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close this bookSCN News, Number 12 (UNSSCN, 1995, 60 p.)
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NEWS AND VIEWS

Including:
Can Half of All Hunger be Eliminated by 2000?/Greater Horn Information Exchange/Vitamin A: WHO/UNICEF Statement, IVACG; Mother-to-Child Transmission of HIV-1/New Initiative in Research and Training in Nutrition/Malaria Vaccine Tested in Tanzania/Meetings and Conferences.

Can Half of All Hunger be Eliminated by 2000? Meeting Assesses Progress Towards Bellagio Goals

In 1989, an international group of governmental planners, world hunger scholars, opinion leaders, and scientists met in Bellagio, Italy to discuss the problem of world hunger. Their discussions culminated in the production of a declaration -the Bellagio Declaration - which concluded that by concentrating on the achievement of four goals, it would be possible to halve world hunger by the year 2000 - the four goals being the elimination of famine deaths; the ending of hunger in half of the poorest households; the reduction of malnutrition among women and children; and the elimination of vitamin A and iodine deficiencies as public health problems.

At the mid-way stage of a decade of work towards achieving these goals, representatives from 18 countries and six international organizations, including many of those who were present in Bellagio in 1989, met at Mahidol University in Thailand last November to assess progress so far and to determine what else might be done in the next five years and beyond to fight hunger.

Amongst the participants at the meeting were Ellen Messer and Robert W. Kates, director and director emeritus respectively of the World Hunger Program at Brown University, Rhode Island - the institution responsible for carrying out the groundwork leading to the Bellagio meeting in 1989. The following data on world hunger presented and discussed by Ellen Messer in Mahidol is taken from a press release issued by Brown University shortly after the meeting.

Hunger numbers overall are declining. Although more than three-quarters of a billion people continue to suffer insufficient access to food based on their economic conditions, the trend is downward. And nations such as China, Indonesia and Thailand present evidence that malnutrition due to poverty can be sharply reduced by careful surveillance of consumption and nutrition data and annual budget allocations targeted at those too poor to afford food.

Famine is on the decline except in zones of armed conflict. Early warning systems and interventions that identify areas of food shortfall are preventing famines in formerly endemic areas. In a little-known but important success story, southern Africa suffered the deepest drought of the century in 1992, but good national planning and international assistance helped prevent death from famine. In contrast, political problems in such areas as the former Yugoslavia, Iraq and the Sudan, remain recalcitrant.

Forty nations have improved child and maternal nutritional health; 19 have reduced malnutrition prevalence to less than 10 percent, and 10 nations have plans that should help them reduce the prevalence of malnutrition to under 10 percent by mid-decade.

Efforts to improve micronutrient nutrition, especially to eliminate iodine deficiency disease and vitamin A deficiencies, are advancing through combinations of scientific and technical progress. Progress also is being made in national policy: At last count, some 82 out of 118 countries where iodine disorders are known to be prevalent have instituted universal salt iodization programs.

Economic growth, combined with social welfare programs, are being developed in many nations, and are being recognized by major donors, such as the World Bank, as joint keys to development. Non-government organizations, working with governments, have successfully engaged in a diverse and expanding number of public service enterprises that enable individuals in households and communities all over the developing world to gain food security, improve health and nutrition, and better the options for the next generation.

Increasingly, links are being made between the burgeoning number and scale of grassroots organizations and larger provincial, national and international programs. Experiences in overcoming hunger show that national plans of action are no longer limited to the realm of government, but also involve community and non-governmental organizations. Grassroots groups in South Asia, Africa and Brazil have been especially successful.

Finally, the media are increasingly vigilant in reporting situations of hunger, such that nations can no longer hide their policy inadequacies in addressing hunger disasters or their use of hunger as a weapon.

However, despite progress in the right direction, the feeling amongst participants was that it had been slower than anticipated. As Ellen Messer pointed out "five years is a very short time to assess progress and anticipate improvements" but suggested that "action could be taken now to examine countries where hunger and malnutrition are not on the decline to consider where some enlightened mix of economic and social programs might produce benefits over the remainder of the decade". Above all, she urged that "individuals all over the globe need to maintain their awareness of the problems and possible solutions so that they can create legitimate expectations for accomplishments. Hunger will only be halved, and later prevented, by coalitions of concerned individuals and groups making peace, security, and the human right to food their priorities. These priorities need to begin now, to produce measurable accomplishments, by the end of the century."

(Source: Brown University Press Release, January 1995)

Greater Horn Information Exchange

The Greater Horn Information Exchange (GHIE) has been established to serve as a focal point for information sharing between and among the disaster response and national and international development communities active in the Greater Horn of Africa. This Internet resource, managed by William Bender and Daniel Zalik, is an outgrowth of the Rwanda Crisis Web, a World Wide Web (WWW) site established this summer by Zalik.

The GHIE, a no-fee resource accessible via email, telnet, gopher, and the WWW, is catalyzing the sharing of site reports, fact sheets, activity summaries, data sets, scientific papers and analyses. The utility of the GHIE is primarily a function of the active participation of users. In order to keep the GHIE up-to-date, relevant and sustainable, all organizations and agencies active in the Horn are encouraged to post materials.

To date the Rwanda Crisis Web (RCW) has enjoyed thousands of users from 45 countries requesting tens of thousands of documents. Over 60 megabytes on the RCW include materials from InterAction members, European NGOs, DHA, USAID and OFDA, UNHCR, UNICEF, WHO, ICRC, Amnesty International, CBC, USDoD, Human Rights Watch/Africa, the Secretary General and Security Council, and the European Union. Also accessible are an assortment of detailed geographic and situation maps.

Please select a country by clicking on this map:


Figure

The GHIE began in late February with funding from USAID's Bureau for Humanitarian Response's Office of Foreign Disaster Assistance. The resource is growing very quickly and already includes many geographic and thematic maps, sitreps, and datasets derived from FAO, WFP and UNICEF. Field operations guides, disaster histories, and activity summaries are being added. An exciting tool called Interactive Data Rendering allows users to graph data via the WWW.

Establishment of the GHIE is part of a larger USAID supported Greater Horn of Africa initiative which is designed to promote sustainable development and crisis prevention in the 10 countries comprising the Greater Horn.

The Greater Horn Information Exchange and the Rwanda Crisis Web are accessible via the WWW at

http://www.intac.com/PubService/rwanda/HORN/
http://www.intac.com/PubService/rwanda/

respectively. For information about other ways to access these resources, including via email, or how to post information, please contact Daniel Zalik (401 272 7802: zalik@intac.com) or William Bender (508.448.9472: bender@tiac.net).

(Source: Electronic Communication from William Bender. 14 March 1995)

XVI IVACG Meeting Focusses on Successful Strategies for Eliminating Vitamin A Deficiency

408 participants representing 56 countries - including policy makers, implementors, and scientists in health, nutrition, agriculture, and development - attended the XVI International Vitamin A Consultative Group (IVACG) Meeting, held from 24-28 October 1994, in Chiang Rai, Thailand.

The focus of the meeting was successful strategies for eliminating vitamin A deficiency as a public health problem, and their contributions to national development. Specific topics discussed include: linking vitamin A to development: food-based interventions, information, education, and communication; home gardening; assessment of vitamin A status; health implications of vitamin A deficiency; and recent advances in vitamin A-related biochemistry and molecular biology.

Progress towards the micronutrient goals of the World Summit for Children, and the International Conference on Nutrition were highlighted during the meeting. The World Health Organization (WHO) reported that in more than 90 countries vitamin A deficiency is still a public health problem, putting at risk the health and survival of an estimated 230.6 million children: 3.1 million preschool-age children annually are estimated to be clinically affected, and another 227.5 million are subclinically affected at a severe or moderate level. UNICEF and WHO have established policies for the achievement of the mid-decade goal of ensuring that at least 80% of all children under 24 months of age living in areas with inadequate vitamin A intake receive adequate vitamin A through a combination of breastfeeding, dietary improvement, fortification, and supplementation. The two organizations considered carefully the research presented at the meeting, and made a joint statement to meeting participants, reproduced in the box on page 22.

WHO/UNICEF Joint Statement to XVI IVACG Meeting Participants
Chiang Rai, Thailand, October 26, 1994.

WHO and UNICEF have an agreed policy document, approved by the Joint WHO/UNICEF Committee on Health Policy which provides guidance to WHO and UNICEF offices on action that the two organizations should support to assist countries to reach the Mid Decade Goal of increasing intake of vitamin A in young children.

This document states that a mixture of approaches should be supported, including supplementation, dietary diversification, and fortification. Where vitamin A deficiency is a clinical problem, supplementation programmes are warranted.

The document describes different ways in which vitamin A supplements can be delivered, and suggests that providing supplements of 100,000 IU with measles vaccine around 9 months is one important way of delivering supplements.

Increased consumption of dietary sources of vitamin A is also suggested as being an activity which should be promoted to help reach the goal.

The two agencies have carefully noted the scientific presentations given at this conference, and much of the scientific work does have important implications for policy development.

At the present time however we do not consider that any of the findings presented call for an immediate change in policy, and that the policy established above to achieve the mid-decade goal should be pursued.

With particular reference to the linking of vitamin A with measles immunization at nine months, we note that the study presented looked at the effect on measles immunization given at six months of age on antibody response, and that a small reduction was found. The reduction would be expected to be considerably less at nine months.

With respect to the work on the effect of dark green leafy vegetables on vitamin A status, both organizations have already noted that the choice of vegetables, and the way in which they are prepared and fed are important determinants of the bio-availability of pro-vitamin A. The presentations confirm this. The conclusions of the data presented should not, in the view of the two agencies, be taken as a reason to change existing programmes which are currently under implementation. In the design of new programmes, ways of maximizing the bio-availability of carotene should be sought, and steps are already underway to promote operational research in this area.

Both organizations reaffirm that in areas of vitamin A deficiency, supplementation of mothers within a month of delivery with 200,000 IU vitamin A is recommended to improve the vitamin A status of the mother, the level of vitamin A in her milk and the intake of an adequate amount of vitamin A by her nursing infant.

During pregnancy, emphasis should be placed on the mother receiving an adequate intake of vitamin A through her diet. Where circumstances do not permit this, supplements not to exceed 10,000 IU daily can be given safely at any time during pregnancy.

Prophylactic supplementation to children is reaffirmed at levels of 200,000 IU for children 1 year of age and older and 100,000 IU for infants 6-12 months at intervals of 4-6 months. Where necessary and appropriate (particularly for non-breastfed infants in areas of vitamin A deficiency), 50,000 IU for infants less than six months of age.

WHO and UNICEF have agreed that the indicators appropriate for use in monitoring decade goals are serum vitamin A distribution curves or breastmilk retinol levels and prevalence of night blindness where this can be appropriately applied.

