PROGRAMME NEWS

Update on progress around the world.

CANADA

Centre for Nutrition and the Environment of Indigenous Peoples (CINE)

Why CINE was created

The Centre for Nutrition and the Environment of Indigenous Peoples (CINE) has been created in response to a need expressed by Aboriginal peoples for participatory research and education to address their concerns about the integrity of their traditional food systems. Deterioration in the environment and in lifestyles have resulted in serious questions about the impact on human health, and in particular health and nutrition as derived from food and food traditions. The expertise of Centre staff will address problem-solving on these issues in collaboration and partnership with the Centre Board and communities of Indigenous Peoples.

What CINE is

CINE is a permanent research and education resource for Indigenous Peoples. In concert with Indigenous Peoples, CINE will undertake community-based research and education related to traditional food systems and nutritional well-being. The empirical knowledge of the environment inherent in Indigenous societies will be incorporated in all of its efforts.

The Centre has a Governing Board of representatives of the following: the Dene Nation, the Metis Nation of the Northwest Territories, the Inuit Tapirisat of Canada, the Inuit Circumpolar Conference, the Council for Yukon Indians, and the Assembly of First Nations. The Aboriginal host for CINE is the Mohawk Council of Kahnawake. The first Governing Board is chaired by Bill Erasmus, National Chief of the Dene Nation. CINE has a focus with Indigenous Peoples in Canada and the circumpolar North. Its scope will be extended to other parts of the world as funding becomes available.

Funding for the establishment of the Centre was obtained in 1992. The Centre has its physical resource base on the Macdonald Campus of McGill University in Ste. Anne de Bellevue, Quebec. It is affiliated with McGill's School of Dietetics and Human Nutrition and the Faculty of Agricultural and Environmental Sciences. There is an initial staff of four Ph.D-level researchers, and 5 support personnel. CINE and McGill have a partnership with Arctic College and Yukon College to provide training to Aboriginal People on topics related to nutrition and the environment.

What CINE will do

CINE is an independent research and education centre with activities promoted and directed by the Governing Board to serve Indigenous Peoples in partnership at the community level.

There are three primary areas of interest and activities in research and research training at CINE:

A. The social sciences of what foods people select, how much, and why, in relationship to environment and culture. This is important to understand the balance of traditional to market foods, and the various social forces contributing to changing dietary patterns and nutritional health.

B. The laboratory sciences of the nutrients and contaminants in foods and people. CINE has the analytical chemistry needed to understand the quantities of elements and compounds in specific food items; also to understand their impact in humans.

C. Data management sciences provide the application of the extent of food use (A) and the quantities of nutrients and contaminants (B) to address questions of holistic human nutrition and health, and to explore the limits of nutrient and contaminant exposure to people in specific age and gender categories.

Education programs are being developed at several levels (community, college, university), to meet the needs of the Centre.

(For further information please contact Dr Harriet Kuhnlein, Director, CINE Centre, Macdonald Campus, McGill University, 21,111 Lakeshore, Ste. Anne de Bellevue, Q.C. H9X 3V9, Canada. Tel: (514) 398 7544 Fax: (514) 398 1020.)

(Source: CINE Communication, October 1993)

FAO

Implementation of the ICN World Declaration and Plan of Action for Nutrition: The Role of FAO.

The World Declaration and Plan of Action for Nutrition, adopted unanimously at the December 1992 International Conference on Nutrition (ICN), confirms the determination of all nations and other concerned parties to work together to eliminate hunger and all forms of malnutrition, calls for concerted action to direct resources to those most in need, and stresses the need to protect the nutritional well-being of vulnerable groups.

The ICN Declaration and Plan of Action is being used to stimulate effective follow-up activities, particularly in the form of practical actions at the local and national levels, undertaken by the cooperative efforts of governments, nongovernmental organizations (NGOs), the private sector, communities, individuals and international development agencies. The broad-based participation which was so essential to the success of ICN is continuing to be a fundamental element in the follow-up. FAO, along with WHO, actively endorses the need for continued and expanded collaboration, including wide-ranging participation of multilateral and bilateral organizations.

Incorporation of nutrition objectives into development activities

At the country level, FAO is taking an active role in identifying and trying to meet needs for technical and financial assistance in follow-up activities, especially in the formulation of national plans of action for nutrition, which all countries have agreed to prepare by the end of 1994. Guidelines for preparing national plans of action have been written and distributed to countries through FAO Representatives, who are serving as a primary focus for encouraging the development and implementation of follow-up activities. FAO Representatives are facilitating the preparation of national plans of action and are working to foster interagency cooperation by keeping in contact with representatives of WHO, UNICEF, UNDP, World Bank, and other concerned agencies. To encourage the participation of NGOs in ICN follow-up activities, FAO is actively promoting the establishment of international and regional NGO networks which aim to improve food supplies and nutritional status. Work with the non governmental organizations, particularly the NGO working groups which were formed to promote participation in the ICN, is continuing.

Agriculture is of prime importance

One of the key strategies endorsed by the ICN is the explicit promotion of better nutrition through a range of agricultural and development policies and programmes. Indeed, without improved agricultural performance and the integration of nutritional considerations into agricultural development, many countries will not be able to attain their nutritional goals. As the leading UN technical agency for agriculture and rural development, FAO is eager to provide advice on most aspects of policy and technology in this crucial sector.

FAO will concentrate its efforts on five aspects of the ICN Plan of Action in which it has a "comparative advantage", thereby complementing the work of other UN agencies which have different mandates. FAO offers assistance to Member Countries in the following areas.

Promoting Household Food Security and Community Development

An objective of FAO's work is to assure that households have access to adequate amounts of good quality food throughout the year. Beyond national food security, households must have the economic and physical means to obtain the foods they need. FAO can assist governments in accomplishing the fundamental goal of alleviating poverty and improving household food security by promoting strategies of economic and community development in which the rural poor participate and benefit.

Providing Nutrition Education

Even when the potential for an adequate amount and variety of foods exists, individuals may lack information about how to best use the resources which are available to improve their nutritional status. Furthermore, misinformation about particular foods can inhibit production and consumption of foods which can bring nutritional and economic benefits. FAO is increasing its activities in the area of nutrition education and communication.

Combating Micronutrient Deficiencies

Believing that food-based strategies are the only sustainable means to combat micronutrient deficiencies, FAO is involved in promoting the production and consumption of foods rich in micronutrients, especially Vitamin A. With the combined efforts of its plant, animal, and fisheries divisions, FAO is able to provide technical assistance in all aspects of this long-term strategy.

Assessing and Monitoring Food and Nutrition Situations

FAO has advised governments on the collection and analysis of data on nutritional status for many years. Data on food supplies and nutritional status are indicators of a country's level of development and can inform policy makers and planners. One example of FAO's monitoring efforts is a global early warning system. As an agency with expertise in surveillance, nutrition, and development, FAO is able to inform the international community when food shortages occur, provide nutritional advice for the provision of food aid and assist in rehabilitation and resettlement when crises occur.

