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close this bookFood, Nutrition and Agriculture - 10 - Nutrition Education (FAO - FPND - FAO, 1994)
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(introduction...)

Technical Editor / Rctrice technique/ Redactora tica

J.L. Albert

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J.R. Lupien, K. Richmond, A. Randell, M. Papetti, A. Ghazali, R. Dawson, J.P. Cotier

Food, Nutrition and Agriculture is published by the Food and Agriculture Organization (FAO) of the United Nations. Three issues are published annually with articles in English, French and Spanish. Free subscriptions may be obtained from the Technical Editor, Food Policy and Nutrition Division, FAO, Viale delle Terme di Caracalla, 00100 Rome, Italy. Unless specifically copyrighted, articles and photographs may be reprinted. Two copies should be sent to the Technical editor and acknowledgement should be as follows: “reprinted from Food, Nutrition and Agriculture, the FAO world review of food policy and nutrition”. Ideas expressed in signed articles are those of the authors and do not necessarily reflect the viewpoint of FAO. Mention of any firm or licensed process does not imply endorsement by FAO. The designations employed and the presentation of material in this periodical do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

La revue Alimentation, nutrition et agriculture est publipar l’Organisation des Nations Unies pour l’alimentation et l’agriculture (FAO). Elle paratrois fois par an et contient des articles en frans, en anglais et en espagnol. Des abonnements gratuits peuvent e obtenus auprdu rcteur technique. Division des politiques alimentaires et de la nutrition, FAO, Viale de Terme di Caracalla, 00100 Rome (Italie). Sauf indication de droits rrv les articles et photographies peuvent e reproduits ondition de porter la mention: «Repris de Alimentation, nutrition et agriculture, revue de la FAO consacraux politiques alimentaires et a nutrition dans le monde». Pri d’envoyer deux exemplaires de toute reproduction, an rcteur technique. Les articles signexpriment les opinions de leurs auteurs et ne reflnt pas nssairement celles de la FAO. La mention de toute soci ou tout proc brevete sous-entend pas l’approbation de la FAO. Les appellations employ dans cette publication et la prntation des donn qui y figurent n’impliquent de la part de la FAO aucune prise de position quant au statut juridique des pays, territoires, villes ou zones, ou de leurs autorit ni quant au trace leurs frontis ou limites.

AlimentaciNutrici Agricultura es una publicacie la Organizacie las Naciones Unidas para la Agricultura y la AlimentaciFAO). Se publica tres veces al a contiene artlos en ingl francy espa La suscripciratuita a la revista podrolicitarse al Redactor tico. Direccie Polca Alimentaria y NutriciFAO, Viale delle Terme di Caracalla, 00100 Roma, Italia. Salvo que se indique la reserva de los derechos de autor, los artlos y las fotograf podrreproducirse siempre y cuando se declare lo siguiente: «reproducido de AlimentaciNutrici Agricultura, la revista mundial de la FAO de polca alimentaria y nutrici187;. Se ruega enviar dos ejemplares del texto reproducido al Redactor tico. Las ideas expresadas en los artlos firmados son de sus autores y no reflejan necesariamente la opinie la FAO. La mencie cualquier empresa o procedimiento autorizado no implica aprobacior parte de la FAO. Las denominaciones empleadas y la forma en que aparecen presentados los datos no implican, de parte de la FAO, juicio alguno sobre la condiciurca de pas, territorios, ciudades o zonas, o de sus autoridades, ni respecto de la delimitacie sus fronteras o ltes.

FOOD, NUTRITION AND AGRICULTURE
ALIMENTATION, NUTRITION ET AGRICULTURE
ALIMENTACION, NUTRICION Y AGRICULTURA

10 - 1994

Editorial

People throughout the world have a strong need for clear and balanced information about nutrition, FAO is assisting its member countries in developing and implementing nutrition education strategies which can enhance the ability of people to consume balanced diets from the variety of foods that are available.

While inadequate access to food is the major cause of malnutrition, it is widely acknowledged that alleviating nutrition problems also depends upon individuals having sufficient knowledge and motivation to make appropriate food choices. This is not always easy with the constant barrage of information about nutrition from newspapers, magazines, radio and television. Much of this information is based on the latest nutrition research, but unfortunately some is based on unproven beliefs or outright efforts to mislead the public.

The Plan of Action for Nutrition, signed by 159 governments at the International Conference on Nutrition (ICN) in 1992, calls for the implementation of “community-based nutrition education programmes in conjunction with appropriate communication strategies”. The ICN deliberations once again firmly established the need for basing all nutrition education on sound scientific evidence and reaffirmed that there are no “bad foods”, only inappropriate diets and lifestyles that can lead to health problems.

This issue of Food, Nutrition and Agriculture features current theories and methods of nutrition communication and examples of nutrition education strategies in developing and developed countries. By providing our readers with information about these approaches, we wish to encourage discussion about the methods that are most appropriate. FAO hopes to stimulate the sharing of talent and knowledge among countries, agencies and the public and private sectors so that the most effective approaches will be used to enhance the public’s knowledge of nutrition.

Partout dans le monde, il faut une information claire et judicieuse sur la nutrition. La FAO aide ses Etats Membres oncevoir et appliquer des strates d’cation nutritionnelle de fa ermettre aux gens de choisir des aliments sains et ilibrparmi tous ceux qui sont disponibles.

Certes, le manque de nourriture est la principale cause de malnutrition, mais on sait aussi que pour rer certains probls nutritionnels il faut informer et motiver les gens pour qu’ils choisissent de bons aliments, Ce n’est pas toujours facile compte tenu de la masse d’informations sur la nutrition que drsent sans cesse les journaux, les magazines, la radio et la tvision. Ces informations reposent le plus souvent sur les rltats des dernis recherches nutritionnelles, mais malheureusement elles sont parfois sans fondement, voire bas sur une volontbe de tromper le public.

Le Plan d’action pour la nutrition, approuvar 159 pays a Confnce internationale sur la nutrition (CIN) de 1992, invite ettre en œuvre des programmes d’cation nutritionnelle au niveau des collectivitparallment es strates de communication appropri. La CIN a ncermement la nssite baser toute l’cation nutritionnelle sur des faits scientifiquement prouv et elle a rfirmu’il n’y a pas de «mauvais aliments», mais uniquement des rmes alimentaires et des styles de vie qui peuvent provoquer des probls de sant

Ce num d’Alimentation, nutrition et agriculture prnte les thies et modes actuelles de communication en mati de nutrition et donne des exemples de strates d’cation nutritionnelle dans les pays en dloppement et dans les pays dlopp En informant nos lecteurs de toutes ces strates, nous souhaitons promouvoir un dialogue sur les modes les plus appropri. La FAO veut encourager l’ange de compnces et de connaissances entre les pays, les organisations, les secteurs public et privpour parvenir tiliser les meilleures modes d’information sur la nutrition.

En todo el mundo existe una gran necesidad de disponer de informacilara y equilibrada en materia de nutriciLa FAO ayuda a los Estados Miembros a preparar y poner en prica estrategias de educaciutricional que pueden contribuir a mejorar la capacidad de la poblacie consumir dietas equilibradas utilizando toda la variedad de alimentos disponibles.

Si bien la principal causa de la malnutricis el acceso inadecuado a los alimentos, existe la opinieneralizado de que para mitigar los problemas de nutriciambies necesario que los individuos cuenten con los conocimientos y la motivaciuficientes para tomar decisiones adecuadas sobre su alimentaciEsto no siempre es fl dado el constante bombardeo de informaciobre nutricior parte de los perios, las revistas, la radio y la televisiGran parte de esta informacie basa en las as investigaciones en materia de nutricipero, por desgracia una parte se basa en creencias no probadas o en esfuerzos denodados por desviar engamente la atenciel po.

El Plan de Acciara la nutriciaprobado por 159 gobiernos en la Conferencia Internacional sobre NutriciCIN) celebrada en 1992, solicito que se pongan en practica «programas adecuados de ensea en materia de nutriciasados en la comunidad, en conjuncion estrategias de comunicacipropiados». Una vez m las deliberaciones de la CIN establec firmemente la necesidad de basar toda la ensea en materia de nutricin pruebas cientcas racionales, y reafirmaban que no existen «malos alimentos» sino dietas y modos de vida inadecuados que pueden provocar problemas de salud.

El presente n de AlimentaciNutrici Agricultura presenta las teor y mdos acts de la comunicaciobre nutrici ejemplos de estrategias de educaciutricional en pas desarrollados y en desarrollo. Al presentar la informacielativa a estos planteamientos o nuestros lectores, deseamos fomentar el debate acerca de los mdos que son madecuados. La FAO espera poder contribuir a que los pas, las organizaciones y los sectores po y privado compartan sus aptitudes y conocimientos de manera que lleguen a emplearse los mdos meficaces para mejorar los conocimientos sobre nutricior parte de la poblaci

(introduction...)

1 This article is based on a case-study prepared for the International Conference on Nutrition entitled Communicating to improve nutrition behavior: the challenge of motivating the audience to act. The work was supported by the United States Agency for International Development.

M.B. Parlato, C. Fishman and C. Green

Margaret Burns Parlato is Vice-President for Nutrition, Academy for Educational Development (AED). Claudia Fishman is an Account Executive with Porter/Novelli. They are Director and Deputy Director, respectively, of AED’s Nutrition Communication Project. Cynthia Green is an independent consultant.

For 20 years, social marketing - the promotion of socially responsible products, behaviour and ideas through the application of commercial marketing principles - has been used successfully to promote better nutrition. The premise of social marketing is that consumers weigh the perceived benefits of alternative behaviours against the costs in terms of economic assets, time, energy or psycho-social value. The challenge to programme planners is to develop the best product, behaviour or idea at the least cost and to promote it in such a way that it clearly stands out from the competition. A successful product offers a benefit that is perceptible and valued by the consumer.

Nutritional products (such as certain foods or dietary supplements), practices or concepts may be valued not for their inherent nutritional qualities but for other attributes, and they must be promoted accordingly. For instance, implementers of programmes to prevent vitamin A deficiency found that mothers value green leafy vegetables because they are believed to give children bright eyes, shiny skin and good health, not because mothers fear that their children will develop night blindness and xerophthalmia (Favin and Griffiths, 1991; Shafritz, 1989).

Consideration has to be given to what consumers must exchange if they adopt a new behaviour to improve nutrition. Only those products or recommended behaviour changes that are economically feasible for consumers should be promoted. Costs to consumers may include monetary expenditures (for ingredients, fuel, etc.), time (for fixing a special weaning food or tending a kitchen garden), opportunity costs (carrying a nursing baby to market instead of more food to sell) and psychological costs (the strain of adopting a new feeding practice not sanctioned by tradition).

Seasonality may apply in cost-benefit considerations. For example, the Academy for Educational Development (AED) vitamin A programme in Mali recognized that the purchase and/or gathering of nutritious fruits, vegetables and herbal seasonings is affordable for most of the year. At times of the year when these items are not available, however, the purchase of small quantities of high-nutrient foods, such as liver, can be highly cost beneficial.

For behavioural change to occur, the product or service must be available and easily accessible and messages must reach the intended audience. Nutrient-rich foods must be present in the marketplace; nutritional supplements must be available in health clinics or on the open market; and distribution outlets (markets or service delivery points) must be accessible. Instead of relying exclusively on health centres, communication programmes can benefit by promoting nutrition through local markets and communities where decisions about food are made.

DEVELOPING A COMMUNICATIONS PROGRAMME

A promotion strategy should be developed only after the issues of product, price and place are resolved, The first step to developing a plan involves market research to obtain qualitative and quantitative information ‘about the knowledge, attitudes and practices of consumers. This step is essential to shaping message development and evaluating a programme’s impact.

Interpreting the results of the formative research to develop a comprehensive strategy is the second step, This strategy will be revised after the programme has been pre-tested and experience has been gained in implementing it. An important component of the strategy is audience segmentation. Most nutrition programmes define a primary target audience, i.e. those who may actually change their nutrition practices, Few programmes try to reach those who influence the primary audience (e.g. health and nutrition care providers, family and friends and popular public figures). It is also important to reach decision-makers, financial supporters and other influential people who can make the programme a success.

Selecting the channels of communication is the third step. Interpersonal communication is generally considered the most persuasive and influential means of communication, largely because of the intimacy, responsiveness and client participation that it affords. The use of this method can be problematic, however, unless investment in the training and supervision of field workers (agents) is sufficient to ensure that they have the skills to be open, patient and non-prescriptive when conveying new ideas.

The frequency of contact between agent and client determines the success of interpersonal education, Many nutrition programmes rely on health centre personnel for interpersonal education, which limits total client contact. In many parts of Africa and Latin America, less than half the population is within the catchment area of modern health facilities.

Programme planners should identify community workers, teachers and religious leaders to carry an interpersonal message. Reaching these non-traditional agents requires new institutional structures or interagency agreements, expanded management systems and cooperative training and supervision. Interpersonal education is necessary so that clients can explore the many facets of a proposed habit change with a known and knowledgeable agent.

The mass media have an equally important role in providing clients with initial information about a habit change and in encouraging favourable attitudes towards it. Both channels of communication should be programmed together. In a diarrhoeal disease control programme in Swaziland, for example, interpersonal activity alone had a profound effect on behaviour, but only a limited audience was reached. Radio was used to reach large numbers of people but had less impact on habit change. Twenty percent of the mothers who had interpersonal contact with a health or outreach worker were likely to use a home rehydration solution appropriately, while only 13 percent of the mothers who had been heavily exposed to radio used the remedy properly. However, 60 percent of the population heard the radio messages, while health workers were able to reach only 22 percent of the people and outreach workers spoke with only 16 percent (Hornik, Rice and Atkins, 1989).

Using mass media can be a cost-effective means of reaching key audiences, including families living in rural and peri-urban areas and those not reached through the health system. Messages can be repeated to ensure adequate frequency of message exposure. Mass media format and presentation can be varied to appeal to different audiences. Dramas, soap operas, quiz shows, advertisements and catchy tunes have been used successfully. Popular actors may perform gratis to promote an important social cause, adding to the appeal and memorability of a spot or show. In Brazil in 1981-82, famous actors, singers and athletes appeared in television spots to support breast-feeding. Four years after the campaign ended, 85 percent of mothers and health professionals interviewed recalled at least one spot, indicating their effectiveness (da Cunha, 1991).


In Swaziland, radio spots on the control of diarrhoeal disease reached 60 percent of the target population - Au Swaziland, des messages radio sur la lutte contre la diarrhatteignent 60 pour cent de la population vis- En Swazilandia, los mensajes radiales sobre la lucha contra la diarrea llegaron al 60 por ciento de la poblaci la que se dirig

Development and pre-testing of materials is the fourth important step in social marketing. The importance of pre-testing all materials, products and messages cannot be overstated. Pre-testing is often seen as an unwanted expense in terms of money, time and effort which would slow down the programme. However, omitting this step could lead to an even greater loss and to the failure of the entire communication activity.

Monitoring and evaluation may be considered a fifth step although they are not a separate stage but continuous processes that feed regular analyses of the results back into the programme. Careful monitoring identifies constraints that have been overlooked or underestimated, provides insight into audience characteristics that were misunderstood and suggests important factors that have changed during the programme. Evaluation includes measurement of the overall impact of the communication programme (i.e. degree of habit change, improvement in attitudes or increase in knowledge and understanding) and analysis of the degree to which individual programme elements (research, planning, training, media production, etc.) have contributed to programme success or failure. Solid data on a programme’s impact are often key to obtaining continued funding.

SUCCESSFUL NUTRITION PROGRAMMES

A number of programmes have succeeded in improving nutritional status using a social marketing approach involving market research, mixed media and advertising or consumer-based communication.

In the Dominican Republic, the prevalence of malnutrition among 4000 rural children under age five fell from 12.2 percent to 6.9 percent and breast-feeding practices improved. Feeding of newborns on demand rose from 35 percent in 1983-84 to 63 percent in 1986 (USAID, 1988).

Community nutrition education through individual counselling, print and audiovisual materials and use of mass media was among the key elements in Thailand’s Nutrition and Primary Health Care Programme. This programme reduced the prevalence of severe malnutrition among children under five in rural areas from 36 percent in 1982 to 20 percent by 1989 (INPF, 1989).

After a national breast-feeding campaign was carried out in Jordan from 1988 to 1990, 94 percent of the women interviewed recalled the song used in radio and television spots. The proportion who knew about the appropriate time to initiate breast-feeding rose from 41 to 74 percent, while the proportion having knowledge regarding delayed supplementation grew from 36 to 61 percent. The proportion of mothers initiating breast-feeding within six hours of birth increased from 38 to 56 percent (McDivitt and Ayman, 1991; Seidel, 1992).

In Indonesia, radio, banners and outreach by health workers and village health volunteers increased the proportion of young children who received a vitamin A capsule from a health post from 24 to 51 percent in test areas (Seidel, 1992). A second project used radio spots, promotional marketing activities and counselling materials for health workers to promote vitamin A-rich foods. Among those who heard the radio spots, the daily consumption of dark-green leafy vegetables increased from 19 to 32 percent among pregnant women, from 14 to 33 percent among nursing mothers, from 10 to 21 percent among infants aged 5 to 12 months and from 17 to 27 percent among children aged 13 to 60 months (Favin and Griffiths, 1991).

In Peru, a new weaning food for children with diarrhoea was developed using recipe trials with mothers. It was promoted through radio spots, cooking demonstrations in mothers’ clubs and local markets, a flip chart, a calendar and training materials for health professionals. In the test area, 80 percent of women interviewed had heard of the food, 16 percent had tried it and 12 percent said that they would continue using it (Johns Hopkins University, 1990).

KEY FEATURES OF SUCCESSFUL PROGRAMMES

A number of lessons can be derived from nutrition communication experiences worldwide. First, successful programmes have used in-depth research to build an effective communication strategy. To influence nutrition knowledge and behaviour, programme planners must have an understanding of the factors affecting dietary practices in at-risk populations. This foundation is obtained through careful, in-depth analysis of current nutrition status, dietary practices, food availability and cost, cultural beliefs and use of social services.

To select the most appropriate interventions, it is necessary to identify barriers to sound nutrition (e.g. families’ inability to afford nutritious foods or improper food preparation) and address them directly, Among the specific problems identified, those most harmful or widespread and most amenable to change must be determined. Possible interventions need to be assessed for their feasibility, cost and potential nutritional impact.

Effective nutrition communication campaigns and products are based on consumer preferences. Usually, programme managers seek to identify a nutrition behaviour that is susceptible to modification, to develop a new recipe or mode of delivery for a food supplement or to introduce improved feeding or care practices. If consumers are involved in identifying and perfecting the end product - whether it be a tangible product, a practice or avoidance of something harmful - the chances of the end product’s sustained adoption are increased.

Successful programmes promote simple, practical habit change. In the past, many nutrition communication programmes promoted complicated and unrealistic actions and had little effect in changing nutrition behaviour. In contrast, recent campaigns such as those in the Dominican Republic (USAID, 1988) and Cameroon (Hollis et al., 1989) have focused on highly specific behaviours, for example by promoting specific numbers of meals, specific quantities and other defined, related feeding tasks.

Often people are more willing to accept a new food or product than a change in their customary eating patterns. Products that do not alter the basic adult meal are more acceptable. Cultural rules concerning children’s food or between-meal foods are generally more flexible. Snack foods could overcome cultural barriers, for example by helping women to increase their own dietary intake without increasing the total amount of food provided at family meals.

Experience shows that successful programmes identify and reach audiences that have the power to influence the primary target audience. Many nutrition communication programmes focus on mothers, who are often the main providers of food and child care. Fathers and other family members, however, often influence decisions regarding food purchasing and food allocations within the family.

Family members influence dietary practices by their opinions, their financial contribution to food purchases and the labour they contribute to the household. Changes in nutrition behaviour often entail shifts in time allocation among household members. For example, if women are devoting more time to breast-feeding or food preparation, other household members may have to take on additional responsibilities such as carrying water or fuelwood. Therefore, it is important to direct some messages to other family members and to involve them in efforts to improve family diets. For example, in Mali a communication effort reinforced fathers’ traditional practice of buying small pieces of liver (high in vitamin A) as a snack for their children (Fishman, Tournd Gottert, 1991).

Community leaders can help identify problem areas and possible solutions, ensure acceptance of new products or practices and establish new cultural norms related to nutrition. While the level of community involvement varies greatly among projects, it is critical that leaders help identify the most severe nutrition problems, provide advice on proposed behaviour changes, messages and communication channels and give overall support for community-level activities.


A father purchasing a nutritious snack of liver - Un p ach un casse-croutritif de foie - Un padre de familia comprando un bocadillo nutritivo de hdo

TRAINING AND MANAGEMENT OF OUTREACH WORKERS IS KEY

Effective agent training uses a social marketing approach that teaches outreach workers to view the women they see in health centres or visit in communities as clients or consumers of the services and information they offer.

This perspective requires that outreach workers:

· understand the client’s circumstances and why current opinions and feeding practices are prevalent;

· seek solutions to nutritional problems in collaboration with the consumer, based on the resources available to the family;

· be systematic about follow-up and community sensitization, knowing e.g. when to check back with the client; whether a problem could be brought to the attention of a village health committee; whether a topic is suitable for a group demonstration, health talk or role-play activity.

As outreach workers both “sell” information to their own clients and “consume” it from their superiors, communications materials (such as lively bulletins, videos and self-evaluation checklists) have been developed to motivate and reinforce their confidence while helping to improve their nutrition counselling skills.

Involving community leaders in project planning helps to ensure their cooperation and active participation in project implementation.

A balance between centrally managed functions and community input is necessary. Central management ensures accurate, consistent messages, allows economies of scale and provides specialized expertise, while community advice ensures that messages are culturally appropriate and that they reach their intended audience.

Frequent, direct message exposure is widely recognized as a key factor in behaviour change. Putting the message out does not necessarily guarantee that it is received and understood by the target audience. For example, health and field workers may be inadequately trained in nutrition, or people may not listen to radio broadcasts. The message may be misinterpreted, or it may be understood but ignored. People usually need to hear messages over and over again before they take action. It is a mistake to assume that once people have heard the message they will immediately and flawlessly adopt the desired behaviour. In reality, people have many demands on their time and many preoccupations. Even the most clever message must cut through the clutter of everyday communications.

Combined use of interpersonal communication and mass media is important to attain different objectives, The mass media can bring new ideas and information to large audiences, encourage favourable attitudes towards them and generate support among opinion leaders. Interpersonal education can provide the intimate, interactive contact with clients necessary for final habit change.

A recent assessment of 16 health communication projects concluded that programmes that achieved a high mass-media exposure (reaching at least 60 percent of the target audience) were associated with substantial change in behaviour, while most of those with low rates of exposure (below 30 percent) resulted in little or no change (Hornik, Rice and Atkins, 1989). Since it is assumed that in both cases intensive, high-quality interpersonal education was a constant, it can be concluded that the mass media have a complementary role in preparing the way for behavioural change.

While mass media costs can be high, particularly in privatizing economies bent on cost recovery, they can be reduced. Free air time for short public service announcements can be secured from networks, stations or government ministries of information. It may be possible to negotiate for free production services from advertising agencies or commercial companies with a large and visible presence. Messages can be integrated into already-popular programmes.

Special efforts to train outreach workers in counselling and communication skills and to provide regular supervision are important. Working far from a centralized authority in remote communities, these workers must always be - and feel - part of an integrated management system. In which their needs are met, their contribution is acknowledged and their performance can continuously improve. The investment required to achieve such a system is significant, including transport for supervision, resources for training and improvements in financial and benefits packages to make remunerations commensurate with job effort and responsibility.

Finally, successful programmes are long-term commitments for which the return is sustained behaviour change. While brief interventions have produced measurable results, new behaviours are fragile and can rapidly disappear. Evaluations of communication projects over time strongly support the need for long-term, intensive efforts. The implication for programme planners is that sufficient funds, human resources and political commitment are required to obtain results. Even after most people have adopted the desired behaviour, reinforcing messages are needed to prevent reversion to original behaviour (“decay”). In addition, audiences keep changing: young people start families and need to know about infant and child feeding, rural people move to the city and income levels change. By sequencing messages over time, building in audience feedback and using evaluation results to plan new campaigns, programme managers can build on past efforts and reinforce behaviour change.

REFERENCES

da Cunha, G. 1991. The national programme to promote breast feeding. Brazil. Paper presented at the Sixth International Conference of the International Nutrition Planners Forum, Paris, 4-6 September.

Favin, M. & Griffiths, M. 1991. Social marketing of micronutrients in developing countries. Washington, DC, Manoff Group.

Fishman, C., TourD. & Gottert, P. 1991. Nutrition promotion in Mali: highlights from a rural integrated nutrition communication program. Sixth International Conference of International Nutrition Planners Forum, Paris, 4-6 September.

Hollis, C., Seumo, E., Mal Bappa, A. & Griffiths, M. 1989. Improving young child feeding practices in Cameroon: project overview. Washington, DC, CARE/Cameroon; Education Development Center; Manoff Group.

Hornik, R., Rice, R. & Atkins, C. 1989. Channeling effectiveness in development communication programs. In Public communication campaigns. Newbury Park, California, USA, Sage Publishing. 2nd ed.

