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close this bookSCN News, Number 10 (ACC/SCN, 1993, 52 p.)
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Nutritional Crisis of Displaced People in Africa/FAO/WHO Recommendations on Consumption of Fats and Oils/Nutritional Health Surveys in Former Yugoslavia/Planning for the Future through Participatory Rural Appraisal/Human Growth Patterns/Meetings and Conferences.

Nutritional Crisis of Displaced People in Africa

Ethnic conflicts in Africa are a major cause of severe malnutrition and avoidable death. They are causing displacement of millions of people, who then suffer severe food shortage and dreadful living conditions, leading to severe ill health and malnutrition. By the end of 1993, it was estimated that up to 16 million people were displaced (as refugees or internally), of which at least one million were severely malnourished with greatly increased mortality.

So widespread is this disruption that it is increasing significantly the extent of malnutrition in Africa - a substantial proportion of all the severely malnourished children, for example, are among the refugee and displaced populations. Severe wasting, defined as weight-for-height of less than -3 sds of the standard, is rare in normal populations - certainly less than 1%. Yet surveys in refugee and displaced populations where the situation is uncontrolled, regularly report severe wasting prevalences of 5% or even 10% or more. Very high mortality is associated with this degree of emaciation and it is causing widespread child deaths. Indeed, in these situations, young child mortality rates are reported as five times normal or higher - as are overall mortality rates -and a substantial proportion of the three million or so African child deaths per year are among the refugee and displaced population.

The refugee and displaced populations are numerically the greatest in the Liberian and Burundi situations, in Sudan, Mozambique, Rwanda, and Angola - see figure 1. Some indications of the severity are also shown, in the figure, emphasizing high levels of malnutrition in the situations in and around Liberia, Angola, Burundi, and Southern Sudan. A number of recent nutrition surveys have found very high prevalences of wasting in many situations - up to 50% wasting in young children, for instance. Trends in the situation show a probable increase in recent months of the proportion of severely malnourished or at high risk among the 16 million or so people displaced. Here we summarize some features of the current situation (as reported to the SCN's Refugee Nutrition Information System).

Although the main underlying factor precipitating and prolonging these nutritional and health crises is war/civil conflict and resulting inaccessibility of affected populations, other factors have also played a major role in constraining effective emergency responses. Amongst the factors reported are:

· Inadequate donor pledges of food aid and insufficient resources for local and regional purchase - especially in the early stages of an emergency;

· Poorly established registration systems, leading to excessive ration card allocation and consequent reduction in per capita food receipts;

· Logistical difficulties caused by poor infrastructure and insufficient donor resources for establishing adequate transport capacity;

· Inappropriate siting of camps and over-crowding creating serious health problems; and

· Unbalanced and inappropriate general rations leading to outbreaks of micronutrient deficiency disease and elevated levels of wasting in young children.

Some of the worst situations currently are:

Liberian Situation - Civil wars in Liberia and Sierra Leone have caused the displacement of almost three million people. Many have become refugees in Guinea, Cote D'Ivoire, Liberia or Sierra Leone while others are internally displaced. In Liberia, recent surveys have found prevalences of wasting rising to 55%, and crude mortality rates up to seven times normal in the most insecure counties. It is estimated that some quarter of a million people are currently in a critical nutrition situation. Although the situation in Sierra Leone is far better, recent escalation of fighting in the South East and resulting cessation of food distributions places many thousands at risk.

Ogaden Region of Ethiopia - The situation in three camps for 45,000 returnees/displaced people in the Ogaden region in South East Ethiopia continues to be disastrous with levels of wasting greater than 30% and crude mortality rates 3-6 times normal. There are also reports of widespread micronutrient deficiencies such as scurvy and xerophthalmia. This situation has persisted for more than a year.

Angola - The resumed civil war in Angola has now led to a situation where an estimated 3.2 million people are in urgent need of food or non-food aid. Many of this population are in large besieged towns, where, until recently, international aid agency access had been denied. Thus starvation and epidemics have reportedly decimated many of these populations. Recent reports from Huambo cite levels of wasting between 36-48%, while eye-witness accounts from Cuito and Menongue describe a "catastrophic nutritional and medical situation"

Southern Sudan - The continuing civil war in Southern Sudan - recently escalating - is placing almost 2 million displaced/war affected people at constant risk. Although the aid operation which has had to rely upon air and river transport has so far staved off the worst excesses of famine, the rapidly changing security situation and external resource factors periodically create pockets of crisis. For example, recently over 15,000 people in a displacement camp in Kotoba were exhibiting levels of wasting between 20-40%.

Figure 1 - REFUGEE AND DISPLACED POP Selected Areas (Dec-Jan 1994)

Zaire - The ethnic violence which erupted last year in Shaba region has led to the displacement of almost 300,000 people. Approximately half of this population have returned to their former homes in East and West Kassai, while the other half reside in transit camps/sites. Recent data on those in transit show continued crisis with levels of wasting between 25-38% and crude mortality rates over 4/10,000/day, over ten times normal. Pellagra has also been reported.

Burundi Situation - This is the most recent emergency (October 1993) and has, with Angola, the largest numbers of people currently known to be in a critical nutrition situation. The failed Burundi coup and subsequent fighting led to the displacement of almost one million people to surrounding Rwanda, Tanzania, and Zaire, and within Burundi. Most recent data indicate that almost all of this population have excessive levels of wasting. Crude Mortality Rates in some Rwanda camps vary from 3.7-5.6/10,000/day (10 to 15 times normal). Lack of food, appalling sanitation and overcrowding are major factors in prolonging this emergency.

Two nutritional aspects of these situations demand attention. First, some situations become stabilized with unacceptable malnutrition, especially micronutrient deficiencies: scurvy and xerophthalmia in the Ogaden in Ethiopia is an example. Second, the rate of improvement in emerging crises is too slow: many people die before situations are brought under control.

But they are often brought under control, and we should emphasize successes too. Normal nutrition, health and survival is achieved - for example, in Northern Kenya, Mozambique, and Rwanda outside the Demilitarized Zone. Here, security plus effective efforts by relief organizations have brought nearly normal health, nutrition, and survival situations. It can be done. To save lives, one crucial issue is to achieve this faster.

UNICEF - Halving Child Malnutrition by the Year 2000

The XV International Congress of Nutrition took place in Adelaide, Australia from 26 September to 1 October 1993. The following is extracted from a report on the opening address of Dr Urban Jonsson, Senior Nutrition Adviser, UNICEF, published in issue no. 3 of the Congress newsletter "Daily Delegate News".

In his opening address Monday morning, Urban Jonsson, Senior Adviser Nutrition, UNICEF, presented delegates with the greatest nutritional challenge for the remainder of the century - malnutrition.

