Publications

Preparation and use of food-based dietary guidelines (1996) Report of a joint FAO/WHO consultation, Nicosia, Cyprus

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The overall purpose of the joint FAO/WHO Consultation on preparation and use of food-based dietary guidelines, was to establish the scientific basis for developing and using food-based dietary guidelines and to improve the food consumption patterns and nutritional well-being of individuals and populations. This report on the Consultation demonstrates how national authorities can change the traditional focus from nutrients to locally available foods, with dietary guidelines based on country-specific or local dietary practices and prevailing diet-related public health problems, rather than be based on nutrient requirements and recommended intake levels.

The report includes a summary of dietary assessment methodologies - national food supply data, household food consumption data, and individual consumption data - which are appropriate for drawing up and monitoring the use and impact of dietary guidelines. For the last, five methods are presented: food records, 24-hour dietary recall, food frequency questionnaires, diet histories and food-habit questionnaires. Methods of analysis and computation of nutrient intakes including computer software are described, as is the method of presentations of data on consumption of particular foods and food groups.

The scientific basis for food-based dietary guidelines and the requirements for energy, nutrients and related non-nutrient food components are presented in detail. Examples of the food groups and dietary guidelines used in different countries, and some comments on their respective advantages and disadvantages are also given.

Copies of this document can be obtained on request from: WHO, Programme of Nutrition. 20 Avenue Appia. CH-1211, Geneva 27, Switzerland.

Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. (WHO, 1996) Document based on a joint WHO/UNICEF/ICCIDD consultation, Geneva, July 1996

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Universal salt iodization is the recommended intervention for preventing and correcting iodine deficiency. Substantial experience has been gained in the last decade in implementing this strategy and in assessing its impact on iodine deficiency disorders (IDD). A major achievement is the reduction of IDD in countries that have adopted appropriate measures.

There are some cases however, of unnecessarily high iodine intakes that may occasionally be associated with iodine-induced hyperthyroidism. For this reason, WHO, UNICEF and ICCIDD carried out a study in seven African countries to examine the relationship between salt iodization and population iodine status. Previous recommendations for iodine levels in salt have been reexamined as a result of this study, and in the light of other recent technical and scientific developments.

New information suggests that in general, 20% of iodine in iodized salt is lost from the production site to the household, with another 20% lost during cooking before consumption. The average salt intake per capita per day is estimated to be lug. Based on this information, this document summarizes current WHO, UNICEF and ICCIDD recommendations concerning iodine levels in salt, risk of associated iodine-induced hyperthyroidism, and requirements for monitoring both iodine status and the adequacy of iodine levels in salt.

Copies of this document can be obtained on request from: WHO, Programme of Nutrition, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland.

Anaemia Detection in Health Services: Guidelines for Program Managers (PATH, Seattle, 1996)

These guidelines are a useful tool for health care program managers in developing countries. The guidelines are intended to help managers determine appropriate anaemia detection methods for incorporation into their services or to enhance existing services. They include a general overview of the programmatic issues of anaemia screening to provide a context for method choice and a description of the commonly used anaemia detection devices and methods. The guidelines were produced by the Program for Appropriate Technology in Health (PATH) under the USAID-supported HealthTech project. PATH is a partner in the Opportunities for Micronutrient Interventions Project (OMNI).

Single copies of the guidelines are available by writing to: HealthTech Project Director, PATH, 4 Nickerson Street, Seattle, WA 98109 or by fax at (206) 285 6619 or by Email at [email protected].

Micronutrient Fortification of Foods: Current Practices, Research, and Opportunities (1996)

By Mahshid Lotfi, M.G. Venkatesh Mannar, Richard J.H.M. Merx and Petra Naber-van den Heuvel. Micronutrient Initiative, Ottawa & International Agriculture Centre, Wageningen

Deficiencies in three micronutrients - iodine, iron, and vitamin A - are widespread affecting more than a third of the world's population. Individuals and families suffer serious consequences including learning disabilities, impaired work capacity, illness, and death. They could waste as much as 5% of gross domestic product (GDP). Addressing them comprehensively, using an array of low-cost solutions, could cost less than 0.3% of GDP. In the words of the World Bank in its recent publication “Enriching Lives” “... No other technology offers as large an opportunity to improve lives... at such low cost and in such a short time...”

