cough in
an infant. below 6 months. Treat at once, if a
baby gets fits of coughing and swollen or puffy
eyes.
• Give nutritious food, soon after the child vomits
to avoid weight loss and malnutrition.

Diphtheria • Keep child under bed rest, keep separate from .

other persons.
• Get medical help quickly. There is a special
antitoxin for diphtheria.
• Give antibiotic therapy. Testing for penicillin
allergy is vital.
• Have the child gurgle warm water with a little
J) salt
J
I
• Have the child breathe hot vapours often.
- • Try and remove the membrane from the throat
i2
2> of the child, using a cloth wrapped around your
jj finger, if the child begins to choke and turn blue.
I)
I

Polio • Use aspirin in suitable doses to reduce pain

• Use warm water soaks to relieve pain in muscles
'affected by the disease.
• Once polio starts, nothing can prevent paralysis. 51
Themes- and Messages
in Nutrition and Health
5.4.12 How can we prevent degenerative diseases in old age?
Education Lifestyle and habits are very important in preventing illness later in life. It's important
to take adequate precautions when you are young- don't wait till you are older. By
then, it may already be too late. What are these precautions? Here's a list.

• Eat a well balanced diet. Avoid too much offoods rich in fat and sugar
• Do not consume!too much alcohol

• Do not smoke

• Reduce weight if you are overweight

,. Keep physically and mentally active

• Try to get enough rest and sleep

• Learn how to relax and deal positively with things that worry or upset you.

5.4.13 What can we do to treat burns?

For minor burns, that do not form blisters i.e. for first degree bums, PUT THE
BURNED PART IN COLD WATER AT ONCE.

Second degree bums or bums, that cause blisters may need special treatment. Do
not break the blisters. If the blisters are broken wash gently with soap and boiled
water, that has been cooled. Sterilize a little vaseline, by heating it until it boils and
spread it on a piece of sterile gauze. Then, put the gauze on the bum. If there is no
vaseline leave the bum uncovered. Never apply grease or butter. KEEP THE BURN
AS CLEAN AS POSSIBLE. PROTECT FROM DIRT, DUST AND FLIES.

Act immediately, if signs of infection appear. These signs are pus, bad smell, fever
or swollen lymph-nodes. The doctor will usually tell you to apply compresses of
warm salt water (1 teaspoon salt to one litre water) 3 times a day. Boil both the
water and cloth before use. With great care, remove the dead skin and flesh. It is
best to seek the doctor's help for this. An antibiotic ointment can be spread, if
advised. Taking antibiotic capsules may become necessary, if the infection is severe.

For deep burns (i.e, third degree bums) a person should be taken to a medical or
health centre at once. The burned part can be kept wrapped with a very clean cloth
or towel.

In deep burns, the skin is destroyed and raw or charred flesh is exposed. It is
important to prevent infection, by using vaseline or if there is no vaseline, using a
loose cotton covering. This covering should be very clean and should be changed,
every time it gets soiled with liquid or blood from the bum.

A person who has suffered very serious bums loses a lot of fluid from the oozing
bums. Give plenty of liquid. Mixing half a teaspoon of salt and half a teaspoon of
bicarbonate of soda with 2-3 tablespoons of sugar or honey and some orange/lemon
juice in one litre of water, makes a good drink. The burned person should drink this,
as often as possible. It is particularly important to do this till the person starts passing
urine frequently.'

52
 In cases of severe burns, eating nutritious food is most important. Foods rich in Tbemes in Healtb
~ucadon
protein must be emphasised i.e., "grow" goods. Do you know why? Yes, of course.
That's because so much body tissue has been destroyed and needs to be replaced.

5.4.14 How can we prevent cases of poisoning? What should

we do if we suspect poisoning?
A little carelessness causes most cases of poisoning. The following precautions can
help to prevent poisoning.

• Do not keep poisonous or non-edible substances along with food items.

• Dispose of old medicines.

• Do not use food containers for storing poisons.

• Keep all poisons out of reach of children. This is extremely important Many children
die from swallowing things, that are poisonous. If you suspect poisoning, do the
following immediately :

• make the person vomit by putting a finger in the throat or by making the person
drink water with salt or soap in it.

• Then make the child/adult drink as much of milk as possible. Milk counteracts
the effect of many poisons. Eating beaten eggs or flour mixed with water can
help.

