Dr. Chris masila – Principal Investigator Jack onyango – Co- Principal Investigator

1. A KNOWLEDGE, ATTITUDES AND PRACTICES BASELINE STUDY OF THE NESTLE HEALTHY KIDS PROGRAM IN NYERI, MURANG’A AND MERU COUNTIES OF KENYA Dr. Chris masila–Principal Investigator Jack onyango–Co- Principal Investigator

2. Outline • Objectives of the Baseline survey • Methodology • Background • Results • Conclusions • Recommendations

3. Study Objectives • General Objective • To assess and determine nutrition knowledge levels, attitudes and dietary practices of primary school pupils in classes 1, 2, 3 and 4 in Nyeri, Murang’a and Meru primary schools. • Specific Objectives • To determine knowledge levels on nutrition among classes 1,2,3 and 4 primary school children in the three counties • To assess attitudes around nutrition among classes 1,2,3 and 4 primary school children in the three counties • To assess dietary practices among classes 1,2,3 and 4 primary school children in the three counties

4. Methodology • Design: Cross sectional • Key population: Primary school pupils in class 1,2,3 and 4 in both public and private schools within the three counties of Nyeri, Murang’a and Meru • 568 pupils participated • Structured schedules containing questions based on the HKP training modules for each class level were administered to the pupils. • Study conducted from May to August 2017 • SPSS – statistical software used for the analysis • Knowledge levels were categorized from total percentage score of each student as poor (0-40%), average (41-69%) and high (70-100%). • Ethics – authority to conduct sought from Ministry of Education however for Impact evaluation study ethics approval granted by KNH-UON Ethics Review Board based on protocol

5. Quality assurance • Some of the study sites posed communication challenges owing to low literacy levels • Risks associated with misinterpretation are inherent in consecutive translation, but a number of strategies were used to improve on accuracy • Because of the timing of this study during the Kenya General Elections there was need to modify the scope of the baseline study but this did not affect the outcome of the results • triangulating results using different techniques ensured the rigour of the analytical process.

6. Background (1/2) • Poor dietary practices are major contributors to the development of chronic non-communicable diseases (Schmidt M.I et al., 2011). • Nutrition shift in Kenya due to rapid urbanization which results in changing lifestyles and consequent changes in dietary practices • Under-nutrition is responsible for more than one-third of deaths globally (Black RE et al., 2008). • Nutrition education has been shown to ultimately impact nutrition behaviour of pupils and improve nutrition and hygiene (Vivas et al., 2010). • Environmental factors are also critical in promoting nutrition education

7. Background (2/2) • Nutrition education in schools provides the opportunity to impact the necessary knowledge that can motivate adoption of positive attitudes towards healthy eating practices and active lives. • Limited information on nutrition knowledge, attitudes and dietary practices of pupils in primary schools in Kenya.

9. Results:1. Nutrition knowledge

10. Results: Mean age and % knowledge of nutrition

17. 2. Attitudes around nutrition

18. Nutrition attitudes: class 2

19. Class 3

20. Class 4

21. 3. Nutrition practices: Dietary recall 24 hour food consumption patterns

28. Summary nutrition practices • Cereals, white tubers, vegetables, legumes, milk, fats, sweets, honey and juices were consumed more than other types of foods. • Fish, organ meat and eggs were the least consumed in all the three counties. • Fruits were averagely consumed in the three counties. • Factors: Availability and affordability of these types of foods around these counties than nutrition practices by these children and their parents.

29. conclusions: • Meru county had the highest number of class 1 and 2 pupils with high levels of nutrition knowledge compared to Nyeri and Murang’a counties. • No significant differences in nutrition knowledge levels of class 3 and 4 pupils in the three counties with majority of them showing poor nutrition knowledge levels. • Some significant differences among class 2 pupils in the three counties in terms of importance of using clean utensils for cooking and eating • Significant percentage of class 3 pupils who were not sure whether eating the right amounts of a balanced diet was important or not.

30. KEY RECOMMENDATIONS

31. Recommendations (1/2) • Emphasis on improving nutrition knowledge levels of class 3 and 4 pupils in the three counties without overlooking the differences in nutrition knowledge levels of class 1 and 2 pupils in the three counties. • Emphasis on the importance of hygiene in class 2 pupils in the three counties. • Emphasis on the importance of portion management in class 3 pupils and balanced dieting among class 4 pupils. • Capacity building of teachers and guardians on nutrition knowledge and practices and how to teach their pupils and children

32. Recommendations (1/2) • Conducting public awareness and sensitization campaigns targeting parents in the three counties on good nutrition • Emphasis on school feeding program particularly through setting up or restoring school gardens within the schools to not only make l food available to the pupils but also offer variety of different locally available foods for balanced diets. • Multi-sectoral collaboration: There is need to establish mechanisms to foster multi-sectoral collaboration among all line ministries like Ministry of Health, Ministry of Education, Ministry of Sports and Ministry of Environment to ensure the pillars of the nutrition campaign are well implemented through public education and social marketing on prevention of malnutrition right from childhood especially within captive environments like the school setting.

34. Acknowledgements • Nestle team – Kenya and regional teams • Pema Scientifics research assistants team • KNH-UON ethics board • KEMRI data analysis team • Ministry of Education and county teams in Meru, Muranga & Nyeri • All the teachers, children and pupils and guardians and stakeholders who participated in the survey

35. Thank you!