Foreword

Trends in nutrition are becoming clearer as new information becomes available. Steady improvement is now being seen on average in most regions of the world, with the important exception of Sub-Saharan Africa, over the 20 years since such estimates became feasible. This pattern was noted, although data were limited, in the ACC/SCN's First Report on the World Nutrition Situation, in 1987, and in its Update (1989). The Second Report in 1992-3 confirmed this, adding considerable detail with the substantial increase in available information. This Update (1994) focusses on trends in the early 1990s.

The conclusions direct attention more strongly than ever towards Sub-Saharan Africa and South Asia. Nutrition in the African region is deteriorating, possibly more so than in the 1980s. In South Asia, which has both the largest numbers of underweight children and the highest prevalences, the task is enormous, and although the underlying trend is probably for slow improvement, there is concern that this may have faltered. This report illustrates such findings with country data, drawing some overall conclusions to supplement those in the Second Report, and to bridge the gap to the Third Report on the World Nutrition Situation, due in 1995.

Rising concern for the nutrition of refugee and displaced populations led to the regular reporting on this situation amongst these populations mainly in Sub-Saharan Africa, coordinated by the ACC/SCN (known as the Refugee Nutrition Information System). The opportunity is taken with this Update Report to summarize the information available on this over the last two years, to provide a baseline description and to highlight the extreme severity of the situation. The section in Chapter 3 of this report brings this together and it is hoped this will help to stimulate more effective action. The collaboration of UNHCR, World Food Programme, and Save the Children Fund (UK),in initiating the system, its increasing involvement with a wide number of agencies and NGOs, and broadened funding (from Canada, Norway, and USA) have been crucial in bringing together this important information on a regular basis.

This Update Report continues the process of integrating data from a variety of sources, and follows the pattern in the Second Report. Nutrition is regarded as an outcome, for which the main indicator is the prevalence of underweight preschool children. Infant mortality rates are also included. The indicators and text (in Chapter 2) are clustered into topics related to food, health, and women's role and caring capacity, as underlying causes of malnutrition, in line with current thinking. In addition, the opportunity of greatly increased availability of nutritional trend data has been taken to compare these with economic growth rates, which both shows the important contribution of economic growth, and also emphasizes that substantial improvement in nutrition can be achieved over and above that explained by economic growth. This interpretation, brought forward at the SCN's workshop at the International Union of Nutrition Sciences meeting in 1993 in Adelaide¹, includes the impact of health and education investments, as well as direct nutrition interventions.

¹ Case-studies are available for Brazil, India, Indonesia, Tanzania, Thailand, and Zimbabwe, as well as summary background material for the workshop.

This report, as the others in the series on the world nutrition situation, is intended to provide accurate and up-to-date information describing trends in the nutrition situation, as a basis for better awareness and understanding, leading to more enlightened and effective policies and programmes to improve it. The intended audience is both those professionally concerned with nutrition, as well as a broader constituency concerned with development and human rights, for which nutrition is both a central objective, and indicator of progress.

Abraham Horwitz
Chairman
ACC Sub-Committee on Nutrition