• If the person has swallowed kerosene, petrol or strong acids or corrosive

substances, do not make the person vomit.

SEEK MEDICAL HELP AS SOON AS YOU CAN I

5.5 THEME 3: USING MEDICINES
Medicines used properly save lives. However, if they are used in the wrong manner
or'in unsuitable dosages, they can even kill. This theme explores the ways in which
we can remove the common misconceptions of people regarding the use of medicines.

5.5.1 "Medicines are always necessary." True or False?

Medicines are NOT always necessary. For example, a common cold will just go
away by itself. There's' no need for pills or syrups.

However, some illnesses will not go away without medicines. In these cases delaying
treatment would make the disease worse. Later, it can become difficult to control.

- 5.5.1' "Injections are always better." True or False?

2
2> False. It is true that any medicine when injected has a greater effect BUT this is
J needed only rarely. Ifthe needle used for injecting is not clean, serious infections
I)

result It is also much easier, to give too much of a medicine while injecting. This can
I

~
5 kill! So injections should be given only when absolutely necessary.
5
I
I)
:>
J
; 53
5
Themes and Messages
in Nutrition and Health
5.5.3 When symptoms disappear, should we stop taking
Education medicines?
In most cases, symptoms disappearing may mean only that the disease is under
control NOT CURED. Continuing therapy in these cases is most important. For
example, TB may be cured completely, only after a year of treatment.

5.5.4 Can antibiotics be dangerous?

Antibiotics are very powerful medicines. They should only be used when the need
is great. The following guidelines can help you use these drugs properly.

• .Use in recommended doses- never more, never less. The dose depends on age or
weight of the person who is ill.

• Never ask for injections. This is necessary only in very serious cases.
• Stop using the antibiotic ifthere is any sign of allergy e.g. rash on skin, itching,
difficultbreathing.

IF SUCH A REACTION HAS OCCURRED EARLIER, NEVER USE THE

ANTIBIOTIC AGAIN !

• Do not stop therapy early. This results in incomplete cure. In addition, there is a
greater chance that the disease causing organisms would become resistant to the
antibiotic..

• All antibiotics are not equally effective for all illnesses. One or two may be
recommended for a specific disease, because they kill that particular organism most
effectively.

• Never take penicillin, unless you have been tested for allergy to penicillin.

• Do not use a dangerous antibiotic such as chloramphenicol, except in the case of

J typhoid. Never give this drug to newborn children- it can kill the infant.

• Never use antibiotics for colds, flu (influenza).

• Always take supplements of vitamins, since antibiotics kill the helpful bacteria in the
gastrointestinaltract.These bacteria add to the body's supplies of essential B-complex
vitamins, in particular.

5.5.5 How do we measure the amount of a medicines ?

Medicines are available in different forms- tablets, capsules or liquid forms such as
syrups. The amount of the medicine contained per unit weight or volume or according
to number is given on the packaging e.g. per 100 milliliters, per teaspoon.

Explain to community members how to take smaller doses e.g. half a tablet,
quarter tablet using actual tablets or by using simple diagrams.

Look carefully at the packaging. The dose mentioned should be equivalent to the
recommended dose. For example. suppose you are prescribed 250 mg of an antibiotic
and the capsule is for 500 mg do not use it. Ask for 250 mg capsules. If not
available, it is possible to open the 500 mg capsule and divide the powder inside
54 taking only half of it. But, if this is not done carefully, you may take too much; this
can be dangerous.
 Measuring liquids is best done with a standard spoon of 5 ml. This is sometimes Themes in Health
Education
supplied free with a medicine. Otherwise, use such a spoon from your medical centre
to find out how much is contained in the spoon you use at home. To do this, fill the
. standard spoon with water and pour this water into your spoon without spilling any.
Use a 5 ml syringe if you have it. Make a mark on the spoon at the level of water.
You now have your own measuring spoon ready.

5.5.6 How often should a medicine be taken?

Follow the medical advice you get from your doctor or your medical centre. The
doctor writes out a prescription. This is a sheet of paper which mentions the name
of the medicine with information on dose i.e., how much and at what time? Follow
the prescription, regarding how often and how much of the medicine you should
take. The following chart may help you.

How often? " .

