Development of nutrition, healthy eating and food preparation guidelines for child and youth care centres in KwaZulu-Natal, South Africa

Abstract

Background Child and youth care workers (CYCWs) are human service professionals that have constant contact with the children and youth placed in child and youth care centres (CYCCs). Some CYCWs work with children are uneducated and under-empowered. Childhood and adolescence are critical stages in life when physical, social, cognitive, and behavioural development occur. Methodologies and Results The development of the child nutrition, food preparation, food safety, and healthy eating guidelines in this study was carried out in accordance with the FAO framework used for planning, implementing, and evaluating. Situational analyses of child and youth care workers were part of phase 1 of the project (CYCCs). Nine respondents (two child and youth care managers (CYCMs) and seven CYCWs) from the two CYCCs were chosen. Selfadministration, one-on-one interviews with English-written interview questions that were translated into IsiZulu, weighing food to determine plate waste, and the collection and analysis of microbial samples for surfaces, hands, and water were all used to gather data. Thirty respondents responded to a second survey that was given out in the same CYCCs to determine the preferred learning materials. The outcomes of this phase improved the success of the primary study and helped design the guidelines. The results of this phase showed that all of the respondents had low levels of education, and some had no formal education. The respondents had a high level of work experience, with 44.4% having more than five years of experience in the CYCCs. Additionally, 100% of the respondents lacked training in food safety and hygiene. The observers noticed that food for the older children and adolescents was kept in the oven or stove for longer than 15 minutes before serving. None of the CYCCs had appropriate guidelines or procedures in place, nor did they have written and signed policies and procedures in place for receiving, storing, and serving food, as well as maintaining good hygiene and adhering to administrative practises. Despite a coliform count of 57 in the collected water samples, the CYCCs had access to water for drinking and cleaning utensils. According to the nutrition knowledge results, 88.9% of respondents did not understand the keys to healthy eating. When 77.9% of respondents suggested that starch should not be consumed in most meals, this revealed limited knowledge. Respondents were also unaware of how much water they should drink each day, with 66.9% incorrectly reporting that six or fewer glasses were sufficient. The food served to the children and youths, which included uPhutu and beef served with potatoes, lacked the variety of nutrients recommended by the FBDGs. Guidelines were preferred by 46.7% of respondents. Meanwhile, a sizable proportion of respondents (83.3%) preferred the learning material with drawings, images, photographs, and words written in isiZulu. The guidelines were developed based on the literature and phase one findings and presented to three subject matter experts for content validity. The experts received completed and language-edited guidelines. The guidelines' organisation and content were subjected to expert evaluation. They had two to three weeks to read and comment on the guidelines' content, organisation, structure, and overall aesthetic appeal. Reviews and comments were provided back to the researcher, who used them to update the guidelines based on advice from the experts. The guidelines were then revised, published, and translated. In order to collect data in the two CYCCs from 18 participants (pre-) and 14 participants (post-) implementation in the same study site(s), the behaviour over time was assessed using a three-step approach (pre- implementation (phase three), implementation (phase four), and post-implementation (phase five). the participant's prior knowledge of the guidelines' subject matter (menu planning, nutritious recipes, nutritional guidelines, food handling, and preparation). A behavioural change technique was used in the post-implementation phase to evaluate knowledge change over a ten-month period (the implementation process). Zoom was used for the interviews with the CYCMs and CYCWs. The discussion for this interview was facilitated by a video, which was also recorded with the participants' knowledge and consent. During the 10-month implementation period, participants were reminded once a week via phone and email to incorporate the guidelines into their day-to-day work activities and to ask clarification questions. Data from the pre-and post-implementation phases were transcribed and analysed using thematic analysis. Poor menu planning, failure to prepare nutritious recipes and follow nutritional guidelines due to limited funds, limited nutrition training, and limited knowledge of food handling, storage, and preparation were among the key findings that emerged from the pre-implementation of the guidelines.Guidelines were reported to be useful in the post-implementation phase in terms of menu planning, food handling and preparation taking into account all food groups, handling of cutlery and cutlery, proper washing of hands, hair covering, and food storage. Menu planning, the development of nutritious recipes for children and youths, following nutritional guidelines, food handling and food preparation, sourcing of ingredients, food preparation equipment, and personnel required to prepare the food were reported as lessons learned from the guidelines. Conclusion Poor hygiene and food handling procedures among CYCWs were attributed to a lack of skills training or guidelines prior to implementing the newly developed guidelines. However, there was a positive impact from the developed guidelines' post-implementation phase, where the respondents were discovered to have improved menu planning abilities, nutritional guidelines awareness, and food-handling skills, and could allocate correct portion sizes. The proper implementation of the guidelines developed in this study could reduce the rate of malnutrition and foodborne infections caused by poor food handling and preparation.