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close this bookSCN News, Number 14 - Meeting the Nutrition Challenge (ACC/SCN, 1997, 60 p.)
View the document(introduction...)
View the documentUnited Nations Administrative Committee on Coordination Sub-Committee on Nutrition (ACC/SCN)
View the documentDedication to Tim Stone
View the documentChairman’s Round-Up: Message from the Chairman
View the documentThe Nutrition Challenge in the Twenty-First Century: What Role for the United Nations?
View the documentMeeting the Nutrition Challenge: A Call to Arms
View the documentUpdate on the Nutrition Situation, 1996
View the documentPoor Nutrition and Chronic Disease
View the documentEffective Programmes in Africa for Improving Nutrition
View the documentNews and Views
View the documentProgramme News
View the documentPublications
View the documentSCN Publications Available

News and Views

World Food Summit
13-17 November 1996, Rome

World leaders from 186 participating countries assembled in Rome in November 1996 for the World Food Summit, which was aimed at renewing global commitment to the fight against hunger and malnutrition, and achieving lasting food security for all. The FAO called the Summit in response to widespread undernutrition and growing concern about the capacity of agriculture to meet future food needs.

With more than 800 million people throughout the world unable to meet their basic nutritional needs, the Rome Declaration on World Food Security reaffirmed the right of everyone to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger. It pledged commitment to achieving food security for all and to eradicating hunger in all countries with an immediate view to reducing the number of undernourished people to half their present level no later than 2015. The Declaration sets out seven commitments:

· Laying the groundwork for development a peaceful, stable and enabling political, social and economic environment, based on full and equal participation of women and men is the essential foundation for food security and poverty eradication.

· Reduce poverty and facilitate access to food: poverty is a major cause of food insecurity and sustainable progress in poverty eradication is critical to improve access to food.

· Adapt development policies: sustainable agriculture, fisheries, forestry and rural development are essential for adequate and reliable food supplies. The problems of pests, drought and desertification need to be combatted.

· Facilitate trade: trade is a key element in food security - food, agricultural and overall trade policies must be conducive to fostering food security for all through a fair and market-orientated world trade system.

· Improve forecasting and respond to food security: natural disasters and man-made emergencies give rise to transitory and emergency food requirements. Such emergencies must be prevented or prepared for.

· Encourage investment public and private investment is required to foster human resources, sustainable food agriculture, fisheries and forestry systems, and rural development.

· Implement, monitor and follow up the Plan of Action.

The FAO World Food Summit Web Site offers all the major Summit documents, including Part One of the 'Report of the World Food Summit'. The site includes news bulletins, information for NGOs, and transcripts of some of the speeches. The texts of the Rome Declaration on World Food Security and the World Food Summit Plan of Action are also available at this site. The web site can be found at:

Source: FAO WFS Web site; the Rome Declaration on World Food Security and the World Food Summit Plan of Action

SCN Statement on the World Food Summit

At the 23rd Session of the Sub-Committee on Nutrition which took place from 24 February - 1 March 1996, in Accra, Ghana, the following consensus statement was issued to reflect the SCN's support for the World Food Summit initiative. The Summit took place in Rome the following November.

Malnutrition robs a country of its best minds and bodies and the lives of children. In the two decades since the World Food Conference of 1974, the questions of how much food the world grows and how that food is distributed have rightly remained at the centre of international debate and concern. However, emphasis on large- and small-scale food production must be linked to access to food and its utilization by households and communities. In Sub-Saharan Africa, the prevalence of undernutrition increased between 1990 and 1995 and nutritional improvement in most other developing areas of the world is slowing down or stagnating. The gravity of malnutrition cannot be overemphasized. Malnutrition reduces intelligence, educability, disease resistance, productivity and activity. Furthermore, it is passed along to the next generation if the pregnant woman is malnourished. Reducing or preventing malnutrition offers widespread, tangible benefits for individuals and countries.

The SCN strongly supports the World Food Summit which will be organized by the Food and Agriculture Organization of the UN (FAO) at its Rome headquarters in November 1996. It welcomes the attention and focus the Summit will bring to the problems of hunger and malnutrition, and sustainable strategies to address them, particularly in view of current and projected world population growth, concerns about the environment, and problems of global, national and household food security. We urge all participating member governments, international organizations, bilateral and non-governmental organizations, to review all background documents to assure adequate attention is paid to malnutrition and to assure the widest possible participation in the preparation for, deliberations at, and follow-up to the World Food Summit.

Agricultural development will have the greatest impact on reducing malnutrition if it is coupled with efforts to improve family income, the health environment, and nutrition behaviours. Agricultural production must be linked to household food security, improved education, and appropriate care practices. To assure a sustainable and sufficient world food supply, it is necessary to keep under review investments in agricultural development affecting supply. It is also imperative to increase the production and consumption of legumes, fruits, and vegetables to address micronutrient malnutrition. However, these necessary steps are not enough. We believe that increased investments in these areas must be matched with programmes of action on nutrition to achieve the goals set by the 1992 International Conference on Nutrition.

It is clear that continued supportive action at the global level is needed. Since the World Food Conference and the International Conference on Nutrition, we have learned much about what works to address malnutrition. It is now clear that a variety of approaches can work within the resource constraints of developing countries. What is common in these approaches is that they involve the family and the community in finding the appropriate solutions to the nutrition problem.

Neither financial resources nor technology are binding constraints. What is required is political commitment and a sound strategy in each country. The world is not trapped in irreversible downward trends. Many countries have shown how to improve the nutritional status of their people, especially the most vulnerable. If clear action is taken seriously and soon, improvements in nutrition will become evident - with positive results for today's society and for future generations.