Every 4 hours 6 times a day

(morning, midday, afternoon, night)
Every 6 hours 4 times
(allow about same time between pills)
Every 8 hours 3 times
(Morning, afternoon and night)

Always check with the doctor, before you leave the clinic .
.::
) 5.5.7 Can we take medicines with food?
i
Some medicines, work best when you take them on an empty stomach- that is, one
hour before meals. For others, it is quite the opposite. They work best, when taken
on a full stomach'.

6 This following chart gives you some examples of medicines which are best taken, 1
~ hour before meals/together with or soon after meals.

Take these medicines one Take these medicines together with

hour before meals or soon after meals

• Penicillin • Aspirin/medicine that contains aspirin.

• Ampicillin • Iron (ferrous sulfate)

• Tetracycline • VItamins

• Erythromycin

s:::
Some medicines cannot enter the body, if eaten with certain foods. For example,
.!Q milk should not be taken just before or after taking tetracycline. Keep one hour gap
C>
c
w whether you take it one hour before or one hour after taking milk. It is better, if you
('I)
I
keep the gap longer than one hour, if possible.
T"""

~
o
o
CDI
('I)
o
W
I 55
Z
o
 Themes and Messages
10 Nutrition and Health
Education 5.6 SUMMING UP: IDEAS ON HOW TO USE
THIS Ml\TERIAL
This unit summarises basic issues in health education. The list of questions is endless.
You have to think of ways to put across issues raised by people in your community.
The answers we have given are just an indication of how you can go about it.
Remember that the matter in capital.and italic telJs you what to do ,when trying to
explain a paticular topic to an audience. As we mentioned earlier, you need to add
methods and media to make a package. This block gives you only the "contents".

56
 UNIT 6 MESSAGES IN NUTRITION
AND HEALTH EDUCATION
Structure
6.1 Introduction
6.2 Messages in Nutrition Education
6.3 Messages in Health Education
6.4 How to Improve Relevance and Effectiveness of a Message?
6.5 Summing Up: Ideas on Using this Marterial

6.1 INTRODUCTION
In the previous two units of this block, you have studied various themes in nutrition
and health education and gone through possible answers to questions commonly
raised in community groups. Emerging from these and other themes, is the list of
messages we will give in this unit. It is of course not possible to list all messages or
even to list various ways in which a given message can be delivered to an audience.
In order to help you decide on how to present messages we have given a separate
. section on this aspect.

6.2 MESSA(;ES IN NUTRITION EDUCATION

When a message is conveyed to a community group or individuals, the target group
receives both elements=-content and presentation. In other words, the "what" and
"how" of the message. As we mentioned earlier, Blocks 3 to 5 would give you an
in-depth knowledge of the features of "how" messages can be conveyed or in what
manner they can be presented, using different types of media and methods.

For our present discussion, we can think of messages, being either positive 01; .

negative or combining both approaches, for example.

• AVOIDING KESARI DALPREVENTS PARALYSIS (Positive).

• KESARI DALCAN PARALYSE YOUR LEGS (Negative).
• EATING KESARI DALPARALYSES THE LEGS. SO KEEP AWAYFROM IT
AND KEEP HEALTHY (Positive + Negative).

You would have to assess how the message you have in mind could be best put
across. This depends on the community with which you are working as well as the
?
?
J
nature of the message. However, any message must be action-oriented. In other
words, it should urge people either to adopt a new practice or to give up an .existing
- practice. The message should at least clearly suggest people, a certain course of
2
i> action.
.u
"I)

I
In the ~ase of positive messages, it is vital to give a reason. For example,
t!
:..>
o
s EATGREEN LEAFY VEGETABLES (No reason given; limited impact).
I
Y)
.')
EAT GREENS AS OFTEN AS YOU CAN. THIS KEEl'S YOUR EYES
uc HEALTHY. (reason given; better impact)' 57
,.
:l
 Themes and Messages
in Nutrition and Health Negative messages, however usually do include a reason and a cause and effect
Education relationship. For example, .

EATING K£SARI DALCAUSES PARALYSIS

In this case, it is more important to remember to tell people clearly, what to do to

avoid the dangers you are highlighting. So the previous message can be reworded
like this: .

STOP EATD'lG KESARI DAL.

IT CAN CAUSE PARALYSIS.

To help you select and improve important messages in nutrition education, you would
find this list useful. Messages are arranged in specific categories, to make it easy to
locate a particular topic. The messages given are only suggestion. Can you improve
on them? Yes! you can.

