News and Views

PRACTICAL ANALYSIS OF NUTRITIONAL DATA (PANDA)

Tulane University's Public Nutrition Program and UNICEF

Improving nutrition requires appropriate analysis of data based on local conditions leading to decisions for program design. Data collection and nutritional surveys are available widely, yet immediate assessment of the results is often delayed, incomplete, or based on unsound statistical analysis. Thus, many projects are poorly targeted, contain unrealistic goals, and do not reflect the true needs of the community. With improved analysis skills, more precise recommendations could be made; thus, improving project implementation and outcomes. The capability to improve analysis of the collected data requires time, practice, and exposure to a variety of datasets, analysis methods, and procedures. One method to improve these skills is to implement technology-infused, yet practical analysis techniques for the training of health workers.

The Practical Analysis of Nutritional Data (P.A.N.D.A.) is a CD-ROM-(& Web-browser) based interactive learning package which is being developed by Tulane University Department of International Health and Development, with UNICEF support. The package is designed for those who want to expand their basic analytical skills and apply them to analyzing nutritional and related data, to answer relevant questions about malnutrition, its distribution, causes, correlates, synergies (or interactions), and related issues. It is hoped that readers will start to use, and also help develop, the PANDA. Analytical exercises use SPSS and (soon) EPI-2000 Windows version of EPI-INFO. The alpha (test) version of the CD-ROM is now being distributed free of charge for the nutrition community. An updated version of PANDA is being developed, and will include modules on micronutrients, emergencies, food and livelihood security, and program monitoring and evaluation in collaboration with the Micronutrient Initiative and CARE International, for release later in 1999.

For requests for copies of PANDA, and for further information and suggestions, should be addressed to: Public Nutrition Program, do John Mason, Department of International Health and Development Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112 USA; tel: (504) 586-3987; e-mail: [email protected]. UNICEF staff should contact: Krishna Belbase, UNICEF Headquarters, Nutrition Section, Program Division, 3 UN Plaza T-24A, New York, NY 10017 USA; email: [email protected]

Maternity Entitlements

WABA and IBFAN

World Alliance for Breastfeeding Action and the International Baby Food Action Network

During the 87th International Labour Office meeting in June 1999, the International Labour Organisation (ILO) voted to maintain 12 weeks paid maternity leave as a minimum standard for all employed women; to maintain the entitlement to paid breastfeeding break(s), with their frequency and length to be determined by national law and practice; and to provide for an unspecified period of compulsory leave (previously six weeks compulsory leave). Excepting the specified period of six weeks compulsory leave established in 1952, these minimal standards vary little from those outlined in that year.

This NGO caucus noted that during the lead-up period to the meeting of the Maternity Protection Committee the nursing breaks entitlement* was under threat. Under a list of proposed conclusions prior to the Conference, the International Labour Office (the ILO's Secretariat) had suggested that these were more appropriately placed in the optional Recommendation. This would have weakened the status of these breaks and meant that ratifying countries were no longer legally bound to implement nursing breaks in their own national legislation. The ILO Report V(1) on maternity protection notes that over 80 countries already have nursing breaks in national laws. Fortunately, the proposal to remove nursing breaks to the Recommendation was narrowly defeated when it came to the vote in Committee.

* The ILO defines nursing as both breastfeeding and the expression of breastmilk (Maternity Protection at Work, Report V(2), ILO, 1999, and Maternity Protection at Work, Report V(1), ILO, 1997. Note: WABA/IBFAN Press Release, June 20, 1999. For further information contact: Sarah Amin, WABA, PO Box 1200, 10850 Penang, Malaysia; tel: 604 658 4816; fax: 604 657 2655; Internet: http://www.elogica.com.br/waba; email: [email protected]

Concerned NGOs noted that the Convention would not be formally adopted until June 2000 when the Committee next meets. Intense work thus needs to be undertaken at the national levels by the health sector, public interest NGOs and women's groups and organizations to educate trade unions, employers and particularly governments about the importance of breastfeeding. Much of this work needs to occur before November this year, at which time governments must submit comments on the revised Convention and Recommendation to the ILO. Given the rapid rise in labour market participation among women of childbearing age, it is vital that these minimal standards are retained within the new Convention. The need for maternity protection is just as relevant now as it was in 1919, when the Maternity Protection Convention was first devised.

Towards a Virtuous Circle - A Nutrition Review of the Middle East and North Africa

Atsuko Aoyama, Health Specialist, The World Bank

The countries of the Middle East and North Africa (MENA) region face unprecedented challenges. The pace of change in the global economy has never been faster, prompting the need for new strategies to promote economic and social development. Governments in the region are struggling to sustain the improvements in the quality of life of their citizens. Good nutrition is key to maintain or improve health, and people's ability to secure an adequate diet is fundamental to achieving social and economic advances. Improving nutritional status is linked to economic progress, and economic progress often helps people improve their nutritional status, creating a virtuous circle. Nutritional status is one of the best proxies to measure poverty and social development, however, nutrition disorders frequently escape notice.

