|SCN News, Number 14 - Meeting the Nutrition Challenge (ACC/SCN, 1997, 60 p.)|
FAO - Joint FAO/WHO Expert Consultation on Management of Risks Posed by Foodborne Hazards
A Joint FAO/WHO Expert Consultation on the Application of Risk Management to Food Safety Matters was held in Rome, Italy, from 28 to 31 January 1997. Participants included experts in food safety and risk management, representatives of international organizations and observers from the Codex Alimentarius Commission (CAC) and relevant Codex Committees. The primary objective of the Consultation was to provide recommendations on the practical application of risk management to food safety matters to FAO and WHO, thus to Member States and the CAC.
The Consultation considered risk management definitions, the general principles of food safety risk management and proposed guidelines for developing a risk management framework. In addition, the consultation reviewed the current risk management practices within the Codex Alimentarius Commission, and its subsidiary bodies and the interaction with advisory expert committees.
Among the key recommendations from the consultation, was the need for FAO/WHO to establish a joint expert committee to provide microbial risk assessment information to support Codex risk management decisions and recommendations. The consultation also recommended that the Codex Committees should review standards and advisory texts in their respective areas of responsibility.
The report has been published as Risk Management and Food Safety; Report of a Joint FAO/WHO Consultation, Rome, Italy, 27-31 January 1997, FAO Food and Nutrition Paper No. 65, and is available on the FAO WWW Home Page.
Joint FAO/WHO Expert Consultation on Carbohydrates in Human Nutrition
Our understanding of the role that carbohydrate foods play in both human nutrition and health has taken great strides during the past decade. With the advances in knowledge of carbohydrate foods have come new issues for nutritionists and public health officials to consider. A Joint FAO/WHO Expert Consultation on Carbohydrates in Human Nutrition was held from April 14-18, 1997 at FAO headquarters in Rome, Italy. The group of experts made recommendations regarding the role and use of carbohydrate foods in the diet and in the maintenance of health, including for the prevention of some non-communicable diseases.
There is growing understanding of the diverse physiological roles that these substances play, particularly when they are not glycemic and go on to be fermented in the colon. The consultation adopted recommendations to revise terminology for dietary fibre. Other recommendations are focused on disease prevention, encouraging an intake of at least 55 percent of energy from carbohydrate foods from a variety of sources, including a gradual transition in the diet of two year-olds toward diets consumed by adults.
The interim report of the consultation can be viewed on the Internet (http://www.fao.org). The final report of the consultation, including background papers, will be available later this year.
FAO Technical Consultation on Food Allergies
From 13-14 November 1995 a Technical Consultation on Food Allergies was held in Rome. In the interest of consumer safety, thirteen experts from developed and developing countries discussed food allergies and made proposals on the labelling requirements for packaged foods.
To assist the food industry in their task of consumer protection and to facilitate international harmonization and a uniform approach to the labelling of foods, the Codex Committee on Food Labelling (CCFL) considered including a mandatory listing of foods and ingredients which are known to cause hypersensitivity and which shall always be declared as such in the General Standard for Labelling of Prepackaged Foods.
FAO requested the group of experts to develop science-based criteria to determine which substances should be placed on the list of substances. Their opinion was sought on how to overcome the problem of class naming conventions for the products of allergenic foods, which are themselves also allergenic and which may be used as food ingredients. Finally the experts provided guidance on scientific considerations to be made in striking a balance between health requirements and technological limitations when considering labelling requirements for minor ingredients or for components of composite ingredients which are allergenic.
The experts provided FAO with clear guidelines and recommendations on how the CCFL should proceed in its work. The three criteria for inclusion on the list is the severity of reaction, prevalence of sensitivity among the population and the level of allergen in the food. Food ingredients or additives which are products of allergenic foods are to be included on the label and where an ingredient is given its functional name, the source of the ingredient should also be indicated, for example emulsifier (soya).
A report of the Consultation is available from The Chief, Food Quality and Standards Service, Food and Nutrition Division of the FAO, Viale delle Terme di Caracalla, 00100, Rome, Italy.
