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A collaborative effort in community nutrition
training
Nutrition teaching at the tropical metabolism
research unit, university of the West Indies
A collaborative effort in community nutrition training
Margaret Gilliland, Director,
Community Nutrition Program, University of Queensland, Brisbane,
Australia
Aree Valyasevi, Director, Institute of
Nutrition, Mahidol University, Bangkok, Thailand
Sakorn Dhanamitta, Director, Research
Center, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand
INTRODUCTION
Numerous enquiries have been received from a number of countries about the curriculum of the community nutrition training programme offered by the University of Queensland in collaboration with institutions in ASEAN countries. This is an advanced training course, leading to the Master of Community Nutrition degree awarded by the University of Queensland. The course is funded by the Australian Development Assistance Bureau and the Australian Government. Fellowships are available only for applicants from some developing countries, but candidates with fellowships from the United Nations or other agencies or from multinational corporations etc. may also be accepted.
Almost half the course consists of field work in an ASEAN country (other than the candidate's home country). The candidates are of middle-level management status or higher, i.e., with decision making responsibilities and control over some discretionary resources. Applicants must have a degree in agriculture, behavioural sciences, biology, economics, food technology, home economics, medicine, nutrition, or related areas, and relevant work experience. The course is not for training village-level workers, who are preferably trained in their own countries, nor is it a postgraduate course in dietetics, but it does examine the multidisciplinary factors that can lead to malnutrition in communities from village to national levels. The graduates of the course are expected to participate in service, training and/or research in their home countries.
In view of the wide interest that has been shown, the following outline of the Master of Community Nutrition (MCN) course is presented.
OBJECTIVES
The goal of the programme is to produce community nutritionists so that they can diagnose, alleviate, and prevent malnutrition, with the ultimate aim of maintaining adequate nutrition of people in communities from village to national levels, and to train community nutritionists so that they will be better able to handle global malnutrition problems.
At the successful completion of the course, the participants should be able to
- identify and explain the significance of the interrelation ship of the social sciences, economics, and agricultural and health sciences that are relevant to community nutrition;
- use the methodologies of these sciences;
- undertake an investigation and critical analysis of particular nutrition problems;
- undertake community diagnosis;
- plan, manage, participate in, and evaluate community nutrition programmes;
- critically observe and evaluate on-going community nutrition programmes;
- identify research needs and suggest proposals relevant to those needs;
- communicate scientific findings effectively, both orally and in writing;
- train others in the area of community nutrition.
COURSE ORGANIZATION AND PARTICIPANTS
The course consists of seven months of academic studies and a local project in Australia, and five months of field work in an ASEAN country. The whole course is planned, coordinated, implemented, examined, and evaluated by the collaborating institutions.
The collaborating institutions are
- in Australia: the University of Queensland;
- in Thailand: the Institute of Nutrition, Mahidol University, and Khon University;
- in the Philippines: the Nutrition Center of the Philippines - in association with the United Nations University - and the University of the Philippines; - in Malayasia: Universiti Kebangsaan Malaysia.
The target groups for training are
- upwardly mobile middle-management personnel who will become senior nutritionists at regional or national levels;
- non-nutrition professionals - e.g., economists, medical practitioners, agriculturalists - who will use their training to incorporate community nutrition in planning, implementation, and evaluation in regional and national programmes.
It is emphasized that the course is not for training village-level workers.
Entrance criteria are
- academic: an acceptable degree in agriculture, health, or social sciences from a recognized university;
- work experience: a minimum of two years of relevant work, preferably more;
- position: middle-management level with potential for using the training on return to the home country;
- English language proficiency: less than seven months of training needed.
The course began in 1979 in association with the ASEAN Subcommittee on Protein, with only ASEAN students. Since 1980, the Australian Development Assistance Bureau has undertaken the funding of the programme, and students have come from ASEAN, other Asian, and African
countries. Citizens of a developing country may apply for Australian Government fellowships to the MCN course through the scholarships nominating agency of their own country's government. Nominations are then forwarded through the Australian Embassy or High Commission to the University of Queensland. Applicants with fellowships from the United Nations or other agencies or with private funding may be accepted if places are available; they should write, with copies of degrees and transcripts and documentation of the fellowship offer, to the Course Director.
