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Open and distance learning (ODL) could be a potential tool to bring nutrition ... means of eradicating malnutrition especially obesity among children and women using ODL tools as an alternative e- .... All the drama series, plays, music, sports, etc. are recorded in them and sold at minimal prices. .... Jme.infosheet.pdf.
F.N. Uchendu

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ELSEVIER JOURNALS JOURNAL OF NUTRITION RESEARCH ____________________________________________________________________________ Article

Open and distance learning, a potential tool for eradicating malnutrition Uchendu N. Florence School of Health Sciences, National Open University of Nigeria, Victoria Island, Lagos, Nigeria.

ARTICLE INFO _________________

ABSTRACT _____________________________________________________

Article history Reviewed 26 September 2014 Accepted 1 October 2014 Available online xxxx

Malnutrition is a global public health problem. There is a link between poor nutritional knowledge and malnutrition. A comprehensive literature search reveals the importance of nutrition education in the eradication of malnutrition. Open and distance learning (ODL) could be a potential tool to bring nutrition education to mothers and children in their households using interactive animated computer-based nutrition games/gadgets thereby eradicating malnutrition. Early nutrition education could protect children from nutrition-related chronic diseases in adulthood. This paper reviews the potentiality of ODL tools as a means of passing nutrition education to vulnerable groups to eradicate malnutrition .

____________________ Key words: open and distance learning tools Malnutrition Nutrition education Women Children

© 2014 The Authurs. Published by Elsvier B. V. This is an open access article under the CC BYNC-ND licence (http://creativecommons.org/licences/by-nc-nd/3.0/) ______________________________________________________________________________________________________ School of Health Sciences, National Open University of Nigeria, Victoria Island, Lagos, Nigeria. E-mail address: [email protected]

1. Introduction Malnutrition is a public health problem in many countries especially among children, pregnant and lactating women. It includes macro and micro nutrient deficiencies such as protein energy/calorie malnutrition (PEM/PCM), vitamin A deficiency (VAD), iodine deficiency disorders (IDD), iron deficiency anemia (IDA), zinc deficiency, vitamin D and foliate deficiencies. Other nutritional problems include obesity, dental caries, and cardiovascular diseases (CDVs) such as hypertension, stroke, and heart attack. Prevalence of micronutrient deficiencies is more in SubSahara Africa and Asian countries. Major causes of malnutrition are poor nutritional knowledge, low nutrient diversity, cultural beliefs, food taboos, and low nutrient dietary intake. Proper nutrition education can help to minimize the effect of the other factors. However, formal nutrition education is mainly in tertiary institutions and limited to few universities, polytechnics and higher schools. Mothers who are interested to learn might be restricted in time and space by unmet admission cut off marks, house chores, child bearing and rearing, and poor economic status. Overweight, obesity and diabetes occur as a result of excessive dietary intake of carbohydrate, fats and oil foods with less of the stored sugar and fats being utilized or expended. Consumption of energy giving foods is meant to provide the consumer with energy and strength for daily activities. If the quantity consumed per day is more than the quantity utilized, the excess is stored in the blood and adipose tissues. When the stored level becomes higher than the recommended daily intake, the result is a caloric imbalance. This “caloric imbalance” could be affected by genetic, behavioural, and environmental factors (Daniels et al., 2004, Office of the Surgeon General, 2010). Research has found that children especially in Britain spend an average of 5 hours daily in front of a television and

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computer screen than they do exercising (Thomas, 2011). In England, 61.3% of adults and 30% of children 2-15 years old are either obese or overweight. People who are overweight have a higher risk of getting type 2 diabetes, heart disease and certain cancers. Actions expected include helping people to make healthier choices by eating and drinking more healthily and being more active (UK Department of Health, 2013). There is a global 13-year plan (2012-2025) to address maternal, infant and child nutrition and the goal is to alleviate double burden of malnutrition in children, starting from the earliest ages of development. One of the objectives of the plan is to achieve a 40% reduction in the global number of preschool children who are stunted by 2025, compared to the baseline of 2010 (WHO-UNICEF-WORLD BANK, 2011). Conventional strategies being used to eradicate malnutrition in many countries include food fortification, biofortification, food supplementation, food diversification and formal nutrition education. However, these deficiencies still persist in many countries due to the various limitations of these strategies. ODL tools could bridge this gap by serving as an informal alternative to conventional strategies. The aim of this paper therefore is to review and discuss means of eradicating malnutrition especially obesity among children and women using ODL tools as an alternative elearning strategy.