Periodic high-dose supplementation remains an important cornerstone of most national programmes. The Disability-Adjusted Life Years (DALYs) analysis of the World Bank and WHO confirmed that vitamin A supplementation is one of the most cost-effective public health interventions in developing countries. A study in Indonesia showed that low-cost, low-dose supplements improved the vitamin A status of lactating and pregnant women, and providing a supplement to the child at birth dramatically reduced subsequent mortality. It was recommended that supplementation programmes be targeted at both mothers and infants. Speakers stressed that innovative delivery methods of vitamin A were needed to cover more children, and in particular those in hard to reach areas.

The potentially important role of vitamin A in HIV and AIDS related morbidity and mortality was discussed. A study in Malawi linking maternal vitamin A status with mother-to-child transmission of HIV infection was discussed (see also page 27) and South African researchers reported that oral administration of moderate to high doses of vitamin A to HIV-1 infected infants resulted in a substantial reduction in morbidity.

Fortification, a dietary-based intervention, is another important intervention tool for combatting vitamin A deficiency. Successful fortification programmes in Guatemala - where sugar was used to provide a source of vitamin A to children - and in the Philippines - where margarine was used as the carrier for added vitamin A in a trial targeted at preschool children - were highlighted.

Evidence showing an increase in consumption of vegetables through home gardening projects in Bangladesh, Vietnam, India, and Niger was presented. In Bangladesh and Vietnam there was a concomitant decline in night blindness.

Meeting participants also emphasized the crucial role of information, education, and communications activities for all interventions and the need to complement educational activities with support in other areas, such as food production or storage, that strengthen desired behaviours.

In his concluding remarks, Dr Abraham Horwitz, IVACG Chairperson said "we should put to rest the apparent controversy between a medical model and a food model. There is only a human model with an overall objective, the virtual elimination of vitamin A deficiency".

Opportunities for Micronutrient Interventions (OMNI), a project of the Office of Health and Nutrition, Global Bureau for Programs, Field Support, and Research, U.S. Agency for International Development, provided significant support for this meeting. The IVACG Steering Committee and Secretariat organized the meeting collaboratively with a local organizing committee based at the Institute of Nutrition, Mahidol University. Other organizations, including bilateral agencies, United Nations agencies, and the food industry, provided additional support.

IVACG was established in 1975 to guide international activities aimed at reducing vitamin A deficiency globally.

IVACG strongly supports the goal of virtually eliminating vitamin A deficiency as a public health problem by the turn of the century. The XVI IVACG Meeting provided a forum for exchanging new ideas and important research findings, encouraging innovation, and promoting action programs to help reach the goal.

A complete report of the meeting will be available in May from the IVACG Secretariat, ILSI Research Foundation, 1126 Sixteenth Street, N.W., Washington, D.C. 20036, USA. Phone (202) 659 9024; Fax (202) 659 3617; and Email OMNI@DC.ILSI.ORG.

(Source: IVACG Press Release, January 1995; OMNI "Update", February 1995)

Conference on Unmet Research and Training Needs in Nutrition

Scientific understanding of the causes of malnutrition has advanced in recent years, as has experience of nutrition programmes that have significantly reduced malnutrition. Applying this knowledge to running more effective programmes may be lagging. More programme-oriented training and operational research in nutrition might greatly improve the situation. These ideas were publicized in 1991 by Alan Berg (in the Martin Forman lecture), including the widely-aired view that what was needed was "nutrition engineers"1 They led in November 1994 to a Conference at the Rockefeller Centre in Bellagio, Italy, to identify actions now needed. Preparatory work was done by Dr J Levinson, currently of Tufts University.

1 "Sliding Toward Nutrition Malpractice - Time to Reconsider and Redeploy". Martin Forman Memorial Lecture, June 24 1991

A New Initiative

In seeking to address the need for more effective programmes, the Conference identified a two fold challenge: (1) how to utilize existing knowledge in programs that affect communities and individuals, and (2) how to generate additional knowledge that can improve the impact of such programmes. There was also recognition that these training and research needs are highly interactive with programme operations and with one another.

Most importantly, the Conference proposed a new world wide effort designed specifically to encourage these approaches internationally.

The following specific actions were proposed:

· Programmes and institutions in Africa, Asia, and Latin America concerned with malnutrition will be invited to meet at the subregional level to consider means of participating in this initiative through new or expanded training, operationally-oriented research and resource and experience exchanges. They will be encouraged to identify means of encouraging community level participation in these initiatives as well as research and training opportunities emerging specifically from programme needs.

· Subregional organizations will be encouraged to establish small secretariats responsible for the overall management of these initiatives and specifically for:

- the conduct of training needs assessments;

- the monitoring of research and training activity which emerges from the initiative;

- the dissemination of results throughout the region - and to a global focal point for purposes of international dissemination; and

- the establishing of advisory groups responsible for the review of proposed training and research, and for ensuring that their methodologies and content are both state of the art and that they are tailored to country and programme needs.


· Donor agencies will be invited to consider the importance of this approach and provision of support for such subregional initiatives.

There was consensus in the meeting that such programme-related training and research represents a fundamental reorientation in that, for the first time, programme personnel and country-level policy makers concerned with malnutrition, and affected communities themselves, will have central roles in the identification of training and research needs. The Conference urged all members of the international community concerned with the alleviation of malnutrition in the world to join with them in promoting and supporting this new initiative. The Declaration from the Conference is given in the box on page 25.

Networks for Training and Research to Improve Nutrition Programmes

The proposals from the Conference are for action at regional, sub-regional, and national levels. The intention is to foster the development of networks at these levels to promote and collaborate in relevant training and operational research. The Bellagio meeting invited certain of its participants to form an interim steering committee to stimulate and guide the next steps. This committee convened briefly during the Bellagio meeting, and asked Dr M. Beaudry (UNICEF) to act as Chair. Secretariat support is being provided, during an initial stage, by IDRC and the ACC/SCN.

The next steps envisaged are regional needs assessments, meetings, and planning, including preparation of proposals for external funding. Some initial seed money has been provided by IDRC and UNICEF, to help start the work and to contribute to needs assessments in two regions.

It is proposed that those representing concerned programmes and institutions would benefit from participating in networks aimed at promoting operational research and training. The designation "Networks for Training and Research to Improve Nutrition Programmes" has been put forward by the interim steering committee. These would operate primarily at regional level, with focal points in each region; in addition, global networking between these will be promoted. To develop these networks, within and between regions, the interim steering committee aims to arrange for exchange of information, perhaps including regular bulletins (print and e-mail) to be circulated to all those involved. This information could include:

- methods of needs assessment, to relate these specifically to programme needs;

- examples of successful developments in operational research and training;

- institutional capabilities for different aspects of research and training, and training materials available;

- results of assessments, details of training and research activities as they develop, and related information; and

- analysis and comparative evaluation of such experiences, which will be promoted to identify the most effective procedures, and to contribute to sharing information on these.

Further Information

The report of the Conference, and more details of the proposed network, are available from the ACC/SCN Secretariat or the International Development Research Centre (IDRC). An insert in this issue of SCN News reproduces the declaration, and provides a form which can be mailed back - or see address on inside cover of this newsletter for ACCSCN. The address of IDRC is: 250 Albert Street, PO Box 8500, Ottawa, Canada K1G 3H9. Fax: (1 613) 567 77148 Email: idrcnuttr@idrc.ca.

Zinc Nutrition and Public Health - UNICEF Sponsored Consultation

Of the forty or so nutrients essential in the human diet, deficiencies of only three, vitamin A, iron, and iodine, are generally thought to be of public health significance and targeted for prevention in development programmes. There is growing evidence, however, that zinc deficiency may also be important. Zinc is known to have many essential functional roles in the body, perhaps the most important being its involvement in multiplicative cell growth and mediation of the activity of growth hormone. Zinc deficiency is also thought to have close links with vitamin A deficiency - inhibiting the mobilization of vitamin A from the liver, and adversely affecting fat and vitamin A absorption. Sub-optimal levels of zinc are hard to detect, however, and proof that it is deficient depends at present on the observation of a beneficial effect of supplementation, and there is to date only limited knowledge about the positive health effects of intervention. SCN News No.9 (mid-1993) included an article by Roger Shrimpton of UNICEF entitled "Zinc Deficiency - Is It Widespread but Under-Recognized?" summarizing current knowledge on this topic, and where more detail may be found on the above. Subsequent to this UNICEF sponsored an informal consultation on "Zinc Nutrition and Public Health in Developing Countries". The consultation, organized by the Nutrition Program of the University of Queensland and held in Brisbane from 4-5 October 1993 was held in an effort to determine a consensus position on the public health significance of zinc deficiency in low income countries and possible strategies for its correction. The following are the Summary and Conclusions of the consultation.

1. Zinc deficiency is widespread in developing countries and is often closely associated with iron deficiency. The most vulnerable groups are infants and children and pregnant and lactating women. In children, zinc deficiency is likely to be an important but often overlooked factor in the aetiology of poor child growth, and increased incidence and severity of infection. In addition, zinc deficiency may be a factor in impaired cognitive development. Zinc deficiency is also likely to be common in pregnant and lactating women in these countries and to contribute to complications during pregnancy and poor pregnancy outcome. Zinc deficiency impairs the mobilisation of vitamin A from the liver and may also decrease absorption of vitamin A and carotene, thereby contributing to vitamin A deficiency.

2. The richest sources of bioavailable zinc are flesh foods. The bioavailability of zinc is decreased by phytate in the diet. Thus, zinc deficiency is likely where intake of animal foods is low and the prepared staple is high in phytic acid. The dietary patterns leading to iron deficiency may also induce zinc deficiency. In populations in which maize, sorghum, millet, wheat or unpolished rice are the staples, total zinc intake may be adequate but zinc bioavailability may be decreased by the phytate present in these cereals. Where roots or tubers are the staples and the consumption of animal products is low, total zinc intakes will be low but bioavailability higher than for a similar diet when unrefined cereals are the staples. The bioavailability of zinc from legumes depends on the solubility of the phytate and the preparation techniques used.

3. In areas where zinc deficiency is common studies indicate clear benefit from zinc supplementation of young children and malnourished infants. The evidence for similar benefits from zinc supplementation in pregnancy, lactation, and apparently healthy infants in developing countries is less clear and further trials are needed.

4. Zinc intakes can be improved by supplementation, fortification, and dietary diversification/modification. There is little experience with zinc supplementation programs for children or women in developing countries and more information is needed on the optimal frequency of dose and the effect of other dietary constituents on absorption. Fortification with zinc is feasible, and should be considered together with iron fortification programs and the effectiveness evaluated. Dietary diversification/modification can also be used to improve the content and bioavailability of zinc and includes increasing the consumption of zinc dense foods and using food processing and preparation techniques to reduce the phytic acid content of unrefined cereals and legumes.