"As was stated at the Rome ICN last year, we regard malnutrition as one of the most serious and embarrassing problems in the world today. Serious because it affects hundreds of millions of people - mostly innocent children. Embarrassing because the world has the knowledge and the means to solve it. The shocking fact is that malnutrition is a factor in around 40 per cent of the 13 million child deaths each year. As nutritional scientists gathered here today from all comers of the globe we have the knowledge and ability to develop, promote and implement the actions required to solve this issue."

At present, malnutrition is decreasing at only 1/2 percentage point per year in developing countries. Four times this rate is required to halve malnutrition and meet the year 2000 goal. Overall the percentage of underweight children has fallen by 2% since the 80s. However, due to rapid population growth the total number of underweight preschool children has in fact risen from around 164 million to 193 million.

The extent of the problem varies across the regions - Southeast Asia, some countries in South America and the Middle East are improving rapidly. Whereas areas such as South Asia and Sub-Saharan Africa have a long way to go.

"The problem of undernutrition is compounded by the fact that nutrition is marginalised by governments, universities and agencies. Nutrition work is often coordinated by small nutrition units - with inadequately trained staff and small budgets. At the same time, senior health officials often fail to realise that major programs undertaken - such as diarrhoeal disease control and immunization against measles - are important factors related to improving local nutritional status" he added.

The Convention on the Rights of the Child provided a significant step forward in the fight against malnutrition. Adopted by the UN General Assembly in November 1989, this 'Magna Carta' for children and youth took just a year to become international law. Among many other landmark provisions, the Convention states to ensure, to the maximum extent possible, the survival and development of all children.

The principle of 'first call for children' was also agreed upon at the first World Summit for Children in 1990. At the summit world leaders committed to achieve over 20 measurable health, nutrition and education goals for children and women by the year 2000 in addition to producing national and sub-national programmes of action to reach these targets. And at the International Congress of Nutrition in Rome last year, the world reiterated its commitment to fight malnutrition. "At last we can see humankind's first social 'contract' between children and leaders of the world. We must ensure that these nutritional goals agreed on by the international community are promoted as a moral minimum. We must remember our children are the most vulnerable and powerless." continued Dr Jonsson.

Mid-decade targets including universal iodization of salt; virtual elimination of vitamin A deficiency; implementation of the Baby Friendly Hospital Initiative and 20 per cent reduction of PEM are among these 1995 targets. Other key areas to address are diarrhoea - a major cause in malnutrition - in addition to protecting, promoting and supporting breastfeeding.

Access to food is only a small part of malnutrition. Nutrition security for all is required - security of this kind may be separated into three components:

- access to appropriate quantities and types of food for each household;
- access to basic health services and a healthy environment;
- care for children and women in their family and community environment.

UNICEF's Nutrition Strategy promotes a practical approach to social mobilization and empowerment recognising the fact that poor people already use very resource-relevant coping strategies for their survival and development. There are essentially two strategies:

- community participation and empowerment through improved assessment, analysis and capacity to design and implement sustainable development;

- improved national nutrition policies and strategies through policy dialogue, training and the use of improved nutrition information systems.

"The nutrition community represented at this Congress can contribute to and even lead a global movement for the eradication of malnutrition. An increasing number of people today know that the nutrition goals can be achieved. With your help, an ever increasing number of people will continue to think the world should achieve these goals and an ever increasing number of people will start to question why governments do no more. Our efforts for human progress in the 90s will not only influence what political leaders choose to do - but also which political leaders are chosen" Dr Jonsson concluded.

(Source: XV International Congress of Nutrition Daily Delegate News, issue No. 3, September 1993)

FAO/WHO Recommendations on Consumption of Fats and Oils

On 19-26 October 1993 a Consultation on Fats and Oils in Human Nutrition was held in Rome, jointly organized by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO). The meeting - a follow-up of a joint FAO/WHO consultation on the same subject held in 1978 - was attended by 20 experts from 13 countries in Africa, the Americas, Asia and Europe representing fields ranging from public health to food science and technology, as well as the food industry.

The consultation discussed both the positive and negative roles of fats and oils in human nutrition and health. Data were reviewed which suggest that certain fatty acids may play a role in the function of the immune system, child growth and brain development (see also article below "Maternal Nutrition and Neurodevelopmental Disorders"). Other data, suggesting that fat soluble antioxidants such as carotenoids and vitamin E may offer protection against the toxic effects of free radicals - formed in the body during metabolic processes - were also reviewed.

In addition, participants noted that "fats provide energy in concentrated form, often associated with other important nutrients like carotene, vitamins A,D,E & K", and recommended that "where possible they provide at least 15-20% of dietary energy". In non sedentary populations a healthy fat intake is considered to be one which accounts for from 15 to about 35% of dietary energy, with an adequate supply of essential fatty acids, fat soluble vitamins, and other essential nutrients, and with saturated fatty acids providing less than 10% of energy.

The consultation discussed the role of specific fatty acids in relation to cardiovascular diseases (blood lipids, atherosclerosis, thrombosis, hypertension), cancer (especially mammary, colorectal, prostate), obesity, diabetes mellitus, and gallstones. They recommended that "sedentary persons with high fat intake - and much of that derived from land-animal sources - should reduce their fat intake to no more than 30% of energy intake as a possible means of reducing the risk of ischaemic heart disease and types of cancer that are positively associated with dietary fat".

In general, according to recommendations resulting from the meeting, "consumers should be encouraged to use liquid oils or soft fats wherever possible, and avoid large intakes of fat from land animals". In addition "people who are currently using oils rich in monounsaturated fatty acids such as olive oil may be encouraged to continue their use ...In countries where vitamin A is a health problem, the use of red palm oil, wherever readily available, should be encouraged".

For further information, please contact Dr Ratko Buzina, Nutrition Unit, Food and Nutrition Division, WHO, Geneva. Tel: 41 22 791 3316.

(Source: WHO Press Release, 8 December 1993)

Maternal Nutrition and Neurodevelopmental Disorders

Every year, approximately 1.4 million babies are born with, or develop, severe neurodevelopmental disorders, which will stay with them throughout their lifetimes. Disorders include cerebral palsy, blindness, deafness, mental retardation and autism - and although infant mortality rates have declined, the number of babies suffering from this type of handicap has not shown a corresponding reduction.

The causes of these handicaps have largely remained a mystery, but studies carried out at the Hackney Hospital in London have attempted to piece together the existing evidence in an effort to help prevent these debilitating disorders.

Low birth weight babies are known to be at increased risk of neurodevelopmental disorders - incidence increases from 6.8 per 1,000 births in the 3.5-4.5 kg birth weight range to over 200 per 1,000 below 1.5 kg. In addition, it is known that all these defects occur during brain development.

