An urgent need to invest in promoting healthy nutrition and lifestyle among school children

Transcription

1 An urgent need to invest in promoting healthy nutrition and lifestyle among school children NORIMAH A. KARIM NUTRITIONAL SCIENCE PROGRAMME FACULTY OF HEALTH SCIENCES UKM

2 Outline of presentation Introduction Prevalence of overweight and obesity Initiative to promote healthy nutrition and lifestyle particularly carried out by Nutrition Society of Malaysia (NSM) Nutrition Division, MOH Universities (UKM, UPM)

3 Introduction 3 Rapid socio-economic growth has led to nutrition transition in Malaysia Childhood obesity has become a major concern Promotion of healthy nutrition among school children has been found to be an important strategy in the reduction of risks of obesity and nutrition-related diseases later in adulthood. Recognising this, such interventions have been successfully implemented in several countries.

4 Introduction In Malaysia, various initiatives to promote healthy nutrition and lifestyle in schools have been carried out. This presentation will discuss such initiatives, particularly those carried out by Nutrition Society of Malaysia (NSM) Nutrition Division, MOH Universities (UKM, UPM)

5 Percentage (%) Prevalence of overweight and obesity among primary school children in South East Asia 25 Finding from SEANUTS (South East Asian Nutrition Survey) Obesity Overweight Source: Schaafsma et al. 2013; Rojroongwasinkul et al. 2013; Nguyen et al. 2013; Sandjaja et al. 2013; Poh et al. 2013

6 Nutritional Status of Malaysian Children 6 Overall Prevalence of Thinness, Overweight and Obese among Malaysian Children 13.8 Thinness Overweight Obese SEANUTS Malaysia (7-12y) MyBreakfast Study (6-12y) Source: SEANUTS Malaysia: Poh et al. (2013); MyBreakfast Study: Tee et al. (2015)

7 Nutritional Status of Malaysian Children by sex 7 Prevalence of Thinness, Overweight and Obese by Sex among Children in SEANUTS Malaysia (7-12y) Thinness Overweight Obese 20.4 Prevalence of Thinness, Overweight and Obese by Sex among Children in MyBreakfast Study (6-12y) Thinness Overweight Obese Boys Girls Boys Girls Source: SEANUTS Malaysia: Poh et al. (2013); MyBreakfast Study: Tee et al. (2015)

8 Nutritional Status of Malaysian Children by area Prevalence of Thinness, Overweight and Obese by Area among Children in SEANUTS Malaysia (7-12y) Thinness Overweight Obese 20.1 Prevalence of Thinness, Overweight and Obese by Area among Children in MyBreakfast Study (6-12y) Thinness Overweight Obese Urban Rural Urban Rural Source: SEANUTS Malaysia: Poh et al. (2013); MyBreakfast Study: Tee et al. (2015)

9 Nutrition Society of Malaysia Initiatives to promote healthy nutrition and lifestyle in schools by NSM Healthy Kids Programme (HKP) Good Nutrition, Key to Healthy Children(GNKHC),

10 Nestle Healthy Kids Programme Initiated by In collaboration with Feb 23, 2017

11 Background of NHKP In Phase 1 ( ) Nestle and the Nutrition Society of Malaysia (under the Nestle Healthy Kids Malaysia) had conducted a 3-year longitudinal intervention study to develop and evaluate effectiveness of a nutrition education package in improving the nutrition knowledge, attitude and practice among selected primary school students in Klang Valley.

12 Background of NHKP Therefore, in line with the programme s long-term goal of rolling out the programme to benefit more students in the country, Nestle and NSM extended the programme into its Phase II ( ) utilising the modules developed during the research study (Phase I). involves the collaboration of Ministry of Education and rolling out the modules to 77 selected primary boarding schools in Sarawak and Sabah.

