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close this bookSCN News, Number 18 - Adequate Food: A Human Right (ACC/SCN, 1999, 116 p.)
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Programme News

AGENCIES REPORT ON NUTRITION ACTIVITIES

ADB

Asian Development Bank, Manila, Philippines

In 1998 and early 1999, the Asian Development Bank initiated its lending program in maternal and child nutrition through investment projects in the Philippines, Indonesia, and Pakistan, and has established a forward lending program for an additional project in Indonesia and a new project in the Kyrgyz Republic.

In addition, policy and sector work are in various stages of completion, intended to strengthen the Bank's regional role in policy dialogue and nutrition programming for Asia and the Pacific. Sector work includes: (I) publication of the findings for a seven-country study (a collaboration with UNICEF) on investment requirements to reduce child malnutrition in a sustainable manner; (ii) a planned investment roundtable for Asian children to promote dialogue between the seven countries and the donor community; (iii) an ongoing six-country study on safe motherhood policies and programs in Asia, the Bank's second fruitful collaboration with UNICEF; and (iv) a new regional study on nutrition trends, strategies and policies in Asia and the Pacific that will involve an intensive set of consultations with Asia governments on public nutrition priorities. This study will provide technical background material for the Bank's nutrition policy paper, expected to be presented for Board consideration in late 2000.

Philippines (1998): The Early Childhood Development Project (ECD), approved in January 1998, is the culmination of a three year collaboration between the ADB and the World Bank in preparing joint sector work, assisting the Government to prepare and endorse a ten-year investment program for pre-school children, and the investment project. About five million preschoolers are expected to benefit from the project's interventions which include preventive health and nutrition, and early education/day care services at the community level. Food fortification is another component focused on quality control for iodized salt and public-private partnerships for iron fortification of staples and complementary foods.

Indonesia (1998-99): Two large social safety net programs have been approved within the last 12 months to address the serious impacts of the financial crisis on poor women and children. The Social Protection Sector Development Program, approved in June 1998 for US$300 million over two years, provides scholarships to primary school students, along with essential health and nutrition services to families in need. Complementary feeding to 250,000 "under twos" is the target. A second program targets health and nutrition services to street children and victims of child labour. The links between malnutrition and communicable diseases will be addressed, and 800,000 pregnant and nursing mothers will receive supplementary feeding.

Pakistan (1999): The National Women's Health Project addresses the delivery of preventive maternal and reproductive health services at community and primary care levels. The project integrates maternal nutrition as a core element in reproductive health care for women and infants.

Future Programs: The ADB is looking forward to integrating maternal and child nutrition in an Indonesian project called Woman and Child Protection and Development, which will integrate health and nutrition, care and psycho-social development, early education and ECD-enriched primary learning environment. A new ECD project in the Kyrgyz Republic will compensate for the lost subsidies for nutrition and kindergarten services with a home-based early education project focused on cognitive development of under-fives, early literacy and reading skills.

For further information contact: Joseph Hunt, Project Economist, AD, PO Box 789, 0980 Manila, The Philippines; tel: 632 632 6830; fax: 632 636 2404; email: jhunt@mail.AsianDevBank.org

FAO

Gender and Food Security: On International Women's Day (March 8, 1999) FAO officially launched a web site on Gender and Food Security. The site will serve as FAO's permanent information system on gender in agriculture and rural development, including forestry and fisheries. It is anticipated that the web site will be a reference library for Member States, researchers and civil society organizations. The web site includes information on nutrition, household food security and food quality and safety.

Africa Nutrition Database Initiative: The African Nutrition Database Initiative (ANDI) was developed with initial support from Italy and the World Bank. The objective is to pilot test a virtually self-maintaining information system that will facilitate quick access to good quality nutritional information concerning Sub-Saharan African countries. The system is comprised of 20 nutrition and socio-economic indicators, which are contributed to the common database and updated by the participating agencies at least three times a year. FAO, the World Bank and UNICEF all currently participate in ANDI. ANDI is a precursor to the Common International Database (CID) that will eventually be established as part of the global portion of the FIVIMS program.

