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close this bookSCN News, Number 16 - Nutrition of the School-aged Child (ACC/SCN, 1998, 80 p.)
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Prevention of Micronutrient Deficiencies:
Tools for Policymakers
and Public Health Workers (1998)
edited by Christopher P. Howsen, Eileen T. Kennedy and Abraham Horwitz, Committee on Micronutrient Deficiencies, Institute of Medicine

Review by Frances Davidson, USAID



Together with many colleagues, USAID has a longstanding Interest in Identifying and sharing analyses of programmes it helps implement so as to extend their impact and encourage others to benefit from these experiences - successes and failures. To a certain extent this commitment comes out of the recognition that meaningful evaluations of nutrition programmes and their true impact remains a considerable void in our communal development experience. Answers to the question 'what does it really take to develop, implement and sustain a successful nutrition intervention' remain elusive.

In 1989, the International Nutrition Planners Forum published, 'Crucial Elements of Successful Community Nutrition Programs'. In this document an attempt was made to develop an analytic framework to identify the crucial issues identified as responsible for the success of a few selected programmes. It was thought this might be a practical way of promoting better nutrition and avoiding failures. The 1989 publication synthesised the experience of USAID's efforts to identify the elements that had been crucial in achieving nutrition programme success. It found that success required broad participation in the planning and implementation by those who are expected to benefit from the programmes and those who are to provide the services. It further documented a developing theme at that time of 'partnerships' between service providers and targeted groups, between government and the private sector, between entrepreneurial groups and volunteer groups, and other partnerships necessary to establish and, more importantly, sustain successful programmes. Since then other agencies, notably the World Bank, the Micronutrient Initiative, and IVACG have made valuable contributions to this discussion.

In attempting to make a further contribution to the state-of-the-art in analysing programme performance, USAID asked the National Academy of Sciences (NAS) to call together an expert group of individuals to do a systematic examination of the reasons for the success of programmes and at the same time, identify the constraints that limited successes. The group included scientists and programme implementers. Their charge was to review past approaches that had or had not resulted in success and to identify the elements of success or failure. The NAS focused on micronutrient malnutrition because it is a topic that has seized a great deal of attention from many donors and country governments. This is due in large part to the elimination of micronutrient malnutrition being seen as something 'doable' and because we hoped that from this beginning, the way in which to ensure progress in the larger issues of malnutrition might be encouraged.

The case studies represent only a fraction of the many successful nutrition programs that have been implemented in developing countries. They were selected as reflecting broad geographical diversity and as illustrative of a variety of community and technical approaches.

Organisation of the Report

The Report is organised into two volumes. The first volume is the Summary and Key Elements. The second includes the contents of the first, along with the three commissioned background papers on vitamin A (by Barbara Underwood), iron (by Fernando Viteri) and iodine deficiency (by John Stanbury). The NAS report does not offer recommendations on how to alleviate specific mcironutrient deficiencies - these recommendations are already available through the publications of diverse organisations, including USAID, WHO, UNICEF and others. Rather, this report provides a conceptual framework based on past experience that will allow funders to tailor programmes to existing regional/country capabilities and to incorporate within these programmes the capacity to address multiple strategies (e.g., supplementation/fortification/other food based approaches/public health measures and multiple micronutrient deficiencies).

Several global conferences have focused attention on micronutrient malnutrition and raised awareness of the problem and the tremendous toll they take in human and country development. Solutions to these micronutrient deficiencies were said to be technologically possible, and substantial financial resources have been committed to solving the problem by many governments and donors. Less attention has been devoted to understanding the key elements needed to implement and sustain a micronutrient intervention on a fully operational scale - regional or national - as opposed to a pilot project scale, at either the national or community level. In fact this has been cited as a problem not only of micronutrient interventions but nutrition programmes in general.

This report focuses on lessons learned from past interventions to address iron, vitamin A and iodine malnutrition - the committee limited its evaluation to these three micronutrients because it felt there was adequate experience for each. However, they believe that the lessons learned for improving future intervention strategies would also be applicable to prevention and control of malnutrition created by deficiencies of other nutrients. And as the literature and experience accumulate, it will be appropriate to explore similar theses regarding other micronutrients such as zinc, folate and vitamin B12.