International Nutrition Planners Forum (INPF). 1989. Crucial elements of successful community nutrition programs. Report of the Fifth International Conference of the INPF, Seoul, 15-18 August 1989.

Johns Hopkins University. 1990. Dietary Management of Diarrhoea (DMD) Project: final report. Baltimore, Maryland, USA.

McDivitt, J. & Ayman, A. 1991. The HEALTHCOM Project in Jordan: final case study evaluation report. Philadelphia, Pennsylvania, USA, Centre for International Health and Development Communication, University of Pennsylvania.

Seidel, R. 1992. Results and realities: a decade of experience in communication for child survival. Washington, DC, Academy for Educational Development.

Shafritz, L. 1989. Social marketing approach to vitamin A communication. Washington, DC, Academy for Educational Development.

United States Agency for International Development (USAID). 1988. Growth monitoring and nutrition education: impact evaluation of an effective applied nutrition program in the Dominican Republic, CRS/CARITAS, 1983-86. Washington, DC.

Améliorer les habitudes alimentaires par l’application des techniques de marketing social

Depuis une vingtaine d’ann, des spalistes de la communication s’efforcent d’inciter la population morer son comportement nutritionnel. Ils utilisent des techniques de communication efficaces dv des sciences du comportement et des strates commerciales pour comprendre le comportement nutritionnel de la population dans son contexte social rgi. Ces activitreposent sur une participation communautaire ous les aspects de la recherche, de la mise au point du message et des enqus prables.

Les programmes de communication les plus efficaces ont isoln petit nombre de comportements spfiques influant considblement sur l’t nutritionnel d’un groupe de bficiaires. Ces programmes ont proposuelques changements comportementaux acceptables compte tenu des contraintes de temps et d’argent des mges et des collectivit Ils ont en outre mis au point pour chacun des groupes de populations diffnts messages qui influent d’une mani ou d’une autre sur les bficiaires vis en utilisant les porte - paroles, les images, les sons et les mots les plus efficaces pour chaque groupe. Pour finir, ils ont transmis ces messages avec vigueur et insistance jusqu’e que les id rentrent dans la conversation - voire le comportement - habituels des individus ou des collectivit

Les rltats prouvent que la communication en mati de nutrition peut apprendre aux gens des choses utiles, les aider cqur les connaissances nssaires et les inciter odifier leur style de vie. Les programmes qui ont axeur message sur un public ont eu un effet positif sur l’t nutritionnel, m dans les groupes aible revenu. La plupart d’entre eux utilisent des techniques de marketing ou de mobilisation sociale pour mettre au point leur strate de communication.

Mejora del comportamiento nutricional a través de la mercadotecnia social

En los os veinte a los especialistas en comunicacian colaborado en la tarea de lograr que la poblaciejore su comportamiento nutricional. En esta labor, se han empleado ticas de comunicacificaces, derivadas de las ciencias y del comportamiento y de la mercadotecnia, para comprender los comportamientos relativos a la nutricin un contexto social mamplio. Esta comprensie basa en la participaciomunitaria en todos los aspectos de la investigaciducativa, la elaboracie mensajes y los ensayos previos.

La comunicaciobre nutricie ha mostrado meficaz cuando sus responsables individuaron un n limitado de conductas especcas que afectaban de forma significativa al estado nutricional del grupo de beneficiarios y a continuaciropusieron pequecambios de conducta que ofrec una alternativa viable teniendo en cuenta las limitaciones de tiempo y costo de los hogares y de la comunidad. Luego, elaboraron distintos mensajes para cada uno de los grupos de poblaciue influ o por lo menos afectaban a los beneficiarios correspondientes, en los que se empleaban portavoces, imnes, sonidos y textos especialmente concebidos para cada grupo, y por o transmitieron estos mensajes con la difusi el tiempo suficientes para que estas ideas entraran a formar parte de la conversaci#171;habitual» - y con el tiempo, del comportamiento - de la poblacin el plano individual o comunitario.

La experiencia ensee manera concluyente que la comunicaciobre nutriciuede mostrar a la poblaciechos beneficiosos, prestarle ayuda para adquirir los conocimientos necesarios, e impulsarla a realizar cambios en sus modos de vida. Los programas que han utilizado mdos enfocados a la poblacian tenido un efecto positivo en el estado nutricional, incluso entre los grupos de bajos ingresos. La mayor parte de estos programas tienen un planteamiento basado en la mercadotecnia y movilizaciociales que incluye un proceso de preparacie sus estrategias de comunicaciuy bien definido.

(introduction...)

M. Andrien

Michel Andrien est coordonnateur du Centre d’enseignement et de recherche en cation pour la sante l’Universite Li (CERES). Il a rises missions de consultant en cation nutritionnelle dans les pays en dloppement et a animde 1986 991, le Rau pour l’cation nutritionnelle en Afrique.

La rexion sur l’cation nutritionnelle, ses strates et ses modes a connu un essor considble durant ces 20 dernis ann. Une conviction a gagnrogressivement l’ensemble des intervenants en nutrition: les troubles nutritionnels sont souvent le rltat d’une mauvaise utilisation des ressources disponibles.

La Confnce internationale sur la nutrition a confirmette orientation des politiques nutritionnelles vers une meilleure prise en compte des comportements et des fas de les modifier (FAO/OMS, 1992). Il s’agit l’un projet ambitieux.

Telle qu’elle se pratiquait et se pratique encore sous la forme de causeries dans les centres de santl’cation nutritionnelle a fait faillite (Hornik, 1985; Andrien et Beghin, 1993). Elle se fondait sur une approche pgogique de la modification des comportements lia nutrition. Le raisonnement a base de cette drche pouvait se rmer comme suit: si les adultes commettent des erreurs dans leur fa de s’alimenter, c’est qu’ils sont mal inform uquons-les, donnons-leur le savoir qui leur fait dut. Leurs attitudes ’rd de ‘alimentation changeront, d’ors comportements se modifieront dans un sens favorable a nutrition.

Dans la drche, tout semblait hte l’approche pgogique la plus traditionnelle, avoir:

· transmission d’un savoir nutritionnel de celui qui sait (souvent un agent de santeux qui sont supposignorants (souvent des ms de famille);

· disposition des lieux opposant un mae (utilisant ntuellement un tableau comme support de communication) et un public assis en rangs;

· attitude dogmatique et autoritaire de la part de celui qui dent l’autoritu livre (celui des sciences de la nutrition).

Les amorations que l’on a pu apporter ette approche n’ont pas permis de lui confr une efficacitle (Andrien, 1986), et ce constat d’ec a durage nombreux responsables de la santublique et agents de terrain d’entreprendre quoi que ce soit en ce domaine.

Heureusement, d’autres pratiques de communication en nutrition se sont dlopp sur le terrain, tout en bficiant de l’airage d’ipes de recherche multidisciplinaires.

APPORT DU MARKETING SOCIAL LA COMMUNICATION EN NUTRITION

L’le du marketing social a apportne contribution majeure au renouveau de la communication en nutrition. Cette le domine le dt au dt des ann 90 (Koniz-Booher, 1993). Elle a rv#145;education nutritionnelle en y introduisant les res du marketing: de approfondie du consommateur, ciblage de la communication, segmentation du public, crivitstrate multima.

Cette approche a produit des rltats indables. Dans un ouvrage de synth sur l’expence de la Banque mondiale, Berg (1987) cite en exemple le programme indonen d’amoration de la nutrition, conduit autour des ann 80 par l’ipe de R.K. Manoff et M, Griffiths. Cette expence a prouvu’il it possible d’amorer l’t nutritionnel d’une population par les seules vertus de la communication. Ce programme respectait d les res de l’art du marketing social: des messages simples, fondsur une de approfondie des caractstiques du public, transmis par des canaux de communication interpersonnels (ici les kaders agents de nutrition semi-bvoles) relaypar des mas (ici la radio) (Manoff, 1984; Mantra, Manoff et Griffiths, 1985; Manoff Group, 1991).

L’efficacitu marketing social a ouven nutrition comme dans d’autres domaines de la santRasmuson et al., 1988; Seidel, 1993). Le marketing social a ainsi le principe organisateur de campagnes visant romouvoir des produits tels que les vaccins, la solution de rdratation orale ou encore le prrvatif.

Quoique nos propres propositions tiennent compte des les tir par ‘le du marketing social, il nous paraimportant de nous en drquer sur trois points au moins.

Tout d’abord, nous considns la nutrition comme un probl global, impliquant de nombreux secteurs de l’activitumaine. Il nous semble dangereux de chercher la solution des probls nutritionnels dans la modification de comportements isolde leur contexte d’rgence, sans considtion pour les ntuels effets pervers de tels changements. Nous concevons la communication en nutrition dans ses interactions avec les autres facteurs de dloppement d’une soci.

Ensuite, beaucoup de programmes fondsur le marketing social ne visent que l’adoption ourt terme des nouveaux comportements: le plus souvent, des comportements d’achat ou d’utilisation de services. Dans ce domaine, le marketing social a prouvon efficacitMais qu’en est-il des modifications en profondeur de conduites li a la nutrition lorsque ces conduites font partie du patrimoine culturel de toute une communaut

Notre troisi critique, fondamentale, tient a dndance que de telles approches de la communication entretiennent chez les bficiaires de programmes de dloppement. Notre volontst d’aider les populations qui souffrent de probls nutritionnels a les prendre en charge elles-ms en toute connaissance de cause. Nous pensons que leur autonomie dans la dsion est seule garante d’un dloppement durable de ces communaut Le rde l’expert, trimportant dans un programme fondur le marketing social, doit diminuer au profit de la participation de la communautt de ses reprntants ltimes.

L’objection selon laquelle la nutrition serait affaire d’expertise ne tient plus: on voit aujourd’hui les experts nutritionnistes remettre en cause les certitudes d’hier, celles-ls sur lesquelles ont fonddes programmes catifs dogmatiques. Comme le soulignait dans ces colonnes Cerqueira (1991, 1992), il est temps de fonder les programmes de communication en nutrition sur la participation communautaire plutu’en rrence aux nutriments.

MODIFIER LA COMMUNICATION SOCIALE EN NUTRITION: QUELLES CONDITIONS?

La communication sociale peut e dnie comme l’ensemble des res, implicites ou explicites, qui rendent prsibles les interactions entre les participants ne m culture (Winkin, 1993). Si nous appliquons cette dnition a la communication sociale en nutrition. nous dirons qu’elle est constitudes conventions admises, consciemment ou non, entre les membres d’une m communautu sujet de la fa de traiter les actes de la vie quotidienne qui ont une incidence sur la nutrition, en particulier la fa de se nourrir. Constatons d’emblque, dans toute soci humaine, la communication sociale en nutrition est riche et complexe et ce, avant toute intervention d’un soi-disant cateur nutritionnel.

Dans un livre rnt consacr ‘anthropologie nutritionnelle, Fischler (1990) montre, aprd’autres (Farb et Armelagos, 1985), uel point nos manis de consommer la nourriture sont culturellement drmin. Cette drmination porte d’abord sur la dnition de ce qui est comestible et de ce qui ne l’est pas (les mollusques pour les uns, les sauterelles pour les autres). Elle porte ensuite sur le partage de la nourriture (les meilleurs morceaux de viande pour le p chez les uns, pour les enfants chez les autres), Elle porte encore sur les formes que doit prendre la consommation des aliments (le plat collectif chez les uns, les plats individuels chez les autres).

Si les pratiques li a nutrition luent et, par l, la communication sociale en nutrition, force est de constater que c’est rarement sous ‘influence de l’cation nutritionnelle. C’est bien plus souvent sous ‘effet de facteurs socionomiques trigndes prcupations des responsables de la santublique.

L’cation nutritionnelle devrait, selon nous, se concevoir comme une intervention visant odifier la communication sociale en nutrition dans le but d’amorer l’t nutritionnel de certains groupes de population. Les groupes prioritaires sont aujourd’hui bien connus: les enfants de moins de 5 ans et les femmes enceintes et allaitantes.

Ce type d’intervention requiert une grande prudence. Elle ne peut e mise en œuvre que dans le respect de principes d’action que nous avons dloppilleurs (Andrien et Beghin, 1993), mais dont nous rappelons le fondement:

· L’itde telles interventions ne peuvent avoir pour but d’adapter des populations dnies eur situation de pauvretelles doivent, au contraire, favoriser une plus grande justice sociale.

· La participation: les communautconcern doivent e associ aux processus de dsion concernant les messages iffuser dans le corps social.

· La globalitla communication doit e conside comme une activit’appui es processus de dloppement plus larges, orientvers une amoration de la nutrition.

· La rationalittoute intervention dans la communication sociale en nutrition devrait e fondsur une analyse approfondie du probl nutritionnel et suivre une drche logique de planification des activit

Sur les probls nutritionnels, il est temps de rendre toute son importance a communication entre les gens, de les aider rouver eux-ms les pratiques romouvoir au sein de leur communaut’appartenance, de les aider nter ces pratiques dans un projet plus global d’amoration de la nutrition. En d’autres termes encore, s’il est nssaire de modifier la communication sociale pour que s’amore la nutrition, que cela se fasse avec la participation active des groupes concern L’expertise conserve son importance: on ne peut, par exemple, demander es populations analphabs de reduvrir le rde la vitamine A dans la prntion de certains troubles visuels. L’expert doit se mettre au service d’une communaut la recherche de solutions es probls nutritionnels et non imposer ses propres recettes. Les processus de communication qui seront mis en oeuvre valoriseront alors le savoir et le savoir-faire populaires, tout en blissant un pont entre ceux-ci et le savoir scientifique: par exemple, dans certaines socis traditionnelles, le gusseur donne du foie cuit aux personnes atteintes de xphtalmie, pratique que le nutritionniste applaudira, sur la base de sa connaissance du rde la vitamine A contenue dans le foie.

La question est rnt de savoir comment peut e be une intervention dans la communication sociale qui, tout en respectant nos principes d’action, favorise l’adoption par la population de pratiques plus favorables a nutrition.

CONCEPTION DES INTERVENTIONS DANS LA COMMUNICATION SOCIALE EN NUTRITION

Identification et analyse du probl nutritionnel

La finalite la communication en mati de nutrition rde dans la responsabilisation des communautvis-is de leurs probls nutritionnels. L’exemple d’Iringa, en Tanzanie, montre que, bien encadr, et si on leur laisse le temps nssaire, des communautrurales peuvent prendre conscience des probls nutritionnels qui les touchent, les analyser et rechercher ensemble des solutions es probls (Gouvernement tanzanien, 1988; Moneti et Yee, 1989). Les processus de communication et d’animation jouent un rprimordial dans la progression des communautvers la rlution de leurs probls nutritionnels.

La premi pe du processus consiste dentifier, puis nalyser le (ou les) probl (s) nutritionnel (s) prioritaire (s). Une mode d’analyse causale a dlopppar ‘ipe de nutrition de l’Institut de mcine tropicale d’Anvers dans un ouvrage d bien connu des nutritionnistes de santublique (Beghin, Cap et Dujardin, 1988).

Cette mode consiste nalyser, dans le cadre d’un groupe intersectoriel incluant des agents de terrain, des reprntants de la population et un «expert» en nutrition, les facteurs qui influencent l’t nutritionnel d’un groupe de population. Ce groupe intersectoriel peut e constituu niveau central, lorsqu’il s’agit de mettre en place des strates nationales ou ronales, comme au niveau local, lorsque la communaute base prend en charge, avec ses moyens, la rlution d’un probl nutritionnel. L’articulation des interventions nutritionnelles men au niveau local avec la politique nationale d’alimentation et de nutrition est de toute fa indispensable.

L’analyse causale se fait en arbre, de haut en bas, en partant des facteurs immats pour atteindre des facteurs de plus en plus distants de la variable que ‘on die. L’exemple donnn encadrp. 15) illustre ‘analyse des facteurs qui influencent ‘t nutritionnel du jeune enfant, telle qu’elle a risrmment offo, au Bn, par un groupe intersectoriel d’une dizaine de personnes (Andrien et al., 1994).

L’analyse aboutit a construction d’un mod hypothque causal qui s’enrichira tout au long de la mise en œuvre de l’intervention et qui servira de cadre conceptuel commun aux diffnts partenaires. Il permettra de choisir les objectifs - catifs ou non - de l’intervention et, plus tard, d’en mesurer les effets en tenant compte de tous les facteurs qui influencent l’t nutritionnel.

On objectera que ce mode d’analyse n’implique qu’une toute petite minorite reprntants de la population concern Nous rndrons que, d’une part, ces reprntants sont invitrocr de leur cn large ange de vues sur la nutrition avec ceux qu’ils prndent reprnter1 et que, d’autre part, l’analyse s’enrichira a faveur des enqus qui seront men dans la population, tout au long de la phase de conception de l’intervention.

1 Cela peut, notamment, e risar les agents de sant l’occasion des sces de surveillance de la croissance des enfants.

Une fois connus les facteurs du probl nutritionnel, il est important de se pencher sur les drminants des conduites humaines qui ont mises en cause.

ude des conduites intervenant dans le probl nutritionnel

L’analyse de la conduite humaine repose aujourd’hui sur des mods psychosociaux bien connus2. On sait que les conduites, notamment celles qui influencent la nutrition, obsent ’autres drminants que les seules connaissances. Les facteurs internes de la conduite humaine sont aussi d’ordre affectif (attitudes, valeurs, image de soi et de sa capacit agir) et conatif (motivation gir et dsion d’agir dans un sens ou un autre). Les facteurs externes a personne sont d’ordre social (normes) ou nomique (disponibilites ressources).

2 Nous nous rrons en particulier aux mods de Fishbein, Bandura, Rosenstock et Triandis, admirablement prntpar G. Godin (1988).

On doit donc situer les conduites dans leur contexte avant de pouvoir espr les modifier dans un sens favorable a nutrition.

Les modes d’de des reprntations et des conduites li a nutrition ont bien di durant ces dernis ann. Nous en avons proposne synth dans le manuel que la FAO a consacrux modes d’intervention dans la communication sociale en nutrition (FAO, 1993).

L’id serait sans doute de s’appuyer, dans tout programme de ce genre, sur une de anthropologique approfondie, dont les rltats seraient discutpar des membres de la communautoncern Malheureusement, les ressources sont souvent insuffisantes pour mener de tels travaux, co en temps et en argent. On se contente alors d’des plus rapides, qui font appel au tignage de la population, par le biais de rions de groupes focalis(Simard, 1989; Steward et Shamdasani, 1989; Andrien et al., 1993), d’entretiens individuels approfondis ou d’enqus sur les connaissances, attitudes et pratiques d’un antillon reprntatif de la population concern Si l‘on fait appel ’observation dans les mges, on se concentre sur les pratiques directement li a nutrition.

Dla phase de conception d’une intervention, divers mas peuvent e utilis Ainsi, la radio rurale peut fort bien, dce moment, ouvrir un large dt entre auditeurs sur le th nutritionnel diOn sait que la finalite la radio rurale est de rendre la parole aux «sans-voix» (FAO, 1991). Des hommes et des femmes issus des communautrurales ont ainsi l’occasion de s’exprimer et de se faire entendre par des groupes de population qui vivent les ms difficult L’analyse des probls nutritionnels ne se passe plus entre experts, mais entre des personnes qui les vivent au jour le jour sans avoir eu l’occasion d’en parler entre elles, parce que trop ign les unes des autres. La radio rurale leur offre cette possibilitle est prnte.

Definition des objectifs graux d’une intervention nutritionnelle

Au terme de la phase de conception d’une intervention, le probl nutritionnel doit e clairement identifises drminants doivent e connus et les facteurs qui influencent les conduites en cause doivent avoir analys Il est alors possible de formuler les objectifs d’une intervention nutritionnelle.

L’objectif peut, par exemple, rder dans la promotion d’un aliment susceptible de rndre au probl nutritionnel soulevC’est notamment le cas dans le cadre du programme de promotion des jardins potagers dans le nord-est de la Thande. Les responsables du programme ont d’abord mis en dence la carence en vitamine A dans l’alimentation des jeunes enfants ainsi que des femmes enceintes ou allaitantes. Aprune de approfondie des besoins et des ressources des producteurs et des consommateurs (parfois les ms personnes) et sur la base d’une large participation de la communautles responsables du programme ont amenromouvoir la production et la consommation d’une courge locale riche en vitamine A. Tel it l’objectif gral de l’intervention (Attig et al., 1993).

FORMULATION D’UN PLAN DE COMMUNICATION

Dnition des objectifs

Il appartient au groupe intersectoriel charg’animer la communication sociale en nutrition de dnir les objectifs de communication de l’intervention nutritionnelle.

Dans le cadre d’un programme nutritionnel qui vise romouvoir la production et la consommation d’un nouvel aliment, par exemple une courge, des objectifs de la communication pourraient e, entre autres, de:

· favoriser l’acquisition d’une reprntation positive de ce produit et de ses qualitnutritives;

· rendre les cultivateurs capables de cultiver ce lme dans de bonnes conditions;

· rendre les personnes charg de la cuisine capables d’introduire ce produit dans les plats habituellement consomma maison et de les convaincre qu’elles en sont rlement capables.

Formulation des messages

De ces objectifs dulent les messages. Ceux-ci doivent e prsttant dans leur contenu que dans leur forme.

Les recettes prnis sont-elles applicables dans les familles concern? Seuls des essais en situation rle permettent de donner une rnse dnitive ette question.

Les messages sont-ils compris comme nous le souhaitons? Des essais auprd’antillons du public cible constituent un moyen de le vfier.

Les messages seront ensuite traduits sur des supports varicorrespondant aux canaux de communication retenus.

Choix des canaux de communication

Une de des raux de communication actifs dans les communautconcern aura entreprise dla phase de conception. De ses rltats, on aura dressn tableau des canaux privilpour parler de nutrition. On sait aujourd’hui que les meilleurs rltats sont obtenus quand on associe, en synergie, l’utilisation des mas de masse (radio, tvision, presse ite, affichage, etc.) et des canaux de communication interpersonnels (agents de santvulgarisateurs agricoles, enseignants face eurs publics respectifs). La strate sera donc multima.

Compte tenu de nos principes de drt, nous pensons qu’il faut donner la prioritux mas interactifs. Cela signifie qu’un r dialogue s’instaurera dans la communication interpersonnelle (trop souvent ve comme une communication ens unique). Les mas de masse se verront lement encouragratiquer l’interactivitcomme la radio rurale). Si des supports modernes sont utilis ils favoriseront, eux aussi, la participation au dt des personnes principalement concern3.

3 La Division de l’information de la FAO a ainsi mis au point une mode d’animation s’appuyant sur l’utilisation de la diapositive (FAO, 1989).

aboration d’un plan multima

L’boration d’un plan de communication est l‘occasion de fixer, pour un temps drminles modalitd’intervention des uns et des autres en faveur des ms objectifs.

N’oublions pas, cependant, que c’est sur le long terme que se modifient les conduites li a nutrition. Il faut donc inscrire le discours sur la nutrition dans les activitroutinis des services concern programmes scolaires, activitde surveillance de la croissance, vulgarisation agricole, grille des programme de radio, etc. Plus encore, les messages en faveur de la nutrition doivent progressivement se propager dans le corps social a faveur des interactions entre ses membres non spalistes.

MODE HYPOTHIQUE CAUSAL DE L’AT NUTRITIONNEL DU JEUNE ENFANT TOFFO (BIN)

Ce mod en trois figures a risn Janvier 1994 offo, dans le drtement de l’Atlantique La sous-prcture de Toffo est une ron riche du point de vue de la production agricole, elle est pourtant confrontn taux ve malnutrition infanto-juvle.

Il s’agit de la premi version d’un mod appel s’enrichir au cours des prochains mois et des prochaines ann Il a risar un groupe intersectoriel d’une dizaine de personnes, en vue d’une intervention dans la communication sociale en nutrition. Il doit e consid comme une esquisse de l’de des facteurs de l’t nutritionnel offo Il ne peut en aucun cas e utilisour dire les causes de la malnutrition dans une autre partie du monde, ni, ortiori, servir de mod universel!

Le dloppement initial du mod est prnt la figure 1 Deux branches de l’arbre des causes sont di le nombre de repas par jour (figure 2) et la quantit’aliments par repas (figure 3) D’autres branches pourront e dlopp par la suite

Parmi tous les facteurs relevlors de cette premi analyse, le groupe a marqu’un astsque (*) ceux qui lui paraissent vulnbles ne approche utilisant la communication Sur ces facteurs, des enqus plus approfondies seront men durant la phase de conception de l’intervention dans la communication sociale en nutrition.


Figure

Par exemple, un grand pas en faveur de l’allaitement maternel est fait quand les ms entre elles (et non plus seulement les personnels de santse transmettent des conseils concrets e sujet (allaiter a demande, pratiquer l’allaitement maternel exclusif jusqu’rois mois au moins, positionner l’enfant correctement, etc.). On peut alors parler d’une modification positive de la communication sociale - qui n’est parfois qu’un retour es pratiques ancestrales, y par la recherche scientifique contemporaine.

MISE EN ŒUVRE ET ALUATION DE LA COMMUNICATION SOCIALE EN NUTRITION

Production des supports

La production des supports inclut leur conception, la risation des prototypes, le prst de ces prototypes, la mise au point des supports dnitifs et leur reproduction en un grand nombre d’exemplaires en fonction du plan adoptans la phase de formulation (Andrien et Beghin, 1993).