Background Papers of the Expert Consultation on Nutrition Education for the Public
The complete set of six discussion papers prepared for the Expert Consultation on Nutrition Education for the Public, held in 1995, has been published as FAO Food and Nutrition Paper Number 62. The publication covers the following topics: past experiences and needs for nutrition education; a framework for nutrition education programmes; nutrition education and communication strategies for different groups and settings; training needs for nutrition education; evaluation of nutrition education programmes; and new developments in computer-mediated technology for nutrition education. This document complements the earlier publication, Nutrition Education for the Public: Report of an FAO Expert Consultation FAO Food and Nutrition Paper, Number 59, which was published in 1995.
- Participatory Approaches in Community Nutrition
To promote a coordinated approach to improving household food security and nutrition at the local level, the Food and Nutrition Division is carrying out a joint in-service training programme for senior development officers (government and NGOs) at district level in three districts of Nepal. These five-day participatory training-cum-planning workshops are developed and implemented by a national training institution with technical assistance from FAO. Participants become familiar with relevant nutrition information, participatory planning approaches and participatory appraisal tools, as well as the use of the Guidelines for Participatory Nutrition Projects. The problem-solving approach promoted by the programme leads to the identification of concrete follow-up actions within on-going development programmes and projects. Participants are expected to replicate this training at a more decentralized level. A video on this exercise, 'Introducing Participatory Nutrition Programmes' is now available from the Food and Nutrition Division of the FAO, Viale delle Terme di Caracalla, 00100 Rome, Italy, Fax 39-6-52253152.
A similar approach - based on the joint identification of at risk groups and corresponding causes of malnutrition - is being followed in Guatemala as part of an activity to formulate a food and nutrition strategy for returnees and displaced people.
FAO believes that the two-stage participatory nutrition approach (training at district level followed by promotion of participatory nutrition activities at community level) can prove particularly useful in food insecure areas (e.g. drought-prone, HIV/AIDS affected areas, emergency relief and rehabilitation). It can also contribute effectively to sustainable human development and poverty alleviation.
- Improving Nutrition in Africa
An intercountry workshop on Improving food supplies and nutrition through household and village level processing of vegetables and fruits in Eastern and Southern Africa was organised by FAO in collaboration with the Government and the University of Zimbabwe and was held in Harare, 12-16 February, 1996. Delegates from five countries including Zimbabwe, Zambia, Tanzania, Kenya and South Africa participated in the workshop, presented country papers, discussed and exchanged information and made important recommendations for the improvement of village level preservation and processing of vegetables and fruits in the region. They also decided to establish a network for the exchange of information between the countries of the region with the Jomo Kenyatta University as the focal point. A report of the workshop is available in the Food and Nutrition Division, FAO, Rome.
A national workshop on Food-based approaches for the control of micronutrient deficiencies was held in Morogoro, Tanzania. This workshop was sponsored by FAO and was organised by the Food and Nutrition Unit of the Ministry of Agriculture, Government of Tanzania. The main objective of the workshop was to prepare a national programme for the control of micronutrient deficiencies in Tanzania through implementation of food-based programmes. The participants reviewed all ongoing nutrition activities and prepared an action programme on the subject with recommendations for future work.
Food Composition Activities
FAO is promoting the establishment and strengthening of national food composition programmes as well as increased regional collaboration among countries aimed at the generation and dissemination of reliable food composition data that meet the needs of national users. FAO anticipates that the regional orientation of collaborative work will assist in the sharing of resources and lead to the cost-effective implementation of food composition activities.
In 1996, these activities included technical and financial support to inter-country meetings on food composition activities in various regions; training courses in several technical aspects; assistance for national institutions and preparatory work for the establishment of Regional Technical Co-operation Networks on Food Composition. The inter-country meetings covered South Asia (SAARCFOODS); Canada, USA and Mexico (NORAMFOODS) and Central America (LATINFOODS). The first two meetings were jointly organized with UNU/INFOODS. At these meetings, participants addressed the major issues relative to food composition activities in their regions, and formulated recommendations useful for policy development at both central government and institutional levels. The recommendations focused on national programme development, regional co-operation, and linkages among food control, food industry and food composition programmes. Copies of the final reports of these meetings can be obtained from the Food and Nutrition Division upon request.