(Source: 1. Consensus Statement on Zinc Nutrition and Public Health in Developing Countries. Report of UNICEF Sponsored Consultation. Brisbane, Australia, December 1993. 2. Shrimpton, R. (1993). Zinc Deficiency - Is It Widespread but Under-Recognized? SCN News No. 9, 24-27)

Overcoming Malnutrition: A New Global Initiative
A Bellagio Declaration

A group of 22 international nutrition specialists met at the Rockefeller Foundation Study and Conference Centre in Bellagio, Italy, from October 31 to November 4, 1994. The purpose of the Conference was to address shortfalls in the effectiveness of efforts to reduce global malnutrition, focussing specifically on the need for more responsive, programme-related training and research efforts. The following declaration was agreed on by participants after the Conference.

Participants all agreed that, despite the progress of recent years, concerted efforts are needed if new knowledge and the lessons learned from past successes are to affect the lives of the malnourished. Specifically, a twofold challenge must be met:

(a) how to better utilize existing knowledge and transfer new knowledge to programmes that reach communities and individuals; and

(b) how to generate additional knowledge that can improve the impact of such programmes.

Dynamic new approaches to operationally-oriented research and training to solve problems will be key to meeting these challenges and, therefore, must be fundamental to any such undertaking.

A New Initiative

Emanating from the conference will be a worldwide effort to use existing knowledge and technology and to undertake practical research to improve and expand programmes to combat malnutrition. This new initiative will encompass the following:

· Training and research will be intimately linked to programme operations, a fundamental reorientation.

· A new culture of inquiry will be developed through training and research that focusses attention on the identification and solution of problems.

· Regional partnerships and networks will be created to link individuals and institutions that often work in an uncoordinated way but that, collectively, can make a significant contribution to the reduction of malnutrition.

· Communities will be full partners in the training and research.

· A concern for the ethical dimensions of malnutrition will be brought together with training and research so that practice can inform - as well as become informed by - theory.

· Training and research activities will make use of new participatory approaches that enable learners to integrate new approaches with job responsibilities.

Programmes and institutions concerned with malnutrition and facing similar problems will be invited to meet at the regional or subregional level to consider means of participating in this initiative through new or expanded training, operationally-oriented research, and resource and experience exchanges, supported, as appropriate, by a consortium of donor agencies.

In launching this initiative, participants confirmed the need to address malnutrition, a major cause of human suffering in the world's low-income countries. Consider the following:

· Fully one-third of young children in these countries are stunted because of malnutrition.

· One half of all deaths among young children are, in part, a consequence of malnutrition.

· 40 percent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birthweight infants.

· One in four individuals is at risk for cognitive deficits or disease due to iodine deficiency.

· In many countries, particularly in Africa and South Asia, the number of malnourished individuals continues to grow.

These numbers reflect a legacy of poverty and wasted human potential that is fully preventable. Malnourished individuals are less likely to participate productively in the labour force, gain a basic education, and contribute to the development of their families, communities, and nations.

An Unparalleled Opportunity to Act

The world community has, in the last several years, committed itself to reducing malnutrition by half in this decade. National governments have expressed their commitment to this goal through the World Summit for Children and the International Conference on Nutrition. In addition, through ratification of the Convention on the Rights of the Child, states parties have explicitly recognized nutrition as a human right. However, these goals and expectations will not be met unless the rate of progress increases sharply.

Scientific progress, new understandings about the causes of malnutrition, and examples of programmes that have significantly reduced malnutrition in some regions represent important departure points for new initiatives. Yet much remains to be done, and economic growth alone will not lead to the elimination of malnutrition.

An Invitation to Participate

We urge all members of the international community concerned with the alleviation of malnutrition in the world to join us in promoting and supporting this new initiative.

(Source: Bellagio Conference: Addressing the "How" Questions in Nutrition: Unmet Training and Research Needs. Conference Report, 20 March 1995, available from ACC/SCN, Geneva.)

Universal Salt Iodization - Working with Small Salt Producers

Universal salt iodization (USI) by the end of 1995 in all countries where iodine deficiency disorders are a public health problem is one of the mid-decade goals for the health of women and children set jointly by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Most countries are on track to achieving this goal, but in some cases USI may be a more difficult target to reach. In some countries a large proportion of edible salt is produced by small or very small salt producers, and it is these countries which pose the greatest challenge.

Whilst the best strategy for achievement of USI in those countries with many small salt producers may be to facilitate the handing over of salt production to larger, more efficient salt producers, or to encourage the importation of salt, in reality the small-scale production of salt in some countries provides employment for large numbers of people who may not have access to other sources of income. For example, in India it is estimated that salt production by small businesses provides employment to around half a million people, and in Indonesia, there are over 6,300 small producers in the salt sector, and much of the labour of salt production is done by women. On the other hand, an approach which is so beneficial to small producers that it actually encourages more to appear would only intensify the problem of ensuring USI.

In order to address the case of the small salt producer and present potential solutions for achieving USI without causing more harm than good, the UNICEF Nutrition Section has produced a working paper entitled "Small Salt Producers and Universal Salt Iodization: Helping UNICEF Meet the Challenge". The paper has been produced as a response to numerous enquiries from UNICEF field offices on how salt produced by small scale producers can be iodized. A summary at the beginning of the paper outlines its contents: "Small scale producers are defined, and the relative importance of small scale salt producers in different regions is discussed. The nature of the salt market and the potential role that price and other market-oriented incentives as well as taxation policies may have on increasing the availability of iodized salt are noted. Several options for working with small salt producers are discussed - forming cooperatives or other types of groups, use of mobile iodization equipment, or the provision of individual iodization machines to small producers. A summary of recent experiences in the formation of groups of small producers is given, and a description of the types of machinery which small producers could use is provided."

Whilst the UNICEF document acknowledges that "it will be in the interests of sustainable and effective salt iodization for a country to encourage a long term trend towards consolidation of the salt industry" it also recognizes that "this will ideally be a slow process in which small producers who slowly find that they are unable to compete are able to find other viable means of livelihood. In countries where there are relatively few small salt producers and where there are plenty of other means by which such producers could earn a livelihood, a government strategy which discourages salt production by small producers may be viable. Where this is not feasible, UNICEF must look for ways of working with governments to support and assist small producers to iodize salt, and this paper suggests a number of ways in which this could be done."

For further information please contact: UNICEF Nutrition Section, UNICEF, 3 UN Plaza, New York, NY 10017, USA. Phone: (1) 212 326 7000 Fax: (1) 212 888 7465.

(Source: UNICEF (1994). Small Salt Producers and Universal Salt Iodisation: Helping UNICEF Meet the Challenge. Nutrition Section, UNICEF, New York, 16 November 1994)

PAMM Salt Iodine Analysis Offer

As part of the international goal of virtual IDD elimination by the year 2000, the Program Against Micronutrient Malnutrition Laboratory, located at the US Centers for Disease Control, Atlanta, Georgia, is offering countries a simple cross-checking service for salt iodine analysis.

When requested through a country UNICEF office, the PAMM laboratory will analyze, free of charge, up to 20 salt samples per country, for the purpose of cross-checking/validating the testing method and/or level of fortification being used in-country. If more than 20 samples are to be analyzed per country, the additional samples will cost $US5 each.

For further information please contact: Warwick May, Program Against Micronutrient Malnutrition, Centers for Disease Control, 4770 Buford Highway, N.E., Mailstop F20, Atlanta, GA 30341-3724, USA. Tel: (404) 488 4088 Fax: (404) 488 4609.

(Source: PAMM leaflet, undated)

New Slides on Iodine Deficiency Disorders

A set of 24 training slides with accompanying text has been produced by ICCIDD (International Council for Control of Iodine Deficiency Disorders) and TALC (Teaching Aids at Low Cost). The set describes the disorders caused by iodine deficiency, explains how to recognize them and deals with different methods of control. The slides are available from TALC, PO Box 49, St Albans AL1 5TX, UK. Prices UK£6.20 (surface), £7.20 (airmail). Payment by UK£ or US$ cheque or Visa or Mastercard.

(Source: Communication with ACC/SCN, 31 October 1994)

Vitamin A and Mother-to-Child Transmission of HIV-1

A study published in June 1994 in The Lancet appears to have found evidence of a link between maternal vitamin A deficiency and mother-to-child transmission of HIV-1 (human immunodeficiency virus type 1) - the virus which leads to Acquired Immunodeficiency Syndrome (AIDS).

Transmission of the virus from HIV-positive women to their children occurs in 10-40% of pregnancies (transmission rates are generally higher in developing countries) - and is thought to occur either in utero, during delivery, or through breastfeeding - the exact timing of transmission being unclear as infants can only reliably be tested for HIV-1 infection at 12 months of age. Risk factors already identified as being associated with transmission include preterm birth, birth order, breastfeeding and low maternal CD4+ lymphocyte cell counts (one of the earliest laboratory abnormalities recognized in patients with AIDS was the depletion of CD4+ cells. CD4+ cell count has since been shown to have some correlation with the severity of the disease, and to be a predictor of mortality in HIV-1 positive individuals).

It is thought that vitamin A deficiency may be an important risk factor because of its role in stimulating the immune system and in the maintenance of mucosal surfaces. Vitamin A deficiency has been linked to reduced T-cell and B-cell function which may contribute to higher viral loads or lower levels of maternal antibodies crossing the placenta. Deficiency may also compromise the integrity of the placenta, or make the birth canal more susceptible to trauma and exposure of infants to maternal blood. Vitamin A deficiency is also associated with higher viraemia in breastmilk.

HIV infection itself and pregnancy are risk factors for vitamin A deficiency. Episodes of opportunistic infection during HIV-1 infection may contribute to a decrease in vitamin A status, as may increased metabolism of vitamin A and effects of haemodilution during pregnancy.

The study took place in Blantyre, Malawi. HIV infected mothers and their infants born at Queen Elizabeth Central Hospital in Blantyre between November 1989 and August 1991 were included in the study that examined maternal serum vitamin A. height, weight, CD4+ cells, maternal age, and duration of breastfeeding. The aim was to investigate whether vitamin A could be isolated as a risk factor for mother to child transmission.

Of 567 HIV-infected mothers who delivered their infants at Queen Elizabeth Central Hospital during the specified time period results are reported on 338 HIV-positive mothers whose infant's serostatus was known. Mother-to-child transmission of HIV was 21.9% for mothers whose children survived to the age of one year. HIV positive mothers were divided into four groups according to serum vitamin A concentrations: less than 0.70µmol/L; 0.70 - 1.05µmol/L; 1.05-1.40µmol/L; and ³ 1.40µmol/L (vitamin A deficiency in adults was defined as serum vitamin A less than 1.05µmol/L, because biological function is compromised below this concentration). The mother-to-child transmission rates for each group were 32.4%, 26.2%, 16.0%, and 7.2% respectively. Maternal CD4+ was also associated with increased mother-to-child transmission of HIV, independently of vitamin A concentrations. Maternal age, body-mass index, and breastfeeding practices were not significantly associated with higher mother-to-child transmission

Deficiency of vitamin A is only one amongst several specific nutritional abnormalities that have been associated with HIV infection - others include vitamins E, B6, B12, riboflavin, copper, and zinc. Therefore, as the authors of the study themselves caution "we cannot attribute these findings to lack of vitamin A alone, since other micronutrient abnormalities may act as cofactors". The conclude, however, that "the temporal relation we find between low vitamin A in the second and third trimesters of pregnancy and increased mother-to-child nutrition is important, because it suggests that improving vitamin A during pregnancy may lower vertical transmission rates of HIV. Nutritional intervention may be a practical, inexpensive, and widely applicable option among several strategies that have been proposed to reduce mother-to-child transmission."