Accra, 1 March 1996

Regular Deworming of School-Age Children: Study Shows Promising Results

A new study has indicated that a low-cost deworming strategy in school-aged children can significantly reduce the amount of blood loss caused by intestinal worms. According to WHO estimates, around 1,400 million people worldwide are currently infected with one or more of three intestinal helminths - roundworm, whipworm, or hookworm. Infection with any of these can cause health problems, but hookworm is particularly debilitating, attaching itself to the intestinal wall, and causing iron deficiency anaemia by blood loss.

Amongst the most vulnerable to adverse effects are an estimated 400 million infected school-age children, whose normal growth, nutritional status, and learning ability are all threatened.

The study - carried out by a collaborative team with members from Johns Hopkins University, USA, the World Health Organization, and the Ministry of Health of Zanzibar, United Republic of Tanzania - involved 3,600 primary school children in 12 schools on Pemba Island, one of the two main islands of Zanzibar. Researchers estimated that treatment with mebendazole - given three times yearly - saved the loss of almost a quarter of a litre of blood per child annually at a cost of about 15 cents - a fraction of the cost of other drugs currently used for deworming.

Dr Lorenzo Savioli, a WHO expert in parasitology put the findings into context: “these results are a milestone, because they conclusively demonstrate that regular deworming is an effective, cheap and sustainable tool to control debility among children in endemic countries... the challenge now is to utilise this tool and integrate it with other health interventions, especially micronutrient supplements, to improve the health of children.”

More information can be obtained from Dr Lorenzo Savioli, Schistosomiasis and Intestinal Parasites, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41-22-7912664, Fax: 41-22-7914869. Email: [email protected]

Gujarat's Improved Mid-Day Meal Programme for 3 Million Primary Schoolers from 1994

A report on the pre-post impact evaluation of the improved mid-day meal programme, Gujarat. By Tara Gopaldas & Sunder Gujral, 1996

By the year 2000 the Government of India will universalize primary education, and approximately 200 million undernourished and underprivileged schoolers (6-15 years) will get free mid-day meals. The Western state of Gujarat, acknowledged to be one of the most pragmatic in the country, has been the first to realise the vital link between “Education and Educability”, and since 1994, nearly 3 million schoolers in its Mid-Day-Meal Programme (MDMP) have been receiving a simple additional school health package of “deworming + iron + vitamin A”. This report provides an evaluation of the improved mid-day meal programme, based on the operational research conducted by Professor Tara Gopaldas and her group at Maharaja Sayajirao University at Baroda.

The school health package consists of a six-monthly dose (400 mg) of albendazole and vitamin A (200,000 IU) and one tablet daily of ferrous sulphate providing 60 mg of elemental iron for 85 days per term for 2 terms a year. On an average, 72% of schoolers participated in the Health Package Programme.

To evaluate the effects of the package, two rounds of surveys - one at baseline and one 6-9 months after implementation of the Health Package Programme by the Government of Gujarat - were carried out on approximately 6,000 children in 3 selected districts by Tara Consultancy Services.

The prevalence of intestinal parasitic infections in schoolers significantly reduced from 40% to 32% in response to the health inputs. These findings are supported by the stool examination conducted on a sub-group of schoolers where the prevalence was 71% in those who had not received the health inputs, compared to 40% in those who had. The mean haemoglobin levels of schoolers significantly improved in response to the health inputs from 10.6g to 11.8g/dl. Consequently, the prevalence of iron deficiency anaemia (IDA) reduced from the Baseline survey to the Resurvey (84% to 53%).

A significantly smaller proportion of schoolers were affected with diarrhoea/dysentery/upper respiratory tract infections at the Resurvey as compared to the Baseline Survey. Vitamin A deficiency ocular signs decreased from 48% to 22%. These reductions were recorded in younger (6-10 years) as well as older (11-15 years) age schoolers. Growth improved markedly, and so did the weight-for-age and height-for-age curves of the schoolers.

More schoolers were nutritionally in the normal category by the Body Mass Index at the Resurvey. About 70% schoolers perceived that they felt physically more fit than before (more active/energetic; could study and play well etc.) after taking the health inputs.

This simple and cost effective intervention was achieved for about 34 US cents per schooler per annum. It can well be adopted by the entire developing world.

For further information please contact: Professor Tara Gopaldas, Director, Tara Consultancy Services, “Saraswathi”, 124/B, Varthur Rd., Nagavara Palya, Bangalore 560093, KA, India. Phone 91 (80) 5282999 Fax: 91 (80) 5285914

Breastmilk's Unique Protective Qualities

It is well known that infants who are formula fed contract more infections than those who are breastfed, and the use of contaminated water in feeds has commonly been thought to be responsible for this. But even when fed sterile formula, infants suffer from more meningitis and infection of the gut, ear, respiratory tract, and urinary tract than their breastfed counterparts. Why is this? The answer may lie in the intricate and unique make-up of human breastmilk - according to an article in Scientific American scientists have discovered a range of components which actively offer protection to newborns from disease in a variety of ways.

Antibodies Amongst the antibodies found in breastmilk, one known as IgA, or more specifically secretory IgA, is found in the largest quantities. Secretory IgA is present in abundance in the gut and respiratory system of adults where it binds to pathogens and denies them access to the body's tissues. Infants are unable to make secretory IgA on their own, often until several weeks or even months after birth, and thus rely on the antibody being passed on through breastmilk.

Furthermore, the antibodies in breastmilk are formed in direct response to pathogens ingested by the mother. The result is a highly specific collection of antibodies which can protect an infant against those disease-causing agents he is most likely to encounter.