In 1997, two intercountry workshops to set-up technical cooperation networks on food composition in Central and Eastern European Countries (CEECFOODS) and in Mediterranean Countries (MEFOODS) have been held and training courses on the production and use of food composition data in nutrition are being organized. Through its Technical Co-operation Programme (TCP), FAO is considering proposals received from Bulgaria, China, Cyprus; Egypt and Lebanon for direct technical assistance in this area.
Collaboration in Nutrition Education
In light of technical issues and recommendations resulting from the World Food Summit, held in Rome in November 1996, the Food and Nutrition Division and the University of Giessen's Department of Nutrition are reviewing the curricula of selected international community nutrition masters' degree courses. Following the review, a document will be prepared to assist training institutions in developing and developed countries to strengthen their ongoing or planned courses.
Under the new FAO Special Partnership Programme, the Food and Nutrition Division is developing nutrition education materials for schools in collaboration with the National Institute for Nutrition in the Netherlands.
International Fund for Agricultural Development (IFAD)
Zambia - An Integrated Approach to Generate Drought Resilience
IFAD have adopted an integrated approach to improve household food security (HFS) and nutrition for drought affected households in Zambia. This is one of several recently launched projects in Southern and Eastern Africa that address the particular problem of transitory food insecurity induced by recurrent droughts.
Food insecurity is addressed in three ways:
1. Improving the long term resilience of households to food security risks. This would result from improved research particularly on soil and water conservation techniques and diversification towards drought-tolerant crops. Agricultural goals would be complemented by improving accessibility of remote areas, upgrading potable water supplies, and diversifying income sources.
2. Stabilizing household food access in deficit periods, through better storage practices and distribution of insecticides as well as improved market access.
3. Strengthening household food security monitoring.
The project aims to target the most vulnerable areas and meet the needs of the intended beneficiaries according to their own priorities. Gender awareness permeates all activities, recognising the special constraints faced by women, their needs and responsibilities for HFS and nutrition. The project features strong support for a unified national food security monitoring system, integration into a broader agricultural sector programme, and inter-agency collaboration with UNICEF and WFP. The project also highlights the need for a national perspective and a set of policies and mechanisms through which the Government of Zambia could consistently address the food insecurity problem.
For further information, please contact Dr Mona Fikry, Technical Advisor on Gender and Household Food Security, IFAD, 107 Via del Serafico, 00142 Rome, Italy. Phone: 39 6 54591 Fax: 39 6 5191702
Interactive Multimedia in Nutrition Learning
For many years, UNICEF have discussed the need of a comprehensive Nutrition Learning System, based on modern multi-media and communication systems. This idea was discussed at two meetings during the UNICEF Network for a Nutrition Initiative in South Asia, 1996; the first in Rajasthan (10-12th October), and the second in Bangkok (11-13th September).
Preparing this interactive global learning package will require the cooperation of a global network of partners. UNICEF and learning institutions (primarily universities) will be the key partners. Data on all aspects of the nutrition problem will be compiled centrally (UNICEF HQ) and stored in databases.
The learning package will consist of three major parts; a Knowledge Base (structured in 10 modules according to the UNICEF promoted Conceptual Framework), a Triple A Tool Box, and a Triple A Stimulation (game). The 10 modules of the Knowledge Base will be (1) nutritional status and mortality, (2) dietary intake, (3) diseases, (4) household food security, (5) care practices, (6) health services, (7) water and sanitation, (8) education, information and communication, (9) access and control of resources, and (10) basic determinants and causes. The Triple A Tool Box will include a series of modules on how to assess, analyse and act, and will also include description and information on how different strategies (advocacy, information, education, training and service-delivery) affect the establishment and/or strengthening of Triple A processes at different levels. Each of these components, and the relationships between them will be described and presented using a variety of multimedia; text, graphics, audio, video and animation. The learning package may be available as CD-ROM, through the internet, or a hybrid of both with links to the Internet launched from various parts of the CD-ROM.