Early on in the process, it was recognised by the Expert Committee that there would be an array of potential alternative strategies to deal with micronutrient malnutrition, and that it was unlikely that any one intervention by itself would solve all the micronutrient deficiencies in a given region, country or population group. Thus, the mix of scientists and project implementers invited to the workshop were designed to help ensure identification of the optimal combination of interventions most likely to be successful in a selected context. The range of participants also allowed for complementarities in treating micronutrient deficiencies to be identified.

An important feature of this report is the Committee's attempt to provide a framework for planning intervention programmes that integrate the three micronutrients and provide matrices for assigning priorities to interventions in different contexts. The Committee offers these matrices as guidelines only, recognising that there may be circumstances in which unique opportunities or barriers - in both human and material resources - exist that may lead countries to deviate from the priorities in the matrix. It is hoped that the matrices offer a useful starting point for planners and donor agencies.

A special note of thanks is due to the members of the Expert Committee and the Report Editors who so generously gave of their time and talents to this endeavour.

Published by the National Academy Press. 224pp (including 51 pp for the Summary and Key Elements). US $30. Special discount price of US $24 if ordered through the web ( Discounts are also available for orders of multiple copies. Both volumes of the report are available from the National Academy of Sciences Press, 2101 Constitution Avenue, N.W., Lockbox 285, Washington, D.C. 20055, USA. Tel: 1 202 334 3313 Fax: 1 202 334 2451.

Frances Davidson can be contacted at USAID, Office of Health and Nutrition, RRB, 3rd Floor, 320 21st Street N.W., Washington DC 20523-3708, USA. Tel: 1 202 712 0982 Fax: 1 202 216 3174 Email:

WHO Nutrition Publications -1998 Catalogue

The 1998 catelogue listing WHO nutrition publications and documents is now available from WHO Distribution and Sales, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 2476 Fax: 41 22 791 4857 Email:

Agriculture, Food and Nutrition for Africa A Resource Book for Teachers of Agriculture (FAO, 1997)


The need for a comprehensive source of training materials about African food systems has long been recognised. To address this need, FAO has published 'Agriculture, Food and Nutrition for Africa', which is designed as a source of teaching material for teachers of agriculture in Sub-Saharan Africa who wish to introduce a food and nutrition component into their training programmes. Resource material, presented in boxes, tables and figures, has been selected from a range of mainly English-speaking African countries and ecological regions. The material is elaborated in nine chapters covering such topics as the food chain and links among agriculture, nutrition and food security, food supply systems in Africa, food and dietary diversification, food storage and processing, nutrients and diets, malnutrition and micronutrient deficiencies, and nutrition education.

With selection and adaptation of the material to meet specific needs, this resource book may be used for diploma and bachelor's degree-level courses in fields such as general agriculture, agricultural extension and agricultural education; for in-service training courses, workshops and seminars for agricultural extension agents, rural development workers, administrators of agriculture and of rural development programmes, and government policy-makers in food, nutrition and agriculture; and for in-service education of secondary school, college and university teachers of agriculture.

Published by FAO. 412pp. US $40 (discounts available for developing countries and bulk orders). Copies are available from the Sales and Marketing Group, Food and Agriculture Organization, Viale delle Terme de Caracalla, 00100 Rome, Italy, Tel: 39 6 5705 5727 Fax: 39 6 5705 3152 Email: Web: For more information about this, and other FAO nutrition publications, please email Nutrition

Breaking the Rules, Stretching the Rules (1998)
A worldwide report on violations of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes

Breaking the Rules, Stretching the Rules 1998 reports on violations of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes1 and relevant WHA Resolutions revealed during a 31-country survey carried out between January and September 1997. Even though the marketing practices of the main producers of infant formula and other breastmilk substitutes claim to abide by the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes, the report provides evidence that the producers continue to undermine breastfeeding and infant health.

