Arrived in Cap-Haitien late Sunday afternoon and despite the seven hour delay I couldn't believe how incredibly beautiful my first glimpses of the country were. We flew in a small prop plane and so we were not as high up as we would have been had we been in a jet. Haiti is extremely mountainous but I was not expecting the mountains to greet me as we descended. The literally rose right out of the water and into the clouds and as we landed in Cap, flew between them. Of all my descents and flights, this is definitely in the top three for its sheer beauty.
Come Monday morning, I got right into the swing of things and visited the schools we are partnering with. These schools (six total) are throughout Cap and cover students from first grade through sixth, although a few schools also have the equivalent of kindergarten as well. Like Senegal, these schools operate with very little resources and I am always amazed at the teachers who are dedicated to work within these obstacles - many of whom have not been paid for several years. But the children love school and they love learning - it is so easy to see that on their faces and the pride they take in wearing their uniforms and caring for their textbooks. Each of the schools are very different, for many reasons; some are in the city center and are smack in the urban chaos while others are more on the outside of the city, able to enclose a larger area for the kids to play. Some have electricity (though very limited), some have separate rooms for classes while in others classes are all taught in one large space. Nonetheless, every school has been more than gracious and cooperative in letting us constantly disrupt classes in order to conduct this study.
The government of Haiti (Ministries of Health and Education), as part of their child nutrition initiative is looking to add a school snack component to schools. As several of the kids I've met do not get to eat breakfast and are maybe given enough money to buy a bonbon at school (think processed, sugar and no nutritional value) it is important that the school snack be up the upmost nutritional value while being low cost to produce and distribute. There are three groups for the study, two schools in each group. As the study is quasi-experimental, it is important that the schools get matched and paired as equally as possible so that any noticeable difference between the groups can be identified and should the study be effective, reduce bias and strengthen validity. One group is our control group where they carry on business as usual with no specific snack or snack time. Although this group is not getting one of the two snacks we are studying, I feel that these groups are the most important in getting a picture of the school lifestyle that these kids encounter as well as getting an accurate measure of the nutritional status of these kids. The second group is testing a granola bar made from peanuts, oats, sesame and honey. While it isn't fortified with any micronutrients, it does have a decent amount of nutritional value for the kids. It is currently being made in Haiti and is very affordable. The third group in the study is receiving Mamba, a fortified peanut butter and soy bean blend. It is jam-packed with micronutrients and while slightly more expensive to make, would cover a child's nutritional needs for the day. So that’s a basic overview of setting up the study and the different between the three groups.
So the study is currently in it's implementation phase. This means that all of the children have gone through baseline measurements; their height, weight and hemoglobin have been recorded before the start of the study. This gives us a base from which to compare our mid-line (to be conducted in March) and end-line (to be conducted in June) data with, highlighting any changes in growth and iron content. While we are taking anthropometry measurements (height and weight), changes to these are harder to contribute to our study as kids naturally grow over time and it is affected by lots of outside forces (ie, genetics). However, where we hope to make the biggest impact and record the biggest change is in iron content in the body. Iron is just one of several micronutrients that significantly impacts anemia rates. Improving micronutrient status like iron is important for fighting infections, addressing diarrhea and improving cognitive development. Should the Mamba product we are studying be significant in improving rates of anemia, there is potential further impact child nutrition throughout a child’s life. During implementation, the children in the granola bar and mamba groups receive their snack everyday during the school week that they are present. So if there are present everyday, they receive the snack five times a week. The control group does not receive any snack but as I said before, it is common that the children are given a little money (usually about one Haitian dollar) to buy something.
What I'm doing now is visiting the various schools during snack time and in the morning to help with and observe snack distributions. Are the kids eating the snack? Do they like it? Do they eat something afterwards? How do the teachers think the snack impacts the children? Do the teachers like the snack? These are all qualitative questions that I ask that will give me a deeper understanding of the snacks' impacts beyond just what the data says. I’m also assisting in getting all of the baseline data entered and organized so that we can conduct a descriptive report of the kids as a preview of things to come.
It has been a busy first week in Haiti, but a great one. The schools have been so much fun to visit and learn about and I have gained a wealth of insight from the teachers, our enumerators (who distribute the snacks) and the kids themselves and look forward to work every day as I know it brings something new for me to learn and experience. Stay tuned for more!
Peace,
Jaime
Also- if you are more interested in learning about fortified peanut butter projects in Haiti, check out a few old stories on NPR
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