Source: 'Interactive Multimedia in Nutrition Learning' (Part I) - report on the second meeting at Bangkok, Thailand, 11-13 December, 1996; U. Jonsson, Regional Director, UNICEF Regional Office for South Asia, P.O. Box 5815, Lekhnath Marg, Kathmandu, Nepal, Fax (977-1)419479, Email: firstname.lastname@example.org
Nutrition Improvement in Niger
A UNICEF-supported Nutrition, Family Food Security and Environment Programme in Maradi Province, Niger has shown successful outcomes in several key areas. Malnutrition has declined: in one of the first districts to implement the Programme, malnutrition of preschoolers declined by 18%. Crop production has improved, breastfeeding practices have improved, and women's workload has declined.
The key to this success is the empowerment of women, enabling them to manage small enterprises, be members of village development committees, and generally to help assess community problems and find solutions appropriate to their own needs.
Programme activities include motorised grinding mills, mule carts to reduce time needed to fetch water, cereal banks that help reduce seasonal dips in food availability, and basic health and sanitation measures. Government agents who have been trained in community participation will continue to train and support women. The Programme should cover about a quarter of the country by the year 2000.
Source: UNICEF Communication, June 1996
Eighth Meeting of the UNICEF ESARO Household Food Security and Nutrition (HFSN) Network, Mangochi, Malawi, 16-19 April, 1996
In Africa, urbanization is occurring rapidly. UNDP estimates that the urban population in Africa will double to 361 million by the year 2000. The result is a shift in poverty from rural areas to low-income peri-urban slums that are unplanned and generally fast growing.
In recognition of the urgent and important need to address the urban problems related to nutrition and care, the eighth meeting of the UNICEF ESARO Household Food Security and Nutrition Network was convened in Mangochi, Malawi, 16-19 April 1996. The following recommendations were agreed upon.
Nutrition policies should differentiate between urban and rural household food security and nutrition conditions, with special attention given to vulnerable groups in urban poor families, street children and disabled children. City-wide policies on urban HFS should be formulated, and as women are the key persons in promoting urban HFS and nutrition, activities to empower women socially and economically must be implemented.
Urban Policy, Analysis and Planning
The new paradigm for urban poverty eradication must be South-South cooperation, particularly African-Asian cooperation on urban agricultural micronutrient rich food production and exchange of technological information and experiences.
Urbanization, Policy Making and Planning
UNICEF and other donors are encouraged to fund the emerging post-Bellagio ESARO research and training network to improve the efficacy of nutrition programmes to review, refine and adapt existing poverty indicators to urban situations. The UNICEF policy on urbanization should be reviewed to consider the changing conditions of the urban poor.
For further information, please contact Dr Festo Kavishe, UNICEF, No. 11, Street 75, Straschark Quartier, P.O. Box 176, Phnom Penh, Cambodia. Fax: 855-23-426284 Phone: 855-23-426214/5 & 427957/8 Email: email@example.com
Performance of WFP in 1996
For the fourth consecutive year the global availability of resources for food aid declined; the volume of food decreased from over 16 million tons in 1993 to 7.5 million tons in 1996. In 1996, WFP delivered 2.6 million tons to 45 million beneficiaries, among which 25 million were emergency victims (refugees, internally displaced people and victims of natural disasters). In order to meet its commitments for emergency food aid, WFP had to curtail its development programme, including Food for Work, School feeding and MCH activities, in all but the least developed countries, as increased efficiency could only compensate for part of the reduction in resources.
The importance of nutrition considerations in food aid implementation is increasingly recognised in WFP. As a consequence, there are now two senior nutrition advisers at HQ, while provisions are being made to employ nutrition expertise at regional/country level in the ongoing decentralisation exercise.
WFP has started to review its operational policies for use of food in development activities, looking for windows of opportunities where food aid has comparative advantage. In this connection, guidelines for School feeding have been completed with emphasis on cost-efficiency. Particular attention is paid to short-term hunger and micronutrient deficiencies as impediments for learning ability.
A new policy concerning MCH interventions is being discussed. A workshop on the theme Breaking the
Inheritance of Hunger has reviewed the role of supplementary feeding.
The realisation of the strategic role of women in household food security has changed WFP's approaches which now strongly support the involvement of women in management and implementation of food aid activities, contributing thereby to women's empowerment.