Immune Cells White blood cells (or leukocytes) are abundant in human breastmilk and have the ability to fight infection themselves, and to activate other defence mechanisms.

Protective Molecules Amongst the other components of breastmilk thought to offer protection are:

· Oligosaccharides - these simple chains of sugars can prevent bacteria from entering cells by providing binding sites similar to those on cell walls;

· Mucins- have similar properties to oligosaccharides;

· Lactoferrin - a protein which can bind to two atoms of iron making it unavailable to pathogenic bacteria;

· B12 binding protein - deprives microorganisms of vitamin B12:

· Bifidus factor - promotes growth of the harmless bacterium Lactobacillus bifidus, which helps to crowd out more dangerous bacteria;

· Free Fatty Adds - these can damage the membranes of enveloped viruses such as chicken pox;

· Interferon - displays strong antiviral activity; and

· Fibronectin - this has the ability to make some phagocytes (a cell which engulfs particles such as invading microorganisms) more aggressive.

Something in breastmilk also appears to bring about faster maturation of an infant's immune system - for example, breastfed babies produce more antibodies when immunized. And something, as yet unidentified, seems to stimulate infants' production of secretory IgA, lactoferrin, and lysozyme, all of which are found in larger amounts in the urine of breastfed babies than formula fed babies (breastfed babies cannot absorb these molecules from human milk into their gut). Perhaps this explains the findings of recent studies that demonstrate that the breastfed infant has a lower risk of acquiring urinary tract infections.

Source: Newman, J. (1995) How Breast Milk Protects Newborns. Scientific American, December 1995, 58-61

Poverty Assessment in Kenya

The results of a poverty assessment in Kenya, published by the Population and Human Resources Division, Eastern Africa Department of the World Bank, have revealed no improvement during the decade 1982 - 1992 in the proportion of the rural population below the poverty line - the figure remains at around 50%. It also showed that in 1992, the proportion of the urban population below the poverty line was around 30%.

According to an article on the findings, the rural poor are predominantly subsistence farmers and families whose income comes mainly from the informal sector, whilst the urban poor are either unemployed or in the informal sector. Children from poor families have less schooling, are more likely to be malnourished, less likely to be immunized, and face higher chances of dying in infancy and childhood.

From 1982-1992, Kenya did achieve improvements in some of its social indicators. However, a lack of sustained per capita income growth together with unequal distribution of education and health care benefits are amongst the factors singled out as responsible for the increase in numbers of poor in the country. These factors are targeted in the strategy for improvement suggested in the report.

The report concludes that “broad-based economic growth and the provision of basic social services to the poor are two mutually reinforcing strategies that could assure rapid and sustainable progress for the people of Kenya. One without the other is insufficient and inadequate progress in one constrains the other.”

To obtain a copy at the report “Kenya Poverty Assessment” Report No. 13152-KE published in 1995 by the Population and Human Resources Division, Eastern Africa Department, Africa Region, World Bank, Washington, D.C. please contact: Ms Yordanos Seium, Room J10-204, World Bank, Washington, D.C. Phone: (202) 473-4099

Source: World Bank (1996) Assessing Poverty in Kenya. Findings: Africa Region, No. 55, 1-3

Thrasher Research Fund.

Request for proposals on food-based approaches to preventing micronutrient malnutrition

Food-based approaches offer sustainable solutions to problems of malnutrition, and include all activities affecting human nutrition and health, which are associated with the production, acquisition, preservation and utilization of food. To exploit the potential for food-based systems, the Thrasher Research Fund are inviting submission of research proposals in the following areas:

· Increasing the effectiveness of foods and/or diets as sources of key micronutrients

· Increasing the supply of micronutrient-rich foods and increasing the micronutrient densities of foods

· Developing effective information, education and communication methods to promote food-based micronutrient interventions.

· Developing programs and policies that influence the choices of consumers and producers to increase the supply and consumption of micronutrient-rich foods.

· Evaluating existing or planned food-based micronutrient interventions to assess their impact in terms of acceptance, effectiveness, efficiency, utilization and sustainability.

The review committee will evaluate proposals based on several criteria: effect on health; practical application; innovation; purpose and aims; project site; replicability; funding considerations; and participatory approach.

Proposals will be accepted until 31 December 1998, or until all designated funds are committed. Support will be limited to three levels of funding: up to US$10,000; US$10,000-25,000; and US$25,000-$50,000.

For full details of policies, guidelines and application procedure, please contact Food-based Approaches, Thrasher Research Fund, 50E, North Temple Street, Salt Lake City, Utah 84150, USA. Fax: 801 240 1964 Phone: 801 240 4753

World Alliance on Breastfeeding Action (WABA)

The World Alliance on Breastfeeding Action (WABA) held its first Global Forum in Bangkok 2-6 December 1996. It brought together about 380 people from 85 countries, representing a multitude of disciplines as well as organizations.

WABA has existed for five years, but the present Forum was the first occasion for its supporters and users to meet in body. The Forum was ambitiously entitled “Children's Health, Children's Rights: Action for the 21st Century”, concentrating for action for the next century. There were 82 working groups in the course of the four days of meeting, formulating a series of recommendations and actions for the future.

The Forum for the first time addressed the issue of breast milk as a human right for babies, with all its legal and moral implications. A working group was established to work out how to utilise existing tools, such as the Convention of the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination Against Women. The reporting obligations and the requirements for observance that these Conventions entail for the states that have signed them can also have implications for work to protect and promote breastfeeding.