Assuring the Quality and Safety of Food Supplies

FAO's expertise in the area of food quality and safety is widely acknowledged. Through its food quality and safety work, FAO directly contributes to improved nutrition by protecting the health of consumers. By assisting developing countries in establishing food control systems, FAO attempts to remove non-tariff barriers to trade. The economic benefits of increased trade can stimulate agriculture and help to reduce poverty within a country, thus improving access to food. In addition to the ongoing activities (some are noted elsewhere in this issue) FAO is exploring the possibility of establishing an FAO/IAEA Training and Reference Service for Food Quality and Pesticides.

Nutrition: an FAO Priority

To mobilize FAO's agricultural and rural development experts to assist in the ICN process, the Director General has placed nutrition high on the Organization's agenda. Two major FAO meetings, the Committee on Forestry (COFO) and the Committee on Agriculture (COAG), as well as the FAO Council, met last spring and the ICN follow-up activities were major items for discussion. The Committee on Forestry endorsed the intersectoral approach to improving nutrition, emphasizing the importance of strengthening the communication and collaboration among foresters, agriculturalists, nutritionists and health officers at the country level. Recognizing the central role of national and local governments in achieving the goals of the World Declaration and Plan of Action for Nutrition, the Committee on Agriculture emphasized that FAO support should be primarily directed towards strengthening national capacities to identify, address and monitor food and nutrition problems, and to alleviating poverty, ignorance and social inequity. The FAO Council reiterated its support for the goals and approaches set forth in the World Declaration and Plan of Action for Nutrition as adopted by the ICN, supported overall FAO efforts to promote follow-up activities, and endorsed FAO's emphasis on providing support for strategies and actions in the five areas of major focus. Within FAO, Special Action Programmes are being established to better coordinate support to countries in the ICN follow-up. These are the Programme on Nutrition and Food Quality and the Programme on Policy and Planning Assistance on Household Food Security and Sustainable Agricultural and Rural Development. Through the mechanisms and strategies described above, FAO is working vigorously to initiate and implement follow-up activities to meet the goals and objectives agreed to at the ICN.

(Source: FAO, 1993)

Codex Alimentarius: A New Approach

The FAO/WHO Codex Alimentarius Commission held its Twentieth Session in Geneva in June/July 1993. The Session marked the transition of the Commission's previously commodity-oriented work programme to a programme based on general considerations for protecting the consumer - facilitating international food trade. The new Codex approach is consistent with the Plan of Action adopted by the ICN and by the FAO/WHO Conference on Food Standards, Chemicals in Food and Food Trade, March 1991.

The Commission, chaired by Professor F.G. Winarno (Indonesia), called on its Member governments to strengthen the role which consumers played in the development of food standards at the national and the international Codex level. More importantly it called for a partnership between consumer and producer organizations and national food control authorities in the development and operations of national food control, inspection and certification systems. Responding to its future responsibilities within the framework of GATT agreements on sanitary and technical barriers to trade in foods, the Codex Commission reviewed the risk analysis and assessment procedures inherent in its decision-making processes and undertook to make these procedures more transparent, more uniform where possible, and better understood.

New standards, recommendations and guidelines were adopted by the Commission in the areas of food additives, pesticide residues, food labelling, food hygiene and handling, and nutrition. Commodity standards for cereals, fresh fruit and vegetables, and fishery products were also adopted. For the first time, the Commission adopted a series of maximum residue limits for the presence of veterinary chemicals in foods; detailed codes of practice for the hygienic handling of fresh meat and game and for ante- and post-mortem inspection of meat and meat-producing animals were fully revised. The Commission extended the coverage of its work to include the development of quality assurance principles in its work on food import and export inspection and certification systems.

Codex standards, maximum residue limits, guidelines and other recommendations are being published in a new series. They are available from the world-wide sales offices of FAO and WHO or directly from the Distribution and Sales Service of FAO, Via delle Terme di Caracalla, 00100 Rome, Italy.

(Source and contact for further information: Director, Food Policy and Nutrition Division, FAO, Via delle Terme di Caracalla, 00100 Rome, Italy.)

ICCIDD

Increased Governmental Support for IDD Control

The striking recent feature about IDD has been the increasing political support for national programmes. The objective of elimination of IDD by the year 2000, accepted by the World Summit for Children 1990 and the World Health Assembly 1990, followed up by the 1991 Montreal conference on "Ending Hidden Hunger", has led to a number of governments giving top priority to IDD control. The governments include Indonesia, the Philippines, Thailand and China.

National Advocacy

In association with a National Advocacy Meeting in June 1993, President Fidel Ramps of the Philippines appeared on television to promote the IDD elimination programme and has called on his government to fully support IDD elimination in order to ensure that no baby is born physically or mentally handicapped because of iodine deficiency.

A National Advocacy Meeting for the Elimination of IDD in China by the Year 2000 was held in the Great Hall of the People under the sponsorship of Premier Li Peng. This meeting brought together Provincial Governors and staff from all Provinces and representatives of International Agencies. The Chinese Vice Premier Mr Zhu Rong Ji, made a commitment of full government support to the Provincial Governors. He also indicated the strong support of the government to a meeting of representatives from the World Health Organization, UNICEF, UNDP, World Bank and ICCIDD, and the Ministry of Public Health. This decision recognizes the significance of the threat of IDD to neonates born in China in light of its one child family policy.

Salt lodization

The mid decade goal of 95% access to iodized salt has been accepted by UNICEF and WHO for December 1995. Assessments of verification of progress towards the mid decade goal are now proceeding and will be reviewed at Joint ICCIDD/UNICEF/WHO Regional Meetings in Latin America, Asia and Africa over the next 2 years.

A procedure for monitoring salt iodization is now being developed following a joint ICCIDD/UNICEF/WHO Consultation on IDD Prevalence and Programme Indicators held in Geneva 3-4 November 1992. Criteria for tracking progress towards elimination of IDD involving salt iodization, measurement of urine iodine, to be followed where possible by measurements of thyroid size and blood TSH, have now been agreed. A full report is available from the offices of WHO, UNICEF and the ICCIDD.

IUNS Congress

At the recent IUNS International Congress of Nutrition in Adelaide, the ICCIDD arranged a symposium which reported substantial progress towards the goal of elimination with papers by Hetzel (ICCIDD), Pandav (India), Gutekunst (UNICEF), Kavishe (Africa), Wang (China), Darnton-Hill and Clugston (WHO). An informal consultation was also held with progress reports from Bangladesh (PROFILES study), Indonesia and India, and discussions of the UNICEF strategy for salt iodization.

KIWANIS

At its recent World Congress, Kiwanis International announced a fund raising target of $100M towards the elimination of IDD in association with UNICEF over the next five years. This is the first World Service Project of Kiwanis International which has 9,000 clubs with over 300,000 members throughout the world. The ICCIDD is already involved in assisting in the IDD education programme for Kiwanis members throughout the world.