Special donor funding mainly from Canada is available to strengthen micronutrient components in WFP activities. A major limitation is the lack of available cost-effective technologies to fortify cereal and legume grains, which form a large part of the commodities WFP distributes. Some highlights:
· only iodised salt is distributed in WFP programmes;
· most vegetable oil is fortified with vitamin A; in local purchases partially refined palm oil is now selected;
· local production of fortified blended foods is growing; this product is increasingly used in School feeding (Nepal, Ethiopia), MCH programmes (India, Senegal) and increasingly in the general rations of emergency and refugee programmes;
· low-cost cereal drinks basically consisting of blended food with a generous addition of sugar, are used in School feeding programmes and vulnerable group feeding programmes to replace milk;
· when cereal flour is distributed, most of it is now fortified with B vitamins and iron (maize flour from South Africa for Liberia, wheat flour from Europe for ex-Yugoslavia and CIS-countries);
· the introduction of fortification of wheat flour with B vitamins and iron on a nation-wide scale is assisted by WFP (Bolivia and Yemen);
· a pilot project for milling of cereals at the distribution site is in preparation; this activity will also investigate the possibility of flour fortification.
Restructuring of Nutrition, Food Safety and Food Aid Programmes
As part of the ongoing reform process and with a view to strengthening operational integrated programmes in public health, the Director-General decided to restructure the nutrition, food safety and food aid programmes at headquarters. The following changes were effective from April 1997.
The Division of Food and Nutrition was disbanded. The Director-General announced the appointment of Dr G.A. Clugston as Director, Programme of Nutrition (NUT), which is placed within Family and Reproductive Health (FRH), with Dr T. Turmen, Executive Director.
The Food Safety and Food Aid Programmes became the Programme of Food Safety and Food Aid (FSF), reporting to Dr F.S. Antezana, Assistant Director-General. The Director-General announced the appointment of Dr F.K. Krstein as Director, Programme of Food Safety and Food Aid.
Source: WHO Information Circular, 1997
A New Growth Reference Curve for the 21st Century
Plans to conduct an international multi-centre study have been drawn up by WHO in collaboration with the United Nations University and other international and national institutions, with the primary aim of constructing a new international growth reference. The intention is to carry out the study over a period of four years with the objective of building a set of growth curves for children up to five years from seven geographically diverse countries, with WHO Geneva taking responsibility for central coordination and data management.
The proposal comes in response to deliberations by a WHO Expert Committee, who in 1993 drew attention to the problems associated with the existing growth reference, challenging its suitability for international purposes and expressing serious concern over its use for assessing the growth of healthy, breast-fed infants. WHO-supported research indicated that an inappropriate international reference may lead health workers to misinterpret the growth patterns of breast-fed infants and mistakenly advise mothers to supplement unnecessarily with complementary foods or even to stop breast feeding altogether. The potential adverse consequences for the health and nutritional well-being of infants and the implications for child-spacing resulting from this misinterpretation, led to a request by the World Health Assembly in 1994 to develop a new international growth reference to assess the growth of breast-fed infants (resolution WHA47.5). It is expected that a new, technically sound growth reference will support the identification of the earliest signs of poor growth and, as a result, promote early remedial action to prevent the cycle that, unbroken, leads to more severe forms of malnutrition and increased mortality.
For further information, please contact: Dr Mercedes de Onis, The WHO Multicentre Growth Reference Study. Nutrition Programme, World Health Organisation, 20, Avenue Appia, 1211 Geneva 27, Switzerland. Tel: 4122 791 3320; Fax: 41 22 791 0746/4156, Email: firstname.lastname@example.org
Development of Strategies on Caring for the Nutritionally Vulnerable During Emergencies
WHO is currently implementing activities to develop strategies on caring for the nutritionally vulnerable during emergencies as part of its efforts in implementing the World Declaration and Plan of Action for Nutrition.
A draft review document on Caring for the Nutritionally Vulnerable during Emergencies: A Review and Implications for Policy has been prepared. This review document will be sent out for the peer review in June 1997. In addition, several rapid assessment case studies which examined intrahousehold resource distribution, caring practices and nutritional vulnerability during emergencies were undertaken to provide additional information and data to be incorporated in the review document. It is planned that, in collaboration with concerned agencies and experts, a technical consultation will be organized later in 1997 to examine the review document and develop strategies on caring for the nutritionally vulnerable during emergencies. It is envisaged that based on the strategies and guiding principles developed at the consultation, training modules will be developed in order to assist health personnel working in emergencies.