(Source: Semba, R. et al (1994). Maternal Vitamin A Deficiency and Mother-to-Child Transmission of HIV-1. The Lancet, 343, 1593-1597)

Breastfeeding - Review of Effectiveness of Infant Feeding Policies in Maternity Wards

In May 1989, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) published a joint statement on the protection, promotion, and support of breastfeeding, with special reference to the role of maternity services. The statement describes in detail activities that every facility providing maternity services and care for newborn infants should undertake to encourage the initiation and maintenance of breastfeeding, and summarizes them as "ten steps to successful breastfeeding" as follows.

Every facility providing maternity services and care for newborn infants should:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff;

2. Train all health care staff in skills necessary to implement this policy;

3. Inform all pregnant women about the benefits and management of breastfeeding:

4. Help mothers initiate breastfeeding within half an hour of birth;

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants;

6. Give newborn infants no food or drink other than breastmilk, unless medically indicated;

7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day;

8. Encourage breastfeeding on demand;

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants; and

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

These ten steps form the basis of a joint WHO and UNICEF undertaking, launched in 1991 in 12 "starter" countries, and worldwide in 1992, known as the Baby Friendly Hospital Initiative (BFHI). the aim of which is to encourage national action to promote and support breastfeeding in maternity wards, hospitals, and other facilities. To date almost 1000 hospitals have been designated baby friendly worldwide on the basis of their practice of the "Ten Steps to Successful Breastfeeding".


Figure

Where these recommendations have been translated into practice in hospital maternity wards, how successful have they been - have they actually led to an improvement in breastfeeding practice? This is the question a review published in the American Journal of Public Health has attempted to address. 65 articles on the relationship between maternity ward practices and lactation success published in English or Spanish between 1951 and 1991 were identified, of which 18 met the specified criteria laid down for inclusion in the review (hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation). The technique of meta-analysis - the quantitative synthesis of a large collection of summary statistics from individual studies on a single topic was used to explore the effects various maternity ward practices were having on breastfeeding.

The review provided strong evidence that several of the WHO/UNICEF infant feeding policies - the discontinuation of commercial discharge packs, rooming-in, and breastfeeding guidance - were successfully encouraging good breastfeeding practice in hospital maternity wards. The impact of encouraging breastfeeding on demand could unfortunately not be properly evaluated because of methodological problems in the studies. The review also found some evidence that early mother-infant contact might he related to lactation success, but unfortunately the meta analysis was not easily interpretable due to there being some inconsistencies between the studies.

The authors conclude "this review was restricted to infant feeding policies in maternity wards; we know almost nothing about the potential synergistic effect that these policies might have when combined with prenatal and postnatal breastfeeding interventions. It is important to fill these gaps in knowledge in order to tailor cost-effective interventions whose aim is to increase the chances of lactation success and ultimately improve infant health."

(Source: Perez-Escamilla, R., Pollitt, E., Lonnerdal, B. & Dewey, K. (1994). Infant Feeding Policies in Maternity Wards and Their Effect on Breastfeeding Success: An Analytical Overview. American Journal of Public Health. 84(1), 89-97)

Breastfeeding and Neurological Dysfunction

Our knowledge about the beneficial effects of breastfeeding is constantly expanding. As well as the significant nutritional benefits of breastmilk over formula milk for infants, several studies have presented evidence which suggests that the method of feeding during early childhood can have a long-term effect on cognitive development. Other research has shown that slow cognitive development at nine years of age as measured by school failure and behavioural difficulties is linked to minor neurological dysfunction. Could breastfeeding then have a beneficial effect over formula feeding on neurological development later in life? A study in Groningen, the Netherlands, which investigated whether neurological development in a group of nine-year-old children was linked to how they were fed as infants appears to have found evidence that it does.

135 breastfed and 391 formula fed children, born at term in the University Hospital Groningen, between 1975 and 1979 were included in the study. A standard at-birth neurological examination was used to classify the infants as normal (247), slightly abnormal (213), or frankly abnormal (66). At nine years of age the children were reexamined and their mothers were asked to complete a questionnaire about how the children were fed as infants. After adjustment for factors which might also have affected neurological development, a small advantageous effect of breastfeeding on neurological status at nine years of age was found.

Three possible explanations as to why the method of feeding might be linked with neurological development are offered by the authors of the study: "firstly, the psychosocial aspect of breastfeeding seems to have a role, but its importance remains unclear...; secondly, maternal hormones (e.g. thyroid-stimulating hormone and thyroid hormones) and other biologically active peptides might reach the infant via breast-milk; and thirdly, some components of breastmilk may have a beneficial effect on brain development." According to the authors, there is evidence that "longer-chain polyunsaturated fatty acids, particularly arachidonic and docosahexaenoic acid, should be considered as essential nutrients for infants because they are present in structural lipids in brain and nervous tissue. At the time of rapid neural multiplication and development, the placenta enriches the foetal circulation with arachidonic and docosahexaenoic acids" - (see "Maternal Nutrition and Neurodevelopmental Disorders, SCN News No. 10, Late 1993, p22-23) - "the source for these fatty acids postnatally is breastmilk; few infant formulas contain detectable amounts of these acids".

The researchers conclude "our finding of a small beneficial effect of breastfeeding on postnatal neurological development shows the need for prospective research on this influence of breastfeeding and its consequences for the later behavioural and cognitive development of the child."

(Source: Lanting. C., Fidler, V., Huisman, M., Touwen. B. & Boersma, E. (1994). Neurological Differences Between 9-Year-Old Children Fed Breast-milk or Formula-milk as Babies. The Lancet, 344, 1319-22)

Infant Nutrition and Breast Cancer

Researchers in New York have found evidence suggesting that early childhood nutrition - in particular bottle feeding - may be linked to breast cancer development later in life. A case-control study carried out in Western New York compared the method of feeding as infants of 528 women, aged 40 - 85 years, who had newly diagnosed primary, pathologically confirmed breast cancer, with 602 randomly selected women of similar age to the case group, and from the same community. After controlling for a number of other characteristics which may affect individual risk, the study found that women who had been breastfed were less likely to have contracted breast cancer than those who had not been breastfed as infants (adjusted odds ratio 0.74, 95% confidence interval 0.56 - 0.99).

(Source: Freudenheim, J. et al (1994). Exposure to Breastmilk in Infancy and the Risk of Breast Cancer. Epidemiology. 5(3). 324 -331)

Homelessness and Nutrition in the United Kingdom

In Britain the level of homelessness has escalated dramatically over the past few years. Official figures from the Department of the Environment estimated that 145,800 individuals were homeless in 1991 - the number rising to 218.100 by June 1992. The actual figure is probably much higher, however, due to single homeless and childless couples not generally being recognized officially whilst priority is given to families with children, pregnant women, the elderly and the disabled.

Of those who are recognized officially, many are housed in temporary accommodation such as hostels or Bed and Breakfast hotels (B&B) - which are often cramped and lacking facilities. These temporarily housed low-income people are amongst the most deprived in Britain.

Existing evidence already clearly demonstrates the nutritional shortfalls low-income households in permanent accommodation suffer, but there has been little investigation into the diets of temporarily accommodated households. A study was thus carried out in Liverpool UK, and published in 1994, which looked at the diets, income, age, shopping habits, nutritional awareness, spending on food, and storage and cooking facilities of a sample of 30 B&B residents (both single and couples, but not their children). The nutritional value of the food consumed was assessed and compared with guidelines outlined in the UK Govt. Dept. of Health's 1991 Dietary Reference Values (DRVs) which give the recommended contribution various nutrients should make to total energy intake.

Energy intake itself was not insufficient in 25 of the 30 respondents. However, in all but two fat intake was excessive - with all consuming too much saturated fat. Only five respondents were consuming sufficient carbohydrates (as recommended by DRVs), and in all cases the contribution of "extrinsic" sugar to carbohydrate consumption was far in excess of DRVs due to consumption of large amounts of refined and manufactured foods such as cakes, biscuits, pastries, and soft drinks. Dietary fibre was well below the recommended value in all respondents, which, according to the authors of the study findings, was due to the minimal consumption of fruit and vegetables.

Intake levels of seven micronutrients are reported. Sodium intakes were found to be excessive in all respondents, even without accounting for salt (sodium chloride) added to food by respondents themselves. Five respondents were consuming too little vitamin A, vitamin B (riboflavin) and calcium, 25 too little vitamin B (nicotinic acid) and all too little vitamin C (some consuming less than a third of the DRV for this vitamin). Only certain groups of people are generally at risk of vitamin D deficiency as it is naturally synthesized as long as skin is exposed to the sun. Pregnant women are considered at risk, and all three respondents who were pregnant were consuming less than half of the DRV for this vitamin.

The types of food consumed by respondents which led to the reported deficiencies appeared to be dependent not only on income, but also on cooking facilities, food storage units, and preparation amenities - all of which are often minimal, if present at all, in the temporary accommodation assigned to homeless families, and which make the task of trying to eat healthily on a low-income virtually impossible (according to the report, respondents were as aware of nutritious foods as any other section of the population). When buying foods respondents therefore looked for food which was cheap, easily available, was quick and required little preparation and represented value for money - respondents relied on eating take-away and convenience foods with little fresh fruit or vegetables. The report of the study concludes "the notion of choice in eating for the homeless is thus somewhat of a cruel illusion. With the money available to spend on food and the circumstances in which it must be eaten, the sample felt it unwise to purchase foods which are nutritionally healthy".

(Source: Stitt, S., Griffiths, G., & Grant, D. (1994). Homeless and Hungry: The Evidence from Liverpool. Nutrition and Health, 9, 275-287)

Diets of Lone-Parent Families in the United Kingdom

Findings have recently been published of a study in the United Kingdom into the diets of lone-parent families, many of whom are dependent on low levels of income. Elizabeth Dowler and Claire Calvert at the Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, contacted a random sample of 200 lone-parent households in the greater London area during 1992/3. Food intake over three days was weighed for each lone parent and at least one child in each household. A food frequency questionnaire, used to assess both overall food variety, and variety within food groups such as fruits and vegetables, was also administered to parents and children - and a taped, semi-structured interview looked into how household income was managed in relation to food and health. 35% of the lone parents making up the sample were working full- or part-time. Nineteen of these were claiming supplementary income from the government, either in the form of Income Support or Family Credit, and for the other 65% of lone-parents studied, Income Support was the main source of income. For the majority of households studied money was very tight. In others money was not a problem, so internal comparisons could be made.