(Source and contact for further information: Dr Basil S Hetzel, Executive Director, ICCIDD, c/o Health Development Foundation, 8th Floor, Samuel Way Building, Women's and Children's Hospital. 72, King William Road, North Adelaide 5006, Australia. Tel: 61 8 204 7021 Fax: 61 8 204 7221)

IDECG

Benefits of Early Supplementary Feeding on Child Development

In the summer of 1990, IDECG sponsored a workshop bringing together scientists involved in the follow-up of a longitudinal food supplementation study in Guatemala. Data presented at the meeting indicated that nutritional improvements during the critical period of gestation and the first 2 to 3 years of life can enhance human development assessed by a wide range of variables not only in infancy and during the preschool years but also in adolescence.

A first series of papers with the background of the Guatemala Oriente Study, the supplementation effects in early childhood, the demographic and social changes between the initial and the follow-up, as well as the design and main findings of the follow-up, appeared in the Food and Nutrition Bulletin, Volume 14, Number 3, September 1993.

Supplementation effects on cognition are presented and discussed in a Monograph of the Society for Research in Child Development (Serial No. 235, volume 58, number 7, 1993) entitled "Early Supplementary Feeding and Cognition". Interested individuals who do not have easy access to this monograph series can obtain a free copy from the IDECG Secretariat.

A third series of papers, focusing on the follow-up study and presenting its results in detail will appear as a supplement to the Journal of Nutrition in 1994.

Causes and Mechanisms of Linear Growth Retardation (Stunting)

A workshop on this topic, proposed and organized primarily by John C. Waterlow, was held at the Ciba Foundation in London from January 15-18, 1993. The meeting brought together scientists who had made observations on causes, correlates and patterns of linear growth retardation, with experts on the cellular biology and hormonal regulation of bone growth who could speculate on the mechanisms involved. Twenty-eight scientists from 12 countries were involved in the presentation and discussion of the following issues: The genetic determinants of stature (S.J. Ulijaszek); prenatal influences on child growth (F. Falkner); the three-phase pattern of child growth (J. Karlberg); the reversibility of stunting (M. Golden and R. Martorell); relations between gains in weight and gains in height (J.C. Waterlow and M. Golden); nutritional influences on linear growth (L. Alien, M. van Dusseldorp, Ch. Neumann); effects of socio-emotional deprivation on linear growth (D. Skuse); cellular biology of bone growth (J. Price); hormonal regulation of bone growth (A. Nilsson); mineral supply, bone growth and mineralization (A. Prentice); mechanical influences on bone growth (J. Golding, B. Torun); inflammatory response and bone growth (T. Skerry); and the possible usefulness of metabolic markers (S. Robins).

The workshop proceedings, published as a supplement to the European Journal of Nutrition, are available from the IDECG Secretariat free of charge.

Proceedings of Earlier IDECG Workshops

Earlier IDECG workshops dealt with

· chronic energy deficiency: consequences and related issues
· biology of adaptation to seasonal cycling of energy intake
· activity, energy expenditure and energy requirements of infants and children
· protein-energy interactions

Free copies of the proceedings of these meetings can still be obtained by writing to: Beat Schurch, M.D., PhD, Executive Secretary of IDECG, c/o Nestle Foundation, Case Postale 581, 1001 Lausanne, Switzerland.

Reanalysis of Human BMR Data

IDECG has commissioned Dr CJK Henry to reanalyze human BMR data meeting stringent validity criteria. Scientists with access to unpublished BMR data meeting such criteria are kindly requested to contact Dr CJK Henry, School of Biological and Molecular Sciences, Oxford Brookes University, Gipsy Lane Campus, Headington, Oxford OX3 OBP, UK. Fax: 00 44 865 48 32 42.

(Source and contact for further information: Beat Schurch, IDECG, Secretariat, c/o Nestle Foundation, PO Box 581, 1001 Lausanne, Switzerland. Tel: 021 20 33 51 Fax: 021 20 33 92)

IDRC

Within the Health Sciences Division of IDRC, malnutrition has been recognized as a significant global threat to health. As such, the Division has identified among its priority areas of research malnutrition, including protein energy malnutrition, micronutrient deficiencies, the effects of supplementation on infectious and non-infectious disease, and improving household food security.

This year the Health Sciences Division has funded two new projects related to malnutrition and infection, one investigating the effects of iron supplementation on malaria risk (Ethiopia) and one on iron and/or vitamin A supplementation impact on growth and morbidity in anaemic preschool children (Ethiopia).

Of the on-going projects, several are also related to micronutrient deficiencies: two are epidemiologic studies on the prevalence of iodine deficiency disorder (Ghana, India); IDRC is also supporting a Canadian project on the development of dually fortified salt with iodine and iron.

IDRC is supporting Ethiopia's research contribution to the Multi-centre Trial on Immunization-linked Vitamin a Supplementation.

Food-based strategies to overcome vitamin A deficiency are the focus of two on-going projects (India, Canada).

IDRC is also supporting five projects related to protein energy malnutrition; one is a longitudinal study of the growth of children in Benin, one is a cross sectional study of the children of banana plantation workers (Uganda) and two are interventions, one with the utilization of legumes (Philippines); in the second nutrition and morbidity is being investigated in India.

Five projects are investigating educational strategies to solve nutrition-related problems, one on nutrition education of young women (India), in urban slums (India), of preschool children (Nepal), for families through home-based and hospital-based rehabilitation of malnourished children (Philippines), and for communities (Thailand, Indonesia).

In order to strengthen the capacity of nutrition research and training institutions, IDRC is currently supporting projects for nutrition surveillance training and nutrition research in Colombia, China, India, and Kenya. Other on-going projects include: the evaluation of a community nutrition/agricultural development project in Nigeria, an epidemiologic study of the nutritional status of women subsistence farmers in Malawi, and two studies on food security (Lao PDR and the Congo).

IDRC is also providing financial support for the global nutrition reporting of the ACC/SCN.

(Source and contact for further information: Janice L. Johnston, PhD., Nutrition Coordinator, Health, Society and the Environment, Health Sciences Division, IDRC, 250 Albert St., PO Box 8500, Ottawa, Ontario, Canada K1G 3H9. Tel: (613) 236 6163 Fax: (613) 567 7748).

IFAD

IFAD's Evolving Nutrition Strategy

Focus on Food Security of Poor Rural Households within the Context of Poverty Alleviation

IFAD's mandate is to increase food production, alleviate poverty and improve nutritional levels among poor rural households. In 1993, IFAD presented a Strategy to its Executive Board outlining how it proposed to strengthen its efforts towards addressing the nutritional objectives of its mandate. While a number of activities had been undertaken during the 1980s to include nutritional objectives in IFAD project design, the recent strategy builds on more systematic efforts to establish nutrition-relevant objectives as an integral part of the Fund's lending operations.

