Preface
Commitments to virtually eliminate vitamin A deficiency and all
its consequences by the year 2000 were made by high level politicians attending
the World Summit for Children in 1990 and the International Conference on
Nutrition in 1992. The World Health Organization (WHO) currently estimates that
there are over 250 million preschoolaged children, and an unknown number of
women of fertile age, who are vitamin A deficient. Obviously, to meet the goal,
it will be essential to improve the dietary intake of vitamin A in a very large
segment of the world's growing population.
At a public health level, the primary cause of vitamin A
deficiency is an inadequate intake of vitamin A-active foods, both of animal and
vegetable origins. The critical immediate need for vitamin A could be met by
periodic high-dose supplements to children, and appropriate lower dose
supplements to fertile women, a system used by some Western countries where an
infrastructure is in place for delivery through a welfare system or through
affordable private sources. Governments of most developing countries, however,
currently cannot sustain from their own resources the perpetual broad
distribution of vitamin supplements, and a well-developed, affordable source for
delivery through the private sector is not available. Alternatively,
fortification of a suitable, centrally-processed food that is broadly consumed
by the vulnerable groups within a limited range of intakes could be an effective
approach to the problem, as demonstrated in several industrialized countries.
Foods with such characteristics, however, do not exist in many developing
countries.
Natural food-based interventions, therefore, are the only
sustainable solution to vitamin A deficiency - and to several other nutritional
problems - in nonindustrialized countries. For these approaches to be effective
in improving vitamin A intake, local answers are needed to the questions of what
vulnerable groups are eating, why they are eating it, and if they are willing
and have the necessary means to change or modify their dietary patterns. Answers
are critical for planners of nutrition, health, and even more broadly-oriented
development programs. This book and the accompanying manual Community
Assessment of Natural Food Sources of Vitamin A: Guidelines for an Ethnographic
Protocol provide a methodology, and demonstrate its flexible application,
for an in-depth understanding of the local context critical for designing
appropriate interventions.
The purpose of the book is to describe issues regarding the
consumption of natural food sources for preventing vitamin A deficiency, to be
used by development planners as well as students, in a variety of related areas
in nutrition, public health, and anthropology. As such, it is a useful
compilation of experiences reflecting widely diverse cultures and settings where
vitamin A deficiency occurs in different levels of severity. It brings the
reader up to the point where interventions could now be planned, utilizing the
information gained locally by applying the focused ethnographic study (FES)
methodology.
The FES methodology is, in fact, a subset of general ethnographic
approaches for information gathering that can be adapted to various program
requirements, in this case to learn about the availability of vitamin
A-containing food; perceptions influencing its uses, preparation, preservation
and consumption; and age/gender/illness and other factors that modify
consumption patterns. Hence, the approach deals with issues of food availability
from a perspective not usual in most assessments provided to development
planners from agriculturalists on the one hand, and nutritionists on the other.
Agriculturalists generally view food availability in terms of yield per acre,
and nutritionists by the nutrient content of the food in the household or in the
meal as consumed. The FES methodology provides a more holistic framework for
viewing the issues within a local cultural and food systems context. From such
context interventions can be designed that are more relevant and appropriate to
both opportunities and constraints for creating the supportive environment
needed for sustainable behavioral changes to occur in eating patterns.
This book is intended for nutrition intervention program and
development planners, as well as students from related disciplines. Although it
is quite clearly written, some sections, for example parts of Chapter 2, have
details that will be of less interest to the development planner, but will be a
useful orientation for students.
There are many uses for information about what is being eaten and
by whom in specific population settings. One of the most frequent uses of this
information is to seek association with nutritional status or, for example, with
disease patterns in epidemiologic surveys. Often, the speed required for
conducting large, population-based epidemiologic surveys requires rapid
assessment procedures (RAPs) that do not slow the survey process. Yet, local
actions that require behavioral changes to improve amenable, diet-related
adverse survey findings, must be imbedded in an understanding of the community's
organization and resources, and the knowledge and perceptions of vulnerable
inhabitants. This information is crucial but often unobtainable from rapidly
conducted interviews. The accompanying manual provides detailed guidance and
forms for acquiring, recording, and analyzing the required information in a
relatively short time frame, i.e., six to eight weeks. It may also be useful,
therefore, in conjunction with studies in selected sentinel areas where more
extensive surveys are in progress.
Barbara A. Underwood
Nutrition
Unit
World Health Organization
Geneva,
Switzerland