Over 60% of the structural material of the brain is lipid, which uses arachidonic acid and docosahexaenoic acid for growth, function, and integrity. Both these acids are essential fatty acids (EFAs) which the body is unable to synthesize, and which must therefore be provided in the diet. Development of the brain in the embryo is dependent on the nutrition of the mother. Approximately 70% of brain cells have divided before birth - and the most active period of brain cell division is in the first few weeks of pregnancy, before the placenta has formed, and often before the mother is aware she is pregnant.

In studies of low birth weight babies, it has been found that the levels of arachidonic and docosahexaenoic acids in the umbilical endothelium and maternal and cord blood at delivery correlate strongly with birthweight. And a study in London of over 500 pregnancies found "significantly reduced intakes of several vitamins, minerals and fatty acids by mothers who produced low birth-weight babies compared to those whose babies were in the 3.5-4.5 kg reference range". Importantly, the study found that "maternal nutrition at or before conception was more strongly correlated with birth dimensions than nutrition during pregnancy itself. What the evidence appears to suggest, then, is that poor maternal nutrition, especially during the first few weeks of pregnancy, results in a lack of essential nutrients needed for brain development - in particular the EFAs arachidonic and docosahexaenoic acid - and leads to low birthweight babies with increased risk of having or developing neurodevelopmental disorders.

Professor Michael Crawford - author of the reports -concludes that "if the sum total of this evidence is true, then clearly the health of the next generation can be influenced by maternal nutrition prior to and during pregnancy, and lipids and their associated nutrients play an important role in this process. Given these findings, preventative measures could have wide implications for human health and intellectual abilities in subsequent generations."

(Source: (i) Crawford, M.A. (1993). The Role of Essential Fatty Acids in Neural Development: Implications for Perinatal Nutrition. American Journal of Clinical Nutrition. 57 (suppl.), 703-710. (ii) Crawford, M.A. (1992). The Role of Dietary Fatty Acids in Biology: Their Place in the Evolution of the Human Brain. Nutrition Reviews, 50(4), 3-11.)

Low Birthweight Babies - A Global Problem

According to information taken from the World Health Organization's Safe Motherhood database, in 1990 close to 25 million infants worldwide were born with a low birth weight - defined by the World Health Organization as a weight at birth - whatever the gestational age - of less than 2500 grammes.

Low birth weight babies are at increased risk of becoming malnourished in their first year of life - and are more likely to succumb to malnutrition and infection by the age of four or five - especially in developing countries.

Low birth weight can be caused by either prematurity -defined as birth at less than 37 weeks - or retarded intra uterine growth - or both. The main causes of prematurity are reproductive tract infections and sexually transmitted diseases, although cigarette smoking and low weight of the mother also contribute.

Causes of poor intrauterine growth are low maternal calorie intake or low weight gain, low weight before pregnancy, short stature, cigarettes smoking or malarial infection.

The 25 million low birth weight babies represented approximately 17% of live births in 1990. The highest incidence was in Asia, where 21% of babies had low birth weight. In Oceania 20% of babies had low birth weight, followed by Africa (15%), Latin America (11%), North America (7%) and Europe (6%).

(Source: One Newborn in Six Weighs Less Than 2,500 Grammes. Safe Motherhood Newsletter, Issue 12, July-October 1993, p8-9).

Breastfeeding Counselling: A Training Course

The World Health Organization has just released materials designed for use in a 40 hour training package for health workers who care for mothers and young children in maternity facilities, health centres and hospitals - including nurses, midwives and doctors - entitled "Breastfeeding Counselling: A training course". The course has been developed by the WHO Programme for the Control of Diarrhoeal Diseases (CDD) with the cooperation of UNICEF and provides basic training designed to enable health workers to support optimal breastfeeding practices, and where necessary to help mothers to overcome difficulties. It will be reviewed in more detail in the next issue of SCN News. The illustrations below - extracted from the course materials - depict one aspect of the changes in caring practices the course will encourage.



Meeting Cultural Requirements with Ready-to-Eat Meals

Over the past two years, over 53 million Meals, Ready-to-Eat (MREs) - originally designed as combat rations for soldiers - have been provided by the Pentagon in humanitarian efforts to help alleviate malnutrition amongst refugees. These meat-containing meals, however, have occasionally been rejected for religious and cultural reasons, and so a variety of new recipes, called Humanitarian Daily Rations (HDRs), have been developed by Pentagon food scientists.


According to an article in New Scientist "the new meals can safely be dropped from aeroplanes and require no refrigeration or water. They have a shelf life of two years. Unlike meals designed for soldiers, they contain no animal products. Each package is designed to sustain one person for one day, providing between 1900 and 2200 calories at a cost of $3.95."

The rations are not designed to be a long-term solution -but rather to help in emergency situations, to provide nourishment until other relief efforts such as feeding stations can be set up.

(Source: Kiernan, V. (1993). Menu Change for Air-Dropped Meals. New Scientist, 16 October, p. 10.)

Nutritional Health Surveys in Former Yugoslavia

As part of a joint initiative by UNHCR, UNICEF and WHO, four surveys were carried out in Bosnia-Hercegovina during June and July 1993 with the aim of assessing three main areas of health: nutritional status; breastfeeding practice; and vaccination coverage.

Data were collected on a representative sample of about 500 children and their mothers in each of four areas: Bihac Pocket; Sarajevo; Tuzla Region; and Zenica Municipality. Analysis of the data collected led to the following conclusions:

· No signs of protein-energy malnutrition were detected in underfive children in the four areas surveyed.

· The level of protein-energy malnutrition among mothers was low. However, many adults report having lost about 10kg on average since the war began.

· Clinical signs of serious micronutrient deficiencies among mothers and children were few. However, data from some areas, notably Bihac, suggest that anaemia may be a growing problem.

· Breastfeeding levels are very low and bottles are introduced at an early age. Concerted efforts need to be made with local health services to promote breastfeeding. The first priority should be to re-educate hospital staff.

· Vaccination coverage is not universal. Action and tangible help is needed to undertake health protection strategies. These should include strategies to maintain the nutritional status (to increase the body's natural resistance to infectious diseases), and increase vaccination coverage.

· It is likely that if humanitarian food aid had not been supplied, the nutritional status of the population would have been seriously compromised. For the health of the population to be maintained, it is vital that food distribution is continued in the areas where the population is largely reliant on humanitarian aid.

