Under Nutrition Remains a Major Health Problem Among Nigerian School Children

In this interview, Ms. Philomena Orji, Country Director, Helen Keller International, an American NGO that focuses on nutrition, talks about the achievements of the Nutrition and Healthy Lifestyle Project funded by Mondelēz International, parent company of Cadbury Nigeria Plc, in Nigeria, among other issues. Dike Onwuamaeze brings excerpts

Please can you give us a background to the Nutrition and Healthy Lifestyle Project that Mondelēz International, the parent company of Cadbury Nigeria Plc, is funding in Nigeria?

As you are aware, Nigeria suffers from high levels of food insecurity and malnutrition, including micronutrient deficiencies and poor child growth. Diets that are poor in vitamins and minerals, contribute to preventable malnutrition and mortality in children under five. Among the risk factors are extremely high levels of vitamin A deficiency, and extremely low levels of exclusive breastfeeding and dietary diversity. The rate of stunting, or chronic malnutrition, is 37 percent, resulting in lifelong cognitive and physical deficits. Undernutrition remains a major health problem among Nigerian school children, while overweight and obesity are emerging problems in urban areas. The main reason for this is that dietary diversity is limited, contributing to micronutrient deficiencies. A study of 200 primary school children in Lagos State revealed 38 percent were suffering from anemia. There is clearly a need to formulate and implement nutrition education programmes to correct malnutrition among primary school children in Lagos. According to the Lagos State Universal Basic Education Board, 60 percent of the children in the state attend public schools, which have fewer resources than private schools. While physical education is a compulsory subject in primary school, there has been a systematic decline in its implementation over the past two decades. Moreover, physical education and sport facilities and equipment are inadequate. At the start of the project in 2018, among the nine project schools, only Agidingbi Primary School had a few footballs for exercise, while all other schools have no sports equipment.

Parent-Teacher Associations (PTAs) existed in the schools but were weak, due to lack of parental engagement. To combat these issues mentioned above, Helen Keller International, in collaboration with the Lagos State Government, had to intervene by implementing the Nutrition and Healthy Lifestyle Project, with funding from the Mondelez International Foundation since 2018, to support schools and communities to reach under-served children in Nigeria through innovative ways. The programmes are all geared towards creating school and community environments that encourage children and families that adopt lifelong healthy habits.

What are the objectives of the project and who are the beneficiaries?

The primary objective of this project is to reduce undernutrition, and overweight among primary school pupils aged six to 11 years in nine public primary schools in Ikeja LGA, Lagos State. The target schools are Agidingbi Primary School, Estate Primary School, Ogba Primary School, St. Peters’ Primary School, Tokunbo Alli Primary School, Oke-Ira Primary School, and Ojodu Primary Schools (1, 2, and 3). The project has three major objectives, which are as follows: to provide nutrition and hygiene education to children in the identified primary schools; to promote active play and a healthy lifestyle among primary school children; and to promote the cultivation and consumption of diverse micronutrient-rich fruits and vegetables. Since the inception of the project in 2018, Helen Keller International has taught over 6,000 children the importance of proper nutrition, physical activity, and gardening through in-school and after-school activities. The programme in Nigeria targets a direct reach of 6,000 children in primary schools, and an estimated indirect reach of about 48,000 out-of-school children, and their families across the Community Development Areas (CDAs) of Lagos State. So, we have made tremendous progress in terms of reaching our target.

To what extent would you say that you have achieved your objectives?

To a very large extent, I would say. A lot of effort has gone into achieving the project outcomes since its inception. For instance, for nutrition education, the percentage of pupils with improved knowledge increased by 20.61 per cent on good nutrition and healthy lifestyle. For active play, the percentage of pupils who reported that they are physically active or engage in play for 30 minutes or more daily, increased by 26.67 per cent, while the number of students who report increased consumption of vegetables, fruit and fresh foods, increased by 12.33 per cent. The project has reached over 179,309 people in Lagos State. We have conducted four harvest fairs, four sport festivals, and established over 2,917 gardens in the communities. The crops grown in the gardens are nutrient-rich crops such as vitamin A maize, orange fleshed sweet potato (OFSP), green leafy vegetables, cucumber, etc.

What is the extent of government’s involvement in the project and what efforts have you made to take it to the rural dwellers?