IFAD is a multilateral financing institution focusing on the agricultural sector. Its operations promote the capacity of small farmers and the landless to improve their production and income-generation potential in poor rural areas. IFAD is now in the process of employing the Nutrition Strategy to set clear priorities as to where its resources can best be channelled to promote nutrition-relevant objectives within this broad context. This means identifying elements within the broad nutrition spectrum where the comparative advantages of IFAD can make a difference. In so doing, the Fund seeks to link measures for poverty alleviation, both on- and off-farm, with those that will ensure that such linkages would lead to improved access to adequate food and better food intake. The strategy proposes a range of instrumentalities by which these linkages can be established and also other more direct measures. Among these, efforts towards the mobilization of people to enhance their own household food security conditions are very much at the forefront of the Fund's approach to a participatory self-reliant rural poverty alleviation strategy.

IFAD recognizes that improving access to sufficient food will not per se ensure adequate nutritional status, for which additional measures are needed within the field of health and sanitation. These measures are normally not within the scope of IFAD's lending programmes. However, the opportunity for cofinancing with other agencies whose tasks are to provide support in these areas, is an option which is being increasingly pursued by IFAD, to enhance the nutritional levels of its beneficiaries through integrated, mutually supportive activities along the spectrum of nutrition-relevant action. The conceptual framework for the causes of malnutrition, originally promoted by UNICEF, has been found extremely useful as a point of departure for strengthening the focus on nutrition as part of rural poverty alleviation. Furthermore, as conceived in its Nutrition Strategy, IFAD considers nutrition security to mean "the sum total of the socio-economic, cultural, physical and behavioural conditions that mutually reinforce each other in affecting the situation which will favour or disfavour the physiological nutrition outcome". Nutrition security thus embraces a wider notion than "nutritional status" and facilitates communication regarding complementary nutrition-relevant action.

The Fund decided to further elaborate on the household food insecurity "cluster" as an underlying cause of inadequate dietary intake - given that its operations, by their very nature, are more likely to impinge directly on this aspect of Nutrition Security. This provided the basis for constructing a supplementary framework, or analytical model, for the factors conditioning household food security in given field situations. It is indeed at the specific investment project level that IFAD can promote household food security conditions relevant to that particular context, rather than at the macro level of policy advice. With this new model, essential aspects of household food security (HFS) can now be more systematically discussed and operationalised for assessment, planning and evaluation.

This work benefited form a previous major effort undertaken by IFAD and UNICEF jointly: the preparation of a review of the HFS concept as it has evolved over the last ten years or so, as well as the corresponding indicators and systems of measurement that have been proposed and used in the field. A technical discussion paper was subsequently prepared by IFAD on the occasion of the ICN, which included the analytical model for HFS assessment. Following field testing in various countries, so far by soliciting reactions and ideas from IFAD project field managers and other government personnel in selected countries, the concepts used in the model are currently being fine-tuned.

The model will now be introduced in a logframe approach in order to develop monitoring and evaluation of household food security conditions and changes in these. This will mean translating each "cluster" of conditions for HFS into feasible indicators for field monitoring, supervision and evaluation. These indicators will, in turn, facilitate the formulation of objectives directly pertaining to HFS and also to other project concerns that can enhance HFS through horizontal and vertical linkages and effectively find their place in overall project design.

IFAD is thus confident that a systematic approach to HFS as an important outcome goal of agricultural production and poverty alleviation will not only respond to the nutrition challenge but could also be a means of integrating the activities of an investment project, thereby resulting in greater coherence and synergism between these activities vis-a-vis the overall project goals. In any case, the increasing interest in HFS that has been observed both within IFAD and among field personnel, holds promise for a renewed opportunity to support agricultural development in a manner which may lead to a positive nutritional outcome.

IFAD is pursuing strong collaboration with other UN and bilateral agencies in further developing the basis for Household Food Security and Nutrition Security. The Fund especially welcomes opportunities to work with other partners at field level to enhance the effectiveness of its investment operations. Plans are underway, with UNICEF in particular, to work out a common basis for field interaction between investment activities and social intervention programmes so as to maximize the impact on the food security of poor rural households and enhance nutritional objectives in the context of promoting global nutritional goals. Fruitful collaboration has also been initiated with FAO, i.e. through the organization of a joint workshop on indigenous underutilized foods in promoting HFS in Luapula Province in Zambia, and in ongoing preparations for an HFS project in the Southern Province. Dialogue with the World Bank is also being pursued to build up complementary initiatives involving both the WB's sectoral lending operations and IFAD's investment projects.

(Source and contact for further information: Wenche Barth Eide, IFAD, 107, Via del Serafico 00142 Rome, Italy. Tel: 54591 Fax: 5191702)

IFPRI

International Policy Workshop on Employment for Poverty Alleviation and Food Security

The International Food Policy Research Institute coordinated an international policy workshop on Employment for Poverty Alleviation and Food Security at Airlie House, Virginia, from October 11 to 14, 1993. Participants included policymakers in charge of employment and poverty programmes, policy advisers, analysts, and experts from 20 developing countries, as well as representatives from various aid agencies and nongovernmental organizations such as ILO, WFP, USAID, World Bank, IMF, EuronAid, GTZ, and FAO. Eleven papers addressing strategic and conceptual issues or reporting new research results from long-term studies in Africa, Asia, and Latin America were presented. In addition, policymakers and programme planners shared experiences through three panel sessions.

The workshop aimed to identify effective, sustainable, and efficient employment policies that address the rural and urban poor in different country circumstances. It is now widely accepted that the poor are increasingly dependent on labour markets, which is why understanding the labour market today is as important as understanding the food market for addressing the food security problems of the poor in developing countries. Employment policies have become more relevant, and there is a need to address sources of growth jointly with poverty alleviation. The changing linkages between employment, poverty, and food security must be taken into account.

Despite growing recognition that productive employment is fundamental to overcome the food entitlement failures of the poor, there is much less understanding and agreement on how to go about doing that. Insufficient attention has been given to the potentials of investing in productive employment as an alternative to subsidizing food or capital. Of particular relevance for policy strategy is the question of the role of the state and of public action for employment creation. This, of course, relates not only to the question of whether public policy should or should not play a role in productive employment generation but also to the question of how it should play a role.

The 1980s have seen a tremendous growth in poverty-alleviating employment programmes. The workshop considered what prompted these types of programmes to be initiated at that particular point in time in so many countries or, where they had existed before, to be substantially expanded. Was this due to changes in the economic and political environment or was it due to the infeasibility of or frustrations with other programmes with similar objectives of poverty alleviation? Also considered were the impacts of such programmes on poor people in the short run and on development in the long run. Issues of implementation of employment programmes, including questions of programme design, wage policy, and modes of wage payment were also discussed, as was the issue of how to target, directly and indirectly, the impact of these programmes on the poor.

The ultimate objective of the workshop was to stimulate action by governments and international organizations to improve existing policies and programmes and to establish appropriate programmes where they are lacking.