The study revealed the following about the diets in lone-parent households:

· Poor material circumstances, particularly when combined with severe constraints on disposable income through repayment of debt arrears, are the main factors associated with poor nutrition in lone parents and sometimes in their children.

· The poorest, most financially stressed lone parents in the study managed tight budgets in several ways, for example, buying stamps for future bills. As food was the most flexible item, this often led to poorer diets, particularly for the parent.

· Lone parents who aimed to shop for 'healthy', 'fresh' food did achieve better diets for themselves and their children than those who did not; nevertheless - despite any 'positive' approach - the diets of poorer families were still less healthy than those of better-off families.

· Parents who smoked had worse diets than those who didn't but any detrimental effect of smoking on diets was exacerbated in poorer families. However, the diets of smokers' children were hardly affected.

· Ethnicity is an important factor: those who shop for and eat diets that are typical of black British or Afro-Caribbean families by and large do better nutritionally than those eating meals typical of white families.

· Lone parents seem to protect their children from the worst nutritional consequences of poverty: where there is evidence of nutritional deprivation, it is the parents who tend to suffer it.


Adequacy of lone parent's nutrient intake 1992/3

Note: poverty index 2 = long term unemployed council tenants, no holiday, and whose rent or fuel (and arrears) are automatically deducted from benefit, or paid via a key meter; poverty index 1 = either unemployed council tenants or with rent fuel deductions; poverty index 0 = neither category.

The authors concluded that "those who live for years on Income Support, in poor material circumstances, particularly with automatic benefit deductions for debt recovery, have difficulty obtaining a healthy diet, however hard they tried to shop and cook for health. The problem of affording sufficient fresh fruit and vegetables, in order to avoid increasing social differentials in morbidity and mortality is acute. Shopping in markets is not the answer - most already do it: more money to buy fresh produce in the markets is".

These research results have been published in the "Findings" series by the Joseph Rowntree Foundation - which describes itself as "an independent, non-political body which funds programmes of research and innovative development in the fields of housing, social care, and social policy. It supports projects of potential value to policy-makers, decision-takers, and practitioners. It publishes the findings rapidly and widely so that they can inform current debate and practice".

In the UK a national Nutrition Task Force was created in 1993 which recognized that "people on limited incomes may experience particular difficulties in obtaining a healthy and varied diet" and set up a Low Income Project Team in June 1994 to address these problems. The research described above will help inform their work.

A full report on the study entitled "Nutrition and Diet in Lone-parent Families in London" by Elizabeth Dowler and Claire Calvert is available, published by the Family Policy Studies Centre. 231 Baker Street, London NW1 6XE Phone: 0171 486 8179 Fax: 0171 224 3530 Price £9.50. For further information on the study, contact Elizabeth Dowler at the Human Nutrition Unit, Dept of Public Health and Policy. London School of Hygiene and Tropical Medicine; 2, Taviton Street. London WC1H OBT. Tel: 0171 927 2143/2126.

The address of the Joseph Rowntree Foundation is: The Homestead, 40 Water End, York YO3 6LP. Tel: 0904 629241 Fax: 0904 620072.

(Source: Dowler, E. & Calvert, C. (1995). Diets of Lone-Parent Families. Findings. Joseph Rowntree Foundation Social Policy Research Report No.71)

25 Years of Oral Rehydration Solution

In 1994 the Government of Bangladesh and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) celebrated 25 years of life-saving use of Oral Rehydration Solution (ORS) - a combination of sodium chloride, sodium bicarbonate, potassium chloride and glucose which replaces fluids and electrolytes lost during the repeated heavy purging associated with diarrhoeal disease. Scientists working at ICDDR, B developed ORS in 1968/9, and in 1971 its value was clearly demonstrated when it was used to treat many thousands of refugees fleeing the war for independence in Bangladesh. Thanks to ORS, death rates from cholera were reduced from 50% to less than 3%. It is estimated that ORS now saves the lives of over one million children in over a hundred countries around the world each year. 95% of potentially lethal dehydrating diarrhoeas can be successfully treated using ORS.

(Source: ICDDR, B (1994) Information Release Accompanying Commemorative Stamp for 25 Years of ORS. ICDDR, B "Glimpse" Newsletter. Vol 16 (2&3). March-April & May-June 1994, p.14-15).

Malaria Vaccine Tested in Tanzania

Recently published results in The Lancet of a trial carried out in southern Tanzania to assess the efficacy of the antimalarial vaccine SPf66 have shown that it can reduce the occurrence of clinical malaria caused by the Plasmodium falciparum parasite by an estimated 31% in children aged 1-5 years living in an area of intense year-round malaria transmission.

The trial took place between February 1993 and August 1994 in the village of Idete in the Kilombero Valley region of Southern Tanzania. 586 children were randomly assigned to receive either three doses of vaccine or three doses of placebo. The vaccine reassuringly caused no severe side effects and no medical care was required for the mild side effects recorded. During the follow-up period after the third dose, the annual incidence rates of malaria were 0.25 in the vaccine group, and 0.35 in the placebo group. As already mentioned, the vaccine efficacy was estimated as 31% after adjusting for the confounding factors "age at episode" and "distance from dispensary."

Over 400 million clinical cases of malaria - the most dangerous form of which is caused by P. falciparum - are recorded each year, resulting in an estimated 1 - 3 million deaths annually.

SPf66, developed by Manuel Patarroyo at the Institute of Immunology in Bogota. Colombia, is the first synthetic vaccine shown in field trials to offer protection against malaria. The first published results of a field study of the vaccine appeared in The Lancet in March 1993, and showed that the vaccine could give almost 40% protection overall against Malaria in an at-risk Colombian population. However, malaria risk is comparatively mild in Colombia compared to the area of southern Tanzania where this more recent trial took place. Here, 80% of infants are infected with the malaria parasite by six months of age, and on average an individual suffers 300 bites from malaria-infected mosquitos each year. The Tanzania trial has thus been a tough test for the vaccine.

Whilst the trial confirms that SPf66 can reduce the risk of malaria among children in high-risk areas, the efficacy is lower than most vaccines used to provide protection against other infections. The World Health Organization (WHO) anticipates that clinical trials of 6 to 8 other P.falciparum malaria vaccine candidates may be carried out over the next two to four years, but acknowledges that "as no single tool will represent a panacea, an effective malaria vaccine is expected to be used in an integrated approach, together with other malaria control tools, including drugs, and insecticide-impregnated bednets".

The authors of the findings of the Tanzania trial themselves conclude that "the potential of SPf66 vaccine as a public health measure in Africa will be debated... however, since the burden of malaria morbidity and mortality is vast, measures with moderate efficacy merit development".

SPf66 is also currently undergoing trials in The Gambia, on infants 6-11 months of age, and on the border of Thailand and Myanmar on children 2-15 years old.

(Sources: 1. Alonso, T. et al (1994) Randomised Trial of the Efficacy of SPf66 Vaccine Against Plasmodium falciparum Malaria in Children in Southern Tanzania. The Lancet, 344. 1175-81; 2. Brown, P. (1994) Guarded Welcome for Malaria Vaccine. New Scientist. 5 November, 14-15; 3. WHO Press Release, 28 October 1994)

Controlling Malaria with the Help of Coconuts

With funding assistance from the International Development Research Centre in Canada, researchers at the Alexander von Humboldt Tropical Medicine Institute in Lima, Peru have developed a simple way of helping prevent the spread of Malaria, using coconuts to support the growth of bacteria capable of killing mosquito larvae.

Malaria, a viral infection spread by the bite of a mosquito causes fever, chills, nausea, and muscle pain, and can lead to severe complications and death. In countries where malaria is endemic, workforce and school absenteeism is high. Over 400 million clinical cases of Malaria result in 1 -3 million deaths annually and close to half of the world's population is at risk of catching the disease.

Chemical insecticides, such as DDT, have been used for many years to control malaria, but are expensive to use and can pose a threat to human health, and cause environmental contamination.

The method of control designed by the researchers in Peru has none of these drawbacks. It involves the use of the mosquito-larvae killing bacteria Bacillus thuringiensis var israelensis H-14 (Bti) - a naturally occurring environmentally friendly bacteria - harmless to humans and livestock. It is commercially available, but its cost can be prohibitive for developing countries. However, coconuts, which are plentiful, free, and often grow close to ponds infested with mosquito larvae, have been found to provide the environment required for growth of the bacteria. The technique involves the introduction of a small amount of Bti on a cotton swab through a hole drilled in a coconut. The hole is then plugged with a wisp of cotton and sealed with candle wax. The coconut's hard shell protects the Bti during incubation while the coconut milk contains the amino acids and carbohydrates the bacteria must eat to reproduce. After coconuts have fermented for 2-3 days they are broken open and thrown into an infested pond. Mosquito larvae eat the bacteria, and the Bti kills the larvae by destroying their stomach lining.


Figure

It is reported that in tests, the Bti killed nearly all the mosquito larvae in a pond and stopped breeding for 12-45 days. A typical pond needs 2-3 coconuts for each treatment.

(Source: IDRC (1994) Malaria Control in a Nutshell". from the International Development Research Centre's "Science in Action" series of brochures profiling IDRC projects worldwide. For further information contact: Public Information Program, IDRC. 250, Albert Street. PC) Box 8500. Ottawa, Ontario K1G 3H9. Tel: (613) 2366163 Fax: (613) 238 7230)

Integrated Management of The Sick Child

WHO, in collaboration with UNICEF and the World Bank, is developing and integrated approach to the management of five major fatal childhood illnesses: pneumonia, diarrhoea, malaria, measles, and malnutrition. The following is taken from the programme description.

Five diseases cause 7 out of 10 child deaths.

Since 1990, around 60 million children died before their fifth birthday. Forty two million of them were killed by diarrhoea, pneumonia, measles, malaria or malnutrition. Unless action is taken now an even larger number of lives will be lost before the year 2000. Inexpensive treatments would save most of those lives.

At least three in every four of the children seeking health care every day suffer from one or more of these five conditions. Since symptoms may overlap, it is not always easy to decide which conditions are present.

Standard treatment guidelines

Newly developed treatment guidelines for the sick child cover the most common potentially fatal conditions. The health worker assesses every child for:

- non-specific danger signs
- four main symptoms
- cough or difficult breathing
- diarrhoea
- fever
- ear problems
- nutritional status
- immunization status

The guidelines enable the health worker to classify each child's illness according to whether the child needs:

- urgent referral
- specific medical treatment and advice
- simple advice on home management

The child is given vaccinations as needed and other problems are assessed.

Guidelines for management of the sick child in outpatient settings are available on wallcharts and in booklets.

Integrated management of the sick child focuses on the child rather than on a specific disease. It makes identification of illnesses more accurate and avoids duplication of effort.

