PUBLICATIONS

Reproductive Health: The MotherCare Experience
The Nutrition and Lives of Adolescents in Developing Countries
Time for a Change? A Field's Eye View of Donor Agency Support for Nutrition
War & Hunger: Rethinking International Responses to Complex Emergencies

plus selected announcements of new publications

Reviews

“Reproductive Health: The MotherCare Experience”

(1995) Supplement to Volume 48 of the International Journal of Gynaecology and Obstetrics. Elsevier, New York.

This special supplement consists of a series of articles describing 5 years of operational experience of the MotherCare Project of the USAID. This project has sought to develop a package of effective maternal and neonatal health and nutrition services to reduce maternal and neonatal mortality and morbidity in developing countries. The first article provides a series of conceptual models or frameworks for programme planning in different settings reflecting variations in infrastructure, service delivery and utilisation. The second article describes the nature and magnitude of the problem in global and regional terms and provides a useful table or “scorecard” detailing the magnitude of maternal morbidity and the consequences for both the pregnant woman and the newborn. The third article examines the elements of a basic safe motherhood programme, including components of information, education and communication, family planning and obstetrical care as well as first level referral facilities and functions. It includes a useful section on reproductive epidemiology which provides a framework for assessing maternal health conditions and also identifies a set of programme performance indicators which will be useful to managers. The fourth article describes a study to validate self reported obstetrical history against records information; this is particularly important in situations where service records do not exist and critical information must be obtained from verbal accounts. It finds that dystocia and haemorrhage are reliably reported whereas the reporting of sepsis and eclampsia was less clear. It also provides a useful appendix of optimal sets of questions for obtaining valid information on obstetrical complications. The fifth and sixth articles describe MotherCare Projects in Bolivia, Guatemala, Indonesia, Nigeria and Uganda which involve a range of interventions for strengthening different components of the primary care pyramid, from community to referral hospital level. The seventh article addresses the important issue of training hospital staff to support the process of referral from the community, through prompt attention and improved quality of care. The study provides evidence that appropriate staff framing can favourably change users’ perceptions of referral services and thereby increase the rate of completion. The eighth article examines nutritional issues in a project in West Java and specifically addresses the contribution of maternal nutrition to the outcome of pregnancy, the estimation of pre-pregnancy weight, weight gain patterns during pregnancy and the influence of iron supplementation on neonatal anthropometry. Supplementary iron consumption during pregnancy was a significant predictor of full-term neonatal weight and length, while maternal height and weight contributed to the specification of the neonatal length and weight models respectively. The ninth article describes the benefits of a decentralised syphilis control project in Nairobi and the results emphasise the advantages of a one-stop diagnosis and treatment service for pregnant women and their partners. Of more than 13,000 women screened, 87% of sero-positive women and 50% of their partners were treated successfully by this approach, at a cost of approximately US$50 per case prevented. The final article deals with policy formulation in the area of sate motherhood and the underlying issues of access and quality that need to be considered in this context. The involvement of women as beneficiaries is emphasized as an important ingredient of progressive policies.

Given the current paucity of experience and information on sate motherhood in developing countries, this is a valuable publication summarizing ideas and experiences derived from a range of projects and programmes operating in different settings. As such, it will be particularly useful to programme managers concerned with the design and evaluation of intervention packages at the primary care level.

To obtain a copy of this supplement please contact: Elsevier Science, Customer Service Dept., PO Box 882, Madison Square Station, New York, NY 10159-0945, USA. Phone: (1 212) 633 3750 Fax: (1 212) 633 3764.

John Kevany

“The Nutrition and Lives of Adolescents in Developing Countries: Findings from the Nutrition of Adolescent Girls Research Program.”

Figure

(1994) Kathleen M. Kurz and Charlotte Johnson-Welch, International Center for Research on Women (ICRW). 35 pages.

This document is a synthesis of research findings from the ICRW/USAID Nutrition of Adolescent Girls Research Program established in 1990. The Programme included 11 research projects: five in Latin America and the Caribbean (Ecuador, Mexico, two in Guatemala, and Jamaica), four in Asia (Nepal, India and two in the Philippines) and two in Africa (Benin and Cameroon).

