Student’s name:

ENACT course in nutrition education

Unit 1: The need for nutrition education

Student’s book: printable version for student’s answers

Contents
Section 1. Introduction 2
Section 2. Stories 4
Section 3. Argue for nutrition education 13
Section 4. Global and national malnutrition 13
Section 5. The causes 15
Section 6. Summarising the arguments 17

Assessed activities for unit (max 30) Criteria for assessment are:
• all activities completed
Assessment

Overall completion of workbook (max 10) • clear and comprehensible answers

• honest independent work & no evidence of
copying answers
Outside activity (max 20)
• evidence of careful reading &
comprehension
Total (max 60) • interest and originality
 ENACT course in nutrition education Unit 1: The need for nutrition education
Student's book: printable version for student’s answers

Section 1. Introduction

Activity 1 What do you think? in groups

Follow the instructions on p. 9 of the Student's Book and complete the survey of opinion.

Beliefs Your view

1. Hunger and malnutrition will be solved when the world produces enough food to feed everyone.

Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree

Comment

2. The world already produces enough food but for the poor it is often too expensive or inaccessible.

Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree

Comment

3. The real solution to malnutrition is not nutrition education but government action to ensure people have access to
nutritious foods, enforce food fortification, tax or regulate unhealthy foods, provide clean water, and so on.

Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree

Comment
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

4. Nutrition education is not an effective solution to nutrition problems: in rich countries, people continue to eat
unhealthy diets even though they know the health risks.

Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree

Comment

5. Nutrition education is important to tackle problems of overweight and obesity, because these are the
consequence of personal choices, but not so important in cases of undernutrition, which is caused by lack of access
to nutritious food.

Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree

Comment

6. Farmers should learn to produce varied and nutritious foods, not just the most profitable crops.

Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree

Comment
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

Section 2. Stories

Activity 2 Analyse the stories assessed 1

A. Understand the stories

Mwende’s story
a. What is wrong with Mwende’s diet?

b. What are the health consequences of this problem for Mwende?

c. What advice was given to her mother?

d. Do you think this advice will be effective?

(Personal answer)

Henintsoa’s story
e. What’s wrong with Henintsoa's diet?

f. What are the health consequences of this problem for Henintsoa?

1
Answer boxes for assessed questions have a double border.
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

g. What advice was given to his mother?

h. Do you think this advice will be effective?

(Personal answer)

Amarech’s story
a. What’s wrong with Amarech’s diet?

b. What are the health consequences of this problem for Amarech?

c. What advice was given to her?

d. Why was it not effective?

(Personal answer)
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

Kagiso’s story
a. What is wrong with Kagiso’s diet?

b. What are the health consequences of this problem for Kagiso?

c. What advice was given to her by the doctor?

d. Do you think this advice will be effective? Explain why.

(Personal answer)

B. Compare the stories

Now discuss what the stories have in common. Find at least three points and write them here:

2.2 What’s the problem?

Activity 3 What went wrong? in pairs

Illustrate the dialogue on p. 17 of the Student's Book by adding examples from the stories in the answer boxes
below. There is an example in each box. Try to find at least one other example for each box.
a. “Why are there so many people who don’t eat properly or take proper care of their health?” What do people
in the stories actually do, or fail to do?
For example, Mwende doesn’t eat breakfast in the morning and in the evening has only maize porridge. Although
she is often sick, her mother doesn’t take her to the clinic.
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

b. “They don’t see the link between diet and health.”

For example, Kagiso’s family says she is tired because she worries too much: they do not see that she is ill because
of her diet. Kagiso herself does not see that the root of her problem is eating too much of the wrong foods.

c. “Nutritionists must try to make them see this link and give them the knowledge they need.”
For example, the nurse gave Amarech nutrition advice.

d. “Just telling people is usually not enough: they may not be convinced, or they may listen to someone they
trust more, or go back to old habits, or follow what everyone else does, rather than trust expert advice.”
For example, Mwende’s mother listened to her friends, not to the foreign researcher.

e. “Sometimes it is very hard for them to follow the advice, and they give up.”
For example, in Kagiso’s culture, women are not expected to take exercise just to lose weight. In any case Kagiso
is not rich enough to join a gym or a tennis club, and the streets are too dangerous for jogging.
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

2.3 KAPP: the core of nutrition education

Activity 4 Knowledge, attitudes, perceptions, practices in pairs

Look again at the examples below (taken from the last activity) and find a good label for each one (knowledge,
attitudes, perceptions, practices).
You may think of more than one label: choose the best in your opinion.