13 Background of NHKP Phase II Healthy Kids programme, teachers from the 77 selected primary boarding schools who were expected to implement the nutrition modules to their student in their respective boarding schools were trained on the use of the modules (6 topics per year). The first 2 years (2014 and 2015) of rolling out Healthy Kids Programme Level 1 and 2 modules successfully reached out to 5000 primary school children in Sarawak and Sabah

14 2016 Phase III TM Malaysia Nestle Healthy Kids (Primary School Module with NSM) A. On-ground Activities Phase III (Post-3-year research) In Collaboration with MOE (as part of Program CHS) Module training for primary school teachers (Train-the-Trainer Workshop) Teaching of modules by teachers In collaboration with NSM B. Media Website English version of Educational Module In collaboration with NSM 14

15 Teaching modules for teachers

16 Teaching modules for teachers Consist of 6 different topics which has been separated accordingly 16

17 Props for Engagement Session TOPIC 1: Healthy Food Preparation Methods Game Card Topic 1 (5 set) 17

18 Props for Engagement Session Topic 2: Read Labels On Food Packaging Foldable cards Topic 2 Game card Topic 2 (3 set) 18

19 Props for Engagement Session Topic 4: Under/ Over Nutrition Issues BMI Wheel 19

20 Activities during training of trainers Registration Participants were listening to the speech Year 2 Result Presentation by Prof Dr Norimah Claims Briefing Session 20

21 Activities during training of trainers Breakout session for Topic 1 by Prof Dr Norimah Breakout session for Topic 1 By Mr Tan Breakout session for Topic 2 by Dr Zawiah Breakout session for Topic 2 by Mr Thirukkanesh 21

22 Activities during training of trainers Kuching Breakout session for Topic 5 Breakout session for Topic 5 Breakout session for Topic 6 Closing Dinner 22

23 Activities during training of trainers Kuching Warm up session Summary of Year 3 Module by Dr Zawiah Pre & Post Survey Briefing by Dr Chin Feedback and Q&A session 23

24 Conclusion and Recommendations from NHKP 24

25 Conclusion and Recommendations Modules were implemented by the trained teachers and all were cooperative and supportive of this programme. However, about three quarters of the schools were non-compliant with the timeline suggested. The prevalence of overweight and obesity was high (~18%) among the students. The mean score of the nutrition knowledge showed an increase following the module implementation by the teachers.

26 Conclusion and Recommendations However, attitude and practices scores of students decreased following the module implementation by the teachers. Further investigations need to be carried out in order to identify the reasons for the low compliance rate with the timeline.

27 Conclusion and Recommendations Useful feedback which were obtained from the teachers during TOT Workshop should be taken into consideration by MoE, Nestle and NSM when planning for future progammes (if any). Continuous effort in implementing a systematic nutrition education programme such as the Nestle Healthy Kids in primary schools must be continued to address the prevalence of childhood overweight and obesity as this will help pave the way to a healthier nation.

28 GNKHC A multi-country school nutrition initiative Assisted by: Secretariat, SEA PHN Network Date: 13 July 2018

29 Rationale of GNKHC Programme Implementation of the nutrition education module previously (by various parties including NSM) has been proven to be effective in improving the nutritional knowledge of students. School settings recognized as appropriate for nutrition intervention by various research groups and authorities: To decrease the prevalence of overweight and obesity important strategy in the reduction of risks to nutrition-related diseases later in adulthood The SEA-PHN Network is conducting a multi-country nutrition education initiative, namely GNKHC to empower students with knowledge about healthy eating and an active lifestyle. To ensure that the growth and development, as well as the learning potential of the students are achieved 29

30 SEA-PHN Network decided to implement a multi-country nutrition education programme (GNKHC) for school-going children, conducted by teachers, utilising a specially designed nutrition teaching module developed by members of the SEA-PHN Network. Contribution of the Network to the promotion of knowledge of healthy healthy eating and active living in SEA Increased awareness of parents on the importance of healthy eating and active living among school children Provide a platform for professional bodies and corporate partners in the region to collaborate in a public health nutrition programme Experiences gained in the implementation of the project can be used for implementing larger scale interventions in more schools in the countries 30

