PROGRAMME NEWS

AUSTRALIA

AIDAB's Health Strategy

A strategy to raise the profile of the health sector in Australia's official aid programme has been adopted by the Australian International Development Assistance Bureau (AIDAB) with these three main objectives:

a. increased visibility, through collating and distributing information on Australian expertise relevant to regional health needs, as well as information on existing planned health aid activities;

b. increased focus, in relation to women and their children's health;

c. improved programming to better incorporate health activities into Bureau programmes in a systematic way.

Each country-specific study covers health priorities and policies, the relevant institutional context, other donor activity, and the narrow areas of focus in which Australia has the capacity to assist and which are consistent with AIDAB policies and administrative considerations.

A major focus of health activities will be nutrition programmes. AIDAB has issued Development Paper No. 9 on Healthier, Wealthier, Wiser? - AIDAB's health sector strategy one year later. The address for AIDAB is: GPO Box 887, Canberra ACT 2601, Australia.

FAO

Nutrition Country Profiles

FAO's Food Policy and Nutrition Division is often asked for summary information on the food and nutrition situation in different countries. Such requests come from international and non-governmental organizations, from universities and research institutions, as well as from inside the UN system.

To improve the response to such requests, FAO undertook to develop Nutrition Country Profiles of all developing countries that are members of FAO. The following principles have guided the preparation of the profiles:-

a. the profiles would provide brief explanatory texts and supporting data describing the food and nutrition situations of countries, with related factors such as agricultural production, and selected economic and demographic variables;

b. to ensure inclusion of the most recent information, national institutions would be contacted to prepare the original drafts, according to a pre-defined format;

c. in the first instance, the profiles would be available in one language each, i.e. English, French or Spanish, as appropriate;

d. the format of the profiles would permit routine updating.

Over 100 of the 127 developing countries included have been contacted. Final profiles are available for 32 countries, and a further 30 are in various stages of draft.

Full country coverage, textual editing and improvements in layout are planned for 1989/90; routine updating will begin in 1990.

All Nutrition Country Profiles will eventually be available on FAO's World Agricultural Information Centre (WAICENT) for users with access to international computing networks. The preparation of programmes to effect the necessary online availability is in process. Until the computer link is established, and for users without the requisite computer facilities, Nutrition Country Profiles may be obtained by writing to the Food Policy and Nutrition Division, FAO, Via delle Terme di Caracalla, 00100 Rome, Italy.

FAO/WHO/UNICEF

Inter-Agency Food and Nutritional Surveillance Programme (IFNS)

The IFNS programme - a joint initiative by FAO, WHO and UNICEF, with coordination and support provided by the SCN - was initiated in late 1987 in order to i) promote the development of food and nutritional surveillance systems in a substantial number of developing countries, and ii) compile and report on existing information on nutritional status at national level. Core funding for the programme's activities was provided by the Swiss and Dutch Governments. In the intervening year and a half substantial progress has been made both in terms of the long-term objective and in support for the production of a report on nutritional status trends in 33 countries (Update on the Nutrition Situation, ACC/SCN, Jan/Feb 1989).

A major concern was to produce as early as possible a document which - in addition to describing the purposes of the programme - also set out the kinds of projects which would be considered for funding and the guidelines for preparation of project proposals. These guidelines have been widely distributed through the participating agencies and during the course of a number of inter-country/regional meetings on nutritional surveillance (Guidelines for Project Preparation, IFNS Programme, July 1988, UNICEF, New York). These meetings - a number of which were planned in conjunction with the IFNS and with the latter's support - have taken place in Africa, Asia, Latin America and the Near East, and have contributed to a growing momentum in the thinking and development of surveillance systems in most regions of the world. They also served to provide a forum for discussing the IFNS programme and a large number of project proposals have been received as a consequence. To date, more than 20 countries have submitted proposals which have been and are being reviewed, with several already approved and funded.