(Source: Robertson, Aileen. (1993) Summary Report of Nutritional Health Surveys Carried out in Bosnia-Hercegovina during June-July 1993, WHO Nutrition Unit, Zagreb, September 1993)

1994 - UN International Year of the Family

On 8 December 1989 - recognizing that, as an important part of global social development, there was a need for greater awareness and international cooperation on issues relating to the family - the United Nations General Assembly unanimously proclaimed 1994 as the International Year of the Family. The theme of the Year is "Family: resources and responsibilities in a changing world" and its motto is "Building the smallest democracy at the heart of society."

The specific objectives of the Year are to:

· increase awareness of family issues among Governments and the private sector;

· strengthen national institutions to formulate, carry out and monitor family policies;

· stimulate efforts to address problems affecting the situation of families;

· enhance the effectiveness of local, regional and national efforts to carry out family programmes;

· improve the collaboration among national and international non-governmental organizations (NGOs); and

· build upon ongoing international activities benefiting women, children, youth & ageing and disabled persons.


Amongst the issues to be focused on is that of the implications of rapidly changing family structures. The concept of the "family" exists throughout the world - but it takes many forms and these are undergoing rapid change under the influence of strong demographic, social, political and economic forces. For example, improvements in health care have increased life expectancy and lowered infant and child mortality rates. In regions where fertility levels are still high, including Africa and much of Southern and Western Asia, the age structure is becoming younger - and in regions where fertility rates are still falling, the population is ageing. In countries where significant fertility decline started before 1950 (mainly industrialized countries), 12% of the population is aged 65 and over.

In addition, in many areas the length of widowhood has increased, due to the increase in men's life expectancy lagging behind that of women. As one background paper prepared for the Year states "such shifts and many others will have far-reaching consequences for social security systems, national economies and societies as a whole."

There will be no major United Nations meeting to mark the Year - the General Assembly has decided that major activities should be organized at local, regional and national level, assisted by the United Nations and its system of Organizations.

Preparatory activities for the Year have been taking place in many countries. As of 11 May 1993, 83 countries had set up national coordinating mechanisms, 80 countries were developing national programmes of action, and 91 Governments had created national focal points for liaison with the IYF Secretariat - which is situated in Vienna, Austria.

At least 34 organizations and agencies of the United Nations system are preparing activities and NGOs have responded positively to an invitation by the General Assembly to become actively involved in the preparations and observance of the year.

For further information please contact: Coordinator for the International Year of the Family, United Nations Office at Vienna, PO Box 500, A-1400 Vienna, Austria. Tel: (43 1) 21131 4223 Fax: (43 1) 23 74 97.

(Source: 1993 "Backgrounders" provided by the UN Office of Information, Geneva.)

Planning for the Future through Participatory Rural Appraisal

A new approach to addressing problems of development and environmental improvement called Participatory Rural Appraisal (PRA) is showing promising results. According to an article in New Scientist the approach is "very different from the orthodox 'top-down' approach to rural development planning, where outside specialists get information from field workers and fit it into an official plan of action in which locals are only invited to participate". In contrast, PRA, with the help of "facilitators" effectively "hands planning initiative over to local people who are encouraged to use their first-hand knowledge and expertise of practices and priorities to construct charts, maps and matrices, all of which yield information making it easier to plan for the future."

In many cases, local people are first encouraged to make maps and models of their surroundings - highlighting details that are important to them. According to New Scientist "these maps - of villages, farms, community resources and relations - then become a basis for further analysis to show, say, the flow of essential resources such as water and food into and out of the communal pool. While constructing their diagrams, villagers identify key problems and new ways to tackle them. The process emphasizes environmental care and sustainable living... Paper and ink could be used - but more often diagrams are made with sand, sticks, seeds, chalk, leaves, or any other materials at hand, and arranged in a village square or other public place."

The most important attribute of the designs, says New Scientist, is that they really do work. "Maps provide a framework for people to plan and monitor innovations in farm management, agroforestry, resource distribution, community health care and so on. By putting local people in the centre of the picture - their own picture - PRA helps them set and achieve their own management standards working within local means."

"In one village in India where I was working with a Kenyan colleague, Elkanah Odembo, we asked a young farmer if he could plot the local rainfall month by month. He plotted the last year's rainfall, using lines of seeds on the ground for the rainy days in each month. The chart showed the number of days in rain, but not their frequency, so we asked him to do this. 7 can do that,' he said, 'but I'll need more seeds' Elkanah and I looked at one another: to us the request made no sense. But we found more seed and he used these to make each of the four rainy months into a line of 30 seeds. Then he started taking them away for the days when it didn't rain, leaving those when it did. To cap that, he then took a new kind of seed and contrasted a normal year alongside it."

Robert Chambers of the Institute of Development Studies at the University of Sussex as reported in New Scientist describing one aspect of Participatory Rural Appraisal.

And communities are adapting the applications of PRA to their own needs. "Health mapping, for instance, was invented by a voluntary community health care group in India which had heard about PRA in general terms and had assumed it was a system for improving health care. Now its medical applications range from assessing demand for (and obstacles to) family planning and immunization projects, to identifying the kinds of health care and nutrition programmes that are best suited to local needs."

Despite its many strengths, however, PRA has been shown to have limitations - such as whether it is possible to scale up locally-based schemes to the national level. However, Parmesh Shah, who has helped pilot the PRA approach in many parts of Asia and Africa, believes the situation will be resolved over time as larger cooperation results from the pooling of knowledge from several sites.

(Source: Lamb, R. (1993). Designs on Life. New Scientist, 30 October, 37-40.)

Use of "Tippy Taps" in the Prevention of Diarrhoeal Disease

Diarrhoea is largely caused by oral intake of faecal germs (faecal-oral transmission) which can occur in several ways including not washing hands after defecating - or cleaning up children's faeces - and then touching food, water or eating utensils, or touching mouths or other people's hands.

Illustration by Ingrid Emsden, extracted from Dialogue on Diarrhoea no. 54 (see end of article).

One way in which the transmission of diarrhoeal germs can be prevented is therefore to promote handwashing after defecating or after handling babies' faeces and before preparing food. Hands should be washed with an agent such as soap, mud or ashes in addition to water, which alone will not remove faecal contamination.

Studies in a highland village in Guatemala revealed that handwashing was not commonly practised there due to water shortage. In order to address this problem an intervention was designed based on the use of a simple device made from a plastic bottle called a "tippy tap" requiring about a tenth of the water normally used to wash hands.

In a trial project, selected mothers in the village were given tippy taps together with hanging soap and clean cloths for hand drying - and also guidelines as to how to use the "tippy tap" for handwashing.

Despite problems with older children being tempted to play with the "tippy tap" - and the requirement of extra work in using and maintaining it, ten months after the start of the intervention more than half the intervention mothers (54%) were still using it for handwashing. The average incidence of diarrhoea among children in families belonging to the intervention group was lower than in a control group - but the difference was not statistically significant. This might be partially explained, however, by the fact that a cholera outbreak occurred in Guatemala during the intervention period during which the Ministry of Health (MOH) initiated community clean-up campaigns and distributed hygiene information pamphlets house-to-house. Of 19 cases of cholera that occurred in a population of 10,000, none occurred in houses with tippy taps.