1 The WHO/UNICEF International Code of Marketing of Breastmilk Substitutes was adopted in May 1981 by the World Health Assembly. It presents a code, developed jointly by WHO and UNICEF, for the marketing of breastmilk substitutes. The code applies to the marketing of breastmilk substitutes, including infant formula, and other milk products, foods, and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable for use as a partial or total replacement of breastmilk. The code deals in successive articles with information and education needs concerning the feeding of infants, advertising or other forms of promotion to the general public, and standards for product labelling and quality. 35pp. CHF3 (US $2.70); CHF2.10 in developing countries. Available from WHO, Distribution and Sales, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 2476 Fax: 41 22 791 4857 Email: Web: The Code is also available in full text on the IBFAN website at (Source: WHO publications website


The major conclusion of the report is that the industry continues to focus on the health care system, building up mailing lists of new mothers. Most companies have stopped advertising infant formula directly to the public. Nearly half of the 56-page illustrated report is devoted to examples of continued violations of the International Code in hospitals and clinics. It also gives numerous examples of companies breaking the rules of the Code and WHA resolutions, by donating samples and supplies, posters, calendars, promotional booklets and gifts to health professionals and to mothers.

The subtitle 'Stretching the Rules' refers to the final section of the report, which describes how new products and practices have been introduced to a number of countries. One such product, marketed by at least 10 major companies, is a 'formula for mothers', which, says the report, allows companies to ride on the breastfeeding wave, sell a new product, and by promoting it widely, remind mothers, doctors and midwives of their company name.

IBFAN. 56pp. US$6 to non-profit groups; US$15 to profit groups, inclusive of airmail postage. Copies of the report are available from IBFAN, Penang: IBFAN, P.O.Box 19,10700 Penang, Malaysia. Tel: 60 4 6569799 Fax: 60 4 6577291 Email: The report is also available in French and Spanish.

Sources: IBFAN press release 'Baby Food Marketing: More Infants at Risk' 14 March 1998, the report 'Breaking the Rules, Stretching the Rules, 1998'.

The Code Handbook (1997)
by Ellen J. Sokol

The Code Handbook provides a guide to implementing the International Code of Marketing of Breastmilk Substitutes¹. Each article of the Code is carefully analysed and examples are given of how different countries have avoided particular weaknesses and loopholes. It provides a mix of examples of marketing techniques and their effects, and clear suggestions for drafting protective provisions. The book also presents a complete collection of related documents under one cover: the full International Code, all subsequent relevant WHA resolutions, the Innocenti Declaration and full text of a dozen baby food marketing laws from all over the world. The comprehensive coverage of the history of the Code, the history of baby milk marketing and of the purpose and achievements of the Code, makes this book valuable reading, not only for lawyers but for everyone who wants to study the legal aspects of the breastfeeding campaign.

1 The WHO/UNICEF International Code of Marketing of Breastmilk Substitutes was adopted in May 1981 by the World Health Assembly. It presents a code, developed jointly by WHO and UNICEF, for the marketing of breastmilk substitutes. The code applies to the marketing of breastmilk substitutes, including infant formula, and other milk products, foods, and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable for use as a partial or total replacement of breastmilk. The code deals in successive articles with information and education needs concerning the feeding of infants, advertising or other forms of promotion to the general public, and standards for product labelling and quality. 35pp. CHF3 (US $2.70); CHF2.10 in developing countries. Available from WHO, Distribution and Sales, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 2476 Fax: 41 22 791 4857 Email: Web: The Code is also available in full text on the IBFAN website at (Source: WHO publications website

361pp. US$130 for profit organisations; US$50 for non-profit organisations (incl. of surface mail delivery). Published by the International Code Documentation Centre, International Baby Food Action Network, Penang, Malaysia. Available from IBFAN, Penang: IBFAN, P.O.Box 19,10700 Penang, Malaysia. Tel: 60 4 6569799 Fax: 60 4 6577291 Email:

Source: forward to the 'Code Handbook by Ellen J. Sokol, 1997.

The International Code of Marketing of Breast-milk Substitutes (1998)
A summary of action taken by WHO Member States and other interested parties, 1994-1998

Since the adoption of the International Code of Marketing of Breast-milk Substitutes in 1981, and consistent with its Article 11.7, the Director-General of WHO has reported every two years on the status of the Code's implementation. Thus far 158 of WHO'S 191 Member States - 83% in all - have reported to WHO on action taken in this connection. Primary emphasis has been on relevant action taken by Member States, but information has also been included on WHO'S technical support to governments and action by NGOs, professional groups, and consumer organisations, which are called upon to collaborate with governments in monitoring the Code's application (Article 11.4).