This nutrition review in the MENA region is to develop a base of knowledge and a sector strategy, and to help fulfil the World Bank's mandate for poverty reduction. This is the Bank's first comprehensive overview of nutritional issues in the region. It aims to place nutrition in an overall economic development context, and to focus on the health implications of poor nutrition. MENA countries have largely achieved food security, and the nutritional status of most people has improved over the last two decades. Despite these achievements, undernutrition and micronutrient deficiencies remain a serious threat to public health. Recently, the prevalence of stunting has even increased in several countries. Anaemia is widespread among women and children; and there is a high incidence of iodine deficiency disorders and vitamin D deficiency. Changes in the diet brought about in part by new-found prosperity have escalated the rise in obesity and diet-related non-communicable diseases such as heart disease and diabetes mellitus. Even though nutritional deficiencies are strongly linked to poverty, economic progress does not always improve nutritional status. This appears to indicate that even in well-performing economies, living conditions are uneven, leaving pockets of poverty in its wake, especially among rural populations. On the basis of available data, MENA countries could be divided into three categories with very different actions required:

· Type 1: high malnutrition and micronutrient deficiency; low economic and social indicators; e.g. Yemen. Specific nutrition interventions and comprehensive health and social programs are required urgently. Decreasing malnutrition of small children and pregnant women should be the first priority. International support will be essential.

· Type 2: relatively large population with undernutrition, large urban/rural gaps and high degrees of micronutrient deficiency; relatively well performing middle income economy with a significant number of poor; e.g. Iran. Specific nutrition interventions and comprehensive health and social programs should be targeted to the rural population, urban poor, women and small children. Food policies should be assessed for their effectiveness and real nutrition impacts on the vulnerable groups.

· Type 3: high obesity and micronutrient deficiency; relatively high income with pockets of poverty and social indicators that are low in comparison with similar level economies in other regions; e.g. Saudi Arabia. IEC programs for obesity and micronutrient deficiencies prevention and micronutrient fortification programs are needed, in addition to nutrition and social programs targeted to the vulnerable groups. International agencies may need to provide technical assistance.

Specific actions should be planned based on assessment of each country and existing programs. Options for the World Bank to assist MENA countries in improving nutrition include:

· Stimulate country discussions among stakeholders in the social and economic sectors.

· Make nutrition a policy priority in the context of economic and social development.

· Promote specific programs; strengthen current national public health programs with more nutrition activities; and monitor nutrition outcomes.

Contact: A Aoyama, Health Specialist, Middle East and North Africa Region, The World Bank, MNSHD, Washington, DC 20433 USA; email: [email protected]

Maputo... February 15...

Regional HIV/AIDS and Nutrition Workshop Held

Commonwealth Regional Health Community Secretariat (CRHCS)

A one-week HIV/AIDS and nutrition workshop, the first of its kind in the region, was convened by CRHCS in collaboration with the LINKAGES and SARA projects of the US Academy of Educational Development. It was attended by HIV/AIDS programme managers, country level nutrition experts and reproductive health managers from Botswana, Kenya, Lesotho, Mauritius, Malawi, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

The Workshop participants produced several recommendations. One recommendation urges that women of reproductive age in the eastern, central and southern African Region have access to information regarding mother-to-child transmission (MTCT) of HIV/AIDS through breastfeeding, including available feeding options. It was also recommended that member states of the CRHCS should continue to promote breastfeeding among HIV-negative women and those of unknown status and intensify information on HIV/AIDS transmission for women and their partners. Member states were also urged to promote voluntary counselling and testing as an important component of HIV/AIDS prevention and control programmes. Other recommendations included that members states should strengthen the involvement of people living with HIV/AIDS in policy and programme interventions; and strengthen community-based initiatives to care for people living with AIDS and their affected family members. Member states should also explore possibilities for improving access to drugs and other modes of health care that have been scientifically proven to reduce MTCT of HIV/AIDS.

Also recognizing the crucial role of nutrition in HIV/AIDS and related illnesses, participants recommended that member states, in collaboration with CRHCS and other relevant agencies, should develop and strengthen existing food and nutrition policies and plans of action at national levels within the primary health care context. CRHCS Regional Secretary, Dr Winnie Mpanju-Shumbusho, told the participants that one immediate action would be the moblization and strengthening of partnerships among governments, regional and international organizations, and other key actors and stakeholders to mount a collective response to address the region's HIV/AIDS epidemic and to intensify efforts towards primary prevention of HIV/AIDS. She added that CRHCS would facilitate dissemination of models of good practice in HIV/AIDS/STIs and nutrition and will also identify support mechanisms and facilitate work plans towards implementation of the recommendations.

Contact: B Giyose, CRHCS, Food & Nutrition Programme, PO Box 1009, Arusha, Tanzania; tel: 255 57 8362; fax: 255 57 8292; email: [email protected]