31 Partners of GNKHC programme All 5 member countries of the Network are participating in this initiative, namely nutrition societies/associations of Indonesia, Malaysia, Philippines, Thailand & Vietnam Funding for the project is from the SEA-PHN Network, provided by Associate Members of the Network 31

32 Goal of GNKHC To empower school children with appropriate nutrition knowledge to enable them to adopt healthier eating habits and be physically active. Objectives of GNKHC 1. To improve children s knowledge, attitude & practice (KAP) on diet & physical activity. 2. To increase awareness of parents on the importance of healthy eating and active living among school children. 3. To emphasise to health and education authorities the importance of improving nutrition knowledge of school children. 4. To encourage schools and national nutrition societies to utilise the SEA-PHN Network nutrition module for future promotion to other school children. 32

33 Components of GNKHC programme 1. Training-of-Trainers Nutrition Workshop 2. Roll-out of nutrition education /lessons 2-day training session For selected teachers Led by nutritionists appointed by the nutrition societies 9 lessons For Year 3 students To be completed in one year minutes per lesson To be conducted during physical education class by trained teachers 33

34 Implementation of GNKHC Training-of-Trainers Nutrition Workshop Roll-out of nutrition education/lessons in school 1. Pre-lesson KAP Survey 2. Measurement of weight and height Roll-out of nutrition lessons (9 Topics) 1. Post-lesson KAP Survey 2. Measurement of weight and height Introduction Session Interactive Session Education Session Practice Session 34

35 SEA-PHN Network nutrition module -Master version in English -Status: Completed -Module comprises: 1. Teacher s guidebook 2. Aids for Interactive Activities 3. Teaching slides 4. Student s workbook 5. Leaflets for parents 6. Feedback forms 35

36 For the Teacher: Teacher s Guidebook There are 9 topics in teacher s guidebook. Teaching materials for each topic use specific color theme. 36

37 For the Teacher: Aids for Interactive Activities There are interactive activities for each topic. Topic 1: The Healthy Way of Eating: From Pyramid to Plate Activity 1: Build Your Food Pyramid Activity 2: Healthy Plate Folding Card Game Cards (31 pieces) 37

38 For the Teacher: Teaching Slides PowerPoint file for teaching slides of 9 topics will be saved in CD. 38

39 For the Student: Student s Workbook There are 1-2 worksheets to be completed after the lesson for each topic. Each workbook consists of: Learning Slides Worksheet 39

40 Leaflets for parents 8 GNKHC nutrition leaflets will be provided to parents so that they will understand what their children have learned in school. Teacher will distribute the leaflets for students after each lesson. 40

41 Malaysia Training-of-Trainers (TOT) Nutrition Workshop Teachers from SK Padang Jawa and SK Puchong Nutrition Module Briefing Group Photo Interactive Session Interactive Session Q&A Session Conducted on 30 & 31 May 2018 Selangor State Library Anthropometric Measurement 41

42 Malaysia Roll-out in Malaysia: June September 2018 SK Padang Jawa & SK Puchong Measuring height Measuring weight Pre-lesson KAP Survey 42

43 Monitoring & Evaluation Activities 1.Pre- & Post- lesson KAP Survey 2.Module Feedback Forms 43

44 Nutrition Division, MOH Initiatives to promote healthy nutrition and lifestyle in schools by Nutrition Division HiTs (Program Hidangan Berkhasiat di Sekolah) or School Meal Program Collaboration with MOE

45 Nutrition Division, MOH MOH initiated HiTs, a nutritious meal programme targeted to primary school children. The meal consists of nutritious foods from cereals, meat, fruits and vegetable food groups and fulfilled the caloric and nutrient needs of children according to meal time at school. The one month menu cycle of the nutritious meal is prepared by Nutritionists in MOH. Up to 2018, 28 schools in 5 states have participated in this initiative, with the most schools in Johore, where this initiative began.