The Nutrition and Healthy Lifestyle Project is implemented in collaboration with the Lagos State Government. Helen Keller has a memorandum of understanding signed with the Lagos State Ministry of Economic Planning and Budget. Helen Keller aligns with the developmental partners department of the ministry. The project has a technical working group (TWG), which comprises various stakeholders in government. Helen Keller also collaborates with regulatory agencies such as State Universal Education Board, Ikeja Local Government Authority, relevant line ministries such as Ministry of Agriculture, Ministry of Health, Primary Health Care Development Board, Ministry of Community and Local Government Affairs, Ministry of Environment and Water Resources, and other community bodies. To reach the rural dwellers, the project engaged with community development committees and associations, School Based Management Committee (SBMC), and Parent Forum (PF).

What were some of the key challenges that you faced in the implementation of the project and how did you overcome them?

At the earlier part of the project implementation, we had bureaucratic challenges with obtaining permission to conduct activities in the schools. We engaged officially with authorities at every single time, but with the inauguration on of the TWG, the bottlenecks were reduced, and we were able to implement freely. We also encountered another challenge during the project’s second year, when the Lagos State Government introduced the EKO EXECL platform to be used in the primary schools. The platform was rigid and could not accommodate the extra-curricular activities of the pupils, such as school gardening activities, active play, and some other components of the project, because it is centralised, electronically controlled, and must be adhered to. Helen Keller had to conduct series of advocacy meetings with the authorities for its adjustment and flexibility. We are happy that these advocacies yielded a positive outcome. Also, the COVID-19 pandemic resulted in the schools shutting down for several months. Soon after re-opening, the schools had to shut down again for a short period due to the EndSARS protests in October 2020.

What has been the impact of the COVID-19 pandemic on the project?

The impact of COVID-19 pandemic has affected the whole world. It affected the programme implementation as well since the pupils who are the direct beneficiaries had to stay at home due to school closure. Many activities that were already planned were put on hold during the lockdown. During the first outbreak of COVID-19, Helen Keller donated some sanitary and hygiene materials such as hand sanitizers, soap, disposable face masks, construction of tippy taps, and hand washing stations, to the schools and communities. Helen Keller also used virtual platforms to follow up on project champions to ensure continuous management of smart gardens.

From your experience, what are the challenges involved in implementing a social and behavioral change program such as this, in a developing country like Nigeria?

Helen Keller International employed a Social and Behavioral Change Communication (SBCC) strategy to enable the adoption of improved nutrition, water, sanitation, and hygiene (WASH) practices and active lifestyles, across the project schools. The major challenge with this is that change takes a long time to materialise, especially when there are few resources like we encountered in the public schools. With continuous training of teachers and other technical support we have made much progress in catching the pupils young. Many of them are already adopting the nutrition and healthy lifestyle. They are now change agents, positively influencing their family and their community.

To what extent have you succeeded in creating the desired change?

We have recorded many success stories. Many of these testimonies from the schoolteachers include how sedentary pupils are now active in class and are representing their schools at different competitions including inter-house sport, quiz and debates amongst other. Also, many parents and families now have smart gardens in their homes since Lagos is a cosmopolitan city with limited space. In addition, more than 450 pupils across the schools have formed Health and Young Farmer Clubs, and have been a great positive influence on their other colleagues and families.

What level of training did you carry out to ensure success of the project and to what extent did you involve the parents of these children in the project?

The project has conducted a series of trainings since inception, which include Training of Trainers (TOT) on the three thematic areas of the project: Nutrition Education, Home Gardening and Active Play. The target participants were teachers, project stakeholders, community members such as the Parent Forum, School Based Management Committees, and others. We have conducted extensive training for our project champions and equipped them with the right training materials. This was done to ensure that the trainers are passing the right knowledge to their participants. We are confident the training guides and manuals developed will outlast the project.

What were some of the key milestones that you achieved and what steps have you taken to ensure the project is sustainable after your exit in December this year?

Key milestones achieved in the project include but are not limited to the increased knowledge of our pupils in the project schools on nutrition and healthy lifestyle, active participation in class and garden-based production, and consumption of nutrient-rich foods. The produce from school gardens have been showcased at the annual harvest fair in the project school in Ikeja. The project has also engaged 25 other public primary schools in Lagos State, at different times, during the Healthy Sports Festival. Activities of the project led to the establishment of the demonstration garden at the Ikeja Local Government Education Authority Complex. Project champions, who are parents, were also engaged and all these champions have their smart gardens and have recruited other champions in the communities. The project also supported Cadbury Nigeria Plc, our host company, to establish a garden on their premises, as part of their 2021 Purpose Day’s activities. We believe this is a legacy project. The project has also been able to influence EKO EXECL in adopting the Nutrition and Healthy lifestyle Project’s co-curricular activities, thus engaging all the primary school pupils in Lagos State. So, the impact has been quite huge and felt across Lagos State.Liverpool