(Source and contact for further information: Ms Rajul Pandya-Lorch, IFPRI, 1200 Seventeenth Street, NW, Washington DC 20036, USA. Tel: 202 862 5600 Fax: 202 467 4439)

NORWAY

Norwegian Development Assistance for Nutrition

Nutrition is not defined as an explicit issue of priority for Norwegian development assistance. Nutrition work in the field is often carried out by health workers, and a lot of the general education regarding nutrition is taking place in the school system. There are normally separate nutrition units at ministerial level, and within research it is, of course, a separate discipline.

A general improvement in living conditions in a population will normally improve the nutritional status, although this connection is not direct and totally predictable. Norway gives priority to the poorest of the poor, and they are also the ones most vulnerable to mal-and undernutrition. Norway's focusing on women, who have a main responsibility both in production and preparation of food, will also have consequences for nutrition. This goes both for the women themselves and for other members of the family. Support for general education, child care, and environment are also relevant. Furthermore, efforts to create and sustain peace and to avoid political unrest have indirect implications for food security and nutrition. The strong emphasis Norway has put on population has also been seen as important for the nutrition situation. This may be true for smaller communities, but does not hold at global level. White Paper No. 51 (1991-92) on North-South collaboration refers to the estimates of FAFO, which is the research unit of the Norwegian Labour Organization, that the total production of food in the world is 10% more than what would have been sufficient for all the people living on the earth, if the distribution had been fair.

UNICEF has promoted a model for good nutrition, and it has been recognized by most of the international organizations and by donors. The model has been designed for children, but can be used in a more general way. It states three preconditions for good nutrition:

1. Household Food Security
2. Care
3. Prevention and control of diseases

The model can be applied to developing and developed countries alike, and is used in the Norwegian country paper to ICN. The model is important, among other things, for its showing that food alone is not sufficient for achieving good nutrition.

Norwegian development assistance to nutrition involves food security, monitoring of nutritional status and nutrition education, general health conditions and water supply. The latter is important both for agricultural reasons and for provision of drinking water.

Bilateral Assistance

Nutrition concerns are indirectly assessed, e.g. in water programmes (irrigation and drinking water), and in health sector collaboration. Some examples are: in Sri Lanka, two Integrated Rural Development programmes are supported, where there are health components. Norway contributes to the funding of the Welfare Programme of the Estate Sector, which provides water supply, primary health care and child care (creches). Norway has a health sector agreement with Botswana. In Zimbabwe, Norway supports the Family Health Project, which is a strengthening of the primary health care. The project has a nutrition component that Norway supports. Rural District Development programmes in Tanzania are supported, and the water sector is supported in Zimbabwe and Zambia.

Private Organizations

Most of the Norwegian organizations for development assistance have projects and programmes linked to food security and nutrition. This is especially so for the district development programmes, and for Mother-and-Child health programmes. Some of the school programmes are also of relevance, as education in nutrition related topics is given, and meals are provided both on an ordinary basis and as demonstration for the school children. In addition, private organizations are involved in relief programmes, where food distribution is essential.

Research Collaboration

There are two central agreements for research that are relevant for nutrition. One is an agreement with the Sahel countries - the drought stricken belt south of Sahara. Projects on food security in Mali, Sudan and Ethiopia come under this agreement. The University of Oslo is the collaborating partner for Mali, and the University of Bergen is collaborating with Sudan and Ethiopia.

The other agreement, the so called NUFU agreement, runs for the period 1991 to 1995, and the Norwegian partner is the University Council. The objective is to establish collaboration between universities in Norway on one hand and in developing countries on the other. Presently there is an ongoing project on nutrition and food security with the University of Botswana under NUFU.

The Nordic School of Nutrition at the University of Oslo is involved in education of nutrition professionals at various levels, both in developing countries and in European countries. The institute is a collaborating centre for WHO.

(Source and contact for further information: Berit Austveg, PO Box 8128 Dep, 0032 Oslo 1, Norway. Phone: 47 22 34 95 90 Fax: 47 22 34 88 24)

UNICEF

"20/20" - Mobilizing Resources to Achieve the World Summit for Children Goals

"20/20" is UNICEF's packaging of a set of ideas and figures - originally put forward by UNDP in their Human Development Reports of 1991 and 1992 - which UNICEF has found to be useful in global efforts to mobilize resources for achieving the goals for children and development in the 1990s.

The strategy advocates the allocation of a minimum of 20% of developing country budgets, and a matching minimum of 20% of development aid, to "human development priorities": primary health care, including family planning; basic education; nutrition; and low-cost water and sanitation. The bringing together of the "20" and "20" fundamentally implies a reciprocity of donor and recipient country commitment to these priority areas.

It is acknowledged that the 20/20 message can only be one of broad advocacy, not one of precise proportions which any or every country must achieve if they are to reach the Summit goals: the proportion of total government expenditure in relation to GNP varies considerably among countries, and thus 20% of government expenditure can represent very different levels of resources in different countries; in many countries a significant portion of public expenditure in the social sector occurs at the state and local levels, and information on this is not included in data on government expenditure; and in many countries, the private sector plays an important role in financing of the social sectors.

However, at its centre, the 20/20 concept focuses on the fact that sufficient resources do exist to drastically reduce poverty and achieve the goals for children by the end of this century. The principal constraint is a lack of political will. 20/20 is thus a key instrument for broad advocacy and for stimulating dialogue both with governments and donors on these issues.

(Source: Advocacy Strategies for "20/20": An Information Note for Field Offices, 20 October 1993. UNICEF, New York)

UNICEF Nutrition Strategy Training Workshop for Consultants

Embu, Kenya, 17-23 September 1993

Instead of increasing the number of staff at headquarters, UNICEF Nutrition Section has chosen to establish, support and use a global network of experts, who can provide technical support to UNICEF field offices on a consultancy basis. A five-day workshop was arranged for a group of potential consultants to familiarize themselves with UNICEF's procedures in general and to allow them to learn about the UNICEF Nutrition Strategy in particular. Twenty-three consultants attended the workshop and four UNICEF staff facilitated the work.

The workshop started with an open discussion of knowledge and perception of the nutrition problem among the participants. This was followed by nine topics which were introduced by the facilitators and discussed in plenary. These included: (1) scientific and ethical aspects of the problem of malnutrition in society; (2) a theory of the nutrition problem - the UNICEF conceptual framework; (3) the practice of solving nutritional problems; (6) protection, promotion and support of breastfeeding; (7) basic causes of malnutrition; (8) nutrition information strategies and systems; and (9) iodine deficiency disorders. A full day was used for a field visit, followed by the last day of group-work, presentations and discussion. The field visit was organized as the action-component of a Triple-A process.

The evaluation showed that all participants were very satisfied with the workshop and that its objectives have been achieved. They are now better prepared to provide technical support to UNICEF's field offices.

(Source and contact for further information: Urban Jonsson, Senior Adviser (Nutrition), UNICEF, 3 United Nations Plaza, New York, New York 10017.)