For further information, please contact: Ms C. Nishida, Nutrition Programme, World Health Organisation, 20, Avenue Appia, 1211 Geneva 27, Switzerland. Tel: 41 22 791 3317; Fax: 41 22 791 0746/4156, Email: email@example.com
Multi-Country Study on Improving Household Food and Nutrition Security for the Vulnerable
A multi-country study on improving household food and nutrition security was launched in February 1995 as part of WHO'S efforts to implement the World Declaration and Plan of Action for Nutrition and is currently being implemented in China, Egypt, Ghana, Indonesia, Myanmar and South Africa. The ultimate aim of the multi-country study is to develop guiding principles for use by policy makers for increasing awareness of household dynamics and also the importance of incorporating cultural, socio-economic and behavioural considerations in development policies and programmes intended to improve household food and nutrition security for the vulnerable.
The specific objectives of the study are:
1. to identify factors influencing the dynamics of intrahousehold food and other resource distribution for improving nutritional security of the vulnerable;
2. to stimulate and build a national capacity for operational research on the examining determinants of health, nutrition & behavioural change and also on approaches to enhance the health, nurturing, caring and development functions within households and communities;
3. to facilitate household and community-based interventions to ensure and enhance family well-being with specific focus on caring for the vulnerable, e.g. infants, young children, women, and the aged;
4. to foster the development of programmes and human resources to protect and promote the health and nutrition security of the vulnerable;
5. to collect and disseminate scientific and technical information, and facilitate and encourage the international exchange of ideas and experience.
The following are the collaborating institutes and organizations in each site:
China - Chinese Academy of Preventive Medicine
Egypt - National Nutrition Institute
Indonesia - GTZ and Universitas Indonesia
Ghana - Noguchi Memorial Institute for Medical Research at the University of Ghana, International Food Policy Research Institute (IFPRI), Rockefeller Foundation, CIDA, IDRD, UNICEF and national NGOs
Myanmar - Ministry of Health
South Africa - Department of Paediatrics and Child Health at the University of Natal Medical School
A mid-project review meeting will be held at the WHO Centre for Health Development in Kobe, Japan from 12 to 14 November 1997.
For further information, please contact: Ms C. Nishida, Nutrition Programme, World Health Organisation, 20, Avenue Appia, 1211 Geneva 27, Switzerland. Tel: 41 22 791 3317; Fax: 41 22 791 0746/4156, Email: firstname.lastname@example.org
WHO, at the request of the International Labour Office (ILO), plans to revise the Maternity Protection Convention (Revised), 1952 (No. 103), which will be on the agenda of the 1999 International Labour Conference. In view of the two organizations' common interest in the health aspects of maternity protection, ILO has asked WHO to collaborate in the preparation of a law and practice report for discussion by the Conference, including recommended care for pregnant women and women who have recently given birth; minimum period of prenatal and postnatal leave; recommended duration of breast-feeding and breast-feeding breaks; on-the-job accommodation of job duties and rest breaks for pregnant women and women who have recently given birth; and protecting pregnant and lactating women from occupational and industrial hazards.
For further information please contact Ann Herbert, CONDIT, International Labour Office, Route des Morillons. CH-1211 Geneva 22. Switzerland. Fax: 41-22-798 86 85, Email: email@example.com
Foodborne Disease Problems Posed by Escherichia coli O157:H7
A WHO Consultation on the Prevention and Control of Enterohaemorrhagic Escherichia coli (EHEC) Infections was held in Geneva from 28 April to 1 May 1997. Food Safety experts from 14 different countries assembled to share national experiences and lessons learned regarding the contamination of the food supply with EHEC strains, and to exchange information on current approaches to the prevention and control of infections and outbreaks caused by E. coli O157:H7 and other EHEC strains. Escherichia coli commonly occurs in the intestine of humans and other animals. There are several pathogenic types of E. coli, which cause a variety of human diseases. In 1982, E. coli O157:H7 was recognized as a human pathogen for the first time, and, since then, has been a steadily increasing cause of foodborne illness worldwide. The pathogen produces potent toxins and causes a particularly severe form of human disease, haemorrhagic colitis. About 10% of these patients can go on to develop the haemolytic uraemic syndrome (HUS), a life-threatening complication of E. coli O157:H7 infection that is characterized by acute renal failure, haemolytic anaemia, and thrombocytopenia that is particularly serious in young children. On average, 2-7% of patients with HUS die, but in some outbreaks among the elderly the mortality rate has been as high as 50%.