This manual has been prepared to facilitate and encourage large-scale implementation of fortification programs in countries where micronutrient malnutrition is prevalent. It responds to a long-felt need for a comprehensive documentation of technologies and opportunities for fortification.

Given that technologies are in different stages of development and application, an attempt is also made to review critically the status of these technologies and identify the steps involved in refining them for large-scale application. In addition, the manual appraises their technological feasibility, practicability, cost effectiveness, and consumer acceptability. An annotated bibliography on food fortification, containing more than 500 references with abstracts, including the references mentioned in this manual, will be published as a companion volume.

It is hoped that this manual will be a useful reference for national micronutrient program managers and food industry managers to plan and expand food fortification as a long-term and sustainable solution to the global problem of micronutrient malnutrition.

This document is a product of a unique collaboration between the International Agricultural Centre (IAC) in the Netherlands and the Micronutrient Initiative (Ml) in Canada. It has also evolved out of experience gained in organizing the short-term training course in food fortification at the IAC.

To obtain a copy of this book please contact: The Micronutrient Initiative, PO Box 8500,250 Albert Street, Ottawa, Ontario, Canada K1G 3H9 Phone: 613 236 6163 Fax: 613 236 9579 or the International Agriculture Centre, PO Box 88, Lawickse Allee 11, 6700 AB Wageningen, The Netherlands. Phone: 31 317 490355 Fax: 31 317 418552

Midwives and Safer Motherhood (1996)

Edited by Susan F Murray, Mosby, London

Midwives and Safer Motherhood draws its title from the Safe Motherhood Initiative (WHO, UNFPA, World Bank, 1987). This book provides a unique insight into the ways in which midwives may be involved in the achievement of safer motherhood, especially a reduction in maternal mortality and morbidity. Divided into four key areas, it explores: Research for Safer Motherhood, Midwives' Changing Rotes, Midwifery Education, and The Midwifery Profession Internationally. The international team of contributors offers a rich and varied perspective on the changing rote of midwives worldwide. The status of midwives across countries and cultures, the impact of medical technology, and the way in which midwives have organized as a profession across frontiers are also examined.

Midwives and Safer Motherhood is essential reading for all midwives, maternity service managers, nursing and midwifery educators, and students undertaking advanced diplomas or degrees in midwifery, advanced studies in mother and child health, primary health care, tropical health, or international public health.

To obtain a copy of this book please contact: Times Mirror International Publishers Limited, Lynton House, 7-12 Tavistock Square, London WC1H 9LB, United Kingdom.

Feeding the World, Preventing Poverty, and Protecting the Earth: A 2020 Vision

IFPRI, Washington, D.C.

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Feeding the World, Preventing Poverty, and Protecting the Earth is about people - a farmer in the Amazon, a fisherman in West Africa, a landless family in South Asia. And it is about a vision that every man, woman, and child has enough food for a health life, that each person has economic opportunities for a productive life, and that all of us can achieve these goals in harmony with our natural environment.

This booklet presents eleven stones to show how the broad and often abstract concepts of hunger, poverty, and environmental damage are tragically real when applied to the lives of individuals. It then proposes solutions for improving the lives of these people and millions of others by the year 2020, incorporating comments by world leaders and experts as well as results of research on food and the environment.

Here is a clear and informative introduction to these complex issues for anyone concerned about the prospects for feeding the world in coming decades.

To obtain a copy of this book please contact: IFPRI, 120017th Street, N.W., Washington, D.C. 20036-3006 USA. Phone: 202 862 5600 Fax: 202 467 4439. Email: [email protected]

Food Safety and Foodborne Diseases (1997)

World Health Statistics Quarterly. Volume 50, No 1/2

Illness due to contaminated food (i.e. foodborne disease) is perhaps the most widespread public health problem in the contemporary world and an important cause of reduced economic productivity. Be it in the form of infant diarrhoea, cholera, salmonellosis, listeriosis, infections caused by enterohaemorrahagic Escherichia coli or acute or chronic intoxications caused by chemical contaminants, to mention but a few, foodborne diseases cause mortality, morbidity, suffering and economic losses which no country can afford. While by no means a comprehensive account of all the food safety problems encountered worldwide, this issue of World Health Statistics Quarterly tries to foster an awareness of a growing and serious public health problem and advocates the need for change. Food safety does not receive the degree of attention and funding which it deserves; the health and economic impact of foodborne diseases associated with the contamination of the food supply has to be recognized nationally and internationally so that resources can be set aside for their prevention.