This document provides a detailed summary of available information on action taken by 63 WHO Member States, technical support provided by WHO, and the activities of a number of NGOs, especially affiliates of the International Baby Food Action Network (IBFAN). It complements information provided in recent reports by the Director-General on infant and young child nutrition presented to the WHO Executive Board at its sessions in January 1996 and January 1998, and the Forty-ninth and Fifty-first World Health Assemblies in May 1996 and May 1998, respectively.

The report concludes that since 1981, Member States have gained considerable practical experience, and have provided a wealth of information on the implementation and monitoring of the Code. Action taken during the period 1994-8 provides convincing evidence that many governments are taking seriously their commitment to safeguarding the health and nutritional status of infants and young children.

WHO/NUT/98.11 31pp. Available in English and French from: Programme of Nutrition, WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 3325 Fax: 41 22 791 4156 Email:

Community Nutritional Problems among Latino Children in Hartford, Connecticut (1997)
by Rafael Perez-Escamilla, David A. Himmelgreen and Ann Ferris


Hartford, Connecticut, is an impoverished American city where around 45% of children live in poverty and residents are continually confronted with an array of health and social problems, including poor nutrition. This report presents the results of a needs assessment of the food and nutrition situation of the Latino community living in inner city Hartford, and identifies a great need for the development of culturally appropriate nutrition education interventions to improve the nutritional habits of Latino families. Results show that special attention needs to be paid to:

· low levels of breastfeeding (over half the women did not breastfeed their children);

· poor dietary quality, in particular the very low intake of fresh fruits and vegetables and the frequent intake of high fat foods;

· physical inactivity;

· high obesity rate (one in five children were obese);

· excess stunting (11 % of children had stunted growth);

· iron deficiency anaemia (almost one quarter of children had anaemia);

· lead poisoning (one in five children had been diagnosed with lead poisoning at some point).

In light of these findings, the report makes a number of recommendations including the continuation of food assistance programmes, monitoring the impact of welfare reform on household food security, development of culturally sensitive campaigns that promote breastfeeding, and promotion of healthier, more nutritious diets and higher levels of physical activity.

The report has ten chapters covering the following areas: project design, description of the environment and project participants, food assistance and purchase, food insecurity and hunger, infant feeding, dietary intake patterns, child anthropometry, child and child caretaker health, biochemical assessment and conclusions and recommendations. A summary is given at the end of each chapter, and tables, graphs and photographs are used frequently, making the report interesting and easy to read.

Connecticut Family Nutrition Program Technical Report #1, Storrs and Hartford, CT.52pp. Readers from industrialized countries can request copies of this report by mailing a US$10 cheque/money order issued to 'UConn' to Rafael Perez-Escamilla, Assistant Professor and Extension Nutrition Specialist, Department of Nutritional Sciences University of Connecticut, 3624 Horsebam Rd Ext, Storrs, CT 06269-4017. Tel: 1 806 486 5073 Fax: 1 860 486 3674 Email There is no charge for readers from developing countries.

WHO Global Database on Child Growth and Malnutrition (1997)
compiled by Mercedes de Onis and Monika Blossner

This book presents the vast amount of data contained in the WHO Global Database on Child Growth and Malnutrition. The data, which indicate the growth and nutritional status of children under five, have been collected by WHO since 1986 as part of its efforts to monitor global progress in combating childhood malnutrition and to identify those groups in need of priority interventions.


This detailed account of data on child growth and malnutrition -as measured by underweight, stunting, wasting and overweight - is divided into two parts. Part one explains the importance of global nutritional surveillance and describes the origins and development of the database. Against this background, subsequent chapters summarise global, regional, and national situations and trends for key indicators of child growth and nutritional status. Numerous tables and selected maps are used to indicate the country-specific prevalence and geographical distribution of underweight, stunting, wasting, and overweight for boys, girls and the two sexes combined in developing and developed countries. Countries are classified according to very high, high, medium and low prevalence for each indicator and to global and regional trends are estimated over time. While noting important achievements in overcoming malnutrition among under-fives, the analysis concludes that global progress is entirely inadequate to reach the goal, set for the year 2000, of a 50% reduction in 1990 prevalence levels of moderate and severe malnutrition. Part one concludes with chapters describing the methods used in data collection and their standardised presentation, and offering guidance in the interpretation of the statistical tables.

