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close this bookSCN News, Number 09 - Focus on Micronutritients (ACC/SCN, 1993, 70 p.)
close this folderPUBLICATIONS
View the document“Hunger 1993: Uprooted People”
View the document“Child Malnutrition: Progress Toward the World Summit for Children Goal”
View the document“Investing in Nutrition with World Bank Assistance”
View the document“Understanding Intrahousehold Resource Allocation”
View the document“The Health of Women: A Global Perspective”
View the document“The Incidence of Poverty in Developing Countries: A Compendium of ILO Data”
View the document“Food, Health and Care: The UNICEF Vision and Strategy for a World Free from Hunger and Malnutrition”
View the document“Breastfeeding, Growth & Illness: An Annotated Bibliography”
View the document“The State of Breastfeeding in Ghana: Practices and Promotion”
View the document“The Economic Rationale for Investing in Nutrition in Developing Countries”
View the documentUrban Nutrition in Developing Countries

“Hunger 1993: Uprooted People”

(1992) Bread for the World Institute on Hunger and Development, Washington, D.C. 204 pages.


This is the third annual report on the state of world hunger compiled and published by the Bread for the World Institute on Hunger and Development - an organization involved in research and education about hunger working closely with Bread for the World, described in this book as “a Christian citizens movement of 45,000 members who advocate specific policy changes to help over come hunger in the United States and overseas”.

It consists of a series of essays focussing on the problems of those who face hunger as a result of being forced against their will to leave their home communities, and addressing what has and can be done to alleviate the suffering. The subject matter “uprooted people” covers not only refugees in the traditional sense - defined in the report as “people who have crossed international boundaries to escape persecution based on race, religion, national origin, political opinion, or membership in a social group, or to escape war, civil strife, or political chaos”, but also internally displaced people, uprooted indigenous peoples, and the growing number of environmental refugees, those “forced to abandon their homes or homelands as a result of human-induced environmental conditions that threaten their livelihoods.” The report also contains chapters on “Hunger Among Uprooted People in the United States”, “Reforming the International Refugee Aid and Protection System” and “Regional Hunger Updates”, covering Africa, Asia and the Pacific, Latin America and the Caribbean, Middle East, North America, and the Former Soviet Union and Central and Eastern Europe. Additional features are updated and expanded tables of country-level indicators, state-level indicators of poverty in the United States, a glossary and an extensive bibliography.

To obtain a copy of Hunger 1993: Uprooted People, please contact: Bread for the World Institute on Hunger & Development. Attn: Publications Order, 802 Rhode Island Avenue, N.E., Washington D.C. 20018. Tel (202) 269 0200, Fax: (202) 529 8546.


“Child Malnutrition: Progress Toward the World Summit for Children Goal”

(1992) UNICEF Statistics and Monitoring Section, New York. 31 pages.

One of the goals of the World Summit for Children for the year 2000 is to reduce the level of underweight prevalence amongst children by one-half of the levels in 1990. This recent publication of UNICEF is one of the significant contributions towards a reliable assessment of the progress made to date. Significant increases in availability of reliable national data have improved the process of assessing the performance of countries in terms of the goals set forth in the Child Summit. Since 1985, the number of national anthropometric surveys, either as modules of national health surveys such as those done by the Demographic and Health Surveys, or by national household budget surveys done for example in the World Bank, and by national governments, have doubled to around 75 countries. At least 28 countries now have at least two data points with which to determine trends in nutrition. The acceptance of malnutrition data as indicators of social well-being has provided much of the impetus towards the increasing number of national data sets that encompass anthropometric measurements.

The standardization of anthropometric data (with respect to growth standards, cut-off points, and age), has considerably improved the interpretation of underweight data being reported by many United Nations agencies. Thus, this UNICEF publication reports information that are in accord with the data compiled by WHO and the ACC/SCN, and which were also reported in the ACC/SCN Second Report on the World Nutrition Situation (1993).

The data tables presented in the report are very clearly laid out, differentiating three alternative measurements: prevalence of underweight children; stunted children; and children with low weight for height (or wasted). This is important since many users are interested in distinguishing between long term nutrition (stunting) and short term nutrition (underweight). An important feature of this report is also the breakdown of data by three important characteristics, namely: by prevalence by age group; by gender; and by urban-rural residence.