46 History of School Meal Program (SMP) in School Meal Program (SMP) was initiated in SJKC in Muar Johor since 2007, by Parent Teacher Association (PTA) President and the school Headmistress To reduce the consumption of less healthier food and drink in school canteen To promote balanced snacks and improve dietary habits among school children during recess. SMP was then expended to other schools in Malaysia Program Hidangan Berkhasiat di Sekolah (HiTS) by Nutrition Division, Ministry of Health since

47 School Meal Program or HiTS in Malaysia ( ) Kuala 3 Lumpur Putrajaya A total of 38 schools in Malaysia is implementing SMP or HiTS National Plan of Action for Nutrition of Malaysia III ( ), every state have to implement School Meal Program in at least 3 schools by 2020 and at least 6 schools by 2025 (NCCFN, 2016). 47

48 Name of School year Started SJC Chin Kwang Wahyu 2007 SJKC Sin Ming 2013 SJKC Hwa Ming 2014 SJKC Chung Hwa 1A 2014 SJKC Chian Kuo 2014 SJKC Yong Peng SJKC Pei Hwa 2015 SJKC Kung Yu 2015 SJKC San Yu 2016 SJKC Sulong 2016 SJKC Ai Chun SJKC Chern Hwa 2016 SJKC Panchor 2017 SJKC Nan Hwa 2017 SJKC Chung Hwa Ketiga 2017 SJKC Pu Nan 2017 SJKS Soon Mong 2017 SJKC Soon Cheng 2017 SJKC San Chai 2017 SJKC Chung Hwa 1B 2017 SJKC Chi Sing 2017 SK Pekan Pagoh 2017 SK Orang Kaya Ali 2017 SJKC Woon Hwa, JB 2017 SK Seri Puteri 2017 SJKT Seri Pelangi 2017 SJKC Chung Hwa Segenting 2017 SJKC Chung Hwa Senggarang 2018 SJKC Li Chun 2018 Tangkak Batu Pahat Muar HiTS is expanding..in ) Total of 29 schools (4,571 children) in Johor is joining HiTS Program! 48

49 20 different types of menu every month Different types of vegetables every week 49

50 Implimentation of HiTS in school canteen

51 Implimentation of HiTS in school canteen

52 Universities Healthy Lifestyle Programmes (UPM) a part of research interventions among school children. Collaboration with NSM HLP with two components; Nutrition education program and Healthy meals in school (adapted from HiTS) was carried out among school children in Batu Pahat, Johor.

53 Healthy Lifestyle Programme To increase nutrition and health knowledge and practices among teachers and children. The nutrition modules were adapted from HKP and were also made available in Bahasa Melayu, Chinese, and Tamil. For the healthy meals in schools, the canteen caterers were trained to provide healthy foods to students during school recess. A total of 41 teachers from three different schools were trained. 14 teachers from National Primary School, 15 teachers from National Primary School (Chinese) and 12 teachers from National Primary School (Tamil).

54 Training of Trainers for teachers at SK 54

55 Training of Trainers for teachers at SJKC 55

56 Training of Trainers for Teachers at SJKT ~ Interactive Games 56

57 PROGRAM PEMAKANAN SIHAT KU di SK (KEM 1,2 & 3) 57

58 PROGRAM PEMAKANAN SIHAT KU di SJKC (KEM 1,2 & 3) 58

59 PROGRAM PEMAKANAN SIHAT KU di SJKT (KEM 1,2 & 3) 59

60 PROGRAM PEMAKANAN SIHAT KU ~ Senaman 60

61 PROGRAM PEMAKANAN SIHAT KU di SK (KEM 1,2 & 3) 61

62 PROGRAM PEMAKANAN SIHAT KU di SJKC (KEM 1,2 & 3) 62

63 Component 2: School Meal Program / Hidangan berkhasiat di sekolah (HiTS) Provide healthy food environment in primary school, to increase healthy eating practices among primary school children. The school canteen caterers were trained to provide healthy foods to students during school recess time By nutritionists 5 different menu every week 63

64 Hidangan Berkhasiat Di Sekolah (SK) 64

65 Hidangan Berkhasiat Di Sekolah (SJKC) 65

66 Hidangan Berkhasiat Di Sekolah (SJKT) 66

67 Universities Program Juara Sihat (UKM) The Juara Sihat TM, is a research intervention to promote healthy nutrition practices and physical activities and was carried out among obese primary school children in Kuala Lumpur.