Source: Programme of Food Safety and Food Aid, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Health Issues for the 21st Century: Nutrition and Quality of Life (1996)

Edited by P. Pietinen, C. Nishida and N. Khaltaev

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Health Issues for the 21st Century: Nutrition and Quality of Life is the proceedings of the symposium, held in Japan in December 1993. The aim of the symposium was to address the issues concerning the increasingly important nutrition-related causes of morbidity and mortality in many countries, including the socio-economic and behavioural aspects of nutrition and healthy lifestyles.

The proceedings highlight the global situation and trends of nutrition and quality of life: approximately one-fifth of the world's population is estimated to be undernourished, while up to another one-fifth is estimated to be over nourished. If global population growth remains the same, then there will only be enough food until the year 2020. Hunger and nutritional deficiencies, such as PEM and micronutrient deficiency disorders, are among the most pressing problems of the developing world. Chronic noncommunicable diseases (eg. cardiovascular diseases and diabetes) are also emerging in many developing countries. With increasing urbanization, many traditional dietary patterns and life styles are changing, and increasing numbers of refugees and displaced persons brings nutritional problems ranging from an adoption to an unfamiliar and more costly diet, to serious nutritional deficiencies.

The proceedings are divided into thee main sections (in addition to the plenary and state-of-the-art lectures): nutrition, health and lifestyle - transition across history and culture; emerging issues in diet, nutrition and the prevention of chronic diseases; and nutrition education - the critical intervention. The highlights of the symposium are also summarised.

Copies of this document can be obtained on request from: WHO, Programme of Nutrition, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland.

Global Initiative for the Elimination of Avoidable Blindness (1997)

A document prepared by the Task Force of the Partnership Committee in collaboration with the WHO Programme for the Prevention of Blindness and Deafness.

This document reports the conclusions of a meeting between the WHO Programme for the Prevention of Blindness and Deafness and the Task Force of Nongovernmental Development Organizations (NGDO's), which was called as a first step to develop a global initiative to eliminate avoidable blindness over the next 25 years.

150 million people worldwide suffer from visual impairment, 38 million of whom are blind. The major causes of blindness are cataracts (16 million people), trachoma (5.9 million people) and glaucoma (5.2 million people). India, China and Africa bear the greatest burden of blindness, and globally, the number of blind people is increasing by an estimated 1-2 million a year. Projections from demographic trends indicate that, by the year 2020, there will be 54 million blind people over the age of 60 years, and 21 million blind people in other age-groups. Although there are limited population-based data, the available data are sufficient to enable the development of a strategic plan, and to confirm that over two-thirds of all blindness is avoidable.

The document lists the major causes of blindness and reports the aims, indicators, strategies and targets of the global initiative with respect to each cause. Vitamin A deficiency remains an important cause of preventable blindness in some regions of the world. In this respect, the aim of the global initiative is to achieve and sustain the elimination of blindness due to this vitamin A deficiency (xerophthalmia). The control of xerophthalmia is expected to be achieved by the year 2000 through the Global Child Survival Programme. This consists of a number of short-, medium- and long-term strategies. Firstly, to work closely with nutrition, immunisation and PHC systems to achieve and sustain elimination of vitamin A deficiency; and secondly, to establish surveillance systems to identify any new cases of blinding xerophthalmia and report the occurrence for action by child survival programmes.

Copies of this document can be obtained on request from: WHO, Programme for the Prevention of Blindness and Deafness, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland.

