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Nutrition Training Manual Developed for Tea Communities in Uganda
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NUTRITION TRAINING MANUAL
DEVELOPED FOR TEA COMMUNITIES IN UGANDA

NUTRITION TRAINING MANUAL: Developed For Tea Communities in Uganda
Acknowledgements
This nutrition training manual has been developed by Uganda Action for Nutrition (UGAN)
and the Ethical Tea Partnership (ETP) with the financial support of the Sustainable Trade
Initiative (IDH) and Tata Global Beverages (TGB).
Authors:
Peterson Kato Kikomeko & Ndahura Nicholas Bari: Lecturers at the Department of Human
Nutrition & Home Economics, Kyambogo University, Uganda
Rukanda Grace and Nangosha Elisha: Researchers at the Uganda Action for Nutrition
Editors and technical contributors:
Heleen Bulckens, Programme Manager, Ethical Tea Partnership

Tina van den Briel, Senior Adviser, Global Alliance for Improved Nutrition
We are especially grateful to the management and workers of Mpanga Growers Tea Factory
Ltd and Rwenzori Commodities Ltd for their support to and participation in this project.
2
TABLE OF CONTENTS
Acknowledgements……………………………………………………………………..2
Document Overview…………………………………………………………………….4
Introduction………………………………………………………………………..……..4
How to use the manual………………………………………………………….……...4
MODULE 1: FOOD&NUTRITION SECURITY
Introduction……………………………………………………………………….….…..5
Objectives of the module……………………………………………………….………5
Overview………………………………………………………………………….……...5
Food and nutrition security situation on tea estates in Western Uganda………....6
1.1. Food, nutrition and nutrients……………………………………….….…7
1.2. Balanced diet and child feeding…………..…………………………….14
1.3. Food and nutrition security…………..………………………………….17
Summary module 1…………………………………………………………………….20
MODULE 2: NUTRITION & HEALTH
Introduction……………………………………………………………………….….…..22
Objectives of the module……………………………………………………….……....22
Overview………………………………………………………………………….……...22
2.1. Overview of malnutrition………………………………………………….23
2.2. Causes of under-nutrition………………………………………………...23
2.3. Form of under-nutrition…………………………………………………...24
2.4. Wider impact of under-nutrition………………………………………….31
2.5. Family and community prevention of under-nutrition………………….31
2.6. Tips for optimal infant and young child feeding………………………..32
2.7. Nutrition during pregnancy & breastfeeding……………………………35
2.8. Disease prevention & sanitation and hygiene………………………....35
Summary module 2……………………………………………………………………..38
MODULE 3: FOOD SAFETY, STORAGE & PRESERVATION
Introduction……………………………………………………………………….….…..40
Objectives of the module……………………………………………………….……....40
Overview………………………………………………………………………….……...40
3.1. The concept of food safety and hygiene…..……………………………41
3.2. Food storage and preservation…………………………………………..45
3.3. Food poisoning…………………………………………………………….48
Summary module 3……………………………………………………………………..50
3
Document Overview
Introduction
This manual has been produced to support Mpanga and Rwenzori employees in providing
nutrition training to workers and their families who live in housing provided by the tea
estates. Potential users of this manual are: field managers / officers, welfare officers, nurses,
doctors, labour line leaders, or anyone else with an interest in this area. The authors have
presented the information in an accessible way so that not much background knowledge on
nutrition is required before undertaking training delivery.
The manual was developed with the clear intention of improving the food and nutrition
security – and ultimately the health - of the Mpanga and Rwenzori tea workers and their
families. It aims to complement the kitchen garden programme that is being rolled out in the
labour lines of Mpanga and Rwenzori, also with the support of ETP, IDH and TGB.
In order to establish the current nutritional status of the workers, a nutrition baseline
assessment was carried out by UGAN in May 2014. The manual describes the key results of
this study and provides information on how the food and nutrition security of the workers can
be improved through a more varied diet, the consideration of wider health/food issues such
as food hygiene, disease prevention, as well as food storage and food preservation.
This is a freely available resource and we would like to encourage other tea producers to
use it – in addition to other user groups such as schools, nurses, church groups, etc.
How to use the manual
The manual has been divided into 3 modules so as to allow for 3 separate sessions to take
place and not overload workers with too much information in one go. The modules cover:
Module 1: Food &Nutrition Security
Module 2: Nutrition & Health
Module 3: Food Safety, Storage & Preservation
When workers were interviewed as part of the baseline survey the majority of them made it
clear that they would prefer to receive short but frequent training sessions, ideally on the
weekend, rather than one long training session over a whole day or two consecutive days.
The manual was developed for the trainers, not for distribution amongst the workers. When
workers and/or their family members attend the sessions, they should be given the 1-page
hand-outs which were developed for each of the modules. These hand-outs give a short
summary of what was covered during the sessions. In addition, the poster developed by the
ETP and UGAN should be used during the training and can be hung at strategic places
around the estates where they are visible to many workers (e.g. on the wall of the
dispensaries).
4
MODULE 1: FOOD & NUTRITION SECURITY
Introduction
We all need food. It allows us to be alive, to grow and be active and in the case of women, it
can sustain the growth of a baby. What we eat (our diet) has the power to keep or make us
and our children healthy and give us a better life.
In the context of tea production, which is very labour-intense, it is important to point out that
the diet of the workers will impact not only on their health – and thus their ability to function
physically and mentally – but also on their labour productivity.
This module covers: the definition of nutrition, the role of nutrients in our body, the food
sources of these nutrients, the importance of adequate feeding, the concepts of ‘a balanced
diet’ and ‘food and nutrition security.’ The module starts by outlining the current food and
nutrition security situation in the tea estates of Rwenzori and Mpanga as was observed
during the nutrition baseline study carried out by UGAN in May 2014.
Objectives of the module
After having completed this module, participants should be able to:
 Differentiate between food, nutrients and nutrition

 Understand the classification of food into different food groups
 Name the nutrients and discuss their importance in the body
 List the primary food sources for each of the nutrients
 Understand what constitutes an adequate diet and optimal feeding to children
 Understand what is food and nutrition security and how it can be achieved
Overview
Part 1: Food, Nutrition and Nutrients
Part 2: Balanced Diet and Child Feeding
Part 3: Food and Nutrition Security
5
Food and nutrition security situation on tea estates in Western

Uganda
In May 2014 UGAN interviewed 125 workers from 3 estates in Western Uganda (as part of
the baseline survey) and found that most tea workers and their families did not achieve food
and nutrition security. The diets consumed by the workers were not diverse: most
households ate only 3 out of 15 food groups. People mostly ate legumes (beans), cereals
(maize, rice, millet) and tubers (sweet potatoes, cassava and Irish potatoes). There was very
little consumption of other vegetables, fruits, fats and foods of animal origin (such as meat,
fish, poultry and milk). The predominant diets were found to be nutritionally inadequate for
workers.
Different factors were found to influence the foods chosen by the workers, including: income,
food prices, types of food available, individual food preferences, cultural background and
land availability. The fact that estate policies do not allow estate workers to domesticate
birds and animals was also found to have a direct effect on the food and nutrition security of
the workers. If they were given the chance to rear fowls and animals then these could act as
affordable/cheap sources of animal protein for individual households.
With regards to food access; the majority of households purchased their food and very few
workers grew (at least some of) their own food. Several factors influenced the purchase of
foods, including: respondents’ financial resources, food prices, availability of transport to and
from the market, availability of food in the market and distance from the market. Workers
who did grow some crops mostly grew tubers/roots, legumes and nuts. Only a small
percentage of workers also grew cereals, vegetables and fruits.
Factors that were mentioned as affecting crop production included: limited access to land,
climate, the time it takes to grow food, soil fertility and lack of confidence in the yield that
would be produced. When unable to access adequate food supplies, the majority of workers
said that they coped by borrowing food from friends/neighbours. Other coping measures
included: getting food on credit, eating less or going hungry and eating any available foods.
6
1.1. FOOD, NUTRITION AND NUTRIENTS
We often hear the terms food, nutrition and nutrients. Health workers advise us to have a
diverse and nutrient-rich diet if we are to be healthy. But what are nutrients and what is
nutrition?
Food
Food is defined as any substance containing nutrients (such as carbohydrates, proteins, and
fats) that can be ingested by a living organism and metabolized into energy and body tissue.
In essence, food stimulates growth, helps us to stay alive and produces energy.
Nutrients
Nutrients are the chemical substances found in food. They are extracted from food as it
passes through our digestive system and are used by the body to perform its functions.
Nutrients contained in food are needed in the right amounts and combinations for the body
to function properly.
Nutrients are divided into two broad categories: MACRO nutrients and MICRO nutrients.
 Macronutrients are required by the body in large amounts; they include

carbohydrates, proteins and fat.
 Micronutrients are required in relatively smaller amounts by the body; they include
vitamins and minerals.
The body needs a mixture of both macro and micro nutrients for it to be
healthy and function optimally. We access these nutrients through
eating food.
Nutrition
The term ‘nutrition’ broadly covers all processes through which we obtain, prepare and eat
food. It further describes what different foods are made of (i.e. nutrients) and the processes
through which our bodies make use of the nutrients to enable us to perform daily activities
such as work.
Apart from focussing on what we should eat, nutrition is also concerned with promoting
aspects of personal and environmental hygiene and sanitation, promoting health
seeking behaviours and providing care for all household members so that they are
healthy.
Classification of foodson the basis of the key nutrients they supply

Different foods can be grouped into different groups depending on the major nutrients they
provide. According to this classification there are:
 Energy giving foods/GO foods

 Body building foods/GROW foods
 Protective foods/GLOW foods
 Water (sits outside of the classification but is mentioned here as it is also essential
for the human body to function properly)
7
Most foods provide more than one nutrient. Many energy giving foods are also sources of
proteins and micronutrients, while many body building foods also provide energy and
micronutrients.
ENERGY GIVING FOODSOR GO FOODS
Energy giving foods provide the energy needed by our bodies to:
 Perform activities such as walking, digging, working