Several countries reported at least two data points, which could potentially assess changes over time. One potential problem in such comparisons is the reliability of data on the age of children. Since indicators such as weight for age are dependent on age, the misreporting of age could confound the interpretation. This was the case for example in at least one country reviewed by the ACC/SCN.

For further information please contact: UNICEF, 3 UN Plaza, New York, NY 10017, USA.


“Investing in Nutrition with World Bank Assistance”

(1992) by Joy Miller Del Rosso, World Bank, Washington, D.C. 23 pages.

This booklet - targeted at government managers and staff responsible for, and interested in, addressing malnutrition - describes how and why the World Bank is involved in nutrition programmes. It is split into four sections. The first “Why Invest in Nutrition” discusses the returns gained from investing resources directly in alleviating malnutrition, emphasizing the important contribution of such investment to poverty alleviation in general and economic growth, “Improving nutrition directly addresses some of the worst consequences of being poor. It concretely improves the well-being of populations even when incomes remain low, and it offers the promise of increasing future incomes by boosting productivity. Investment in nutrition can help workers produce more and children learn more in school. Such investment in people is the firmest foundation for economic and social development.” (p.1)

The second section “How Countries are Confronting Malnutrition” gives examples of recent World Bank involvement in projects aimed at improving nutrition directly and immediately through several strategies:

· targeting food transfer programs;

· providing essential nutrition services to those at risk;

· supplying critical micronutrients;

· using a multifaceted approach; and

· building capacity in nutrition programming.

The next section “How the World Bank can Help” describes and explains the resources the World Bank is able to make available - substantially strengthened in recent years - for helping governments interested in strengthening or expanding nutrition activities.

Finally, the last section “What Lessons for the Future” draws on past experience of the World Bank and other donors, host governments, NGOs and communities involved in nutrition projects to provide a set of guidelines on how governments can address malnutrition.

To obtain a copy of the publication or find out more about how World Bank can assist in addressing malnutrition problems please contact: The World Bank, Director, Population, Health & Nutrition Department, 1818 H Street, N.W., Washington, D.C., 20433, USA.


“Understanding Intrahousehold Resource Allocation”

(1992) IFPRI Policy Brief. IFPRI, Washington, D.C. 52 pages.

A growing body of empirical and theoretical literature from various disciplines has pointed out that the costs and benefits of different policies are borne disproportionately by some individuals within households, according to their gender, age, and relationship to the household. These argued that the very success of development policy is likely to be undermined by a failure to view the household and the family in a holistic manner. This IFPRI policy brief emanated from a conference on intrahousehold issues hosted by IFPRI in Washington, D.C. in February 1992. More than 40 economists, nutritionists, anthropologists, sociologists, demographers, and political scientists participated in this conference, half of whom presented papers which are summarized in this policy brief. This IFPRI policy brief documents numerous examples of costly, unintended policy effects due to the neglect of intrahousehold decision making processes. For instance, since patterns of food consumption within households differ, programmes targeted to certain household members may be wide of the mark, with heavy leakages. Or programs that are intended to increase employment may reduce school enrollment because adolescents may be required to stay at home to care for infants while their mothers are at work. Most analysis of programmes stop at the door of the household. The results from studies presented indicate that the outcome of policies may change due to the differences in the understanding of intrahousehold allocation behavior.

For further information please contact: IFPRI, 1200 Seventeenth Street, N.W., Washington, D.C., 20036-3006, USA. Tel: (202) 862 5600. Fax: (202) 467 4439.


“The Health of Women: A Global Perspective”

(1993) Edited by Marge Koblinsky, Judith Timyan and Jill Gay, published by Westview Press. 291 pages.


The Health of Women: A Global Perspective is essential reading for topics to include in a women's health agenda in developing countries. The strength of this book is the depth of its perspective. Much more is included than the medical aspects of maternal morbidity and mortality. As the titles of the chapters indicate, the health of women in developing countries is placed in a comprehensive context:

1. Women's Health: The Price of Poverty.

2. Mother and More: A Broader Perspective on Women's Health.

3. Women's Nutrition through the Life Cycle: Social and Biological Vulnerabilities.

4. Infection: Social and Medical Realities.

5. Family Planning: A Base to Build on for Women's Reproductive Health Services.

6. Abortion.

7. Women's Mortality: A Legacy of Neglect.

8. Violence against Women: The Missing Agenda.

9. Women's Mental Health: A Global Perspective.

10. Access to Care: More than a Problem of Distance.

11. Quality of Care: A Neglected Dimension.

12. Health Women's Way: Learning to Listen.

Each chapter justifies inclusion of its topic in a women's health agenda for developing countries. The reasons for each topic's inclusion are clearly and strongly presented, supported by relevant statistics. Each chapter provides a fresh perspective. Either the topic of the chapter itself is fresh (e.g., violence, mental health) or the approach towards it is fresh (infection, family planning). Each chapter also includes thoughtful and practical recommendations, often categorized for policy, program, and research.

The audience for this book is broad. It includes people who have not yet considered women's health in developing countries, and would benefit from seeing a comprehensive agenda; people who are convinced of the need to address women's health concerns, but need information and new approaches with which to convince others; and people who need suggestions on how to design health services to better meet women's needs.

Chapter 1 makes the case that poverty is a major factor in women's poor health. Poverty limits women's access to health care and reduces women's decisions to seek care, yet increases women's chances of suffering ill health. Chapter 2, “Mother and More” reviews existing information on the levels of morbidity for those conditions that most frequently cause maternal mortality: ill health consequences of hemorrhage, obstructed labor, infection, gestational hypertension, and septic abortion. Other topics reviewed are what is known about the menstrual cycle, ill health consequences of women's work, and the health 'isues of aging women.

Chapter 3 discusses women's nutrition, first in terms of social vulnerability, due to women's low status, in each of four life cycle stages (preference for males in infancy/childhood, early reproductive role in adolescence, multiple roles in the reproductive years, and marginalization in the later years), and second in terms of biological vulnerability, due to women's reproductive role. Chapter 4 on infections (reproductive tract infections, sexually transmitted diseases, and HIV) has useful sections on existing interventions and considerations for designing them.

Chapter 5 presents family planning as one of the basic and most important preventative health care services for women. To play this role effectively, family planning “services must be available to women in a way that incorporates and satisfies their other primary of reproductive health care needs and is simultaneously responsive to the various stages of their reproductive lives,” and the chapter outlines ways in which this can be done. Chapter 6 on abortion addresses ways to reduce the poor health outcomes of unsafely performed abortions, chief among which is promotion of family planning services to prevent unwanted pregnancies. Other strategies for tackling the problem of ill health effects of unsafe abortions are safe technologies and access to safe care.

Chapter 7 on women's mortality discusses both mortality due to the low status of women, and maternal mortality (deaths due to complications of pregnancy, childbirth, and the early postpartum months). Specific priorities are outlined for reducing maternal mortality. Chapter 8 on violence presents a compilation of available statistics on domestic violence, dowry deaths, rape and sexual assault, violence against refugee women, female circumcision, and discrimination against girl children. Following the grim statistics, the author gives examples of ways women are fighting against violence in their lives, and makes action-oriented recommendations for reducing this problem.

In Chapter 9 on mental health, the author starts by challenging the myth that mental health is a luxury item. She then describes the most prevalent types of mental illness in women of different age groups, and ends by outlining an effective mental health policy. Chapter 10 on access to care discusses thoroughly the many factors that constrain women's access to health care services. On the service side are factors such as service organisation, service location, characteristics of personnel, structural adjustment, cost and quality of services. On the user side are factors such as informational barriers, decision-making dynamics, and cultural barriers. Specific recommendations are made to reduce each of these constraints to women's access to health care.

Chapter 11 on quality of care outlines characteristics of the delivery of health services to ensure quality, and thus use, of services. The original audience for the quality-of-care arguments was the family planning community, but applies to a variety of health services that could be serving women's health concerns. Chapter 12 describes the importance of listening to women in order to design health services to meet their needs. Programs that meet women's needs are more likely to be sustained and to be more effective. Perhaps more importantly, the authors describe eloquently effective methods for listening to women to discern these needs.

The Safe Motherhood Initiative was launched six years ago after the high rates of maternal mortality became apparent. It focused on mortality of women during pregnancy, childbirth, and the early postpartum months. While the Initiative has brought long overdue attention and programmatic action to a problem of enormous proportion, it is gratifying to see that the specific focus of the Initiative is now being complemented by a broader focus of women's health in developing countries.

