Rural India Nutritional Assessment 2017
By: Sarah Wainewright, Nutritionist
To determine the food patterns, health knowledge and food security of the families of the students attending School in rural Boghgaya.
This information is intended to assist nutrition education programs run by volunteers at the school, which aim to improve the nutrition status and health of the communities this School serves.
Over one week, a translator was used to assist in interviewing 40 mothers, each from different families, on their dietary patterns and food security.
There were 10 mothers, selected via convenience sampling, from 4 different villages out of the 7 villages children from Bodhi Tree School live.
The 4 villages were selected as they have a playschool for young children who will later attend school when they are able to join Class One. The playschool was used as the meeting place for the interviews to be conducted.
Of the 40 women interviewed:
- Majority of the children come from families who work as labourers or farmers, they are considered as coming from the lowest castes with poor living conditions and don’t have much money for food
- Meals commonly consist of rice, chapatti and dhal and often only small amounts of mixed vegetable curry
- Breakfast and dinner are eaten hot, lunch is eaten cold as it is typically left overs from breakfast or food prepared earlier in the day and taken to work
- Vegetables are typically purchased once or twice a week from the market, with stocks of rice, flour and pulse stored to last a month or so
- The vegetables eaten most commonly are potato, eggplant, lady finger, tomato, cauliflower and locally grown green vegetables
- Fruits is eaten by most families only a couple of times a week, depending on what fruit is in season
- Milk is mostly only regularly available to families who own a cow, as it is expensive. However even with a cow milk is not produced year round, depending instead on when the cow has offspring and produces milk
- Eggs and chicken are mostly eaten once a week or less, again because of their cost. Some families reported that eggs were not eaten as they upset their stomach
- Families with fields most commonly grow rice, wheat, pulse and potato, depending on the season
- Most families use a stick to brush their teeth in the morning, very few people use a toothbrush and toothpaste or brush their teeth twice a day
- Snacks, mostly biscuits, are eaten more often among children than adults, and are given to young children after playschool or to older children by the parents for extra energy.
- Soft drinks and juices are not commonly had, and mostly only during the hot summer season when they visit the markets
- When asked about whether they think the food they eat is healthy many women weren’t sure what ‘healthy’ meant. Elaborating if they though the food gave them good energy and strength, and helped their children grow, the women often replied that they didn’t have any extra money to eat differently
- It is not uncommon for families to run out of food and skip meals. I think that it is most likely under-reported as well, due to embarrassment in admitting it with other women around to hear
It was found that due to poor health literacy, more education is needed to help the parents understand the importance of a balanced diet to improve their family’s health.
A lack of physical and economic access to vegetables, meat, eggs and milk is the main reason of poorly balanced diets.
Solutions need to be appropriate for the socioeconomic of the communities and should focus on health education, raising awareness on the need of a balanced diet and cooking practices to ensure the nutrients of vegetables are maintained to provide maximum benefits
Enablers and Barriers
What is Working
School Lunch Program
- The school director ensures students are fed lunch each day from 12:30pm after classes have concluded. There are three cooks that prepare rice, dhal and vegetable curry for the students, with a plate consisting of roughly 2/3 rice, 1/6 dhal and 1/6 vegetables. This lunch might be the main meal the students receive for the day and may provide extra incentive to come to school.
Library: Workshop Space
- Monika (Volunteer Coordinator) and I have recently spent a couple of weeks fixing up the library, which was previously used as a storeroom. The library can now be used as a large space to run health education workshops and a projector has been set up to allow presentations and movies to be shown to the students.
Increasing Vegetable Consumption during School Lunches
- Attempts in the past to increase vegetables consumption among students, by reducing the serving of rice for school lunches and increasing vegetables servings, resulted in students eating less overall. The students didn’t eat the extra vegetables they were given, wasting the vegetables and just eating the rice.
Limited Access to Vegetables, Meat, Eggs and Milk
- Although many children come from farming families, the main produce grown is wheat, rice and potato. Vegetables are purchased from the market, however access to the market may be difficult, especially during monsoon season. This, along with an often small budget, means vegetables may only be purchased once or twice a week. As a result small quantities of vegetables are eaten, leading to likely micronutrient deficiencies. This is the similar case for chicken, milk and eggs, which are expensive for families to eat regularly unless they own chickens or a cow.
Poor Food Storage
- Fridges are rarely owned as they are expensive and the power source in the villages is unreliable. This means it is difficult to store food, such as meat, milk and vegetables for more than a day. Food is mostly cooked fresh for each meal, as it is not safe to eat leftovers.
Poor Health Knowledge
- Many parents are illiterate, not finishing school or learning about healthy eating and how best to look after their bodies. Education is needed to increase their understanding of why eating a balanced diet is important, or practices such as brushing teeth after breakfast and dinner, or washing hands before cooking and eating.
- Minimal English is spoken among the teachers and older students, however communicating with the parents throughout the villages without a translator restricts the ability to provide education on healthy eating. The best way to get around this is using Hindi videos on health topics to provide engaging education that is understood by everyone.
Primary Reasons Identified behind Malnutrition
Lack of variety in the diet
- The main staples are rice, potato and flour. Vegetables, chicken, fish, eggs and dairy are eaten more sparingly leading to difficulties consuming enough micronutrients. Education is needed to explain the importance for eating a more balanced diet, however access to foods and small budgets are barriers that also restrict the consumption of a varied diet
Common Deficiency Signs
Skin conditions (dry, itchy)
- Some children have dry/itchy/red/irritated skin conditions especially on the face/forehead, which is likely due to micronutrient deficiencies
Fainting and weakness
- In the heat especially, some children faint from a lack of food and/or water in the mornings. Many children walk long distances to school, sometimes without eating breakfast in the morning, and don’t eat until lunchtime. This can lead to weakness and fainting when they get to school. It was also found with one girl that she only eats at school to make sure she doesn’t gain weight, so it is evident education on healthy eating is needed to improve understandings of why eating a balanced diet is needed
Education on eating a balanced diet
- Use the assistance of a translator, or educate teachers and village representatives to spread the messages among their communities
Educating School Cooks
- Explaining the importance of cooking vegetables for a shorter period of time to maintain a higher nutrient count to improve the benefits they provide. Vegetables are often cooked for so long they breakdown and lose a lot of their benefits, this may be because it ensures harmful bacteria is killed off, as they water in the villages is not safe to drink and the fields are used as bathrooms.
- Supplements to assist underweight children to gain weight could be useful, however in the longer-term there needs to be a more sustainable solution when supplements are not always available.
– A small fish made from iron has been used in similar circumstances in South-East Asia among iron deficient communities. The fish is used during cooking by placing it in meals such as soups and curries while cooking and it releases iron into to the food. The iron fish can be used multiple times and is a long-term, cheap method to increase the iron content of foods
Eggs for lunches
- Too many children to set up chicken project
School vegetable garden
- Many children are from farming families and this is seen as a chore The last thing they want to do is work at school ,when they are needed to help in the fields when they get home each day
- Also problems with maintenance, no one is enthusiastic about looking after this project when they have their own farms are they live far away