The introduction justifies research on adolescents by highlighting the growing proportion of young people of this age group in developing countries; the change in sexual behavior leading to a rise in incidence of pregnancy, sexually transmitted diseases including HIV infection; the inadequacies of health services to deal with adolescents needs; and finally the lack of knowledge on the subject. The underlying rationale includes the hypothesis that adolescence is a time when behaviours are being formed and therefore potentially provides a window of opportunity for influencing the adoption of health conducive behaviours. The research programme sought to provide information on the factors that affect and are affected by nutritional status which could guide the formulation of policies and programmes.

The eleven research studies differ in design, features of which are tabulated as part of this document’s introduction - only the Ecuadorian study sample was nationally representative. Studies also appear to vary on specific objectives. Nutrition results include findings on anaemia, stunting, undernutrition, catch-up growth and dietary intakes. Information on other aspects of adolescents’ lives is also described e.g. health education factors, activities, and self perceptions.

Although study findings are not strictly comparable due to variation in methodologies, each section concisely brings together findings against the backdrop of what is currently known on each of the topics.

Anaemia was the greatest nutritional problem among adolescence in the ICRW/USAID studies, the prevalence of which was quite high in the Nepal, India, Guatemala metabolic and Cameroon studies. However a large variation across studies exists ranging from only 5% anaemia in the Guatemala longitudinal study to 55% in the India study. The nationally representative Ecuadorian study showed a moderate level of anaemia with a significantly higher prevalence of anaemia in boys than girls, however it did not appear to investigate the functional consequences of this finding.

Unexpected findings like the greater prevalence and of stunting in boys in the Cameroon and Benin studies in contrast to findings in the India study and the finding that there were twice as many boys undernourished as girls, emphasizes the need for further investigation. However, undernutrition prevalence was found to be high only in the India, Nepal, and Benin studies and by the end of adolescence was not found to be high in any of the studies.

Findings on catch-up growth appear to be consistent with other research findings that not all growth can be recovered even under optimal conditions. The Guatemala study suggested that only small gains in height may be possible with intervention. Warnings against supplementation in situations where a low underweight prevalence coexists with a high prevalence of stunting are underlined in the Benin study, which indicates that adolescents gain more weight relative to BMI reference data than height relative to the height reference data. The conclusion with regard to this issue is that “before interventions can be recommended, further investigation is needed into how much height and weight could be gained by increasing food intake”.

Violence was particularly noted from the Jamaican study as impacting on the lives of adolescents. Poverty was not surprisingly related to other aspects of adolescents lives, e.g. in the Ecuador study adolescents from the poorest households had the worst nutritional status and were least likely to attend school. A surprising finding from Nepal and Benin studies was that poor nutritional status was related to high school attendance.

Conclusions and general recommendations, though difficult to draw from apparently mixed findings, were made in broad terms. The authors highlighted vulnerability among boys, identified through nutritional indicators, and among girls through social indicators. Recommendations include providing integrated health services that are accessible and acceptable to adolescents boys and girls; improving iron status within existing programmes; implementing programmes which increase the productivity and income of the poor and promoting access of girls to education opportunities.

This well written and nicely published document contributes comprehensively to the literature on the nutrition and lives of adolescents in developing countries, which is relatively sparse, and whets the appetite for further review of the individual studies referred to.

To obtain a copy of this report and obtain information on other publications please contact: ICRW, Publications Department, 1717 Massachusetts Avenue, N.W., Suite 302, Washington, D.C. 20036, USA. Phone: (202) 797 0007 Fax: (202) 797 0020 Email: [email protected]

Fiona O’Reilly, ACC/SCN

“Time for a Change? A Field’s Eye View of Donor Agency Support for Nutrition”

(1995) by Julia Tagwireyi The 7th Martin J Forman Memorial Lecture, June, 1994. Helen Keller International, New York.

Julia Tagwireyi is internationally recognized as one of the very outstanding individuals involved in national-level nutrition planning and programming. She has coauthored reports reviewing the development of nutrition programs and evolution of nutrition problems in Zimbabwe. When Julia Tagwireyi speaks, it commands the attention of all involved in international nutrition.

The tradition of the Martin Forman Lectures has been maintained. With her ever-optimistic approach to constructive criticism, Julia Tagwireyi has directed attention to some of the realities of international assistance and the difficulties these can cause for national planners. As she points out, there are three root causes of less than maximal impact of donor support; (a) differences between country and donor perceptions of problems and priorities in nutrition and preferred approaches; (b) inadequate harmonization of activities among donor agencies; (c) short term, piece-meal approaches to nutrition program support, usually for a maximum of 5 years when 10-20 years is needed to effect substantial improvement.