FAO/UNU INFOODS: In 1994 FAO joined UNU in sponsoring INFOODS - the International Network of Food Data Systems. In January 1999 INFOODS relocated most of its activities to FAO Headquarters. The main objectives of FAO/UNU INFOODS will continue to be establishing a regional network of food composition programmes for all countries compiling regional and national food composition databases and tables; facilitating interchange of food composition data; improving the competence of national and regional institutions responsible for food analysis and the compilation of food composition databases.

Uruguay Round Table Agreements: In 1998 FAO launched a web site to provide information about the Uruguay Trade Agreements. The web site includes information on the Agreements on the Application of Sanitary and Phytosanitary Measures and Technical Barriers to Trade in relation to the Codex Alimentarius, the International plant Protection Convention and animal health, animal production, forestry and fisheries. Information about the impact of the agreements and technical assistance to developing countries is given.

For further information contact FAO Food & Nutrition Division, Viale delle Terme di Caracalla, 00100 Rome, Italy; fax: 396 5225; Internet: http://www.fao.org/waicent/faoinfo; email: food-quality@fao.org OR nutrition@fao.org

PAHO

Vitamin A Supplementation through national Immunization Days (NIDS)

The Food and Nutrition Program and the Division of Vaccines and Immunization of the Pan American Health Organization, with the support from Ml, are providing technical support to Bolivia, Brazil, Dominican Republic, Ecuador, Nicaragua and Peru, in order to implement a vitamin A supplementation project. The initial project development took place from April 1998 to April 1999, and many lessons were learned.

Procurement and Logistics: Because of delays in shipping specifications and untimely production and delivery of vitamin A capsules, it has been recommended that countries begin to purchase their own supplies of vitamin A capsules at the same time and in the same manner as vaccines. International donor agencies could then assist individual countries in supporting other more costly activities for sustaining the program, i.e., training of health personnel, education and communication.

Operations and Management: It was recommended that specific tasks and responsibilities for both Nutrition and Immunization Programmes at every level in the country need to be clearly defined in order to ensure co-ordination and administration of all follow-up doses to complete the vitamin A supplementation schedules of the target populations. Registration of children's health cards and data collection are essential components to facilitate the monitoring and evaluation of the programme. Training of supervisors and health workers needs to be conducted to ensure that the strategies and methodology of the integrative nature of the vitamin A programme is dearly communicated; correct dosing schedules for children and mothers are reinforced; and correct techniques for capsule administration and data registration take place. Coverage of all missed opportunities should be ensured by screening the child's health card at each routine health contact, and by providing the supplement directly or through an immediate referral.

Expectations for the second year of the project include further collaboration and definition of roles between the Nutrition and Immunization Programs at all levels; continued supervision and feedback within the programme; implementation of maternal supplementation; increased coverage; and further evaluation. At the end of the project, PAHO expects to systemize the lessons learned and the data collected in order to develop a study model for countries in other regions of the world.

Vitamin A deficiency, at sub-clinical levels, is still a problem in Latin America and the Caribbean, and supplementation programmes in high-risk populations are expected to be maintained. Fortification, however, was identified by the participating countries as the eventual long term intervention strategy for addressing the problem of vitamin A deficiency in this region. PAHO persists in its efforts to motivate countries to engage in national vitamin A fortification programmes.

For further information contact Wilma Freire, Program Coordinator, Food & Nutrition Program, PAHO; tel: 202 974 3505; fax: 202 974 3682; email: freirewi@paho.org

SIDA

Global NutriTion 2000 - A New Advanced Training Initiative

Under the heading Global NutriTion 2000, the Nutrition Unit of the Department of Medical Sciences, Uppsala University, has initiated a new programme to support academic postgraduate training in nutrition in the South. The programme combines an update of information priority areas in global nutrition with information on and skills training in the use of computer technology. The programme receives funding from the Swedish International Development Agency's Department of Infrastructure and Economic Cooperation.

Academic institutions in the South have a challenging task in training national professionals to work effectively with the double burden of nutrition deprivation and increasing problems of chronic diseases related to nutrition issues. Staff in agricultural and medical faculties who are responsible for this training deserve conceptual, technical and pedagogical support in their work. This new programme aims to create long term collaboration among higher training institutions in the North and the South through use of information technology. The specific objectives of the programme are to share knowledge of new findings, new methods and new concepts in global nutrition; and to train and develop skills among lecturers in optimal use of IT in academic training in global nutrition, thereby making possible a continuous search for information and contacts with colleagues in other countries.