La communication s’appuie toujours sur des supports, ne serait-ce que la voix humaine. Il est important de vfier la pertinence de la transcription du message sur chaque support, que c’est bien l’effet attendu qui est produit.

Formation des intervenants

Une intervention dans la communication sociale en faveur de la nutrition suppose une bonne formation de ceux qui auront ommuniquer avec la population. Les messages aire passer doivent e clairs. Les modes de communication doivent e interactives.

Les communicateurs en nutrition doivent connae les probls nutritionnels qui se posent a population et les solutions possibles. Mais ils doivent aussi e capables de moduler le message en fonction de la situation des groupes auxquels ils ont affaire, et d’utiliser les supports qui auront produits pour eux.

Dans ces colonnes, Tour1993) a rapport’action de la FAO en mati de communication en nutrition dans les pays sahens. Des ipes multidisciplinaires originaires de cinq pays sahens ont convi a trois snaires de formation sur l’utilisation de la radio rurale, de la videt des supports audiovisuels de la communication en face-ace. Cela illustre la nssite former les agents chargd’intervenir dans la communication en nutrition, au niveau national d’abord, es niveaux plus pphques ensuite. Cette formation s’adresse a fois aux nutritionnistes et aux agronomes, qui doivent apprendre ommuniquer avec la population, et aux communicateurs professionnels, qui doivent saisir toute la complexites probls nutritionnels. Ils doivent en outre apprendre ravailler ensemble, ce qui n’est pas toujours aiscompte tenu de leurs rrences et de leurs intts respectifs.

Permanence de l’action et de l’luation

Pour assurer la permanence des activitde communication favorable a nutrition (au-dele la pode dlue ne intervention ponctuelle), les groupes d’animation de la communication sociale pourraient e constitusur une base permanente, tant au niveau national qu’au niveau local.

Chaque intervention peut demment faire l’objet d’une luation particuli: des processus et de l’impact.

L’luation des processus s’intsse a fa dont les activitse dulent. Respectent-elles les principes dnis plus haut? Satisfont-elles les groupes concern(bficiaires, commanditaires, agents de terrain, «experts»)?

L’luation de l’impact d’une intervention vise d’abord esurer les rltats obtenus a suite des activitqui ont men: intervenants form supports produits, messages diffus publics concern etc. Elle vise ensuite valuer l’effet produit sur les reprntations, les attitudes, les valeurs et, en dnitive, les pratiques li a nutrition.

Cependant, au-dele l’luation d’une intervention ponctuelle dans la communication sociale en nutrition, il nous semblerait intssant que chaque pays mette en place des observatoires de revolution des reprntations et des pratiques li a nutrition. La communication sociale en nutrition ferait alors l’objet d’un suivi rlier, qui permettrait d’intervenir au moment opportun, dans le cadre des programmes incluant une composante nutritionnelle. A l’heure onombreux pays se voient contraints de rienter les habitudes alimentaires vers la consommation accrue de produits locaux, une telle proposition ne devrait pas rester lettre morte.

RENCES

Andrien, M. 1986. Limites de l’cation nutritionnelle conventionnelle: un exemple en milieu urbain d’Afrique de l’Ouest. Hygie, 5(4): 21-25.

Andrien, M. et Beghin, I. 1993. Nutrition et communication: de l’cation nutritionnelle conventionnelle a communication sociale en nutrition. L’Harmattan, Paris.

Andrien, M., Monoyer, M., Philippet, C. et Vierset, V. 1993. Le groupe focalisfocus group): une mode qualitative de recueil d’informations. ucation Sant77: 3-9.

Andrien, M., Sagbohan, A. et al. 1994. Mod hypothque causal de l’t nutritionnel de l’enfant de moins de cinq ans offo (Bn). Premi version. CERES, Li.

Attig, G.A., Smitasiri, S., Ittikom, K. et Dhanamitta, S. 1993. Promoting home gardening to control vitamin A deficiency in northeastern Thailand. Alimentation, nutrition et agriculture, 7:18-25.

Beghin, I., Cap, M. et Dujardin, B. 1988. Guide pour le diagnostic nutritionnel. OMS, Gen.

Berg, A. 1987. Malnutrition: les rems existent. L’expence de la Banque mondiale. Banque mondiale, Washington.

Cerqueira, M.T. 1991. Nutrition education: a review of the nutrient-based approach, Alimentation, nutrition et agriculture, 2/3:30-35.

Cerqueira, M.T. 1992. Nutrition education: a proposal for a community-based approach. Alimentation, nutrition et agriculture, 4:42-48.

FAO. 1989. Le diapo-langage. Nouveau regard sur la diapositive, par J.-Y. Clavreul. Collection La communication pour le dloppement. Rome.

FAO. 1991. Les mille et un mondes. Manuel de radio rurale, par F. Querre. Rome.

FAO. 1993. Guide modologique des interventions dans la communication sociale en nutrition, par M. Andrien. Rome p. 27-44.

FAO/OMS. 1992. Nutrition: le d mondial. Rome.

Farb, P. et Armelagos, G. 1985. Anthropologie des coutumes alimentaires. Deno Paris.

Fischler, C. 1990. L’homnivore. Odile Jacob, Paris.

Godin, G. 1988. Les fondements psycho-sociaux dans l’de des comportements relia santSantI> soci, 2: 5-25. Collection Promotion de la santMinist de la santt des services sociaux, Quc.

Gouvernement tanzanien. 1988. Joint WHO/UNICEF Support Program in Iringa, Tanzania, 1983-1988, Evaluation Report. Dar-es-Salaam.

Hornik, B.C. 1985. Nutrition education: a state-of-the-art review. Nutrition Policy Discussion Paper No, 1, United Nations Administrative Committee on Coordination, Subcommittee on Nutrition, New York.

Koniz-Booher, P. ed. 1993. Proceedings of an International Conference on Communication Strategies to Support Infant and Young Child Nutrition. Cornell International Nutrition Monograph Series, Nos 24 and 25. Cornell University, Ithaca, New York.

Manoff, R.K. 1984. Social marketing and nutrition education: a pilot project in Indonesia. Assignment of Children, 65/68:95-114.

Manoff Group. 1991.The Weaning Project: Improving Young Child Feeding Practices in Indonesia - project overview. Manoff Group, Jakarta.

Mantra, J.B., Manoff, R.K. et Griffiths, M. 1985. Indone; un programme efficace d’information sur la nutrition avec le concours actif de la collectivitL’cation pour la sant1:11-29.

Moneti, F. et Yee, V. 1989. Mobilisation en faveur de la nutrition: rltats de l’expence d’Iringa. Ms et enfants, 8(2): 1-3.

Rasmuson, M.R., Seidel, R.E., Smith, W.A. et Booth, E.M. 1988. Communication pour la survie de l’enfant. Academy for Educational Development, Washington.

Seidel, R.E. ed. 1993, Notes from the field in communication for child survival. Academy for Educational Development, Washington.

Simard, G. 1989, La mode du «focus group». Mondia, Laval.

Steward, D.W. et Shamdasani, N. 1989. Focus groups: theory and practice. Applied Social Research Methods Series, Vol. 20. Sage, Newbury Park, Californie.

TourR.B. 1993. Communication et nutrition; l’exemple des pays du Sahel. Alimentation, nutrition et agriculture, 7:41-46.

Winkin, Y. 1993. Communication individuelle et communication sociale, in Sfez, L. (). Dictionnaire encyclopque critique de la communication, PUF, Paris.

Interventions in social communication on nutrition

For the past 20 years, there has been intense debate on the strategies, objectives and methods of nutrition education. The traditional conception of this form of intervention - a pedagogical one - has gradually given way to an approach based on communication sciences.

Nutrition communication based on social marketing has had positive results in terms of behavioural change. The following are some of the recognized conditions needed for effective intervention.

· The definition of messages and the choice of communication channels should be based on careful studies of the needs, expectations and resources of the target community.

· The messages should be simple and tailored to clearly identified population groups.

· The communication strategies to be employed should be multimedia based and should include at the minimum an interpersonal communication channel and a mass-media channel.

However, social marketing has its limits. The main criticism is that it does not sufficiently reinforce the community’s autonomy in dealing with its nutritional problems. New practices are called for so that communities can be more closely involved in seeking solutions to their nutritional problems.

Social communication on nutrition exists in all human societies. It represents the body of implicit or explicit rules that make interaction regarding nutrition predictable. When the authorities in charge of public health, rural development or community education embark on large-scale nutritional education programmes, they set out to modify social communication on nutrition which is sometimes the result of an age-long process of adjustment. To undertake such a venture without the support and involvement of the communities concerned is both illusory and dangerous. Actions in this area should be guided by principles of equity, participation, comprehensiveness and rationality. The following model can be laid out for all interventions in social communication on nutrition.

The first stage is to analyse the nutritional problem that has been identified, with the involvement of the target community. This analytical or conceptual stage includes an in-depth examination of the motives behind the human behaviour pattern that is to be influenced. It leads to the formulation of a nutritional objective that is realistic and acceptable to the community.

The second stage is the formulation of the strategy to be used to modify the behaviour pattern in question: definition of the communication objectives, choice of communication channels and formulation of a multimedia plan.

The third stage is the implementation: production of communication aids, training of the parties involved and implementation of the communication activities with the population.

The fourth stage is the evaluation stage. Although evaluation is built into the implementation process, a modicum of resources should always be earmarked for the evaluation of the programme’s impact.

Apart from activities of limited duration which often take the form of communication campaigns, countries and regions could envisage setting up permanent monitors of nutritional practices. These would keep programme authorities abreast of changes in nutritional behaviour and would guide their interventions in social communication on nutrition.

Las intervenciones en la comunicación social sobre nutriciónH

Desde hace unos veinte a la educaciutricional ha suscitado una intensa reflexiobre sus estrategias, sus objetivos y sus mdos. La concepciradicional de este tipo de intervenci una concepciedaga - ha ido dejando lugar progresivamente a planteamientos basados en las ciencias de la comunicaci

Las experiencias de comunicaciobre nutriciasadas en la mercadotecnia social han tenido resultados positivos por lo que respecta a la modificacie las conductas. De este modo, en la actualidad se conocen bien algunas de las condiciones necesarias para que las actividades de comunicacin pro de la nutriciean eficaces, entre ellas, las siguientes:

· La definicie los mensajes y la eleccie los canales de comunicacieben basarse en estudios en profundidad de las necesidades, los resultados esperados y los recursos de las comunidades correspondientes.

· Los mensajes deben ser sencillos y adecuados a sectores bien identificados de la poblaci la que van destinados.

· Las estrategias de comunicacieben basarse en mles medios de comunicacies decir, deben comprender por lo menos la utilizacie un canal de comunicacinterpersonal y de un medio de difusiocial.

Sin embargo, la mercadotecnia social tiene sus limites. El principal defecto que le encontramos es que no fortalece suficientemente la autonomde las comunidades para resolver sus problemas nutricionales. Por lo tanto, creemos que serconveniente encontrar nuevos mdos que permitan una mayor participacie la poblacin la bda de soluciones a sus problemas nutricionales.

La comunicaciocial sobre nutricis un feno que ocurre en todas las sociedades humanas. Representa el conjunto de normas, impltas o expltas, que permiten prever las interacciones relativas a la nutriciCuando emprenden la tarea de la educaciutricional en gran escala, los responsables de los programas de salud pa, desarrollo rural o educaciopular se fijan como objetivo modificar esta comunicaciocial sobre nutricique en ocasiones es el resultado de un proceso de adaptaciecular; emprender una tarea de estas caractericas sin contar con la adhesie las comunidades interesadas puede resultar ilusorio y peligroso.

Nuestras actividades en este ito deben guiarse por los principios de equidad, participaciglobalidad de la intervenci racionalidad; sentonces podrrazarse el plan de cualquier intervencin la comunicaciocial sobre nutriciplan que podrarticularse en cuatro etapas.

La primera etapa consistirn analizar, con la participacie la comunidad interesada, el problema nutricional que se haya detectado. Esta fase de ansis, o de concepciincluye el estudio en profundidad de los mes de las conductas humanas que son objeto de examen, y finaliza con la formulacie un objetivo nutricional racional y aceptable para la comunidad.

La segunda etapa consistirn la formulacie la estrategia de modificacie las conductas que tienen una incidencia sobre la nutriciserecesario definir los objetivos de la comunicacielegir los canales de comunicaciy formular un plan basado en mles medios de comunicaci

En la tercera etapa, se pondrn prica la intervencise prepararlos soportes materiales de la comunicacise formarl personal que llevar cabo la intervenci se realizarlas actividades de comunicacion la poblaci

La cuarta etapa es de evaluaciLa evaluacis un proceso permanente que acompa las actividades, si bien, al concluir un programa de comunicacise deber asignar siempre unos medios mmos a la evaluacie los efectos de dicho programa.

Malle la actividades limitadas en el tiempo, a menudo presentadas bajo la denominacie «campade comunicaci187;, los pas y las regiones podr plantearse la posibilidad de establecer observatorios de los htos relativos a la nutriciEstos observatorios proporcionar informaci los responsables de los programas sobre la evolucie dichos htos, y ser de ayuda para orientar sus intervenciones en la comunicaciocial sobre nutrici

(introduction...)

K. Tontisirin, G. Attig, P. Winichagoon and J. Yhoung-Aree

Prof. Dr Kraisid Tontisirin is Director of the Institute of Nutrition, Mahidol University (INMU), Thailand. George A. Attig is an INMU consultant. Dr Pattanee Winichagoon is head of INMU’s Division of Community Nutrition. Jintana Yhoung-Aree is an INMU researcher.

Most South and East Asian countries still encounter problems of under-nutrition, of which the most common and persistent are protein-energy malnutrition (PEM) and vitamin A, iron and iodine deficiencies, Infants and children under five and pregnant and lactating women are the most vulnerable people, especially those living in poor rural areas and urban slums.

Compounding nutrition problems is the fact that several South and East Asian societies are entering a transitional stage in their development. This transition involves shifts in the population structure; changes in disease patterns (from infectious to chronic degenerative diseases); socio-economic transformation from fully subsistent to semi-subsistent, market-oriented economies; and an advance from struggling for child survival to aiming for development of full growth potential. Furthermore, contradictory problems such as under- and over-nutrition exist in the region and must often be dealt with in the same country.

To highlight the importance of creating nutritional awareness among populations through nutrition education and communication, FAO sponsored the Inter-Country Workshop on Nutrition Education for South and East Asian Countries, organized by and held at the Institute of Nutrition at Mahidol University, Salaya, Thailand from 22 to 26 February 1993. Nutritionists. communicators. agriculturists and public health officials came from Bangladesh, China, Laos, Nepal, the Philippines, Sri Lanka, Thailand and Viet Nam to exchange information and discuss effective education and communication strategies in order to benefit from each other’s experiences in implementing local and nationwide programmes. In planning the workshop, it was realized that in terms of programme development these South and East Asian countries can be divided broadly into two groups. China, the Philippines and Thailand have successfully developed and operated nutrition education programmes for the public to control and prevent malnutrition; Bangladesh, Laos, Nl, Sri Lanka and Viet Nam have not yet developed such programmes successfully at the national level. The workshop’s concept rested on using the expertise available in the first group of countries to assist in the preparation of national project proposals for the second group, in the true spirit of FAO’s concept of Technical Cooperation among Developing Countries (TCDC).

The workshop opened with presentations on the countries’ efforts to combat nutrition problems through nutrition education strategies. The merits and limitations of current methods were assessed and ways of making the methods more effective were discussed. Case-studies of successful programmes in Thailand, China and the Philippines were presented. The teams from the second group of countries then prepared nutrition education project proposals and the group provided suggestions to improve them. In addition, the work and needs of the institutions that implement nutrition education programmes in each country were discussed, and specific forms of intercountry collaboration were developed so that resources can be shared between nations and specialists.

COUNTRY SITUATIONS

Bangladesh

In 1991, Bangladesh had a population of 109 million people, with an annual population growth rate of 2.17 percent. In this densely populated country, approximately 83 percent of the people were living in rural areas. Life expectancy was 56,4 years for males and 54.4 years for females. The infant mortality rate (IMR) was 110 per 1000 live births and the under-five mortality rate was 180 per 1000, while the maternal mortality rate was 6 per 1000 births. The literacy rate was 29 percent and 19 percent for males and females, respectively.

Bangladesh’s major nutritional problems include chronic energy deficiency, PEM, maternal malnutrition, low birth weight, vitamin A deficiency, iron deficiency anaemia, iodine deficiency disorders (IDD) and deficiencies of other micronutrients such as riboflavin, vitamin C and zinc, The major causes of the nutritional disorders can be listed as inadequate supplies and/or intake of micronutrient-rich foods; lack of nutritional awareness; low production and purchasing power; inadequate household food security; inequitable food distribution within families; traditional food beliefs; and inappropriate infant feeding practices (e.g. bottle feeding, colostrum discarding).

Despite obstacles and the lack of a nutrition education policy, important nutrition education work has been carried out. In agriculture, nutrition education has been a component in a marginal-farming and small-farm system, crop intensification and diversification programmes, horticultural development, strengthened nutrition research, sessions for training trainers and field demonstrations. The Ministry of Health and Family Welfare has programmes for nutrition education, feeding malnourished children, vitamin A capsule distribution, growth monitoring, iron and folic acid supplementation for pregnant women, extended programme of immunization (EPI) activities, treatment of minor illnesses, antenatal care and family planning. The Ministry of Women’s Affairs and Social Welfare offers training for enhancing nutrition and socio-economic development, vitamin A capsule distribution, nutrition awareness-raising programmes and day care services for children of working women. Plans to conduct radio and television programmes on health, family planning and nutrition are under way in the Ministry of Information. In addition, 117 non-governmental organizations (NGOs) are involved in community nutrition programmes, some of which deal with nutrition education.

While people with knowledge of nutrition education are available for activities, there are constraints including lack of strong political and administrative commitment; inadequate integration of nutrition into the nation’s overall development plan; poor intersectoral coordination, monitoring and evaluation; and insufficient budgetary resources. Capacity to produce audiovisual aids and training materials, access to media services and personnel development and exchange of scientists with other nations are limited. Technical assistance is required for provision of training inputs, equipment, transport and maintenance. Personnel development facilities are also needed, especially for advanced training and education. Increased facilities are needed for infrastructure development.

Laos

Laos has a small, sparsely settled population of 3.94 million people, of whom 43.7 percent are under 14 years of age. The nation’s economy is dependent on agriculture and forestry, and 85 percent of the people live in rural areas. Life expectancy rates are 47.5 years for females and 44.6 years for males. The IMR was 104 per 1 000 live births in 1990, and the under-five mortality rate was 193 per 1 000 in 1985. Malaria, acute respiratory infections and diarrheal diseases are the top three causes of morbidity and mortality among infants and small children. The adult literacy rate is estimated to be 44 percent.

Laotian households are largely dependent on rice and horticultural products, which provide a daily dietary intake of approximately 1745 to 1976 calories, or about 70 to 80 percent of the recommended requirement. Protein requirements cannot be met through farming alone; hence almost every rural household is involved in gardening and/or hunting. Markets are not common sources of food.

Nutrition surveys in Laos are limited and confined to small-scale studies. They show, however, that the major problems are low birth weight, PEM in preschool children (0 to 60 months), IDD, vitamin A deficiency, vitamin B, and B2 deficiencies, nutritional anaemia and bladder stone disease. To combat these problems, nutrition activities such as anthropometry and nutrition education are being conducted in provincial hospitals and Vientiane Municipality.

Led by the Lao Women’s Union, the Ministries of Public Health, Agriculture and Forestry, and Education are working together to disseminate nutrition messages to the population. The government has set objectives for 1992 to 1996 to reduce low birth weight to less than 20 percent, lower moderate malnutrition to less than 20 percent and lower severe malnutrition to less than 1 percent. For micronutrients, the objectives are to reduce iron deficiency anaemia in women to less than 20 percent; to reduce IDD in terms of the goitre rate among schoolchildren to 15 percent; and to reduce xerophthalmia to less than 1 percent or, in preschool children with less than 10 mg of serum retinol, to 10 percent. Another goal is for 50 percent of mothers to breast-feed exclusively for the first four to six months. Most women should be able to continue breast-feeding, with complementary food, well into the child’s second year. Growth promotion will be institutionalized and monitored regularly in 50 percent of the villages, with 80 percent coverage of preschool children. Finally, nutrition messages will be disseminated to 50 percent of villages.

The constraints to attaining these objectives include a limited number of trained workers. Furthermore, those who have nutrition training usually have other responsibilities. The quality of printed materials is poor, and access to newspapers, magazines and other technical handbooks is restricted to urban areas, generally because of low interest and poor communication. Budget constraints prevent regular health and education sessions, and programmes lack appropriate equipment, transportation facilities and financial support.

Training of trainers in health and nutrition education is needed, including instruction in the use of audiovisual and other educational materials. Equipment for audiovisual aids and production of radio and television programmes needs upgrading. Financial support is required for production of printed materials and simplified handbooks and for community outreach programmes. Finally, short-term fellowships, study tours and fora for exchange of experiences would improve the capabilities of nutrition education personnel in Laos.

Nepal

In 1990, Nepal had a population of 19,1 million, of which 3.1 million were under age five. The IMR was 123 per 1000 live births in 1990, and life expectancy at birth was 52 years. Approximately 35 percent of the Nepalese people are literate, though a disparity exists, with men showing higher literacy rates than women.

Present assessments of Nepal’s nutrition situation are based on data from the 1975 National Nutritional Status Survey as well as recent and ad hoc studies. Over 50 percent of children are undernourished, and PEM and micronutrient deficiencies (vitamin A, iron, iodine) are prevalent at very high levels in parts of the country.

The most significant cause of nutritional problems is poor dietary intake. Inadequate food supplies, health services, awareness, water supplies, sanitation facilities, food hygiene and child care, as well as population growth, improper feeding practices, traditional food beliefs and other social and economic constraints, contribute to nutritional problems. These problems stem from inequitable distribution of resources and poverty.

The Nepalese government has created a large cadre of teachers and field workers and strong extension networks in agriculture, health, education and development which conduct many nutrition-related activities. Nutrition education efforts employ both interpersonal and media (radio, television, print) programmes.1

1 Editor’s note: See the article “Building Nepal’s capacity to create nutritional awareness through multisectoral training” by D. Shrestha and M.A. Hussain in Food, Nutrition and Agriculture, 7:34-40, 1993.

Many NGOs, international organizations and international development agencies are active in development communications; however, they work in an ad hoc manner. Most projects lack the experts or resources required to produce communication and training materials. With a few exceptions, current communication activities in communities depend on the extension systems of government and non-government agencies. Other areas needing strengthening include personnel qualifications, training, equipment availability, institutional arrangements, commitment, financial arrangements and interdisciplinary involvement and coordination. Perhaps the greatest challenge for nutrition education is in developing and delivering effective programmes (media and interpersonal) that can accommodate Nepal’s geographic, racial, ethnic and cultural diversities.

Sri Lanka

Sri Lanka has a population of nearly 17.5 million people, of whom about 70 percent live in rural areas. Agriculture is the main source of income. Although Sri Lanka has an average annual per caput income of less than US$ 450, the health status of the people remains impressive with a crude birth rate of 21.3 per 1 000 people, crude death rate of 7 per 1000 people, IMR of 19 per 1000 live births, maternal mortality rate of 0.1 per 1 000 live births and life expectancy at birth of 74.8 years for females and 76.7 for males. The vast majority of people, 87 percent, are literate. These exceptional achievements are attributed to social welfare measures. Paradoxically, this favourable overall situation exists in parallel with high rates of morbidity and ill health.

Malnutrition, including PEM, low birth weight and deficiencies in iron, iodine and vitamin A, is a major health problem in Sri Lanka. Among many causal factors, inadequate dietary intake, low awareness and improper food habits are prominent. Family planning, maternal and child health (MCH), nutrition and immunization services form an integral part of the Health Ministry’s Family Health Programme. Comprehensive programmes vary and are mainly implemented by the Ministry of Policy Planning and Implementation, the Ministry of Education and the Mahaweli Authority. Nutrition is also a component of the training programmes conducted by institutions in other sectors. The only mass media campaign has been one that promotes consumption of iodized salt.

Common hindrances are lack of expertise and trained personnel, limited resources and inadequate coordination. An urgent necessity is nutrition orientation for ore group of people, for example medical officers, who could train primary health care workers and others. Technical assistance is needed to develop an information, education and communication (IEC) programme on nutrition. While the equipment and expertise exists within Sri Lanka for producing audiovisual materials, lack of finances obstructs development. Video is gaining popularity, and video recorders and televisions for medical officers would be an asset.

Viet Nam

Viet Nam is an agricultural country with a population of over 70 million people. In 1991, the average annual per caput income was still low at US$ 200. Food-consumption and nutrition-survey data indicate that chronic energy deficiency exists among a large proportion of the population. PEM afflicts about 42 percent of children under five, with severe PEM affecting approximately 14 percent of young children. Prevalence of nutritional anaemia in pregnant women in urban areas is 41 percent, while among rural women the rate is 49 percent. Vitamin A deficiency and xerophthalmia affect many people, and iodine deficiency is found in certain regions. Low levels of education and literacy among vulnerable groups, lack of awareness and improper child feeding practices are the main causes of these problems.