(Source: Hurtado, E. (1993). Tippy Tap' Saves Water. Dialogue on Diarrhoea, 54, 6. Instructions on how to make a 'tippy tap' are also included in that issue.)

WHO Strategy to Reduce Mortality from Acute Respiratory Infections

According to World Health Organization estimates, 4.3 million young children die each year from Acute Respiratory Infections (ARI). 1.5 million of these deaths occur in Africa - which is the focus of a new WHO report being distributed to health authorities throughout Africa "The Control of Acute Respiratory Infections in Africa, Time to Act".

The most serious disease amongst ARIs is pneumonia -often part of the cycle of malnutrition and infection -which can result in death in days if not treated. In Africa, 80% of childhood pneumonia is caused by bacteria, and most cases can be treated successfully if diagnosed in time and an appropriate antibiotic is administered. However, whilst treatment will help save lives in the short run, preventative measures - such as improved nutrition with particular emphasis on breastfeeding, reduction of the incidence of low birthweight, and cutting down on indoor air pollution - could potentially avoid much suffering in the longer term. It is also estimated that 10% reduction in mortality from pneumonia could be achieved through high coverage with measles and pertussis vaccination.

WHO advocates "standard case management" as the main strategy for the reduction of mortality from pneumonia, and has developed a simple and effective diagnosis and case management procedure which, it believes, could prevent at least 65% of pneumonia-related deaths.

The diagnostic procedure, whilst simple, can detect more cases of pneumonia than the clinical methods traditionally used, and it can be used by health staff at all levels of the health system. The "standard case management" strategy includes the use of oral antibiotics that are effective, cheap, and readily available (usually cotrimoxazole or amoxycillin) at the first level, with injectable second-line antibiotics for children who have been referred for hospital care. This case management system is at the centre of ARI control programmes which WHO, UNICEF, and other major agencies are supporting in developing countries throughout the world.

According to Dr Jim Tulloch, Director of WHO'S Division of the Control of Diarrhoeal and Acute Respiratory Diseases: "so far, less than half the countries in Africa have adopted ARI control, but many more are now recognizing it as a major priority. In the coming years the WHO ARI programme will be giving special emphasis to the needs of African countries."

(Source: WHO Press Release, 15 October 1993)

Malaria Vaccine Rights Donated to WHO

The rights to the first synthetic vaccine shown in field trials to offer protection against malaria have been handed over to WHO by the Colombian immunologist Manuel Patarroyo.

The first published results of a field study of the vaccine appeared in The Lancet in March, 1993 - and showed that it gave almost 40% protection overall against malaria in an at-risk Colombian population. In some age-groups results suggested higher protection rates. Further field trials are currently taking place or planned in South America, Africa and Asia - the results of which it is hoped will lend support to the findings of the Colombian study.

It is thought that WHO will await the results of these trials, expected by 1995, before deciding whether and how the vaccine will be used. The Colombian Government is planning to begin work on a US$4 million facility to produce the malaria vaccine and other peptide vaccines, if necessary - and says that production could be expanded very quickly should WHO decide that the vaccine is to be used for disease control.

(Source: "Colombian Scientist Donates Malaria Vaccine Rights to WHO". TDR News, 42 (July 1993), 1-2)

Remodelling Human Growth Patterns

Researchers investigating the nature of human growth have found evidence to suggest that it occurs not as a continuous process over time with velocity depending on age, as traditionally thought, but as a series of discontinuous jumps (saltatory spurts).

The study tracked the linear growth of 31 clinically normal Caucasian American infants - 19 females and 12 males -between the ages of 3 days and 21 months. The recumbent length of 10 of these infants was measured weekly for periods of 4-12 months, 18 were measured semi-weekly for 4-18 months, and 3 were measured daily for 4 months.

Results revealed that infants measured weekly grew in length increments of 0.5-2.5cm with 7-63 day intervals of no growth in between (stasis); those measured semi-weekly grew in increments of 0.5-2.5cm with 3-60 day intervals of stasis; and those measured daily grew by 0.5-1.65cm separated by 2-28 days of stasis. As the authors of the study point out "the daily data suggest that many of the weekly and semi-weekly increments may have occurred during individual 24-hour (or shorter) intervals" - and conclude that their findings "generate the hypothesis that human length growth during the first two years occurs during short (<=24 hours) intervals that punctuate a background of stasis."

Daily length measurements of a male infant from 90 to 218 days of age (with the exception of 11 days). Data are plotted by length (cm) and age (days × 102). The saltatory model identified 13 significant increments separated by 2 to 15 days of stasis.

Source: see end of article

(Source: Lampi, M., Veldhuis, J.D. & Johnson, M.L. (1992) Saltation & Stasis: A Model of Human Growth. Science, 258, 801-803.)

Anthropometry and Public Health: Expert Committee Meeting

On 1-8 November, 1993, an Expert Committee convened by the World Health Organization (WHO) on "Physical Status: The Use and Interpretation of Anthropometry" met in Geneva to discuss the potential uses of anthropometry in the health and other sectors, and to formulate recommendations for the development of appropriate anthropometric reference data and anthropometric indicators of health, nutrition and social and economic welfare.

Anthropometric measurements - such as height and weight - are a simple means of assessing the extent of inadequate or excess food intake, insufficient exercise, and disease, and they allow targeting of individuals, families and communities for interventions to improve nutritional status and health.

The Expert Committee Meeting was the culmination of three years' work by subcommittees focusing on appropriate uses of anthropometry to assess health and nutritional status of pregnant and lactating women, infants, children, adults, adolescents and the elderly, and to monitor fetal growth.

Recognizing that public health and clinical practice have as yet benefited little from the potential applications of anthropometry, the Expert Committee called on WHO Member States to adopt policies favouring the use of anthropometry as a social and technical instrument for assessing health and nutritional status and, more broadly, for measuring social and economic conditions and the impact of development. The Committee also recommended that anthropometry be incorporated in national and local health and nutrition surveillance systems and become part of clinical screening for health and nutrition interventions.

At present anthropometric reference data and indicators of health, nutrition and social and economic welfare concentrate on preschool children and infants. The Expert Committee recommended therefore that working groups be established by WHO to compile reference data and indicators for other age groups, as well as improving the existing data.

The inadequacy of infant data was particularly highlighted due to differences in growth patterns between formula fed infants - on which current WHO reference data is based -and breastfed infants (see SCN News #9, p.53 "Growth Patterns in Breastfed and Formula Fed Babies").