Starting with this set of perceived issues, Julia Tagwireyi offers both case examples and suggested new approaches. Mechanisms of ensuring sustainability are key factors, it is suggested that “providing support in a manner that facilitates ownership of the program by the nationals will facilitate sustainability...” Investment in the development of infrastructure to implement, evaluate and modify programs is also seen as pivotal.

One extremely important component of the potential success story the author presents is omitted from the discussion. This reviewer has the feeling that, in the final analysis, much of the success that the author offers may be dependent upon personality and personal abilities. What we need to know is how can one clone that small number of highly successful programme managers, and moreover where they are performing outstanding work, how can their removal from the setting in which they achieve so much be avoided.

Perhaps a Forman lecture in the near future will address the other side of the coin - a donor’s eye view of field use of available dialogue between country personnel and donor that Julia sees as essential to successful programs but all too often lacking in the busy have intervention will fund it for you’ approach of today.

Julia Tagwireyi deserves a strong vote of thanks from all of us for this lecture and the messages it leaves.

To obtain a copy of the report please contact: Helen Keller International, 90, Washington Street, 15th Floor, NY 10006, USA. Phone: 212 943 0890.

George H. Beaton

“War & Hunger: Rethinking International Responses to Complex Emergencies”

(1994) Edited by Joanna Macrae and Anthony Zwi with Mark Duffield and Hugo Slim, Zed Books, Save the Children (UK). 242 pages.

This book is a useful collection of essays on a hot area in the relief/development industry: complex humanitarian emergencies, disasters in which conflict/war play a major role. Since the end of the cold war, these emergencies have been increasing dramatically in both frequency and severity while obstacles to the international community’s ability to respond to them have been removed. As one of the co-editors correctly assesses, this work is a “modest contribution to the debates on war, hunger and international policy.” The book is particularly relevant to policy makers in international organizations. It provides useful pointers to the dramatic changes that are occurring on the landscape of international development and the implications of these changes for the relief/development industry.

The book is the result of a review of the literature and workshop sponsored primarily by Save the Children (UK) and the London School of Hygiene. It is organized in three parts:

1. A framework for the analysis of war and hunger in Africa
2. Case studies of complex emergencies in three African countries
3. Policy issues and conclusions

The main message of the work is that the new world “order” has dramatic implications for both the etiology and management of international relief and development. The work describes complex emergencies as a function of “active underdevelopment”: the breakdown of the state and its replacement by a political culture that utilizes violence for economic profiteering and maintenance of political power. It further describes the complexity of diplomatic, political, and human rights issues that must be examined and addressed if these emergencies are to be successfully prevented or mitigated in the modern world. It identifies major inadequacies of the international development industry in dealing with these; a chapter is devoted to the United Nations, particularly.

The work, however, stops short of offering solutions. The conclusions chapter is somewhat sophomoric, identifying generic solutions that already have been made clear by earlier international luminaries active in the area of disaster relief (Cuny, Anderson). These solutions include the need for beneficiary participation, the value of appropriate monitoring and evaluation systems, the clarification of intervention framework, the need to recognize the linkage between development and disasters (particularly as conflict affects development), and the need for an impartial international monitoring system. The major co-editors do have, however, more recent relevant works available through the London School of Hygiene and Tropical Medicine’s Health Policy Unit.

Another limitation of the book is the lack of supporting data. The analyses are somewhat speculative, inclusive of the authors’ observations and citations of agency communications. This final critique may be more the result of poor data availability than the style and intent of the authors. Indeed, one of the contributing authors, Alex de Waal noted that “slow rhythms of academia and security concerns” obscured reasonable documentation of the recent Somalia disaster relief efforts. These issues and the action orientation of traditional disaster relief largely have precluded effective data-driven analysis. This limitation should be perhaps emphasized further by the authors. The dearth of analyses published on a reasonable empirical data base is disappointing.

The book does, however, bring intellectual focus on a stark reality recognized by senior policy makers in the development industry; i.e., that complex humanitarian emergencies are among the most important development problems in the new world order; business as usual is no longer relevant. The book represents a timely contribution to inducing major changes in the field of international development.

To order a copy of the book please contact: Zed Books Ltd., 6 Cynthia Street, London N1 9JF, UK. Phone: 44 171 837 4014.