A project is being implemented to educate people about the biological values of vitamin A and to raise their awareness of the benefits of breast-feeding, consumption of various food sources and proper child care. Home garden production of vitamin A-rich fruits and vegetables is promoted. Health education materials (manuals, flip charts, slide programmes, leaflets and videos) have been developed. The main interpersonal programme involves the strengthening of commune and village communication networks.

THEORIES IN NUTRITION COMMUNICATION

A paper was presented reviewing theories of nutrition education as background to assist participants in developing nutrition communication proposals. Over the last 50 years, three streams of thought have influenced nutrition communication. The first is concerned with education, psychology and behaviour change, the second with communication and the third with social marketing. Today’s integrated model suggests that experts interact with audiences to plan original messages that are delivered through channels or media that are accessible to the audiences. This interaction improves the way a message is perceived, as the audience is moved from attention, through awareness and concern, to comprehension, then through decision-making or action, and finally to behaviour adoption. Consideration is given to local, socio-cultural and historical contexts. Programme planners need to consider each stage in the above sequence and to determine how they will address key issues over time with the audiences of interest.

CASE-STUDIES

Thailand

To improve the nutritional status as well as knowledge, attitudes and practices of pregnant and lactating women and preschool children in seven regions, Thailand undertook a project from 1985 to 1989 to assess and analyse food habit problems and explore flexible community-based approaches for behavioural modification, The objective was to change undesirable food habits while strengthening desirable ones. A fourfold strategy of participatory action research (PAR), nutrition communication, supportive activities and evaluation was used to attain the objectives.

Modifying inappropriate food habits requires an integrated concept of nutrition that includes biomcal and behavioural-science perspectives. A clear understanding of the target groups and audiences, as individuals and as family members, and of their behaviour, attitudes and environmental constraints was necessary to set realistic objectives, and flexibility was required to achieve them. To begin, an accurate, early analysis was needed of the ways in which aspects of the socio-cultural, economic, political, psychological and physical environment shape existing food practices in a community.

Formative research indicated that the major causal and contributing factors affecting food habits were learning experiences, culture, food availability, health services and mass-media advertisements.

A participatory atmosphere and a “bottom-up/top-down” team approach was created for implementing the project. Local development agents from the health, agriculture, education and rural development sectors were encouraged to work with community leaders in developing and implementing communication and support activities. Using the PAR approach, villagers identified their major problems (e.g. illiteracy, insufficient household food security, poor access to health services and ineffective school lunch programmes) and then worked with local development agents to develop community-based intervention programmes such as food production and preservation activities, school lunch programme improvements, literacy campaigns and environmental sanitation campaigns.

Coordination was critical for the project’s long-term success and sustainability. Activities and responsibilities were shared by communities, local development organizers and project personnel. Accordingly a positive, empathetic relationship needed to be developed among all collaborators based on a common purpose and a meaningful set of attainable objectives. Combining nutrition messages with concrete support activities and emphasizing careful, effective management and evaluation were crucial.

Last, a style was adopted that included a variety of supportive nutrition communication media and activities that fit practically with village life and the people’s interests. This adaptation was crucial because, ultimately, community members are the ones who make the real difference. They are the ones who must change themselves.

China

An intervention to change nutrition and food hygiene behaviour took place in rural China in 1991. In Shanxi Province 212 villages participated in a pilot project to increase the intake of high-quality protein by adding animal and soybean foods, to increase intake of vitamins A and B2 by eating more dark-green vegetables, to decrease salt intake and to control diarrhoea.

After one year, the intervention district showed great change, while the control district showed no significant changes. In the intervention district the proportion of residents aged 15 to 60 years with basic health knowledge increased from 11 percent to 81 percent. In the same age group, the proportion that ate at least one egg and 100 g of soybean food per day increased from 39 to 71 percent. Furthermore, the percentage of persons consuming less than 10 g of salt per day rose from 21 to 42 percent.

Three lessons were drawn from the programme: first, support from community leaders, who are not only decision-makers but also influential persons in rural communities, is essential. Second, the focus should be on the most important target group, such as women who have control over family food selection and preparation; activities should be tailored to fit this group. Third, a comprehensive communication strategy is essential, and it should use media programmes that target a wide audience. Interpersonal communication is also needed, including training and counselling aimed at community leaders, families, local health workers and other important change agents.

The Philippines

The Barangay Integrated Development Approach for Nutrition Improvement of the Rural Poor (BIDANI), initiated in 1978, was conceived to improve family welfare, generate income and enhance food security. The intention was to coordinate efforts of the barangay or village people, the local government, NGOs and state colleges and universities in an agriculture-based action-research project. The five objectives were: to establish participatory models of improving the nutritional status of the rural poor; to develop practical nutrition education approaches, e.g. training courses for barangay leaders and trainers; to develop packages of participatory communication approaches and services at the village level; to institutionalize the models at the provincial and municipal levels for speedy, sustained and wider implementation and impact; and to sustain BIDANI with the technical assistance of state colleges and universities, as a complement to a programme of the National Nutrition Council of the Philippines entitled Toward A Stronger Body with Adequate Nutrition.

During Phase 1, Barangay Nutrition Scholar-Development Workers were selected and given technical and practical training. A programme planning and implementing committee was organized at each barangay, a situational analysis was conducted and a barangay integrated development plan was formulated. Linkages with government and private agencies were established and indigenous extension and communication approaches were used. The barangay projects were implemented, monitored and evaluated.

Phase 2 focused on institutionalizing the programme by turning it over to existing government structures, personnel and resources. Phase 3 involved regionalization and expansion of the BIDANI model, which now covers seven regions in the Philippines.

All stages of the development support communication (DSC) process were embodied in the components and phases of the BIDANI programme. These DSC stages are communication training; communication research; communication strategy planning; message design; materials and media development; the use of interpersonal, group and mass media; and communication evaluation. From the outset, the BIDANI programme planners recognized the pivotal role of communication in building sustainability and institutionalization into the programme.

The BIDANI experience illustrates how nutrition, information, education and communication can be built into an overall nutrition programme. DSC should be an integral component of development programme or project planning, implementation and evaluation. While the initial investment in DSC may be high, it has been proven cost-effective in terms of multiplier effect, project survival, sustainability and, more important, socio-economic impact.

PROPOSALS AND RECOMMENDATIONS

Bangladesh, Sri Lanka, Viet Nam, Laos and Nepal formulated proposals for controlling nutrition problems in their respective countries. These projects will require coordination at the country level and collaboration within and among countries.

· The Bangladesh Ministry of Agriculture proposed that communication facilities, equipment and personnel be upgraded so that communication can be used to solve problems of food production and nutritional practices among landless and marginal farm families.

· Sri Lanka planned an effort to improve haemoglobin levels using a multisectoral multimedia approach involving interpersonal and small group discussion methods and community organization techniques as well as radio spots and video.

· The Ministries of Health and Agriculture in Viet Nam aim to improve the energy and micronutrient status of farm families and raise their levels of nutrition knowledge, attitudes and practices.

· To alleviate PEM among children, Laos seeks to employ nutrition communication and technical skills to improve attitudes and feeding practices of mothers as well as food handling behaviours. Breast-feeding and the timely introduction of supplementary foods are to be promoted and household food production improved.

· In Nepal, a multimedia communication approach was proposed to coordinate health, agriculture, education and local development activities to improve household food security and promote better nutritional practices.

The workshop participants recommended that governments and international development agencies provide both technical and financial assistance to promote nutrition education and communication. The need for a network to exchange technical information and experiences in nutrition education and communication was recognized. This network should incorporate the concept of intersectoral approaches and integrating nutrition in development. Meetings, seminars and training workshops were also suggested for further development of technical skills in nutrition communication, communication project planning, strategy formulation and implementation, management and evaluation. Finally, interinstitutional and person-to-person information exchange was encouraged.

Because of the importance of nutrition education and communication for improving food habits and nutrition status and sustaining the improvements, Asian governments, FAO and other United Nations organizations were urged to make it a priority in planning and to promote it through establishment of national policies and continuous international efforts.

Atelier sur l’éducation nutritionnelle en Asie

La sous-alimentation, et en particulier la malnutrition proto-rgque, les carences en vitamine A, en fer et en iode sont encore frentes en Asie. Pour favoriser la cooption technique entre les pays en dloppement qui luttent contre ces probls, en 1993 la FAO a financn atelier sur l’cation nutritionnelle pour les pays d’Asie du Sud et de l’Est, ’Universitahidol, en Thande. Des spalistes de la nutrition, de la communication, de l’agriculture et de la santublique - venus de pays qui ont mis au point et risvec succdes programmes d’cation nutritionnelle, tels que la Chine, les Philippines, et la Thande, et de pays o programmes ne sont pas encore au point, tels que le Bangladesh, le Laos, le Nl, Sri Lanka et le Viet Nam - ont anges informations et envisages strates d’cation et de communication efficaces.

Pour permettre un ange mutuel d’expences nationales en ce qui concerne l’extion des programmes locaux et nationaux, l’atelier a tires conclusions. Il a identifies considtions essentielles rendre en compte dans l’boration des programmes nationaux de nutrition et de communication, sur la base des projets d’cation nutritionnelle mis en oeuvre avec succen Chine, aux Philippines et en Thande, II a prntes informations rntes sur l’t nutritionnel au Bangladesh, au Nl, ri Lanka, au Laos et au Viet Nam, et dit les programmes entrepris pour amorer la nutrition. Il a proposne se d’activitfutures et formules plans pour une collaboration permettant un ange des ressources entre nations et entre spalistes. De plus, les participants ’atelier ont lancn appel aux gouvernements d’Asie et a communautnternationale pour qu’ils renforcent leur soutien aux programmes de communication et d’cation nutritionnelle.

Taller sobre educación nutricional en Asia

La desnutricien particular la malnutriciroteinoenergca (MPE), y las carencias de vitamina A, hierro y yodo son todavcomunes en Asia. Con el fin de favorecer la cooperaciica entre los pas en desarrollo para luchar contra estos problemas, la FAO financi Taller Internacional sobre Educaciutricional para los pas de Asia meridional y oriental, que se celebr la Universidad Mahidol de Tailandia en 1993. Se reunieron especialistas en nutricicomunicaci agricultura, asomo funcionarios de la salud pa - procedentes de pas con programas de educaciutricional bastante desarrollados, como China, Filipinas y Tailandia, y pas que todavno han desarrollado tales programas, como Bangladesh, Laos, Nepal, Sri Lanka y Viet Nam - para intercambiar informaci debatir sobre estrategias eficaces de educaci comunicaci

Durante el Taller, se expusieron los conocimientos adquiridos en la ejecucie programas locales y nacionales, con el fin de permitir que cada pase beneficiara de la experiencia de los dem Tambise seron las consideraciones mimportantes para el disee los programas nacionales de comunicaciobre nutricitomando como ejemplo proyectos de educaciutricional satisfactorios de China, Filipinas y Tailandia. Se presentaron los os datos sobre la situaciutricional en Bangladesh, Laos, Nepal, Sri Lanka y Viet Nam, y los programas que se han llevado a cabo para mejorar la nutricise propuso ademuna lista de actividades para el futuro. En el taller se planific colaboracintre pas de forma que los pas y los especialistas pudieran compartir los recursos disponibles. Por o, los participantes solicitaron que los gobiernos de los pas de Asia y la comunidad internacional dieran mayor apoyo a los programas de educaci comunicaciobre nutrici

(introduction...)

A. Valyasevi and G. Attig

Prof. Dr Aree Valyasevi is Dean of the Faculty of Medicine, Thammasat University, consultant to the Institute of Nutrition at Mahidol University (INMU) and President of the International Union of Nutritional Sciences (IUNS). George A. Attig is consultant to INMU, Thailand.

United Nations agencies and international organizations have firmly acknowledged that many nutrition problems can be overcome if effective communication is used not only to educate people, but also to change their behaviour patterns. The aim of nutrition communication is to use innovative techniques founded on behavioural change theories and experiences to encourage people to try, adopt and sustain new behaviours relating to food and nutrition.

Recently, nutrition communication has been highlighted at several international meetings. The Sixth International Conference of the International Nutrition Planners Forum (4 to 6 September 1991) stressed the need to synthesize and learn from the world’s wide-ranging nutrition communication experiences in order to identify transferable processes that could be implemented in different situations (Achterberg, 1991).1

1 A follow-up symposium was held at the 15th International Congress of Nutrition in Adelaide, Australia (26 September to 1 October 1993).

The Plan of Action for Nutrition adopted at the FAO/WHO International Conference on Nutrition in December 1992 specifically stated the need for “strengthening educational systems and social communication mechanisms to improve and implement nutritional knowledge, especially at the individual, family and community levels”. On a more operational level, a main objective of the Inter-Country Workshop on Nutrition Education for South and East Asian Countries,2 held at the Institute of Nutrition, Mahidol University, Thailand, was the sharing of the experiences of developing nations that have undertaken successful nutrition communication programmes, to assist other developing nations in formulating projects.

2 Editor’s note: This workshop is described in the article “Asian workshop on nutrition education: Sharing expertise” in this issue of Food, Nutrition and Agriculture.

These meetings found several commonalities and differences in the ways that nutrition communication programmes are being implemented today. First, developing nations have a wide array of nutritional problems, and some countries have a mixture depending on their stages of development. In China, the Philippines and Thailand, for example, different problems, such as under- and over-nutrition, persist within the same country. Even within countries, specific populations may exhibit both problems among different subgroups. For instance, within a city, slum residents and the wealthy have different nutrition problems. To direct nutrition communication interventions precisely at such specific target groups is thus a real challenge.

A broad spectrum of approaches are being used to improve nutritional status; the most prominent are dietary diversification, fortification and supplementation. An even greater variety of nutrition education and communication methods are used in efforts to change people’s behaviours. Therefore, today we see a plethora of approaches being tested in many different nations. But the question remains: are they having an equal impact, if any impact at all?

This commentary on the four most common strategies being used today is based on the experiences and reports given by ten South and East Asian countries at the FAO-sponsored Inter-Country Workshop on Nutrition Education. It represents an effort to step back and take an overall look at current practices in the hope of stimulating thought and constructive debate about the actual ways nutrition communication should be conducted.

NUTRITION COMMUNICATION STRATEGIES

The diverse ways in which nutrition communication is being used today in South and East Asian countries are illustrated in the accompanying figure. While these approaches appear to be separate, sometimes different ones are used within the same national context to address different nutritional problems. Alternatively, different approaches can be used within the same intervention programme. In Thailand, for example, government breast-feeding promotion programmes often use the information dissnation approach, while vitamin A interventions apply participatory communication.

Information dissemination

Countries using the “information dissemination” model (left column of the figure) usually (but not always) include the least developed and developing nations which have limited communication capabilities. This approach parallels the “knowledge dissemination” model presented by Achterberg (1993) at the intercountry nutrition education workshop. According to this model, if people receive the knowledge they need to change, then change will automatically follow. However, “knowledge” is here extended to “information” in general, since not all of what is transmitted can be considered knowledge, at least in terms of how the receiver interprets it. Nonetheless, this approach is centred on the belief that providing people with information is enough to get them to change their behaviours. The mechanisms for providing information range from posters to slick radio and television spots to non-participatory group counselling sessions where a “teacher” provides knowledge to target group members. Most of these efforts are founded on the KAB (knowledge, attitude, behaviour) or KAP (knowledge, attitude, practice) model which postulates that such mechanisms lead to improved knowledge, followed by changes in attitudes and behaviours or practices.


Major nutrition communication approaches in South and East Asia - Principales modes de communication en mati de nutrition en Asie du Sud et de l’Est - Principales planteamientos de comunicaciobre nutricin Asia meridional y oriental

Although this approach has been used for over 100 years, it has been shown to be ineffective (Achterberg, 1993). Despite the wishes of some international development agencies, it is still believed to be useful by many policy-makers and it is often a cornerstone of national government efforts in nutrition communication or health education. Consequently, this method continues to be used in many programmes with perhaps little or no effect. Little is known about the magnitude of resources being applied to this approach or its cost-effectiveness.

Educational communication

The first of three more common recent approaches, illustrated on the right in the figure, is a strict educational communication approach, often characterized by one of two strategies. First, a strictly mass media approach may be used to persuade people to adopt a new product, service and/or behaviour. This method is close to the information dissnation approach, but often goes beyond information dumping to apply a social advertising strategy to encourage people to try something new. However, people are not always told how to use the product properly, and countless experiences have shown that use of mass media alone is not effective in leading to behaviour change (Achterberg, 1993; Smitasiri, Attig and Dhanamitta, 1992; Smitasiri et al., 1993). The result is that little change occurs and resources are often wasted.

Nevertheless, this approach is particularly attractive to countries that are trying to develop nationwide mass-media programmes, since it is assumed to be a relatively effective way to tackle large-scale problems affecting many people. Yet their efforts can be effectively blocked by limited coverage, for instance where media programmes are restricted largely to urban areas and literate populations. The impact is prevented where programmes are developed for the general audience and do not consider socio-economic, class, linguistic or ethnic diversity.

At the other extreme, education can occur primarily through face-to-face instruction in non-formal health care clinics, such as village or district health stations. Some pamphlets, brochures or posters may be used, but the assumption is that a person can be convinced to adopt a new behaviour by using traditional teaching and educational approaches. This method was common in the 1950s and 1960s, and to some extent it did lead to behaviour change. However, its utility is limited in terms of coverage and magnitude because it is most effective on an individual rather than population level.

In some countries, such as China, both media and interpersonal education are being skillfully combined with some positive results (Wang, 1993), generally on a small scale in clinic and community settings.

The educational communication approach rests largely on a top-down model of communication where information is passed down the hierarchy from official or doctor to patient. For individuals this strategy can work, but it may be resisted when communities are not encouraged to participate in nutrition interventions (Achterberg, 1991, 1993; Smitasiri et al., 1993). In general, information dissnation and educational communication are characteristic strategies of government efforts, largely because they can be readily implemented through existing primary health care networks.

Participatory action

Among non-governmental organizations, the primary focus is on participatory action and empowering people to identify their problems, determine viable solutions and implement and evaluate interventions using their own resources. It is “premised on the practical reality that nutrition-oriented development projects cannot be sustained at the grassroots level if these are planned from the top, focused on individual components and isolated from a total development process” (Stuart, 1993). This strategy relies heavily on a participatory action research (PAR) framework and a bottom-up development approach. The participatory strategy is very effective on a small scale and has the potential to be so on a large scale as long as the momentum continues and people remain involved, as has happened, for example, in the Barangay Integrated Development Approach for Nutrition Improvement of the Rural Poor (BIDANI) in the Philippines.

Nutritional disorders, however, transcend communities, and many are rooted in matters of government concern (e.g. poverty alleviation, national economic goals). Therefore, a participatory action approach needs to be integrated within the government infrastructure to be sustainable. The BIDANI project shows that this integration is possible, but questions still exist about what type of process can bring it about, especially in cases where community members and the government are viewed, and view themselves, as having different development goals and expectations.

Participatory communication

Today, the communication component and the participatory action component are being joined into a combined top-down/bottom-up participatory communication process (Attig, 1993; Smitasiri, Attig and Dhanamitta, 1992; Smitasiri et al., 1993). Efforts in Thailand provide a good example of this strategy. Borrowing from approaches such as social marketing, planners have combined the traditional creative media and interpersonal education strategies of communications with the learning-by-doing programmes of concrete participatory action. While all facets are important, the degree to which a nutrition programme succeeds depends largely upon the ability to intertwine media and action programmes in such a manner that the former supports the latter and not vice versa. In this way, programmes can reach out to large audiences. For instance, in Thailand’s Social Marketing of Vitamin A-Rich Foods project, district-wide programmes may reach over 100 000 people while still having a great impact at individual, family and community levels.

Participatory communication has two very important characteristics. First, it focuses on people’s felt needs through the use of formative research which entails the collection of data and information to identify important factors that may affect a programme’s acceptance; these considerations are then incorporated into a communication programme’s design. The intent is not to confront people with their inappropriate beliefs or resource constraints, but to use these beliefs to build nutrition communication programmes (Attig, Yoddumnern-Attig and Kanungsukkasem, 1992).

The second important aspect of participatory communication is that it focuses primarily on changing the environment in which people see themselves. People are a product of their environment, and the latter must be conducive to change before people can be asked to change. Social mobilization is based upon creating a local need and demand for change by initially focusing on how people view their environment, rather than how they view themselves. Once again, this need and demand rests on formative research into the needs of the people themselves. Emphasis is placed on saying “What do you need?” instead of “What do you have?” or even worse “Look at what you are doing” or “Look at what you are not doing”. In the end, focusing on felt needs makes nutrition interventions more personal and acceptable to people since they can place a problem and its solution within their own cognitive system of understanding and way of life (Attig, Yoddumnern-Attig and Kanungsukkasem, 1992).

In this context, the term “people” does not mean vulnerable target groups only, but target audiences. The general public is not a uniform mass and should not be treated as such. Rather, it should be separated into specific groups according to their characteristics, needs, wants and predispositions. Media and interpersonal action programmes can then take these characteristics into account and become more effective behaviour-change mechanisms (Achterberg, 1993).

The participatory communication approach is not a panacea, and it may not be feasible for all situations. It requires a great deal of advocacy, management and planning skills on the part of implementers, and it may have limited utility in countries where there is the need to strengthen human resources. It also requires an intimate partnership and trust between the people and local government officials, for which a great amount of political finesse and building of rapport are necessary. In countries where the people and the government are distant or, worse yet, where they see each other as adversaries, participatory communication may not be sustainable until the environment changes and becomes more conducive to this approach. In this case, participatory action programmes may be a better short-term strategy.

FUTURE NEEDS

Nations are using different nutrition communication approaches, depending upon the resources and expertise available to them. Some have adopted new and innovative methods while others are using more outdated ones such as a purely information dissnation approach. Moreover, countries with lower technological and personnel capacities are using older models of nutrition education, while other developing nations are applying newer, more integrated communication approaches. The result is uneven achievement within and among nations in changing the nutritional situations of vulnerable target groups.

It is now important to start thinking about how to merge or at least systematize the various approaches in order to gain more even and equitable achievements in nutritional status. One mechanism might be a systematic cross-national analysis of which approaches and processes work and which do not work. Innumerable “model” projects exist and have been presented at international meetings. While such meetings are good fora for bringing successful programme experiences to light, they are not always good for reaching a consensus about the processes that work. Consequently, it is essential to focus more on identifying effective processes that can be transferred from one country to another or at least within the same country to address one or several nutritional problems.

Great strides have been made in the last five years. The aim should now be to identify which approaches are most effective, under which conditions and for which interventions, and then to develop, test and promote those that hold the greatest promise. Only in this way will it be possible to develop more reliable and cost-effective interventions to benefit the Asian people and those living in other world regions.

REFERENCES

Achterberg, C. 1991, Effective nutrition communication for behavior change, Report of the Sixth International Conference of the International Nutrition Planners Forum, Washington, DC, Nutrition Foundation, Human Nutrition Institute, International Life Sciences Institute.

Achterberg, C. 1993, Update on nutrition communication. In K. Tontisirin & G, Attig, eds, Report of the Inter-Country Workshop on Nutrition Education for South and East Asian Countries, Salaya, Thailand, 22-26 February 1993. Unpublished report.

Attig, G. 1993. Participatory action for nutrition communication: social marketing vitamin A-rich foods in Thailand, In K. Tontisirin & G. Attig, eds, Report of the Inter-Country Workshop on Nutrition Education for South and East Asian Countries, Salaya, Thailand, 22-26 February 1993, Unpublished report.

Attig, G., Yoddumnern-Attig, B. & Kanungsukkasem. 1992. Building nutrition education programs from a people’s perspective. In P. Winichagoon et al., eds, Integrating food and nutrition into development: Thailand’s experiences and future visions, Salaya, Thailand, Mahidol University Institute of Nutrition; Bangkok, UNICEF East Asia and Pacific Regional Office.

Smitasiri, S., Attig, G. & Dhanamitta, S. 1992, Participatory action for nutrition education: social marketing vitamin A-rich foods in Thailand. Ecol. Food Nutr., 28: 199-210.

Smitasiri, S., Attig, G., Valyasevi, A. & Tontisirin, K. 1993. Social marketing vitamin A-rich foods in Thailand: a model nutrition communication for behavior change process. Salaya, Thailand, Mahidol University Institute of Nutrition; Bangkok, UNICEF East Asia and Pacific Regional Office.

Stuart, T. 1993. Nutrition education in the Philippines: the BIDANI experience. In K, Tontisirin & G. Attig, eds. Report of the Inter-Country Workshop on Nutrition Education for South and East Asian Countries, Salaya, Thailand, 22-26 February 1993. Unpublished report.

Wang, Q. 1993, The challenges of nutrition education in China. In K. Tontisirin & G. Attig, eds. Report of the Inter-Country Workshop on Nutrition Education for South and East Asian Countries, Salaya, Thailand, 22-26 February 1993. Unpublished report.