Messages linked to nutritional deficiencies

• INCLUDE THE THREE FOOD GROUPS IN EVERY MEAL.

• GIVE FOODS IUCH IN IRON TO PREGNANT WOMEN.

• EAT GREEN LEAFY VEGETABLES, IT PREVENTS BLINDNESS.

• LACTATING WOMEN AND PREGNANT WOMEN NEED EXTRA FOOD.

• VITAMIN A IS GIVEN FREE TO PRESCHOOLERS AT YOUR HEALTH

CENTRE. ACT NOW! OR YOUR CHILD MAY GO BLIND.

• YOUR CHILD··S GROWTH CHART WILL SHOW, IF THE CHILD IS ILL

OR NEEDS ATTENTION.

• WEIGHYOURCHILDREGULARLY

• ENCOURAGE OLDER PEOPLE TO EAT FRESH FRUITS AND

VEGETABLES.

• EATING WHOLE CEREALS AND PULSES GIVES YOU PLENTY OF B

VITAMINS.

• USE IODIZED SALT.

• PARBOILING ADDS B VITAMINS TO YOUR CEREAL.

• EAT SPROUTED PULSES. THEY GIVE YOU EXTRA VITAMIN C AT NO

EXTRA COST

• DEHYDRATION CAN KILL. SO IF YOUR CHILD HAS DIARRHOEA, GIVE

ORS OR OTHER FLUIDS FREQUENTLY

Messages linked 10 other nutrition-related disorders

• YOU CAN REMOVE EXTRA FLUORIDE FROM YOUR WATERAT HOME.

58
 Messages in Nutrition
• STOP EATING KESARI DAL. JF YOU CANNOT AVOID IT, SOAK THE and Health Education.
DAL IN WATER THAT'S JUST BEEN BOILED AND SUN DRY BEFORE
USING
• EATING TOO MUCH OF ANYfHING IS BAD FOR YOUR HEALTH. AVOID
TOO MUCH OF FATAND SUGAR IN YOUR DIET.

• KEEP STRICT CONTROL OVER YOUR DIET IN DIABETES AND IN

HEART DISEASE.
• ONLYYOU CAN SAVEYOURSELF. EATMODERATELYAND 00 PLENTY
9F EXERCISE.
• TAKING TOO MUCH OF SALT CAN PUSH UPYOUR BLOOD PRESSURE.

• DO YOU HAVE A RELATIVE WITH DIABETES OR HEART DISEASE? IF

YES, BE EXTRA CAREFUL ABOUT INTAKE OF SUGAR AND FAT.

• AVOID SATURATED FATAS IT CAN HARM YOUR HEART.

• DON'T EAT TOO MUCH REFINED FOODS. EAT WHOLE CEREALS AND .
PULSES. THEY ARE MORE NUTRITIOUS.

• PROCESSED FOODS CONTAIN A LOT OF CHEMICALS WHICH CAN

HARM YOU. NEVER RELY ONLY ON THEM. USE THEM ONLY IF IT IS
MUST.
Messages linked to dietary patterns in various age groups

• BREAST FEED YOUR INFANT. BREAST MILK IS THE BEST FOOD FOR
YOUR BABY.
• INTRODUCE COMPLEMENTARY FOODS BY THE AGE OF 6 MONTHS.
OTHERWISE YOUR BABY WILL NOT GROW WELL.

• GIVE SUPPLEMENTARY FOODS RICH IN ENERGY, PROTEIN, IRON AND

VITAMIN.
• PRESCHOOLERS MUST TAKE SMALL FREQUENT MEALS.

• GET FOOD RICH IN ENERGY, PROTEIN, VITAMIN AAND IRON.

• INCLUDE GOOD IRON SOURCES IN THE DIET OF GIRLS WHO HAVE

BEGUN THEIR PERIODS.

• PACKED LUNCHES SHOULD BE BALANCED AND COMPACT.

• PRESCHOOLERS CANNOT HANDLE STICKY, MESSY FOODS. GIVE

THEM FINGER FOODS.
• DON'T SERVE SNACKS CLOSE TO MAIN MEALS. THIS REDUCES
APPETITE AND DOES NOT PROVIDE ENOUGH NUTRIENTS.