Nancy B. Mock
Tulane University Center for
International Resource Management

New Titles

In this section we include selected publishers’ announcements of new publications; these are not independent reviews, but are included to draw attention to relevant material.

“Nutrition Matters: People, Food and Famine”

Figure

(1995) by Helen Young and Susanne Jaspars. Intermediate Technology Publications Ltd, London. 151 pages.

The classic disaster model of an emergency, which assumes simple cause and effect between food shortages, malnutrition and death, no longer holds. The nature of emergencies, and outsiders’ perceptions are changing. In fact most emergency situations are protracted, with obvious political dimensions, and the great majority of crises can be predicted, often recur in the same area and, with appropriate interventions, the progress of famine can be halted.

This book is based on the authors’ views and experience as fieldworkers in situations of food insecurity and famine, combined with their in-depth knowledge of the discipline of nutrition. The practical constraints encountered by the authors and the ineffectiveness of standard interventions, has encouraged them to consider new approaches to nutritional assessments and response, which are generally applicable in situations of famine.

The authors develop a new conceptual framework of the role of nutrition in famine which can be used to analyse the underlying causes of malnutrition, the stage of famine, and the risks of disease and death. This is useful as a basis for nutritional assessments, for identifying appropriate interventions, and targeting strategies. Practical suggestions for carrying out assessments and for alternative interventions are given. The institutional and political change needed for the successful implementation of appropriate interventions is also considered.

To obtain a copy of this book please contact: IT Publications, 103-105 Southampton Row, London, WC1B 4HH, UK. Phone: (44 171) 436 9761 Fax: (44 171) 436 2013. Email: [email protected]

(Source: Information extracted from cover of “Nutrition Matters”)

“Child Growth and Nutrition in Developing Countries: Priorities for Action”

(1995) edited by Per Pinstrup-Andersen, David Pelletier, and Harold Alderman. Cornell University Press, Ithaca and London. 447 pages.

What can be done for the estimated 190 million of the world’s children under age five who are chronically undernourished? This book presents a broad, multi-disciplinary approach to eliminating child malnutrition in developing countries. Exploring its causes, consequences, and solutions, the volume offers a penetrating analysis of why so many previous policies, programs, and technological interventions have tailed to alleviate protein-energy malnutrition. While the authors feel that technology can play a role, they conclude that effective and sustainable solutions must be sought through careful analysis of the behaviour of individuals, households, and communities - preferably with community involvement in the analysis - to identify the ways in which community-based or external interventions can be designed or redesigned to improve nutrition.

Nineteen experts offer current knowledge and perspectives from nutrition, public health, epidemiology, agricultural and consumer economics, anthropology, child development, rural sociology, and community development. Combining academic perspectives with practical experience, they summarize a vast body of knowledge and experience and provide state-of-the-art guidance for future policy and program design.

The book can be ordered from: Cornell University Press, PO Box 6525, 750 Cascadilla St., Ithaca, New York 14851-6525, USA.

(Source: New Book Announcement, Cornell University Press)

“Human Development Report, 1995”

(1995) UNDP Oxford University Press, 240 pages.

This sixth edition of the widely-respected Human Development Report includes and updates the unique Human Development Indicators comparing human development in most countries of the world, and the data tables on all aspects of human development. This edition includes a special section that examines issues of gender. The report analyses global trends in closing and widening gender gaps in different regions and countries. It presents new indicators of gender equality in order to rank countries on a global scale, while it highlights policies which have ensured equal access to opportunities for men and women. It proposes new methodologies to measure and value unpaid contributions made by men and women to human development through household and community activities. It identifies a new action agenda for promoting gender equity in the decades ahead.

To obtain a copy of the report please contact: Oxford University Press, Walton Street, Oxford OX2 6DP, UK. Phone: 0865 56767

(Source: Oxford University Press New Book Announcement)

“World Agriculture: Towards 2010. An FAO Study”

(1995) edited by Nikos Alexandratos. FAO, Rome and John Wiley & Sons, Chichester.

World Agriculture: Towards 2010 details the latest forward assessment by the FAO or likely developments in world food and agriculture, including forestry and fisheries. The book focuses mainly, but not only, on developing countries, and examines two overlapping central themes: on one hand food security, and on the other natural resources, the environment and sustainability.

Containing a detailed analysis and evaluation of the agricultural potential of land resources and their use in developing countries, the book discusses the prospects for putting agriculture on a sustainable path. This is assessed against a background of population growth with a prevalence of food insecurity and undernutrition, progressive reduction in world agricultural growth, the degradation of natural resources, and anticipated overall economic developments.