Training

Training of health workers is based on the treatment guidelines and emphasizes hands-on practice. The training materials must be adapted to local situations so that, for instance, local foods and drinks can be mentioned or locally appropriate drugs recommended.

Further guidelines and training materials will cover:

- improving health workers' performance
- managing drug supplies at the health facility
- assessing and changing family behaviours regarding the care of sick children
- hospital care of children with severe illness

Impact

According to the World Development Report 1993, management of the sick child is among the most cost-effective health interventions in both low and middle income countries.

It was assessed to be the intervention likely to have the greatest impact in reducing the global burden of disease.

The programme is coordinated by the World Health Organization Division of Diarrhoeal and Acute Respiratory Disease Control with Division of Communicable Diseases. Division of Control of Tropical Diseases. Action Programme on Essential Drugs. Global Programme for Vaccines. Maternal and Child Health and Family Planning. Nutrition, Oral Health, Programme for the Prevention of Blindness, and Special Programme for Research and Training in Tropical Diseases, in collaboration with UNICEF and the World Bank.

For further information please contact: The Division of Diarrhoeal and Acute Respiratory Disease Control (CDR), World Health Organization. 20. Avenue Appia, CH-1211 Geneva 27, Switzerland. Phone: (41 22) 791 2632 Fax: (41 22) 791 0746.

(Source: CDR, 1995)


Figure

(Source: UNICEF/94-0093/GIACOMO PIROZZI)

James Grant

On 28 January, 1995, the United Nations Children's Fund (UNICEF) announced, with great sadness, the death of its former Executive Director, James P. Grant.

Mr. Grant assumed office as the third Executive Director of UNICEF, with the rank of Under-Secretary-General of the United Nations, on 1 January 1980. He resigned on 23 January this year because of ill health.

Although Mr. Grant was diagnosed with cancer in May 1993, he continued to lead UNICEF with characteristic energy and commitment until he resigned. Over the last year, despite his illness, he met with more than 40 world leaders to seek their active support for the cause of children.

During his 15-year tenure as head of UNICEF, Mr. Grant was acclaimed for his tireless advocacy, and his unflagging commitment, vision and dedication to improving the lives of the world's least advantaged - the children of the developing world. Under his leadership, UNICEF has confronted and decried what Mr. Grant called "the silent emergency", the daily tragedy of millions of children caught in the relentless downward spiral of poverty, population, and environmental degradation. Each year these conditions cause the deaths of millions and result in many more stunted lives. During Mr. Grant's term, UNICEF has also responded to the "loud" emergencies, and worked to save the lives of women and children caught in disasters such as earthquakes, famine and war.

In the 1980s, UNICEF launched the Child Survival and Development Revolution, which to date, has saved the lives of an estimated 25 million children and prevented disabilities in many more. Its success was predicated on Mr. Grant's unique strategy to emphasize simple, low-cost and practical methods for child welfare - like immunization, oral rehydration and breastfeeding - and to inspire a world-wide movement by mobilizing the political will necessary to bring these remedies to the millions of children and mothers threatened by preventable disease and malnutrition. An unquenchable optimist, Mr. Grant always believed in the human potential for achieving what others considered impossible.

In his statement following Mr. Grant's death, United Nations Secretary-General Boutros Boutros-Ghali, said, "Very few men or women ever have the opportunity to do as much good in the world as James Grant; and very few have ever grasped that opportunity with such complete and dedicated commitment. He will be remembered as a most distinguished servant of the United Nations and as one of the greatest international public servants of his generation."

The President of the United States, Bill Clinton, in a personal note to Mr. Grant on his resignation, said, "I am writing to thank you from the bottom of my heart for your service to America, to UNICEF and most of all to the children of the world. You have set a permanent standard for energetic and committed global leadership. You can count on us to help sustain the momentum you have given UNICEF and to work as you have always done for a more just and caring world."

The World Summit for Children in 1990, the first meeting of its kind where world leaders met to address serious social issues, stands out as one of the main highlights of his career. The Summit set 27 child health and welfare goals that have been incorporated into the national plans of more than 100 countries. In promoting the goals and targets of the Summit, Mr. Grant was able to show the world in the past five years, that its efforts for children did make a difference.

Mr. Grant's strategy of setting specific, measurable goals, lobbying tirelessly for their achievement, and monitoring and publicizing progress towards them, has been remarkably effective. In the decade and a half he spent as the head of UNICEF, he personally met with more than 100 Heads of State or Government to enlist their personal and political support for the achievement of specific goals for children. He always had a sachet of oral rehydration salts in his pocket, along with the latest figure of the number of children being killed and maimed by common and preventable diseases in the nation concerned.

Another milestone in his career was the 1989 United Nations Convention on the Rights of the Child - a Magna Carta for children. The Convention recognizes, for the first time, the economic and social as well as political rights of all children and is today the most widely ratified human rights treaty ever.

In 1980, soon after assuming office, Mr. Grant established the annual State of the World's Children report, which provides an assessment of conditions and prospects for children worldwide. The annual Progress of Nations report, established by Mr. Grant in 1993, serves as an important benchmark for the international community by ranking countries on their progress in meeting their basic health, nutrition and education needs.

In 1994, Mr. Grant received the Presidential Medal of Freedom - the highest civilian honor conferred by the President of the United States - for his "compassion and courage in his crusade for the world's children and his tireless efforts to alleviate suffering around the world." He also received national awards from many other countries around the world including Sri Lanka. Brazil. Mexico, Pakistan. Ecuador, Peru, Italy and Japan. The most recent award, the International Development Conference's Special Award, was presented on 17 January this year. All of these honors recognised Mr Grant's distinguished service and contribution to human progress and development.

Mr. Grant came to UNICEF from the Overseas Development Council, which he helped found in 1969, serving as its President and Chief Executive Officer. He had previously served with the United States Agency for International Development (USAID) as an Assistant Administrator (1967-1969) and as Director of the USAID programme in Turkey with the rank of Minister (1964-1967). He was Deputy Assistant Secretary of State for Near East and South Asian Affairs (1962-1964) and a Deputy Director of the International Co-operation Administration (USAID's predecessor) with responsibility for world-wide programming and planning (1959-1962). His overseas assignments included service as Director of the United States aid mission in Sri Lanka (1956-1958). and Regional Legal Counsel resident in New Delhi for United States aid programmes for South Asia (1954-1956).

Mr. Grant began his career in 1946 with the United Nations Relief and Rehabilitation Administration in China. His early experience in China, and the pioneering work in international public health of his father. Mr. John B. Grant, remained a lifelong influence. In particular, he based his efforts for children on the belief that medical advances do not reach the poor majority by any automatic process of diffusion, but must be made available by conscious and sustained efforts to bridge the gap between what science knows and what people need.

Born in Beijing on 12 May 1922, Mr. Grant received a Bachelor of Arts degree from the University of California at Berkeley in 1943 and a Doctorate in Jurisprudence from Harvard University in 1951. He is survived by his wife. Ellan Young, of Croton on Hudson, New York: three sons from his marriage to the late Ethel Henck Grant. John of Washington D.C., James of Fairfield. Iowa and William of Casablanca, Morocco; two step-daughters, Melissa and Sarah Young, a step-son. Andrew Young; and eight grandchildren.

Everyone who knew him sensed his vision: but everyone who worked with him also recognized an even rarer quality - the ability to translate that vision into practical action, often against great odds and on a massive scale, by inspiring many thousands of individuals and organizations to sustained action on behalf of children in virtually every country of the world.

Those who were privileged to work with him will always remember Mr. James P. Grant as a visionary and a determined champion for children. We shall miss his leadership.

(Source: UNICEF Press Release, 28 January 1995)

(see also "Unfinished Business of the 20th Century", p. 50)

First 2020 Conference to be Held in June 1995

The "2020 Vision for Food, Agriculture and the Environment" is an initiative of the International Food Policy Research Institute (IFPRI) to develop and share information on how to meet future world food needs while reducing poverty and protecting the environment.

The first in a series of major 2020 Vision conferences to be held around the world will take place from June 13-15, 1995, in Washington, D.C. The conference will be co-hosted by IFPRI and the National Geographic Society and will be held in National Geographic's Gilbert H. Grosvenor Auditorium, 1600 M Street, N.W.

The conference will identify the most promising solutions to meeting the challenge of feeding a growing world population while protecting and preserving the environment. Sessions of the conference will present new research and suggest policy directions. Some 400 participants from dozens of nations around the world, including prominent policymakers, leading scientists and economists, and heads of nongovernmental organizations and aid agencies are expected to attend.

The 2020 initiative seeks to help sustain the momentum generated by major United Nations' initiatives held over the past decade by taking a fresh look at development issues though the lens of food and agriculture. It is also hoped that the outcome of the 2020 Vision initiative will be useful to the United Nations Food and Agriculture Organization's upcoming World Food Security Summit.

For further information and to obtain copies of the 2020 Vision Newsletter "News & Views" and/or the 2020 Vision discussion paper series "2020 Briefs" please contact: IFPRI, 1200 17th Street, N.W., Washington, D.C. 20036-3006, USA. Phone: 1 202 862 5600 Fax: 1 202 467 4439 Email: IFPRI@CGNET.COM.

(Source: International Food Policy Research Institute Communication, 6 March 1995)

Diploma in Reproductive Health in Developing Countries.

New Course Offered by the Royal College of Obstetricians and Gynaecologists, and the Liverpool School of Tropical Medicine, UK.

Starting in 1995, the Royal College of Obstetricians and Gynaecologists and the Liverpool School of Tropical Medicine will jointly run a ten week course from May to July each year, leading to the qualification of diploma in reproductive health in developing countries.

The following information is extracted from the course leaflet.

The focus of the course will be on reducing reproductive mortality and morbidity through an integrated community orientated approach, appropriate to developing countries.

Who is the course for?

· doctors from developing countries undergoing postgraduate training in obstetrics and gynaecology in the UK;

· doctors practising obstetrics and gynaecology in developing countries;

· community health doctors responsible for maternity services in developing countries;

· graduates of medical schools in the UK and other European countries preparing for work in the developing world; and

· nurse/midwives working in maternity services in developing countries, with an interest in other aspects of reproductive health relevant to their work.

Aim

To contribute to the reduction of reproductive mortality and morbidity in developing countries. The course aims to equip participants with additional up-to-date skills and to bring about this reduction in mortality and morbidity.

Learning Objectives

At the end of the course participants should: -

· have developed an awareness of, and commitment to, reducing reproductive mortality and morbidity through a multi-dimensional and team approach. This would include exploring the possibilities of, and developing ideas for interventions to meet identified reproductive health needs.

· have increased their capabilities to plan, implement and evaluate programmes.

· appreciate the skills and techniques involved in staff motivation, training, supervision and leadership.

· be able to understand and explain the basics of epidemiology and simple research strategies, leading to the ability to critically analyse research papers and reports.

· be capable of applying the principles of health economics, medical audits and cost effectiveness in health care.

· have received an introduction on how to use a microcomputer and have acquired appropriate computing skills.