For order and other information, please write to: Westview Press, 5500 Central Avenue, Boulder, Colorado 80301-2877 or 36 Lonsdale Road, Summertown, Oxford OX2 7EW.

Kathleen Kurz International
Center for Research on Women

“The Incidence of Poverty in Developing Countries: A Compendium of ILO Data”

(1993) by Hamid Tabatabai and Manal Fouad. International Labour Office, Geneva. 105 pages.

The renewed interest in poverty alleviation requires a deeper understanding of the problem. This suggests the need for strengthening the data base on poverty and its changes. This publication of ILO is a significant step towards filling this need. The search for relevant data on incidence of poverty is a time consuming process, and at times impossible due to lack of access to the original sources. Estimates of incidence of poverty are scattered in thousands of different articles, unpublished documents, reports, and books. The compilation presented in this publication serves the purpose as a single source document of most of the estimates of incidence of poverty of the last 20 years.

This report, which is in two parts, lists and summarizes a large number of recent (usually post 1970) studies on the incidence of “absolute” poverty in developing countries. The studies listed are all based on household income and expenditure surveys whose coverage is reasonably comprehensive, usually distinguishing between rural and urban poverty. For some large countries, e.g. India, there is also a regional breakdown of poverty. The poverty lines are usually derived from calorie requirements. The major world regions covered are Africa, Asia and the Pacific, Latin America and the Caribbean, and some developing countries in Europe. Part I lists the regions and countries and, for each country, presents in chronological order the main surveys, the incidence of poverty, the poverty line and the data source. Part II has background notes on the studies reviewed.

The survey will be useful in facilitating comparisons of poverty across countries, across regions in the same country or over time, because this can only be done with an absolute measure of poverty. There will also be less of an excuse for sticking with the rather crude measures based on per-capita GNP (whether adjusted or not for purchasing power) which are so popular today.

ILO publications can be obtained through major booksellers or ILO local offices in many countries, or direct from ILO Publications, International Labour Office, CH-1211 Geneva 22, Switzerland. A catalogue or list of new publications can be obtained free of charge from the above address.

Sumiter Brocka

“Food, Health and Care: The UNICEF Vision and Strategy for a World Free from Hunger and Malnutrition”

(1993). UNICEF, New York. 40 pages.

In the words of James Grant, Executive Director of UNICEF in the foreword to this 40 page booklet “this publication offers the UNICEF perspective - from the point of view of the children of the developing world, in particular - on the critical problem of nutrition: the dimensions of the problem and doable goals and strategies for combating it, at surprisingly low cost, during the 1990s”

The first part of the booklet - after reminding us of the 1948 Universal Declaration on Human Rights' affirmation of the fundamental right or us all to adequate food, health and medical care - outlines succinctly the severity of the problems of hunger and malnutrition that still exist in the 1990s, including the combined effects of malnutrition and infection, and how these are seriously affecting the lives of many people in developing countries.

In a section called “the ethical imperative”, the booklet goes on to point out that knowledge is available to alleviate the problems - nutritional goals such as those laid down at the 1990 World Summit for Children are not simply ethical goals but are, UNICEF believes, achievable. This section also describes the newly recognized role of the poor in poverty alleviation - particularly women, whose participation, it states “will lead to empowerment, mobilization of local resources, and sustainability.”

The causes and effects of the four major forms of malnutrition existing in the developing world - protein-energy malnutrition, iron deficiency anaemia, vitamin A deficiency, and iodine deficiency - are discussed in the booklet together with strategies for achieving the conditions believed to be necessary for adequate nutrition: access to food (household food security); access to basic health services, together with a healthy environment; and care of children and women. Strategies discussed include:

· control of major micronutrient deficiencies (iodine, vitamin A and iron);

· protection, promotion and support of breastfeeding and improved child feeding practices;

· improved nutrition through community participation and empowerment, reflected in improved assessment, analysis and action (the triple-A approach), including support to community organizations and the use of community-based nutrition information systems; and

· improved national nutrition policies and strategies through dialogue, training and the refining of information systems (nutrition surveillance).

Interspersed with many photographs, the text of this booklet is highly readable and accessible to those interested in, but with perhaps a limited technical knowledge of, the global problems of malnutrition and hunger. The realities of the problem are shocking, but the booklet offers some optimism that, with adoption and implementation of the correct strategies “the world can be free from hunger and malnutrition.”