Communication en matière de nutrition en Asie du Sud et de l’Est

Les Nations Unies ont soulign’importance de la sensibilisation de la population aux probls nutritionnels par des programmes de communication et d’cation nutritionnelle, dans le but de prnir la malnutrition. Des organisations de dloppement international ont tenu plusieurs rions sur le th de la communication nutritionnelle, y compris un atelier sur l’cation nutritionnelle pour les pays d’Asie du Sud et de l’Est financar la FAO, qui s’est tenu ’Universitahidol, en Thande, en fier 1993. (Voir l’article de Tontisirin et al., page 18.)

Toute une gamme de strates sont utilis ou propos pour mettre en œuvre des programmes de communication sur la nutrition en Asie. Ces strates se divisent en quatre grandes catries:

· information;
· cation;
· participation;
· communication.

Toutes ces approches sont de qualitariable et s’adaptent aux diffnts pays. Le programme de communication varie aussi selon le type d’intervention nutritionnelle choisi (diversification du rme alimentaire, aliments d’appoint, aliments enrichis).

Le prnt article analyse chacune de ces approches et prune luation nationale approfondie des programmes de communication nutritionnelle visant ettre au point des programmes plus systtiques et rentables aux niveaux communautaire, national et international.

Comunicación sobre nutrición en Asia meridional y oriental

Las Naciones Unidas han destacado la importancia de fomentar la atenciutricional entre la poblaci travde la educaci la comunicaciobre nutriciomo valioso medio de prevenir la malnutriciLas organizaciones internacionales para el desarrollo han celebrado numerosas reuniones para tratar el tema de la comunicaciobre nutricicomo el Taller Internacional sobre Educaciutricional para los pas de Asia meridional y oriental, que fue financiado por la FAO y se celebr la Universidad Mahidol de Tailandia en febrero de 1993 (NdR: ve el artlo de Tontisirin et al. en la pna 18).

Se estempleando, o proponiendo, una amplia gama de estrategias para poner en marcha distintos programas de comunicaciobre nutricin Asia. Estas pueden clasificarse en cuatro categor:

· difusie informaciBR>· comunicaciara la educaciBR>· actividades participativas, y.
· comunicaciobre nutricie manera participativa.

Todos estos planteamientos var en lo que respecta a los resultados y de un paa otro. Adem el planteamiento de comunicacie modifica en funciel tipo de intervencin materia de nutricilevada a cabo (por ejemplo diversificacie la dieta, suplementaci/o fortificacie alimentos).

Ademde examinar detenidamente cada uno de estos planteamientos, es necesario realizar una evaluaciomparativa de los programas de comunicaciobre nutricin diversos pas, con el fin de lograr que sean msistemcos y rentables en el plano comunitario, nacional e internacional.

(introduction...)

N.O. Bwibo, R. Biteyi and S. Kilobia

N.O. Bwibo, a former professor of paediatrics, is the Deputy Director General (Technical) of the African Medical and Research Foundation (AMREF). Robina Biteyi, a public health nurse, is Project Leader for AMREF’s Kibwezi Rural Health Scheme. Susan Kilobia, an agricultural extension officer, is the coordinator of the Applied Nutrition Programme in Kibwezi.

In Kenya, some of the poorest families reside in areas where the rainfall is low and unreliable, Kibwezi, a division of Makueni District of Kenya (see map), is located within the region known as the Arid and Semi-Arid Lands (ASALs). Approximately 200 km from Nairobi, Kibwezi is about 3 400 km2 in size with an estimated population of 170000. The main crops are maize, beans, cowpeas and pigeon peas, Millet, sorghum, cassava and sweet potatoes are grown by a few households. In spite of the area’s rich, dark volcanic soils, low rainfall affects the agricultural output and there are frequent crop failures.


Makueni District, Kenya - District de Makueni (Kenya) - Distrito Makueni, Kenya

In 1984, Kibwezi faced one of the worst droughts and famines in its history. At the time, the African Medical and Research Foundation (AMREF) was operating an integrated primary health care (PHC) programme in the area, and nutrition was a critical element in the programme, AMREF is a developmental non-governmental organization (NGO) in East Africa serving the health heeds of communities, particularly those in remote, difficult-to-reach areas such as Kibwezi. While AMREF focuses on reaching people directly, it also works in close partnership with ministries of health, AMREF’s work in Kibwezi illustrates a multisectoral approach to improving nutrition and the endeavours of an NGO to empower and support communities to develop the capacity to look after their health.

APPLIED NUTRITION PROGRAMME

When the famine occurred, an emergency feeding programme was carried out to stop further deterioration in the nutritional status of young children. The supplementary feeding programme lowered the rate of malnutrition among children under five years of age from 40 percent in October 1984 to 20 percent in June 1985. Yet there was an urgent need to find more appropriate ways of addressing the basic causes of malnutrition in Kibwezi. Recognition of this heed led to the initiation and implementation of the Applied Nutrition Programme (ANP) in 1986.

The ANP aimed to improve the nutritional status of young children, especially to reduce severe and moderate malnutrition from 29 to 14 percent. Other objectives were to raise production of drought-resistant crops from 37 to 57 percent; to increase production of rabbits from 7.4 to 10 percent; and to increase the number of birds per family from 13 to 20. In addition, 14 tree nurseries were to be established among 14 schools in Mtito Andei and Makindu. Support was given for the construction of energy-saving stoves and for two production units among 20 women’s groups. Through participatory efforts, 100 water tanks were to be constructed in Mtito Andei and Makindu. Finally, six women’s groups were to be assisted in initiating and managing income-generating activities.

An integrated approach was taken to address health, nutrition, household food security and income-generation objectives, using the following strategies: intersectoral collaboration; information, education and communication (IEC); capacity building of the community’s own resource people (CORPs); and a revolving loan fund.


At community meetings, men and women discuss the causes of malnutrition and local solutions - Lors d’une rion communautaire, les hommes et les femmes dient les causes de la malnutrition et envisagent des solutions locales - En las reuniones de la comunidad, los hombres y las mujeres debaten las causas de la malnutric y buscan soluciones locales

COMMUNITY PARTICIPATION

Community involvement was a guiding principle in implementing activities to reduce malnutrition. Through participation, people develop their capabilities and feel more self-reliant; thus activities can be sustained over time. One common definition (Rifkin, Muller and Bichman, 1988) states: “Community participation is a social process whereby specific groups with shared needs living In a defined geographic area actively pursue identification of their needs, take decisions and establish mechanisms to meet these needs. In the context of PHC this process is one which focuses on ability of these groups to improve their health care and by exercising effective decisions to force the shift in resources with a view to achieving equity”. The 1986 National guidelines for primary health care in Kenya (Bennet and Maneno, 1986) define community participation as a “process by which a community mobilizes its resources, initiating and taking responsibility for its own development activities and sharing in decision making for and implementation of all other development programmes for overall improvement of its health status”. In tackling Kibwezi’s nutrition problems, the communities participated in all stages of programme development and implementation, as described below.

PROBLEM IDENTIFICATION

Through community meetings, people were mobilized to identify problems related to poor nutrition and to determine the magnitude of malnutrition in Kibwezi. Through women active in the community, self-help groups and religious and village leaders, AMREF staff were introduced to the local men and women. The leaders held several meetings and eventually identified four major problems: poor food security at household level, lack of income-generating activities, inadequate safe water and malnutrition among the young children.

When the leaders were asked to identify the causes of malnutrition among the young children, they first called attention to inadequate knowledge of good feeding practices. Second, they noted that women’s heavy work load left them little time for child-rearing, nutrition and other activities. One village elder said. “Our women are extremely busy during planting season; as a result children are not fed as often as they should be”. The third factor contributing to malnutrition was the high incidence of childhood illnesses (i.e. diarrhoeal diseases, measles and respiratory infections), which affected food intake. Finally, food insecurity at the household level led to poor nutritional status among children.

Late weaning, nutritionally inadequate feeding and withholding of food from children with measles or diarrhoea were inappropriate practices noted by the community. This information was very valuable for planning community health education sessions and for training community health workers (CHWs) and traditional birth attendants (TBAs).

It was interesting and rewarding to note that there were no misconceptions as to the causes of malnutrition, so the basis for health education was good. Furthermore, the community’s views of the causes of malnutrition were very similar to those identified by the project staff (see figure).


Causes of malnutrition in Kibwezi - Causes de la malnutrition au Kibwezi - Causas de la malnutricin Kibwezi

PROBLEM ASSESSMENT AND RESOURCE MOBILIZATION

The next stage was to involve the community in assessing the scope or magnitude of malnutrition, CHWs were briefly trained in the use of a Shakir strip, a simple technology to measure mid-upper-arm circumference. With initial supervision, they measured mid-upper-arm circumferences of all children under five years of age, and 30 percent were found to be mildly or severely wasted. This information was shared with the communities, and the leaders agreed that malnutrition was becoming a serious problem for the communities and their children and that something had to be done about it.

Meetings were organized to plan how best to approach the problem. Community leaders, women’s groups, CHWs, TBAs, schoolteachers and children were selected as the most appropriate people to obtain the skills needed to carry out community activities. The communities assembled resources for meetings, materials and nutrition activities. Schools as well as individual households provided land for agricultural activities.

PLANNING AND IMPLEMENTATION

Awareness-raising activities and discussions were held about the roles of the community groups and the implementation and sustainability of the activities. The community’s identification of problems as well as other social and cultural factors, for example eating habits and beliefs, were the basis for the interventions.

Community mobilization and nutrition education were planned to instil good nutrition practices. Actions were initiated to assess, monitor and survey the nutrition situation, and malnourished children were rehabilitated. To improve household food security, community members were educated about food production, and income-generating activities were promoted, particularly those that could reduce women’s workload.

Nutrition education

A learner-centred, problem-posing, self-discovery, action-oriented (LePSA) methodology of adult teaching (Freire, 1973) was used to approach nutritional problems (such as late weaning, infrequent feedings of foods low in nutrients, and withdrawal of foods, especially those high in protein, during measles or diarrhoeal episodes) identified during the initial dialogue between AMREF staff and the communities and through studies carried out in Kibwezi. Emphasis was put on the need for frequent feeding and preparation of nutritionally balanced feeds. Undesirable practices, especially withdrawal of certain foods during illness, were discouraged.

Nutrition assessment, monitoring and surveillance

Discussions of nutrition assessment, monitoring and surveillance of young children addressed some of the methods communities use to determine how well children are growing. For example, a child might be lifted to determine whether he or she is gaining or losing weight. A band worn by the child around the arm or hips indicates growth as well; if the band becomes tight, the child is gaining weight. After finding a parallel between their own traditional concepts of child growth monitoring and the modern concepts of weighing children and measuring mid-upper-arm circumference, the communities became interested in initiating their own child growth monitoring centres.

Two parameters, weight for age and mid-upper-arm circumference, were used by CHWs in assessing nutritional status and monitoring malnourished children. The project provided Salter scales and trained the CHWs in weighing children, plotting their weight on a health card and interpreting the weight as well as in taking upper-arm circumference measurements. They were also trained in counselling individual families. Community leaders and CHWs mobilized their communities in identifying venues for assessment and in acquiring stationery.

Rehabilitation of malnourished children

To rehabilitate malnourished children in the community, parents were encouraged to participate in the weekly monitoring of their children’s weight gain and were shown ways to prepare high-energy, high-protein feeds; children were screened and referred for immunizations; and breast-feeding was promoted. Families with children who did not gain weight within three months were considered to be at high risk, and these children were followed more closely by CHWs and TBAs. Children who failed to gain weight were referred to a health facility or an outreach clinic for the opinion and management of a professional health worker.


Community members were trained to use local resources for child growth monitoring - On a appris aux collectivittiliser ce qu’on trouve surplace poursuivre la croissance des enfants - Los miembros de la comunidad han recibido capacitaciara utilizarlos recursos locales para la vigilancia del crecimiento de los ni/I>

Improvement of household food security

Skills training is provided to all the leaders, CHWs, TBAs, women’s groups, teachers and pupils using the LePSA methodology noted above. Training covers promotion of drought-resistant crops, provision of seed loans, appropriate grain storage and preservation techniques and production of cheap animal protein, e.g. rabbits and poultry.

Since Kibwezi is prone to frequent famine and drought, an early warning system for detection of such problems has been developed to make possible timely and appropriate action to minimize their effects (see box). This system is a result of joint efforts between communities and intersectoral extension workers. It is based on traditional community experiences and proven scientific factors.


Drought-resistant crops are promoted to enhance household food security - On encourage la culture de plantes rstant a seresse pour promouvoir la sritlimentaire des mges - Con objeto de mejorarla seguridad alimentaria de los hogares, se fomentan los cultivos resistentes a la sequ/I>

DROUGHT EARLY WARNING SYSTEM INDICATORS USED IN KIBWEZI

· Abundant fruits on baobab, acacia and mango trees

· A few flowers on the baobab

· Prolonged rains in the coastal region

· Patchy clouds accompanied by thunder and lightning prior to onset of rainfall

· Ten-year cycle

· Grouping of stars before the rains, with more stars in the group on the sunset side than in the group on the sunrise side

· Windy and cold September (prior to the rainfall month)

· Two consecutive good harvests in the long season

Income-generation activities

Income-generation activities, particularly activities that would reduce women’s workload, were promoted among women’s groups. The women use newly acquired skills doing simple feasibility studies, simple bookkeeping and leadership and group management. For instance, two groups of women were trained in small business management. Through a loan repayment scheme, both groups were able to borrow money to purchase maize milling machines. The first group borrowed KSh 48000 (US$ 1920); it has repaid the loan and the business is now self-sustaining.

MONITORING AND EVALUATION

The CHWs collect baseline information on all the children under five years old in their area. They identify all homes with children in this age group, count the total number of children and note their ages and their immunization status.

CHWs in each growth-monitoring centre keep the following information on a monthly basis: the number of children who attend growth-monitoring sessions; the age, sex and village of the children; their weight and arm circumference; and the action taken. The CHWs use this information to determine whether they are reaching their target and to identify high-risk children for closer follow-up or referral. The CHWs analyse the data and inform the community through meetings. Simple quantitative methods are used in presenting results; for example, orange sections are used to explain the proportion of malnourished children.

Because of the slowness of changes in food traditions, habits and customs, any meaningful evaluation of the programme should be conducted after at least five years. Evaluation will be done using participatory methodology and focus-group discussions. The communities will be involved in planning and carrying out the evaluation activities to determine whether the objectives have been achieved.

CONSTRAINTS AND PROBLEMS

In spite of Kenya’s long-standing self-help movement, some people continue to expect hand-outs, having become used to them in other projects. The first step in motivating people to participate is defining the concepts of dependency and sustainability, looking at the community’s strengths and capabilities and seeing what people can do for themselves. With the community, AMREF identifies those areas where people think they heed help. Finally, it is necessary to look at causes of dependency and its effects.

Collection and analysis of information is time consuming, and finding time is a sacrifice for the CHWs, who are volunteers. It is difficult to calculate the amount of time spent on information collection because CHWs have different numbers of households under their care and the distance between households varies. However, experience shows that most CHWs spend at least a full day visiting their communities, and when they have to collect complete information they need another day and a half. Therefore, designing and implementing an adequate but simple monitoring system is still a very big challenge.

Community participation is community empowerment. Sometimes the recognition that is being accorded to communities and their ability to manage activities has been resented by professionals who considered these matters to be their domain. However, there has been considerable change in this attitude among professionals.

ACCOMPLISHMENTS

The implementation of ANP activities in Kibwezi has already produced tangible results, which are recognizable in the areas of growth monitoring, community empowerment and changes in infant feeding and food production practices. At the beginning of the project, prior to mobilization of the community, 483 children aged 36 to 59 months were measured and monitored by stationary and mobile clinics. As a result of community participation, 667 children in the same age group have been monitored in their own community by their own community members. In 1993 the number is on the rise. Until now, these vulnerable children have been difficult to reach because after completing the immunization schedule they attended the clinic less regularly or stopped attending completely.

Community participation in nutrition activities has given people confidence and empowered them to venture into other activities. For example, one community has initiated a community resource centre which keeps and lends reading materials on nutrition, food production and health.

Weaning diets developed with the people’s participation are increasingly being utilized in the community. Previously introduced weaning diets, e.g. soybean mixtures, were not adopted because they did not use foods that were commonly grown and available in Kibwezi households.

Progress has been made in food production. Communities have established multiplication centres for cassava. Clean planting materials are now obtainable within the community. The proportion of farmers growing drought-resistant crops such as millet, sorghum, cassava and green gram is higher because of revolving seed loans, initiated and managed by the community.

Schools have initiated activities such as gardening and rearing of rabbits. Through the pupils, these activities have now filtered into the community. The communities at large are learning from their own children.

LESSONS LEARNED AND CONCLUSION

Community participation should be promoted right from the initiation of a nutrition programme. If promoted later, it meets with resistance and an already-established culture of dependence which is difficult to break. Considerable effort is required to build the capacity to make community participation in nutrition truly effective and sustainable.

In promoting community participation, both the real and felt needs of the community need to be addressed. An entry point or need that is meaningful to the community must be identified and used. Nutrition may not be a good entry point in certain communities; food production or activities to generate women’s income may be better entry points, and their relationship with nutrition can then be emphasized. Food production should be given a priority in the quest for improvement of the nutritional status of the communities.

Nutrition problems are deeply ingrained in people’s way of life, and fundamental changes need to take place before any lasting impact can be seen. Therefore, the priority of any nutrition project should be to develop the community’s own resource persons, people with skills and expertise who can assist other community members in support of good nutrition.

Use of the at-risk approach, in which risk variables are defined and used to identify high-risk individuals and groups who require special attention, is important for targeting the most vulnerable families and making the best use of limited resources. In ANP the risk variables included single parenthood, family size, birth intervals, immunization status and landownership. Targeting high-risk families is one way of promoting their participation.

Several sectors are involved in nutrition, and collaboration among them is very important. Collaboration will minimize replication and mobilize resources for a concerted effort. In Kenya, the sectors include agriculture, livestock, water, social services and health. In these areas AMREF has been a facilitator rather than an implementing agency, focusing on building the capabilities of the community and supporting development of extension personnel.

REFERENCES

Bennet, F.J. & Maneno, J., eds. 1986, National guidelines for implementation of primary health care in Kenya. Nairobi, Ministry of Health, Government of Kenya.

Freire, P. 1973. Education for critical consciousness. New York, Seabury Press.

Rifkin, S.B., Muller, F. & Bichman, W. 1988, Primary health care: on measuring participation. Soc. Sci. Med., 26(9): 931-940.

Participation communautaire à un programme nutritionnel dans une région aride du Kenya

La ron de Kibwezi fait partie des terres arides et semi-arides du Kenya. Le manque de pluie est fremment ’origine de mauvaises rltes et les cycles de famine et de seresse reviennent tous les sept ou huit ans.

L’AMREF (African Medical and Research Foundation), organisation internationale indndante, a but non lucratif, s’efforce d’amorer l’t de sante la population de Kibwezi depuis 1979. Elle a entrepris un projet de nutrition appliquen 1986, pour aborder le probl de la malnutrition par une approche intenglobant la santla production alimentaire, la nutrition et la crion de revenus. Le principe de base de ses activitest la participation communautaire. L’AMREF a assura participation des collectivit’identification des probls, eur luation, a planification, a mobilisation des ressources, ’extion, la surveillance et l’luation des activit

La participation communautaire est drminante pour la mise en valeur des capacitlocales et la poursuite des activitau-dele la phase de financement. Elle est encouragpar la mobilisation collective, la sensibilisation du public et le renforcement des capacitdes collectivit Il y a eu quelques rltats: l’amoration de la surveillance de la croissance des jeunes enfants dans les collectivit Ce groupe d’ reste hors d’atteinte pour les centres de soins maternels et infantiles traditionnels. Des aliments de sevrage appropriont mis au point avec les collectivitartir de produits locaux. Ils sont de plus en plus souvent utilis On a augmenta production de cultures rstant a seresse telles que manioc, mil, sorgho et cales vertes. Les les se sont lanc dans la promotion de la production alimentaire.

En conclusion, on peut dire que la participation communautaire profite autant aux collectivitqu’’AMREF. Les enseignements tirde ce projet aideront l’AMREF et les collectivitlanifier leurs strates futures.

Participación comunitaria para mejorar la nutrición en zonas de sequía de Kenya

La Regie Kibwezi forma parte de las tierras das y semidas de Kenya. La escasez de lluvias provoca a menudo cosechas deficientes, por lo que se han producido peros de caresty sequaproximadamente cada siete u ocho a

La Fundacifricana para la Medicina y la InvestigaciAMREF), organizacinternacional independiente y sin fines de lucro, trabaja desde 1979 para mejorar el estado de salud de la poblacie Kibwezi. En 1986 puso en marcha un proyecto de nutriciplicada para tratar de solucionar el problema de la malnutricion un planteamiento integrado que aborda las cuestiones de la salud, la produccie alimentos, la nutrici la generacie ingresos. El principio en que se basan sus actividades es el de la participaciomunitaria con el fin de garantizar la participacie las comunidades en la determinacie los problemas, su evaluacila planificacila movilizacie recursos y la ejecucila vigilancia y la evaluacie las actividades.

La participacie la comunidad se considera fundamental para fomentar la capacidad local y mantener las actividades despudel pero de financiaciy esta enormemente apoyada por la movilizaciomunitaria, el fomento de la toma de conciencia y la creacie capacidad. Se han alcanzado algunos logros, entre los que cabe destacar; el aumento de la vigilancia del crecimiento de los nipeque que era difl de atender a travde los centros de salud maternoinfantil; la preparaci creciente utilizacie dietas de destete adecuadas utilizando alimentos locales, en la que han colaborado las comunidades; el aumento de la produccie cultivos resistentes a la sequ como por ejemplo, la yuca, el mijo, el sorgo y los cereales verdes; y, en las escuelas, la puesta en marcha de actividades que fomentan la produccie alimentos.

La participaciomunitaria beneficia tanto a la comunidad como a la AMREF y los conocimientos adquiridos gracias a este proyecto serde ayuda a ambos para planificar su estrategias para el futuro.

(introduction...)

V. Wilkening, P. Dexter and C. Lewis

Virginia Wilkening is Chief of the Nutrition Regulations Unit, United States Food and Drug Administration (FDA). Patricia Dexter worked previously for FDA and FAO as a nutritionist. Christine Lewis is Director of the Division of Technical Evaluation in the Office of Food Labeling, FDA, Washington, DC, USA.

In the United States, nutrition labelling is an integral component of nutrition education efforts to raise consumers’ awareness and encourage positive dietary behaviour change. The labelling regulations are designed to be consistent and complementary to national nutrition education campaigns aimed at the general public. The need for improved labelling grew out of public demand for accurate and clear information in the marketplace to help consumers choose foods for a healthy diet. With the passage of the Nutrition Labeling and Education Act (NLEA) of 1990, food manufacturers are now required to put nutrition labels on almost all processed foods regulated by the Food and Drug Administration (FDA) of the United States Department of Health and Human Services. In addition, the United States Department of Agriculture (USDA) has voluntarily instituted similar food labelling regulations to apply to meats and poultry.

For Americans, the benefits of nutrition labelling in terms of lower health care costs related to coronary heart disease and cancer, the two largest public health problems in the country, are estimated to surpass by far the costs incurred by food companies to comply with the labelling reforms. When the new labels were proposed, it was estimated that the total costs of nutrition labelling would be between US$ 1400 million and US$ 2300 million for the food industry, plus US$ 160 million for the government. A cost-benefit study commissioned by FDA estimated that if consumers change their consumption practices as a result of food labelling, the reduction in risk of cancer and coronary heart disease alone will bring benefits ranging from US$ 4400 million to US$ 26000 million.

DEVELOPMENT OF NUTRITION LABELLING IN THE UNITED STATES

FDA labelling regulations for declaring the nutrient content of packaged and processed foods using a standard format were first established in 1973. However, provision of a label was voluntary unless a nutrient was added to the food or a claim about a nutrient was made on the label or in advertising, in which case it was mandatory. In response to the country’s public health concerns about the effects of over-consumption of certain nutrients, strategies to reform labelling regulations were developed in the late 1980s.

In 1989, FDA and USDA issued a request for comments and held nationwide hearings to find out what consumers, food manufacturers and health professionals wanted on food labels. In response to comments received, FDA proposed in July 1990 that regulations mandate nutrition labelling for almost all processed foods, establish reference daily values for certain nutrients and define serving sizes. In 1990, the NLEA was passed by the United States Congress and signed by the president, giving more force to nutrition labelling efforts.

The goal of the NLEA is to provide consistent, understandable and usable food labels to enable consumers to make healthy food choices and to provide an incentive for manufacturers to improve the quality of the foods they produce, FDA was given authority to require nutrition information on the label even when no nutrient claim is made. Developing the regulations required extensive data analyses related to the nutrient content of foods, daily reference values for various nutrients and food components and customary serving sizes for categories of foods. In addition, the scientific literature on diet and health relationships was examined to establish which health claims would be allowed on food labels. FDA reviewed over 40 000 comments from the- food industry, consumer advocacy groups, professional organizations and individuals before finalizing the NLEA regulations, which take effect in 1994.