COURSE STRUCTURE
A. University of Queensland Components (June-December)
1. The academic programme (three days per week) covers:
- social change and development, including cultural practices, nutritional anthropology, communication; community involvement; human nutrition and associated factors, including nutritional and related disorders, recommended dietary intakes, nutrition of vulnerable groups; and family planning - with symposia on selected topics, e.g., community problems with malaria and other parasitic diseases, gastrointestinal and respiratory disease, immunization, and oral health;
- resource use, including management, supply and distribution, and costing and budget preparation; agricultural economics, tropical crops and pastures, and animal production in the tropics; food transport, storage, and spoilage; and food technology - with a workshop including conceptual modelling of village agricultural systems and the use of the "Green Revolution" game;
- community diagnosis, including collection and analysis of data relative to appropriate indicators and mechanisms for community participation; research design; and nutrition planning, implementation, and evaluation.
2. The local survey training (two days per week) consists of setting general and specific objectives in socio-economic, nutritional, and remedial areas, learning appropriate techniques and methodologies for constructing and fielding a survey, collection and analysis of data, conclusions, remedial planning, and presentation. The techniques and methodologies include biometrics, sampling, anthropometry, assessment of dietary intake and practices, cultural problems, questionnaire design, interview techniques, and nutrition education.
3. The library research project comprises a critical evaluation of current literature on an elective topic, conclusions, and potential research plans.
B. Field-Work Programme in the ASEAN Countries (Thailand, the Philippines, Malaysia)
The five-month field-work programme is designed for students to undertake field work in a country other than their home country. In the field work the students use the disciplines of health, agriculture, economics, and social sciences in which they have been trained during the previous seven months of course work at the University of Queensland, to serve the multidisciplinary approach to solving food and nutrition problems and maintaining adequate nutrition of people in the community. The students will devise the survey, collect and analyse the data to undertake community diagnosis in selected villages, identify the problem, and develop community planning in consultation with the community.
The time frame is as follows:
- first month - orientation, overview of the course, introduction and preparation for field work;
- second month - field work, including pilot field testing and three weeks for data collection;
- third and fourth months - about six weeks for data analysis and preparation of field-work reports; two weeks to expose the student to an on-going implementation programme in the country for critical evaluation;
- fifth month - completion of field-work reports in the required format.
The conclusion of the course includes an oral examination by the international examiners' committee and public presentation of the field-work reports.
The Field-Work Syllabus
1. Briefing on national nutrition policy and planning; roles of various agencies in the country. National nutrition programmes and background studies.
2. Exposure of the student to various food and nutrition programmes or activities and institutions; encouragement of critical analysis of the programmes or activities visited and discussion of those that are relevant to their own countries.
3. Introduction to field work at village level; preliminary planning of field work, including visits to the selected villages, locally available data, discussion with local authorities; work on field-work proposal to obtain conceptual framework for community assessment, objectives, methodology, and design of questionnaires, sampling, equipment, administration, staff, etc.
4. Field work: pilot testing (pre-test of the questionnaires) and standardization of the community assessment to obtain the final plan. Data collection and data analysis for community diagnosis based on close supervision for quality control and statistical requirements.
5. Identifying the problems from preliminary results of the community assessments and reporting to local authorities as well as the community with open discussion.
6. Preparation of field-work reports on community assessment and community planning according to the format required.
7. Critical observation and evaluation of an on-going nutrition programme of the country in selected villages and writing a short report evaluating the programme as implemented.
ASSESSMENT
Oral and written assignments and oral examinations will be given both in Australia and in the field to assess students' progress. Written and audio-visual presentations of group reports on field projects are required. Students must satisfy requirements in both the Australian and the ASEAN sections.
