Intervention
pulses-based, Pulses-based foods
UNDERNUTRITION
The intervention was a pulses-based nutrition education delivered to female adolescents from the two schools. The comparator was the usual dietary practices of female adolescents from the other two schools. The female adolescents from the intervention arm received weekly lessons for four weeks on one session per week basis, each session lasting for about 45–60 min.The first session was about the definition of undernutrition and the short and long-term consequences of undernutrition for female adolescents. The second session was an overview of food groups that constitute a balanced diet, including their sources and nutritional functions. The third session emphasized common pulses in the study area, such as broad beans, peas, chickpeas and lentils. This session included the daily required quantity of pulse and the details of pulse processing, which included cleaning, washing, soaking, germination and boiling, and the benefit of further processing of pulses relating to removing anti-nutrients, improving its test and digestibility, and mixing them with cereals for improving the quality of proteins. All the above three sessions were theoretical sessions, the teaching methods of which were lecture and group discussion with the aid of flip charts, posters and leaflets. The fourth session was a demonstration of what was detailed in the third session. Selected pulses-based foods were demonstrated during this session. The selection of recipes considered the relative ease of accessing the pulses and other ingredients and ease in terms of time and skill to prepare them. Pulses-based foods like foods in soup and solid forms mixed with rice and vegetable were demonstrated. This is because our previous survey revealed that although the consumption was less frequent and not usually mixed with cereals, the preparation in roasted, boiled, germinated and bread forms are not new in the study area. Pulses and rice were the main components in the demonstrations, with vegetables, spices and oil added to enhance the flavor of the food. The quantities of pulses mixed were made to approximate the recommended quantity. Broad beans were used for the demonstrations conducted in the North and chickpeas in the South.The theoretical components of the nutrition education were delivered by the investigators, and the demonstrations were conducted by a chef. The maximum number of participants per training session for the theoretical and demonstration was 50.To enhance adherence to the nutrition education sessions, participants who were unwilling to participate after an explanation of the purpose, risks and benefits of taking part in the intervention were excluded. We also excluded participants who were not sure whether they would leave the school during the study period or not. A nutrition education manual was developed and used to enhance fidelity.The nutrition education manual was developed following a review of Food and Agriculture Organization (FAO) materials related to general dietary knowledge, attitude and practice assessment guidelines, and guidelines specific to pulses processing and pulses-based food preparation [