FOODS REQUIRING NUTRITION LABELLING

Under the NLEA, about 90 percent of processed food sold in the United States is required to carry nutrition information.1 The USDA has made nutrition labelling mandatory on processed and packaged meat and poultry products as well. Nutrition labelling will remain voluntary for many raw foods. A voluntary point-of-purchase programme has been developed by FDA for providing nutrition information for raw foods, including fish and the 20 most frequently eaten raw fruits and vegetables, USDA has developed a similar voluntary programme to provide nutrition information for 45 major cuts of meat and poultry.

1 Foods sold by small businesses, in restaurants and by food service vendors, ready-to-eat foods and donated foods are exempt from the regulations, as are coffee beans, tea, food colours and flavours which have no nutritional significance.

CONTENT OF THE LABEL

To help consumers focus on the nutritional factors most important to public health, the number of nutrients allowed on the nutrition label is limited. The required information and order of appearance on the food label were selected to reflect public health priorities and to minimize confusion.

Information on 14 nutrients must be listed on the label, in the following order: calories, calories from fat, total fat, saturated fat, cholesterol, sodium, total carbohydrate, dietary fibre, sugars, protein, vitamin A, vitamin C, calcium and iron. In addition, several nutrients may be voluntarily declared by food manufacturers, including: calories from saturated fat, mono- and polyunsaturated fat, potassium, soluble fibre, insoluble fibre, sugar alcohol, other carbohydrates, other vitamins and minerals for which Reference Daily Intakes (RDIs)2 have been established and beta-carotene (as a percentage of vitamin A). If a claim is made about any of the nutrients or food components that are otherwise optional to list or if the food is fortified or enriched with one of them, they must be listed on the nutrition label.

2 The term RDI replaces FDA’s earlier term US RDA (US Recommended Daily Allowance) to avoid confusion with the Recommended Dietary Allowances (also abbreviated RDA) determined by the United States National Academy of Sciences for various population groups.

DAILY VALUES AND SERVING SIZES

In addition to RDIs, FDA established Daily Reference Values (DRVs) for total fat, saturated fat, cholesterol, total carbohydrate, dietary fibre, sodium and potassium to help consumers evaluate how a particular food fits into a healthy diet. For the nutrition label, the simpler term Daily Value was chosen to refer to both the RDIs and the DRVs.

Currently, recommendations for the general American public suggest that individuals limit total fat intake to 30 percent or less of calories and saturated fat to 10 percent or less of calories; obtain 60 percent of calories from carbohydrate and 10 percent of calories from protein; and consume 11.5 g of fibre per 1000 calories. Although it is recommended that Americans moderate their sugar consumption, a DRV was not established for sugars because the natural sugars in milk, fruits, vegetables and grain products would make setting such a value very difficult.

Since the dietary guidance recommendations were made relative to calorie intake, FDA had to choose a particular calorie value on which to base the DRVs. A 2000-calorie diet was selected for labelling purposes because it is a basis from which consumers can easily calculate specific values for their own estimated calorie intake. A diet of 2000 calories is considered appropriate for most women, including teenage girls, and for some sedentary men.

To enable consumers to compare the nutrient content of similar foods, more consistent serving sizes are to be specified on the label. Serving sizes must be expressed in both household measures and metric measures. For example, the serving size for milk may be stated as “1 cup (240 ml)” and that for bread as “1 slice (28 g)”. To define serving sizes for the over 40000 foods on the market in the United States, FDA grouped foods into 139 food product categories and specified “reference amounts customarily consumed” for each category. These are the portions normally eaten at one time according to USDA’s national food intake surveys.

On the label the absolute quantitative amount of each nutrient per serving is listed next to the name of the nutrient so the consumer can find it easily. However, as the absolute quantity of a nutrient may have little meaning to some consumers, the amount must also be expressed as Percent Daily Value, which indicates the food’s contribution of the nutrient in the context of the daily diet.

Since protein deficiency is not a public health concern in the United States, listing of Percent Daily Value for protein is not required. However, protein quality information must be declared for foods for infants and children under four years of age and if claims are made about a food’s protein content.

NUTRIENT CONTENT CLAIMS

Manufacturers often wish to make positive claims about the nutrient contents in a food. To give consumers greater confidence in what they read on the label, FDA regulations state which nutrient content claims are allowed and under what circumstances they can be used. FDA has defined criteria for the use of terms such as the following; free, low, lean, extra lean, high, good source, reduced, less, light, modified, more. For example, for a food to be labelled “reduced” in calories, it must have at least 25 percent fewer calories per serving than the usual form of the food established as a reference.

FORMAT OF THE NUTRITION LABEL

When consumers were asked about nutrition labels, they emphasized the need to keep the nutrition label format as simple as possible, to retain the listing of nutrients with quantitative amounts per serving, to allow consumers to compare the nutritional quality of various foods and to estimate the foods’ contributions towards a total daily diet.

To help the consumer recognize information on the label quickly, the regulations include specific graphic requirements such as easy-to-read type styles, upper- and lower-case letters, larger type size and specific line and letter spacing (Figure 1). Exceptions will be granted to make nutrition labelling practical on smaller packages.

A simplified format (Figure 2) is allowed for those foods where at least half of the nutrients are present in insignificant amounts, for example, foods that are primarily carbohydrate or fat such as margarines, oils, sugars, jams, syrups, fruit juices and some fruits and vegetables. When a simplified format is used, the label must include five “core” nutrients: calories, total fat, sodium, carbohydrate and protein, even when they are present at 0 levels.

1 - The new food label - Le nouvel quetage des aliments - La nueva etiqueta de los alimentos

Nutrition Facts
Serving Size ½ cup (114 g)
Servings Per Container 4

Amount Per Serving

Calories 260

Calories from Fat 120


% Daily Value*

Total Fat 13 g

20%


Saturated Fat 5 g

25%

Cholesterol 30 mg

10%

Sodium 660 mg

28%

Total Carbohydrate 31g

11%


Dietary Fiber 0 g

0%


Sugars 5 g


Protein 5 g


Vitamin A 4 %

Vitamin C 2 %

Calcium 15 %

Iron 4 %

* Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:


Calories:

2,000

2,500

Total Fat

Less than

65 g

80 g


Sat Fat

Less than

20 g

25 g

Cholesterol

Less than

300 mg

300 mg

Sodium

Less than

2,400 mg

2,400 mg

Total Carbohydrate


300 g

375 g


Dietary Fiber


25 g

30 g

Calories per gram:

Fat 9

Carbohydrate 4

Protein 4

2 The simplified nutrition label - Etiquetage simplifies informations nutritionnelles - La etiqueta simplificada con informaciutricional

Nutrition Facts
Serving Size 1 can (360 mL)

Amount Per Serving

Calories 140


% Daily Value*

Total Fat 0 g

0 %

Sodium 20 mg

1 %

Total Carbohydrate 36 g

12 %


Sugars 36 g


Protein 0 g


* Percent Daily Values are based on a 2,000 calorie diet.

Some claims refer to the nutrient content of the food relative to the Daily Value for that nutrient. For a product to qualify as an “excellent source” of a nutrient, a serving of the food must contain 20 percent or more of the Daily Value for that nutrient. To qualify for a “good source of...” claim, a serving must contain 10 to 19 percent or more of the Daily Value for that nutrient.

The claim “-free” and its synonyms are allowed when the food is absolutely free of the nutrient or if the amount is so small that it is considered “dietetically trivial or physiologically insignificant”. For example, the regulations will allow a “fat-free” claim on a label if the food has less than 0.5 g of fat per serving. This amount is considered physiologically insignificant even if a person eats several servings.

HEALTH CLAIMS

For the first time, food labels will be allowed to carry information about the link between certain nutrients and the risk of specific diseases or health conditions. For such a “health claim” to be permitted on a package, FDA must first determine that the link between diet and disease risk is supported by scientific evidence. As with the nutrient content claims discussed above, health claims may be made on the label only if they are authorized by FDA.

At this time, FDA allows eight such health claims, as listed in the table. The nutrient content of foods bearing these health claims must meet the criteria set for the terms listed in the “food characteristics” column. Health claims must also be phrased so that the consumer can understand the relationship between the nutrient and the health condition and the nutrient’s importance in the daily diet. Model claim statements have been developed by FDA (see table).

When the scientific evidence has not been conclusive, FDA has not allowed health claims. In addition, the NLEA specifically prohibits health claims about any food that contains any nutrient in an amount that generally increases the risk of disease or a health-related condition.


NUTRITION EDUCATION CAMPAIGNS

To help consumers learn how to use the new label, FDA and USDA have embarked on a joint national food labelling education campaign which is carried out in conjunction with consumer, trade and health groups as well as other government agencies. The goal is to provide consistent messages on the use and importance of the new food label. The campaign features national annual conferences; a labelling Education Information Center that includes a database of activities, materials, research and publications; a research and evaluation component; and a strong focus on media and materials development.

As part of the United States’ nutrition education campaigns, USDA and the Department of Health and Human Services jointly issued the Dietary Guidelines for Americans and developed the Food Guide Pyramid (see Figure 3) to illustrate them. Through the widespread dissnation of the Food Guide Pyramid and the nutrition label, it is hoped that consumers will understand the appropriate amounts of each type of food that should be eaten on a daily basis to maintain good health.

The dietary information presented on the food label is complex, and consumers vary in their ability to understand and make use of it. Perhaps one of the greatest challenges of nutrition labelling lies in educating the public on how to use the information on the label to make wise food choices for an overall healthy diet. FDA brochures, messages, educational guidelines and media activities all emphasize this focus.

Health claims allowed on food labels - Informations sur la santouvant figurer sur l’quette des aliments - Informaciones sobre la salud permitidas en las etiquetas de los alimentos

Food characteristics

Health claim -reduced risk of:

Model claim statements

High in assimilable (bioavailable) calcium; supplements must disintegrate and dissolve; phosphorus content cannot exceed calcium content

Osteoporosis

Regular exercise and a healthy diet with enough calcium helps teens and young adult white and Asian women maintain good bone health and may reduce their high risk of osteoporosis later in life.

Low sodium

Hypertension

Diets low in sodium may reduce the risk of high blood pressure, a disease associated with many factors.

Low fat; fish and game meats must be “extra lean”

Cancer

Development of cancer depends on many factors. A diet low in total fat may reduce the risk of some cancers.

Low saturated fat, low cholesterol and low fat; fish and game meats must be “extra lean”

Coronary heart disease

While many factors affect heart disease, diets low in saturated fat and cholesterol may reduce the risk of this disease.

Grain products, fruits or vegetables that contain dietary fibre; low fat; good source of dietary fibre (without fortification)

Cancer

Low-fat diets rich in fibre-containing grain products, fruits and vegetables may reduce the risk of some types of cancer, a disease associated with many factors.

Fruit, vegetable or grain products that contain fibre; low saturated fat; low cholesterol; low fat; at least 0.6 g of soluble fibre per reference amount (without fortification)

Coronary heart disease

Diets low in saturated fat and cholesterol and rich in fruits, vegetables and grain products that contain some types of dietary fibre, particularly soluble fibre, may reduce the risk of heart disease, a disease associated with many factors.

A fruit or vegetable; low fat; good source (without fortification) of at least one of the following: vitamin A, vitamin C or dietary fibre

Cancer

Low-fat diets rich in fruits and vegetables (foods that are low in fat and may contain dietary fibre, vitamin A or vitamin C) may reduce the risk of some types of cancer, a disease associated with many factors. Broccoli is high in vitamins A and C, and it is a good source of dietary fibre.

Good source of folate

Neural tube defects

Women who consume adequate amounts of folate, a B vitamin, daily throughout their childbearing years may reduce their risk of having a child with a neural tube birth defect. Such birth defects, while not widespread, are very serious. They can have many causes. Adequate amounts of folate can be obtained from diets rich in fruits, dark-green leafy vegetables and legumes, enriched grain products, fortified cereals or a supplement. Folate consumption should be limited to 1 000 mg per day from all sources.


3 - Food Guide Pyramid created to assist United States consumers in daily food choices - Pyramide alimentaire mise au point pour aider les consommateurs amcains hoisir leur rme alimentaire journalier - Pirde gude los alimentos elaborada para ayudara los consumidores de los Estados Unidos a elegir su dieta diaria

Food advertising presents another challenge within the objective of providing consistent and accurate messages to consumers. The Federal Trade Commission (FTC) Is being asked to abide by the same standards as those created under the NLEA so that food advertising related to health claims and nutrient content claims will be consistent with information allowed on the food label.

CONCLUSION

The nutrition labelling policy being implemented in the United States will result in the provision of more information about food products under a single national uniform system and will benefit both consumers and ‘ manufacturers. Efforts by FDA to develop regulations to improve nutrition labelling have focused on making the information on the label useful, to consumers in light of current public health concerns and useful to manufacturers for promoting foods that will contribute to a healthy diet.

The United States’ efforts to establish comprehensive and far-reaching nutrition labelling regulations illustrate some of the many factors that should be considered in developing labelling policies. As scientific evidence linking the nutrient content of foods to health conditions continues to emerge, public health policy and dietary guidance may shift and may vary from country to country. Each country may establish its own requirements for providing nutrition information through food labelling in light of its own priorities. It is hoped that these priorities will also include a major focus on educating consumers to understand and use the food label in ways that will improve their health and make society the greatest beneficiary.

Étiqueter les aliments pour améliorer la nutrition aux États-Unis

Pour rndre au besoin accru d’information des consommateurs sur la qualitutritionnelle des aliments, les ats-Unis ont promulgun 1990 une loi sur l’cation nutritionnelle et l’quetage des aliments, qui oblige onner des informations nutritionnelles sur l’quette de presque tous les produits transformrementpar la Food and Drug Administration (FDA). Le Drtement de l’agriculture a institun outre une rementation sur l’quetage des viandes et de la volaille. Les grandes lignes de cette rementation sont les suivantes:

· obligation de fournir des indications nutritionnelles sur l’quette pour presque tous les produits transform

· autorisation d’indiquer sur l’quette certains ments nutritifs et bienfaits pour la sant

· blissement de valeurs journalis de rrence pour les macronutriments et harmonisation des tailles des portions entre les diffntes marques.

Le nouvel quetage nssite des informations approfondies sur la composition des aliments et les habitudes alimentaires des Amcains, et des preuves scientifiques pour yer les alltions concernant les bienfaits pour la santui figurent sur l’quette. Les consommateurs, les fabricants et les professionnels de la santnt consultpour mettre au point la lslation et le nouvel quetage. Pour aider les consommateurs irer profit de ces indications, la FDA et le Drtement de l’agriculture ont entrepris une campagne d’cation sur l’quetage des aliments, de plusieurs ann.

La nouvelle quette type contient des informations sur 14 ments nutritifs pour aider les consommateurs uivre les Directives nutritionnelles ’usage des Amcains (voir encadr. 41). Les consommateurs peuvent suivre les indications nutritionnelles de l’quette et la «pyramide alimentaire» rmment mise au point pour choisir les aliments qui leur permettront d’avoir un rme alimentaire sain et ilibrvoir figure p. 43).

Cette rrme de l’quetage aux ats-Unis rlte du besoin d’informations claires et prses du grand public, afin d’aider les consommateurs hoisir les aliments qui leur assureront une alimentation ilibr compte tenu des probls de santublique. Chaque pays devra blir ses propres besoins en mati d’informations nutritionnelles sur l’quette des aliments en fonction de ses priorit

Etiquetado de los alimentos para mejorar la nutrición en los Estados Unidos

En respuesta a la necesidad de los consumidores de disponer de minformaciobre las cualidades nutricionales de los alimentos, en 1990 en los Estados Unidos se promulg Ley de Etiquetado y Educacin materia de Nutricique exige que pricamente todos los alimentos elaborados controlados por la Administracie Alimentos y Medicamentos (FDA) lleven una etiqueta con dicha informaciPor otra parte, el Departamento de Agricultura (USDA) ha establecido una normativa para el etiquetado de la carne incluyendo la de aves de corral. Entre los principales aspectos de la normativa de etiquetado cabe ser los siguientes:

· obligacie colocar etiquetas con informacielativa a la nutricin pricamente todos los productos elaborados;

· posibilidad de incluir determinada informaciobrl contenido nutricional y los beneficios para la salud en las etiquetas;

· establecimiento de valores de referencia diarios de macronutrientes y armonizaciel tamae las porciones de las diferentes marcas de productos.

Para crear las nuevas etiquetas con informaciutricional fue necesario disponer de amplia informaciobre la composicie los alimentos y las pautas de consumo alimenticio de la poblaciasomo datos cientcos que sirvieran como fundamento de la informaciobre los beneficios para la salud que figura en las etiquetas. En el proceso de proponer la legislaci diselas etiquetas, se hicieron consultas a los consumidores, los productores y los profesionales de la salud. Con objeto de que los consumidores aprendan a interpretar las nuevas etiquetas, la FDA y el USDA han iniciado una campae divulgacie varios asobre el etiquetado de los alimentos.

La etiqueta con informaciutricional normalizada (ve el recuadro de la p 41) contiene informaciobre 14 nutrientes para ayudar a los consumidores a seguir las directrices dietcas establecidas en el pa Los consumidores pueden utilizar esta informacisomo la pirde gude los alimentos recientemente elaborada para escoger adecuadamente los alimentos y seguir una dieta saludable y equilibrada (ve la figura en la p 43).

La necesidad de reformar el etiquetado en los Estados Unidos surgi la demanda de los consumidores por disponer de informacilara y concisa que sirviera de ayuda para escoger los alimentos y poder seguir una dieta saludable, a la luz del reciente interpor la salud pa. Cada padeberstablecer sus propias exigencias a la hora de proporcionar informaciutricional en las etiquetas de los alimentos, en funcie sus prioridades.

Codex Alimentarius

The Codex Alimentarius Commission1 is a subsidiary body of the Food and Agriculture Organization and the World Health Organization. It was established to formulate internationally accepted food safety standards with the aim of protecting the consumer’s health and ensuring fair trade practices. The Commission is composed of 146 member countries.

1 Codex alimentarius is a Latin expression meaning “food code” or “food law”.


CODEX COMMITTEE ON FOOD IMPORT AND EXPORT INSPECTION AND CERTIFICATION SYSTEMS

The second session of the Codex Committee on Food Import and Export Inspection and Certification Systems (CCFICS) was held in Canberra, Australia from 29 November to 3 December 1993. Extensive discussions were held on various issues related to the inspection and certification of foodstuffs moving in international trade.

Subjects discussed included harmonized guidelines on the many aspects of import and export inspection and certification systems; a glossary of terms based on internationally accepted definitions; guidelines for the exchange of information on rejections and on the principle elements in an electronic documentation system; a list of contacts for food import control agencies; and the application of the ISO 9000 series on quality control to food inspection and certification systems.

The committee proposed draft principles for food import and export inspection and certification and guidelines for information exchange in emergency food control situations to the Executive Committee of the Codex Alimentarius Commission for preliminary adoption.

In considering the principles for food import and export inspection, the committee agreed on several amendments based on suggestions arising from review of the principles at the 20th Session of the Codex Alimentarius Commission (Geneva, 28 June to 7 July 1993). These changes clarified the application of equivalence principles in practice; differences between mandatory versus voluntary and private versus government inspection systems; enhancement of mutual confidence in such systems between importers and exporters; differences between inspection and verification; the role of consumers; and the perspective of the developing world. The importance of promoting trade, protecting consumers and publishing timely information on rejections and detentions of products was also noted.

The committee reiterated its strong support for the continued elaboration of the guidelines for information exchange in emergency food control situations, as traditional information exchange had often been slow and inappropriate in emergency situations. In this regard, the committee stressed the importance of providing timely information exchange while respecting matters of confidentiality, and the obligation of governments to do so. The importance of establishing a simple and readily available system was also stressed.

The Codex Alimentarius Commission, recognizing the importance of the deliberations of the committee, agreed that it should continue to meet in the future. The third session of the CCFICS is tentatively planned to be held in Australia from 27 February to 3 March 1995.

GATT URUGUAY ROUND

The recently concluded General Agreement on Tariffs and Trade (GATT) Uruguay Round of Multilateral Trade Negotiations will have significant implications for the work of the Codex Alimentarius Commission. Especially relevant are the final acts of the GATT agreements on sanitary and phytosanitary measures and on technical barriers to trade.

The GATT Agreement on the Application of Sanitary and Phytosanitary Measures reaffirmed that “no member should be prevented from adopting or enforcing measures necessary to protect human, animal or plant health, subject to the requirement that they are not applied in a manner which would constitute a means of arbitrary or unjustifiable discrimination between members where the same conditions prevail or a disguised restriction on international trade”.

International standards, guidelines and recommendations in the area of food safety are defined as those established by the Codex Alimentarius Commission relating to food additives, veterinary drug and pesticide residues, contaminants, methods of analysis and sampling, and codes and guidelines of hygienic practice.

The agreement also promotes participation of members in the development of harmonized sanitary and phytosanitary measures on the basis of international standards, guidelines and recommendations developed by the relevant international organizations, including the Codex Alimentarius Commission. Regarding dispute settlements involving scientific or technical issues, the agreement provides for consultation with relevant international organizations such as Codex. The agreement also recognizes that developing-country members may encounter special difficulties in complying with the sanitary or phytosanitary measures of importing members and encourages assistance in this regard.

The GATT Agreement on Technical Barriers to Trade emphasizes some of the same principles by recognizing the important place of international standards and conformity assessment systems in facilitating the conduct of international trade. This agreement encourages the development and use of technical regulations and standards in such areas as packaging, marking and labelling. It also ensures that these international standards as well as procedures for assessing conformity with them do not create unnecessary obstacles to international trade.

The agreement recognizes that no country should be prevented from taking measures necessary to ensure the quality of its imports; the protection of the environment or of human, animal or plant life or health; or the prevention of deceptive practices, as long as such measures are not applied in a manner that would constitute a means of arbitrary or unjustifiable discrimination or a disguised restriction on international trade.

In addition, the agreement recognizes that international standardization can assist the transfer of technology from developed to developing countries as well as encourage developed countries’ desire to help in this regard.

D. H. Byron
Food Standards Officer.
Joint FAO/WHO Food Standards Programme

La Commission du Codex Alimentarius1 est un organe subsidiaire de l’Organisation des Nations Unies pour l’alimentation et l’agriculture et de l’Organisation mondiale de la santui a crpour mettre au point des normes de sritlimentaire universellement accept. Ces normes visent rotr la santes consommateurs et arantir des pratiques commerciales itables. La Commission se compose de 146 pays membres.

1 Codex alimentarius est une expression latine signifiant «code alimentaire» ou «lslation sur les produits alimentaires».

COMITDU CODEX SUR LES SYSTES D’INSPECTION ET DE CERTIFICATION DES IMPORTATIONS ET DES EXPORTATIONS ALIMENTAIRES

La deuxi session du Comitu Codex sur les systs d’inspection et de certification des importations et des exportations alimentaires (CCFICS) s’est tenue anberra (Australie) du 29 novembre au 3 dmbre 1993. Le Comit longuement examiniverses questions li a l’inspection et a certification des denr alimentaires faisant l’objet d’anges internationaux.

Le Comit examines directives harmonis pour les multiples aspects des systs d’inspection et de certification des importations et des exportations; un glossaire des termes basur des dnitions accept au plan international; des directives pour l’ange d’informations sur les produits refuset sur les principaux ments d’un syst de documentation ctronique; une liste de points de contact pour les organismes de contrdes importations alimentaires et l’application des ses de l’ISO 9000 sur le contrde qualitux systs d’inspection et de certification des denr alimentaires.

Le Comit proposes projets de principes pour l’inspection et la certification des importations et des exportations de denr alimentaires et des directives pour la fourniture d’informations en cas d’urgence au Comitxtif de la Commission du Codex Alimentarius pour adoption provisoire.

En examinant les principes pour l’inspection des importations et des exportations de denr alimentaires, le Comit acceptlusieurs amendements, sur la base de propositions nant de l’de effectua vingti session de la Commission du Codex Alimentarius (Gen, 28 juin - 7 juillet 1993). Ces amendements apportent des aircissements sur l’application des principes d’ivalence dans la pratique; les diffnces entre l’application obligatoire ou volontaire et les systs d’inspection privet publics; le dloppement de la confiance mutuelle dans les systs d’inspection/de contrentre importateurs et exportateurs; les diffnces entre l’inspection et la vfication; le rdes consommateurs; et les perspectives pour le monde en dloppement. Le Comit lement not’importance de la promotion du commerce, de la protection des consommateurs et de la publication en temps opportun d’informations sur les produits refusou saisis.

Le Comit rfirmon ferme soutien a l’boration de directives pour l’ange d’informations dans les situations d’urgence, car les systs traditionnels sont lents et inapproprien cas d’urgence. A cet rd, le Comit soulign’importance et l’obligation pour les gouvernements de fournir des informations en temps opportun tout en respectant la confidentialit

Le Comit lement soulign’utilit’un syst simple et facilement accessible.

La Commission du Codex Alimentarius, reconnaissant l’importance des dbtions du Comitest convenue qu’il devrait continuer e rir ’avenir. La troisi session du CCFICS a fixtemporairement du 27 fier au 3 mars 1995, en Australie.

L’URUGUAY ROUND DU GATT

Les nciations commerciales multilatles de l’Uruguay Round du GATT (Accord gral sur les tarifs douaniers et le commerce) qui viennent de se conclure auront des rrcussions significatives sur le travail de la Commission du Codex Alimentarius, surtout les actes finals des accords relatifs ’application des mesures sanitaires et phytosanitaires et aux obstacles techniques au commerce.