Mwende doesn’t eat breakfast in the morning and in the evening has only maize porridge.
Although she is often sick, her mother doesn’t take her to the clinic.

Kagiso’s family says she is tired because she worries too much: they do not see that she is ill
because of her diet.

The nurse gave Amarech nutrition advice.

In Henintsoa’s story, the mothers follow the advice of the health workers, but then go back to
their own ways.

In Kagiso’s culture, women are not expected to take exercise just to lose weight.

Activity 5 Perceptions and attitudes individually or in pairs

a. Some of the statements in the table below express facts, others reflect perceptions or attitudes. Match the
sentence with the category.

Statement Perception/
attitude/fact

Pumpkin seeds have no food value: throw them away. Perception

Children should not be forced to eat food they don’t like. Attitude

Beer is not as strong as whisky. Fact

• Red meat is a food for men

• Women should not drink beer

• Red meat is a good source of iron

• This beer is quite strong

• Beer is less alcoholic than whisky

• Chicken is more expensive than fish

 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

b. Would you say these have to do with knowledge, attitudes or perceptions?

• Amarech doesn’t know the danger of anaemia in pregnancy.

• People think that white rice is better than brown rice.

• Overweight women are seen as beautiful.

• Mwende’s mother was not aware that diarrhoea and bad sight can mean vitamin A
deficiency.

• Mwende’s mother did not trust advice from a foreigner.

2.4 Gender attitudes and practices

Activity 6 Gender and malnutrition assessed

Mwende, Kenya
1. “In the tribe of Fatma (Mwende’s mother), men don’t like women to know how much money they have, so
Fatma never asks how much money her husband makes or where he spends it.”
a. What is expected of women?

b. How could this attitude affect the health of the children in the community?

c. Can you see a practical solution?

• n.b. Gender attitudes are slow to change and are usually a sensitive issue.

Henintsoa, Madagascar
2. “During the day, the mothers are busy working in the field.”
a. What is expected of women?
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

b. How can this attitude affect the health of the young children?

c. Can you see a practical solution?

• n.b. Gender attitudes are slow to change and are usually a sensitive issue.

Amarech, Ethiopia
3. “She had been married at the age of 15 and became pregnant at 16.”
a. What is expected of women?

b. How does this affect their health, and the health of the babies?

c. Can you see a practical solution?

• n.b. Gender attitudes are slow to change and are usually a sensitive issue.

4. “Whenever the family could afford meat it went to the men.”

a. What is the attitude here?

b. How does this affect the nutrition/health of children and women?

c. Can you see a practical solution?

• n.b. Gender attitudes are slow to change and are usually a sensitive issue.
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

Kagiso, Lesotho
5. Her husband says, “The bigger you are, the more attractive you are. A man likes a woman with flesh on her
bones.”
a. What is the attitude?

b. How does it affect the nutrition/health of women and children?

c. Can you see a practical solution?

• n.b. Gender attitudes are slow to change and are usually a sensitive issue.

In your country
6. Reflect on the role of gender issues in your country/region/community. Are these issues linked to malnutrition
problems among women and children?
 Unit 1: The need for nutrition education
ENACT course in nutrition education Student's book: printable version for student’s answers

2.5 Analysing causes in the stories

Activity 7 Find the best explanation in groups

• Choose one of the stories

a. Which of the following explanations fit your story best? Discuss. Number the three most important factors
from 1 (most important) to 3.

Name of story:

The causes of the problem in this story were:

☐ the lack of knowledge and information about nutrition and health

☐ mistaken perceptions and attitudes

☐ cultural attitudes and traditions which lead to poor nutrition practices

☐ gender attitudes and the unequal power of men and women in family and society

☐ social influences from friends, family, community

failure in communications through misunderstanding, mistrust of sources of information and advice,

☐ conflicts with other sources, inadequate motivation and involvement, lack of explanation and examples,
one-off counselling (without practice) etc.

☐ circumstances which did not allow people to improve their practices or which led them into poor dietary
habits

☐ institutional failings: the absence of assistance, advice and support from health and agricultural services,
schools, social services etc.

b. Explain the choices you made in your answer to question a.

 ENACT course in nutrition education Unit 1: The need for nutrition education
Student's book: printable version for student’s answers

Section 3. Argue for nutrition education

Activity 8 Briefing for the presentation (no writing required)

Section 4. Global and national malnutrition

Activity 9 Analyse the article ‘A damning record’ in pairs

Read the article ‘A damning record’ on p. 8 of the Unit 1 Resources with a colleague.
a. Look for two things you already knew, and two things that you didn’t know. Write them here.

b. In the first paragraph the three main categories of nutrition problem are mentioned. What are they?

c. The article talks about the causes of one of them. Which?

d. The article talks about the effects of another one. Which?

e. As you read, note what these numbers refer to.