The 1999 programme focuses on Africa, and 26 senior lecturers from 17 African countries participated during the first year of the programme. They reflect the multidisciplinary nature of nutrition with training responsibilities in medical schools, food and/or nutrition departments and agricultural schools. These participants will be influential in developing a strong network among academics involved in nutrition training in Africa.

The programme has three phases, an initial short course in Uppsala, pedagogical team assignments in the respective countries and a follow-up workshop. In the initial five week course, approximately half of the time is spent on new global nutrition concerns and controversies, and the remainder on computer technology. Participants are taught internet skills; search information; how to convene net meetings; the production of computerized materials; and computer pedagogics. The 1999 course has introduced the participants to ongoing work with the African Nutrition Database Initiative (ANDI); the Micronutrient Initiative's CD-ROMs on micronutrients; the NGONut mailing list (initiated by Professor Michael Golden, University of Aberdeen, to supply non-governmental organizations with correct and current information on nutrition questions they raise while doing field work); and a videoconference for the IVACG meeting in Durban. All information and material provided during the course, including free software, has been compiled as CD-ROMs so that participants may teach this course to others in their home institutions.

In the second phase, smaller interest groups will be working on case study nutrition material to be included in a computer-based program for undergraduate training in Africa. During this phase the participants will also review curricula and existing programmes in their own institutions with respect to nutrition.

For the third phase, the group will meet for a nine day workshop and continue to work with the 'e-book' material. At that time they will jointly formulate a proposal for continued support to enable them to continue networking and accessing information and technology to improve the quality of training and research in Africa.

In the year 2000 the Global NutriTion Programme will continue to focus on African institutions, and later, extend the programme to South and South East Asia. In the initial agreement, SIDA's Department of Infrastructure and Economic Co-operation will provide financial support for a three year period.

For further information contact: Britta Ogle, Swedish University of Agricultural Sciences, Dept of Rural Development Studies, Box 7005, SE-750 07 Uppsala, Sweden; tel: +46 18 671953; Fax: +46 18 673420; Internet http//www.Ibutv.slu.se; email: britta.ogle@Ibutv.slu.se

Innovative Ways to Reach out to Women and Children: SIDA-Supported Integrated Child Development Services (ICDS) Tamil Nadu, India

India's ICDS began in 1975 and has expanded to become what is undoubtedly the largest welfare project in the world. It pursues an approach which would seem to be a prescription for bureaucratic constraints, run jointly by national and state governments and crossing into the "territories" of several sectors. Nevertheless, it has maintained a spirit of innovation and continues to evolve at both state and national levels. SIDA has supported the ICDS in Tamil Nadu since 1989. Though it began in only eight blocks (each block has a population of approximately 100,000-150,000), by 1994, during Phase II of the support, it expanded to cover 47 blocks in four districts. It has also focused only on developing and testing new approaches on a large enough scale so that they could be replicated by other states at relatively low cost and low risk of failure. SIDA support to the ICDS has provided approximately US$20 million over a period of 11 years. The total cost for the nutrition component, about US$10 per beneficiary per year, is within the range expected to lead to about a 1% reduction in malnutrition rates per year, and project statistics suggest this is occurring.

Statistics for the health component remained fairly stable, however, additional medicine kits and supplemental nutrient supplies need to be procured. Improved hygiene and sanitation strategies are recommended. Growth monitoring has proceeded better in Tamil Nadu than in most places, however, additional training in taring (setting scales to zero prior to each weighing) and record-keeping is desirable. Coverage levels for vitamin A and iron are satisfactory, but in many cases are not high enough to make a significant public health impact. Of concern is Tamil Nadu's policy of not requiring salt to be iodized. It is recommended that all of the project's centers use iodized salt, and that a communication strategy related to iodine's importance to mental development and intelligence should be developed.

The nutrition gardens continue to be one of the most successful components of the project. The noon meals have become more nutritious, educational and appealing due to the garden produce, however, increased attention to nutrition education regarding vitamin A is recommended. Seasonal changes in nutritional status has been identified, suggesting that when mothers have a heavy work burden, their children are at-risk. This is especially the case when young infants are given diluted cow's milk; exclusive breastfeeding for six months would improve the levels of moderate malnutrition still prevalent in these districts.