For further information about the course, please contact: Course Secretary (DRH), Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA. Fax: 0151 707 2885 Phone: 0151 708 9393.

(Source: Diploma in Reproductive Health in Developing Countries. Course Leaflet. September 1994)

5th International Course on Food Processing

The International Agricultural Centre (LAC), based at Wageningen, the Netherlands, is organizing two course programmes on Quality Assurance and Marketing, and on Food Fortification Management as part of its International In-service Training Course on Food Processing (ICFP). The following information about the courses is extracted from the course booklet.

The course on Quality Assurance and Marketing (ICFP-QAM) is intended for professionals from: business advisory, training and support institutions; technical and technological services for formal small and medium scale food processing enterprises; and entrepreneurs in small and medium scale enterprises. This programme aims to broaden participants' views on problems of small and medium scale food processing, to upgrade participants' knowledge concerning the analysis of problems and the selection of appropriate technologies, and to impart techniques for the implementation of selected technologies, focusing on quality assurance and marketing. The course will take place from August 13 - November 18, 1995.

IAC participates in the Program Against Micronutrient Malnutrition (PAMM), a global network based in Atlanta USA, that is working towards the virtual elimination of iodine and vitamin A deficiency disorders and a one-third reduction or iron deficiency anaemia by the year 2000. Assistance for the development of interventions includes support for dietary supplementation, food diversification and fortification of common foods with physiological amounts of micronutrients.

Fortification is the most sustainable long-term strategy to control iodine deficiency disorders. It is also an important short and medium-term strategy to combat vitamin A deficiency and iron deficiency anaemia. A six week international course programme on Food Fortification Management is offered by IAC. Wageningen. It provides information on fortification technology and processes, appropriate food vehicles that may be fortified, and fortificants that convey micronutrients

The programme is intended for candidates who have been selected by their governments to be members of a multidisciplinary national PAMM team and who have a direct relation to the realization of a national food fortification strategy component such as: government employees with an advisory role to the food processing industry; industry employees in-charge of food fortification processing; and private consultants, hired as advisors on technical and operational questions on food fortification by government and/or industry. This programme aims to provide participants with insight and views on how to develop or refine the skills to manage the fortification of foods with micronutrients for national programmes and to create acceptance of fortification among groups concerned. The strategic focus is to assist governments in the development and strengthening of own capability to achieve and sustain the elimination of micronutrient malnutrition. This course will take place from October 8 - November 18, 1995).

For further information contact: IAC, PO Box 88, 6700 AB Wageningen, The Netherlands. Phone: 31 8370 90111 Fax: 31 8370 18552 Email: IAC@IAC.AGRO.NL.

(Source: Courses Leaflet, undated)

Short Course on Participatory and Rapid Appraisals for Management of Health, Nutrition, and Family Planning Programmes. London School of Hygiene and Tropical Medicine

Participatory and rapid appraisals and evaluations which involve local people are increasingly gaining interest amongst programme managers in health development programmes as a way of enhancing both the acceptability and sustainability of health, nutrition, and family planning programmes. Such appraisals and evaluations depend on the obtaining of appropriate information, and the objective of the above course - which will take place from 4-22 September 1995 - is to familiarize participants with the tools and techniques needed to provide timely and appropriate information as well as facilitate participation of local people in the planning process.

According to the course leaflet, at the end of the course participants should be able to:

· begin to apply a range of tools and techniques for appraisals and evaluations with community people,

· identify the appropriate tools/techniques to carry out participatory and/or rapid assessments involving local people.

· identify community problems using both qualitative and quantitative methods; and

· develop a proposal for solving planning problems systematically and with the use of methods which are relevant to the identified question.

The course is designed for people who: 1. are working in the field as programme managers; 2. are training people to use methods for participatory and rapid appraisals based on community involvement: and 3. are using or planning to use these approaches and methods for research.

For further information please contact: the Assistant Secretary (Welfare & Services), Short Courses, Registry, London School of Hygiene & Tropical Medicine, Keppel Street (Gower Street). London WC1E 7HT, UK. Phone: 0171 927 2074 Fax: 0171 323 0638.

(Source: Course leaflet. January 1995)

Second European Congress on Nutrition and Health in the Elderly - Preliminary Announcement

This Congress will take place in Elsinore, Denmark, from May 9-12 1996, and is expected to focus on the following themes as they relate to health and ageing: body composition: obesity; growth hormones; malnutrition; osteoporosis; antioxidants; meal patterns in Europe; elderly as consumers; and oral health and ageing. Any suggestions for the programme of the congress are most welcome.

For further information please contact: The Congress Secretariat, CONVENTUM Congress Service, Hauchsvej 14, DK-1825 Frederiksberg, Denmark. Phone: 45 31 31 08 47 Fax: 45 31 31 06 14.

(Source: Preliminary announcement of the Second European Congress on Nutrition and Health in the Elderly, undated)

Conference on Dietary Exposure to Contaminants and Additives. Noordwijkerhout, The Netherlands, 12-13 June 1995

Organized by the TNO Nutrition and Food Research Institute and the WHO Collaborating Centre for Nutrition, Ziest, The Netherlands, under the auspices of the WHO Regional Office for Nutrition, a conference on Dietary Exposure to Contaminants and Additives will take place in June 1995 at the Leeuwenhorst Congress Centre, Noordwijkerhout, The Netherlands. The aim of the conference will be to provide a forum for researchers and policy-makers to exchange knowledge and opinions on the health risks of xenobiotics in the diet and methods to assess dietary exposure to contaminants and additives. Toxicological data will be combined with information on dietary intake and results from epidemiological studies. Participants will include representatives from the food industry, European public health authorities, nutritionists, toxicologists and epidemiologists. The official language of the conference will be English.

For further information please contact the conference secretariat: Ms Hanny Leezer, TNO Nutrition & Food Research Institute, PO Box 360, 3700 AJ Zeist, The Netherlands. Tel: 31 3404 44751 Fax: 31 3404 57952.

(Source: Conference Announcement, undated)

7th Asian Congress of Nutrition, Beijing, China, October 7-11, 1995

Scientists, practising nutritionists, clinicians, biologists, nutrition educators, agriculturalists, food industrialists, and policy-makers in food and nutrition will be amongst the participants at the 7th Asian Congress of Nutrition to be held in Beijing, China, from 7-11 October, 1995. The Congress is being organized by the Chinese Nutrition Society under the auspices of the Federation of Asian Nutrition Societies. Co-sponsors of the congress are: the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the National Natural Science Foundation of China.

The scientific program will consist of plenary lectures, symposia, free communications, and posters covering a wide range of topics in nutrition. Plenary lectures will be on the following: A Forum on the Current Food and Nutrition Situation in Asian Countries; A Global View of Food Supply, Access to Food and Nutrition Adequacy; Trace Elements in Health and Disease; Antioxidants in Food and Chronic Degenerative Diseases; and Genetic Variation and Nutrition.

For further information please contact: Mr Ma Shi-liang, Chinese Academy of Preventive Medicine, 27 Nan Wei Road, Beijing 100050. China. Phone and Fax: 86 1 3022960/86 1 3170892.

(Source: 7th Asian Congress of Nutrition, Second Announcement, undated)

The Leeds Course in Clinical Nutrition 1995

The above course will take place from 5-8 September, 1995 at the St. James's University Hospital, Leeds, United Kingdom. The itinerary and themes for the four days will be: day 1 -Metabolism in Disease; day 2 - Clinical States Associated with Nutritional Problems; day 3 - Symposium on Nutrition in the Management of Renal Disease, and The Treatment of Nutritional Problems I; and day 4 - The Treatment of Nutritional Problems II. In addition, there will be an exhibition of related products from the pharmaceutical, equipment and food industry.

For further information please contact: Mrs Hilary L Thackray, Department of Continuing Professional Education, Continuing Education Building, Springfield Mount, Leeds, LS2 9NG. Phone: (0113) 233 3233 Fax: (01-13) 233 3240.

(Source: Course Booklet, undated)

Sweden - Symposium on Iron Nutrition in Health and Disease

The Swedish Nutrition Foundation and the Swedish Society of Medicine are organizing a Symposium on Iron Nutrition in Health and Disease, which will take place in Stockholm, Sweden, from 24-27 August 1995. The purpose of the meeting is to describe and discuss the present state of the art of research regarding the importance of iron in nutrition, and to identify areas where there is still disagreement in opinions and interpretations of data. The overall aim is to obtain a new platform for further research and for the development of programmes to optimize iron nutrition.

For further information please contact: Anita Laser Reutersward, Symposium Coordinator, The Swedish Nutrition Foundation, Ideon, S-223 70 Lund, Sweden. Phone: (46) (0) 46 18 22 80 Fax: (46) (0) 46 18 22 81.

(Source: Symposium Information Leaflet, undated)

Notice from Barrie Margetts, International Committee, Nutrition Society, 10, Cambridge Court, 210 Shepherds Bush, London WG 7NJ, United Kingdom

Our Society is interested in making formal and reciprocal links with other Nutrition Societies, particularly those in 'developing countries'. For more details please contact me at the above address.

(Source: as above)

Post-Graduate Training in Human Nutrition

Compiled by the International Committee, Nutrition Society, 10 Cambridge Court, 210 Shepherds Bush, London W6 7NJ, UK

This list aims to give prospective students an overview of many of the training programmes available and addresses from which to obtain up-to-date details. All the courses are taught in English and claim to be relevant to students from developing countries.

Entry qualifications vary but most require an undergraduate degree. Some programmes can suggest sources of funds. Organizations which may be able to advise on funding are Ministries of Education, British Council, WHO, USAID, World Bank and the Regional Development Banks. European Union nationals should write to the Educational Grants Advisory Service, 501-5 Kingsland Rd, Dalston, London E8 4AV. Overseas students wanting to study in UK can contact the Overseas Student Affairs, 60 Westbourne Grove, London W2 5FG.

The list was prepared from data collected in 1993 and 1994. We thank everyone who supplied information and would be pleased to receive additions and corrections so we can keep the list updated.

The order of the data given is: Institution, Name of course, Qualification offered, Duration, Address for more details.