The Forum was important as a manifestation of the strength and liveliness of WABA, and the goodwill and willingness to work together that exist among the various voluntary organizations working in this field, in spite of differences in origin and agenda apart from breastfeeding which united them all. WABA thus has demonstrated its ability to serve as a unifying force, which can only bode well for the health of tomorrow's children.

For more information contact: WABA, P.O. Box 1200, 10850 Penang, Malaysia. Telephone 60-4-6584816, Fax: 60-4-6572655, Email: [email protected]

Source: Elisabet Helsing, Co-Chair, WABA
Email: [email protected]

Zvitambo: Zimbabwe Vitamin A for mothers and babies project

“Zvitambo” is a Shona word which literally means precious or very valuable. It is frequently exclaimed when visiting a newborn baby who is particularly robust and healthy. It is also the acronym for a project about to be launched, Zimbabwe Vitamin A for Mothers and Babies. This study aims to determine whether oral administration of vitamin A to mothers and infants immediately after childbirth will reduce mother-to-child HIV transmission during lactation, sexually transmitted HIV infection in women during the post-partum year, and infant mortality. The study will be carried out in Harare, Zimbabwe where mild vitamin A deficiency is apparent, 30% of pregnant women are HIV sere-positive and 6% of women who are seronegative at delivery become infected during the post partum year. This is a collaborative project between the University of Zimbabwe and the Centre for Tropical Diseases at McGill University, with the main trial due to start in October 1997. The project is funded by the Canadian International Development Agency (CIDA).

Breast feeding policy in HIV endemic countries is becoming a very difficult and emotional issue. Maternal-to-child transmission accounts for over 90% of paediatric HIV infections worldwide, and among breast feeding populations, some one-quarter to one-third of HIV infected infants acquired the infection while breast feeding. The reality of this risk presents a great dilemma for many African countries where a substantial proportion of lactating women are HIV infected but alternative infant feeding choices risk the 6 million infant lives saved each year by breast feeding. Making the issue even more difficult is that most African women do not know and many do not want to know whether they are infected with HIV or not. Therefore, breast feeding policy must weigh up the risks and benefits for populations as a whole. The health and survival of the infants born to HIV uninfected women in these populations may be jeopardized when breast feeding promotion is eroded in attempt to reduce risk among exposed infants. An intervention which reduces the infectiousness of the breast milk of HIV infected women and can be feasibly applied to all post-partum women is needed.

Emerging data demonstrating that vitamin A deficiency among HIV infected women is associated with higher concentrations of HIV in their breast milk and higher rates of HIV transmission to their infants suggest that vitamin A supplementation of mothers in the immediate post-partum period may reduce the risk of HIV transmission during lactation. This intervention has already been shown to benefit woman and their breastfed infants who are not infected with HIV by improving their vitamin A status. Providing vitamin A to uninfected post-partum women may also improve the integrity of their vaginal epithelium and strengthen their immune system, reducing their risk of acquiring the infection from sexual partners during the post-partum year, a period when women appear to be at particularly high risk of becoming infected. Furthermore, in one study, providing vitamin A to infants soon after delivery substantially reduced early infant mortality. Vitamin A supplementation of both mothers and their newborn infants in the immediate post-partum period, when the majority of women come in contact with some member of the health care system, would be inexpensive, readily linked with an existing health care system, and may have multiple benefits for HIV infected and uninfected mothers and infants.

Source: Dr Jean Humphrey, Zvitambo Project, 18 Van Praagh, Harare, Zimbabwe. Fax: 263-4-708-413

NGO Nutrition Association - a new initiative

As an initiative of the 'Action Contre la Faim' Scientific Advisory Committee, its Chairman, Professor Mike Golden of the Department of Medicine and Therapeutics at Aberdeen University has recently established an NGO Nutrition Association. The Association has started as an E-Mail discussion group for those who co-ordinate, manage or advise nutrition programmes in developing countries and for those nutritionists who are working in relative isolation. The idea behind the Association is that participants can share problems and opinions, particularly those originating from the field, with a wide range of interested people who have experience and expertise in a whole variety of topics related to such programmes. New initiatives can be discussed before they are implemented. The results of trying new approaches can be disseminated. Even issues such as the ethics of various nutritional interventions can be aired. Important information from the literature can also be brought to the group's attention.

An Association page is currently being constructed on the World Wide Web which will serve as a location for messages that are consensus statements or conclusions from the Association's deliberations. Currently, members of the Association are mainly drawn from both UN and non-governmental organisations and also from a wide range of academics doing research in both rich and poor countries, many of whom have not had the opportunity to interact with humanitarian organisations. Although optimistic about the usefulness of the Association, Golden observes that “the group will only be as good as those who actively contribute to it”. Those who plan, co-ordinate, evaluate, manage or advise nutrition programmes are encouraged to join by sending a message to ngonut-[email protected] which includes their position and address.

Source: Professor Michael Golden, University of Aberdeen, Foresterhill, AB9 2ZD, Scotland. Email: [email protected]

Vitamin A: Fifth Business

Fifth business - definition. ‘Those roles which, being neither those of Hero nor Heroine, Confidante nor Villain, but which were nonetheless essential to bring about the Recognition or the denouement, were called the Fifth Business in drama and opera companies organized according to the old style.’

In the context of control of vitamin A deficiency, there are plenty of examples of Fifth Business - meaning public nutrition actions without whose successful conclusion programme targets will not be reached on time or, worse, cannot be reached at all. But here I intend to focus on just one of them, surveys.