Some 50,000 adolescent girls have attended two-day workshops on issues related to their health and their rights. There has been a great need for these workshops and the results have clearly been positive, however, less than half of this population has been reached. Adolescent boys also require information and activities designed to change patriarchal attitudes and other factors associated with the apparent high incidence of rape in the villages. The WILL centers were established as a post-literacy initiative. Appropriate outreach methods and targeting the poorest groups have been problematic issues with this initiative. The use of sewing machines for income generation seems to have limited success; more promising crafts include leaf plates, soft toys and wooden blocks.

The SIDA approach of encouraging and funding innovation in a compatible manner with existing government approaches appears to have succeeded. Some of the programmes have been replicated in part or completely by other donors and both the state and national governments. Thus the impact of SIDA support has gone far beyond the three districts which were directly assisted by the project.

For further information or for the full report contact Ted Greiner, SIDA Nutrition Consultant, IMCH, Uppsala University, 75185 Uppsala, Sweden; tel: 00 46 18 511 598; fax: 00 46 18 508 013; email: ted.greiner@ich.uu.se

UNICEF

Elimination of Iodine Deficiency Disorders: Programmes for the elimination of IDD are largely focussed on salt iodization. About 65% of all edible salt is now iodized, up from 56% reported a year ago. In East Asia and Pacific, the usage has increased from 52% to 72% largely due to advances in China. UNICEF support for IDD elimination programmes has been expanded to cover over 70 countries. Depending on country-specific needs, support is provided for national legislation on universal salt iodization, procurement and distribution of salt iodization equipment and potassium iodate, quality assurance, and for social mobilization and communication to promote demand for iodized salt. The lack of a practical and inexpensive method of a quality control device for use by small-scale salt producers is a major concern in many countries. There is also a need for additional funding in addition to that being supplied by Kiwanis International, UNICEF's key partner in the global mission to eliminate IDD.

Maternal Nutrition and Low Birth Weight Reduction (Including Control Of Iron Deficiency Anaemia): Maternal nutrition and fetal growth rates, as reflected by low birth weight, is a largely neglected programme area that has tremendous practical significance. There is a need to document programme experiences in this area and develop programme guidelines. About 50 countries have adopted national policies supporting iron/folate supplementation of all pregnant women attending ante-natal care facilities but issues such as supply, access, compliance and monitoring have been obstacles to successful programmes. There is currently no baseline data available on the percentage of pregnant women with regular intake of iron/folate supplements in developing countries. A trial of multiple micronutrient supplements during pregnancy is underway in Mexico. A meeting was held in Singapore to try and agree on the formulation of a multiple micronutrient supplement for use in a trial in Indonesia, with funds provided by the Turner Foundation.

Improved Care and Infant Feeding Practices: In 1998, seven new countries joined the Baby-Friendly Hospital Initiative with total number of countries increasing to 124. At the end of November 1998, there were 14, 519 BF hospitals as compared to 10,949 at the end of 1996. The East Asia and West Africa regions saw most rapid progress. UNICEF support was provided to over 60 countries mainly for training, assessment and communication materials. With the increase in the number of hospitals certified as baby-friendly, quality and sustainability are key concerns. To address these concerns, a reassessment tool and guidelines have been developed. Under the CRC, implementation of the International Code of the Marketing of Breastmilk Substitutes is a concrete tool in protecting the child's right to the highest attainable standard of health. UNICEF support includes advocacy, technical assistance in legislation drafting and reviews and training activities. Although only 17 countries have so far adopted legislation implementing the Code in its entirety, an additional 43 have adopted some provisions of the Code, and 70 have taken some actions towards implementation. The Care Initiative has been widely disseminated and many countries have begun implementation, although on small scales. Several countries were provided technical support for training workshops on care. Apart from promotion of breastfeeding and appropriate complementary feeding practices in communities, the Care Initiative includes care for women, hygiene practices, home-based care practices and psycho-social care. A training manual on care is being finalized. The Care Strategy is also being used for the elaboration of household community component of IMCI. Joint WHO/UNICEF/UNAIDS guidelines on mother to child transmission (MTCT) of HIV/AIDS, including through breastfeeding, were to issued policy makers and health workers, and a training package for health workers is also being developed.