The value of anthropometry in assessing and monitoring public health was summed-up by Dr Fernando Antezana, Assistant Director-General of WHO, in his opening statement: "anthropometry is the single most portable, easily applied, inexpensive and non-invasive method of assessing body composition, which reflects both health and nutrition, and predicts performance, health and survival."

(Source: WHO Press Release, 12 November 1993)

New Method for Combating Iodine Deficiency Tested in West Africa

The World Health Organization estimates that over 1570 million people worldwide are at risk of iodine deficiency which can result in various disorders including goitre, hypothyroidism, impaired mental function, spontaneous abortions, stillbirths, congenital anomalies, increased perinatal and infant mortality, and neurological and myxedematous cretinisms.

The three main methods used to combat deficiency have been iodization of salt, intramuscular injection of iodinated oil, and oral intake of iodinated oil. In certain situations, however, these methods have been shown to have limitations, and so an alternative method of providing iodine to deficient populations has been developed by researchers. The system - also reported in SCN News No. 5 (p.27-28), but in less detail - consists of a silicone elastomer - platinum matrix containing a dispersion of sodium iodide which, when immersed in water, releases iodine at a constant rate over a period of one year. Depending on the average daily consumption of water per person, and the flow rate of the water source, the system is adjustable to provide the required concentration of iodine in the water.

The system was tested in Mali, West Africa over one year from November 1988 to November 1989. Two villages were involved in the study, Woloni and Sirablo. Sample sizes were 94 subjects for Woloni and 107 subjects for Woloni. Both villages had a single water source consisting of a bore well with a manual pump.

One silicon elastomer device designed to release 720mg of iodine/day - with the aim of providing approximately 100 ug of iodine per person per day, the amount recommended by the World Health Organization - was immersed in the well in Woloni, and one not containing iodine was immersed in Sirablo's well on day 0. Neither village received any other intervention for controlling iodine deficiency during the one year study period.

Previous to the study the water supply in both villages had had a very low iodine content of around 4 ug/L. Constant and continuous iodine release in the test village was observed from day 2 until the end of the study, averaging 163.2 ug/L whilst the concentration in the control village remained unchanged.

Urine iodine content was measured in the sample subjects from the two villages, and reported in terms of the WHO definitions of severity of deficiency (<25 ug/L = severe deficiency; 25-50 ug/L = moderate deficiency; 50-100 ug/L = slight deficiency; and >100 ug/L = no deficiency). Before the start of the study, on average 3/4 of the subjects in the two villages had severe deficiency. From six months after the installation of the elastomer system in Woloni until the end of the study, 90% of the subjects had "no deficiency", and 10% had "slight deficiency", and "moderate" and "severe" deficiencies disappeared altogether. There was no significant change in the control village over the same period.

Overall goitre frequency at the beginning of the study was similar in the test (53.2%) and control (56.5%) villages. 12 months later, the overall frequency of goitres in the test village had significantly decreased to 29.2%. Severe forms were particularly affected - their frequency relative to all goitre forms fell from 78.4% to 57.3%. In the control village, no change in goitre frequency was observed.

In summary, the authors of the study conclude: "for a year, the controlled release system supplies a physiological supplement of iodine that is beneficial for all subjects, whatever their age, sex, nutritional status, or previous medical status, while having no ecological effects. In addition, its large-scale feasibility is not impeded by any of the obstacles that applied to previous methods for combating iodine deficiency".

(Source: Fisch, A. et al (1993). A New Approach to Combatting Iodine Deficiency in Developing Countries: The Controlled Release of Iodine in Water by a Silicone Elastomer. American Journal of Public Health, 83(4), 540-545)

World Federation of Public Health Associations (WFPHA) VII International Congress

The WFPHA - a nongovernmental organization composed of national public health associations from 41 countries around the world - is holding its VII International Congress on December 5-9, 1994, in Bali, Indonesia. The theme of the Congress will be "Health, Economics, and Development: Working Together for Change."

Participants are expected to include: health practitioners, policymakers, administrators, development workers, economists, researchers, and many others from governments, international organizations, and private groups. The main aims of the Congress will be to examine the linkages among health, economics, and development, and to develop an action agenda to integrate health concerns with economic and development policies.

WFPHA Congresses are held every three years and are cosponsored by the World Health Organization and UNICEF. This Congress will be hosted by the Indonesian Public Health Association. Participation is open to all.

For further information and abstract forms contact: WFPHA Secretariat, c/o APHA, 1015 15th Street, N.W., Suite 300, Washington DC 20005, USA. Tel: (202) 789 5696 Fax: (202)789 5681.

(Source: WFPHA Communication, November 10, 1993).

Seventh Annual Hunger Research Briefing and Exchange, Brown University, 13-15 April 1994.

"Hunger and Development: Balancing Actions - Linking Local Solutions to Global Policies" will be the theme of the Seventh Annual Hunger Research Briefing and Exchange to be held at Brown University on 13-15 April, 1994. Organized by the Alan Shawn Feinstein World Hunger Program at Brown University, and Inter Action, the American Council for Voluntary International Action, the topics to be addressed will include the following:

* How do Programs Balance Overcoming Hunger With Sustainable Development?;
* What Impact do Changing International Health Initiatives have on Hunger?;
* Food Security and Economic Development: Do Small Landholders Benefit?;
* Hunger and Economic Development: Safety Nets and Other Strategies;
* Sanctions: Need There be Tradeoffs Between Hunger and Democracy?;
* Linking Hunger and Populations: Shared Goals, Shared Resources; and
* Linkages: Public and Private Partnerships for Combating Hunger.

IUNS Declaration: Nutritional Goals for the Nineties: A Call for Advocacy and Action

The International Union of Nutritional Sciences (IUNS) is the union of nutritional scientists from countries throughout the world.

During the XV International Nutrition Congress in Adelaide, Australia, the General Assembly with delegates from over 50 countries agreed to issue the following statement:

The IUNS strongly supports the World Declaration and Plan of Action for Nutrition, in its entirety, as agreed at the International Conference of Nutrition (ICN) in Rome, December 1992. It also reiterates its commitment to the nutritional goals of the Fourth UN Development Decade, the Convention of the Rights of the Child, the World Summit for Children and Agenda 21.

The ICN Declaration pledges countries to make all efforts through their national plans, by the end of this decade to eliminate:

· famine and famine-related deaths;
· starvation and nutritional deficiency diseases in communities affected by natural man-made disasters; and
· iodine and vitamin A deficiencies.

The Declaration also calls on countries within this decade, to substantially reduce:

· starvation and widespread chronic hunger;
· undernutrition especially among children, women and the aged;
· other important micronutrient deficiencies, including iron;
· diet-related communicable and non-communicable diseases;
· social and other impediments to optimal breastfeeding; and
· inadequate sanitation and poor hygiene, including unsafe drinking water.