WHO Consultation on Obesity

3-5 June 1997, Geneva

This report presents global and regional estimates of the prevalence of obesity based on national sample data (where the prevalence of obesity was defined as the prevalence of body mass index (BMI) > 30 kg/m²), and where no data were available, a procedure was used to estimate the country-wide prevalence of obesity derived from the mean BMI for each country (using the 1996 WHO Nutrition Division/FAO global database of BMI).

Provisional estimates suggested that globally, 286 million people (7.9%) are obese. North America, the Caribbean, Western and Eastern Europe, Western Asia (Middle East), and Oceania were identified as high prevalence areas, with intermediate levels of prevalence in Latin America, and mostly low prevalence in Asia and Africa. For those countries where data were available for more than one time period, the trends in obesity prevalence were usually upwards.

The final report will be published in 1998. The following is a summary of the draft recommendations.

· Obesity is a disease which is largely preventable through life-style changes.

· The prevalence of obesity is rapidly increasing worldwide. Sedentary lifestyles and high-fat, energy dense diets largely account for this increasing prevalence.

· Obesity cannot be prevented solely at the individual level. Communities, governments, the media and industry need to work together to modify an environment which is conducive to weight gain. Obesity should be integrated with NCD control programmes.

· The existing WHO classification of body weight based on BMI is endorsed, but the additional use of the abdominal circumference measurement identifies NCD risk more readily. Longitudinal data should be used to complement the existing WHO classification of obesity in children.

· Overweight prevention should begin in early life.

· Management of overweight in adults should begin with efforts to prevent further weight gain by promoting healthy life styles and increased physical activity even when the BMI is still within the acceptable range.

· Management of obesity should be aimed initially at producing and maintaining a modest (5-10%) weight loss.

For further information please contact: Ms C. Nishida, Nutrition Programme, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland. Tel: 41-22-791 3317, Fax: 41-22-791 0746, Email: [email protected]

FAO New Publications and Video

FAO and the International Life Sciences Institute (ILSI) have prepared two new publications on micronutrients:

1. “Preventing Micronutrient Malnutrition: A Guide to Food-Based Approaches”

This is a manual for policy makers and programme planners. After describing the prevalence, causes and consequences of micronutrient diseases, this manual covers such issues as implementing diet- and food-based approaches to reducing deficiencies; planning programmes; monitoring surveillance and evaluation; and special needs of vulnerable groups. A useful guide to agencies working to combat micronutrient malnutrition and list of references are provided.

2. “Preventing micronutrient malnutrition: A Guide to Food-based Approaches I Why Policy Makers Should Give Priority to Food-Based Strategies”

This is a companion publication which briefly summarizes the key issues.

FAO nutrition education packages and videos:

“Get the Best from Your Food”. This a simple nutrition education package that emphasizes basic nutrition concepts that should be conveyed to the public, and provides four central messages that can be refined and incorporated into locally appropriate education and information campaigns. It is now available in French and Spanish. Copies can be obtained from FAO Representatives in Latin America and the Caribbean and Africa. Vietnamese and Polish versions of the package have been completed and versions in Nepalese and Portuguese are being prepared.

“Improving Nutrition through Home Gardening: a training package for preparing field workers in South East Asia”. This training package is for the instruction of agricultural extension, home economics and community development agents working with households and communities in Southeast Asia to promote home gardening for better nutrition. This is currently being adapted for use in Africa and Latin America.

“Introducing Participatory Nutrition Programmes”. The Food and Nutrition Division has produced this video which is available in English, French and Spanish. The video is available in PAL and NTSC format and runs for 13 minutes.

For information about obtaining copies of the above, please contact the FAO Food and Nutrition Division, Viale delle Terme di Caracalla, 00100 Rome, Italy. Fax +39(6) 5225 3152.

World Health Organization Publications on Nutrition - Catalogue (1996)

A catalogue listing WHO publications in the area of nutrition is now available free of charge from WHO Headquarters in Geneva.