 Maintain normal physiological processes such as breathing and all other processes
within our bodies
Energy giving foods are mainly rich in the food nutrients carbohydrates or fats.
We obtain carbohydrates through eating plant-based foods. The main examples of

carbohydrate containing foods include: millet, Irish potatoes, sweet potatoes, cassava,
posho (made from maize or other flour), sorghum, yams, rice, plantain (matooke) and bread.
Fats and oils are usually solid, semi-solids or liquid depending on their chemical
composition and environmental temperatures. Examples of fats and oils commonly
consumed in our diets include liquid oils (sunflower oil, mukwano oil), ghee, suet (fat
normally found on kidney and meat of cattle and sheep).
Apart from being good sources of energy, fats and oils also add flavour and taste to food.
They further insulate the body, cushion vital organs and are essential for the absorption
and utilisation of fat-soluble vitamins A, D, E and K. Thus, a very low consumption of
fats and oils may lead to a deficiency of these vitamins predisposing our bodies to diseases
and/or symptoms associated with a lack of these vitamins. The benefits of vitamins will be
discussed later in this session.
When a person consumes excessive amounts of energy giving foods and doesn’t utilise this
energy through physical activity, this results in surplus energy being converted and stored by
the body as excess fat. This puts affected individuals at risk of developing coronary heart
disease, high blood pressure and certain types of cancers.
The baseline assessment revealed that tea estate workers and their families
eat very little fats and oils. If they were to eat more fats and oils, they might
have more energy and, in combination with eating foods rich in certain vitamins,
their bodies would absorb these vitamins better.
8
BODY BUILDING FOODS OR GROW FOODS
Body building foods or GROW foods are those rich in

the food nutrients called proteins. They are essential
for growth, boosting body immunity against infections
and diseases, the formation of all tissues, including
muscles, bones, teeth, skin and nails and for wound
repair.
Bodybuilding foods come from two major sources:
1. Animal-based foods and related products: fish, meat, poultry, eggs, milk and
yoghurt.
2. Plant-based foods and related products: mainly beans (incl soy beans) and peas
Animal-based foods provide a richer source of proteins that are more easily utilised by the
body than those supplied by plant-based foods. We can increase household intake of
animal-based proteins by domesticating certain animals and birds. The birds (hens, ducks)
can be eaten but also lay eggs, which are a rich source of proteins. Animals like rabbits are
also relatively easy to rear: they do not require much space to be kept, are not too
demanding in as far as feeding is concerned and have high multiplication rates.
The quality of proteins from plant-based foods can be improved by eating a combination of
different such foods, e.g. rice and beans. The proteins missing in beans are present in rice
so when these are eaten in combination one can also obtain a good supply of proteins for
the body. It is therefore important to eat a mixture of plant-based foods in our diets
and even more so if access to animal-based foods is limited.
We have different protein requirements at different ages: children require more protein-rich
foods than adults because they are growing. Pregnant women should also eat plenty of
protein-rich foods because they need to feed themselves as well as their growing baby. The
same is true for lactating / breastfeeding mothers whose bodies need to be able to produce
breast milk.
9
Examples of locally available plant-based foods rich in proteins:
Ground nuts Simsim (Sesame) Soy (soya) Beans

seeds
Examples of locally available animal-based foods rich in proteins:

 Meat, fish, eggs, milk and milk products including yoghurt and fermented milk
 Others include edible insects such as grasshoppers (nsenene) and white ants
(enswa)
Chicken
Beef Fish
Eggs White ants Grasshoppers
10
PROTECTIVE FOODS OR GLOW FOODS
Protective or GLOW foods include vegetables and fruits. These foods are rich in vitamins
and minerals which are required by the body for physiological functions such as the
strengthening of the immune/defence system and to prevent conditions such as anaemia
(resulting from iron deficiency), night blindness (resulting from Vitamin A deficiency), goitre
(resulting from iodine deficiency) and rickets (resulting from a lack of Vitamin D and
calcium). Some vitamins and minerals are also essential for the production of energy by the
body and maintaining water balance in the body.
Vegetables
Vegetables are a rich source of several vitamins and minerals. In addition, vegetables add
taste, flavour and colour to our meals. Common vegetables include: amaranthus (dodo),
spinach, kale (sukumawiki), pumpkin leaves, cowpea leaves, carrots, cassava leaves, green
pepper, nnakati, malakwang,eboo.
Amaranthus (ddodo) Spinach Cabbage Carrots
Fruits
A variety of fruits are grown and are accessible in the markets of Western Uganda, including
avocados, mangoes, pawpaws, pumpkin, passion fruit, pineapple, jackfruit, oranges, lemons
and other citrus fruits. The deep yellow or orange coloured fruits are richer in vitamins,
particularly vitamin A.
Pineapple Orange Passion fruit Mango
11
Table 1: Examples of vitamins and minerals, their functions and food sources
Nutrient Function Food sources

Vitamin A Strengthens our immunity which helps Dark green leafy vegetables such as
us fight off infections spinach, broccoli and carrots. But also:
Improves vision in dim light pumpkin, liver, fish, kidney and dairy
Keeps the skin and the linings of some produce such as yoghurt, eggs, fortified
parts of the body, such as the nose, margarine
healthy
Vitamin D Helps the body absorb calcium Sun light, fish liver oils, milk, fortified
Keeps bones and teeth healthy margarine, eggs, liver
Vitamin E Helps maintain cell structure Soya, groundnuts, fortified margarine or
by protecting cell membranes oil, wholegrain cereals, eggs, peanut
butter, tomatoes
Vitamin K Helps with blood clotting Vegetables such as spinach, lettuce,
cauliflower, and cabbage, broccoli, fish,
liver, meat, eggs
B-group Help the body release energy from Millet, sorghum, beans, peas, eggs, liver,
Vitamins food meat, milk, fresh fruit, green leafy
Keep the skin, eyes and the nervous vegetables, wholegrain cereals
system healthy
Vitamin C Helps with wound healing Citrus fruits such as oranges, lemons and
Strengthens our immunity which helps tangerines, red and green peppers,
us fight off infections tomatoes, broccoli, potatoes
Folic acid Helps form healthy red blood cells Leafy green vegetables such as spinach,
Helps reduce the risk of central broccoli, and lettuce, liver, beans, peas,
nervous system defects such as spina fruits such as oranges, bananas,
bifida in unborn babies avocados and melons
Iron Helps make red blood cells, which Liver, meat, offal, beans, millet, sorghum,
carry oxygen around the body ground nuts, eggs, most dark green leafy
vegetables such as amaranthus and
parsley
Calcium Helps build strong bones and teeth Milk, cheese and other dairy foods, green
Helps muscles and nerves function leafy vegetables, such as cabbage and
normally okra
Helps to ensure blood clots normally
Iodine Helps to regulate the thyroid gland (in Iodized salt, sea food
the neck) which controls the
development of the body, including the
brain, and regulates physiological
processes (or metabolism).
Vegetables and fruits are a major source of vitamins and minerals

which are required by our brain, eyes, muscles, bones, blood, glands,
to perform all the functions for which they are designed
12
Key vitamins and minerals for children and pregnant/breastfeeding women:
 Iron: Iron deficiency is a major cause of anaemia and impairs the child’s/baby’s
cognitive and physical development
 Iodine: Iodine deficiency is the greatest single cause of mental retardation and brain
damage
 Vitamin A: Vitamin A deficiency causes early childhood blindness and increases the
severity of infections and anaemia, in both children and pregnant/breastfeeding
women.
 Zinc: Zinc deficiency affects children’s health and physical growth; it is also essential
for mothers during pregnancy.
WATER
Water is essential for the human body to function properly. As the body cannot store water, it
requires fresh supplies of safe, clean water every day. The amount a person needs to drink
depends on a variety of factors such as environmental temperature and activity level. E.g. if
you work hard in hot weather you may need to drink more. All drinks such as tea, coffee,
fruit juice count towards the recommended daily total of at least 8 cups a day (for an adult).
The body requires water for many reasons:
 To transport nutrients around the body

 To make blood, saliva, tears and sweat
 To enable body processes such as digestion
 To keep the mouth and lungs moist, and to keep the skin moist
and cool
 To produce breast milk, which is also a source of water for
breastfeeding children
13
1.2. BALANCED DIET AND CHILD FEEDING
In part 1, we looked at ‘what’ our bodies need to be healthy. Here we will look at ‘how much’
we need of each of the foods – this is being referred to as ‘adequate nutrition’. A diet that is
able to provide all the recommended (adequate) amounts of nutrients in the right amounts
and quality for the body to perform all its physical and physiological activities depending on
one’s age, sex and physical activity level is called a ‘balanced diet’.
This implies that all the main food types (carbohydrates, fats, proteins, vitamins, minerals,
and water) are eaten in correct proportions throughout the daily life of an individual.
Balanced diets benefit individuals, families, communities and the nation at large. It is
especially important for the following categories of people to have a balanced diet:
Pregnant women
 Their food intake will need to support themselves as well as their growing foetus
 Pregnant women will therefore need more nutrients than non-pregnant women
 The foetus/baby (inside the woman’s womb) needs a wide variety of nutrients in
order to grow well and be physically and mentally healthy, e.g. folic acid and iron
Breastfeeding/lactating women
 Lactating mothers need enough nutrients so that they have enough energy to go
about their daily lives as well as produce breast milk
 Maternal nutrition has only a minor effect on the composition and quantity of breast
milk produced. Unless a mother is severely malnourished, her milk will be fine
 Mothers whose diets are poor deplete their own energy levels, and may become
anaemic, but their bodies will continue to produce the milk their baby needs by
pulling from the mother’s energy stores (at her expense but not her baby’s expense)
Babies (up to 6 months)

 They need to be breastfed. Breast milk contains all the nutrients a baby needs
Children
 They are growing and developing (physically and mentally) and therefore have extra
nutritional needs to be able to do so
 They are meant to gain body weight and height. If children are under-nourished they
risk ‘wasting’ or being ‘stunted’
 The first 1,000 days in a child’s life (starts at conception and until 2 years of age) are
crucial. Any damage to their growth (physically and mentally) in these 1,000 days
through a lack of nutrients is irreversible
 A child with an adequate diet has a stronger immune system (than an under-
nourished child) and this helps him/her fight off illnesses
People with chronic (long-term) illnesses (e.g. HIV/AIDS)