Part two contains over 600 pages of data tables and references. Data on the nutritional status of under-fives in 173 countries are presented, disaggregated by rural and urban areas, by regions, and by sex and age group. Survey data indicate the percentage of children wasted, stunted, and under- and overweight. Each country data table is followed by relevant survey references and additional information useful in interpreting the data.

Published by WHO (WHO/NUT/97.4) 71 Opp. CHF 50 (US $45) CHF35 in developing countries. To order this book, please contact Distribution and Sales, WHO, 1211 Geneva 27, Switzerland. Tel: 41 22 791 24 76 Fax: 41 22 791 48 57 Email: A catalogue of WHO nutrition publications (including an order form) is also available on request. Source: WHO.

The Global Database on Child Growth currently reflects over 1700 nutritional studies and covers 84% of the world's total population of under-fives and 95% of this age group living in the developing world. It is hoped that the continual effort to update this database will stimulate the gathering and sharing of new information, particularly in those countries and regions thus far scarcely investigated. WHO welcomes new contributions to the Database.

Details of how to contribute can be found on the web at, or can be obtained from Dr Mercedes de Onis or Ms Monika Bler, Programme of Nutrition, WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 33 20 Fax: 41 22 791 07 46 Email: or

WHO / WFP Collaboration: Food Aid for Health and Development (1997)

Conceived initially as a tool for informing governments, nutrition and health professionals. and others in the field of international nutrition about a long-standing, yet little-recognised collaboration between WHO and WFP, Food Aid for Health and Development does much more than address the issue of international collaboration.


In moving and graphic terms, this new document addresses in the first section, the issues of malnutrition, health and poverty, and clearly illustrates the links among them. It points out the significant place of women and girls in the cycle of malnutrition and validates the efforts world wide to improve their lot.

The second section introduces the role of food aid provided by WFP and describes its many facets, including not only emergency assistance, but also food aid to primary school children, to food insecure households through food for work programmes, and to pregnant women. breastfeeding mothers and preschool children through health centres. The details of some of these programmes, their links to health and health care, and the role played by WHO in structuring these programmes, are dealt with in section 3, which focuses on how food assistance, especially when coupled with other programmes, directly benefits the overall health and well-being of targeted populations.

The concluding section points to the future: 'WHO and WFP share a vision for the future that is people-centred and gender conscious, seeking to shape a world where people may be the producers of their own welfare as they contribute to that of others. A vision that has no room for complacency in the face of the misery of people who suffer in a world that has the means and the ability to help them. There is no easy way to improve the quality of life for the poorest. Whether it be individuals who require food, compassion and care, or societies that require human rights or dean water, our future will depend on how we mobilise our technology, our knowledge and our social intelligence to meet the dual challenge of ensuring nutrition and health for the world's vulnerable.' Food Aid for Health and Development provides a means of communicating details of this message in a way that is easily comprehended by any reader.

WHO/FSF/FAP/97.2 40pp. Copies are available from the office of Dr M. Mokbel Genequand, Food Aid Programmes, Programme of Food Safety and Food Aid, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27. Tel: 41 22 791 2758/9 Fax: 41 22 791 4807 Email: or

Dietary Guidelines in Asia-Pacific (1997)
edited by Cecilia A. Florencio

Dietary guidelines aim to ensure that sufficient nutrients are present in the diet to prevent the occurrence of undenutrition and nutrient deficiencies, and to reduce the risk of developing diet-related chronic degenerative diseases resulting from dietary excess. 'Dietary Guidelines in Asia-Pacific' reviews the current status and development of guidelines in the Asia-Pacific region.

Included in this volume are contributions from 14 Asia-Pacific countries: Australia, Bangladesh, Brunei, China, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Thailand and Viet Nam. Also included are nutrient standards (Recommended Dietary Allowances, RDA) of the countries.

The introduction to the book, written by the editor, Cecilia Florencio, compares the dietary guidelines that have already been issued for 12 of these countries (Malaysia has finalised its guidelines, which are expected to be formalised soon; and the contribution from India focuses on the concept of balanced diets as translations of RDA). The introductory chapter classifies the dietary guidelines from these 12 countries into two groups: group A, where the major nutrition problems result from dietary inadequacies and group B, where the major nutritional problems result from dietary excess. In comparing the guidelines of countries in these two groups, the author highlights a number of common messages. In particular, there is unanimity in the inclusion of two guidelines: eating a wide variety of foods, and balancing food intake and physical activity. The introduction also tabulates in detail the dietary guidelines for the different countries. In reviewing the dietary guidelines of all 12 countries, the author draws attention to four central food-based messages:

· eat enough food to meet body needs and to maintain or improve body weight;
· choose a diet made up of a variety of foods;
· select foods that are safe to eat;
· enjoy your food.

