Improving Early Nutrition and Health in South Africa through Capacity Building

Ensuring adequate intake of micronutrients (vitamins and minerals) during the first 1000 days of life – the period from conception to the age of two years – is critical, as it is a period of rapid growth and brain development. The body’s requirements of key micronutrients increase markedly during this period but are often not met in low- and middle-income countries due to poor quality diets (e.g. lack of dietary diversity) or poor micronutrient absorption. Micronutrient deficiencies during the first 1000 days of life are associated with premature birth, low birth weight, stunting and impairments in brain development, with potential long-term health effects. In South Africa, an estimated 15% of infants are born with low birth weight and 27% of children under five years are stunted, a prevalence rate that has remained unchanged for almost 20 years.

Healthcare professionals are at the forefront of tackling micronutrient deficiencies

Unlike inadequate or excessive intke of macronutrients, chronic micro-nutrient deficiencies often go undetected, which is why they are also termed “hidden hunger”. It has been estimated that South Africa loses over 1.1 billion USD in Gross Domestic Product annually because of micronutrient deficiencies. Therefore, efforts to prevent micronutrient deficiencies, especially during the first 1000 days of life, should be given high priority. Such efforts include healthcare professionals (HCPs), such nurses and midwifes, supporting women and their families in improving their own and their children’s micronutrient intake and status. In South Africa, this requires a fundamental change in the training of HCPs to equip them with evidence-based and context-specific knowledge and skills to work with communities and individuals to tackle micronutrient deficiencies during the first 1000 days.

Development of a training programme for South African healthcare professionals

The Improving Early Nutrition and Health in South Africa (ImpENSA) capacity building project co-funded by the Erasmus+ Programme of the European Union aims to address the gaps in training of South African HCPs through the development of an innovative, evidence-based, blended learning training programme with focus on micronutrient nutrition during the first 1000 days.

The ImpENSA training programme comprises of two knowledge-based online modules and one skills-based virtual facilitated module.

Overview of ImpENSA Training Programme Modules (ImpENSA).

Development of eLearning module - “It takes a village to raise a child”

The African proverb is indeed very apt to describe the eLearning development and implementation process. eLearning is a multi-disciplinary domain. Thus, the development and implementation of an effective eLearning module requires a multi-disciplinary team. Subject expertise is essential, but it also requires expertise in education (learning theories, pedagogies, etc.), interactive learning design, media creation, digital technologies, educational research, implementation science (e.g. curriculum integration of the eLearning) and so on.

Illustration of eLearning module development process (ImpENSA).

Due to the multi-disciplinary nature of eLearning, good collaboration and communication in the team and documentation for next steps are very important. It has been a long journey for all who have been involved in the conception, development and design of the modules. However, despite the challenges faced caused by the COVID-19 pandemic, which forced the multi-disciplinary and multi-national teams to work and collaborate virtually, we were finally able to launch the ImpENSA Training Programme on the 6th of April 2022 in Stellenbosch, South Africa. A video providing a brief overview of the training programme can be watched online.

Filming of the video in process I (picture: ImpENSA).

Filming of the video in process II (picture: ImpENSA).

However, the work is not done yet. The modules are currently being piloted and evaluated by a group of target users. Once evaluation has been completed, the eLearning modules will be available open access on the ImpENSA Training Programme Platform.

Through the module we sincerely hope that HCPs can gain the necessary knowledge and skills to better support health behaviour change to optimise micronutrient nutrition in the first 1000 days of life.

ABOUT THE AUTHORS

Jeannine Baumgartner is a Lecturer in the Department of Nutritional Sciences at King’s College London in the UK and an Extraordinary Associate Professor at the Centre of Excellence for Nutrition (CEN) of the North-West University in South Africa. From November 2018 to March 2022, she was a Senior Scientist at the Laboratory of Human Nutrition at ETH Zürich.

Estelle Strydom, a Registered Dietitian, is the South African ImpENSA Project Manager and a PhD student at CEN of NWU.

Both authors have a keen interest in the role of micronutrients during early development and health, and in interventions to prevent and manage micronutrient deficiencies.

The World Food System Fund supported the team responsible for the development of the eLearning Module 1 on optimising micronutrient nutrition during the first 1000 days of life.