UNRISD

(United Nations Research Institute for Social Development)

UNRISD and the World Summit for Social Development

As the only centre in the United Nations system devoted exclusively to research on problems of social development, UNRISD is giving highest priority over the next one and a half years to contributing to the preparatory process for the World Summit for Social Development.

The Social Summit will be held in Copenhagen in March 1995. The three core issues which it will address are eradicating poverty, enhancing productive employment and promoting social integration. The need for a World Summit for Social Development is stark: recession in the industrialized West, unless it can be quickly reversed, is likely to worsen the already difficult situation of most people in Africa, Latin America, Central and Eastern Europe, and the former Soviet Union. A long economic crisis, too often associated with civil strife, has left its mark on hundreds of millions of people, whose welfare is now in grave jeopardy. Despite their national and regional specificities, enduring solutions to many social problems cannot be sought within regional or national boundaries alone.

Just as there are global elements in the current crisis, there must be international involvement in developing acceptable and useful remedies.

As a first step towards promoting discussion of major issues of social development and for considering the objectives and potential of the Summit, UNRISD held a conference in July 1993 on the Crisis of Social Development in the 1990s: Preparing for the World Social Summit. In addition, the Institute has recently initiated a number of new research programmes which address themes of direct relevance to the Summit. They include Rethinking Social Development in the 1990s, Rebuilding Wartorn Societies, Ethnic Diversity and Public Policies, and Economic Restructuring and Social Policy. Papers and studies produced during the coming year within the framework of these research programmes will be systematically channelled into the preparatory process of the Summit.

UNRISD also intends to launch a Briefing Paper Series for the Social Summit, consisting of brief monographs on key issues of social development. Each briefing paper will provide a concise analysis of the nature of a particular problem (such as ethnic conflict, political violence, the social implications of economic restructuring or environmental change), its dimensions, attempts to cope with the problem, lessons learned and central issues requiring discussion and debate. The series is intended to be of special assistance to governments, nongovernmental organizations, the media and the public at large as they develop positions on the social issues that will be addressed at the Summit.

(Source and contact for further information: Adrienne Cruz, Programme Information, UNRISD, Palais des Nations, CH-1211 Geneva 10, Switzerland. Tel: 798 8400 Fax: 740 0791)

UNU

Rapid Assessment Procedures (RAP)

The original RAP guidelines for the evaluation and improvement of programmes of nutrition and primary health care, first published in August 1987, has now had five printings and sold nearly 5,000 copies in English as well as nearly 1,000 in Spanish and 250 in French. Portuguese and Arabic versions are in preparation. The report of the RAP conference held at PAHO in Washington D.C. was published in February. Nearly 2,000 copies have already been sold. The 1993 RAP newsletter was distributed to a mailing list of over 800 persons. UNU continues to receive cited evidence of the wide use of the UNU pioneered methodology.

These publications are being followed up by a series of specialized RAP guidelines. The first to appear was "A Manual for the Use of Focus Groups" published in September and the second Rapid Assessment Procedures to Improve Household Management of Diarrhoea" published in November. A guideline "Rapid Anthropological Approaches for Studying AIDs Related Beliefs, Attitudes and Behaviours" is planned before the end of the year and the report of a December 1992 RAP training manual task force meeting is in preparation. Among the workshops in which RAP was presented were the UNICEF sponsored seminar on respiratory disease and the National Institute of Nutrition in Kazakhstan by Dr Nevin Scrimshaw in January. A two-day RAP workshop was held at WHO regional office in Alexandria in September and the office has undertaken to provide an Arabic text of the RAP guidelines.

International Network of Food Data Systems (INFOODS)

The purpose of INFOODS is to improve the availability of food composition data worldwide particularly in developing countries and contribute to the quality of such data. Food composition data are needed for the assessment of nutrient intakes, nutrition education, epidemiological studies of diet and disease, and the determination of agricultural and food policy. The objective is the establishment of regional or subregional food composition data bases that contain all available food composition information for participating countries and the capacity to exchange information among them.

INFOODS is now at the stage when the original goal of coverage of all developing countries through a system of regional data bases can be implemented in two more years if the necessary resources are available.

The ASEANFOODS regional data base at INMU in Bangkok became fully operational in 1992. Programming of the computer to be installed in New Caledonia for OCEANIAFOODS was also completed. At the beginning of the year funds available from the International Development Research Centre (IDRC) of Canada have made possible the purchase of the necessary hardware and software licences for subregional data bases in INCAP and INTA. Following intensive consultant help by Dr John Klensin in November and Dr Klensin and Ms Barbara Burlingame in May, INCAP has proceeded with the installation of the subregional database. That database is expected to be fully operational by the end of the year with the INTA subregional data base to follow. Part of the INCAP effort includes development of additional software to permit interworking between regional databases in various world regions. The INCAP effort, with assistance from New Zealand, will also produce interim revised Central American tables before the end of the year. Funds will also be available from IDRC for an AFROFOODS organizational meeting early in 1994.

The database installation activities have included improving the electronic mail capabilities and linkages of the institutions involved. As a result, INCAP and INMU staff now have improved communications with scientists working in similar areas around the world. The collaborations which have resulted, and the ability to easily ask questions, have permitted work at these institutions which otherwise would have been impossible or very time-consuming.

Representatives of UNU/INFOODS, EUROFOODS, USDA and FAO met at FAO headquarters in February 1993 to discuss collaboration in assisting developing countries to improve the quantity, quality, and accessibility of their food composition data. One outcome was the planning of an FAO financed workshop on this topic to be held in Tunis in February 1994. In addition FAO provided travel and per diem costs for Dr Besrat to visit five African countries in October in order to plan an AFROFOODS organizational workshop in Ghana immediately after the Tunis meeting.

Discussions were held during the year for completing the INFOODS network with regional groupings of the Arab countries and South Asian countries and funding is being sought for them. A separate INFOODS regional data base for Francophone Africa is also under consideration.

A companion project the International Food Intake Directory (INF'ID) is designed to assist developing countries in summarizing all dietary intake data for the past 30 years and to maintain hard copies available for photocopying by anyone who desires to use them. Duplicate summaries and copies of the data will be maintained by the UNU Programme coordinating office in Boston. These data have been difficult to locate even for nationals of a country and are essential for epidemiological studies of diet and disease, for understanding dietary trends, for long-range planning and for a variety of other purposes.

In the current year 50 data summaries have been received and coded from Mexico to complete the data for Mexico. We are still awaiting the remaining summaries from Argentina, the Caribbean and Oceania. Data sets have been promised or are under discussion with Bolivia, Brazil, Bulgaria, China, Cuba, Ecuador, Ghana, India, Japan, Kazakhstan, Kenya, Nepal, Pakistan, Saudi Arabia, Senegal, Tanzania, Tunisia, and Zimbabwe. The first volume of country summaries is being prepared for publication.