The subsequent 14 chapters form the contributions from individual countries, each focusing on their individual nutritional situations, and the development, current status and details of their country-specific dietary guidelines. Reference lists are provided at the end of each chapter, and a list of all contributors is given at the end of the book.

Published by ASEAN-New Zealand IILP, Project 5, Philippines. 115 pp. Copies of this book are available from The Nutrition Foundation of the Philippines, 107 E, Rodriguez Sr. Boulevard, Quezon City, Philippines 1102. Fax:632711-39-80. Further information can be obtained from the Editor, Cecilia Florencio, College of Home Economics, Rm F Ground Floor, CHE Gusali 2, Ma. Regidor Street, University of the Philippines Diliman, Quezon City 1101, Philippines.

Advancing the Social Agenda: Two Years after Copenhagen (1998)
Report of the UNRISD International Conference and Public Meeting, July 1997

SCN News No.15 (p52) reported on the UNRISD-sponsored one-and-a-half day public meeting in July 1997, in follow-up to the World Summit for Social Development held in Copenhagen in 1995. The report of the meeting is now available. Contents include:

· Post-Copenhagen: Personal Reflections by Ambassador Juan Somavia.
· Implementing the Copenhagen Agenda: Achievements and Disappointments.
· Mobilising Resources for Social Development.
· Learning from Successes in Social Development.
· Ethnic Diversity and Social Harmony.
· Social Cohesion: Healing the Wounds of War.
· Stemming the Fragmentation of Cities: Community-Based Approaches to Urban Social Problems.
· Globalisation, Solidarity and Public Policy by Nitin Desai.

US $8 for readers in the North and US $4 for readers in the South. Available from UNRISD, Palais des Nations, 1211 Geneva 10, Switzerland. Tel: 41 22 7988400 or 41 22 7985850 Fax: 41 22 7400791 Email: Further information about all UNRISD publications, visit their recently re-designed website on

Consumo de Alimentos en el Peru 1990-1995(1997) (Food Consumption in Peru) by Cecilia Montes, Luis Segura, Marianella Miranda, Miguel Barrientos and Guillermo Lescano


Established in 1986, PRISMA is a Peruvian NGO involved in developing and implementing programmes in nutrition, health, family planning, agriculture and social development. Through its activities, PRISMA aims to provide the most deprived populations of Peru with better access to the benefits of modern technology.

The 'Consumo de Alimentos en el Peru 1990-1995 presents the results of a food consumption survey involving more than 1900 families with children aged less than 3 years old, and representing 20 socioeconomic dominions within 7 political regions of the country. The regional patterns of nutrient and energy consumption, and food consumption patterns within the family are described. The book is aimed at decision-makers, technicians and professionals involved in health, nutrition and education programmes.

The book is divided into five chapters, each fully illustrated with graphs, tables and photographs. The first chapter describes the study design and methodology; the second and third present results of food consumption in children and families, respectively. The fourth chapter focuses on food consumption patterns of mothers in one region - the Ucayali region, and the final chapter discusses advances in the fortification of foods. A substantial section of appendices is included tabulating the results of the survey.

Published in Spanish. 153pp. The publication is free of charge, but shipment costs range from US$27 to US$41. To order, and for information about other PRISMA publications, please contact J. Luis Segura-Garcia, Direccie InvestigaciAsociacienca Prisma, Carlos Gonzales No. 251 Urb.Maranga, Lima 32, Peru. Tel: 464 0490 - 452 9603 Fax: 452 9758. Apartado Postal 170070 Email: Further information about PRISMA is available on the PRISMA website at

Complementary Feeding of Infants and Young Children (1998)

The transition from exclusive breastfeeding to consumption of the usual family diet is a crucial period for infants and young children. Infectious disease rates, particularly for diarrhoea, are highest during this period.