 They will better respond to treatment
 Adequate nutrition will affect the immune system and help them fight off other
diseases
The key to a balanced diet is to consume a variety of foods in

their right amounts
14
Generally speaking, in order to maintain/attain a balanced diet, we should eat:
 Starchy foods, such as millet, rice, potatoes, cassava, matooke. Starchy foods
should make up around one third of everything we eat
 Fruits and vegetables. They are a vital source of vitamins and minerals. We should
try to eat a variety of fruit and vegetables each day, ideally 5 portions in total (e.g. 3
types of vegetables and 2 fruits)
 Meat, fish, eggs, beans, nuts and seeds. These foods are all good sources of
protein, vitamins and minerals
 Milk and dairy foods: Milk and dairy foods such as fortified yoghurt are good
sources of protein, vitamins A, D, and B group vitamins and the mineral calcium
 Moderate amount of food high in fat and/or sugar. Fats and sugar
are both sources of energy for the body. In addition, fats help transport fat soluble
vitamins. Health recommendations stipulate a modest intake of fat and sugar. An
excess of these foods can lead to being overweight or obese as well as the
development of other diseases like diabetes and heart disease. Given the high
energy requirements for estate tea workers, restrictions on fat and sugar intake are
likely to be unnecessary.
As shown in the pyramid below, it is important to eat a variety of foods. As a general rule, we
should consume less of the foods that are in the tip of the pyramid and more of the foods
that are lower down. For a healthy diet, a minimum of 5 food groups have to be eaten
every day.
15
Table 2 : Common myths and facts about a balanced diet / adequate nutrition
Myths Fact
Adequate nutrition Adequate nutrition is eating all the three main food types (energy giving
means eating foods, body building foods and protective foods) in correct proportions.
chicken, fish and Your diet does not have to be expensive for it to be healthy.
meat. This is
expensive and Plant-based protein sources such as beans, peas, and groundnuts are
therefore fairly affordable and can be grown in the backyard.
unaffordable.
Silver fish (mukene) is rich in proteins and relatively cheap. Beef and
chicken are not the only sources of protein.
Household domestication of chickens, rabbits or goats can enable a family

to afford animal-based proteins.
Fruits are eaten by Fruits and vegetables should be eaten by all, irrespective of age, sex and
children and poor income category. They are a good source of vitamins and minerals which
people only are essential for our bodies to perform their functions.
One day sample menu for an adult (3000 kcal)
The number of meals (a meal is a selection of foods prepared and served in a single serving
as breakfast, lunch, or supper) an individual should eat in a day varies with age, sex,
physiological status, and physical activity level. Children eat smaller food portions because
their stomachs are smaller and so require more frequent feeding compared to adults. While
adults can do with three meals a day, children below five years need five meals a day
because of their increased nutrient requirements for growth and development.
Table 3: One day sample menu for an adult
Breakfast Lunch Supper

Maize meal Bean/peas/fish/meat stew Groundnut/bean/peas/fish/mea
porridge with milk (2 handfuls) with a teaspoon of ghee t stew
and sugar (2 handfuls)
(1 cup/250ml) Millet bread and cassava / matooke /
sweet potatoes/ yams / Irish potatoes / Matooke and sweet potatoes /
2 slices of bread rice / maize (2/4 of the plate) yams / Irish potatoes / rice /
maize (1/4 of the plate)
Yellow banana Amaranthus (dodo) / cassava leaves /
cabbage / spinach / Cabbage / cassava leaves /
Tea (1 cup) avocado(1 handful / 90g) cabbage / spinach /
avocado(1 handful / 90g)
A slice of mango/banana / pawpaw / jack
fruit Fresh (passion) juice
(1 glass)
Boiled water
(1 glass)
16
1.3. FOOD AND NUTRITION SECURITY
At the start of the module we defined the terms ‘food’ and ‘nutrition’ and further highlighted
how these relate to our health. This session adds the term ‘security’ to food and nutrition and
explains the inter-relationship and difference between food security and nutrition security.
We also observed in the introduction that tea estate workers were not food and nutrient
secure as they did not eat adequately (only 3 out of 15 food groups).
What is food security?
When food security is achieved this means that: “Each person has (physical and
economic) access at all times to sufficient, safe and nutritious food that meets their
dietary needs and food preferences for an active and healthy life.”
In other words, to be ‘food secure’ at individual, household, village, or community level, food
should be:
Available: refers to the physical presence of food, be it from own production or from the
market or shops
Accessible: refers to households and all individuals within those households having
sufficient resources such as money, labour, time and knowledge to obtain appropriate foods
for a nutritious diet
Utilizable: Individuals should be able to eat and absorb in their bodies the available and
accessible food. There should be no diseases or ailments like diarrhoea, malaria, worm
infestation that limit individuals from benefiting from the eaten food
Sustainable: Individuals should feel confident that they will have enough food to feed their
family tomorrow, the next week, month and year. Food should therefore be available,
accessible and utilizable at all times
What is nutrition security?
Sustainable access to food does not necessarily mean that all household or community
members will be healthy. There are other factors in addition to food security that help ensure
the achievement of individual, household and community health:
 There is a need to provide adequate care for the young, the sick, the elderly, the
physically handicapped and all other household members. Care can mean ensuring
that all individuals have eaten according to their needs, that those who are sick are
treated, and that women are supported to exclusively breastfeed their children for the
first 6 months
 There is also the need to adequately prevent and control diseases so that foods
eaten can be used by our bodies. This necessitates having measures in place which
prevent, control and treat any diseases. Such measures can include: maintaining
environmental hygiene and sanitation, taking children for immunisation, attending
antenatal clinics by pregnant mothers, seeking medical treatment for any infections,
deworming children and all other household members.
17
From the above, we observe that three conditions must be fulfilled if all individuals are to be
healthy: food security, adequate care and adequate prevention and control of
diseases. It is only when these conditions are fulfilled that a household or community can be
nutrient secure.
Nutrient security is more than food security. Individuals, households and
communities can only attain good health and nutrition if the three conditions
of nutrient security; food security, adequate care, and adequate prevention
and control of diseases are achieved.
How can food and nutrition security be improved on the tea estates?
In order to achieve food and nutrition security among tea estate workers, the underlying
factors holding individuals back from accessing and utilising food, providing care for
household members and seeking treatment for all ailments would need to be addressed.
The challenges will need to be addressed at different levels; at household level as well as at
estate management level.
Actions that can be taken by the workers / households:

 Development of household and community gardens so that a wide variety of fruits
and vegetables can be grown. The following nutritious foods can be grown: beans,
peas, ground nuts and various kinds of green leafy vegetables such as amaranthus
(dodo), spinach, kale (sukuma wiki), cabbages, as well as red/orange/yellow
coloured vegetables such as chilli peppers (habanero), carrots, tomatoes. Fruit trees
can be planted and yield lemons, oranges, mangoes, avocadoes, pineapples,
passion fruit, etc.
 Constructing food stores such as granaries to preserve surplus food and provide
food in times of scarcity
 Household domestication of birds and animals (rabbits, cows, goats, chicken, ducks,
etc.) can provide milk, ghee, meat and increase household income through selling
some of the products
 Preserving and basic processing of food, through methods such as solar drying or
fermentation which can improve the nutrient content of some foods and increase the
availability of seasonal foods (e.g. mangoes, tomatoes, cabbage)
 Practicing exclusive breastfeeding for children below 6 months and giving those 6-24
months nutrient-rich foods 4-5 times a day, in addition to breast feeding
Actions that can be taken by the estate management:

 Allowing workers to grow food in the labour lines and possibly, on other idle land on
the estate (e.g. on some estates in India, workers are allowed to grow rice)
 Using idle estate land for growing fruit trees, e.g. citrus fruits (rich in Vitamin C),
avocadoes or mangoes and distributing this among the workers
 Allowing workers to construct food stores and/or develop communal food storage
facilities
 Allowing the workers to keep livestock in a way that is manageable for the estate (it
works in other countries like India where estate workers have cows and chickens). It
would enable relatively cheap access to animal-based proteins
 Better equipped health facilities and more health-focused campaigns / sensitisation
among the workers, e.g. on breast feeding and child feeding
 Arranging transport to local markets
18
 Buying food products in bulk and selling it on to the workers who will then benefit
from economies of scale (e.g. cooking oil, rice, fruits, …)
 Providing nutrition, cooking and food preservation lessons
 Promoting economic activities through which households can obtain extra income
that can then be used to purchase food
How to ensure adequate care for all household members

 Effectively using the available resources to ensure that food is available to all
household members
 Attending to all household members who are sick
 Nurturing the physical and social development of children (e.g. allowing children to
play and socialise)
 Promoting general family happiness where all members can freely interact and eat
food as a family (i.e. controlling violence in a household and/or community)
How to prevent and control diseases

 Promoting individual, household and community hygiene
 Ensuring that all children are immunised according to recommended health
schedules
 Effective treatment of infections, e.g. diarrhoea, malaria, worm infestations, etc.
 Improving health seeking behaviours such as women seeking antenatal care during
pregnancy, women giving birth at health facilities, individuals going for regular
medical checkups and seeking early treatment for illnesses
19
SUMMARY MODULE 1: FOOD&NUTRITION SECURITY
We need a BALANCED DIET to stay healthy. Children also need it to grow well, both
physically and mentally. Eating a diverse diet means eating many different foods each day
so that we consume lots of different nutrients. These nutrients keep us healthy in different
ways: e.g. iron helps the body make red bloods cells (which carry around oxygen and
therefore give us energy), vitamin C helps fight off illnesses and protein is the body's
primary building block for muscles, bones, skin and hair. Most foods provide more than one
nutrient. We need to eat all of the following in the right amounts:
TYPES OF FOODS THAT CONTAIN THESE BENEFITS OF THESE
NUTRIENTS NUTRIENTS NUTRIENTS
PROTEINS Animal-based: fish, meat (includes poultry), BUILD AND REPAIR OUR
eggs, milk, yoghurt, grasshoppers (nsenene) BODIES
and white ants (enswa)
Plant-based: beans (include soy beans)

peas, nuts, seeds
CARBO- Millet, Irish potatoes, sweet potatoes, cassava, GIVE US ENERGY

HYDRATES posho, sorghum, yams, rice, plantain (matooke)
and bread
FATS Sunflower oil, Mukwano oil GIVE US ENERGY

ghee, suet
VITAMINS & FRUITS: mango, orange, pineapple, avocado PROTECT AGAINST ILLNESS
MINERALS VEGETABLES: amaranthus (dodo), spinach, HELP PRODUCE ENERGY

kale (sukumawiki), pumpkin leaves, cowpea
leaves, carrots, cassava leaves, green pepper, MAINTAIN WATER BALANCE
nnakati, malakwang,eboo, green beans, tomato,
sweet potato
CLEAN WATER and other drinks HYDRATION
Nutritious diets do not have to be expensive; key is to consume a variety of locally

available/grown food on a daily basis.
20
It is especially important for the following categories of people to have a balanced diet:
 Pregnant and breastfeeding/lactating women
 Babies (up to 6 months)
 Children
 People with chronic (long-term) illnesses (e.g. HIV/AIDS)
Key vitamins and minerals for children and pregnant/breastfeeding women:

 Iron: Helps make red blood cells, which carry oxygen around the body. Iron
deficiency is a major cause of anaemia and impairs a child’s cognitive and physical
development
 Iodine: Helps to regulate the thyroid gland (in the neck) which controls the
development of the body, including the brain, and regulates physiological
processes (or metabolism). Iodine deficiency is the greatest single cause of mental
retardation and brain damage
 Vitamin A: Strengthens our immunity which helps us fight off infections. Improves
vision in dim light. Keeps the skin and the linings of some parts of the body
healthy. Vitamin A deficiency causes early childhood blindness and increases the
severity of infections and anaemia, in both children and pregnant/breastfeeding
women
 Zinc: Supports the immune system, promotes healthy growth during childhood,
and heals wounds. Zinc deficiency affects children’s health and physical growth.
The food pyramid: All of these types of food should be eaten but the foods at the bottom
should be eaten most and those at the top more sparingly.For a healthy diet, a minimum
of 5 food groups need to be eaten every day.
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MODULE 2: NUTRITION & HEALTH
Introduction
When workers were interviewed as part of the baseline survey, they were only able to
describe a limited number of signs and symptoms of malnutrition. This poses a risk to the
timely identification of malnutrition in the community setting. To address this, this module
explains the different forms of malnutrition, how it can be identified and what the main
nutrient deficiencies are - which gives us an insight into the prevention of malnutrition.
This module therefore explores the link between nutrition and health for the most vulnerable
groups in society: (young) children, pregnant women, and the sick. It explains how to care
for young children and what the special nutritional needs are of pregnant women. The final
section looks at how optimal nutrition and attention to sanitation and hygiene can help
prevent diseases.
The baseline survey revealed that there is clearly scope to prevent diseases better in the tea
estates covered by the study. For example, around 40% of those interviewed did not boil
water before consuming it with most of them believing that un-boiled water is clean. At the
same time, it was found that 19% respondents had a household member who had suffered
from diarrhoea in the month preceding the survey. In order to control worm infestation, 88%
of the respondents routinely had their children de-wormed. In addition, 81% of respondents
had a household member suffering from malaria.
After having completed this module, participants should be able to:

1. Describe the causes and dangers of under-nutrition
2. Describe how to care for under-nourished children
3. Explain how to prevent under-nutrition and diseases
4. Pass on recommended infant and young child feeding practices
5. Support the community to implement hygiene and sanitation practices
Overview
1. Overview of malnutrition
2. Causes of under-nutrition
3. Forms of under-nutrition
4. Wider impact of under-nutrition
5. Family and community prevention of under-nutrition
6. Tips for optimal infant and young child feeding
7. Nutrition during pregnancy & breastfeeding
8. Disease prevention & sanitation and hygiene
22
2.1. OVERVIEW OF MALNUTRITION

The term ‘malnutrition’ refers to two conditions: under-nutrition or over-nutrition. Over-
nutrition is a condition that results from eating food in excess of body requirements. In such
circumstances, individuals tend to become overweight or obese. Under-nutrition results from
not eating enough to supply the body with all the required food nutrients. In this situation,
affected individuals lose weight, frequently fall sick and become deficient of some macro-
and micronutrients. In children, physical growth and mental development can be severely
affected. Here the main focus will be on under-nutrition given that it is the bigger challenge in
our communities.
2.2. CAUSES OF UNDER-NUTRITION

Many factors can cause under-nutrition as summarized below. Most of these relate to eating
diets low in nutrients, severe and repeated infections, not feeding children as recommended,
poor household and environmental hygiene, failure to treat household members on time and
failure to care and attend to all household members. Some of these factors are in turn
related to low understanding of how we should feed, poverty, and the lack of food at
household level (household food insecurity).
MALNOURISHED
CHILD
Inadequate Frequent
diet illness
Inadequate Poor access to

Household food
maternal and health care and
insecurity
childcare healthy
environment
Livelihoods Culture, education,

awareness
Policies
Financing
Policy and leadership

commitment to
improved nutrition
23
2.3. FORMS OF UNDER-NUTRITION

Under-nutrition manifests itself in 4 different forms:
 Acute under-nutrition or thinness
 Underweight
 Stunting
 Micronutrient deficiencies
1. Acute under-nutrition
Acute under-nutrition is a condition characterized by weight loss, wasting, and in very severe
cases the swelling of both feet with fluids (bilateral pitting edema). It is called acute because
its causes may be sudden and individuals develop related signs within a few days. In most
cases the child is already under-nourished/underweight and if it then suddenly gets sick with
fever and diarrhoea, the condition may become ‘acute.’
Health workers further differentiate between two forms of severe acute malnutrition:
marasmus (non-edematous malnutrition) and kwashiorkor (edematous malnutrition). The
relationship between under-nutrition and external factors can be seen in the following figure:
Inadequate
Poor hygiene knowledge Low food
and sanitation production
Sickness
Gender/Status
UNDER- Lack of
NUTRITION variety of
foods
Absent
parents
Cultural and
social
Poverty practices
24
Figure 2.1: Common Causes of Malnutrition in Communities
25
Box 2: Kwashiorkor/oedematous malnutrition
Kwashiorkor normally happens in Common Signs and Symptoms of Kwashiorkor

children between 6 months and 3 - Swelling (pitting oedema) of feet, hands and face
years. This condition is usually seen
in children who have stopped breast - Thin/ reddish hair which can be pulled out easily
feeding and are mainly fed on
energy-giving foods with minimal - The child’s muscles are weak and wasted,
protein content. especially in the upper arms, thighs and the neck
- Child has no interest in their surroundings
- Skin loses colour and becomes lighter, peels off and

develops sores
- Children develop pot bellies
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2. Underweight
An individual is underweight when he/she has low weight

compared to the average weight of healthy individuals of
the same age and sex. It may develop slowly
or suddenly depending on the cause of malnutrition.
Underweight children can be identified easily if their age

is known. Parents/carers who are worried about their
child’s weight or growth are advised to visit a health
centre on a monthly basis so that health workers can
monitor the child’s weight.
3. Stunting
Stunting is a form of under-nutrition where a person is too short for his/her age compared to
other healthy individuals of the same age and sex (< -2 standard deviations below the
growth reference). It may be as a result of long term inadequate food intake, frequent
illnesses, inappropriate feeding practices and/or poor absorption of nutrients in the body.
This condition reflects growth failure and is irreversible if not addressed within the first two
years of the child’s life. In some communities more than half of the children may be stunted.
This makes it difficult for people to recognize this as a problem. However, the consequences
of stunting are very serious: they affect the child’s mental and physical development, will
lead to poorer results in school and a lower income-earning capacity later on in life.
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4. Micronutrient deficiencies
As covered in module 1, vitamins and minerals, also known as micronutrients, are a critical
component of good nutrition. In particular, folate (vitamin B9), iodine, iron, vitamin A, zinc,
and other B vitamins including thiamine (vitamin B1), riboflavin (vitamin B2), niacin (B3),
cobalamin (vitamin B12) and pyridoxine (vitamin B6) are important for healthy and
productive populations.
Without them, babies may be born with birth defects (because of their mothers’ deficiencies),
children can develop blindness and an inability to learn properly, among other long-term
disabilities. Each year, more than one million children under five die from vitamin A and zinc
deficiencies around the world. Vitamin and mineral deficiencies affect up to two billion
people.
Prolonged failure by individuals to eat foods rich in vitamins and minerals may lead to the
development of vitamin and mineral deficiency disorders. Manifestations of vitamin and
mineral deficiencies take long to develop and individuals may not realize that they are
affected. By the time signs are seen, the conditions are in advanced stages; for this reason,
vitamin and mineral deficiencies are also referred to as hidden or silent hunger. In order to
combat some of these deficiencies, children are given vitamin A supplements, women are
given iron/folic acid supplements when pregnant and people are advised to use iodized salt
in food preparation.
Micronutrient deficiencies that constitute a public health concern in Uganda:
a) Vitamin A deficiency
The body’s immune system needs vitamin A in small amounts to help fight infections.
Vitamin A is also important for proper growth and reproduction. Insufficient vitamin A impairs
vision. Vitamin A deficiency is the leading cause of blindness in children. Globally, an
estimated 250,000 to 500,000 vitamin A-deficient children become blind every year. Half of
these children die within a year of becoming blind. Vitamin A deficiency also causes night
blindness and increases the risk of child deaths, especially from diarrhoea and measles, as
well as maternal deaths. In Western Uganda, 44 of every 100 children between 6 months
and 5 years are not adequately fed on foods rich in Vitamin A.1 Consequently, 30% of these
children suffer from Vitamin A deficiencies.2
b) Iron deficiency
Iron is a mineral that, combined with a protein in our blood, carries oxygen throughout our
body. It is absolutely critical to growth and development and ultimately to survival, and our
bodies store it in several places. Women need more iron than men. During pregnancy, the
growing baby also requires iron that is taken from the mother’s blood and iron stores.
In its more severe stages, iron deficiency causes anaemia. Anaemia is defined as a low
blood haemoglobin concentration. Apart from a deficiency of iron in the diet, anaemia may
also result from other causes, such as severe blood loss, other micronutrient deficiencies or
1
UBOS and ICF International Inc. 2012. Uganda Demographic and Health Survey 2011. Kampala, Uganda:
UBOS and Calverton, Maryland: ICF International Inc.
2
UBOS and ICF International Inc. 2012. Uganda Demographic and Health Survey 2011: Vitamin A Addendum.
Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc.
28
heavy intestinal worm infestation. Iron deficiency also impairs brain development and
increases maternal and child mortality. Globally, more than 130,000 women and children die
each year because of iron deficiency anaemia. In Uganda, it is estimated that 50% of
children under 5 years and 24.2% of women of reproductive age are anaemic. In Western
Uganda, 39 of every 100 children are believed to be anaemic.
c) Iodine deficiency
Eighteen million children per year are born with impaired mental abilities around the world
because of iodine deficiency. Nearly two billion individuals have insufficient iodine in their
diets, including one third of all school age children. Populations with chronic iodine
deficiency showed a reduction in their intelligent quotient (IQ) of 12.5 to 13.5 points.
Iodine is a mineral essential for human development and growth. Our bodies need iodine to
produce the hormones that regulate the thyroid gland. The most commonly known sign of
iodine deficiency is goitre, the swelling of the thyroid gland in the neck. Iodine deficiency
primarily affects the developing brain. If a pregnant mother is severely iodine deficient, this
may lead to cretinism in her baby, the most serious form of mental retardation and
associated physical disabilities.
d) Zinc deficiency
The human body relies on zinc to perform many functions including healing of wounds,
growth and repair of tissue, proper clotting of blood, correct thyroid function, metabolism of
proteins, carbohydrates, fats and alcohol, foetal development and sperm production. The
symptoms of severe deficiency include retarded growth, diarrhoea, mental disturbances and
recurrent infections.
Zinc supplementation trials conducted over the last few decades in children from developing
countries have indicated improved growth rates and reductions in incidences of diarrhoea,
pneumonia and various infectious diseases.
e) Vitamin B12 deficiency
Deficiency of Vitamin B12 (cobalamin) causes neurological deterioration, a specific form of