Growth Monitoring and Promotion: UNICEF support for growth monitoring and promotion is being continued in over 40 countries in the form of training, EC (posters, leaflets, social mobilization) and supplies (scales and growth charts). Despite the fact that the greatest benefits from GMP activities occur in the first 18 to 24 months, in most cases growth monitoring is continued until 5 years. In few, if any, countries is weight gain monitored during pregnancy. These findings suggest, in the light of the recent evidence on maternal and young child nutrition, that guidelines on GMP activities need to be revised, with emphasis on its importance during pregnancy and in the first 24 months of life.

Nutrition Databases and Monitoring: As part of monitoring WSC goals, UNICEF is contributing to the generation of data on key nutrition indicators through Multiple Indicator Cluster Surveys. Over 75 national surveys are planned for 1999 and 2000. UNICEF maintains updated databases on coverage of vitamin A supplements, salt iodization and BFHI, and collaborates with WHO on anthropometry and breastfeeding data sets. These data are published annually in the State of the World's Children Report The Child Information Initiative uses nutrition strategy framework to establish a decentralized database and mapping system on key indicators of child survival, growth and development. After successful implementation in South Asia, two other regions (Eastern and Southern Africa, and East Asia and Pacific) are planning to implement this initiative.

For further information contact: R Shrimpton, Nutrition Section, UNICEF, 3 UN Plaza, NY NY 10017 USA; tel: 212 824 6368; fax: 212 824 6465; email: rshrimpton@unicef.org

UNU

Global Cereal Fortification Initiative of Japan

A United Nations University-sponsored project conducted with the support of the Global Cereal Fortification Initiative of Japan has obtained results of interest in Pakistan. An abstract of the results was published under the title "Effect of lysine fortification of wheat flour on predominately cereal-eating families in Pakistan" by NS Scrimshaw, T Hussain, S Abbas, and MA Khan. The lull paper will soon be presented for publication in the FASEB Journal 1999;13(4):A71.1.

It reports that wheat provides more than 50% of the protein and energy intake of the population of Pakistan. This cereal is relatively poor in protein quality with lysine as the first limiting amino acid. Legumes and animal protein that could complement the amino acid pattern of wheat are not affordable by lower socio-economic groups in developing countries. To determine whether lysine fortification of wheat flour could have a positive impact on populations consuming a predominately wheat based diet, a double blind study was carried out for 3 months on the outskirts of Peshawar, Pakistan. Forty families received wheat flour fortified with lysine and 40 without. Only 38% of the men, 51% of the women and 21% of children had total protein intakes of 1.0 g/kg body weight or above. Wheat protein comprised 59% of the diets of the men, 65% of the women's diets, and 57% of the children's diets. In addition to obtaining socio-economic and dietary data, an adult male, an adult female and a 5-10 year-old child was selected in each family for anthropometric measurement and biochemical and immunological determinations.

Transferrin levels increased significantly in women and children receiving the lysine-supplemented flour, as did hemoglobin values in the women. When change in hemoglobin was calculated only for those children and men with an initial hemoglobin <11, however, the increase in hemoglobin was significant for this subgroup. Men, women and children in the lysine-supplemented families had significant increases in CD4, CD8, pre-albumin, and complement C3 compared with controls. These results indicate that lysine fortification of wheat flour can significantly improve sensitive indicators of nutritional status in a population of individuals consuming a diet in which an average of 57-65% of the protein, depending on age and sex, is supplied by wheat.

The study is now being replicated in China by the Institute of Nutrition and Food Hygiene in Beijing. The community is Huixian City, Henan Province, in which wheat protein supplies a still higher proportion of the diet.

Submitted by: Nevin S Scrimshaw, United Nations University, Food and Nutrition Programme, Charles Street Station, PO Box 500, Boston MA 02114-0500 USA; fax: 617 227 9405; email: nevin@cyberportal.bet

WFP

An unprecedented combination of events in 1998 increased world hunger levels: El Niaused ravaging floods in Asia, drought in Africa and devastating storms in Central America and the Caribbean; economic crises in Indonesia and Russia spawned massive shortages of food and medicine; a resumption of the civil wars in Kosovo, Angola and Sierra Leone displaced tens of thousands of people; and steady long-term conflict in southern Sudan combined with poor rainfall to once again bring famine to this region. As a result, the number of people fed by WFP in 1998 was the highest in any single year, approximately 74 million. Last year WFP distributed over 2.83 million tons of food as follows: 0.77 million tons for development projects; 1.56 million tons for emergency operations; and 0.49 million tons for protracted relief operations.