For further information please contact: UNICEF, 3, UN Plaza, New York, NY 10017, USA.


“Breastfeeding, Growth & Illness: An Annotated Bibliography”

(1992) by Allan S. Cunningham, Derrick B. Jelliffe, and E.F. Patrice Jelliffe. UNICEF, New York. 157 pages.


Prepared as a contribution to information dissemination by the World Alliance for Breastfeeding Action (WABA), this book lists the details of where to find over 500 articles on the subject of breastfeeding, growth and illness. The focus of the bibliography is on recent epidemiological research, but as the authors explain in the introduction to the book, some of the laboratory studies of human milk and proprietary formula are also included “which emphasize the biological plausibility of the epidemiology.” In addition, although it is the belief of the authors that breastfeeding is “one of the most important things a mother can do for her child, anywhere in the world” they acknowledge that it may occasionally be hazardous to an infant. Thus, whilst rare, articles that report such circumstances are also included.

The articles are grouped by chapter under the following 14 broad headings: A. Less Technically Developed Communities; B. Mortality, Nutrition and Growth in Industrial Nations; C. Review Articles and Miscellaneous Infectious Morbidity; D. Gastrointestinal Infections; E. Respiratory Disease; F. Non-infectious Morbidity; G. Neonates, Prematures, Necrotizing Enterocolitis; H. Allergy, Feeding Method, Maternal Diet; I. Long-term Effects and Chronic Disease; J. Maternal (Disease) Benefits, Contraception; K. Microbes in Human Milk and Vertical Transmission; L. Untoward Effects of Breastfeeding; M. How Does Breast Milk Work? and N. Programmatic Considerations. Each chapter has a short introduction summarizing current knowledge on the topic, and a sentence or two with each article describes its main findings or significance.

The authors describe the purpose of the bibliography as being twofold: “to give health workers an efficient overview of a broad subject, and to provide an entree to recent research.”

For further information please contact: UNICEF, Programme Publications, 3 UN Plaza, New York, NY 10017, USA.


“The State of Breastfeeding in Ghana: Practices and Promotion”

(1993) by Adwoa Steel, Mary Ruth Homer, Charlotte Acquah and Comfort Agyekumwaa,

This well presented report (just over 100 pages) was commissioned by USAID to examine the state of art of breastfeeding in Ghana in order to identify those factors which support optimal breastfeeding practices as well as those which obstruct such practices. Drawing on existing studies and research the report is an excellent synthesis of young child health and nutrition in Ghana and as such serves as a valuable reference document.

The authors show that alarming problems exist in Ghana with current breastfeeding practices. Like many African countries the initiation of breastfeeding is near to universal (mean duration 20.4 months), however, at delivery it is rare for a baby to be put to the breast immediately. Colostrum is often discarded and breastfeeding may be delayed for days until a mother is sure that her milk has arrived. Based on an analysis of the 1988 Ghana Demographic Health Survey one striking finding was that only 2 percent of mothers exclusively breastfeed during the first 4 months because of the widespread belief amongst mothers and health workers that babies need to be given water for thirst. In this respect Ghana ranks one of the two lowest of 25 developing countries in which practices in exclusive breastfeeding have been examined. Another alarming finding was that nationally 52 percent of infants 0-3 months were bottlefed, with this figure being 46 percent in rural areas.

The report concludes correctly that serious problems exist in Ghana with current breastfeeding knowledge, attitudes and practices. The authors present a well articulated social mobilisation and IEC strategy which is aimed at training health care providers to better support mothers to breastfeed successfully and motivate them to change inappropriate young child feeding practices. Some of the findings will be immediately incorporated into the USAID funded Ghana Family Planning and Health Project, whilst others will no doubt have wider application in regards to nutrition related policy and programme development.

(This publication is available from: MotherCare, John Snow Inc., 1616 North Fort Myer Drive, Arlington, Virginia, 22209, USA)

Victoria Quinn

“The Economic Rationale for Investing in Nutrition in Developing Countries”

(1992) by Jere Behrman, USAID, Washington, D.C.