The findings of this book are from intensive FAO multidisciplinary analyses, providing a global picture of likely developments in world food and agriculture from detailed assessments by country, by product, and by agroecological zone. As such, this book is the most comprehensive analysis available of the agricultural potential of the land and water resources of developing countries.

To obtain a copy of this book please contact: John Wiley & Sons Ltd, Baffins Lane, Chichester, West Sussex, PO19 1UD, UK. Phone: (44 1243) 779777

(Source: Information taken from cover of “World Agriculture: Towards 2010”)

“The Food System”

(1995) by Geoff tansey and Tony Worsley. Earthscan Publications, London.

Food is a massive industry, and the many key players involved - farmers, workers, manufacturers, traders, retailers, caterers and consumers - have very different interests. In wealthy nations those interests can range from corporate survival and maintaining profits, to promoting a healthy diet and ensuring food safety. For the poor, the emphasis is all too often on simply getting enough to eat.

The Food System provides an essential overview of today’s dominant food system - one developed in and controlled by Northern industrialized countries, and becoming increasingly globalized. As information technology and biotechnology are set to revolutionize the food system, it is essential to understand the broad context in which the different actors operate if all the world’s people are to enjoy a safe, secure, sufficient and sustainable food supply.

The Food System is an absorbing book for the general reader and is packed with information, attractively presented and written in a lively, accessible style. It also makes an ideal text for anyone working on any aspect of food - from agriculture and food technology, management, retailing, catering and consumer studies, to politics and development.

To order a copy of the book please contact: Earthscan Publications Ltd., 120 Pentonville Road, London N1 9JN, UK. Phone: 44 171 278 0433 Fax: 44 171 278 1142.

(Source: Earthscan Press Release, 20 July 1995)

“Nutrition Guidelines”

Figure

(1995) Mcins Sans Frontis, Paris. 191 pages.

Nutrition interventions are among the most essential components of an emergency relief response. Nutritional assessments and interventions have an important place in needs assessments, information systems, preventive and curative services, and public health measures.

In this practical handbook, fundamental concepts and principles for assessing nutritional problems are discussed, including the rationale for designing a strategy. Detailed information is given on planning, implementation and evaluation of selective feeding programs.

As a result the guidelines help one to reflect carefully before taking decisions and implementing a nutritional program.

The methods described are based on scientific insights which are extensively evaluated through field experience of MSF, resulting in practical guidelines adapted to field circumstances.

Many schemes, tables and other illustrations make sure the handbook is practical and easy to use.

This book is intended to facilitate, by MSF and other agencies, effective implementation of nutrition programs on behalf of populations in danger.

Summary

Nutrition Guidelines is arranged into 3 parts: decision making tools and strategy design; techniques of obtaining reliable and valid data on prevalence of malnutrition; and the implementation of selective feeding programs.

1. Nutritional strategies in emergencies
2. Rapid nutrition surveys among populations in emergency situations
3. Selective feeding programs

In the first part of the book the reader is guided through a rational decision making process. Recommendations are given on indicators needed to be gathered in order to be able to make a proper nutritional assessment. Principles of nutritional interventions are made clear and an appropriate nutritional strategy has to be designed based on the interpretation of a nutritional assessment.

One of the most important indicators is the prevalence of malnutrition in the population, which has to be assessed through a survey. In the second part of the book all stages for the planning and implementation of an anthropometric survey is explained: objectives, measurements and indices to be used, cut-off points, various sampling methods, statistical processing, analysis, etc.

Once data are gathered, analyzed and a strategy is chosen, nutritional interventions should be implemented. The last part of the book is a detailed manual on planning and implementing selective feeding programs, e.g. therapeutic feeding programs for the severely malnourished and supplementary feeding programs for the moderately malnourished. Standardized medical and nutritional protocols and procedures ensure a reasonable quality of care and enable a rapid intervention: procedures on screening, admission, discharge criteria, medical treatment, individual feeding schedules, standard feeding schedules, recipes, registration, food preparation, stock control.

Finally, methods for evaluating the performance of the centre facilitate rational management.

To obtain a copy of “Nutrition Guidelines” please contact: Mcins Sans Frontis, Logistique Mcale, 8, rue Saint-sabin, 75544 Paris Cedex 11, France. Phone: (33) 1 40 21 2929 Fax: (33) 1 48 06 68 68.