In terms of women's involvement in food aid and improved food security, WFP has set the following targets:

* 80% of relief food aid should be distributed directly to women

* 60% of all WFP resources should go to women and girls where there is a gender gap

* 50% of educational resources should benefit girls

* at least 25% of food for work and food for training assets should benefit women

* women should take a lead role in decision-making in food management committees

* WFP should aim for gender equity in staffing

* WFP staff and implementing partners should be held accountable for achieving these commitments.

In 1998 WFP produced operational guidelines on Supplementary Feeding for Mothers and Children. The chief purpose of these guidelines is to assist WFP Country Officers to assess and analyze the dimensions of "early malnutrition" in their country or region of responsibility and help decide whether supplementary feeding has a role to play in preventing or alleviating malnutrition among mothers and young children. The term "early malnutrition" has been chosen by WFP to describe the intergenerational cycle of unmet needs and nutrition problems that are transmitted from mother to foetus (manifested by low birth weight) and/or the underweight or stunting that occurs during the first few years of life.

This manual will also facilitate the design, operationalization, monitoring and evaluation of appropriate supplementary feeding interventions.

WFP focuses on countries with the greatest need. WFP aims to have at least 90% of its operational expenditure for development in low-income food-deficit countries and least developed countries. Currently nearly 70% of WFP's resources are devoted to supporting humanitarian activities.

A good example of how WFP works in partnership with other agencies in development is the current Community Nutrition Project in Dakar. The project was designed as a joint activity of WFP, the World Bank, German Technical Co-operation (GTZ) and the Government of Senegal, and the nutrition centres are staffed by local NGOs recruited from the community.

For further information contact: WFP, via Cesare Guilio Viola 68, Parco dei Medici 00148 Rome, Italy.

WHO

Development and Implementation of Effective National Nutrition Policies: Building on the momentum created by the International Conference on Nutrition (1992) and the World Food Summit (1996), over 170 countries have by now prepared or strengthened their national plans of action for nutrition. Some countries are concentrating their efforts on addressing specific nutrition problems, such as preventing and controlling specific micronutrient deficiencies (i.e. deficiencies of vitamin A, iodine and iron). Other countries, in an effort to tackle nutritional problems in a comprehensive manner, are focusing on the development and implementation of national plans and policies for improving food and nutrition security, particularly for vulnerable groups. This is a high priority area for action for WHO's NHD. As the end of the decade approaches, NHD is undertaking a critical review of national nutrition plans and policies, in collaboration with FAO.

A comparative analysis of nutrition policies in the WHO European region is available from the WHO Regional Office for Europe, Scherfigsvaj 8, Copenhagen 2100 Denmark; fax: 00 45 3917 1854.

The Baby-Friendly Hospital Initiative Monitoring And Reassessment: Tools To Sustain Progress: With the steady increase of hospitals world-wide that have been designated "baby-friendly", health authorities in many countries have expressed a need for monitoring and reassessment tools that will help them build on progress achieved through the Baby-friendly Hospital Initiative (BFHI). NHD has just published reassessment and monitoring tools based on the WHO/UNICEF BFHI Global Criteria. The binder is divided into four parts: a guide for monitoring and reassessing baby-friendly hospitals; a monitoring tool; a reassessment tool; a computerized reporting system for BFHI monitoring. The tools are designed to foster involvement of both hospital management and staff in identifying and solving problems, and in implementing the Ten Steps to Successful Breastfeeding. Their application should contribute to the Initiative's long-term credibility and sustainability.

For further information contact Randa Saadeh, WHO/NHD. 20 Avenue Appia, 1211 Geneva 27 Switzerland; tel: 41 22 791 3315/3878; fax: 41 22 791 4156; email: saadehr@who.ch

Complementary Feeding: NHD, in collaboration with the London School of Hygiene and Tropical Medicine, is developing guidelines for district level supervisors' training to inform them about how good feeding practices can help avoid the health risks that often occur during the transition period from breastmilk to family foods. The guidelines take into account the results of recent studies on infant feeding, growth and childhood illness including diarrhoea. The book is intended for those involved in promoting good health and nutrition during early childhood, particularly health and nutrition workers, and their trainers. The guidelines will also be of practical value to health workers involved in in-service training, such as through the WHO/UNICEF course on the Integrated Management of Childhood Illnesses. The information provided in this book will assist health workers in understanding more the nutritional value of available food to produce locally adapted feeding recommendations.