• A FOOD SUPPLEMENT GIVEN IN A FEEDING PROGRAMME SHOULD

NOT SUBSTITUTE FORA MAIN MEAL.I-:- IS GIVEN AS Ai~ ADDITION 59
TO THE HOME DIET, NOT INSTEAD OF IT.
Themes and Messages • BREAKFAST IS IMPORTANT TO KEEP YOU ACTIVE. DON'T MISS IT.
in Nutrition and Health
Education
• DON'T REDUCE FOOD INTAKE TOO MUCH. THIS CAN MAKE YOU
VERY ILL. SOIFYOU ARE OVERWEIGHT, TRY TO EAT LESS AT EACH
MEALAND EXERCISE MORE.

• JUNK FOODS SPOIL YOUR HEALTH. SO DON'T SPEND MONEY ON

THEM.

• DON'T GIVE UP TRADITIONAL FOODS. THEY ARE USUALLY

BALANCE(}.

• EAT NATURAL FOODS AND FOOD COMBINATIONS. THEY WILL ~ELP

YOU KEEP HEALTHY.

• ENCOURAGE GOOD FOOD HABITS FROM CHILDHOOD. THE EARLIER

YOU START, THE BETTER IT IS!

Messages linked to nutrition programmes

• PREGNANT WOMEN CAN GET IRON AND FOLIC ACID TABLETS

FROM THE HEALTH CENTRE.

• PROTECT YOUR CHILD'S HEALTH. YOUR LOCAL SCHOOL PROVIDES

A MIDDAY MEAL.

• IMMUNIZE YOUR CHILD. BREAK FREE FROM THE CYCLE OF

INFECTIU~ AND MALNUTRITION.

• SAVE YO'JR CHILD'S LIFE. IMMUNIZE AGAINST DANGEROUS

INFECTIONS.

• INFECTIONS LEAD TO MALNUTRITION. MALNUTRITION LEADS TO

INFECTION. GOOD FOOD AND IMMUNIZATION PROTECT YOUR
CHILD.

Messages linked to maximal utilisation of food resources

• DOYOUVVANTTOGETEXTRANUTRIENTSATNOEXTRACOST?USE
SPROUTED AND FERMENTED FOODS.

• REDUCE ~WTRIENT LOSSES BY USING JUST ENOUGH WATER WHILE

COOKING.

• PEEL FRUITS AND VEGETABLES THINLY. THE MORE YOU PEEL OFF,
THE MORE VALUABLE NUTRIENTS YOU THROW AWAY.

• DON'T RELY ON PRESTIGE VALUE OF FOODS. PURCHASE FOOD

ITEMS WHICH GIVE YOU MAXIMUM NUTRITION AT REASONABLE
COST.

• CULTIVA:rEAKITCHEN GARDEN. IT WILL SUPPLY YOU WITH FRESH

FRUITS AND VEGETABLES AND YOU COULD SELL THE SURPLUS TOO.

60
 Messag~ in Nutrition
6.3 MESSAGES IN HEALTH EDUCATION and Health Education.
•
As in the case of messages we listed regarding nutrition, the messages we list here
also do not cover all possible topics- you could consider the categories as illustrative.
Feel free to modify any messages we have given to suit to your own needs.

So here's the list.

Messages linked to infectious diseases

• INFECTIOUS DISEASES SPREAD EASILY. SO DON'T LET THE SICK

PERSON COME INTO CONTACT WITH OTHER PEOPLE.

• ANTIBIOTICS CANNOT KILL VIRUSES THAT CAUSE COLDS, FLU,

MUMPS AND CHICKENPOX.

• DON'T USE HOME REMEDIES FOR PNEUMONIA, TYPHOID, TIJBERCU-

LOSIS, INFECTIONS APPEARINGAFrER GIVING BIRTH. THEY DO NOT
HELP.

• IMMUNIZING PREGNANT WOMEN AGAINST TETANUS WILL

PREVENT TET~S IN NEWBORN INFANTS.

• USE MEQICINESAS DIRECTED FOR T.B. COMPLETE CURE USUALLY

TAKES 1TO 2 YEARS.

• TUBERCULOSIS IS VERY CONTAGIOUS. SPIT ONLY IN A SEPARATE

VESSEL OR SPITTOON.

• EAT NUTRITIOUS FOOD. THIS WILL HELP YOU TO RECOVER FAST IF

YOU HAVE AN INFECTIOUS DISEASE.

Messages linked to parasitic infestations

• WORMS OR THEIR EGGS SPREAD FROM FAECES TO MOUTH.