The catalogue provides the latest bibliographic and descriptive information on both published and “in preparation” WHO documents focused on the links between nutrition and human health. Publications are grouped according to the following topics:

· deficiency diseases
· nutritional assessment, monitoring
· infant feeding
· diarrhoeal diseases
· education, training
· nutrition policy
· nutrition programmes
· “baby-friendly” hospitals
· ten steps to successful breastfeeding
· World Declaration on Nutrition

In view of the magnitude of health problems caused by improper nutrition, several of these books offer advice on national food and agricultural policies that can improve nutrition and reduce diseases, whether caused by an inadequate intake of nutrients, excessive intake, or poor environmental conditions. In view of the importance of infant and child nutrition, other books serve as practical guides to appropriate infant and young child feeding and to the prevention and treatment of diarrhoeal disease. Still others, focused on deficiency diseases, provide comprehensive guides to prevention and control, moving from the policy level to field implementation.

Developing countries receive a 30% discount on the prices quoted in the catalogue. In addition to formal priced WHO publications, the catalogue lists several documents that are available in single copies on request.

For a copy of the catalogue please contact: World Health Organization, Publications, Distribution and Sates, CH-1211 Geneva 27, Switzerland. Email: [email protected] Fax: (41 22) 791 4857 Phone: (41 22) 791 2476

Promoting Breastfeeding in Health Facilities: A Short Course for Administrators and Policy-Makers (1996)

Prepared by WHO in collaboration with Wellstart International. 1996, 391 pages, 154 colour slides, eight training modules in loose-leaf binder. SFr 180/US$163 (In developing countries: SFr 126)

This innovative teaching resource consists of a collection of eight training modules, complete with slides and handouts, for use in a short course intended to help administrators and policy-makers promote breastfeeding in health facilities. The course aims to make decision-makers in hospitals and maternity wards aware of specific policy and administrative changes that can have a major impact on breastfeeding practices. The course also contains abundant practical advice on how to introduce changes in a given setting.

In line with common time constraints, the course consists of eight modules that can be presented over a maximum of twelve hours:

1. The national breastfeeding situation. Helps participants review the current infant feeding situation in their own country and understand practices that affect breastfeeding rates.

2. Benefits of breastfeeding. Discusses the advantages of breastfeeding and disadvantages of artificial feeding.

3. The Baby-friendly Hospital Initiative. Describes the history of the Initiative and the related assessment process.

4. The scientific basis for the “Ten steps to successful breastfeeding”. Reviews the research that supports policy recommendations.

5. Becoming baby-friendly. Examines strategies for the successful conversion and management of baby-friendly health facilities.

6. Costs and savings. What will breastfeeding promotion cost a facility - and what will be the savings?

7. Appraising policies and practices. Gives participants an opportunity to assess their own facilities by using the hospital self-appraisal tool developed for the WHO/UNICEF Baby-friendly Hospital Initiative.

8. Developing action plans. Enables participants to prepare a written plan for introducing change in their own health facilities.

To obtain “Promoting Breastfeeding in Health Facilities” please contact WHO Publications, Distribution and Sales, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Email: [email protected] Fax: (41 22) 791 4857 Phone: (41 22) 791 2476.

WHO Food Safety Unit: new documents (1996-1997)

The following new documents are now available from the Food Safety Unit, WHO:

· Guidelines for strengthening a national food safety programme (WHO/FNU/FOS/96.2)

· Essential safety requirements for street-vended foods (WHO/FNU/FOS/96.7)

· Fermentation: Assessment and Research. Report of a joint FAO/WHO Workshop on fermentation as a household technology to improve food safety, Pretoria, South Africa, 11-15 December 1995 (WHO/FNU/FOS/96.1).

· Training aspects of the Hazard Analysis Critical Control Point (HACCP) system. Report of a WHO Workshop on Training in HACCP with the participation of FAO. Geneva, 1-2 June 1995.

These documents are intended to provide guidance for government agencies on, respectively:

1. the development and strengthening of national food safety programmes through integration of the efforts of various government agencies, industry, trade and consumers (this document provides guidance for the implementation of recommendations in the field of food safety made by the International Conference on Nutrition);

2. prioritizing, with the Hazard Analysis and Critical Control Point (HACCP) approach, the essential food safety requirements for street foods;

3. identifying, through HACCP studies, the essential safety requirements for household fermented foods, gaps in existing knowledge and priorities for research; and

4. training in HACCP.