IUNS joins the ICN signatories in their resolve to promote active cooperation between governments, multilateral, bilateral and non-governmental organizations, the private sector, communities and individuals to progressively eliminate the causes that lead to the scandal of hunger and all forms of malnutrition in the midst of abundance.

IUNS calls on nutrition scientists in its member countries to prompt and assist their governments to implement nationally appropriate nutrition plans and policies in line with the International Plan of Action.

Considerable acceleration of the rate of nutrition improvement is needed. For this to occur, there must be greater support of basic, clinical and applied research in nutrition worldwide. Training in nutrition at all levels must be action-oriented to focus on solutions to current problems.

We declare our intention to mobilize all our efforts and resources in the pursuit of achieving the nutritional goals for the nineties.

The countdown to the year 2000 is on.

(Source: IUNS Communication, October 1993)

The ceremony for the 1993-1994 Alan Shawn Feinstein World Hunger Awards will also take place during the Briefing.

For further information and registration details please contact: The World Hunger Program, Brown University, Box 1831, Providence RI 02912, USA. Tel: 401 863 2700. Fax: 401 863 2192. EMail [email protected].

(Source: World Hunger Programme Announcement, December 1993)

XVI International Vitamin A Consultative Group Meeting

The XVI International Vitamin A Consultative Group (IVACG) Meeting will be held 24-28 October 1994 in Chiang Rai, Thailand. The meeting will take the theme of "Two Decades of Progress: Linking Knowledge to Action." The program will include invited presentations on this topic and on the development of national plans of action as part of the follow-up to the International Conference on Nutrition. Other presentations will be selected from submitted abstracts on the following topics:

· Dietary approaches to combat vitamin A deficiency

This topic includes assessment, dietary diversification, fortification, food composition, food production through home gardens, appropriate food preservation technology, home food preservation, and intra-household determinants of diets.

· Education and communication strategies to promote change in vitamin A-related behaviours

This topic includes person-to-person communications, presentations and group interactions, print media, audiovisuals, songs, broadcast media, and especially multimedia.

· New human research related to vitamin A

This topic includes childhood morbidity, immune response, detection and consequences of subclinical deficiency, and safety issues.

The International Vitamin A Consultative Group (IVACG) guides international activities for reducing vitamin A deficiency in the world. Through its international meetings, IVACG provides a forum for new ideas, encourages innovations, recognizes important research findings, increases awareness of the latest survey data, and promotes action programs.

For more information about IVACG and the XVI IVACG Meeting, please write to the IVACG Secretariat, The Nutrition Foundation, Inc., 1126 Sixteenth Street, N.W., Washington, D.C. 20036, USA. Tel: 202 659 9024; Fax: 202 659 3617."

(Source: IVACG Secretariat communication, 5 November 1993)

Network for the Pan-European Food Data Bank Based on Household Budget Surveys

Household Budget Surveys (HBS) are carried out regularly in all European countries and represent a valuable source of dietary information for use in nutritional analyses.

Previously there has been no mechanism for consolidating national HBS information into one central database, but now a new initiative called the Scientific Network for the Pan-European Food Data Bank Based on Household Budget Surveys, or DAFNE (DAta Food NEtworking) will attempt to create an operational European HBS Food Data Bank, accessible to all.

DAFNE is supported by the EC Programme "Cooperation in Science and Technology with Central and Eastern European Countries". Its activities will be to facilitate the expansion of a data communication infrastructure between countries and the exchange of background information concerning national HBS sources and methods; promote the elaboration of a common methodology, which includes analysis and comparison of national reports, their consolidation, development of statistical methods for processing HBS data in each country, formation of a common method for integrating the national ones, and standardization of data collection; build statistical models to convert HBS data into food and nutrient related information; and finally design, develop and carry out pilot operation of the Data Bank in preparation for its implementation.

It is envisaged that the Data Bank will constitute an important source of information for activities such as nutrition strategy planning, agricultural strategy planning, marketing foodstuffs, and assessing dietary intake of additives and contaminants.

Partners in DAFNE are: Dr Kristo Haxhi, Ministry of Health, Department of Public Health, Tirana, Albania; Prof Dr H.K. Henderickx, Faculty of Agricultural Science, Department of Nutrition, Gent, Belgium; Pr Dr I.U. Leonhaeuser, Institute of Nutrition - JLU University, Giessen, Germany; Dr W Sekula, National Food & Nutrition Institute, Warsaw, Poland; and Dr G Zajkas, National Institute of Food Hygiene and Nutrition, Budapest, Hungary.

The project coordinator and contact for further information is: Prof. Antonia Trichopoulu, Dept. of Nutrition and Biochemistry, Athens School of Public Health, 196 Alexandras Ave., Athens, Greece. Tel: 30 1 6428677/6461831 Fax: 30 1 6436536.

(Source: DAFNE leaflet 1993)

UNHCR Announces 1993 Nansen Medal Winner

The United Nations High Commissioner for Refugees has announced that Medecins Sans Frontieres (MSF) has been chosen to receive the 1993 Nansen Medal in recognition of its exceptional service to refugees.

MSF is a non-governmental organization, established in France in 1971, which has expanded its operational network throughout Europe with sections in Belgium, Luxembourg, The Netherlands, Spain and Switzerland, and a dozen branch offices worldwide.

For more than 20 years, MSF staff members have been among the first to arrive on the scene of refugee crises around the world, often risking their lives to provide emergency medical assistance. Seven MSF staff have been killed in the line of duty.

The 1993 winner was honoured at a ceremony on 12 October, 1993, in the Palais des Nations where High Commissioner Sadako Ogata presented the medal to Jacques de Milliano, President of Medecins Sans Frontieres International.

The Nansen Medal, awarded 34 times since 1954, is named after the Norwegian diplomat and explorer Fridtjof Nansen, the first High Commissioner for Refugees under the League of Nations. The award is aimed at focusing attention on the plight of refugees and at giving new impetus to international support for the uprooted.

The Nansen Committee, composed members designated by the Norwegian Government, the Swiss Government, the Council of Europe, the International Council of Voluntary Agencies (ICVA) and UNHCR, was unanimous in its decision to award the Nansen Medal to MSF for its advocacy and longstanding commitment to the refugee cause.

In awarding the 1993 Nansen Medal to MSF, the Nansen Committee also emphasized the crucial role played by NGOs in assisting refugees and advocating for their rights.

On many occasions, the High Commissioner has emphasized the need to strengthen UNHCR's partnership with NGOs and is convening a conference with NGOs worldwide to achieve this goal. This conference known as PARINAC (Partnership in Action) will take place in Oslo in June 1994 preceded by regional preparatory meetings.