E. coli O157:H7 is transmitted principally through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk. Faecal contamination of water and other foods, and cross-contamination during food preparation have been important routes of infection. The range of foods reported as vehicles of transmission and the numerous transmission routes create a major challenge in terms of designing prevention and control strategies.
The consultation specifically considered the issues of surveillance, outbreak investigation and control strategies. When establishing surveillance for EHEC infections, emphasis should be placed on timely collection, analysis and transmission of data to those who can undertake an appropriate response at local, regional and national levels. Appropriate incentives must exist to encourage data providers to supply the needed data in a timely manner. One of the most important of these is the timely feed back of surveillance information in a useful format to those who have provided raw data. A variety of approaches have been taken to surveillance for EHEC infections. The principal systems for surveillance include hospital-based systems for identification of HUS cases and laboratory-based systems for the identification of infected individuals. The latter can be supplemented by active sentinel surveillance systems in some circumstances, for example, in regions in which culture for E. coli O157 is not routine. The development of outbreak surveillance systems (that is, systems to document the number and characteristics of EHEC outbreaks over a given time period) is of great value given the magnitude of past outbreaks, the serious nature of the disease and the valuable lessons to be learned from outbreak investigations.
Successful outbreak investigation often depends on keeping effective lines of communication open among multiple agencies involved in public health, food and agriculture. Experience with recent outbreaks shows that media attention will be swift, dramatic and intense because of the serious nature of EHEC infection and the age groups affected. Information from the outbreak team should be channelled to the media via a designated officer by means of regular press briefings. Information should be accurate and consistent.
In general the prevention of foodborne diseases must be based on good hygienic practices and the control of contamination of foods by biological and chemical hazards. This can be most effectively achieved through the application food safety assurance programmes, based on the principles of the HACCP system. Such a system should be applied by primary producers, manufacturers, retailers, food service establishments and consumers. Recommendations included the application of such food processing methods as pasteurisation of milk to eliminate EHEC, thorough cooking of foods and education of food handlers and farm workers in principles and application of food hygiene measures.
Source: Dr F.K. Krstein. Director, Programme of Food Safety and Food Aid, WHO, 20 Avenue Appia, CH 1211 Geneva 27, Switzerland. Tel: 41-22-791 3535, Fax: 41-22-791 4807 Email: firstname.lastname@example.org
Global Burden of Disease Study
In the minds of some the Global Burden of Disease Study revolutionized priority setting in the health field when its findings were first published in 1993. Up to that time there had been no reliable epidemiological data set comprehensive enough to identify priorities for health services and research. The GBD Study is a worldwide collaboration of over 100 researchers, sponsored by WHO and the World Bank and based at the Harvard School of Public Health. The results of this study provide new analysis of world health.
The GBD is now in its fifth round. The series quantifies the burdens of 483 sequelae of 109 major causes of death and disability disaggregated by region and age-sex groups. Risk factors are evaluated and projections to the 2020 are made. Results are presented in a series of very large (1000 pages, hard cover) volumes.
Where does nutrition fit in? Nutritional deficiencies (including PEM, vitamin A deficiency, IDD and anaemia) are included amongst Group I causes of death, i.e., conditions that decline at a faster pace than all-cause mortality during the process of the epidemiological transition. This is new. At an earlier stage of this work it was felt that there was too much uncertainty in distinguishing these deaths from other nutritional causes using data available at that time. Group II is non-communicable diseases and Group III is injuries.
In general, results show that the epidemiological transition in developing regions is considerably more advanced than is generally thought. Noncommunicable diseases already cause more deaths in the developing world than communicable diseases. Health promotion and disease prevention programmes will have to adapt to this public health reality. So will nutrition thinkers, doers and advocates.