As part of a joint initiative on complementary feeding, WHO and UNICEF convened an expert consultation at ORSTOM in Mont- pellier, France, from 28-30 November 1995. This report summarises the discussions, conclusions and recommendations of the consultation.

The consultation reviewed a state-of-the-art paper on complementary feeding prepared for the consultation by the Program in International Nutrition of the University of California at Davis (USA). On this basis, the group agreed that new, more precise recommendations regarding the introduction and duration for feeding complementary foods are needed.

A number of issues were discussed at the consultation including:

· the energy needed from complementary foods, the basis for estimating needs, and major factors affecting energy intake from complementary foods, in particular energy density and feeding frequency;

· protein and micronutrient requirements from complementary foods, and how complementary foods can provide adequate nutrient density;

· issues of food processing and safety;

· programmatic interventions to improve complementary feeding.

The main conclusion and recommendation arising from these discussions was that further research and discussions are needed. For example, it was recommended that further research be carried out on the bioavailability of micronutrients from complementary foods, and the effects of food processing procedures on bioavailability of nutrients.

This report (WHO/NUT/96.9) is available from the Programme of Nutrition, Family and Reproductive Health, WHO, Geneva. The state-of-the-art review, 'Complementary Feeding of Young Children in Developing Countries: a review of current scientific knowledge' will be published in August (WHO/NUT/98.1) For further information, please contact Randa Saadeh, WHO/NUT, 20 Avenue Appia, Ch-1211 Geneva 27, Switzerland, Tel: 41 22 791 3315 Fax: 41 22 791 4156 Email:

Obesity: preventing and managing the global epidemic (1998)
Report of a WHO Consultation on Obesity Geneva 2-5 June 1997


SCN News No.14 (p47) reported on the draft version and recommendations of this report shortly after the WHO Consultation on Obesity in 1997. The interim version of the report is now available for limited distribution only, but will be widely available (in final version) at the end of 1998 as part of the WHO Technical Report Series (TRS). French and Spanish versions will follow in 1999.

The document reviews global prevalence and trends of obesity among children and adults, factors contributing to the problem of obesity, and associated consequences of obesity, such as chronic noncommunicable diseases. It also examines the health and economic consequences of obesity and their impact on development, and makes recommendations for developing comprehensive public health strategies for prevention and management of obesity.

WHO/NUT/NCD/98.1 296pp. For further information please contact Chizuru Nishida, Nutrition Programme, WHO, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland. Tel: 41 22 791 3317 Fax: 41 22 791 0746 Email:

Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia (1998)
by Rebecca Stoltzfus and Michele Dreyfuss

Published by the International Nutritional Anemia Consultative Group (INACG), the purpose of these guidelines is to provide practical, scientifically sound guidance to those responsible for planning and implementing anaemia control programmes.

While the main focus of these guidelines is on iron supplementation programmes and parasite control for pregnant women and children 6-24 months of age, they also acknowledge the beneficial role that food fortification and dietary diversification can have in controlling anaemia. Guidelines for the treatment or referral of people with severe anaemia in primary care settings, and a summary of key steps necessary to develop an iron supplementation programme are also given.

A selected bibliography lists books and documents that provide more in-depth information on topics related to iron deficiency anaemia. Appendices list contact details for international agencies that provide support or technical assistance for the control of iron deficiency anaemia. Some sources for supplements and other supplies needed to establish programmes are also listed.

These guidelines are available free of charge from the INACG website at Or contact the INACG Secretariat at ILSI Human Nutrition Institute, 1126 Sixteenth Street, NW, Washington, DC 20036-4810, USA. Tel: 1 202 659 9024 Fax: 1 202 659 3617 Email:

Food Quality and Safety Systems: a training manual on food hygiene and the hazard analysis and critical control point (HACCP) system (FAO, 1998)

FAO is the one of the specialised UN agencies dealing with aspects of food quality and safety throughout each of the stages of food production, storage, transportation, processing, and marketing. As part of FAO's ongoing work to build the capacity of food control personnel, a training manual was recently published which is intended for trainers in food quality and safety assurance at the government and industry levels.