anaemia, and possible impaired immune function among other health consequences. In
infants and young children it can severely delay their development.
f) Other Vitamin B deficiencies: thiamine (B1), riboflavin (B2) and niacin (B3),
pyridoxine (B6) and cobalamin (B12)
Vitamin B deficiencies are highly prevalent in many developing countries, especially where
diets are low in animal products, fruits and vegetables, and where cereals are highly milled
prior to consumption. Pregnant and lactating women, infants and children are most at risk of
vitamin B deficiencies. Severe thiamine deficiency can result in potentially fatal heart failure
or peripheral neuropathy. Early symptoms of riboflavin deficiency can include weakness,
fatigue, mouth pain, burning eyes and itching. More advanced deficiency can cause brain
dysfunction.
Niacin (B3) deficiency can result in pellagra, which causes skin rashes. Other symptoms
include vomiting, diarrhoea, depression, fatigue and loss of memory. Symptoms of severe
vitamin B6 deficiency include neurological disorders (i.e. epileptic convulsions), skin
changes and possibly anaemia.
29
g) Folate deficiency
Folate (vitamin B9) plays a key role in cell multiplication and tissue growth. Deficiency of
folate during pregnancy increases the risk of giving birth to infants with neural tube defects
and possibly other birth defects. Spina bifida and anencephaly, the two most common neural
tube defects, occur when the neural tube does not close properly, exposing the baby’s brain
or spinal cord to amniotic fluid. Neural tube defects affect an estimated 300,000 or more
new-borns each year globally. Folate deficiency can also lead to impaired cognitive function
in adults. It tends to be more prevalent in populations that consume a lot of cereals (low in
folate) and few leafy greens and fruits (high in folate).
30
2.4. WIDER IMPACT OF UNDER-NUTRITION

The consequences of under-nutrition are not only felt by the affected individuals; other
household members and the community are equally affected when many individuals in a
particular community are under-nourished.
Individual consequences Family and community consequences
Physical abnormalities/impairments - Cost associated with the treatment of

under-nourished persons
Impaired brain development
- Poor family and community development
Frequent illnesses - Loss of labour productivity which affects

engagement in economic activities and
Death income potential
Children are unable to grow into - Loss of family members and loss of
income
productive adults
2.5. FAMILY AND COMMUNITY PREVENTION OF UNDER-

NUTRITION
It is always important that adequate measures are undertaken for all household members to
stay healthy. Prevention should be the key for optimal health outcomes and is cheaper than
treatment.
 All household members should eat adequately with a focus on everyone eating a
diverse diet (covering all food groups)
 All household members should receive timely treatment for all diseases, e.g.
diarrhoea and malaria
 Maintain individual, family and community hygiene and sanitation
 Babies should be exclusively breastfed for the first 6 months of their life, and given
other nutrient-rich foods in addition to continued breastfeeding from 6 months
onwards
 The growth of children should be monitored till they are 2 years of age
 Children should get their vaccinations in time
 Children should get a Vitamin A supplement two times per year
 Pregnant women should attend ante-natal services and comply with prescribed
iron/folic acid medication
 If parents are HIV positive, their children can be tested at 10 weeks of age so that
they can know if they are infected with HIV and they can begin to receive treatment
and care
A child with any signs of malnutrition (most typically, loss of weight or swelling of the body)
should be taken to a health facility immediately for a medical examination. Also children
showing any of the following signs should be seen by a doctor urgently:
31
 High fever (possible risk of malaria)

 Refusal to feed and being very weak
 Chest infection (cough and difficulty breathing)
 Diarrhoea (more than 3 loose stools a day for two days or more and/or blood in the
stool, sunken eyes)
 Vomiting (cannot keep anything down)
2.6. TIPS FOR OPTIMAL INFANT AND YOUNG CHILD FEEDING
Children under 6 months of age

Breastfeeding is crucial from birth to when children are 6 months old. They should be
exclusively breastfed and do not need any other foods or liquids with the exception of
medications prescribed by health personnel.
How to practice exclusive breastfeeding:

 As soon as the baby is born, have the midwife put the naked baby between the
mother’s breasts, cover her lightly and keep the baby there for at least one hour. Let
the baby start sucking.
 The child should be initiated to breastfeeding within one hour after birth
 During these first days, feed the baby often (every 11/2 to 2 hours) for short feeding
times. Frequent feeding will help the milk to flow sufficiently
 Breastfeed for a longer time at each feed as the child grows older
 Let the baby empty one breast at a time. This will ensure that the baby gets the most
nutritious and satisfying milk. If still hungry, offer the baby the other breast
32
 Ensure correct positioning and attachment of the baby to the breast as this helps to
ensure that the baby sucks well, the mother produces a good supply of breast milk
and it prevents the mother from developing sore and cracked nipples
 Breastfeeding the baby often, at least 10 times, day and night, as this helps to
produce lots of breast milk to ensure that the baby grows healthy
 Water or pre-lacteals (sugar water or liquids/fluids) are NOT necessary and should
not be given to children under 6 months
 The mother should ensure that she eats a diverse diet (containing a variety of foods),
maintains personal hygiene and seeks medical attention whenever feeling unwell
Benefits of exclusive breastfeeding

 Breast milk is the only food that is well balanced; there is no other food as good as
breast milk for a baby
 Breast milk is inexpensive, always available and does not need any preparation
 Breast milk is sterile/clean. It is therefore completely safe for the baby to drink
 It provides the baby with immunity thus preventing the child from frequent illnesses,
such as diarrhoea and respiratory infections
 Breastfeeding initiates bonding between the mother and her child
For a child between 6–24 months old

 Introduce nutrient rich foods and also continue breastfeeding
 Foods should initially be made soft and easy to eat by the child
 It is advisable to introduce one food at a time while monitoring for any likely
intolerances to particular foods
 As the child grows to 12 months, gradually introduce the child to the household diet
 Give children small but frequent feeds
 Always ensure that children are fed patiently; they should not be forced to eat
 Children should be encouraged to eat more at every meal, and given an extra meal
each day (or extra snacks in between meals)
 Give fluids to drink preferably fruit juices, clean water, yoghurt, milk. However, limit
fluid intake before meals as this limits the quantity of food children can eat
Home feeding of a sick child

During illness (malaria, diarrhoea, pneumonia or other) the parent/carer must ensure that
they continue feeding the child and increase fluids as follows:
33
Less than 6 months

 Breastfeed more during illness. This will help the baby fight the illness, recover more
quickly and not lose weight. Breastfeeding also provides comfort to a sick baby
 If the baby refuses to breastfeed, continue to encourage your baby until he or she
takes the breast again
 Give only breast milk and prescribed medicines to the baby
 If the baby has been very ill, you may need support to re-establish exclusive
breastfeeding
 If the baby is too weak to suckle, either express breast milk and feed by cup or hand
express milk directly into the baby’s mouth. This will also help the mother to keep up
her milk supply and prevent breast swelling
More than 6 months

 Increase the frequency of breastfeeding
and offer additional food to the child to
maintain his or her strength and prevent
weight loss
 Feed the child foods that he or she likes in
small quantities throughout the day
 Take time to patiently encourage the sick
child to eat as his or her appetite may be
decreased because of the illness
 Offer the child simple foods like porridge
and fruits, even if he or she does not
express interest in eating
 Avoid spicy or fatty foods
 Do not use bottles, teats or spouted cups,
since these are difficult to clean
During recovery
 When a baby is recovering from an illness, he/she will need to be breastfed and eat
more than usual
 If the child is over 6 months, give him or her one additional meal of solid food each
day during the next two weeks after he/she has recovered. This will help your child
regain the weight lost during the illness
 Take enough time to actively encourage your child to eat this extra food and
breastfeed more frequently until his or her appetite has returned
 It is very important that the child gets the vitamin A supplement twice in the year to
help the body recover faster
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2.7. NUTRITION DURING PREGNANCY & BREAST FEEDING
Adequate feeding is important for all women of reproductive age but especially when they
are pregnant. Pregnant women should:
 Eat one extra meal a day during pregnancy in addition to regular meals, and two
extra meals during breastfeeding
 Eat plenty of fruits and vegetables with every meal
 Drink enough liquids every day (8 glasses)
 Avoid taking tea or coffee with meals because they interfere with iron absorption and
may therefore contribute to anaemia. It is better to drink tea or coffee an hour before
or after a meal
 Throughout your pregnancy and for at least 3 months after your baby is born you
need iron and folic acid to prevent anaemia. It is better to take iron tablets with meals
to increase absorption and avoid potential side effects, particularly nausea
 Always use iodised salt to prevent poor brain development, poor physical growth and
goiter. Iodised salt also protects against abortions, miscarriages and stillbirths
 Get a vitamin A capsule from the nearest health facility and take immediately after
delivery or within 8 weeks to help build your baby’s immune system through your
breast milk
 Take de-worming tablets as prescribed to treat worms and to prevent anaemia
 Do not use alcohol, narcotics or tobacco products. They can damage the unborn
baby
 Sleep under an insecticide-treated mosquito net to prevent malaria. Take anti-
malaria medication as prescribed by a health worker
 Attend antenatal care at least four times during pregnancy and always follow your
health worker’s recommendations
Special note for the adolescent mother:

Before the age of 18 your body is still growing. You need extra care, more food and more
rest than an older pregnant or breastfeeding mother to enable your body to grow fully and
ensure that it produces enough milk for your baby.
2.8. DISEASE PREVENTION & SANITATION AND HYGIENE