Substantial projects in both China and Madagascar are now being supported by IFNS funds. In Tanzania - with large national and community based components - Dutch and Italian funding has been secured. Additional country projects which are now under way include the Philippines and Venezuela (funded by UNICEF and PAHO). Inter-country training projects are being developed in Latin America and the Caribbean, Africa and Asia.

GTZ (FEDERAL REPUBLIC OF GERMANY)

Nutrition in Rural Development

Based on the development policy guidelines of the Federal German Government from 1986, the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH is introducing a strategy to incorporate nutritional aspects in rural development and health projects. The incorporation of nutritional aspects in GTZ projects means:

- implementing systems for monitoring and evaluation of nutritional output and impact;
- execution of a baseline survey and follow-up studies;
- selecting and implementing adequate measures for improving nutritional status.

The strategy is outlined in a position paper on assessing the nutritional impact of projects. The paper will be submitted to anyone interested. Contact: Dr R. Korte, GTZ, Postfach 5180, D-6236 Eschborn 1, Federal Republic of Germany.

INTERNATIONAL ATOMIC ENERGY AGENCY

Bioavailability of essential micronutrients

The International Atomic Energy Agency (IAEA) is interested in starting a coordinated research programme in 1990 on the bioavailability of essential micronutrients. This programme will involve tracer studies using radioisotopes (and possibly also stable isotopes) and is expected to focus on essential trace elements such as iron, zinc and selenium. Some financial support will be available for participating institutes from developing countries. Further information may be requested from Dr R. M. Parr, IAEA, PO Box 100, A-1400 Vienna, Austria.

ICCIDD

Prevention and Control of IDD

The International Council for Control of Iodine Deficiency Disorders (ICCIDD) has now established a global network of more than 300 members with the wide range of expertise necessary for successful development and implementation of Iodine Deficiency Disorders (IDD) control programmes. Dr B. S. Hetzel, Executive Director of the ICCIDD explains that the Council aims to establish national control programmes in countries where a vast number of people are at risk of IDD consequences. A format for the preparation of national programmes has now been adopted as well as recommendations on procedures for funding involving WHO, UNICEF and bilateral agencies. The ICCIDD allocated $50,000 towards activities in 1988/9 which will also be supported by UNICEF and the WHO/UNICEF Joint Nutrition Support Programme, as well as bilateral agencies.

Regional status of IDD control programmes are published in the IDD Newsletter. Here are some of the highlights:

- Intensified activities aiming at development of national control programmes are proceeding in Cameroon, Nigeria and Zaire.

- National IDD control workshops were held in Nigeria and Zaire.

- The second IDD Task Force meeting for Africa received excellent proposals from Kenya, Tanzania and Zimbabwe.

- Control programmes have escalated in Bolivia, Peru and Ecuador with international aid through WHO/UNICEF Joint Nutrition Support Programme, and additional support from the Belgian government in Ecuador. It seems that IDD could be under control within the next 2-3 years in Latin America.

- The policy of universal salt iodization by 1992 in India increased the volume of iodized salt 7-fold during 1983-87. Considerable progress is evident now that individual states have responsibility for control programmes.

- In Nepal, a feasibility study of the social and economic impact of IDD control was undertaken by the UNICEF office with assistance from the Nepalese Government in collaboration with ICCIDD. A report of the national IDD control programmes, with 2.5 million iodized oil injections, was submitted to the government in December 1986, but limited progress has been made with salt iodization.

- In December 1987 a regional seminar was held in Alexandria, Egypt and a national seminar was held in Islamabad, Pakistan.

- In Indonesia, a new preparation of iodized peanut oil is to be produced.

- Recent data from Europe indicated the importance of iodine deficiency in newborn babies who are much more seriously affected than adults.

- A scientific meeting jointly sponsored by the ICCIDD and the Fogarty International Centre on “Iodine and Brain” was held in March 1988. Over 50 papers were presented ranging from molecular biology through animal models to human epidemiological studies. The proceedings of this meeting are published by Plenum Press.

