An innovative model training marginalised women to become culinary health educators
Written by Sento Kai Kargbo, MTK Project Officer at NNEdPro
Edited by Luke Buckner, MTK Project Lead at NNEdPro
Reference:
Buckner, L., Carter, H., Crocombe, D., Kargbo, S.K., Korre, M., Bhar, S.B., Chakraborty, D., Douglas, P., Gupta, M., Maitra-Nag, S., Muhkerjee, S., Saha, A., Rajput-Ray, M., Tsimpli, I., and Ray, S. (2021). ‘Bhavishya Shakti’: Empowering the Future’: establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India. BMJ Nutrition Prevention & Health; 0. Doi: i:10.1136/bmjnph-2020-00018
A recent article published in BMJ Nutrition (BMJ NPH) demonstrates the feasibility of a novel Mobile Teaching Kitchen (MTK) as a nutrition education and upskilling platform for marginalised women in Kolkata, India, and the potential for upscaling to similar people worldwide. The MTK as a public health intervention showed promising results in educating and empowering a group of lay disadvantaged women into culinary health educators, otherwise referred to as ‘MTK Champions’. This blog aims to summarise key findings, limitations, and opportunities for future research.
Background. Malnutrition – undernutrition, micronutrient deficiencies, and overweight/obesity, and other diet-related non-communicable diseases – affects nearly 2 billion people worldwide and is a leading cause of death and disability worldwide (WHO 2019). The simultaneous existence of underweight and overweight/obesity (“double burden of malnutrition”) persists as a public health emergency in India across the socioeconomic gradient (NFHS-4 2017). According to the Global Nutrition Report (2016), although there has been overall progress in rates of exclusive breastfeeding and prevalence of overweight among children under 5 years old in the region, there is still much work to be done as the overall state of malnutrition remains a cause for concern.
The NNEdPro Global Centre, in partnership with local charities, launched the “Bhavishya Shakti” MTK intervention in two slums (Chetla, RG Kar) in Kolkata, India, where the project team including health professionals trained local community volunteers in basic nutritional concepts who then transferred this knowledge to a group of women via a teaching kitchen. The MTK intervention was delivered over the course of 6 months, from baseline assessment to post-intervention data collection. This paper aimed to assess the feasibility of a mobile teaching kitchen as an upskilling platform and nutrition education tool to train marginalised women to become culinary health educators.
Figure 1. Timeline of data collection and nutrition education delivery.
Baseline assessment. With the help of volunteers, licensed dietitians and physicians collected demographic data (age, gender, education level, occupation, no. of siblings) and performed physical exams (anthropometry and clinical assessments) to evaluate the nutrition status of MTK Champions. KAP (knowledge, attitudes, and practices) surveys were also administered to assess awareness of dietary practices.
SODOTO Workshops. The ‘See One, Do One, Teach One’ ("SODOTO") workshops were comprehensive nutrition education and hygiene workshops delivered via cooking demonstrations following a pre-set template menu comprising locally sourced ingredients. In the See One session, MTK champions observed the preparation of nutritionally balanced, affordable meals. In the next session, ‘Do One’, the Champions performed the meal preparations themselves, and in the final session, Teach One, they taught a group of community members who opportunistically assembled. Additionally, following each consecutive session of the SODOTO workshops, the cognitive flexibility and mentalising skills of the MTK Champions were assessed using standard theory of mind (ToM) tasks, the Wisconsin Card Sorting Task, and the Unexpected Transfer task – a novel aspect of the proposed intervention. Mentalising refers to the mothers’ ability to predict, understand, and cater to their children’s psychological needs. Insights into mentalising skills may highlight which candidates are flexible to adapt behaviour to the understanding of others.
Figure 2. Overview of the process of knowledge transmission from trained professionals through to the community.
In the post-intervention data collection step, clinical assessments and anthropometric measurements were repeated to allow for longitudinal analysis of nutrition and health status. KAP surveys were also re-administered.
At the end of the workshops, MTK Champions formed a microenterprise where they prepare and sell meals whilst transferring knowledge onto members of their community.
Summary of key findings
All Champions were domestic helpers (n=8) or housewives (n=6). Although, the majority of the champions were educated to primary level (up to class IV) (n=6). The maximum level was up to UK college standard (XII standard) or above (n=1), and the lowest level was no formal education (n=4).
As anticipated in this timeframe, there was no statistically significant difference in weight, height, or MUAC at baseline or post-intervention in both mothers and children across the 2 slums.
Of the 11 signs of micronutrient deficiencies observed at baseline, only 3 were seen post-intervention. The most common clinical sign observed was pallor.
At baseline, the combined KAP subsections were as follows (mean (SD)): knowledge 11.7 (1.05), attitude 40.6 (0.74) and practice 23.4 (1.24). Following the intervention, the scores were found to have changed by +4.8 (knowledge), −3.8 (attitude), and +0.8 (practice).
Figure 3. Breakdown of KAP scores of Chetla and RG Kar slums
Findings from the MTK pilot intervention in Kolkata should be interpreted with caution given the small sample size (n=12) which limits internal and external validity. Furthermore, many of the clinical assessments, especially the examination of the physical signs are subjective, therefore prone to the effects of chance, bias, and confounding. Anthropometric measurements are also prone to subjective inconsistencies or errors.
Conclusion. Malnutrition poses serious health and economic consequences for individuals and communities. Nutrition and health interventions, like the MTK, provide an opportunity for cost-effective, innovative, and adaptable action toward addressing nutrition and health inequities among underserved populations, which has been further exacerbated by the ongoing COVID-19 pandemic. The main outcomes of the success of the MTK were improvements in nutrition knowledge and practice among the Champions post-intervention. Further, the MTK also serves as a microenterprise opportunity to generate novel sources of household income and new leadership and educator roles within the community. There is also the potential to adapt and upscale this kind of intervention to other settings globally, across the socioeconomic gradient.
References
World Health Organization. Malnutrition is a world health crisis, 2019. Available: https://www.who.int/nutrition/topics/world-food-day-2019-malnutrition-world-health-crisis/en/2
Ministry of health and family welfare. National family health survey (NFHS-4) 2015-16 India, 2017. Available: http://www.rchiips.org/nfhs5
Global Nutrition Report. Country Nutrition Profiles – India. Available: https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/india/
Buckner, L., Carter, H., Crocombe, D., Kargbo, S.K., Korre, M., Bhar, S.B., Chakraborty, D., Douglas, P., Gupta, M., Maitra-Nag, S., Muhkerjee, S., Saha, A., Rajput-Ray, M., Tsimpli, I., and Ray, S. (2021). ‘Bhavishya Shakti’: Empowering the Future’: establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India. BMJ Nutrition Prevention & Health; 0. Doi: i:10.1136/bmjnph-2020-00018
NNEdPro. Mobile Teaching Kitchen (MTK) [Internet]. 2021 [cited Aug 12]. Available: https://www.nnedpro.org.uk/mtk