• 18m

• 60 000

• 70%

• 1/3

f. How does the article support the argument for more nutrition education?
 ENACT course in nutrition education Unit 1: The need for nutrition education
Student's book: printable version for student’s answers

g. “Television is more important than food.” Have you experienced similar attitudes? Is it common? How can it
be explained?
(Personal answers)

h. According to the article, “there is no pressure for change”. Why not?

Activity 10 Research on malnutrition figures in your country in groups

Search for information about malnutrition in your country and make notes below.
Stunting

Wasting

Overweight and obesity

Vitamin A deficiency

Iron deficiency anaemia

 Unit 1: The need for nutrition education
ENACT course in nutrition education
Student's book: printable version for student’s answers

Iodine deficiency

Zinc deficiency

Section 5. The causes

5.1 Causes of malnutrition in your country

Activity 11 What are the top causes? in pairs or groups

a. Make a list of the three top causes of malnutrition in your country (or in your area) in order of importance as
you see it. The box on p. 39 of the Student's Book gives some causes (not in any particular order).
Your list:
1.
2.
3.

b. Justify your choices and their order. Give some evidence from your own experience, or from other sources.

5.2 The UNICEF diagram

Activity 12 The framework of undernutrition in pairs

A. Unpack the framework

Follow the instructions on p. 43 of the Student's Book.
 Unit 1: The need for nutrition education
ENACT course in nutrition education
Student's book: printable version for student’s answers

a. Immediate causes. The arrow connecting “inadequate dietary intake” (a poor diet) and disease points in both
directions. Why is this?

b. Underlying causes. According to the diagram, inadequate care and feeding practices for young children
contribute both to inadequate dietary intake and to disease. Can you give an example?

c. Basic causes. The diagram shows the causes of undernutrition. Would the basic causes be the same for
overweight and obesity? (Think!)

B. Nutrition education in the framework

Below are a few well-known nutrition education activities. Which underlying causes do they tackle? You may find
more than one answer for some of them.

a. A national breastfeeding campaign

b. A campaign to promote consumption of iodised salt

c. Establishing handwashing routines at school

d. Group counselling on good diet for people living with HIV/AIDS

e. Training for communities in food preserving and nutrition

f. Developing home gardens for better nutrition

g. National dietary guidelines for the public

h. Community groups learn to prepare richer complementary foods

i. Training in food-handling for food vendors

j. School lessons on junk food

 ENACT course in nutrition education Unit 1: The need for nutrition education
Student's book: printable version for student’s answers

Activity 13 Use the framework assessed

On your own, choose one of the other stories, or a personal experience, and write a paragraph similar to the
example on p. 45 of the Student's Book. Show how lack of knowledge and awareness, misconceptions, poor
practices and social influences influenced the events.
The story:
The immediate cause

The underlying cause

The basic cause

Section 6. Summarising the arguments

Activity 14 Nutrition education and complementary feeding individually or in pairs

Read (or watch) in the Unit 1 Resources, 3 ‘Nutrition education and complementary feeding practices’. Look for
evidence that education is important to ensure healthy feeding practices. Write your answer in the box.
 ENACT course in nutrition education Unit 1: The need for nutrition education
Student's book: printable version for student’s answers

Activity 15 Why is nutrition education needed? in pairs or group

Here is a list of some reasons why nutrition education is needed. Fill in some of the empty boxes in the table with
more examples from the stories and articles you have read.

Nutrition education is Example

needed so people will…
…understand the Kagiso and her family didn’t see the relationship between her “new” dietary habits
importance of good diet to and the health problems she had.
health and growth,
recognize the risks of poor
diet, and take action

…make better use of the

resources available

…recognize a poor diet and

know how to improve it
(e.g. value dietary variety
and take action to get it)

…learn to feed their

families well (frequent
meals for infants,
breakfast for children,
balanced meals, extra
protein and iron for
pregnant women)

…recognize food myths In Henintsoa’s story vegetables were seen as food for the poor.
and misconceptions and
the health risks

…identify foods that

provide essential nutrients
 ENACT course in nutrition education Unit 1: The need for nutrition education
Student's book: printable version for student’s answers

…be able to start new

habits and keep them up

…know enough to be able

to recognize good advice.
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