Consider surveys of different types - baseline, on-going, for evaluation. Without good baseline data it is impossible to know the size and characteristics of the vitamin A problem, and therefore impossible to come up with appropriate solutions. Without follow-up and evaluation surveys it is difficult to track progress. So for vitamin A public nutrition programs, surveys are certainly Fifth Business.

Yet, as we get uncomfortably close to the year 2000 and its goal of virtual elimination of vitamin A deficiency, many countries (especially for example in Sub-Saharan Africa but also in the Newly Independent States of Eastern Europe and South East Asia) have hardly begun even to establish representative, reliable and countrywide baseline data. Meanwhile other countries with large, longer-term programmes (Bangladesh, India, Indonesia, Viet Nam) are asking questions about cost-effectiveness of different interventions and current vitamin A status.

The reality is that good survey data is in short supply, whether it be recent or historical. The WHO/Micronutrient Deficiency Information System (MDIS) documentation of vitamin A assessments, despite its intended comprehensiveness and ambition, is more like a patchwork quilt of scattered information at different points in time than a complete global mapping.

Furthermore, one cannot fail to be impressed (or more likely depressed) by the increasing number of incomplete, non-reported and simply mis-handled surveys. Is it that our ability to computerize, and superficially juggle, large data sets now exceeds our ability to predict results demanded of the analysis? Sometimes one has the feeling that the ability to deal with more data, in more complexity, has become the drive or principle for designing some studies; rather than the need to ask practical programmatic questions.

Is juggling a large amount of data somehow more fascinating intellectually than creating an interface of critical information linking inputs with likely outputs, that can be used to promote actions for change and improvement, with a realistic amount of resources? EPI-INFO 6, for example, has certainly transformed data handling, but it should not replace the most lucid and clear-headed thought about what data should be handled. Is this evident to readers of SCN News? Probably. But even if so, the point is certainly not understood by plenty of others; and applied during study design by few.

The evidence? Within the past 12 months alone, I have come across examples of uncompleted or only partially reported surveys in Madagascar, Malawi, Nigeria and Senegal. The cost? Not far short of $900,000 if the figures presented me are to be trusted. Difficult to believe?

Agreed. But probably not far from the truth. And that is without discounting the hours of lost labour by planners, survey teams and most numerous of all mothers with their children (an estimated 20,000 of them).

Definitely not a pretty picture of efficiency. One that, if disseminated, could even provoke awkward questions from donors who have to foot the bill. And, as significantly, a total of wasted surveys which could most likely be considerably added to, without much effort, by readers of SCN News.

So much for the problematic. But if Fifth Business is essential, what about solutions? WHO in 1995 updated 'Vitamin A deficiency and its consequences: a field guide to their detection and control' by Professor Sommer. This work is the gold standard for anybody working with vitamin A surveys. Indeed it is one of those rare publications that, along with a few others, has combined to create a radically new approach to micronutrient deficiency in general. This said, it contains so much detail that the inexperienced survey planner could be tempted to go for the seemingly 'safer' option of more, rather than the practically 'surer' option of less.

Is there an alternative? Well, how about a far shorter document (maximum ten pages) that trims the issues down to a few essentials - and approaches them with the heavy-handed clarity of a cookbook. Not a counter publication, but a different and complementary publication, aimed at small and beautiful, deliberately directive and limited. This trimmed down version would answer only the questions that really need answers; not the uncontrolled range of others that 'would be interesting to know'.

The essential ingredients, for example, could be just three-fold: night blindness, distribution of serum retinol in the population and frequency of consumption of vitamin A-rich foods for mothers and preschool-age children - not much more than that. The built-in objective would be to provide a final report within at most three months of completion of fieldwork. It would also contain a range of maximum acceptable costs for different geographical and socio-economic situations.

Coincidentally (or perhaps not) it was the Canadian novelist, Robertson Davies, who awakened the world's interest in Fifth Business, in the opening section of the Deptford Trilogy. Would it not be especially appropriate, therefore, for the Micronutrient Initiative of Canada to take up the challenge of Fifth Business as it relates to vitamin A surveys? Or would one of the UN organizations, or NGOs, agree to focus on simplifying vitamin A surveys; an unfortunately neglected, yet fundamental, issue if the year 2000 goal is to be shown to be achievable?

Source: Nicholas Cohen, Focus Asia, Jakarta, Indonesia
27 Avenue Voltaire, 01210 Ferney-Voltaire, France
Tel: 33-4-5040 5263, Fax: 33-4-5040 9643
Email: [email protected]

World Federation of Public Health Associations

8th International Congress - Health in Transition: Opportunities and Challenges
12-16 October 1997, Arusha, Tanzania

The World Federation of Public Health Associations announces its 8th International Congress to be held in Arusha, Tanzania, 12-16 October 1997. The meeting will be hosted by the Tanzanian Public Health Association. Join health practitioners, policy makers, administrators, development workers, researchers, and many others from governments, academia, international organizations, and the NGO community for this exciting event.

WFPHA is a non-governmental organization composed of national public health associations from 48 countries around the world. WFPHA Congresses are held every three years and are co-sponsored by WHO and UNICEF. Participation is open to all.

For further information and abstract forms contact: WFPHA Secretariat, c/o APHA, 1015 15th Street, NW, Suite 300, Washington, DC 20005, USA. Fax: (202) 789 5681

Collaborate, Communicate, and Celebrate

Society for Nutrition Education Meeting 1997

The society for Nutrition Education's 30th Annual Meeting will take place from 22-26 July in Montreal, Quebec, and will take the theme of “Building bridges... Through Collaboration, Communication and Celebration”.