Institutions in countries thus far not involved in this activity interested in participating should contact Dr Nevin Scrimshaw, UNU Food and Nutrition Programme for Human and Social Development, Charles St. Sta., Box 500, Boston, MA 02114-0500, USA. Tel: (617) 227 8747 Fax: (617) 227 9405 E-Mail: [email protected]. Limited funds are available for facilitating data collection.

(Source and contact for further information: as above)

WFP

International Conference on Nutrition - Follow-Up Activities

The global Plan of Action for Nutrition adopted at the International Conference on Nutrition, in December 1992, stated that the governing bodies of the United Nations, including WFP, "should, in the course of 1993, decide on ways and means of giving appropriate priority to their nutrition-related programmes and activities aimed at ensuring, as soon as possible, the vigorous and coordinated implementation of activities recommended in the World Declaration and Plan of Action for Nutrition". The Plan of Action provided guidelines for a number of strategies grouped into nine action-oriented themes. The activities of WFP with regard to these themes are listed below:

1. Incorporating Nutritional Objectives, Considerations and Components into Development Policies and Programmes.

WFP's most relevant contribution to this is a series of nutrition awareness workshops with the following goals: i) to understand the importance of nutrition in the development process, with emphasis on human resource capacity building; (ii) to become familiar with the advantages and disadvantages of some important techniques of nutritional assessment; (iii) to acquire knowledge regarding significant nutritional problems of the country or region and potential means of combating them; and (iv) to discuss means of increasing the government's awareness of nutritional issues and ways of including nutritional considerations in government policy.

In addition to the above, in June 1993 WFP also organized and sponsored a regional workshop on school feeding targeted at Ministers of Education and others involved in improving the health of school children in the Central American region.

WFP recognizes that sustainable development needs to be addressed simultaneously with economic growth for nutritional well-being, and toward this end it has been assisting small-scale food processors in the production of nutrient-fortified blended foods in a number of countries in Africa, Asia and Latin America.

2. Improving Household Food Security.

All of WFP's activities improve household food security, either in the short term, as in situations of temporary food insecurity, or in the long term, as in situations of chronic food insecurity.

The first two measurable goals of the International Conference on Nutrition (ICN) are to eliminate famine and famine-related deaths and starvation and nutritional deficiency diseases as a result of natural disasters by the end of the decade. WFP is already at the forefront of endeavours to meet these challenges: in 1992 it delivered commodities valued at $742 million for victims of drought, flood, civil conflict, and other natural and man-made calamities. Due to an increased awareness of nutritional deficiency diseases, the commodities included in such programmes are more varied than they were in previous years.

In terms of chronic food insecurity, food aid transfers more resources to the poor than any other form of development assistance. WFP-assisted projects increase the food supply to the household through a number of pathways: i) direct distribution; ii) support to income-generating activities; and iii) supply of credit, considered an essential factor in achieving food security - usually derived from monetized food aid.

3. Protecting Consumers through Improved Food Quality and Safety

WFP assists governments in developing the human resources required for the safe handling of food in schools, hospitals and other institutions. It also ensures that the food commodities it delivers are of good quality and safe for human consumption.

4. Preventing and Dealing with Infectious Diseases

There are a number of ways in which WFP plays a role in this strategy. First, the malnutrition-infection cycle is well recognized; infections interfere with growth, development, work performance and general quality of life, and people who are undernourished are more likely to catch infectious diseases. The ability to fight infection is increased in all age groups as a result of improved nutrition. The WFP-provided food is often essential for the prevention and treatment of infectious conditions. Second, food aid is frequently an important incentive for mothers to take their children to health centres for immunization. Third, the efficient logistical system developed to get food even to remote places is also used to deliver parasite control agents. Fourth, WFP helps promote the use of safe and nutritionally-adequate, locally-produced, low-cost weaning foods. This type of food supplementation protects against the negative effects of diarrhoea. Fifth, in a number of countries WFP has assisted in AIDS prevention by providing support for the training of health workers and for alternative income-generation schemes for prostitutes.

5. Promoting Breastfeeding

WFP supports and encourages mothers to breastfeed and has issued a number of policy guidelines, such as: (i) food-aided supplementary feeding programmes should not interfere with exclusive breastfeeding; (ii) the distribution of milk powder is limited to those situations where it is known with certainty that it will not substitute for breastmilk; and (iii) weaning foods are not to be used for children under six months of age.

WFP-supported supplementary feeding programmes help women lactate more successfully. Food aid is used to train professional health workers and to motivate mothers to attend health facilities where they will be encouraged to breastfeed. Many women could not afford to forego income while nursing without economic support of food aid.

6. Caring for the Socio-Economically Deprived and Nutritionally Vulnerable

The issue of "caring capacity", or enabling women to have more time for "mothering", is very important for children's nutrition and health. Food aid assists in this by decreasing women's workload through providing an income transfer to enable mothers to have more time to care for young children, to prepare more nutritious food for them and to feed them more often, to take them to health care centres and to receive some basic education.

Humanitarian relief operations provide for the nutritional needs of refugees and displaced persons and for civilians caught in zones of conflict and to ensure the safe passage of food. WFP projects also specifically target the destitute, elderly, handicapped/disabled, urban poor, indigenous people and street children.

7. Preventing and Controlling Specific Micronutrient Deficiencies.

WFP assists in overcoming micronutrient deficiencies in a number of ways. Foods rich in a specific micronutrient are distributed as food aid when necessary to prevent deficiency symptoms from developing, and vitamins and minerals are often used to fortify food aid commodities, either by donors before transport or after arrival at destination. In addition to donated commodities, locally-processed products such as biscuits and blended foods are also fortified.

Micronutrient problems are most likely to develop in situations of heavy dependence on externally-provided food, such as protracted feeding operations for refugees and displaced people. In these and other similar situations, WFP attempts to prevent deficiency symptoms from developing by including micronutrient fortified blended cereals (eg corn soya milk and wheat soya blend) in the ration, by adjusting the types of food or the quantities distributed, and by fortifying specific food items.

WFP has policy guidelines regarding vitamin A fortification of dried skim milk and iodine fortification of salt. It has been negotiating with donors for micronutrient fortification of commodities such as vitamin A fortification of edible oil.

8. Promoting Appropriate Diets and Healthy Lifestyles.

As WFP targets the poorest of the poor, most of the problems of appropriate lifestyle are not relevant to them. In order to encourage healthy diets, nutrition education both for parents and children is becoming an integral part of WFP-supported school feeding and health promotion projects.

9. Assessing, Analysing and Monitoring Nutrition Situations.

WFP is already a user of early warning and vulnerability mapping systems. In order to be able to plan development projects in advance and to respond quickly and appropriately to the needs of populations potentially at risk, it will be making even greater use of the information generated by such systems in the future.