• USE LATRINES TO PREVENT SPREAD OF WORMS.

• DO NOT GO BAREFOOT HOOK WORMS ENTER THE BODY THROUGH

THE FEET.

• COOK MEAT THOROUGHLY, ESPECIALLY PORK. RAW PORK CARRIES

DANGEROUS 1APE WORMS ETC.

• KEEP FOOD COVERED TO PROTECT IT FROM FLIES WHICH CARRY

. DISEASE CAUSING GERMS.

• DESTROY MOSQUITOES. TO PREVENTMALARlA, CLEAR STAGNANT

WATER WHERE THEY BREED.

• PREYENT MALARIA BY TAKING ANTI-MALARIA MEDICINES ON A

REGULAR SCHEDULE.

61
Themes and Messages Messages linked to using medicines
in Nutrition and Health
Education
• USE MEDICINES ONLY WHEN NECESSARY.

• BE CAREFUL ABOUT GIVING THE RIGHT DOS,E AT THE RIGHT

INTERVAL.

• IF A MEDICINE DOES NOT HELP OR IT CAUSES PROBLEMS, STOP

USING IT AND CONSULT THE DOCTOR~

• NEVER USE IN JECTIONS, IF ORAL TABLETS WILL WORK.

• CHLORAMPHENICOL IS RISKY. USE ONLY FOR TYPHOID.

• PENICILLIN CAUSES DANGEROUS ALLERGY IN SOME PEOPLE. IK

SUCH PEOPLE IT SHOULD NEVER BE USED. HENCE TAKE A TEST
DOSE.

• USE MEDICINES WHEN NECESSARY TO CONTROL SYMPTOMS SUCH

AS FEVER, DIARRHOEA OR COUGH. BUT SEEK THE HELP OF A
DOCTOR TO FIND OUT AND TREAT THE CAUSE.

Messages linked to overcoming bad habits

• DRINKING TOO MUCH ALCOHOL DAMAGES YOUR LIVER. SO

SHOULD YOU SPEND SO MUCH ON BUYING ILL HEALTH7

• LET'S HELP AlCOHOLICS TO GET OVER THEIR PROBLEM.

• SMOKING CAN' KILL, SO BREAK THE HABIT NOW!

• GIVE YOUR BABY A GOOD CHANCE IN LIFE. DON'T SMOKE OR

DRINK DUMNG PREGNANCY

6.4 HOW TO IMPROVE RELEVANCE A'ND

EFFECTIVENESS OF A MESSAGE
There's no short cut actually. The only reliable way of deciding on the relevance or
effectiveness of a message is to try it out on a small group drawn from the population,
you want to reach. You could also try to talk to experienced field level functionaries
working in a particular area. They can give you valuable advice.

Now look at the following step-by-step guide.

Step 1 Talk to people in your community.

Step 2 List the most common and serious probleins with the help of community
groups.

Step 3 Based on this information, list the important messages that should get
across to people (USING STEPS 1 to 3 MAKES IT MORE LIKELY
THAT PEOPLE WILL FIND THE MESSAGE RELEVANT) .

. Step 4 Now reword the messages to make them as simple and direct as possible,
62 Keep them short. If a message is complex, say it in two simple sentences.
 Messages in Nutrition
Step 5 Next, see if people in the community actually understand, what is being and Health Education.
said. Use local terms for diseases, cures or any other aspect being talked
about.

Step 6 You can then make teachirig aids to help you to influence people more.
Teaching aids can be flash cards, flip books, actual item such as foods or
bottles, flannel graphs, posters, charts (At this stage, you may not know
what these are but don't worry. These willbe discussed later in Blocks
3 to 5).' .

Step 7 Again check with a community group to see if your teaching aids need to
be modified or eve~ changed completely.

Step 8 To make sure your message reaches the maximum number of people,
work with community leaders in designing and using teaching aids. Let
them carry the message to their community members.

To further check on the relevance and effectiveness of a message, you can conduct
discussions with selected individuals and fill in the following chart.

• Is the message related

to a problem you consider
important?
~ G
, .