68 Juara Sihat Modules implemented in the intervention were modification of dietary intakes promotion of physical activity classroom curriculum focused on healthy eating and lifestyle and the involvement of PTA.

69 Juara Sihat The intervention was for 12 weeks The Juara Sihat TM programme showed significant improvements in anthropometric status, KAP scores and physical activity level. Overweight and obese children had a higher likelihood to improve nutrition KAP scores.

70 ORGANISED BY: PROGRAM JUARA SIHAT

71 Programme Goals To increase healthy nutrition practices and physical activities among primary school children. To reduce sedentary lifestyles among primary school children. To reduce the rate of overweight / obesity among primary school children.

72 Key Components: 1 Modification of dietary intakes 2 Promotion of physical activity 3 Classroom curriculum focused on healthy eating and lifestyle 4 Involvement of PTA

73 6 Main Topics: 1 Am I Healthy? Cheerful and Healthy Chef! Choose Wisely for Healthy Body! Look At Me! We Are Active! Fruits & Vegetables are My Best Friend PROGRAM JUARA SIHAT 2015

74 Healthy Lifestyle Seminar Opening Speech Talks from Experts Healthy Lifestyle Forum PROGRAM JUARA SIHAT 2015

75 MODULES Module 1: Am I Healthy? Module 2: Cheerful and Healthy Chef! Content: Identifying body image based on Stunkard Scale for Children. Calculation of BMI and plotting on BMI-for-age Growth Chart Using pedometer Content: Identify the five food groups and portion size based on the Malaysian Food Pyramid. Understand the importance of breakfast and planning healthy menu for breakfast. PROGRAM JUARA SIHAT 2015

76 MODULES Module 3: Choose Wisely for Healthy Body Module 4: Look at Me! Content: Differentiate between energy-dense and nutrient-dense foods and give examples of each. Identify the portion sizes of food that are categorized as high energy, fat, sugar and salt. Identify the portion sizes of food that are categorized as low energy, fat, sugar, salt and high fibre. Planning for a healthy menu based on recommended intake Content: Basic knowledge on body image according to individual perception. Controlling negative thoughts on body shape and size. Role of self-efficacy in practicing healthy lifestyle PROGRAM JUARA SIHAT 2015

77 MODULES Module 5: We Are Active and 3km Fun Run Module 6: Fruits & Vegetables My Best Friends! Content: Definition and way of achieving an active and healthy lifestyle. Importance of doing physical activity together with family and friends. Motivate the children to spend more time being physically active and less time watching television/playing computer games. Content: Increase awareness on the importance of fruits and vegetables consumption. Highlight the role of fruits and vegetables as the main contributor of vitamins and minerals in the body. PROGRAM JUARA SIHAT 2015

78 Aerobic Competition Fun Activities Mini Cheerful Chef Cooking Competition Cooking Demonstration 3KM Fun Run Challenge PROGRAM JUARA SIHAT 2015

79 Summary From this brief review, it can be noted that the current interventions among school children are of limited coverage and duration. It can be acknowledged that programmes by NSM and other non-governmental organisations are not sustainable. Those implemented by the academia are mostly for research purposes.

80 Summary There is ample evidence that there is a high prevalence of overweight and obesity among school children in the country. There is therefore an urgent need for all stakeholders in the public and private sectors to collaborate in designing and implementing comprehensive intervention measures in a systematic manner.

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