The meeting will provide a forum for exchanging ideas and information on how to improve and strengthen nutrition education practice and provide an environment for developing professional skills.

Meeting sessions will include invited presentations. Other oral and poster presentations will be reviewed and selected from submitted abstracts.

The Society for Nutrition Education is a professional association of 2,300 nutrition educators in the US, Canada, Mexico and several countries outside North America. The society promotes the nutritional well-being of people through improved education, research and public policy.

For information please contact: Society for Nutrition Education, 2001 Killebrew Drive, Ste, 340, Minneapolis, MN 55425-1882, USA. Phone: 612 854 6721 Fax: 612 854 7869 Email: labat[email protected]. For information on membership, call 612 854 9697

Online Primary Health Care Database

The Appropriate Health Resources and Technology Action Group (AHRTAG), based in London, UK, is making available on the INTERNET a unique searchable bibliographic database focusing on primary health care and disability issues in the developing countries.

The database contains descriptions of over 15,000 materials held in AHRTAG's resource centre, including articles, books, manuals, reports, as well as unpublished materials on a wide range of issues including adolescent health, evaluation, health education, HIV and AIDS, planning and management, programme implementation, structural adjustment, training, urban health, and nutrition.

For further information please contact: Margaret Elson, Information Systems Officer, AHRTAG, Farringdon Point, 29-35 Farringdon Road, London EC1M 3JB, UK. Phone: (44 171) 242 0606 Fax: (44 171) 242 0041 Email: [email protected]

Source: AHRTAG Information Sheet, January 1996

International Postgraduate Courses, Cuba

The Institute of Nutrition and Food Hygiene (INHA) of Havana, Cuba, in its role of WHO Collaborating Centre, holds every year a Program of International Postgraduate Courses mainly for Spanish-speaking specialists all around the world.

In 1997, INHA will be holding the following International Postgraduate Courses:

1. Fats in Human Diet: Effects on Health
October 13-17, 1997
Coordinator Dr Alejandrina Cabrera, PhD. Fee US$330* US$210**

2. Systems Design and Data Analysis in Nutritional Surveillance
October 20-24, 1997
Coordinator: Lic. Pedro Monterrey, PhD. Fee: US$365* US$275**

3. Food and Nutritional Surveillance
October 27-31, 1997
Coordinator: Prof. John Gay, MD, PhD Fee: US$300* US$210**

4. Computer Programs Applied to Dietary Assessment for Food and Nutrition Surveillance
November 3-21, 1997
Coordinator: Lic. Armando Rodriguez, MSc. Fee: US$1,050* for three modules (US$350/module) or: US$750** for three modules (US$250/module)

5. Food Security
November 24-28 1997
Coordinator: Dr Santa Jimenez, MD, PhD. Fee: US$300*
Fee: US$210

6. Epidemiology and Nutrition
December 1-12, 1997
Coordinator Dr Carmen Porrata, MD, PhD Fee: US$750* US$525**

* Price includes registration fees, printed materials, lodging and meals in the Guest's House of the Institute of Nutrition and Food Hygiene. Teaching activities take place in the same location with the exception of field activities.

** Price includes only registration fees and printed materials.

For further information please contact: Professor Mirta Hermelo, MD, PhD, Head, Department of Postgraduate Education, Institute of Nutrition and Food Hygiene. Calzada de Infanta 1158, La Habana 10300, Cuba. Phone: (53-7) 78 5919/78 1835/78 1479 Fax: (53-7) 33 8313/33 3375

Source: Professor Manuel Amador, Deputy Director, INHA, 21 August 1996

Food Fortification to End Micronutrient Malnutrition: State-of-the-Art

2 August 1997, Montreal, Canada

This one day symposium will present state-of-the-art fortification technologies for a variety of food vehicles. Experts from research institutions, the food industry and non-governmental organisations will review past achievements, provide analysis of the current situation and highlight opportunities for the future. The programme will focus on the state-of-the-art for fortification of five groups of food vehicles generally considered most appropriate for the elimination of micronutrient malnutrition including cereals and grains, fats and oils, dairy products, salt, sugar and condiments.

Food Fortification to End Micronutrient Malnutrition: State-of-the-Art, is an official satellite meeting to the 16th International Union of Nutritional Sciences Congress.

To register please contact Alison Greig, Micronutrient Initiative, 250 Albert Street, Ottawa, Canada KIG 3HP. Fax: 613 236 9579 Email: [email protected]. There is no registration fee. For further information, please phone 613 236 6163 ext. 2203

Short Course on Participatory and Rapid Appraisals for the Health Sector

7-20 September 1997, Keele University

The Centre for Health Planning and Management at Keele University is offering a short course on 'Participatory and Rapid Appraisals for the Health Sector' from 7-20 September 1997. The objective of the course is to familiarize participants with tools and techniques to provide timely and appropriate information as well as facilitate participation of local people in the planning process. The course will introduce a wide range of participatory and rapid methods for assessments and evaluations. There will be considerable group work with course facilitators in applying the methods and skills which are taught, and the course will focus on an intensive interaction for participative learning which will include activities outside the classroom.

Further information, including course fees and an application form, can be obtained from the Course Administrator, Ms Brenda Corbishley, Centre for Health Planning and Management, Darwin Building, Keele University, Keele, Staffs, ST5 5BG, UK. Phone: +44 1782 583192 Fax: +44 1782 711737

The 15th Leeds Course in Clinical Nutrition

2-5 September 1997, Leeds

The Department of Medicine at St. James's University Hospital, Leeds, and the School of Continuing Education at the University of Leeds, are offering a course in clinical nutrition to be held at the University Hospital. Daily sessions will focus on:

· Nutrition, Surgery and Gastroenterology
· Clinical States Associated with Nutritional Problems
· Nutrition in Minority Groups
· Nutritional Treatment

A number of guest lectures will also be included in the programme. The Leeds Course in Clinical Nutrition is approved for a total of 16 hours C.M.E. by the Royal Colleges of Physicians and Surgeons and also has PGEA approval (17 hours A/B).