(Source: New Publication Announcement, Mcins Sans Frontis, 1995)

“The Miracle of Germinated Cereal Grain Powders”

(1992) by Tara Gopaldas and Suneeta Deshpande. Daya Publishing House, New Delhi.

One rarely thinks of germination as biotechnology, it is, however, one of nature’s most astounding and bountiful biotechnology systems that can be harnessed for the improvement of young child feeding in the Third World. The University Department of Foods and Nutrition, Faculty of Home Science, M.S. University, Baroda, has been working in the area of fully germinated, partially germinated and finally to catalytic amounts of germinated cereal flours (Amylase-Rich Foods or ARF) for the improvement of weaning diets. A tremendous impetus was given to the ongoing research by a very generous research grand and the gift of an Infant Foods (India) laboratory by the International Development Research Centre (IDRC), Canada, in 1988. IDRC also supported two International Workshops on “ARF Technology” - the first at the 14th International Congress of Nutrition, Seoul (Korea) in August 1989, and the next in Baroda (India) in October 1990. It has also financed the production of this book. The book has been organized into four sections. The First Section contains the proceedings and papers presented by invited experts at the Seoul and Baroda Workshops. Section Two contains twelve full papers published in various international and national scientific journals. Section Three contains abstracts of the dissertation work or work in progress by four Doctoral and some eighteen Masters students. Section Four tells the reader “How to make ARF” and “How to make simple weaning gruels”. The authors have attempted to illustrate the book with photographs, illustrations and sketches to the extent possible.

To order a copy of the book, please contact: Daya Publishing House, 1123/74 Deva Ram Park, Tri Nagar, Delhi-110035, India. Phone: 7231826.

(Source: Foreword to “The Miracle of Germinated Cereal Grain Powders” by Dr Mrunalini Devi Puar, Chancellor, The Maharaha Sayajirao University of Baroda, India)

OMNI: Salt Iodization Manual is Published

The Program Against Micronutrient Malnutrition (PAMM), an OMNI partner, has recently published a new manual entitled Monitoring Universal Salt Iodization Programmes. The manual was developed through a grant to PAMM from the Micronutrient Initiative (MI). Other sponsoring agencies include UNICEF, the International Council for Control of Iodine Deficiency Disorders (ICCIDD) and the World Health Organization (WHO).

The manual has been prepared in response to a strong need in the field for a systematic procedure to establish a permanent iodized salt monitoring system within a country and to monitor progress of universal salt iodization. It is designed for country program managers who require guidelines and reference materials in order to design and implement iodine deficiency disorder (IDD) monitoring programs. Because of the differences in culture, economics, infrastructure, finances and many other factors, each country’s plan to eliminate IDD must be unique and selective of appropriate activities. The most feasible system will be determined by a combination of local factors, industry and health infrastructure It sill therefore be up to each country to select those elements that are most appropriate for a specific country situation the goal of the manual is to integrate and institutionalize salt monitoring and quality assurance into the daily activity of salt producers with periodic monitoring by the government to ensure adequate iodization of all salt for human and animal consumption.

Some of the materials in the manual are based on training courses at the PAMM in Atlanta, GA. Other ideas and examples included are based on country experiences and on consultations with individuals around the world. Contributors to the manual come from a variety of disciplines, including laboratory science, engineering, medicine, public health, law, nutrition, management and epidemiology. This variety of backgrounds shows the diversity required in national programs to address IDD.

The editors encourage individuals to provide “case studies” on what worked and what did not work in their national programs, and how practical the information provided proves to be. A second version of the manual is planned to include information on how to assess the magnitude and distribution of IDD within the population. This information was purposely left out of this first version in an effort to keep the primary focus on salt iodization and monitoring. As the year 2000 approaches, however, information on the prevalence of IDD will become increasingly important. It is hoped that the second version of the manual will gather more illustrations from developing countries on the approaches and tools being used to monitor iodized salt programs as well as dealing in greater depth with the special needs and constraings facing small-scale salt producers and others in resource-poor situations. Social marketing, another important component, also will be discussed.

For more information, or to obtain a copy of the manual, contact: PAMM/Department of International Health; Rollins School of Public Health of Emory University; 1518 Clifton Road, N.E., 7th Floor; Atlanta, GA 30322 USA. Phone: 404 727 5724 Fax: 404 727 4590 Email: [email protected]

(Source: OMNI Update, May 1995)

“Bridging The Gaps: The World Health Report 1995”

(1995) World Health Organization, Geneva. 120 pages.