AFRICA

University of Mansoura, Egypt Human Nutrition MSc 2yr. Also PhD. Details from Dean, Food Science and Technology Department, Mansoura University, 35516 El-Mansoura, Egypt

University of Ghana Human Nutrition M.Phil 2yr. Also PhD. Details from Head, Department of Nutrition & Food Science, University of Ghana, Box 134, Legon, Ghana

University of Nairobi, Kenya Applied Human Nutrition MSc 2yr. Also PhD. Details from Head, Applied Human Nutrition Programme, Department of Food Technology and Nutrition, University of Nairobi, Box 41607, Nairobi, Kenya

University of Calabar, Nigeria Nutrition and Dietetics MSc 2yr. Details from Course Co-ordinator, University of Calabar, PMB 1115, Calabar, Nigeria

University of Ibadan, Nigeria Human Nutrition MSc 1yr. Details from Course Co-ordinator, Department of Human Nutrition, University of Ibadan, Ibadan 412668, Nigeria

University of Nigeria, Nsukka Nutrition MSc 2yr. Details from Course Co-ordinator, University of Nigeria Nsukka Campus, PO Box Nsukka, Nigeria

AMERICAS

University of Guelph, Canada Nutritional Sciences MSc 2yr (thesis), 1yr (course work). Also PhD. Applied Human Nutrition MSc 2yr. Also PhD. Details from Graduate Secretary. Dept of Nutritional Sciences, University of Guelph, Guelph, Ontario. Canada N1G 2W1

University of Toronto, Canada Community Nutrition MHSc 1½yr. Nutritional Sciences (research) MSc. Also PhD. Details from Co-ordinator of Graduate Studies, Graduate Department of Community Health, Room 6, McMurrich Building, University of Toronto, Toronto, ON M5S 1A8, Canada

Institute of Nutrition of Central America and Panama, Guatemala Food and Nutrition MSc 20mth. Details from Course Co-ordinator, INCAP, Box 1188, Guatemala City, Guatemala

University of California, USA Nutrition MSc & PhD. Details from Interdepartmental Graduate Groups. College of Natural Resources, 146 Morgan Hall 642-2879, Berkeley, CA 94720, USA

Cornell University, USA Nutrition Masters in Professional Studies 1yr. MSc 2yr. Also PhD. Details from Graduate Faculty Representative. Field of Nutrition, 305 MVR Hall, Cornell University, Ithaca, New York 14853-4401, USA

Harvard School of Public Health, USA Epidemiology/International Nutrition and Nutritional Biochemistry PhD. Details from Assistant Director, HSPH, 677 Huntington Ave, Boston, MA 02115, USA

University of North Carolina at Chapel Hill, USA Human Nutrition MPH & PhD. Details from Student Services Manager, CB7400 McGavran-Greenberg, Chapel Hill, NC 27599-7400, USA

Tufts University, USA Human Nutrition Sciences MSc 2yr. Also PhD. Social Sciences of Food Policy and Applied Nutrition MSc 2yr. Also PhD. Details from School of Nutrition, Tufts University. 132 Curtis St, Medford, MA 02155, USA

For a complete list of USA programmes see Peterson's Guide to Graduate Programs in the Biological & Agricultural Sciences 1993 from Peterson's Guides. Box 2123. Princeton, NJ 08543, USA (probably available in USIS libraries)

ASIA

National Institute of Nutrition, India Applied Nutrition MSc 9mth. Details from National Institute of Nutrition, Indian Council of Medical Research, Jamia-Osmania P.O., Hyderabad 500 007, India

University of Calcutta, India Nutrition Diploma 9mth. Details from Faculty of Medicine, University of Calcutta, Senate House, Calcutta 700 073, India

Avinasilingam Institute, India Human Nutrition MSc 2yr. Details from Course Co-ordinator, Avinasilingam Institute for Home Science & Higher Education for Women, Saradalaya, Coimbatore, India

Punjab University, India Nutrition & Dietetics Diploma 1yr. Details from Home Science College, Punjab University, Chandigash, Punjab, India

University of Indonesia, SEAMEO-TROPMED Applied Human Nutrition MSc 2yr. Nutrition MSc 1yr. Also PhD. Details from Directorate SEAMEO-TROPMED Center Indonesia, University of Indonesia, 6 Salemba Raya, Jakarta 10430, Indonesia

Mahidol University, Thailand Nutrition MSc & PhD. Details from Director, Institute of Nutrition, Mahidol University at Salaya, Putthamonthon 4, Nakhon Pathom, 73170 or Director Research Center at Ramathibodi Medical Faculty, Ramathidodi Hospital, Rama 6 Rd, Bangkok, 10400 Thailand

Mahidol University, Thailand Food and Nutrition MSc. Details from Director, Institute of Nutrition, Mahidol University at Salaya, Putthamonthon 4, Nakhon Pathom, 73170 Thailand

Philippine Women's University Nutrition MSc 2yr. Details from Course Co-ordinator, Philippine Women's University, 1743 Taft Ave, Manila B-406, Philippines

University of Philippines Public Health (Nutrition) MSc 2yr. Details from Course Co-ordinator, College of Public Health, 625 Pedro Gil, Ermita, Manila 1000, Philippines

University of the Philippines at Los Banos Regional Training Programme on Food and Nutrition Planning MSc 17mth (Asian and Pacific nationals). Details from FNP College, Laguna 3720, Philippines

AUSTRALASIA/SOUTH PACIFIC

Deakin University, Australia Human Nutrition Diploma 1yr (available by distance learning); MSc (by course work 2yr, by research 1yr). Also PhD. Nutrition Education Diploma 1yr (available by distance learning). Nutrition & Dietetics MSc 2yr. Details from Course Co-ordinator, School of Nutrition & Public Health, Deakin University, Geelong, Victoria 3217, Australia

University of Queensland, Australia (with Universiti Kebangsaan, Malaysia & Mahidol & Khon Kaen Universities, Thailand) Community Nutrition MSc 1yr. Details from The Director, Nutrition Program, University of Queensland, Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia

University of Queensland, Australia Nutrition MMedSc 2yr. Also PhD 3yr. Details from The Director, Nutrition Program, University of Queensland, Royal Brisbane Hospital, Brisbane, Queensland 4029. Metabolic Biochemistry & Nutrition Diploma 1yr fulltime, 2yr part-time. Details from The Post-Graduate Co-ordinator, Department of Biochemistry, Brisbane, Queensland 4072, Australia

University of Sydney, Australia Nutrition & Dietetics MSc 2yr. Nutritional Science MSc 2yr. Details from Course Co-ordinator, Human Nutrition Unit, Department of Biochemistry, University of Sydney, NSW 2006, Australia

University of Wollongong, Australia Nutrition & Dietetics MSc 1yr. Nutrition MPH, MSc and PhD. Details from Nutrition Course Co-ordinator, Department of Public Health & Nutrition, University of Wollongong. Northfields Ave, Wollongong, NSW 2522, Australia

University of Otago, New Zealand Human Nutrition Diploma 1yr; MSc or MCApSc 2yr. Community Nutrition Diploma 2yr (available by distance learning). Details from Course Co-ordinator, Department of Human Nutrition, University of Otago, Box 56, Dunedin, New Zealand

CARIBBEAN

University of West Indies, Jamaica Human Nutrition MSc 2yr. Details from Course Co-ordinator, Tropical Metabolism Research Unit, University of West Indies Mona, Kingston 7, Jamaica

EUROPE

University College Cork, Ireland Nutrition MSc 2yr; Diploma 1yr. Also MSc/PhD (by research). Details from Course Co-ordinator, Department of Nutrition, University College, Cork, Ireland

International Agricultural Centre, The Netherlands International Course on Food Science and Nutrition Diploma 6mth. Details from International Agricultural Centre, Box 88, 6700 AB Wageningen, The Netherlands

Uppsala University, Sweden Human Nutrition MSc 3yr or >3yr (sandwich). Also PhD. Details from Department of Human Nutrition, Uppsala University, Dag Hammarskjold vag 21, S-752 37 Uppsala, Sweden

University of Aberdeen, UK Human Nutrition and Metabolism MSc 1yr; Diploma 44 wks. Details from Course Organiser, Department of Medicine and Therapeutics, University of Aberdeen, Polwarth Building, Forresterhill, Aberdeen AB9 2ZD, UK

University of Glasgow, UK Human Nutrition MSc/Diploma 1yr. Human Nutrition PhD/MSc (by research). Clinical Nutrition MSc/Diploma (medical graduates only) 2yr. Details from Postgraduate Course Coordinator, Department of Human Nutrition, University of Glasgow, Yorkhill Hospitals, Glasgow G3 8SJ, UK

University of Keele, UK Health, Population and Nutrition in Developing Countries MBA 1yr. Details from Programme Director, MBA Programme, Centre for Health Planning and Management, Science Park, University of Keele ST5 5SP, UK

University of London, Centre for Human Nutrition, UK. Human Nutrition MSc 1yr. Also PhD. Details from Registrar, London School Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK

University of London, King's College, UK Human Nutrition MSc 1yr. Diploma 7mth. Also PhD. Details from Admissions Tutor, Department of Nutrition and Dietetics, King's College, Campden Hill Rd, London W8 7AH, UK

University of London, Institute of Child Health, UK. Mother and Child Health MSc 15mth. Diploma 9mth. Details from Institute of Child Health, 30 Guildford St, London WC1 1EH, UK

University of Nottingham, UK Nutritional Biochemistry (Human) MSc 12mth. Also PhD/MPhil. Details from Course Co-ordinator, Department of Applied Biochemistry and Food Science, University of Nottingham, Sutton Bonington, Loughborough LE12 5RD, UK

Oxford Brookes University, Centre for the Science of Food & Nutrition, UK Human Nutrition MPhil/PhD. Details from Course Co-ordinator, School of Biological and Molecular Sciences, Oxford Brookes University, Gypsy Lane, Headington, Oxford OX3 0BP, UK

Queen Margaret College, UK Community Nutrition MSc. 45 weeks (full or part-time). Also Certificat & Diploma. Details from Department of Dietetics & Nutrition, Queen Margaret College, Clerwood Terrace, Edinburgh EH12 8TS, UK

University of Sheffield, UK Human Nutrition M Med Sci 12mth. Diploma 4mth. Details from Course Co-ordinator, Centre for Human Nutrition, University of Sheffield, Sheffield S10 2TN, UK

University of Southampton, UK Human Nutrition PhD/MPhil. Details from Course Co-ordinator, Department of Human Nutrition, University of Southampton, Southampton SO9 3TU, UK

University of Surrey, UK Human Nutrition PhD. Details from Course Co-ordinator, School of Biological Sciences, University of Surrey, Guildford GIJ2 5XH, UK

University of Ulster, UK Biomedical Sciences with option in Human Nutrition MSc 1yr. Diploma 1yr. Also MPhil/DPhil. Details from Senior Course Tutor, Department Biological and Biomedical Sciences, University of Ulster, Cromore Rd, Coleraine BT52 1SA, UK

References and Sources of More Information

- Institute of Biology 1991 Training of Nutritionists from Nutrition Society, 10 Cambridge Court, 210 Shepherds Bush, London W6 7NJ

- International Child Health Unit 1993 Directory of Training Courses 1994 in NU #3 from ICH, University Hospital, S-751 85 Uppsala, Sweden

- UNESCO (with IUNS) 1992 Compendium of Higher Education Programmes in Family and Home Economics, Nutrition, Food Science and Technology and Health Sciences for Africa, Asia and Pacific, and the Arab States from Division of Basic Education, UNESCO, 7 place de Fontenoy, 75700 Paris, France

- WHO/SEARO 1990 Overview of training courses in Nutrition SEARO/WHO, New Delhi