Also available is the document 'Human Listeriosis 1991 - 1992'. This report, prepared by the WHO Collaborating Centre on Foodborne Listeriosis, Pasteur Institute, Paris, is the update of the previous reports forming a regular summary of data on listeriosis in the world. (WHO/FNU/FOS/97.1).

Requests for copies of these documents should be forwarded to: Food Safety Unit, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.

World Health Organization Publications on Food Safety - Catalogue (1996)

This catalogue provides bibliographic and descriptive information for over 40 WHO publications focused on the massive public health problems caused by foodborne diseases and by food losses due to contamination or spoilage. Several of theses books advise the food processing and food service industries on measures that can be taken - whether through systems for quality control or the use of new technologies - to assure that consumers are offered safe, wholesome, and nutritious food. Other publications, such as those establishing acceptable daily intakes for food additives and contaminants, form the basis for national legislation governing the quality and safety of food and food ingredients. In line with WHO policy, other publications stress the importance of prevention through education and training, offering practical - and authoritative - advice that can help consumers, food handlers, and industry managers avoid the errors that so often result in illness caused by contaminated food. Publications are presented under the following subheadings:

· trematode infections
· food safety education and training
· food safety policy
· chemical contamination
· food safety control
· food additives
· biotechnology
· pesticide residues in food
· food irradiation
· biotoxins
· carcinogenicity assessment
· drinking water quality
· zoonoses control
· safe use of wastewater for food production

Copies of Developing countries receive a 30% discount on the prices quoted in the catalogue. In addition to formal priced WHO publications, the catalogue lists several documents that are available in single copies on request.

For a copy of the catalogue please contact: World Health Organization. Publications, Distribution and Sales, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Email: [email protected] Fax: (41 22) 791 4857 Phone: (41 22) 791 2476

Culture, Environment and Food to Prevent Vitamin A Deficiency (INFDC, 1997)

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This book describes the creation of ethnographic research tools and their testing in a broad range of cultures and environments in five developing countries: Philippines, Niger, China, Peru and India. This work is based on the assumption that knowledge about the sociocultural and environmental contexts of vitamin A is essential for instituting and sustaining food based prevention of vitamin A deficiency. The book Is structured to give the logical flow of the research process, and is divided into four parts: 1) knowledge on vitamin A in food and diets, 2) creating the protocol, 3) the community assessment of natural food sources of vitamin A, and 4) new understanding about community deficiency of vitamin A. This book is a very welcome addition to the now burgeoning literature on vitamin A deficiency and reminds us of the role of food and the role of the community.

The root problem of vitamin a deficiency is lack of sufficient vitamin a in community food supplies.

For more information or to order a copy of this book contact: International Nutrition Foundation for Developing Countries, P.O. Box 500, Charles Street Station, Boston, MA 02114-0500, USA. Fax: 1-617-227 9405, Email: [email protected] or [email protected]

Community Assessment of Natural Food Sources of Vitamin A: Guidelines for An Ethnographic Protocol (INFDC, 1997)

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This is a workbook. It is intended for experienced health professionals interested in food-related public health problems. It describes a protocol developed to understand natural food sources of vitamin A: their availability and use, cultural beliefs surrounding their use, and community perceptions about food and vitamin A deficiency. The purpose of the assessment is to provide information for program planning aimed at increasing consumption of vitamin A-rich food among populations at risk of vitamin A deficiency.

For more information or to order a copy of this book contact: International Nutrition Foundation for Developing Countries, P.O. Box 500, Charles Street Station, Boston, MA 02114-0500, USA. Fax: 1-617-227 9405, Email: [email protected] or [email protected]

This is our first issue since late 1995. The SCN Secretariat has received many enquires about SCN NEWS, which we find encouraging. We are pleased to let you know that SCN NEWS will again be issued regularly, twice a year. SCN NEWS No. 15 will be out in December 1997. Please send us material, books, notices of events, letters to the editor, etc., which you would like to see appear in the next issue. Many thanks to all those who contributed to this issue! ACC/SCN Secretariat, c/o World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland Fax: 41-22-798 88 91 Email [email protected]