1. Disease prevention through nutrition
Good nutrition is important to prevent or reduce the duration and impact of many childhood
diseases as well as chronic illnesses which may arise at a later age, like diabetes and
cancer, and to manage diseases like HIV/AIDS and tuberculosis (TB). It ensures your body’s
defence system stays strong and therefore reduces the chance of falling ill.
Eating plenty of protective foods (fruit and vegetables) will help fight off diseases. Ideally,
fruits and vegetables are eaten every day. Green leaves (like: dodo, nakati, bugga,
malakwang, boo, pumpkin leaves, cassava leaves, sukama wiki, spinach) provide nutrients
which help boost the body’s defence system. In circumstances when people are already ill,
they do not feel like eating as they might have side effects from their treatment, infections in
the mouth or lost their appetite. They could be encouraged to eat liquids like soups several
times a day.
35
On the other hand, there are certain foods that we should try to limit consumption of in order
to prevent disease:
Salt: too much salt can cause high blood pressure. 1-3 grams of salt (just few grains) each
day is enough for a child and an adult
Sugar: can cause diabetes (high sugar in the blood) and is bad for your teeth and mouth
because it can cause thrush and holes in the teeth. 2 tea spoons of sugar or honey each day
is enough to meet the daily need for sweetness
Fried food and processed, pre-packed food: like oily or fatty foods like chips and deep
fried meat or chicken. This can lead to the accumulation of fat in the blood vessels making
them thin. This process affects proper blood flow in the body especially blood moving to and
from the heart. This can lead to heart related diseases like hypertension (high blood
pressure).
Unhealthy snacks: like sugary sweets, cakes, buns, chocolate and sweets, which cause
holes in the teeth as well as spoil a child’s appetite. Instead of these, give a child fruits (fresh
or dried), bread, ground nuts, Gizelli (boiled maize and beans) or Kacumbali (cut tomato and
onion salad)
Sodas: which are very bad for small children as they damage their teeth and they develop
the desire for sweet foods early in life
Caffeine: (found in coffee and in smaller doses in tea) when taken too often it can stop the
heart from pumping enough blood. Individuals especially children should not take more than
1-3 cups of coffee a day as it is a drug and can affect their ability to sleep well. Pregnant
women should take it in moderation as well to protect their unborn baby. Tea should not be
taken up to 1 hour after a meal as it can prevent micronutrients (iron) from being absorbed.
Alcohol: it is dangerous for the body when taken in large amounts every day. It can stop
body organs from working properly (mainly the liver) and should therefore never be given to
children and pregnant women
2. Disease prevention through hygiene and sanitation
Also personal and environmental hygiene practices are crucial to prevent and control
diseases. The focus in this section is on hygienic
food preparation. Once children are not breastfed
anymore they lack the immunity protection
provided by breast milk.
In addition, from 6 months, children require
complementary feeds which puts them at risk of
diseases through unsafe food preparation. Key to
clean and safe food preparation: clean hands,
clean utensils, safe water and food, and safe food
storage.
Clean your hands

 After using the toilet
 After cleaning baby’s bottom
 Before preparing food
 Before feeding children or eating yourself
36
Wash hands thoroughly with soap/ash and plenty of water. Wash also between the fingers
and under your nails. Dry hands in the air or use a clean cloth.
Clean your utensils

 Clean surface (table, mat or cloth)
 Wash utensils immediately after use
 Keep clean utensils covered
 Use clean utensils, especially for young
children. Open, smooth surfaced spoons
are easier to clean
 Baby’s cup should be washed &
scrubbed in hot soapy water, and dip the
cup in boiling water before use if feasible
Safe water and milk

- Boil/treat water for drinking and baby’s feeds
- Boiling means water surface is bubbling
vigorously
- Keep water in clean covered container. Ideally, a
container where cups cannot be dipped
- Boil milk before use
- Milk and water can be boiled together
Safe storage
 Keep foods in tightly covered containers
 Store dry foods if possible (e.g. milk powder, sugar)
 Use milk within one day if not refrigerated
 Use prepared feeds within one hour
 Keep rubbish bins covered and remove the rubbish regularly
 Keep food preparation areas in good condition (repair wall cracks or holes)
 Use baits or insecticides to kill pests (taking care not to contaminate food)
 Keep domestic animals and insects away from food preparation areas
 Do not store baby’s milk in pottery (unless it has a lid); it allows evaporation of water
from the surface
Module 3 will talk about food safety and food hygiene in more depth.
37
SUMMARY MODULE 2: NUTRITION & HEALTH

Definition of under-nutrition Family and community prevention of under-
Under-nutrition results from not eating enough to nutrition
supply the body with all the required food nutrients. Prevention should be the key as it is cheaper
Affected individuals lose weight, become deficient of than treatment.
macro- and micronutrients and therefore frequently All household members should:
fall sick.  Eat adequately with a focus on everyone
eating a diverse diet
Causes of under-nutrition  Receive timely treatment for all diseases
 Lack of dietary diversity  Maintain individual, family and community
 Eating foods low in nutrients hygiene and sanitation
 Failure to feed children as recommended
Growth of children should be monitored till they
 Poor household and environmental hygiene
are 2 years of age and take vitamin supplements
 Failure to treat household members on time
Children should get their vaccinations in time
 Failure to care and attend to all household
HIV positive parents should seek additional
members
services
Forms of under-nutrition Tips for optimal infant and young child

Acute under-nutrition or thinness: characterized by feeding
weight loss, wasting, and in very severe cases the • Initiate breast feeding in the first hour of life
swelling of both feet with fluids • Exclusively breast feed children up to 6
Underweight: Individuals have low weight compared months of age and continue breast feeding
to the average weight of healthy individuals of the until they are 2 alongside their other meals
same age and sex
Stunting: Individuals have less height compared to Maternal health
the average height of healthy individuals of the • Eat more during pregnancy and breast
same age and sex. It is irreversible feeding
Micronutrient deficiencies: Individuals are deficient • Eat plenty of fruits and vegetables
of vitamins and minerals. These deficiencies take • Drink enough water (8 glasses)
long to be detected until signs are visible. By then, • Avoid taking tea or coffee
much damage has already been caused • Take iron and folic acid tablets throughout
pregnancy
Impact of under-nutrition • Take vitamin A capsule within 8 weeks of
 Physical abnormalities/impairments giving birth to help build the baby’s immune
 Impaired brain development system through your breast milk
 Frequent illnesses • Use iodized salt
 Death • Take de-worming tablets to treat worms and
 Faltered growth in children to prevent anaemia
 Increased costs associated with the • Do not use substances like alcohol, narcotics
treatment or tobacco
 Poor family and community development • Sleep under an insecticide-treated mosquito
 Loss of labour productivity, income and
net to prevent malaria
family members
• Take anti-malarial drugs as prescribed by a
health worker
38
Sanitation and hygiene to prevent diseases
Clean your hands

 After using the toilet
 After cleaning baby’s bottom
 Before preparing food
 Before feeding children or eating yourself
Wash hands thoroughly with soap/ash and plenty of water. Wash also between the fingers and under your
nails. Dry hands in the air or use a clean cloth.
Clean your utensils and crockery (plates/bowls)

 Before and after feeding your baby and food preparation generally
39
MODULE 3: FOOD SAFETY, STORAGE &

PRESERVATION
Introduction
Ensuring food safety and hygiene is important at individual, household and community level.
It ensures that foods are safe for human consumption and that individuals do not develop
any food-borne illnesses. This module equips participants with an understanding of key food
safety and food hygiene issues and how these can be maintained within households and
communities. The module explores different areas with regards to food safety including: food
spoilage, food storage and food poisoning.
An assessment of the food handling, safety, storage and hygiene practices by workers in
Rwenzori and Mpanga tea estates revealed that:
 Household ownership of food storage facilities varied with only 63% of households
reportedly storing food
 Households that stored food made use of cupboards, containers, baskets, sacks and
open floors to store food. Those that did not own food storage facilities mentioned
the lack of storage space, consumption of all food prepared and the lack of money to
buy food storage facilities as being limiting factors to food storage.
 Respondents identified the following food hygiene practices: proper covering of food
(68% of respondents), cooking of food (22% of respondents), use of clean utensils in
food preparation (5% of respondents), warming of leftover food before consumption
(4% of respondents) and keeping cooked and raw foods separately (1% of the
respondents)
 Main challenges in ensuring food safety included the lack of adequate food storage
facilities and poor storage methods that result in the destruction of stored food by
pests, including cockroaches and rats
By the end of this module, participants should be able to demonstrate good practices with
respect to food safety and hygiene, including through food storage and preservation
techniques. They will also learn how to prevent food poisoning.
Overview
1. The concept of food safety and hygiene

2. Food storage and preservation
3. Food poisoning
40
3.1. The concept of food safety and hygiene

Once food has been harvested, gathered or slaughtered, enzymes and bacteria become
active in this food which cause it to deteriorate in texture and composition until it eventually
becomes unfit for consumption. This deterioration is known as decay and leads to eventual
food spoilage. Food safety and hygiene entail undertaking a series of measures to
avoid spoilage and contamination of food.
At the core of maintaining food safety is the need for proper food handling (including
cooking), storage and preservation as these greatly influence how long a food can stay fit
for consumption.
Food is considered safe for human consumption when it is free from substances like
contaminants, toxins and micro-organisms that can cause undesirable reactions in the body
when such foods are eaten. To ensure that food is safe for consumption, it should be:
 Protected from contamination by harmful bacteria, poison and other foreign bodies
 Prevented from having any bacteria present multiplying to an extent which would
result in the illness of consumers or the early spoilage of the food
 For some foods: thoroughly cooked to destroy any harmful bacteria present
 Discarded when spoilt and/or contaminated
The benefits of proper food safety and hygiene are:

 More efficient utilization of food consumed by the body contributing to improved
health and nutrition outcomes
 Prevention of food-borne illnesses (and sometimes death)
 Less food wastage
Causes of food spoilage

Contamination of food stuffs can occur through different ways, including: inappropriate food
handling at different stages throughout the food chain; poor hygienic conditions of the places
where food is placed, prepared and/or stored; intentional or non-intentional mixing of food
with other foods or non-food substances that are unhygienic (also known as food
adulteration) and general poor environmental hygiene. Food can also be contaminated
when put together with other foods that have already undergone spoilage.
It is normal for food to spoil when no measures are undertaken to prevent its spoilage.
Naturally, foods spoil over time due to the presence of either naturally occurring enzymes in
particular foods or due to other external organisms or factors. Fruits and vegetables spoil
over time because of the presence of naturally occurring enzymes that cause ripening and
eventually, decay. Food spoilage may also be caused by micro-organisms such as moulds
(commonly seen on bread), or yeasts and bacteria. These cause the food to break down, rot
or go sour. The food may then discolour, smell bad or become sticky and slimy. Chemical
hazards like pesticides and toxic metals may also lead to food contamination and spoilage.
Like other living things, micro-organisms such as bacteria, need food, warmth, moisture and
time to grow and multiply. The ideal temperature for most bacteria is 30-45°C. Bacteria
thrive best in damp conditions and in moist foods. When the correct conditions for growth
are present, bacteria can double in number every 10 to 20 minutes, so that in about six
hours 1 million could be produced from just one bacterium! As they increase in number,
micro-organisms feed on nutrients present in a food leading to chemical and physical
41
changes in the natural composition of the food and eventually food spoilage. Boiling kills
most bacteria and cold temperatures slow down their growth. Freezing does not kill bacteria,
it only inactivates the enzymes (they stay dormant until they defrost).
Identifying spoilt food

Food that is spoilt can be identified in different ways:
 Off odours: Foods tend to develop undesirable off-flavours and/or odours as they
spoil
 Discolouration: Food undergoing spoilage normally changes in colour
 Slime / Stickiness: Gravy or soups sometimes become thick and slippery to touch
 Unusual taste: Food that is undergoing spoilage often changes in taste
 The production of gas: Some foods - especially when stored in sealed containers
develop some gases which will be noticeable when opening the container
 Mould growth: Other foods, e.g. bread develop fungi like growth which is easy to see
with the naked eye
Foods at high risk of food spoilage