Note: The guidelines are expected to be published in September 1999 as document WHO/NHD/99, Complementary feeding of infants and young children: feeding family foods with breastmilk. For further information contact Randa Saadeh. WHO/NHD. Tel: 41 22 791 3315/3878 Fax: 41 22 791 4156 Email: saadehr@who.ch

WHO Global Database on Child Growth and Malnutrition: Now on the WEB: The WHO Global Database on Child Growth and Malnutrition is one of the first WHO databases to provide data through the World Wide Web, accessible at the URL: http://www.who.int/nutgrowthdb. The Global Database is a dynamic nutrition/malnutrition surveillance system covering infants and children under five years of age in terms of the indicators weight-for-age (underweight), weight-for-height (wasting), and height-for-age (stunting), and overweight. At present, the database covers over 95% of the total population of under-five year olds in developing countries. This percentage of coverage refers only to nationally representative surveys. A large number of surveys at regional, province, state, district and local levels are also available in this database.

For further details please contact Mercedes de Onis, WHO/NHD, 20 Avenue Appia, 1211 Geneva 27 Switzerland; tel: 41 22 791 3320/4342; email: deonism@who.ch Monika Bloessner, WHO/NHD. tel: 41 22 791 3410; fax: 41 22 791 4156; email: bloessnerm@who.ch

The World Bank

Nutrition Lending: In fiscal year 1998 the Bank approved 13 new projects with a nutrition component. An estimated US$ 391 million was allocated to nutrition in these projects. At present the Bank has a total of 97 ongoing projects in 45 countries that are either self-standing nutrition or include nutrition interventions. An estimated amount of US$1.2 billion is allocated to nutrition, which represents 22% of the total loans for the projects. About 60% of the projects are implemented through the health sector, while the rest are implemented through the education sector, social funds, and the agriculture sector.

Of the 15 projects approved in the Health, Nutrition and Population (HNP) Sector in fiscal year 1999, two have nutrition components and one is a self-standing nutrition project: the LIL (Learning and Innovative Lending) project in Mauritania. Before the end of the Bank fiscal year 1999 on June 30, it is expected that another 16 HNP projects will be approved. Of those, two will include nutrition components. Lending in the HNP sector for nutrition is lower than previous years, due to shifts in the portfolio which have placed greater emphasis on health sector reform projects, many of which do not yet include specific nutrition components. However, progress is being made: nutrition and community-based IMCI will be part of the Health Sector Reform project in Bolivia; and a reform of the structural adjustment loan in Peru will include a reform of the feeding program. In addition, interagency collaboration, in particular with UNICEF, is becoming more prominent in several Bank projects, for example in Guinea, Yemen, and Bangladesh.

Nutrition Sector Work: During fiscal year 1999, nutrition sector work was undertaken in a number of countries, including India. The report, Wasting Away: The Crisis of Malnutrition in India, which will soon be published, makes a strong case that India's development will be seriously impeded if the nutrition problem is not dealt with expeditiously. Malnutrition is not just a consequence of slow economic growth but a cause of it, the report says. The study not only looks critically at the implementation of nutrition in India, it also implicitly poses a challenge to the World Bank, which has invested three quarters of a billion dollars on nutrition in India. The report raises questions about the institutional and policy environment required for effective nutrition lending.

Nutrition Toolkit: The World Bank's Nutrition Toolkit aims to help World Bank staff and country program managers design and supervise effective and feasible nutrition projects and project components, and to carry out comprehensive analysis of sectoral and policy issues affecting nutrition. The toolkit contains 12 tools, of which three have been published and another seven are being finalized for publication by the end of June, 1999. Two more tools are now being developed.

For further information contact: Milla McLachlan, Nutrition Advisor, Human Development Network, World Bank, 1818 H St NW, Washington DC 20433 USA; tel: 202 473 5277; fax: 202 522 3234; email: mmclachlan@worldbank.org

ADEQUATE FOOD:

A HUMAN RIGHT