The GBD will come out with a volume VIII next year that presents estimates of malnutrition as a cause of death and disability. Volume VIII will cover PEM (Bailey, de Onis and Bloessner), vitamin A deficiency (Underwood), IDD (Bailey), anaemia (Bailey and Abou-Zahr), and cancer (Miller). The chapter on PEM will present estimates of mortality attributable to malnutrition based on Pelletier's research on the potentiating effect of malnutrition (see Figure on next page). A separate volume IX on selected risk factors is also planned. A recent article published by the same authors in Science (vol. 274, p.740) presents the global burden of disease attributable to selected risk factors. Malnutrition came out on top, accounting for 11.7% of total deaths. Poor water and sanitation was next. This is important work to follow.
More information can be obtained from Dr Man Lopez, Programme on Substance Abuse, WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41-22-791 2374, Fax: 41-22-791 4851. Email: email@example.com
It would be helpful to the GBD study team if those interested eventually in purchasing the nutrition volume could make this known to Dr Lopez' office. The cost for individual copies will be $49.95. It would be particularly appreciated if professional societies would agree to advance purchase several hundred copies of the volume for subsequent distribution to their constituencies - there would be a reduction for such bulk purchases of around US$10 per copy - contact Dr Lopez for more information. The volume will be available through Harvard University Press.
Child Health and Development
Nutrition is prominent in the work of the Child Health and Development Division (CHD) at WHO. CHD's primary objective is to significantly reduce mortality and morbidity associated with the major illnesses of childhood in the developing world. Deaths associated with malnutrition account for 54% of the 11.6 million child deaths each year.
In April of this year the technical advisory group of the CHD Division stated in recognition of the fact that disease and nutrition are synergistic in determining child mortality and must therefore be dealt with in an integrated way... support for development and testing of nutrition interventions [should] be given even higher priority.
Some of the work in progress includes: research on interventions for the promotion of breastfeeding, persistent diarrhoea and breastfeeding, and complementary feeding. Recent work on the Ten Steps to Successful Breastfeeding, which is the basis of BFHI, systematically reviews the effect of each step on the incidence and duration of breastfeeding.
The Division also continues to support a multicenter trial on the safety and benefits of vitamin A supplementation. This trial involves the follow-up of some 10,000 infants through monthly home visits from birth to nine months of life. Results will be available later this year. A substudy will provide insight into whether bulging fontanelle, a side-effect of supplementation in small babies, is associated with impairments in child development.
Other review work on zinc indicates that zinc supplementation tends to substantially reduce diarrhoea duration and the incidence of pneumonia. Zinc supplementation may also reduce malarial morbidity.
For more information contact Dr J.L. Tulloch, Director, Division of Child Health and Development, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41-22-791 2632, Fax: 41-22-791 4853, Email: firstname.lastname@example.org
Distribution of 11.6 million deaths among children less than 5 years old in all developing countries, 1995
Based on data taken from Bailey K, de Onis M, Bler M. Protein-energy malnutrition, in: Murray CJL, Lopez AD, eds. Malnutrition and the Burden of Disease: the global epidemiology of protein-energy malnutrition, anaemias and vitamin deficiencies. Volume 8, The Global Burden of Disease and Injury Series, 1998 (in press), and Pelletier DL, Frongillo EA and Habicht JP, Epidemiologic evidence for a potentiating effect of malnutrition on child mortality, Am J Public Health 1993; 83: 1130-1133.
African Nutrition Database Initiative
The ACC/SCN Secretariat organized a meeting, 27 June 1997, in Geneva, to consider an African Nutrition Database Initiative proposed by the World Bank. Participants attended from the FAO, ILO, UNHCR, WHO, World Bank, and SCN Secretariat. There was full agreement on the concept, which brings together a common nutrition database for Africa.
The approach will entail linking sectoral databases through a common query engine, agreed standards for data definition, and the establishment of a working group to select the indicators and determine means to assure data quality.
A copy of the meeting report can be obtained from the ACC/SCN Secretariat, c/o WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Fax: 41-22-798 88 91, Email email@example.com