L’Accord du GATT relatif ’application des mesures sanitaires et phytosanitaires rfirme qu’«aucun membre ne devrait e emp’adopter ou d’appliquer des mesures nssaires a protection de la santt de la vie des personnes et des animaux ou a prrvation des vtaux, sous rrve que celles-ci ne soient pas appliqu de fa onstituer, soit un moyen de discrimination arbitraire ou injustifintre les membres o ms conditions existent, soit une restriction disau commerce international».

Les normes, directives et recommandations internationales dans le domaine de l’innocuites aliments sont dnies comme celles qui sont blies par la Commission du Codex Alimentarius en ce qui concerne les additifs alimentaires, les rdus de pesticides et de mcaments vrinaires, les contaminants, les modes d’analyse et d’antillonnage et les codes d’usages et directives en mati d’hygi.

L’Accord encourage lement la participation a mise en place de mesures sanitaires et phytosanitaires harmonis entre les membres, sur la base des normes, directives et recommandations internationales blies par les organisations internationales compntes, notamment la Commission du Codex Alimentarius, sans demander aux membres de changer leur niveau de protection de la vie et de la santes hommes, des animaux ou des plantes. En cas de diffnds concernant des questions scientifiques ou techniques, l’Accord prit de consulter des instances internationales compntes comme le Codex. L’Accord reconnalement que les pays membres en dloppement peuvent avoir des difficulte conformer aux mesures sanitaires et phytosanitaires des pays membres importateurs, et il encourage es aider dans ce domaine.

L’Accord du GATT relatif aux S obstacles techniques au commerce souligne quelques-uns de ces principes et reconnal’importance des systs internationaux de normalisation et d’luation de la conformitux normes, qui facilitent le commerce international. L’Accord encourage le dloppement et l’utilisation de rements techniques et de normes en mati d’emballage, de marquage et d’quetage. Il veille aussi e que ces normes internationales et les procres d’luation de la conformitux normes ne crt pas d’obstacles non nssaires au commerce international.

L’Accord reconnaque rien ne saurait emper un pays de prendre les mesures nssaires pour assurer la qualite ses importations, ou nssaires a protection de la santt de la vie des personnes et des animaux, a prrvation des vtaux, a protection de l’environnement ou a prntion des pratiques de nature nduire en erreur, sous rrve que ces mesures ne soient pas appliqu de fa onstituer, soit un moyen de discrimination arbitraire ou injustifisoit une restriction disau commerce international.

En outre, l’Accord reconnala contribution que la normalisation internationale peut apporter au transfert de technologies des pays dloppvers les pays en dloppement et se dare dreux de les aider dans leurs efforts et rd.

D. H. Byron
Charges normes alimentaires.
Programme mixte FAO/OMS sur les nonnes alimentaires

La Comisiel Codex Alimentarius1 (146 Estados miembros) es un no auxiliar de la Organizacie las Naciones Unidas para la Agricultura y la Alimentaci la Organizaciundial de la Salud establecido para elaborar normas alimentarias internacionalmente aceptadas, destinadas a proteger la salud de los consumidores y asegurar practicas equitativas en el comercio de los alimentos.

1 Codex alimentarius es una expresiatina que significa «co alimentario» o «legislacilimentaria».

COMITDEL CODEX SOBRE SISTEMAS DE INSPECCI Y CERTIFICACI DE IMPORTACIONES Y EXPORTACIONES DE ALIMENTOS

La segunda reuniel Comitel Codex sobre Sistemas de Inspecci Certificacie Importaciones y Exportaciones de Alimentos (CCFICS) se celebr Canberra, Australia, del 29 de noviembre al 3 de diciembre de 1993. En dicha reunise debatieron ampliamente distintos temas relativos a la inspecci certificacie los productos alimenticios que son objeto de comercio internacional.

Entre ellos, cabe ser: directrices armonizadas sobre los mles aspectos de los sistemas de inspecci certificacie importaciones y exportaciones; un glosario de tinos basados en definiciones aceptadas internacionalmente; directrices para el intercambio de informaciobre casos de rechazo y los elementos bcos de un sistema electro de informaciuna lista de contactos para los organismos encargados del control de las importaciones de alimentos; y, la aplicacie la serie ISO 9000 sobre el control de calidad a los sistemas de inspecci certificacie alimentos.

El Comitropuso un anteproyecto de principios generales para la inspecci certificacie las importaciones y exportaciones de alimentos, asomo directrices para el intercambio de informacin situaciones de urgencia del control de los alimentos, al Comitjecutivo de la Comisiel Codex Alimentarius para su aprobacireliminar.

En su examen de los principios generales mencionados, el Comitcordalizar varias enmiendas a los principios de acuerdo con las sugerencias planteadas en el vigmo pero de sesiones de la Comisiel Codex Alimentarius (Ginebra, 28 de junio al 7 de julio de 1993). Entre ellas, cabe ser las opiniones de que se aclararan cuestiones como: la aplicacie los principios de equivalencia en la prica; las diferencias entre aplicacibligatoria y voluntaria y los sistemas de inspeccirivados y gubernamentales; el fomento de la confianza recoca en dichos sistemas entre importadores y exportadores; las diferencias entre inspecci verificaciy la funciue desempelos consumidores en el mundo en desarrollo. Se hizo notar tambila importancia del fomento del comercio, la proteccie los consumidores y la publicaciportuna de informaciobre rechazos y retenciones de productos.

En su examen de las directrices para el intercambio de informacin situaciones de urgencia con respecto al control de los alimentos, el Comiteiter firme apoyo a la prosecucie la elaboracie aquas, dado que el intercambio de informaciradicional es a menudo lento e inadecuado en situaciones de urgencia. A este respecto, el Comitubray obligacie los gobiernos de facilitar el oportuno intercambio de informaciespetando el carer confidencial de ciertos aspectos. Tambise enfatiz necesidad de un sistema sencillo, y del que pudiera disponerse con facilidad.

La Comisiel Codex Alimentarius, reconociendo la importancia de las deliberaciones del Comitacorde el CCFICS siguiera reuniose en el futuro. La tercera reuniel CCFICS se fij manera preliminar para el pero del 27 de febrero al 3 de marzo de 1995 en Australia.

LA RONDA URUGUAY DEL GATT

La recientemente finalizada Ronda Uruguay de Negociaciones Comerciales Multilaterales del Acuerdo General sobre Aranceles Aduaneros y Comercio (GATT) tendrmportantes repercusiones para la labor de la Comisiel Codex Alimentarius, especialmente por lo que respecta a las actas finales del Acuerdo sobre Medidas Sanitarias y Fitosanitarias y del Acuerdo sobre Obstlos Ticos al Comercio.

El Acuerdo sobre Medidas Sanitarias y Fitosanitarias reafirme «no debe impedirse a ningembro adoptar ni aplicar las medidas necesarias para proteger la vida y la salud de las personas y animales o para preservar los vegetales, a condicie que no se apliquen de manera que constituya un medio de discriminacirbitrario o injustificable entre los Miembros en que prevalezcan las mismas condiciones, o una restriccincubierta del comercio internacional».

Las normas, directrices y recomendaciones internacionales en el ito de la inocuidad de los alimentos se definen como aquellas establecidas por la Comisiel Codex Alimentarius en lo que respecta a residuos alimentarios, residuos de medicamentos veterinarios y plaguicidas, contaminantes, mdos de ansis y toma de muestras, y cos y directrices de pricas de higiene.

El Acuerdo tambifomenta la utilizacie medidas sanitarias y fitosanitarias armonizadas entre los Miembros, y la participacie os en su elaboracisobre la base de normas, directrices y recomendaciones internacionales elaboradas por las organizaciones internacionales competentes, entre ellas la Comisiel Codex Alimentarius, sin que ello requiera que los Miembros modifiquen su nivel adecuado de proteccie la vida o la salud de las personas y de los animales o de preservacie los vegetales. En los casos de disputas relativas a temas cientcos o ticos, el Acuerdo prevonsultas a las organizaciones internacionales pertinentes como, por ejemplo, la Comisiel Codex. El Acuerdo tambireconoce que los pas en desarrollo Miembros pueden tropezar con dificultades especiales para cumplir las medidas sanitarias o fitosanitarias de los Miembros importadores, y solicita se dpoyo a este respecto.

El Acuerdo sobre Obstlos Ticos al Comercio hace hincapin estos mismos principios reconociendo la importancia de la contribuciue las normas internacionales y los sistemas internacionales de evaluacie la conformidad pueden hacer para facilitar el comercio internacional. El Acuerdo alienta la elaboraci utilizacie normas internacionales y al mismo tiempo garantiza que los reglamentos ticos y normas, incluidos los requisitos de envase y embalaje, marcado y etiquetado, y los procedimientos de evaluacie la conformidad con los reglamentos ticos y las normas, no creen obstlos innecesarios al comercio internacional. El Acuerdo reconoce que no debe impedirse a ningque adopte las medidas necesarias para asegurar la calidad de sus importaciones, o para la proteccie la salud y la vida de las personas y animales o la preservacie los vegetales, para la protecciel medio ambiente o para impedir pricas engas, a condicie que no las aplique en forma tal que constituyan un medio de discriminacirbitrario o injustificado o una restriccincubierta del comercio internacional.

Adem el Acuerdo reconoce la contribuciue la normalizacinternacional puede hacer a la transferencia de tecnologdesde los pas desarrollados hacia los pas en desarrollo, asomo el deseo de ayudar a estos os en los esfuerzos que realicen en este ito.

D. H. Byron
Oficial de Normas Alimentarias
Programa Conjunto FAO/OMS sobre Normas Alimentarias

In December 1992, 159 governments participated in the FAO/WHO International Conference on Nutrition (ICN). By adopting the World Declaration on Nutrition and the Plan of Action for Nutrition, they pledged their commitment to reduce malnutrition, eliminate hunger and ensure the sustained nutritional well-being of all people.

ONE YEAR LATER

To attain the goals of alleviating suffering from hunger and malnutrition, governments are undertaking a wide variety of activities, FAO has prepared the guidelines Developing national plans of action for nutrition, which are available to governments through FAO offices in member countries. In this column, we provide brief descriptions of some of the efforts to stimulate future actions.

Asia

The Government of Viet Nam will begin implementation of its national plan of action for nutrition (NPAN) in 1994 after the NPAN is ratified by the National Assembly. Among other issues, the Viet Nam NPAN features nutrition education through primary health care and mass-media campaigns, and economic development as a means of alleviating hunger and malnutrition. Under the Technical Cooperation Programme, FAO has provided advice on agriculture, household food security, micronutrient deficiencies and food safety and quality control activities.

The framework of the Bangladesh NPAN will be elaborated through a project to strengthen food and agriculture policies and coordination among nutrition projects and programmes in the country. Similarly, sectoral working groups in Nepal are preparing NPANs by incorporating nutrition objectives into agriculture planning.

In Pakistan, a large nutrition project will incorporate issues of agriculture and rural development and improved community and household food security.

Latin America

Colombia is participating in a regional project on food security and implementing projects in forestry, women in rural development and food expenditure. The NPAN in the Dominican Republic will focus on vulnerable population groups such as sugar-cane workers and those living in periurban areas or near the border with Haiti. Ecuador is completing its NPAN and hosted a subregional workshop on ICN follow-up in March 1994.

Africa

The Tanzania Food and Nutrition Committee (TFNC) conducted a national conference on nutrition to advance ICN activities and formed multisectoral working groups to complete their NPAN.

In Guinea, a national multisectoral seminar on NPAN formulation was held in October 1993 and was attended by several international and non-governmental organizations. Increasing agricultural production, family income and access to food are goals voiced in the NPAN.

Eritrea carried out a rapid assessment of the food and nutrition situation with FAO assistance. A national food security and nutrition programme is being finalized.

Near East

Egypt designated the Ministry of Agriculture and Land Reclamation as the agency responsible for NPAN preparation. The NPAN is expected to contain agriculture-based recommendations and long-term development components. An interministerial committee has completed the Moroccan NPAN.

North America

The NPAN in the United States will incorporate ideas from NGOs, the government and the private sector. At a public seminar in August 1993, working groups were established for each of the nine themes from the Plan of Action for Nutrition.

The United States and Canada have contributed to ICN follow-up activities in other countries. They are particularly involved in micronutrient deficiency programmes.

Europe

The National Food and Nutrition Institute in Poland organized the Scientific National Congress meeting “Food, Nutrition and Health” as an ICN follow-up activity. A number of social programmes were initiated to assist the unemployed, children and the elderly.

Norway, Sweden, the United Kingdom, France and others are preparing NPANs and providing assistance to developing countries for ICN-related activities.

Future columns

More energy, time and resources need to be invested if the goals of the World Declaration on Nutrition and the Plan of Action for Nutrition are to be met. Future issues of Food, Nutrition and Agriculture will provide information on activities of the private as well as public sector to meet these goals.

Lora Iannotti
Associated Professional Officer.
Nutrition Planning, Assessment and Evaluation Service

En dmbre 1992, 159 pays ont particip la Confnce internationale FAO/OMS sur la nutrition (CIN). En approuvant la Daration mondiale sur la nutrition et le Plan d’action pour la nutrition, ils se sont engagire la malnutrition, miner la faim et œuvrer pour le bien-e nutritionnel de tous.

UN AN PLUS TARD

Pour parvenir llr les souffrances provoqu par la faim et la malnutrition, les gouvernements ont entrepris toute une vari d’activit La FAO a bli des «Directives pour l’boration des plans nationaux d’action pour la nutrition» que les gouvernements peuvent se procurer auprdu Bureau de la FAO dans leur pays. Dans cette rubrique, nous divons briment les efforts doypour stimuler des activitfutures.

Asie

En 1994, le Gouvernement vietnamien mettra en œuvre son Plan d’action national pour la nutrition (PANN) aprsa ratification par l’Assemblnationale. Ce plan prit notamment une campagne d’cation nutritionnelle par l’intermaire des centres de soins primaires et des mas, et le dloppement nomique comme moyen de lutter contre la faim et la malnutrition. Dans le cadre du Programme de cooption technique, la FAO a fourni des conseils en mati d’agriculture, de sritlimentaire des mges, de carences en micronutriments et de contrde la qualitt de l’innocuites aliments.

Le PANN du Bangladesh sera borans le cadre d’un projet visant enforcer les politiques alimentaires et agricoles et d’une coordination entre les programmes nutritionnels du pays. De m, au Nl, des groupes de travail sectoriels prrent les PANN en incorporant des objectifs nutritionnels a planification agricole.

Au Pakistan, un vaste projet nutritionnel incorporera des notions d’agriculture et de dloppement rural et d’amoration de la sritlimentaire des mges et des collectivit

Amque latine

La Colombie participe n projet ronal sur la sritlimentaire et exte des projets dans le domaine de la foresterie, du rdes femmes dans le dloppement rural et des dnses alimentaires. Le PANN de la Rblique dominicaine sera axur les groupes de population vulnbles: travailleurs dans les champs de canne ucre, population des zones purbaines et habitants de la ron situprde la fronti haenne. L’uateur ach son PANN et a accueilli un atelier sous-ronal sur le suivi de la CIN en mars 1994.

Afrique

Le Comite l’alimentation et de la nutrition de la Tanzanie a organisne confnce nationale sur la nutrition pour donner suite a CIN et a constitues groupes de travail multisectoriels pour achever le PANN.

En Guin un snaire multisectoriel national sur la formulation du PANN s’est tenu en octobre 1993 avec la participation de plusieurs organisations internationales et organisations non gouvernementales. Le PANN vise ccroe la production agricole, les revenus des mges et l’accaux aliments.

L’Erythra effectune luation rapide de la situation alimentaire et nutritionnelle avec l’aide de la FAO, Un programme national de nutrition et de sritlimentaire est en cours d’achment.

Proche-Orient

L’ypte a charge Minist de l’agriculture et de la mise en valeur des terres de la preparation du PANN. Ce plan devrait contenir des recommandations dans le secteur agricole et des considtions sur le dloppement ong terme. Un comitnterministel a acheve PANN du Maroc.

Amque du Nord

Aux ats-Unis, le PANN incorporera des id nant des ONG, du gouvernement et du secteur privLors d’un snaire public en ao93, des groupes de travail ont cr pour chacun des neuf ths du Plan d’action pour la nutrition.

Les ats-Unis et le Canada ont contribuux activitde suivi de la CIN dans d’autres pays. Ils participent notamment aux programmes de lutte contre les carences micronutritionnelles.

Europe

En Pologne, l’Institut national pour l’alimentation et la nutrition a organisne rion du Congrnational scientifique sur le th «alimentation, nutrition et sant187;, comme suivi de la CIN. Plusieurs programmes sociaux d’aide aux chrs, aux enfants et aux personnes es ont mis en route.

La Norv, la Su, le Royaume-Uni, la France et d’autres pays prrent des plans d’action nationaux et apportent une aide aux pays en dloppement pour le suivi de la CIN.

Futures rubriques

Les objectifs de la Daration mondiale sur la nutrition et du Plan d’action pour la nutrition nssitent davantage d’rgie, de temps et de ressources. Dans les prochains nums d’Alimentation, nutrition et agriculture, nous fournirons des informations sur les actions men par les secteurs public et privour atteindre ces objectifs.

Lora Iannotti
cadre associ/I>
Service de la planification, de l’analyse et de l’luation nutritionnelles

En diciembre de 1992, 159 gobiernos participaron en la Conferencia Internacional sobre NutriciCIN) organizada por la FAO y la OMS, y, al aprobar la Declaraciundial y el Plan de Acciara la Nutricimanifestaron su compromiso de reducir la malnutricieliminar el hambre y asegurar un bienestar nutricional sostenible para toda la poblaci/B>

UN A DESPU

Para alcanzar los objetivos de mitigar el hambre y la malnutricilos gobiernos estllevando a cabo un gran n de actividades. La FAO ha elaborado unas directrices para la formulacie planes nacionales de acciara la nutriciue los gobiernos pueden obtener en las oficinas de la FAO en cada pa En esta columna, ofrecemos una breve descripcie algunos de estos esfuerzos para estimular nuevas acciones.

Asia

El Gobierno de Viet Nam pondrn prica un Plan Nacional de Acciara la NutriciPNAN) en 1994, una vez que sea ratificado por la Asamblea Nacional. Entre otros aspectos, este plan se caracteriza por poner asis en la educaciutricional, basada en la atencianitaria primaria y en campaen los medios de difusiy en el desarrollo econo como medios de mitigar el hambre y la malnutriciA travde su Programa de Cooperaciica, la FAO ha prestado asesoramiento sobre agricultura, seguridad alimentaria en los hogares, carencias de micronutrientes y medidas para controlar la calidad e inocuidad de los alimentos.

El marco del PNAN de Bangladesh se elaborar travde un proyecto que fortaleceras polcas sobre agricultura y alimentaci mediante la coordinacintre los proyectos y programas en materia de nutriciue se llevan a cabo en el pa De igual modo, los grupos de trabajo sectoriales de Nepal estpreparando un PNAN incorporando los objetivos en materia de nutrici la planificacigrla.

En Pakist existe un vasto proyecto sobre nutriciue trata aspectos de desarrollo agrla y rural y la mejora de la seguridad alimentaria en la comunidad y los hogares.

Amca Latina

Colombia participa en un proyecto regional sobre seguridad alimentaria y estlevando a cabo proyectos sobre silvicultura, la mujer en el desarrollo y los gastos en alimentos. El PNAN de la Repa Dominicana se centrarn los grupos vulnerables de poblaciomo los recolectores de cae azy quienes viven en la periferia de las ciudades o cerca de la frontera con HaitEcuador estltimando su PNAN, y en marzo de 1994 hosped taller subregional sobre actividades complementarias de la CIN.

Africa

El Comite Alimentaci Nutricie Tanzania celebra Conferencia nacional para aplicar las medidas de la CIN y formupos multisectoriales de trabajo para ultimar su PNAN.

En Guinea, en octubre de 1993 se celebr seminario nacional multisectorial sobre la formulaciel PNAN al que asistieron varias organizaciones internacionales y organizaciones no gubernamentales. Los objetivos de este plan son aumentar la produccigropecuaria y los ingresos de las familias y mejorar el acceso a los alimentos.

En Eritrea. se ha realizado una rda evaluacie la situacie los alimentos y la nutricion ayuda de la FAO. Se esterminando un Programa nacional de seguridad alimentaria y nutrici

Cercano Oriente

Egipto design Ministro de Agricultura y Bonificacie Tierras como responsable de la preparaciel PNAN. Se prevue dicho plan contendrecomendaciones basadas en la agricultura y componentes de desarrollo a largo plazo. En Marruecos, un comitnterministerial concluy elaboraciel PNAN.

Amca del Norte

El PNAN de los Estados Unidos contiene ideas de organizaciones no gubernamentales, del gobierno y del sector privado. En un seminario po celebrado en agosto de 1993, se establecieron grupos de trabajo para cada uno de los nueve temas del Plan de Acciara la Nutrici

Los Estados Unidos y el Canadan contribuido a realizar actividades complementarias de la CIN en otros pas; en particular, participan en programas sobre carencias de micronutrientes.

Europa

En Polonia, el Instituto Nacional de Alimentaci Nutricirganiz reuniel congreso nacional cientco «AlimentaciNutrici Salud» como actividad complementaria de la CIN; asimismo se pusieron en marcha numerosos programas sociales destinados a prestar asistencia a los desempleados, los niy los ancianos.

Francia, Noruega, el Reino Unido, Suecia, y otros pas estpreparando sus planes nacionales de acciara la nutriciy prestando asistencia a los pas en desarrollo en las actividades relacionadas con la CIN.

Nota final

Para que se cumplan los objetivos de la Declaraciundial y del Plan de Acciara la Nutricihabrue emplear menerg, tiempo y recursos. En los pros ns de AlimentaciNutrici Agricultura proporcionaremos informaciobre las actividades realizadas por los sectores po y privado para lograr estos objetivos.

Lora Iannotti
Profesional asociado
Servicio de PlanificaciEstimaci Evaluacie la NutriciI>

News / Nouvelles / Noticias


Figure

FAO’S NEW DIRECTOR-GENERAL

On 1 January 1994, Mr Jacques Diouf of Senegal took office as the Director-General of FAO, Mr Diouf was elected last November by the 27th FAO Conference in which 168 countries participated. He succeeded Mr Edouard Saouma of Lebanon, who retired after 18 years of service as Director-General of FAO.

Mr Diouf has wide global experience in agricultural research, science, technology, banking and management. He received a Master of Science degree in Tropical Agronomy from the ole nationale d’application d’agronomie tropicale, Nogent-Paris, France and holds a Doctor of Philosophy degree in Social Sciences of the Rural Sector (Agricultural Economics) from the Faculte droit et de sciences nomiques, Panth-Sorbonne, Paris. Prior to being elected Director-General of FAO, Mr Diouf served as Senegal’s-Ambassador to the United Nations in New York.

As Director-General, Mr Diouf has called for new high-level initiatives to combat hunger and malnutrition. While praising the international community for its ability to deal with emergency food situations, Mr Diouf notes that there is a need “to ensure that the food problems of tomorrow will be tackled today, rather than through crisis management when they are thrust upon us later”. FAO’s new Director-General has stated that increasing food production in deficit areas will be FAO’s immediate priority.

Under Mr Diouf’s direction, FAO will work in partnership with others to ensure that “hunger will not walk side by side with affluence, modern technology will not threaten conservation and sustainable use of natural resources and the rural poor will not be left behind in a society making economic progress”.

JOINT FAO/WHO EXPERT COMMITTEE ON FOOD ADDITIVES

A meeting of the Joint FAO/WHO Expert Committee on Food Additives (JECFA) was held in Rome from 1 to 10 February 1994 to consider certain veterinary drug residues in food. This was the sixth JECFA meeting convened to deal exclusively with this subject. The primary tasks before the committee were to elaborate principles for evaluating the safety of residues of veterinary drugs in food and for establishing acceptable daily intakes (ADIs) and maximum residue limits (MRLs) for certain drugs when they are administered to food-producing animals in accordance with good practice.

Nine substances were reviewed in all. Because a number of these substances were antimicrobial agents, the committee gave careful consideration to the relevance of antimicrobial activity as an endpoint for establishing ADIs. Data relevant for assessing the safety of residues of veterinary drugs in human foods were also considered.

The report of the meeting will appear in the WHO Technical Report Series. It will include general considerations, specific comments on substances on the agenda and recommendations. Its annexes will include an extensive and detailed table summarizing the conclusions reached by the committee after its evaluations of the substances on the agenda.

Toxicological monographs summarizing the data that were considered by the committee in assessing the safety of the substances will be published in WHO Food Additives Series No. 33. Residues monographs summarizing the data that were considered by the committee in establishing MRLs will be published in FAO Food and Nutrition Paper Series No. 41/6.

LE NOUVEAU DIRECTEUR GAL DE LA FAO

Le 1er janvier 1994, M. Jacques Diouf (Sgal) a pris ses fonctions de Directeur gral de la FAO. M. Diouf a en novembre dernier par la vingt-septi Confnce de la FAO aquelle 168 pays ont participIl a succ . Edouard Saouma (Liban), qui est parti apravoir occupendant 18 ans le poste de Directeur gral de la FAO.