This book is a direct result of an Expert Consultation on Hazard Analysis and Critical Control Point (HACCP) Principles in Food Control, which was held in 1994. Shortly after this meeting, an Ad Hoc Working Group developed a core curriculum as a 'train-the-trainer' programme. The core curriculum recognises the importance of basic quality and safety controls which are included in the Codex General Principles of Food Hygiene and Good Manufacturing Practices as embodied in the Codex Codes of Practice as a basis for the effective implementation of the HACCP system. The training programme has been tested in Thailand, Brazil, Vietnam and Slovakia.

The manual is structured to ensure that essential information is provided in a standardised, logical and systematic manner while adhering to effective teaching and learning strategies. It is composed of three sections: section one pertains to Principles and Methods of Training, section two to Recommended International Code of Practice - General Principles of Food Hygiene, and section three to the Hazard Analysis and Critical Control Point (HACCP) System. Each section is divided into specific training modules. This format allows the instructor to select sections and modules according to the levels of knowledge, experience and specific responsibilities of the students.

FAO has prepared this manual in an effort to harmonise the approach to training in the HACCP system based on the text and guidelines of the Codex Alimentarius Commission. It is clear that HACCP systems can only be effective when they are a part of a broader food quality and safety programme based on the General Principles of Food Hygiene and Good Manufacturing Practices. Consequently, these aspects of quality and safety controls are incorporated in the training materials.

Published by FAO. 232pp. US$30. Copies are available from the Sales and Marketing Group, FAO, Viale delle Terme de Caracalla, 00100 Rome, Italy. Tel: 39 6 5705 5727 Fax: 39 6 5705 3152 Email: For more information about this, and other FAO nutrition publications, please email

Editor's note: WHO, jointly with the Industry Council for Development (ICD) has prepared a training manual on HACCP: Principals and Practice. A description of this manual will be provided in the next issue of SCN News (No. 17, December 1998).

Poverty Alleviation and Nutrition Program Manuals (1997)
Save the Children US-Wet Nam Field Office

Since the implementation of the Poverty Alleviation and Nutrition Programme (PANP), over 90% of moderate and severely malnourished children participating in the PANP have have responded to nutrition rehabilitation services.

The PANP has four components:

· a growth monitoring promotion programme, which encourages the weighing of children under 3 years old to determine their nutritional status;

· a nutrition education programme, which teaches basic nutrition messages and preparation of a nutritious, calorie-dense meal;

· a nutrition revolving loan programme, which provides supplementary food through in-kind loans; and

· an endowment and income generating programme, which gives grants to communities so they can generate income through projects.

Interest from other countries to replicate this successful and sustainable programme outside Viet Nam, has resulted in the production of these 10 training manuals, which describe the training of trainers for the PANP.

Available in English (US $50) and Vietnamese (300,000 VND). For orders and further information regarding these manuals, please contact Nguyen Thi Tuyet Mai. Tel: 84 48 461801 Fax: 84 48 461807 Email:

New Journal in Public Health Nutrition

This new journal, launched in March 1998 by the Nutrition Society and the Centre for Agriculture and Biosciences (CAB) International on behalf of the Nutrition Society, offers a population-based approach to the practical application of research findings in the field of public health nutrition, and includes high quality reviews of key topics. The international editorial team include Barrie Margetts (editor-in-chief), from the Institute of Human Nutrition at Southampton General Hospital, UK; Lenore Kohlmeier, from the department of nutrition and epidemiology at the University of North Carolina, USA; Frans Kok, from the Wageningen Agricultural University, the Netherlands; and Michael Nelson, from the University of London, UK. A further 13 associate editors are drawn from institutes and universities worldwide. Topics covered in this new journal include:

· nutritional epidemiology - studies relating nutrition to health or disease risk;
· nutrition related health promotion;
· evaluation of effectiveness of intervention studies aimed at improving health;
· role of nutrition in high risk and vulnerable groups;
· development of research methods, validation of measures, calibration;
· population-based research related to primary prevention of illness.

Public Health Nutrition will be issued four times per year. The inaugural issue was published in March 1998. For more information, or to submit papers or suggest topics of interest for future supplements and special issues, please contact the Editor-in-Chief, Dr Barrie Margetts, Institute of Human Nutrition, Southampton General Hospital, Southampton, UK. Tel: 44 1703 796 530 Fax: 44 1703 796 529 Email: Information about subscription is available from CABI, Wallingford, Oxon, OX10 8DE, UK. Tel: 44 1491 832111 Fax: 44 1491 826090 Email: or visit the website at