THE REPUBLIC OF UGANDA Basic Nutrition Concepts &Nutrition Indicators Training manual For Field Extension Service Providers Under IFAD financed projects PRELNOR and VODP II January 2019 By: Beatrice Ekesa, Deborah Nabuuma, Samalie Namukose and George Upenytho. This manual was prepared by Bioversity International on behalf of the Government of Uganda together with IFAD THE REPUBLIC OF UGANDA Basic Nutrition Concepts &Nutrition Indicators Training manual For Field Extension Service Providers Under IFAD financed projects PRELNOR and VODP II January 2019 By: Beatrice Ekesa, Deborah Nabuuma, Samalie Namukose and George Upenytho. Table of Contents List of Acronyms .................................................................................................................................. 5 Nutrition situation in Uganda .............................................................................................................. 6 Introduction session ............................................................................................................................ 9 1.0 Basic Nutrition Concepts ............................................................................................................ 11 2.0 Recommended feeding practices ............................................................................................... 14 Nutrient needs of different family members ............................................................................... 24 3.0 Malnutrition ................................................................................................................................. 32 4.0 Food and Nutrition assessment .................................................................................................. 38 4.1 Household food security indicators and measurement ............................................................. 41 4.2 Anthropometric assessment ....................................................................................................... 41 4.3 Nutrition status assessment ....................................................................................................... 43 5.0 Food Safety and Hygiene ............................................................................................................ 52 6.0 Utilisation of income for food and nutrition security .................................................................. 55 7.0 Action plans for extension workers ............................................................................................. 57 8.0 Closure ....................................................................................................................................... 59 Appendix:1 Ways to add value to children’s meals .......................................................................... 60 Appendix:2 Nutrient needs of different family members ................................................................. 62 Appendix:3 Health/Nutrition Talk Observation Checklist ................................................................ 63 4 | Training manual For Field Extension service providers List of Acronyms ANC Antenatal Care ASP Agricultural Service Provider CBO Community Based Organization CDO Community Development Organization HMs Household Mentors F&ALP Functional and Adult Literacy Programs SACCOS Savings and Credit Cooperatives VSLAs Village Savings and Loan Associations WASH Water Sanitation and hygiene MUAC Mid Upper Arm Circumference OFSP Orange Fleshed Sweet Potato WHO World Health Organization Training manual For Field Extension service providers | 5 Nutrition situation in Uganda ccording to the Uganda Demographic and Health Survey (UDHS 2016), 33% of the Ugandan population was malnourished in 2016, 29% percent of children under 5 were stunted, 11% were underweight, 3.6% were wasted, 11.8% had low birth weight. Prevalence of anemia among women of child bearing age was at 31.8%. The current levels of malnutrition in Uganda Aare unacceptable. In Acholi region, 31% of children below 5 years of age are stunted, 4% are wasted and 15% are under weight. In Central region, 19% of children under 5 years are stunted, 4% are wasted and 7% are underweight. Therefore, nutrition warrants greater investment and commitment for Uganda to realize its full development potential. Among the main contributors of malnutrition is the low awareness of the available options and in some instances - the poverty levels within certain regions that limits households from accessing enough food or providing the appropriate health care. It is upon this background that the Government of Uganda with the support from the International Fund for Agricultural Development funded two projects in Kalangala region and northern Uganda. The objectives of the projects were to improve households’ income by increasing productivity of farmers through adoption of commercial farming. The VODPII project in Kalangala was to achieve its objective through promoting commercial production of oil palm thus increasing household incomes. In northern Uganda, PRELNOR aimed at increasing production of food crops especially maize, beans, cassava and rice…so that farmers have excess surplus to sell. VODPII In 2003 the Government of Uganda, International Fund for Agricultural Development (IFAD), BIDCO and individual farmers in Kalangala under Kalangala Oil Palm Growers Trust (KOPGT) teamed up to establish an oil palm project with expertise from Malaysia, the pilot was rolled out on Bugala Island with plans to expand the project to other neighbouring islands in the district. The project was designed to improve the livelihood of the people of Uganda and Kalangala in particular, more so on the nutrition status of the poor and reduction on the national cost burden of importation of vegetable oils. 6 | Training manual For Field Extension service providers PRELNOR Although only 20% of the Uganda population lives in Northern Uganda, it accounts for 38% of the poor in Uganda with 26% of all the chronically poor living in the area. IFAD included Northern Uganda, particularly the Acholi region, as a high priority in the IFAD project pipeline. Most farmers returning from the IDP camps rely on the natural fertility of the soils, with minimal or no inputs leading to low yields and productivity. The sub-region has excellent potential for agricultural development, which is needed for lifting the rural poor out of poverty. The PRELNOR project aims to achieve increased incomes through; adoption of improved farming practices, improving market processes and structures and providing climate specific information to enable improved farming. This Guide is therefore designed for use by field level staff. The guide gives details that are aimed at enabling the field service providers within PRELNOR and VODP II projects to gain an understanding major concepts in nutrition, identifying nutrition needs for different categories of people, identifying different forms of malnutrition, their causes, consequences, management and preventive strategies. Nutrition indicators and their measurement and monitoring methods are also included. Finally, information on food safety and hygiene is also given. The target trainees include: field level staff (Community based facilitators, Household Mentors and Unit leaders) following the trainings, the field extension service providers will have gained knowledge and skills that can be transferred to communities and household members in projects’ target regions. Outcome This training guide is intended to build capacity of community level resource persons to transfer knowledge on basic concepts regarding appropriate dietery patterns and use of existing farming systems for better household nutrition.In reffering to this manual,the community resource persons will be able to draft action action plans to transfer the information gained to community members.The expected impact is that enhanced knowledge of the links between agriculture,nutrition and health,formation and/or upgrading of existing home gardens into comprehensive gardens as well as proper dietary and health practices will eventually lead to enhanced nutrition and health status. Outputs • Number of extension field workers trained and able to train their community members, number of households reached with the intervention, • Number of households trained by extension field workers that can implement the recommended practices Training manual For Field Extension service providers | 7 Users of the Guide This guide it to be used in creating awareness of the service providers with regards to nutrition to enable mainstreaming of nutrition into PRELNOR & VODP II projects. It will be used for training Field level implementers. Overview of the Training Guide The guide has 7 Main sections: 1. Basic Concepts in Nutrition 2. Ensuring household and individual balanced diet 3. Malnutrition, its forms and causes 4. Food and nutrition assessment 5. Food safety and hygiene 6. Utilization of income for food and nutrition security 7. Action plan for extension workers Each section includes a time allocation, a pre-test, an overview of the learning objectives, materials needed, notes and facilitator fact sheets pertaining to the section. Also contained is an activity that generates discussion and helps in recapping information while focusing on the key learning objectives. 8 | Training manual For Field Extension service providers Introduction session Time: 45 minutes Materials needed: Learning Flip charts, Objectives Markers Pens