WFP is also a partner with FAO in assessing food availability and food needs in countries with potentially vulnerable populations. The nutritional needs of refugees are assessed annually by WFP with the assistance of UNHCR. WFP support to the health sector promotes growth monitoring, often accomplished with the assistance of UNICEF. The rapid appraisal technique is currently in use for assessing the nutritional adequacy of households in protracted refugee and displaced person operations. In order to monitor better the nutritional situation of targeted refugee populations, an improved joint WFP/UNHCR information system, based on a Food Availability Status Report (FASREP), has been put into place.

During the preparations and following the ICN, WFP has been active in a number of ways. Communications with the field began early; field offices were informed about the ICN and their cooperation requested in the preparation of country papers. In addition, all WFP field offices and desk officers were provided with the ICN World Declaration and Plan of Action for Nutrition in the appropriate language. WFP is also an active participant in the Sub-Committee on Nutrition (ACC/SCN) of the United Nations Administrative Committee on Coordination, which facilitates coordination of the follow-up efforts and prepares reports for consideration by the ACC and submission, through ECOSOC, to the United Nations General Assembly.

A document prepared by WFP - "Issues in Food Aid and Nutrition" was made available to delegates at the Thirty-fifth Session of the CFA. The purpose of this document was to examine the potential of targeted food aid to improve nutrition in developing countries over the long term, to discuss some of the constraints on its effective use, and to identify ways in which the nutritional benefits from food aid can be strengthened. In addition to the ICN, this document was also distributed at the Sixth Annual Hunger Research Briefing and Exchange held at Brown University, Providence, Rhode Island in April 1993, and at the meeting of the International Union of Nutritional Sciences in Adelaide, Australia, in September 1993.

Promotional materials, such as a film "Building Blocks for Life" on nutrition and food aid, were displayed at the ICN and at a number of other gatherings where nutritional issues were discussed.

A special issue of the World Food Programme Journal (No. 23) on WFP activities regarding nutrition is also being widely distributed. WFP-sponsored radio programmes on nutrition were broadcast in many countries.

WFP is already at the forefront of efforts to meet the challenge of the first measurable goal of the ICN: to eliminate by the end of the century famine and famine-related deaths. It has, however, pledged to do even better by seeking further commitments, by improving the use of the resources it now commands, by increasing its capacity to respond quickly to new emergency situations, and by improving targeting.

(Source: Information Note on the Implementation of the World Declaration and Plan of Action for Nutrition of the International Conference on Nutrition. WFP CFA: 36/P/INF/1, 22 September 1993. Contact for further information: David French, Senior Programme Adviser, World Food Programme, 426 Via Cristoforo Colombo - 00145 Rome, Italy Tel: (6) 57971 Fax: (6) 5133537)

WHO

Infant and Young Child Nutrition

Report by the Director-General of WHO

The eighth since 1981 in a series of biennial reports by the Director-General on infant and young child nutrition (document EB93/17) is being presented to the ninety-third session of the WHO Executive Board and to the Forty-seventh World Health Assembly, in January and May 1994 respectively. Part I summarizes briefly the current global situation of malnutrition among children under five years of age, specifically protein-energy and micronutrient malnutrition. Part II covers infant and young child feeding, including encouragement of breastfeeding; the promotion of appropriate weaning practices with the use of local food resources; the strengthening of education, training and information on infant and young child feeding; the promotion of the health and social status of women; and the appropriate marketing and distribution of breastmilk substitutes.

The report is presented in the light of the outcome of the International Conference on Nutrition (Rome, 1992), the World Declaration and Plan of Action for Nutrition, which serve as a platform for WHO's continuing technical support to countries. In May 1993 the World Health Assembly called for a reinforcement of the Organization's capacity for food and nutrition action in all relevant programmes so that increased emphasis can be given as a priority to maternal and young-child nutrition including breastfeeding; micronutrient malnutrition; nutrition emergencies, particularly training in preparedness and management; monitoring of nutritional status; control of diet-related chronic disease; food safety control and the prevention of foodborne disease; and research and training in subjects related to food and nutrition.

Highlights of the progress and evaluation report by the Director-General include information on:

· the joint WHO/UNICEF Baby-friendly Hospital Initiative, including related training activities;

· action by WHO Member States, consumer groups, and professional and other technical bodies to encourage and support breastfeeding;

· exclusive breastfeeding as an infant-feeding ideal, and the need for a revised growth reference consistent with the growth patterns of infants who are fed in accordance with WHO recommendations;

· food safety issues in infant and young child feeding;

· monitoring trends in the prevalence and duration of breastfeeding, including the restructuring of the WHO global data bank in accordance with new indicators derived from households and for assessing health facility practices that affect breastfeeding;

· women, work and breastfeeding, including collaboration with ILO in the review and update of international labour standards dealing with maternity protection and their impact on breastfeeding;

· action taken in 50 countries and territories, and in the European Community, since 1991 giving effect to the International Code of Marketing of Breastmilk Substitutes.

Where giving effect to the International Code is concerned, the report also develops a number of themes under the heading "lessons from experience". These include a discussion of the combination of legislative and non-legislative means countries are using; the health implications of direct advertising of infant formula and the perception of infant formula as "just another processed food"; donations or low-price sales of infant formula; and charitable distribution of breastmilk substitutes through ad hoc or long-term feeding programmes.

(Source and contact for further information: Nutrition Unit, World Health Organization, 20, Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel (022) 791 2111. Fax: (022) 791 0746)

WORLD BANK

Nutrition Lending Increasing

World Bank lending for nutrition is continuing to increase - total project resources for nutrition in the financial year 1993 were some four times those of the previous year at around $600 million of which $377 million were Bank loans or IDA credits. In addition to this were nutrition components in education and agriculture projects - amounting to another $100 million in total project resources - and nutrition portions of structural adjustment projects in which nutrition sometimes plays a large part. South Asia far exceeds other regions in quantity of resources invested in nutrition. Latin American Countries and East Asia & Pacific, with nearly equal amounts of lending for nutrition, are next, followed by East and Central Africa. The Middle East and North African region had no nutrition projects in 1993.

Projects approved in 1993 included: Madagascar - Food Security and Nutrition; India - ICDS II; and Honduras - Nutrition and Health. Other projects awaiting approval in 1993 and early 1994 were in Argentina (MCH and Nutrition), Peru (Health and Nutrition), Guinea (Health and Nutrition), Burkina Faso (Health and Nutrition), and Nicaragua (Health Sector Reform Project - includes emphasis on nutrition). Three nutrition projects are in preparation - for Ghana, Kenya, and Nepal. The Government of India, with three nutrition projects underway, has also requested further IDA support.

Work is well underway for a first Nutrition Project for Pakistan. In August, the head of nutrtion for the Pakistan Planning Commission, Dr Mushtaq Khan, told a World Bank seminar that the country's steady economic growth has not led to parallel nutrition improvements. Half of all children under five and more than a third of all pregnant and lactating women are underweight. Micronutrient deficiencies also are serious.

(Source: Alan Berg, The World Bank, 1818 H Street, N.W.. Washington. D.C. 20433.)