Some foods are prone to faster spoilage by micro-organisms than others. Foods that spoil
fast are usually referred to as “high risk foods.” Most often these are ready to eat foods or
rich protein foods and require refrigerated storage. Examples of these foods are:
 (Cooked) meat, including poultry
 (Cooked) meat products including gravy, stews
 Milk and milk products
 Eggs and products made from raw eggs
 (Cooked) Fish
Food cross-contamination
Previously safe food can spoil when it gets contaminated by bacteria from another food in a
process known as cross- contamination. For example, it may occur when raw and cooked
meat are cut on the same board or when fruits and vegetables are cut on a board previously
used for cutting meat on but which was not cleaned. The main carriers of bacteria and
causes of cross-contamination are:
 Humans
 Rubbish
 Pets and other animals
 Food, e.g. raw meat or poultry
In order to avoid cross-contamination:

 Do not let raw meat drip onto other food and keep raw meat separate from other food
 Never use the same chopping board for raw meat and ready-to-eat food without
washing the board (and knife) thoroughly in between
 Maintain personal and environmental hygiene at all times. For example, always wash
hands, chopping boards and utensils before starting food preparation
All individuals carry bacteria in their intestines, nose, mouth and on their hands. These
micro-organisms can easily be passed on to food when individuals do not maintain good
hygienic practices, such as washing hands before cooking and after using the latrine.
General tips for preventing food contamination and spoilage:
Food hygiene
 Keep raw and cooked meats separate to avoid cross- contamination
42
 It is useful to have a separate chopping board for raw meat. Do not put ready to eat
food, such as bread, salad or fruit on a worktop or chopping board that has been
touched by raw meat, unless it has been washed thoroughly first
 Cook eggs, meat, fish and poultry thoroughly to kill bacteria
 Thaw frozen meat and poultry thoroughly before cooking
 Cool and cover leftovers
 Preheat leftovers until piping hot to ensure that all bacteria are destroyed
 Wash fruits and raw vegetables before eating
 Prior to consumption, rinse fresh fruits and vegetables to remove possible pesticide
residues, soil, and/or bacteria
Personal hygiene
 Wash hands thoroughly with soap and water and dry them at each of these times:
before starting to prepare food; after touching raw meat, including poultry; after
touching raw eggs; after going to the toilet; after touching the bin and after touching
pets or other animals
 Cover or tie back hair and wear a clean apron/cloth whenever you are going to
prepare food
 Avoid touching face or hair while preparing food
 Keep fingernails clean and short
 Do not cough or sneeze over food
 Avoid wearing rings, earrings or watches when preparing food
 Cuts and wounds should be covered with a waterproof dressing
 A person who has been ill, especially with food poisoning, should not work with food
or be in the food preparation area
Kitchen hygiene
Cleaning the kitchen and all areas, surfaces and utensils used for food preparation is
important to keep food safe and prevent bacteria from spreading. Avoiding the build-up of
refuse also leads to better hygienic conditions in a kitchen. One must ensure that the area
and utensils that have been used for food preparation are cleaned before doing anything
else. ‘Clean as you go’: This provides a clean environment for other food preparations.
The following should be noted:

 Ideally, the kitchen should have adequate lighting and ventilation
 Ensure having adequate supply of water and cleaning materials
 Always wash worktops/chopping tables and utensils before food preparation begins
 Regularly disinfect and change kitchen cloths as these are an ideal breeding ground
for bacteria
 Use separate cloths for kitchen (dishes) and bathroom (hands and body)
 Keep kitchen bin covered, empty daily and disinfect once a week
 Disinfect worktops regularly
 Keep pets and all domesticated birds and animals out of the kitchen at all times-
including night
 Sweep kitchen floor daily and wash and disinfect regularly
 Wipe up any spoilt foods straight away
 Sanitize worktops/chopping tables and utensils thoroughly (with detergent) after they
have been touched by raw meat, including poultry or raw eggs
 Always ensure using clean utensils for serving food as this prevents the spread of
bacteria
43
Disinfecting and sanitization of kitchen and kitchen equipment
Disinfection refers to the use of antimicrobial agents-referred to as disinfectants to destroy

micro-organisms that live on different objects including kitchen utensils, working tops and floors.
Sanitization on the other hand refers to the cleaning of something by disinfecting or sterilization.
The most commonly available home disinfectant or sanitizer is JIK. JIK is sold inexpensively in a
number of local shops in most trading centres.
To use JIK for disinfecting and or sanitization, follow the following diluting instructions:
Add 1 cup (250ml) of JIK to 1L of water. Wash the affected areas and rinse after 1 minute, or,
Add ¼ cup (62.5ml) of JIK to 5 litres of water. Wash the necessary areas and rinse after 30
seconds
Environmental hygiene
The environment in which we live has a big impact on the safety and hygiene of the food that
we eat. For this reason, proper environmental hygiene should be maintained in our
households, in the markets from where we buy household food, in homestead gardens
where vegetables are grown and in all public and private areas and water sources.
Sanitizers
At household/community are we
level substances that simultaneously clean and disinfect
should ensure:
 Proper refuse disposal in designated places
 We Disinfectants are antimicrobial
use clean pit latrines/toilets agents that
(defecating andareurinating
applied to non-living
should objects
happen in to
destroy
designated places only) microorganisms that are living on the objects.
 We have sufficient supplies of water, soap and other disinfectants
chemical that kills germs: a chemical that destroys or inhibits the growth of microorganisms that cause disease
 Water places are kept clean and not used by animals
 To keep public places clean at all times Failure to maintain environmental hygiene
Microsoft® Encarta® 2009. © 1993-2008 Microsoft Corporation. All rights reserved.
may lead to waste being washed into our sources of water and food. It also leads to
rapid multiplication of flies that further spread germs and bacteria.
Cooking Tips
 All foods that are not eaten raw should be properly cooked (includes boiling, frying,
roasting)
 Especially meat (beef, pork, chicken) should be well cooked as eating undercooked
meat can lead to worms
 Meat that is properly cooked does not have any pink parts. If meat has pink parts,
one should continue cooking as this meat is still undercooked
 To check a whole chicken or other thick piece of meat, pierce the thickest part of the
leg with a clean knife until the juices run out. The juices should not have any pink or
red in them
 Leftover food should always be kept in clean covered containers and kept in cool
temperatures. This food should be reheated (until piping hot) before eating. However,
leftovers should not be reheated more than once and should be used within 1 – 2
days of cooking
44
3.2. Food storage and preservation

Storing food the right way can be a great help in ensuring a household’s food security. This
section discusses the importance of food storage and the different ways in which
households can rightly store different types of foods.
Food storage broadly refers to the different means through which food can be kept for longer
periods without the food spoiling. The shelf life of a food is the length of time a food remains
safe and fit for human consumption.
It is essential to store food properly to ensure the following:

 Food remains in good condition for as long as possible
 Food is protected from flies, dust and other organisms that can spoil and/or
contaminate food
 Food is protected from organisms like insects and rats that eat and spoil food. For
instance, proper storage of grains protects it from rats and aphids which eat and spoil
maize
 Reduction in post-harvest food losses
General guidelines for food storage

Foods should be stored differently on the basis of how fast they will spoil or develop off-
flavours. Foods can be categorised into 3 groups:
1. Perishable (e.g. milk, meat, raw fish)
2. Semi-perishable (e.g. vegetables and grains)
3. Non-perishable foods (tinned or dried food)
Perishable foods: e.g. eggs, milk, cream, fresh meat. These have the shortest shelf life and
must be used within a few days. These should be stored in a clean cool place. In the
absence of refrigerators, such foods can be placed in clean containers, saucepans or pots.
The containers can then be placed in a basin of cold water covered with a clean piece of
cloth. In all circumstances, milk and meat should be consumed within 2 days.
Semi-perishable foods: e.g. bread, cakes, fresh fruit and vegetables. Breads and cakes
should be stored in a bread bin or tin. Fruit and vegetables may be stored in a rack or
basket. When put in storage, care should always be taken to remove and discard the
particular foods that start showing signs of spoilage so as to avoid cross-contamination.
Non-perishable foods: e.g. dry, bottled and tinned foods can be stored in a cupboard on
their own or in airtight containers
Further food categories and their storage methods

The recommended storage conditions for foods often vary; the variations even differ for the
same foods depending on the freshness or dryness of the particular food.
Storage of cereals, bread, flour, and rice

 Bread needs to be stored in its original package at room temperature. It should be
used within 5 to 7 days or else it will grow moulds (a sign of spoilage)
 Cereals - depending on the quantities and level of dryness - may be stored at room
temperature in tightly closed containers to keep out moisture and insects. Properly
dried cereals packaged in sacs can be stacked on racks in a dedicated food store.
Due attention should be taken to keep out rodents (rats) that normally feed on stored
grain
45
 Raw rice can be stored in closed containers at room temperature and used within
one year. Once cooked, rice should be eaten immediately in the absence of
refrigeration
Storing fresh vegetables

 Proper storage of fresh vegetables helps to maintain their quality and retain nutrient
value. Most fresh vegetables need to be stored under low temperatures in areas
which are neither humid nor damp. If available, fresh vegetables can be stored in a
clay pot fridge.
Constructing a clay pot fridge

This is made of a clay pot, a basin of water and a clean cloth. Place the pot in the basin of
water. Put the vegetables inside it and cover the pot with a clean wet cloth. Place one corner
of the cloth in the basin of water so that water is continuously sucked into the cloth as it dries
out.
Figure 1: Demonstrating a clay pot fridge
 Root vegetables (potatoes, sweet potatoes, onions, etc.), squashes and eggplant
can be stored in a cool, well-ventilated place between layers of grass
 Onions should be left to dry thoroughly under the sun to avoid rotting in storage and
when well dried can be kept for about 3 months
 Tomatoes continue to ripen after harvesting and should be stored at room
temperature
Storing fresh fruits

 All fresh fruits generally need to be stored in a cool area, preferably in a clay pot
fridge
 Fruits have a tendency to either be contaminated by other foods and or to absorb
odours from other foods. They therefore need to be kept separately
Storing milk and milk products

 Milk is a highly perishable food and yet very nutritious. To prolong its shelf life, milk
should never be left at room temperature for a long time as it spoils quickly
46
 Care must be taken to keep milk in clean covered containers that should be left to
stand in a cool place. Unrefrigerated milk should be used within a day
Storing meat and fish