• Did you know that your

community had this
problem before discussions
with the community worker?
~ G.
• Do you know what
causes this problem? 'G;J G
• Did you have this
information before
discussion with the ~
[3
community
,'
worker?
• Where do you normally ...............................................
get-informationrelated ..............................................
to health and nutrition? ..............................................
(please specify). . .
• What does the message .................................................
say? Explain in your ••••••••.••••••••••••••••••••••••••••• 1' •••••••.••••••

own words.
• Do you agree with ~,

the statement?
• Give reasons for your ................................................
answer (i.e. why you ................................................
agree with or do not ...................................................
agree with the message).
Advantages Disadvantages
• List the plus and
minus points of (+) (-)
adopting practices
suggested by the 63
message.
Themes and Messages
• If you agree with the
in Nutrition and Health
Education
message, have you decided
to adopt the practices it suggests?
• If you agree with the
message, but have not
yet decided to adopt
practices, why not? .
(please specify)
• If you do not agree
with the message,
list the specific -
reasons which are responsible.

This is just a suggestive list of questions. You can add more questions. In the
questionnaire-cum-chart, the word "you" refers to a community member, of course.
Think of at least :fivemore questions you can add to the list.

1) : .

2) .

3) .........................................................•.................... ~ ~ .

4) .

5) : : , .

After individual discussions are over, you can compile a list of possible problems with
the message you communicated. People may not have understood a difficult or
unfamiliar word or they may not have been able to identify with the pictures you
showed or perhaps they misinterpreted the message .
.
This information should give you ideas on how to put across the message more
effectively.You can now discuss these problems with community leaders. They would
be able to throw more light on many issues. Working with community leaders (these
may even be active, receptive people you've worked with earlier), redesign the
message.

Now the message, which has been 'developed is likely to be more relevant, more
effective and easier for the community to identify with.

On the basis of discussions held with community members, their leaders and field
level functionaries, try to prepare a list of messages that should be conveyed to the
target group as soonas possible (i.e., a priority list). You could put them down in
the space provided.

64
 Messages in Nutrition
A PRIORITY LIST OF MESSAGES and Health Education.

Now you can list other messages which you would like to convey over a period of
.time.

MESSAGES FOR YOUR COMMUNITY IN THE AREA

OF NUTRITION AND HEALTH

65
Themes and Messages In working with community groups, remember that people are more likely to talk
in Nutrition and Health
freely and frankl y in small groups. It may be better to let each person talk one by
Educatio~
one so that you can judge for yourself the opinions of as many people as possible.
Also you can make a private record of what people felt during discussions, using this
fun idea.

A) Alive How many people

animated looked like this?
interested
understanding

B) . Somewhat How many people

interested, looked like this?
but not totally
involved

C) Indifferent How many people

or riot able looked like this?
to understand
fully

D) Unhappy perhaps How many people

because of looked like this?
not being
able to speak etc.
not understanding

It is particularly important to talk separately with members of group D as to why they

felt unhappy with the discussion. What did they feel about the messages
communicated? Did they find the discussions uncomfortable? Why? Was it the group
dynamics or was it the topic being discussed? If the message was not understood,
it can be explained in greater detaiL

Since Groups C and D are the ones likely to resist the message, their opinion can
indicate how .he message can be improved to overcome problems faced by these
groups. Of course, it will be difficult to convince people who have strong reasons
for not agreei ng with a message and therefore not adopting a practice.

In this context, it is also necessary to evaluate the dominant response in groups you
have worked with. A chart like this can help.

66
 Messages in Nutrition
GROUP GENERAL GROUP R"ESPONSE and Health Education.

Positive Neutral Negative

-.J
Group of
Youngmen
-.J
Group of
Young women
-
Group of
-.J
Older men
Group of
-.J
Older women ., ,

This sort of chart can aid you in identifying groups within the population which need
to be worked with closely, in order to improve the effectiveness and reach of the
message. For example, the chart shows that older women are particularly against the
message.

Needless to say, a message put across effectively does not guarantee acceptance!
A person may not want to respond positively or may in fact want to stop the spread
of a message. So, you have to be prepared for a wide range of responses. However,
an effective message always touches upon some point, which would strongly motivate
a person to act. The motivational factor can be protecting health and preventing
illness knowing the economic cost to a poor family of any member being sick. It
could also be the prospect of earning more money, by adopting a new cropping
pattem.

6.5 SUMMING UP: IDEAS ON USING THIS

MATERIAL
Prepare a file for yourself, keeping a note of the messages we have mentioned with
the modifications you would like to make, based on the responses of community
members you have worked with. Keep adding to this file as you collect more
information based on books, manuals or pamphlets you read.

67
r

NOTES