Further information, including course fees and an application form, can be obtained from the Course Secretary - Clinical Nutrition, School of Continuing Education - CVE, Continuing Education Building, Springfield Mount, Leeds LS2 9NG, UK. Phone: +44 113 233 3233 Fax: +44 113 233 3240

Positions Available, World Bank, Washington D.C.

Senior Nutrition Adviser

The World Bank is currently seeking a (Senior) Nutrition Adviser to the Health, Nutrition & Population (HNP) Board at its Headquarters in Washington, D.C.

As the World Bank's most senior adviser for nutrition, the selected candidate will (a) provide leadership in developing and overseeing nutrition strategy for the Bank; (b) guide quality assurance work on nutrition lending at the Bank; (c) lead the consultative process with borrowers, donors, NGOs, and academics during the different stages of preparation of the Bank's nutrition policies.

The selected candidate will be a dynamic individual with the highest professional qualifications and an internationally recognized authority in the nutrition sector, with demonstrated outstanding managerial and communication skills and excellent analytical ability. He/she will have practical experience working on nutrition for an extended period in a developing country situation. Women and candidates of diverse nationalities are strongly encouraged to apply.

The World Bank offers an internationally competitive compensation package, including expatriate benefits. Candidates should fax their resumes within two weeks of the publication date to: Recruitment Unit, Attention: NUTR-Adv.-SCN, World Bank, Room MC4-137, Washington, D.C., Fax 202 477-4744.

Source: World Bank 6/3/97

(Senior) Food & Nutrition Policy Advisor

The Bank seeks an outstanding candidate of international stature as its (Senior) Food & Nutrition Policy Advisor to: (a) link the Bank's food & nutrition policy issues, practices and research with state-of-the-art knowledge and policies of other international organizations, bilateral donors, and non-governmental organizations; (b) coordinate the work of the Bank's various units involved in food & nutrition policy; and (c) implement its Rural Action Plan and Hunger Strategy.

The nature of the work requires a dynamic individual with excellent analytical ability, outstanding communications skills and demonstrated management capacity. The selected candidate will be an internationally recognized authority in international food consumption policy and human nutrition, with the highest professional and academic qualifications (PhD in Economics/Agricultural Economics preferred). He/she will have a minimum of 15 years of varied field and institutional experience in areas relevant to the impact of agricultural policy and development on food consumption and nutrition. Proficiency in English is essential; proficiency in French, Spanish or Portuguese will be a significant advantage. Women are strongly encouraged to apply.

The World Bank offers an internationally competitive compensation package, including expatriate benefits. Candidates should send their resumes by August 15 to: The World Bank Recruitment Unit, Ref: FDAD-SCN, Rm. 0-4-140, Washington, DC 20433, USA. Fax: (202) 522-2148.

Source: World Bank 13.6.97

Refugee Issues

Save the Children Fund (UK)

Household Food Economy Analysis

When people are uprooted from their homes and are deprived of their livelihoods as in refugee situations, access to food is often impeded leading to heightened food insecurity among the population. One way to help alleviate this insecurity is the provision of food aid. In addition, it has long been acknowledged that refugees develop alternative ways to ensure they have access to food. However, in the past, it has been difficult to quantify the methods and extent to which refugees are able to meet their needs.

This new method for assessing needs of populations facing acute food insecurity, regardless of the reason, is based upon a deeper understanding of the various options people employ to secure access to food. The method explores in a systematic fashion other food and income sources people rely upon, and the degree to which these can be expanded in times of crisis. Thus, in times of food scarcity, it is possible to analyse what options people have to support themselves and to quantify the size of any food deficit that they may face. Food aid might be one way to tackle the problem of food scarcity, but it is not the only solution. This approach focuses on interventions that will support local initiatives.

The novelty of this approach is the attempt to quantify factors such as relative wealth, sources of income, sources of food, and patterns of expenditure in refugee situations. Assessments have been carried out in a number of places, including Kenya, Ethiopia, Uganda and Nepal, with the result being a more complete information on how refugees cope and therefore how we can most effectively fill the gap. They will hopefully lead to better and more effective use of food aid, that will support and not undermine local practices.

Source: Household Food Economy Analysis What Is It? by Save the Children Fund (UK)

Field Exchange - the Emergency Nutrition Network quarterly newsletter

The Emergency Nutrition Network (ENN), has recently started publication of a quarterly newsletter, Field Exchange, which will be devoted primarily to publishing field level articles and current research and evaluation findings relevant to the emergency food and nutrition sector. The target audiences of Field Exchange are food and nutrition workers involved in emergencies, and those researching this area.

The ENN focuses on food and nutrition aspects of emergencies and is a result of a shared commitment to improve knowledge, stimulate learning, and provide vital support to food and nutrition workers involved in emergencies. The Network aims to improve emergency food and nutrition programme effectiveness by:

· providing a forum for the exchange of field level experiences;
· strengthening humanitarian agency institutional memory;
· keeping field staff up to date with current research and evaluation findings;
· helping to identify subjects in the emergency food and nutrition sector which need more research.

The newsletter will be central to these activities by reporting and exchanging field level experiences.