 Meat (including poultry), fish, eggs and milk are the best sources of proteins in the
human diet. Given their high protein and moisture content, these products are highly
perishable. It is for this reason that these products will spoil faster than others -
however well prepared and stored. One big contributor to the faster spoilage of fresh
cuts of meat is the fact that these usually contain spoilage bacteria on the surface
that can grow quickly, producing slime and causing spoilage after a few days. Meat
should be prepared and eaten within 24 hours of purchase/slaughter.
 Ground and thinly cut pieces of meat are more susceptible to spoilage given the
larger surface area for bacterial action. Meat and meat products should be used
within a few days. If the meat cannot be used within a day, it is advisable to dry,
smoke or salt it before storing it
 Like meat, fresh fish should be eaten immediately. Never store fish in water as this
leads to loss of nutrients from the fish. In order to store fish for longer, it should be
smoked.
Storing Root Tubers (Cassava, Sweet Potatoes)

 Most root tubers may not be stored well for long after harvest, however root tubers
keep longer than other vegetables, fruits, meat, milk, etc.
 When tubers will not be prepared within a few days, care should be taken to avoid
bruising them. It is advisable to harvest cassava before it becomes fibrous, with part
of the aerial stem still attached. This helps preserve the tubers in good condition.
 Cassava tubers can also be piled into heaps and watered daily to keep them fresh or
coated with a paste of mud to preserve their freshness. They can keep for about 4-7
days.
 Unbruised sweet potatoes can be kept in a cool, dry place for up to 4-7 days. Care
should be taken to remove any sprouting buds.
 In times of bumper harvests, tubers cannot be kept for long; it is advisable that these
are peeled and sliced in small pieces and then sun dried on canvas or cleaned floors.
Once well dried, the sliced dry tubers can be kept in sacks and stored for up to 3-4
months without spoiling.
Food preservation refers to the different techniques that are applied to food to prevent it from
spoiling. The science behind food preservation involves either:
 The destruction of micro-organisms responsible for causing food spoilage
 Reducing/eliminating the water (moisture) content from food
 Altering the temperature and other conditions that favour the growth of food micro-
organisms, and thereby retarding microbial growth and replication (thus delaying
food spoilage).
Simple household food preservation techniques
Drying
A number of foods (fruits, vegetables, tubers-cassava, and potatoes) which cannot be stored
for long in their fresh state without spoiling can be preserved by drying. Before drying, there
should be enough sunshine and foods should be sliced in small pieces for them to dry faster.
Dried fruits can be eaten in their dry state (e.g. dried jackfruit), vegetables and potatoes
need to be cooked by boiling in water while dried cassava can be ground into flour and used
later.
47
Smoking
Smoking meat and fish is a highly recommended method for prolonging their storage life.
The fish is first cooked over a high fire and then smoke-dried in one to five days (and nights)
over a low fire. Fresh-dried fish keeps for up to a week, while hard-dried fish (keeping fish in
salt for several weeks) keeps for several months.
Salting
Salting is a simple food preservation method that can be used to prolong the shelf life of
food for a few days. When added to foods, salt takes out moisture and retards microbial
growth and replication.
Boiling
Boiling of foods kills food microbes. Perishable foods can be boiled, cooled and kept in clean
containers and then used within a day.
3.3. Food poisoning

Food that has not been stored or prepared well has a high chance of containing a lot of
micro-organisms. Depending on the level of micro-organisms, this food becomes unsafe for
human consumption. When individuals consume spoilt or contaminated food, they develop
food-borne illnesses; a condition usually referred to as food poisoning.
Food poisoning is an acute illness, which usually occurs within 1 to 36 hours of eating
contaminated or poisonous food. Symptoms of food-borne illnesses normally last from 1 to 7
days and may include one or more of the following:
 Abdominal pain
 Diarrhoea
 Vomiting
 Fever
 Dizziness
We can avoid most food-borne illnesses through observing strict hygiene and sanitary
measures in preparing and storing food, serving food soon after preparation, and only eating
pre-heated (very hot) leftover foods.
Who is at risk of food poisoning?

Anyone is prone to developing food poisoning if he/she eats contaminated food. Groups with
an increased risk include:
 Young children
 Pregnant women
 Elderly people
 Individuals with autoimmune disorders, liver disease or decreased stomach acidity
 Alcoholics – because of possible liver damage/disease
 People weakened by malnutrition and illness, including chronic diseases
 Individuals eating meals within institutionalised settings who share utensils and
where the risk of unhygienic food handling practices is increased
What to do when food poisoning arises?

When symptoms of food poisoning manifest themselves for less than 24 hours (such as
short episodes of vomiting and small amounts of diarrhoea) then this can usually be cared
48
for at home. If it persists for longer, then medical attention should be sought. The following is
recommended:
 Do not eat solid food while nauseous or vomiting but drink plenty of fluids and cereal
gruels/porridges
 Sip small, frequent sips of clear liquids, including water to stay hydrated
 Avoid alcoholic and caffeinated drinks
 If available, Oral Rehydration Solution can be used. Mix one sachet of ORS powder
into one litre of boiled or treated water in a clean container and stir well until it fully
dissolves into a solution. Where this is not available it can be made from 1 litre of
clean boiled/treated water, 6 level table spoonful of sugar, half level tablespoon of
salt, and stir until sugar and salt dissolve and give to the person experiencing
vomiting or diarrhoea.
 After successfully tolerating fluids, eating should begin slowly from the moment
nausea and vomiting have stopped. One is encouraged to start by eating cereals
49
SUMMARY MODULE 3: Food Safety, Storage & Preservation
Food spoils. It is in our power however to prolong the shelf life of food through correct handling, storage and
preservation. Once food has spoilt it should be thrown away as it can make us sick.
HOW TO HANDLE FOOD? HOW TO STORE FOOD?
Cook with clean hands, utensils and cooking area Keep perishable foods COOL, e.g. in ‘clay pot
fridge’ and use within a few days or less
Meat, eggs, fish contain a lot of bacteria. Cook these
foods thoroughly to kill the bacteria Remove fruits/vegetables that show signs of
spoilage as they will spoil the other fruits/veg they
Avoid these foods from contaminating other food, for are mixed with
example by washing your chopping board before
cutting vegetables Keep dry foods in closed containers
Throw away spoilt food = food that has changed in HOW TO PRESERVE FOOD?
colour, is mouldy/gaseous, smells badly and/or has
changed in taste Drying ( e.g cassava, sweet potatoes, leafy
vegetables)
Wash fruits and raw vegetables before eating
Smoking (e.g. meat and fish)
Salting (e.g meat and fish)
Boiling (all foods with exception of fruits)
Food Poisoning
When we consume spoilt food, we can develop food poisoning. Symptoms normally last from 1 to 7 days
and may include abdominal pain, diarrhoea, vomiting, fever, dizziness. We can avoid it through observing
strict hygiene and sanitary measures in preparing and storing food, eating food soon after preparation, and
only eating pre-heated (very hot) leftover foods.
What to do when food poisoning arises?

When symptoms of food poisoning manifest themselves for less than 24 hours (such as short episodes of
vomiting and small amounts of diarrhoea) then this can usually be cared for at home. If it persists for
longer, medical attention should be sought. The following is recommended:
 Do not eat solid food while nauseous or vomiting but drink plenty of fluids and cereal gruels/porridges
 Sip small, frequent sips of clear liquids, including water to stay hydrated
 Avoid alcoholic and caffeinated drinks
 If available, use Oral Rehydration Solution. Mix one sachet of ORS powder into one litre of boiled or
treated water in a clean container and stir well until it fully dissolves into a solution. Where this is not
available it can be made from 1 litre of clean boiled/treated water, 6 level table spoonful of sugar, half
level tablespoon of salt, and stir until sugar and salt dissolve and give to the sick person
 After successfully tolerating fluids, eating should begin slowly from the moment nausea and vomiting
have stopped. We should start by eating cereals
50
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Nutrition Training Manual Developed for Tea Communities in Uganda

Technical Report · December 2014

Peterson Kato Kikomeko Ndahura Bari Nicholas

SEE PROFILE SEE PROFILE

The user has requested enhancement of the downloaded file.

DEVELOPED FOR TEA COMMUNITIES IN UGANDA

Editors and technical contributors:

Heleen Bulckens, Programme Manager, Ethical Tea Partnership

MODULE 1: FOOD&NUTRITION SECURITY

MODULE 2: NUTRITION & HEALTH

MODULE 3: FOOD SAFETY, STORAGE & PRESERVATION

How to use the manual

Module 1: Food &Nutrition Security

Module 2: Nutrition & Health

Module 3: Food Safety, Storage & Preservation

MODULE 1: FOOD & NUTRITION SECURITY

Objectives of the module

After having completed this module, participants should be able to:

 Differentiate between food, nutrients and nutrition

Food and nutrition security situation on tea estates in Western

1.1. FOOD, NUTRITION AND NUTRIENTS

 Macronutrients are required by the body in large amounts; they include

Classification of foodson the basis of the key nutrients they supply

 Energy giving foods/GO foods

ENERGY GIVING FOODSOR GO FOODS

 Perform activities such as walking, digging, working

We obtain carbohydrates through eating plant-based foods. The main examples of

BODY BUILDING FOODS OR GROW FOODS

Body building foods or GROW foods are those rich in

Bodybuilding foods come from two major sources:

Examples of locally available plant-based foods rich in proteins:

Ground nuts Simsim (Sesame) Soy (soya) Beans

Examples of locally available animal-based foods rich in proteins:

Eggs White ants Grasshoppers

PROTECTIVE FOODS OR GLOW FOODS

Amaranthus (ddodo) Spinach Cabbage Carrots

Pineapple Orange Passion fruit Mango

Nutrient Function Food sources

Vegetables and fruits are a major source of vitamins and minerals

Key vitamins and minerals for children and pregnant/breastfeeding women:

The body requires water for many reasons:

 To transport nutrients around the body

1.2. BALANCED DIET AND CHILD FEEDING

Babies (up to 6 months)

People with chronic (long-term) illnesses (e.g. HIV/AIDS)

The key to a balanced diet is to consume a variety of foods in

Generally speaking, in order to maintain/attain a balanced diet, we should eat:

Household domestication of chickens, rabbits or goats can enable a family

One day sample menu for an adult (3000 kcal)

Table 3: One day sample menu for an adult

Breakfast Lunch Supper

1.3. FOOD AND NUTRITION SECURITY

What is food security?

What is nutrition security?

Actions that can be taken by the workers / households:

Actions that can be taken by the estate management:

How to ensure adequate care for all household members

How to prevent and control diseases

SUMMARY MODULE 1: FOOD&NUTRITION SECURITY

Plant-based: beans (include soy beans)

CARBO- Millet, Irish potatoes, sweet potatoes, cassava, GIVE US ENERGY

FATS Sunflower oil, Mukwano oil GIVE US ENERGY