Evaluations of the course itself and its planning and coordination are made by students and staff members in all sections during the programme and at its completion.
ACKNOWLEDGEMENT
We are grateful to the Australian Development Assistance Bureau for funding the course and being agreeable to the inclusion of a staff exchange programme between the collaborating institutions and an annual planning and coordination staff meeting in an ASEAN country following the concluding student seminars and graduation. The international institutional collaboration is regarded as a very important part of the programme.
Nutrition teaching at the tropical metabolism research unit, university of the West Indies
S. J. Ismail, J. P. Landman-Bogues, and A. A. Jackson, Tropical Metabolism Research Unit, University of the West Indies, Kingston, Jamaica
M.SC. (NUTRITION) PROGRAMME
Objectives
An M.Sc. (Nutrition) course was established by the Tropical Metabolism Research Unit (TMRU) of the University of the West Indies in 1971 to provide locally trained senior-level nutritionists for the Caribbean region. Its major objective is to train science and agriculture graduates in the theoretical and practical aspects of nutrition and in the main disciplines relevant to nutrition Until recently, entrants were from the English-speaking Caribbean territories.
An association between the United Nations University (Sub-programme on Food, Nutrition, and Poverty) and the University of the West Indies began in 1981 for postgraduate training at the interface of human nutrition, food production, processing and marketing, and society. Of the first nine UNU fellows who entered the programme, three - from St. Lucia, Tanzania, and Ethiopia - enrolled in the M.Sc. (Nutrition) course. The other fellows began M.Sc. programmes in the Faculty of Agriculture (Agricultural Economics, Crop Sciences, Agriculture) and the Faculty of Engineering (Food Science and Technology, Chemical Engineering) at the Trinidad campus of UWI. A series of seminars was held to bring together students and staff from the various postgraduate programmes in order to develop an integrative approach to training and research. The UNU/UWI training programme has served to break down the barriers that exist among the more traditional disciplines and has allowed for the creation of a multidisciplinary perspective in addressing problems of development. The programme has proved an invaluable experience for the UNU fellows, their Caribbean counterparts, and the academic staff of TMRU. The presence of the African students within the M.Sc. (Nutrition) course has resulted in the broadening of the syllabus to increase the emphasis on the problems, needs, and experiences of regions other than the Caribbean. It is hoped that the UNU/UWI association will continue and that the programme will continue to attract students from outside the Caribbean region, in particular from the French- and Spanish-speaking islands of the region, from Latin America, and from Africa.
Backgrounds of Participants
All participants enter the programme with a first degree in either natural sciences or agriculture from UWI or another recognized university. In addition, many of our students come with extensive work experience in teaching, government departments, or agricultural extension offices. These students, while occasionally experiencing some difficulty with the academic aspects of the programme, in general show a level of maturity and commitment that is not always found in the younger student. Since our graduates are frequently the first nutritionists in their countries, they are often required to create nutrition departments, train assistants, advise government ministries, and stimulate awareness of nutrition problems. Such activities demand an ability to work independently and against many frustrations. TMRU, in collaboration with the Caribbean Food and Nutrition Institute (CFNI), assists regional nutritionists by offering advice and resource materials and by maintaining close links with them.
Present Positions of Graduates of Programme
In 1983, 12 years after its inception, the programme still provided the only serious teaching of nutrition in the Caribbean. It is the only source of nutritionists of a sufficiently high calibre to fill senior posts within government ministries, notably ministries of health. Over the years, many Caribbean governments have become increasingly aware of the need for nutritionists Thus Jamaica, some years ago, established the Nutrition Unit within the Ministry of Health, and four of our former students are currently employed at this unit. The programme has also supplied nutritionists to work in the Ministry of Agriculture of Jamaica, and the Ministries of Health of Barbados, Trinidad, Dominica, and Grenada. A St. Lucian student has recently completed the programme and has returned to St. Lucia to work as a senior nutritionist in the Ministry of Health.