M. Diouf poss une vaste expence internationale en mati de recherche agricole, sciences, technologies, banque et gestion. Il a un dipld’ingeur en agronomie tropicale de l’Ecole nationale d’application d’agronomie tropicale, Nogent-Paris (France) et un doctorat en sciences sociales du monde rural (nomie rurale) de la Faculte droit et de sciences nomiques (Panth-Sorbonne, Paris). Avant d’e Directeur gral de la FAO, M, Diouf a Ambassadeur du Sgal auprdes Nations Unies ew York. En tant que Directeur gral, M. Diouf a prde nouvelles initiatives de haut niveau pour combattre la faim et la malnutrition. Tout en faisant l’ge de la communautnternationale pour son aptitude arer aux crises alimentaires, M. Diouf a soulignu’il importe de faire en sorte que les probls alimentaires de demain soient traitaujourd’hui, sans attendre qu’ils soient devenus des urgences. Le nouveau Directeur gral de la FAO a affirmue l’objectif prioritaire de l’Organisation sera d’accroe la production alimentaire dans les zones dcitaires.

Sous l’de de M, Diouf, la FAO collaborera avec ses partenaires afin que la faim ne coexiste pas avec l’abondance, que les technologies modernes ne menacent pas la conservation et l’utilisation durable des ressources naturelles, que les ruraux pauvres ne soient pas laissa tra dans une soci qui rise des progrnomiques.

COMITMIXTE FAO/OMS D’EXPERTS DES ADDITIFS ALIMENTAIRES

Une rion du Comitixte FAO/OMS d’experts des additifs alimentaires (JECFA) s’est tenue ome, du 1er au 10 fier 1994, pour examiner certains rdus de mcaments vrinaires dans les aliments. Il s’agit de la sixi rion du JECFA consacrexclusivement e th. Le Comitevait mettre au point les principes d’luation de l’innocuites rdus de mcaments vrinaires dans les aliments et d’blissement de doses journalis admissibles (DJA) et de limites maximales de rdus (LMR) pour certains mcaments administres animaux utilispour l’alimentation humaine, dans le respect des bonnes pratiques d’utilisation des mcaments vrinaires.

Neuf substances ont examin au total. Etant donnue ces substances ient des agents antimicrobiens, le Comit d pris en compte l’importance de l’activitntimicrobienne pour l’blissement des LMR. Il a lement passn revue des donn servant valuer l’innocuites rdus de mcaments vrinaires dans les aliments consommpar l’homme.

Le rapport de cette rion sera publians la se Rapports techniques de l’OMS. Il comprendra des considtions d’ordre gral, des remarques spfiques sur des substances inscrites ’ordre du jour et des recommandations. Les annexes inclueront lement un tableau dillpitulant les conclusions auxquelles est parvenu le Comitpravoir lues substances inscrites ’ordre du jour.

Des monographies toxicologiques rmant les donn examin par le Comitour luer l’innocuite ces substances seront publi dans le num 33 de la Food Additives Series de l’OMS. Des monographies sur les rdus, rmant les donn qui ont examin par le Comitour blir des LMR, seront publi dans l’ude FAO: Alimentation et nutrition n°41/6.

NUEVO DIRECTOR GENERAL DE LA FAO

El 1° de enero de 1994, el Sr. Jacques Diouf, natural del Senegal, accedi cargo de Director General de la FAO. El Sr. Diouf fue elegido el pasado noviembre por la Conferencia de la FAO en su 27° pero de sesiones en el que participaron 168 pas. Sucedi Sr. Edouard Saouma, natural del Lno, quise habretirado despude 18 ade servicio como Director General de la FAO.

El Sr. Diouf cuenta con una amplia experiencia en materia de investigaciciencias y tecnologagrarias, asomo en actividades bancarias y de gestiObtuvo el tlo de ingeniero en AgronomTropical en la Ecole nationale d’application d’agronomie tropicale, Nogent-Paris, Francia, y el grado de Doctor en Ciencias Sociales del Mundo Rural (EconomRural) en la Facultad de Derecho y Ciencias Econas, Panth-Sorbonne, Par Antes de ser elegido Director General de la FAO, el Sr. Diouf habsido Embajador del Senegal ante las Naciones Unidas en Nueva York.

Al ocupar el cargo de Director General, el Sr. Diouf ha pedido la realizacie nuevas actividades de alto nivel para combatir el hambre y la malnutriciA la vez que elogia a la comunidad internacional por su capacidad para afrontar las situaciones de urgencia alimentaria, el Sr. Diouf, se que es necesario «garantizar que se empiecen a afrontar hoy los problemas alimentarios del ma, en lugar de tener que resolver las crisis cuando ya se han producido». El nuevo Director General ha afirmado que el aumento de la produccie alimentos en las zonas deficitarias sera prioridad inmediata de la FAO.

Bajo la direcciel Sr. Diouf, la FAO trabajarn colaboracion otras instituciones para asegurar «que no convivan el hambre y la opulencia, que la tecnologmoderna no amenace la conservaci la utilizaciostenible de los recursos naturales, y que los pobres del medio rural no queden al margen del progreso econo de la sociedad».

COMITMIXTO FAO/OMS DE EXPERTOS EN ADITIVOS ALIMENTARIOS

Del 1 ° al 10 de febrero de 1994 se celebr Roma, Italia, una reuniel Comitixto FAO/OMS de Expertos en Aditivos Alimentarios para estudiar determinados residuos de medicamentos veterinarios en los alimentos. Se trat la sexta reuniel Comitonvocada para examinar exclusivamente este tipo de residuos. La tarea fundamental del Comitue elaborar con mayor extensios principios para evaluar la inocuidad de los residuos de los medicamentos veterinarios en los alimentos y para establecer las ingestas diarias admisibles (IDA) y los ltes mmos de residuos (LMR) para determinados medicamentos, cuando os se administran a animales destinados a la produccie alimentos sega buena prica en la utilizacie medicamentos veterinarios.

Se examinaron un total de nueve sustancias. Dado que un buen n de as eran agentes antimicrobianos, el Comitxamintenidamente la importancia de la actividad antimicrobiana como fase final para establecer las IDA. Tambise examinaron los datos pertinentes para evaluar la inocuidad de los alimentos respecto a los residuos de los alimentos veterinarios.

El informe de la reuniparecern la Serie de Informes Ticos de la OMS, e incluironsideraciones generales, comentarios especcos sobre sustancias que figuran en el programa, y recomendaciones. En los anexos se incluirn extenso y detallado cuadro donde se resumirlas conclusiones a las que ha llegado el Comitespude evaluar las sustancias que figuran en el programa.

En el N° 33 de la colecciood Additives Series de la OMS, se publicara un estudio monogrco sobre toxicologdonde se resumen los datos examinados por el Comitara evaluar la inocuidad de las sustancias. En el N° 41/6 de los Estudios FAO: Alimentaci Nutricise publicara un estudio monogrco sobre residuos donde se resumen los datos examinados por el Comitara establecer los LMR.

Books - Livres - Libros

Nutrition et communication: de l’cation nutritionnelle conventionnelle a communication sociale en nutrition

M. Andrien et I. Beghin. 1993. L’Harmattan, Paris. 157 pages. ISBN 2-7384-1919-4. Prix: 80 FF.

Cet ouvrage s’adresse aux responsables de l’cation nutritionnelle dans les pays en dloppement. Ecrit par le professeur Ivan Beghin, de l’Institut de mcine tropicale d’Anvers et par Michel Andrien, chercheur en cation pour la sant l’Universite Li et fondateur du RENA (Rau pour l’cation nutritionnelle en Afrique), il reprnte le rltat d’une recherche mendepuis 10 ans sur l’cation nutritionnelle dans les pays en dloppement. Il propose une rexion en profondeur sur les aspects thiques de l’cation nutritionnelle conventionnelle - concept, strate et modologie - et critique vivement cette approche classique qui, sans apporter de rltats durables, a lassa population et les intervenants.

Les auteurs exposent ensuite une approche de l’cation nutritionnelle bassur des expences de cooption men dans plusieurs pays en dloppement. Selon eux, les ments clrendre en compte sont une meilleure comprnsion des causes et des mnismes de la malnutrition, des drminants de la conduite humaine ainsi que des processus de communication, et une expence accrue en pgogie descendante et ascendante.

Un chapitre est consacru cadre conceptuel et dille les principes d’action et l’approche causale en cation nutritionnelle. La planification des interventions d’cation nutritionnelle fait l’objet d’un autre chapitre. (Il ne couvre pas les aspects techniques de la communication ou de la nutrition, ceux-ci nt traitdans d’autres ouvrages, notamment dans le Guide modologique des interventions dans la communication sociale en nutrition publin 1993 par la FAO, en collaboration avec M. Andrien.)

Enfin, la ltimite l’cation nutritionnelle et ses implications pratiques sont discut. Les auteurs critiquent leur propre approche, car elle est encore partiellement thique et ne peut donc rndre outes les questions. Ils soulignent l’ampleur du besoin de recherche appliqudans le domaine de l’cation nutritionnelle, notamment ravers l’luation systtique des projets. La conclusion reprend les conditions essentielles pour que l’cation nutritionnelle ait des effets positifs, avoir qu’elle soit «globale, participative et libtrice» et fondsur l’analyse causale et l’de prable des mnismes de communication sociale.

Malgrne rexion parfois trop thique et un style truniversitaire, cet ouvrage est d’une lecture ais car il est concis et rnd es prcupations trrles des professionnels concernpar l’cation nutritionnelle. La qualite l’ouvrage fait qu’il mterait d’e traduit en anglais afin d’e plus largement diffus

Brice Smaud
Nutritionniste.
Service des programmes nutritionnels

Notes from the field in communication for child survival

R. Seidel, ed. 1993. Washington, DC, Academy for Educational Development. 246 pp. ISBN 0-89492-102-9. Price US$ 15. Free of charge to developing countries.

This collection of notes or articles describes a wide array of experiences in social marketing to improve child survival in developing countries. To illustrate their philosophy and techniques, health communication specialists discuss a particular aspect of a field project (all conducted under the auspices of the United States Agency for International Development) carried out in a rural or urban setting in Latin America, Asia or Africa during a 15-year period. Each story of a health communication project is a straightforward account of how work was conducted, the degree to which objectives were met and the difficulties and conflicts encountered.

Practitioners of social marketing recommend a sequence of activities for implementing health communication strategies, and the material in this book is organized according to this framework. Occasionally, the authors do not fully adhere to this structure, and similar points are repeated in different sections; however, these reiterations do not lessen the book’s lively style and may strengthen its usefulness for teaching.

The communication strategies are developed on the basis of the target audience’s perspective. For planning of appropriate educational messages, research using qualitative and quantitative methods to obtain practical information about the clients’ beliefs and habits is strongly advocated. The use of surveys and focus groups to elicit information about local health perceptions and practices is explained.

Experiences in selecting media for specific audiences and society at large and in designing and pre-testing materials are discussed extensively, and useful illustrations are provided. The descriptions of processes of collaboration among communication specialists and artists, health experts and community members to promote participation in health interventions are especially insightful. Many projects attempted to combine government resources with those of private businesses and non-governmental organizations. The authors’ comments about these efforts are particularly interesting.

The authors express great sensitivity to the prices (financial and otherwise) paid by clients, volunteers and agency staff who participate in health promotion activities. They show how individuals were motivated and trained to use mass media and to improve the quality of face-to-face interactions. The need to establish interdisciplinary local teams and realistic goals and procedures is stressed to ensure successful implementation over the long term.

Notes from the field in communication for child survival assumes that the reader is familiar with social marketing techniques. Readers who are new to this field would benefit from a companion book published by the Academy for Educational Development in 1988, Communication for child survival. This earlier book provides a more systematic explanation of how public health communication methods evolved, the steps to consider in planning a communication strategy and the processes and skills that are required. It is also very well written and contains attractive illustrations and a bibliography.

Both books focus on projects to promote child survival interventions such as oral rehydration solutions, immunizations and breast-feeding. However, the methods used and lessons learned may be applicable to other types of health interventions and development activities. Each book is a rich source of ideas in the fields of nutrition education and communication in developing countries. Nutritionists, educators, social scientists and communication specialists, especially those involved in training public health workers and agricultural extension workers, will find these books stimulating and useful.

Janice Albert
Nutrition Officer.
Food Policy and Nutrition Division

Nutrition for developing countries - Second edition

F.S. King and A. Burgess. 1993. New York, Oxford University Press. 461 pp. Paperback, ISBN 0-19-262233-1, Price £19.50. Hardback, ISBN 0-19-262279-X, Price £45. ELBS edition, ISBN 0-19-442446-4, Price £3.95 for developing countries.

Nutrition for developing countries is both a textbook of nutrition and a practical guide for all nutrition workers. The authors have provided a very rich and comprehensive source of information, combining fundamental concepts on nutrition and food science together with very practical, up-to-date concepts that nutrition workers need to know. The scope of the book is wide; it contains chapters on, among others, the following topics: nutrients and how the body uses them; foods and food processing; the cost of meals and budgeting; breast-feeding; feeding older children and adults; growth and development; using a growth chart to help families; under-nutrition in children and women; vitamin and mineral deficiencies; over-nutrition and related disorders; the food paths; nutrition and the environment; food security; working with communities and families; group feeding programmes; nutrition in schools; and training for nutrition.

All of the chapters are presented very clearly, and the manual is well illustrated with self-explanatory figures. The book is structured to facilitate the reader’s understanding of the concepts. For example, each chapter ends with a section called “things to do” which provides good practical examples and clearly explains actions to take. Lists of useful publications are also provided.

The authors hope that unlike the first edition of this book, which dealt with Africa only, this text will be of use to all developing countries. However, all the examples in the new edition do come from Africa. There is some bias in that the exercises under “things to do” are adapted for East Africa and have an English orientation. Some generalizations are inappropriate; for example, descriptions about consumption of fruits by pregnant and lactating women or the relationship between population issues and land fragmentation are relevant to particular segments of the population but not to all cultures. However, these criticisms are very minor in comparison with the overall quality of this book.

As a manual. Nutrition for developing countries is very user-friendly. In conclusion, this excellent book gives a simple approach to nutrition in a professional and serious manner. It is highly recommended.

Simon Chevassus-Agn/B>
Nutrition Officer.
Nutrition Planning, Assessment and Evaluation Service

Household food security: concepts and definitions: an annotated bibliography

M. Smith, J. Pointing, S. Maxwell et al. 1993. Brighton, UK, Institute of Development Studies. 65 pp. ISBN 1-85864-005-9.

In the wake of the International Conference on Nutrition, this annotated bibliography, which contains nearly 200 items related to the development of the concept of household food security, is relevant and timely. Both the World Declaration on Nutrition and the Plan of Action for Nutrition emphasize the need to promote and support household food security as a basic condition for eradicating hunger and achieving adequate nutrition.

Actually, the title can be somewhat misleading since several references do not deal with household food security per se. Although the concept of food security was discussed as early as the 1970s (and became part of the development agenda at the World Food Council Conference of 1974), the bulk of the literature on household food security dates from the 1980s. In the publications listed, household food security has been considered in relation to a variety of issues, including nutrition, gender, environment, structural adjustment, food aid and wider concerns of human rights and cultural dignity.

This bibliography confirms that there is no single definition of household food security but a “rather complex weave of inter-related strands” which are adjusted to suit individual needs and priorities. As the authors themselves point out, clarification of the conceptual framework of household food security is essential before policy can be broached.

The presentation is clear and the alphabetized references are easy to consult. Each bibliographic entry is accompanied by descriptive terms that epitomize the publication’s definition of household food security. This is followed with verbatim quotations on the concepts and definitions related to food security referred to in the publication.

Development institutions interested in concrete applications of the concept of household food security in their area or field of expertise will probably want to use this bibliography for more global purposes; they may have preferred indications of content related to particular countries, regions or topics rather than the descriptive terms that are given. Abstracts of the contents would certainly have been useful, since many interested readers may lack easy access to other sources of abstracts. In addition, one regrets the absence of a list of acronyms, which would have helped the reader recognize the titles of the articles or the names of institutions.

In spite of these omissions, Household food security: concepts and definitions: an annotated bibliography is certainly an essential reference for all those who are concerned with household food security.

Florence Egal
Nutrition Officer,
Nutrition Programmes Service

Urban food insecurity and malnutrition in developing countries: trends, policies and research implications

J. von Braun, J. McComb, B.K. Fred-Mensah and R. Pandya-Lorch. 1993. Washington, DC, International Food Policy Research Institute. 47 pp. ISBN 0-89629-326-2.

This report reviews and takes stock of the food and nutrition policy implications of urbanization in the developing world, and the authors arrive at policy and research implications for urban food security. They compare urbanization processes in regions and countries in the developing world, relate urbanization and urban population growth to economic growth, link urban poverty and malnutrition and explore the relationship between health and sanitation and children’s nutritional status. Available studies on food consumption and dietary patterns in urban and rural areas are reviewed, gaps in knowledge identified and areas for further research suggested. The following sets of policies to improve urban food security and nutrition are analysed and rationalized: macroeconomic policies and market development; food subsidies and targeted food transfers; supplementary feeding programmes; health, sanitation and food safety policies; community development and urban agriculture; and access to credit and savings opportunities. The report argues for a household and intrahousehold focus to improve understanding of urban food security and nutrition problems and takes note of the considerable diversity and dynamics of households in urban settings.

An area that could have been given more attention in this report is urban-rural interactions and linkages (for example, regarding food entitlement, migration and food consumption patterns). Urban food patterns and requirements determine to a large extent food import and agriculture policies. Care issues should also have been discussed further: migration to urban areas implies major socio-cultural changes and often a disruption of traditional solidarity networks. Mothers often have to work away from home, to the detriment of child care. The availability of a wide range of consumer goods combined with social pressure for “prestige” non-food expenditures may lead parents to sacrifice expenditures on essential foods (in particular micronutrient-rich foods). Scarcity of fuel and water can also influence food selection, preparation and distribution. The chapter on policies and programmes could have discussed further the potential role of food aid as a stimulus to community nutrition projects (as with popular kitchens in Peru), the role of consumer education and the need to involve the food industry in efforts to supply more appropriate foods.

This special report will be a useful reference for national-and international-level policy-makers, researchers and development institutions.

Florence Egal
Nutrition Officer.
Nutrition Programmes Service

GUIDELINES FOR AUTHORS

Food, Nutrition and Agriculture reflects the concerns of the Food Policy and Nutrition Division of FAO, covering topics such as nutrition planning, assessment and evaluation; nutrition programmes; and food quality and safety. The review welcomes articles of interest to its readers working in government institutions, universities, research centres, non-governmental organizations, the food industry and the communications media in 168 countries.

Articles may be written in English, French or Spanish. The style should be dear, concise and easy to understand, avoiding journalistic terms, colloquial expressions and professional jargon. Articles may be 2 500 to 5 000 words in length, with not more than about six tables and fewer than 35 references. Complete references must be provided when factual material and other viewpoints are mentioned. References require author name(s), date, title, place of publication and publisher (for books), journal title, volume and pages (for articles).

A summary of approximately 350 words and biographical information (35 words or less) about the author(s) should accompany the article. The article will be published in the original language and FAO will translate the summary into the other two languages of the review. Manuscripts must be typed and double spaced. When possible, provision of a word-processing diskette is appreciated. Tables, graphics and photographs should be provided on separate sheets with a title and number indicating their place in the text.

Manuscripts are reviewed by the Food Policy and Nutrition Division, and the decision to publish an article is made by the Editorial Advisory Board. Copyrights and other ownership rights are vested in the Food and Agriculture Organization, which usually grants permission to the author to reproduce the article. Authors should clearly state whether material included in a manuscript has been copyrighted elsewhere and certify that they have permission to use the material. When printed, up to 25 copies of the issue containing the article will be sent to the author free of charge.

Correspondence and manuscripts should be addressed to: Technical Editor, Food, Nutrition and Agriculture, Food Policy and Nutrition Division, FAO, Viale delle Terme di Caracalla, 00100 Rome, Italy.

PRINCIPES L’USAGE DES AUTEURS

Alimentation, nutrition et agriculture traite de domaines dans lesquels s’exercent les activitde la Division des politiques alimentaires et de la nutrition de la FAO - planification, luation nutritionnelle, programmes nutritionnels, qualitt innocuites aliments. La revue accueille avec intt des articles pouvant intsser ses lecteurs, qui travaillent dans les institutions gouvernementales, les universitet les centres de recherche, les organisations non gouvernementales, l’industrie alimentaire et les mas de 168 pays.

Les articles peuvent e its en frans, en anglais ou en espagnol. Ils doivent e rgdans un style clair et concis, faciles omprendre, ter les termes journalistiques, les expressions familis et le jargon professionnel. Ils doivent avoir une longueur de 2500 000 mots, plus un nombre raisonnable de tableaux et de rrences (pas plus de 6 et moins de 35 respectivement). Des notes compls doivent e ajout si des rrences factuelles et d’autres points de vue sont mentionn Lorsque des ouvrages sont cit il faut indiquer le nom du ou des auteurs, la date, le titre complet, l’teur et le lieu de publication. Pour les articles cit donner le nom du ou des auteurs, la date, le titre de l’article, le titre complet de la publication, le volume et les pages.

Un rm’environ 350 mots et une notice biographique de 35 mots au maximum doivent accompagner l’article. Il sera publians la langue originale, et la FAO traduira le rmans les deux autres langues de la revue. Les manuscrits doivent e dactylographien double interligne. Dans la mesure du possible, les auteurs sont pride fournir une disquette. Les tableaux, graphiques et photographies doivent e fournis sur des feuilles sr, porter un titre et e numtde fa ouvoir les insr dans le texte.

Les manuscrits sont examinpar la Division des politiques alimentaires et de la nutrition, et la dsion de les publier est prise par le comite rction. Les droits d’auteur et autres droits relatifs au manuscrit sont dlus ’Organisation des Nations Unies pour l’alimentation et l’agriculture, qui autorise habituellement l’auteur eproduire son article. L’auteur doit indiquer clairement les parties du manuscrit qui font d l’objet de droits d’auteur ou autres droits de propri et certifier qu’il est autoris les utiliser. Lorsque l’article est publi25 exemplaires au maximum du num en question sont envoygratuitement ’auteur.

La correspondance et les manuscrits sont dresser au Rcteur technique, Alimentation, nutrition et agriculture. Division des politiques alimentaires et de la nutrition, FAO, Viale delle Terme di Caracalla, 00100 Rome (Italie).

ORIENTACIONES PARA LOS AUTORES

La revista AlimentaciNutrici Agricultura trata temas de interpara la Direccie Polca Alimentaria y Nutricie la FAO, incluyendo actividades de planificaciapreciaci evaluacielacionadas con la nutriciprogramas de nutriciy calidad e inocuidad de los alimentos. La revista acepta artlos de interpara sus lectores que trabajan en instituciones gubernamentales, universidades y centros de investigaciorganizaciones no gubernamentales, asomo en la industria alimentaria y en los medios de comunicacie 168 pas.

Los manuscritos podrser redactados en espa franco ingl El estilo deberer claro, conciso y fl de entender, evitando tinos periodicos, expresiones coloquiales y jergas profesionales. Los artlos podrtener de 2 500 a 5 000 palabras y se recomienda un mmo de seis cuadros y 35 referencias. Deberfacilitarse referencias completas cuando se den datos objetivos o se citen puntos de vista de otros autores; en el caso de libros, se deberndicar el apellido y la inicial del nombre del autor o autores, el ae publicaciel tlo completo, el lugar de publicaci la editorial. En el caso de artlos: autor(es), atlo del artlo, tlo completo de la publicacivolumen y n de las pnas.

El artlo ircompa de un resumen de 350 palabras aproximadamente y de una nota biogrca (que no exceda de 35 palabras) sobre el autor. Se publicarn el idioma original y la FAO traducirl resumen a los otros dos idiomas de la revista. Los manuscritos deberestar mecanografiados a doble espacio. Se agradecerl en vio, siempre que sea posible, de un disquete que contenga el artlo. Los cuadros, grcos y fotograf deberpresentarse en hojas aparte, con un tlo y n, e indicando su lugar en el texto.

Los manuscritos serrevisados por la Direccie Polca Alimentaria y Nutricie la FAO y la decisioncerniente a su publicacia tomarl Comitsesor editorial. Los derechos de propiedad y otros derechos de autor correspondera la FAO, que suele conceder permiso al autor para reproducir su artlo. Los autores deberindicar claramente quaterial del manuscrito tiene ya derechos de autor concedidos y certificar que han obtenido el permiso para utilizarlo. Una vez publicado el artlo, se enviargratuitamente al autor 25 ejemplares del n de la revista que lo contiene.

La correspondencia y ¡os manuscritos deberdirigirse a: Redactor tico, AlimentaciNutrici Agricultura, Direccie Polca Alimentaria y NutriciFAO, Viale delle Terme di Caracalla, 00100 Roma, Italia.

FOOD POLICY AND NUTRITION DIVISION
DIVISION DES POLITIQUES ALIMENTAIRES ET DE LA NUTRITION
DIRECCION DE POLITICA ALIMENTARIA Y NUTRICION

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Publicaciones de la Comisiel Codex Alimentarius disponibles en espa france ingl/B>


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