The first issue of Field Exchange was published in May 1997 and is available upon request from: Fiona O'Reilly, ENN Coordinator, c/o Department of Community Health and General Practice, 199 Pearse Street, Trinity College, Dublin 2 Ireland, Email: [email protected]

WPF/UNHCR Co-operation

WFP and UNHCR have signed a new Memorandum of Understanding. According to the cover letter important new elements include provisions for: better assessment of the numbers and needs of beneficiaries, clearer role for WFP in final distribution of food, the need to monitor the food pipeline closely, share timely information and take early joint action on shortfalls in deliveries.

Nutrition is prominent in the objective of this Memorandum. We read that: “through... timely provision of the right quantity of the right food and related non-food inputs, WFP and UNHCR seek to ensure the restoration and maintenance of a sound nutritional status through a food basket that meets the assessed requirements, is nutritionally balanced and is culturally acceptable...”. Further, the Memorandum emphasizes “promotion of... self-reliance... through... programmes to develop food production or... self employment”. This is aimed at facilitating a shift from food distribution towards development activities.

What exactly are assessed requirements? Requirements established by FAO/WHO are to provide the basis for the calculation of food needs, while a set of “agreed nutritional guidelines” are to be used as well. These guidelines will be released shortly by the two agencies. Numbers of beneficiaries, modalities of assistance, composition of the food basket and ration size are to be determined jointly. However, UNHCR is responsible for determining the nutritional status of refugees and for the implementation of selective feeding programmes “as may be found necessary in addition to the agreed general ration.

Interestingly, UNHCR is responsible for mobilizing local fresh foods, spices, tea and “dried and therapeutic milk”. WFP is responsible for mobilizing other commodities, whether for general or selective feeding: cereals, oils, pulses, blended foods, salt (no reference to iodization), sugar and biscuits. WFP will ensure the provision of blended foods “or other fortified commodities” to prevent or correct micronutrient malnutrition.

Reproductive Health in Refugee Situations: An Inter-agency Field Manual (UNHCR, 1995)

Following from the primary objective of the Inter-Agency Symposium on Reproductive Health in Refugee Situations (Geneva, June 1995) to introduce reproductive health activities in all refugee situations, experts and experience field staff have collaborated to produce this Field Manual.

The Manual is intended to inform field managers and operational agencies of the issues related to reproductive health affecting women, adolescents and men in refugee situations, and to serve as a tool to help implement, monitor and evaluate reproductive health-related interventions.

The purposes of the Field Manual are:

· to focus attention on and familiarize field staff with an aspect of refugee rights and welfare which has been too often widely overlooked;

· to offer guidance to field staff in introducing and implementing reproductive health services in refugee situations;

· to foster coordination between potential partners.

The Manual describes the components of a comprehensive reproductive health service. Helpful tools for project implementation and a list of further reading are provided, and appendices contain essential documents on information, education, communication and legal considerations.

A version of this Manual is also available in French. The authors invite users to field test the Manual, so that all comments and input may be used in the preparation of a revised Manual.

Copies of this publication may be obtained from the Programme and Technical Support Section, UNHCR Headquarters, Case postale 2500, CH-1211 Geneva 2 Depot 2, Switzerland. Fax: +41 22 739 7371

Inter-Agency Workshop on Selective Feeding Programmes

18-20 February 1997, hosted by CONCERN, Dublin

This workshop was one of a number of follow-up actions being taken by the Inter-agency Food and Nutrition Group following earlier workshops held in Addis Ababa and Geneva. Among the follow-up actions identified at the Addis workshop (October 95) was the proposal “to develop a typology of the design and objectives of selective feeding programmes currently implemented in emergency situations”. A subsequent meeting held in Geneva (May 96) decided to hold a workshop which would focus exclusively upon unresolved issues related to selective feeding programmes in emergency situations. Funding for the workshop was provided by the Department of Foreign Affairs, Ireland.

The primary purpose of the Dublin workshop was to focus on areas of controversy with a view to reaching consensus amongst the workshop participants and making some headway on issues such as the development of a comprehensive typology for selective feeding programmes. Clarification of terminology, the rationale behind supplementary feeding programmes, a conceptual framework for design, programme objectives and suitable indicators were discussed. In addition, the issue of closure and problems of assimilation of selective feeding programmes into local health structures was discussed. Workshop participants were able to share and update technical information between agencies and to clarify priorities for further field research, including issues such as the use of z-scores for admission criteria, the requirements of appropriate foods for use in supplementary and therapeutic feeding programmes and criteria for the assessment of adult malnutrition.

The workshop report is available from CONCERN, Camden Street, Dublin 2, Ireland. Fax: 353-1-4754647, Email: [email protected]

ACC/SCN Reports on the Nutrition Situation of Refugees and Displaced People

The Reports on the Nutrition Situation of Refugees and Displaced People are published every three months under the AC/SCN's Refugee Nutrition Information System (RNIS). The system was started on the recommendation of the SCN's Working Group on Nutrition of Refugees and Displaced People, by the SCN in February 1993. Updates on rapidly changing situations, and where new information is available, are published on an “as needed” basis, depending on the current situation. The Updates are, where feasible, transmitted by Email.

Information is obtained from a wide range of collaborating agencies, both UN and NGO. The overall picture gives contact and information which separate reports cannot provide by themselves. The information available is mainly about nutrition, health, and survival in refugee and displaced populations.

To obtain more information, or to be put on the mailing list to obtain the reports and electronic mail updates, please contact: Ms Jane Wallace, ACC/SCN, c/o World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41-22-791 04 56, Fax: 41-22-798 88 91, Email: [email protected]