Government nutritionists are responsible for the implementation of much of the food and nutrition policies of their countries. Because of their central role in nutrition intervention programmes, they are responsible for the teaching of nutrition to paraprofessionals and health personnel (community health aides and nurses), for food supplementation programmes, and for the monitoring and surveillance of the nutritional status of young children. They are responsible for a variety of research projects, pilot projects, and the evaluation of intervention programmes They have also been called upon to advise on food import/export policies, on agricultural policies, and on disaster preparedness.
Course Structure and Content
The M.Sc. (Nutrition) programme is a two-year course, the first year of which is devoted to formal instruction. The first year includes lectures, seminars, discussions, laboratory and field work, ward rounds, and visits to relevant institutions in Jamaica. The course is taught largely by the staff of TMRU with the valuable assistance and co-operation of other members of the Medical Faculty of UWI, the staff of CFNI, and visiting lecturers from government ministries. The year provides formal lectures in clinical and applied nutrition, physiology, metabolism, epidemiology, and statistics. Students are expected to familiarize themselves with the socio-economic backgrounds and clinical management of severely malnourished children in the TMRU ward and to follow the progress of such children closely. Case studies are assigned and regular ward rounds are conducted to achieve this end. Moreover, students are exposed to the scientific and applied research carried out by the TMRU staff.
A key feature of the course is the experience students obtain in presenting papers that are the result of their own library research, laboratory or field work, and case studies. At these oral presentations the student is subjected to open criticism and comment by the staff of TMRU. The student is judged on his ability to present a topic concisely and clearly, on his understanding of the concepts presented, as demonstrated by his ability to answer questions and criticisms, and on his selection and preparation of suitable audio-visual aids.
During the second year of the programme the student designs and implements a research project of his/her own choosing, supervised by the academic staff of the unit. A thesis is presented for examination by internal and external examiners at the end of the second year. Most of the projects are in the applied nutrition field, and this emphasis is deliberate. Such projects offer the student excellent field experience as well as provide much needed information on various aspects of nutrition in the Caribbean.
DIPLOMA IN NUTRITION
In recent years, the need has been expressed for a shorter programme to provide training in nutrition for individuals working in nutrition-related fields in health, teaching, social services, industry, and agriculture. Since October 1983, TMRU has been offering a one-year diploma programme which is identical in content and structure to the first year of the M.Sc. (Nutrition) programme except that students also carry out a small field project. The project is designed to introduce students to field work and elementary data processing. Upon successful completion of the diploma programme, the student may choose to proceed to the second year of the M.Sc. (Nutrition) programme in order to obtain the M.Sc. degree.
ASSISTANCE FROM INTERNATIONAL ORGANIZATIONS
While international organizations such as FAO, UNICEF, the UNU, WHO, and Unesco can provide assistance other than fellowships, it must be recognized that the future of the programme relies heavily on the ability of students to obtain such fellowships. Students from the developing world are not in a position to fund themselves, and, in the face of major economic problems, governments and universities are frequently unable to support their nationals. UWI, for example, has been forced to reduce dramatically the number of postgraduate awards. However, other than fellowships, the organizations could provide valuable assistance by contributions toward the costs of research projects, resource materials such as books, journals, and laboratory supplies, and the support of staff to assist in the teaching of the programme.
The cost of resource materials and the maintenance of these materials is generally higher in developing countries than in developed ones. In addition, major foreign exchange problems are faced by institutions in many countries. International organizations could assist substantially by providing grants for the purchase and maintenance of laboratory equipment that is essential for the training programme and by contributions to improve library facilities. Support for academic staff at TMRU, many of whom rely heavily on funding from grants, is an ongoing problem.
One of the major problems facing training programmes in developing countries is the relative isolation of the staff and students. It is essential for staff and students alike to visit other developing countries in order to learn from their experiences, to appreciate the nature of their problems, and to establish closer links for the exchange of ideas that is so necessary for the process of development. International organizations could assist by providing funds for field visits and by organizing seminars and workshops in developing countries that would bring together individuals involved in training and research.