Jere Behrman has been one of the most active scholars in the field of economics of nutrition and human capital in developing countries. This publication, which summarizes what is known about the economic contribution of good nutrition, is another of his important contributions to the understanding of this complex topic. Whenever governments invest in programs such as nutrition, the most commonly used rationale is that it is part of the effort to meet the basic needs of the population, or generally the equity considerations. However, there is an economic argument, though less understood, for investing in nutrition, as Behrman points out. That is, that better nutrition increases the productivity of populations.

The publication is devoted to the review of evidence of the direct and indirect productivity effects of good nutrition. He has divided the evidence between the experimental surveys - using carefully designed controls - and the socio-economic surveys.

Behrman concludes that these studies tend to show that the returns to nutrition are even higher than the returns to education, although most education programs tend to have been much more emphasized in the literature. For example, studies in control of iron deficiency anemia have shown extremely high benefit-cost ratios, although he questions the assumptions related to the benefit side of the calculations. Nonetheless, the question is the order of magnitude of the benefits.

The available evidence, although hardly perfect, suggests that in terms of growth and productivity as well as equity concerns, there maybe payoffs to better nutrition in poorer areas of the developing world.

If the economic productivity gains to households from better nutrition are extremely high, as the studies would argue, why aren't households investing in these foods? Is it due to lack of specific nutrition knowledge? Behrman concludes that governments have the likely comparative advantage in assuring adequate information about nutrition, its nature, and its effects, given the public goods aspect of the information.

This publication is an important contribution to the state of knowledge of the relationship between nutrition and productivity in developing countries.

(For further information please contact: Office of Nutrition, USAID, 320 21st Street, N.W., Washington, D.C., 20523, USA. Tel: 703 875 4074 Fax: 703 875 7483)


Urban Nutrition in Developing Countries

The readership of the ACC/SCN Newsletter interested in either the investigative aspects of urban nutrition in developing countries, or in the programmatic and policy applications, may be interested in the recent publication of two compendiums on the topic that have resulted from a series of regional workshops sponsored over the past three years under the auspices of the IUNS Committee 1/3 on Urbanization and Nutrition.

From September 11 to 14, 1991 at the Pertanian Malaysia University near Kuala Lumpur, the First Asian Workshop on Nutrition in Metropolitan Areas took place, with the participation of 60 professionals from throughout the Asian region. The December 1992 issue of the South East Asian Journal of Tropical Medicine and Public Health, Vol 23, Supplement 3, contains the 172 page proceedings of this event.

In Mexico City, the Second Latin American Workshop on Nutrition in Urban Areas was held from March 2 to 6, 1993 (see SCN News No.8). A 260-page Spanish/Portuguese-language compendium of the proceedings has been published as a supplement to the December 1993 issue of the Latin American Archives of Nutrition (Archivos Latinoamericanos de Nutricion), vol 42, No.4, Supplement. It is expected that an English version will shortly appear, as well.

From June 12-19, 1993, the First Seminar-Workshop on Nutrition in Metropolitan Areas of Africa with the participation of professionals from 24 francophone African countries was held in Cotonou, Benin. It is expected that the proceedings of this event will be published shortly in both French and English.

A number of academic and service entities - local and international - collaborated in the organization of these events. Funding for the publications came from donations from the German Agency for International Cooperation (GTZ) and the International Union of Nutritional Sciences (IUNS). Larger medical and scientific libraries should have the issues available shortly for reference. Both journals, moreover, are indexed by Index Medicus and individual citations may be accessed on Medline.

If you would like to have a personal or institutional copy of the Proceedings, the supplement issue for the Asian Workshop can be ordered for the price of US$15, including mailing and handling, by writing to the Southeast Asian Journal of Tropical Medicine and Public Health, SEAMEO-TROPMED Network, 420/6 Rajvithi Road, Bangkok 10400, Thailand (tel +66 2 2457193; fax +66 2 2468340). The supplement issue for the Latin American Workshop can be ordered for a price of US$35, including mailing and handling, by writing to Dra. Claudia P. Sanchez-Castillo, Institute Nacional de la Nutricion Salvador Zubiran, Vasco de Quiroga 15, Tlalpan CP 14000, Mexico (tel +52 5 5731200; fax +525 6551076).

Contributed by Dr Rainer Gross,
Community Nutrition Training Program,
University of Indonesia, 6,
Salemba Raya, PO Box 3852, Jakarta
10038, Indonesia.


Source: Department of Animal Husbandry, University of Sydney