(Source: UNHCR Information Section Release, 17 September 1993)

Second International Postgraduate Course on Production and Use of Food Composition Data in Nutrition

Organized by the Graduate School for Advanced Studies in Nutrition, Food Technology, Agrobiotechnology and Health Sciences, in cooperation with the United Nations University (UNU) and the Food & Agriculture Organization of the United Nations (FAO), the Second International Postgraduate Course on Production and Use of Food Composition Data in Nutrition will take place from 3-21 October 1994, in Wageningen, The Netherlands.

The course is designed for those involved in nutritional database programmes as analysts and/or compilers and those who teach nutrition and nutritional aspects of food chemistry. The organizers also consider that users of nutritional databases interested in how databases are prepared and their limitations may also find the course useful.

The course will comprise lectures, seminars and group work on the following subject areas:

· Introduction to the use of databases at different levels: international, household, and individual;
· Introduction and organization of a food composition database programme;
· Selection of foods, establishing priorities;
· Sampling;
· Methods of analysis, a critical evaluation; and
· Assuring the quality of analytical data.

For further information please contact: Mrs L Duym, Secretariat Food Composition Data Course, Department of Human Nutrition, Wageningen Agricultural University, PO Box 8129, 6700 EV Wageningen, The Netherlands. Tel (31) 8370 83054/82589. Fax: (31) 8370 83342.

(Source: Course Announcement Leaflet, September 1993)

New Chief of WHO Food Aid Programmes Unit Appointed

Dr Mirella G Mokbel - formerly Technical Officer with the Food Aid Programmes unit (FAP) of the World Health Organization - has been appointed Chief, FAP with effect from 1 August 1993. The FAP Unit, together with the Food Safety Unit (FOS) and the Nutrition Unit (NUT) comprise the newly established WHO Division of Food and Nutrition (see SCN News No. 9, p.58).

(Source: WHO Information Circular No. 73, 7 October 1993)

World Breastfeeding Week 1994

The following is extracted from the World Alliance for Breastfeeding Action (WABA) Newsletter WABA Link, December 1993, p.1.

"Making the International Code Work is (this) year's World Breastfeeding Week (WBW) theme. The WBW themes are focused on the Innocenti targets as part of WABA's mandate to act on the Innocenti Declaration.

WBW 1994 will try to explain the International Code of Marketing of Breastmilk Substitutes to the average breastfeeding supporter and show how society can become involved in 'making it work'.

"While the Baby- and Mother-friendly initiatives both support and promote breastfeeding, an emphasis on putting the International Code into practice nationally is essential to protect breastfeeding.

"WABA is distributing the WBW 1994 calendar to announce the theme and give further information.

"The focus on the Code also reinforces UNICEF's work to end the distribution of free and low-cost supplies of breastmilk substitutes in 1993 for developing countries and by June 1994 for industrialised countries.

"The WBW 1994 Action Folder is being written and scheduled for distribution by February 1994. The French and Spanish versions should be available a month later."

For further information please contact: World Alliance for Breastfeeding Action, PO Box 1200, 10850 Penang, Malaysia. Tel: 60 4 658 4816 Fax: 60 4 657 2655.

(Source: as above)

World Bank Conference on "Overcoming Global Hunger"

A two-day World Bank Conference on "Overcoming Global Hunger" was held in Washington, D.C. on 30 November and 1 December, 1993. The aim of the workshop was to bring together specialists from governmental and international agencies and NGO's both in the North and in the developing world, to agree on specific practical priority actions for achieving results. The participants worked in small groups to discuss questions related to the four major themes and sessions of the conference: Macro-economic Reform: Its Impact on Hunger and Poverty in both the Short and Medium term; Targeted Interventions: What Works Best to Reduce Hunger?; The Political Economy of Hunger: The Need for Focal Points & Decision-Making; and Commitment to Action.

Amongst the dignitaries who addressed the Conference were: UN Secretary General Boutros-Boutros Ghali, former US President Jimmy Carter, Botswana President and World Hunger Prize winner Ketumile Masire, Grameen Bank president Mohammed Yunus, philosopher/economist Amartya Sen, and the heads of USAID, IFAD, the World Food Program and the executive vice-president of IDB. NGOs actively participated on the Steering Committee and had a sizable voice in the agenda and selection of speakers and attendees.

The following paragraphs are extracted from the address made at the Conference by former US President Jimmy Carter.

"I speak today not as a former President but as the leader of an NGO, one of hundreds that are deeply committed to resolve the problem of hunger. Like many NGOs, the Carter Center is free to try new ideas, and is eager to cooperate with others...

"...We have many projects, several dozen in fact, most of which are in African nations. We know that people suffering from starvation are more likely to erupt into civil war and, in a war-torn society, starvation is almost invariably prevalent. The afflictions feed on each other. In fact, we have found that peace, freedom, democracy, human rights (including the right to food), and the alleviation of human suffering are inseparable...

"...We are all concerned about employment, but we should remember that a successful farmer has a good job. One Tanzanian farmer, who lived near the base of Mount Kilimanjaro, was proud of his harvest of 26 bags of maize, comparing it with his previous high yield of six or seven bags on the same fields. He told me that his two sons, who had moved to Dar es Salaam to seek a livelihood, would now be returning to the farm...

"...Recognizing that development aid in general has been relatively ineffective, UN Secretary General Boutos Ghali and I co-chaired a conference last year, sponsored by Carnegie Corporation, to assess what might be done. The World Bank and other major agencies attended, and we derived the final conclusions from them. One proposal that is being initiated is called a "Global Development Initiative." First in Guyana and then in one or two other countries, we will attempt to forge closely coordinated task forces of donors on one hand and recipients on the other. Lessons learned can be applied in many other countries.

"Hopefully, we can evolve a more effective way to alleviate hunger, using some of the principles outlined by all of us here in these sessions. Although past experiences make me skeptical, I hope that this conference will result in common action, and not in just another beautiful report and the creation of another agency. We are eager to cooperate, adding our small capabilities to an overall effort. Success or failure in reducing hunger worldwide will depend on all of you - and of me."

(Source: World Bank Communications, November 15 and 3 December 1993.)

New Agency and Appointment

We were delighted to receive this news about a valued colleague:

"The White House has appointed Eileen Kennedy, research fellow at the International Food Policy Research Institute in Washington DC, as Administrator of a new agency called Nutrition Research and Education under the US Department of Agriculture effective February 16, 1994."

Eileen Kennedy has contributed to many SCN activities, including articles for SCN News (e.g. Number 8, p8-9) and reviews.

(Source: IFPRI communication, February 1994)