1.1 Major forms of malnutrition The four major forms of malnutrition that are public health problems are as shown in Figure 1.

Figure 1. Forms of malnutrition.

1.2 Global prevalence of malnutrition Obesity is a global health problem in many developed countries (Table 1). Even though much of this can be blamed on diet, a sedentary lifestyle is a contributing factor (Clark, 2012). These findings confirm the need for effective intervention strategies starting as early as infancy to reverse anticipated trends. Nutrition knowledge is an integral component of health literacy which is associated with poor health outcomes (Spronk et al., 2014).

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Table 1. Summary of prevalence of obesity in children in some countries

S/N 1 2 3 4

Country/Continent Argentina Australia Canada China

5 6 7 8 9 10 11 12 13

Egypt Germany Greece India Latin America and the Caribbean New Zealand Nigeria Singapore United Kingdom

14

United States

15 16 17 18

Continent Africa Americans Asia Europe

Obese children (%) 35.0 21.0-25.0 9.0 14.0 (boys) 9.0 (girls) 20.0 6.3 18.0 14.0 7.0 28.0 10.0-30.0 12.0 30.0 18.0 (girls) 22.0 (boys) 21.0 10.0 17.0 18.0 18.0 15.0 (girls) 19.0 (boys)

Age (yrs) 10-11 * 6-17 8-18 8-18 0-5 3-17 * 8-18 0-5 5-14 * 10-11 2-15 10-11 10-11 Women Infants(0-2) 2-19 6-11 12-19 * *

8.5 6.7 5.0 6.0-9.0

0-5 6-11 0-5 *

*Not available Sources: Boon and Clydesdale, 2005; Clark 2012; de Onis et al. 2010; Ogden, et al. 2012; NCHS, 2011

2. Importance of nutrition education in the eradication of malnutrition Causes of malnutrition and strategies to eradicate them are tabulated in Table 2. The high frequency of nutrition education among the strategies shows its importance in the eradication of malnutrition. Table 2. Types of malnutrition, major causes, vulnerable groups and eradication strategies.

Malnutrition Protein Energy Malnutrition

Major causes Poor dietary intake

Vulnerable groups Pre-school children

Hidden Hunger

Poor dietary intake, low nutrient diversity, cultural beliefs, food taboos

Pre-school children

Obesity, Overweight

Cardiovascular diseases (CVDs)

Sedentary life style, poor nutritional knowledge, overconsumption, lack of exercise Low nutrient diversity, poor dietary intake, poor nutritional knowledge

Pregnant women Lactating mothers Adolescents Pre-school children Pregnant women Lactating mothers Adolescents Adult stage

Eradication strategies Food fortification, food supplementation, food diversification, biofortification nutrition education Food fortification, Food supplementation, Food diversification, Biofortification Nutrition education Nutrition education

Nutrition education

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Distance education (sometimes referred to as „distributed learning‟ or „distance learning‟) is any educational process in which all or most of the teaching is conducted by someone geographically removed from the learner, with all or most of the communication between teachers and learners being conducted through electronic or print mediums (UNESCO, 2013). It also refers to approaches to learning that focuses on opening access to education and training provision, freeing learners from constraints of time and place while offering flexible learning opportunities to individuals and groups of learners (UNESCO, 2013). The openness of distance learning is also seen in relatively flexible organizational structures, delivery and communication patterns as well as the use of various technologies to support learning (UNESCO, 2013). The openness of distance education is also seen in the relatively flexible organizational structures, delivery and communication patterns, and use of various technologies in supporting learning (UNESCO, 2002). Some of such technologies include audiovisual means (television, radio, Compact discs (CDs) and Digital Versatile/Video Disc (DVDs), multimedia (audio and text files), video and computer-based) materials and the internet. While developed countries are fighting double burden of disease, developing countries are eradicating hidden hunger and poor nutritional status. Research has suggested the need to introduce during school age, nutrition education programs focused on mother and children to improve the population life quality (Ivanovic, 1995). Sometimes open and distance learning is used for school-age children and youth that are unable to attend ordinary schools, or to support teaching in schools, both at primary and secondary levels (UNESCO, 2002). Mothers, housewives, children, illiterate women, carrier women, can access nutrition information through open and distance learning tools anywhere and anytime in different local languages to make it reader friendly. Mothers can improve their nutritional knowledge even in their kitchens using ODL tools. Video and computer games are some of the most popular activities with children. There is a definite link between video games and obesity (Qazalbash, 2013). Playing video games is a sedentary activity. Computer games have been associated with obesity in children because they sit for a long time in front of a screen and this act is a sedentary lifestyle (Clark, 2012). Sedentary lifestyle implies sitting down continuously for a long time with minimal physical activities. Children in developed countries are involved in sedentary lifestyle. Computer games are now designed to last longer and be more challenging therefore involving a longer sitting time and no exercise. Computer and video games encourage consumption of snacks which are implicated in malnutrition. Sedentary lifestyle leads to excess storage of fat and carbohydrates resulting in increased obesity among the children. ODL tools can be used to educate people against the major causes of malnutrition. Research has shown that children were more likely to patronize exercise if the exercise is embedded in video games. Children were given the choice of „normal‟ exercise options and interactive games that also involved exercise. The children only spent 10% of their activity time on childbased fitness equipment, while 60% was spent on identical fitness machines which were connected to a games console (Clark, 2012). Mothers can teach their children healthy eating lifestyles using computer games and gadgets than telling them orally.

