School Nutrition Project in China Changes Attitudes, Habits

Staff from EDC's Health and Human Development Programs (HHD)recently returned from a mid-term evaluation of a school nutrition project in Zhejiang Province, China, where, along with the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), they are working to improve the nutritional intake of schoolchildren and develop a WHO model Health-Promoting School.

"The Health-Promoting School is designed to foster the healthy development of students, school staff, families, and community members," said Carmen Aldinger, research associate at EDC, who heads the nutrition project for HHD.

"Because there is evidence that change is more likely to occur when a community takes a cohesive approach to a problem, the nutrition interventions target students, families, and teachers." About 7,500 students and their families and 800 teachers and school staff are participating in the project.

A national survey conducted in the early 1990s found that nutrient intake was inadequate in Chinese children and adolescents, particularly in rural areas. While energy intake was in line with the RDA (Recommended Dietary Allowance), protein intake was 88 percent of the RDA and calcium intake was only 38 percent. The rate of iron deficiency in primary school students was more than 13 percent. In Hangzhou, one of two southeast Chinese cities involved in the nutrition project, the prevalence of malnutrition was recently found to be 22.5 percent while the percentage of overweight students was nearly 25 percent.

Talks with parents during the evaluation revealed that it was not a lack of availability of foods that was a problem, but a lack of knowledge about proper nutrition. For example, some parents said that before the nutrition project, they thought that eating foods high in protein and calories, particularly meat and fish, was preferable to consuming vegetables, even though some grew their own. And many didn't give their children breakfast in the morning, in part because schools start very early. Research has shown that children may have trouble concentrating in the morning due to hunger.

In addition to Hangzhou, the project is also being conducted in the southeastern city of Wenzhou. Locally, the project is led by a provincial working group from the Health Education Institute in collaboration with the provincial Bureau of Education.

During a week of meetings in late April 2001, the project's six pilot schools presented their progress to EDC, WHO, and FAO. "The pilot schools showed great ingenuity in their efforts to getnutritional messages across to students and families," said Aldinger. For example, students at Washi Primary School in Wenzhou presented songs and skits about healthy nutrition they had written with their teachers. And students at Wenzhou Experimental Middle School designed Web pages with nutritional themes and did a survey about the impact of a garbage collection station next to their school.

Jiubao Middle School in Hangzhou invited parents to attend classes and have a nutritious lunch with students. And at Sijiqing Primary School, students made up nutritious recipes and illustrated them. Jiubao Primary School and Chao Yang Middle School in Hangzhou did outreach to the community and literally hit the streets to share messages with people, one on one, about healthy nutrition.

Students themselves reported changes in both their attitudes and habits. One student said that while sweet and sour pork remained his favorite food, he was eating a more varied diet after learning about nutrition in school.

A final evaluation is planned for April 2002. A follow-up survey to the baseline survey, conducted in May 2000, will be administered in November 2001 among a sample of students, teachers, and parents of the participating pilot and control schools. If the project is found to be effective in changing both attitudes and behavior about nutrition, the experiences and materials will be shared with other schools in China and around the world.

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