Drawing upon a database unprecedented in its completeness, The World Health Report 1995: Bridging the Gaps documents the attributed causes of ill-health and death for each age group throughout the human life span, around the globe. Analytical as well as descriptive in its approach, the report also explores the root causes of health problems and what can be done to solve them.

While progress is evident for some diseases in some countries, others show trends that are deeply disturbing. As the report reveals, today’s global health situation is characterized by ominously widening gaps between rich and poor, between one population and another, and between age groups. Though many countries have already reached the health targets set by WHO for the year 2000, in come parts of the world, life expectancy is actually decreasing and populations lack access to even the most basic health care.

For virtually all the major diseases that kill children or cut short the lives of adults, the picture that emerges is one of immense suffering easily prevented or treated by technologies that already exist and cost surprisingly little to implement. As the report makes abundantly clear, the gaps that need to be bridged include the discrepancy between knowing exactly what should be done and finding the will and resources to do it. Facts and figures gathered in the report also underscore the fundamental importance of health to socioeconomic development: when the poor are made more healthy, they can earn more and become less poor.

By ranking the major causes of death and ill-health, and showing how they can be prevented, The World Health Report 1995: Bridging the Gaps provides a solid foundation for priority setting and action - and challenges the world conscience to face the difficult ethical issues raised by so much preventable suffering.

To order a copy of The World Health Report 1995 please contact: World Health Organization, Distribution and Sales, 1211 Geneva 27, Switzerland. Fax: (41 22) 791 4857.

(Source: Information Announcement, World Health Organization, 1995)

AHRTAG: New Child Health Newsletter Launched

Millions of children in developing countries owe their lives to either oral rehydration therapy, immunisation, or standard case management of acute respiratory infections. Over the past decade, these interventions have been responsible for significant improvements in child mortality.

However, many children continue to die from preventable or treatable illnesses. Five illnesses account for almost three-quarters of deaths of children under five - acute respiratory infections, diarrhoeal diseases, malaria, measles and malnutrition. Most of these deaths could be avoided if families sought medical help promptly and health workers were well trained in recognition and management. Community-level prevention measures are also vital.

In order to support health and community workers to tackle child health, AHRTAG is launchind a new child health newsletter: Child Health Dialogue will focus on practical prevention and management of the five main childhood illnesses. The new 12-page quarterly newsletter will replace AHRTAG’s popular child health newsletters, Dialogue on Diarrhoea and ARI News, and will build on their strengths - the provision of clear, practical information. New features will include an eye-catching colour design, regular columns on essential drugs and training tips, simplified research updates and quizzes.

Child Health Dialogue will be free to readers in developing countries and will cost £12 per year to individuals in Europe, North America, Australasia, and Japan. Special rates are available for students, organisations, and bulk orders.

For further information please contact: Kate O’Malley or Mary Helena, AHRTAG, 29-35 Farringdon Road, London EC1M 3JB, UK. Phone: (44 171) 242 0606 Fax: (44 171) 242 0041.

(Source: AHRTAG Press Release, October 1995)

Journal of Food Policy Special Issue on: Nutrition and Human Rights to be published in February 1996, Volume 21, number 1. Guest Editors: Wenche Barth Eide, Uwe Kracht, and Robert E. Robertson. “Nutrition and Human Rights - why aren’t they the most obvious couple? Why aren’t the two ideas fused in everyone’s mind? Why is it necessary to resort to complex philosophical and legal justifications to establish and define the right to nutrition, when everyone should share an understanding that nutrition is the base upon which all meaningful human activity must stand?” Extracted from Robert E. Robertson’s paper “Nutrition, Human Rights and Resources” In this special issue of Food Policy, legal, nutrition, and development scholars, practitioners, and human rights activists present the historical and legal foundations of modern human rights law as it pertains to the promotion and protection of economic, social, and cultural rights including those particularly relevant to nutrition rights. A limited number of copies of this special issue will be available from WANAHR (World Alliance on Nutrition and Human Rights) Secretariat, Mr. E. Ivas, c/o Norwegian Institute of Human Rights, Grensen 18, N-0159, Oslo, Norway. Fax: +47 22 42 25 42 Email: [email protected]

Figure