3. How ODL tools and games could be used for nutrition education Children have been associated with double burden of malnutrition. Using ODL tools in the form of interactive computer-based animated gadgets, nutrition knowledge and education can be imparted on children early enough in life. Children sit for a long time playing with computer tools and these have been associated with obesity. These gadgets can be converted to nutrition education tools.. They can be used to teach children the nutritional implication of sitting at one place for a long time, eating sugary and sweet foods which cause dental caries in children. Children do not eat some foods such as vegetables. Consequences of not eating vegetables could be demonstrated using ODL animated games. Causes of protein energy malnutrition (PEM), stunting, wasting, and underweight and micronutrient deficiencies can be formulated as games using the same computer games they are familiar with. Obese people cannot make healthier choices if they lack nutrition knowledge. Nutrition education on how to prevent obesity can be put in Compact discs (CDs) and Digital Versatile/Video Disc (DVDs), video and computer games in ODL interactive modules, mass produced and put on sale. Three purposes will be achieved such as educating the viewers, entertaining them and then eradicating malnutrition. Healthy eating habits could be inculcated in children early enough in life to minimize CVDs. Nutrition games duration could be 10-30 minutes for 3 months to 12 years old children. Animated food names, fruits, vegetables, eggs, milk, can come in form of sing-along songs in both English and any other local languages. When the child gets used to the names of these foods, he/she will like to taste them as soon as he/she can speak. The gadgets can be used to describe ways of eating well to prevent sickness. Even if obesity is a genetic factor in a family, children who were monitored early enough from childhood would not be obese. Early childhood nutritional training will cushion the effects of food taboos and poor caring practices from illiterate, poor, and carrier parents and care-givers. ODL tools can be used to teach children causes, health implication and solution to obesity. Children can begin early from infancy to play games that show them healthy foods and foods that pre-dispose them to obesity and those that are not. It will also show them activities that pre-dispose them to obesity using animated stories on healthy diets,

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junk foods, classes of foods, their functions, lack of exercise and sitting down in a place for a long time watching television or playing games. They can teach themselves in the comfort of their homes at leisure times. Many computer-games are now being manufactured to include different forms of exercises. This trend can continue with nutrition education game consoles that will make children interact with healthy foods such as fruits, vegetables and cereal foods. This can be done in form of animated, interactive video and computer games. A compact disc is a thin, circular disc of metal and plastic even though CDs and DVDs have now largely been superseded by MP3 players such as iPods, which are much smaller and lighter and pack lots more music into the same space by compressing it digitally (Woodford, 2011). They are still the most commonly used in developing countries like Nigeria. All the drama series, plays, music, sports, etc. are recorded in them and sold at minimal prices. Many people buy them and watch all day especially house wives. This medium could be used to improve the nutritional knowledge of women, mothers, carrier women and less-privileged groups etc. They can play these gadgets in their comfort zones and at leisure times. Improving the nutritional knowledge of mothers will also affect positively the health of members of the family because women plan, decide and cook what is eaten in their homes. This will reduce childhood and maternal morbidity and mortality. E-learning resources are available for learners to access at affordable prices. The average cost of computer games is about $45. CDs and DVDs are cheaper. It is for the masses. In Nigeria, retail price of average CD is N100 ($0.63). There are commonly used in developing countries. E-learners have a choice from the arrays of ODL tools. 4. Conclusion E-learning tools are potential tools for passing nutrition education among women and children. The information computer technology (ICT) companies should key into it in conjunction with nutritionists in open and distance learning universities.

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