KENYA

Postgraduate Degree Programme in Applied Human Nutrition

Most African professionals seeking postgraduate level training in applied nutrition have to study abroad, often in the USA or UK, where costs are considerably higher and little, if any, opportunity exists for relevant field work.

Since 1985, a two-year postgraduate programme leading to a Master of Science degree in Applied Human Nutrition has been established at the University of Nairobi, Kenya. This followed recommendations by the ACC/SCN. The aim of the programme is to reinforce the skills of professionals in programme planning, implementation and evaluation in the field of applied nutrition and nutrition policy for the region, through provision and improvement of training facilities in the field. The course content reflects the multifaceted causality of nutritional problems in that it incorporates major disciplines crucial to the understanding of the aetiology and consequences of malnutrition, as well as for the formulation of measures aimed at alleviating nutritional problems, either directly, or indirectly by influencing policy decisions. Thus the programme is of special relevance to intermediate level and senior staff from a range of government ministries.

The programme is supported by the Kenyan Government and the German Federal Ministry for Economic Cooperation through the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH. Financial support for the students has come from both the Government of Kenya and the Federal Republic of Germany, as well as international and bilateral organizations such as IDRC, Canada; SIDA, Sweden; UNICEF and UNU. For further details on the course curriculum and entry requirements contact: Dr A. Kielmann, Unit of Applied Human Nutrition, University of Nairobi, PO Box 41 607, Nairobi, Kenya.

OCEANIA

Oceania Foods

The October 1988 Newsletter from Oceania Foods reported progress in the development of national and regional food composition tables for Australia, New Zealand and Pacific Island countries.

Australia Food Tables

The first publication of the revised Australia food tables is now in press. The fruit, vegetable and meat groups provide the majority of the data and contain a comprehensive range of raw and canned fruits, raw and cooked vegetables, and meats.

NUTTAB

The Department of Community Services and Health have made available (on disk) a nutrient data table for use in Australia (NUT-TAB). The data base includes nutrient information available from the Department's ongoing Food Analytical Programme with the balance of data modified or direct from the United Kingdom's reference, McCance and Widdowson's Table of Composition of Foods by A. A. Paul and D. Southgate. The British data will progressively be replaced as nutrient values become available from the Australian Food Analytical Programme.

New Zealand Food Composition Database

In August 1988, the Department of Scientific and Industrial Research released the New Zealand Food Composition Data Base. The data base uses validated local food data, which included comprehensive information on New Zealand fruits, vegetables, dairy products and fish. Nutrient data from the British food tables (Paul and Southgate) have been included to fill the gaps. The current analytical programme will eventually provide a set of food tables, comprising all New Zealand data. The Food Composition Data Base is available in hard copy or in computer readable form (floppy disk or magnetic tape). A data base has also been developed to provide clinical dietitians with access to information on manufactured foods available in New Zealand.

Pacific Island Food Composition Programme

The Pacific Island Food Composition Programme (PIFCP) is a project funded by USAID and administered by the South Pacific Commission, a regional inter-governmental organization which provides programmes of technical assistance to the 22 island nations of the Pacific. The major objectives of the PIFCP are production, management and dissemination of up-to-date and comprehensive data on the nutrient composition of Pacific foods. The current activities of PIFCP include a review of existing published and unpublished nutrient data on Pacific foods, identifying gaps in the information, canvassing users for nutrient and food priorities to guide the production of new data, a programme of analyses of Pacific Island foods in regional laboratories, the establishment of a nutrient data bank and the dissemination of data in print and computerized format.

PIFCP is actively seeking submissions of published and unpublished analytical data on the nutrient composition of Pacific foods. In addition, interested persons are requested to provide their views about foods and nutrients in need of inclusion in the analytical programme. A periodic PIFCP Newsletter will be produced by the South Pacific Commission and those interested in receiving copies are invited to register on the mailing list.

In 1987 PIFCP was able to provide funds for equipment purchase for two regional laboratories that are involved in the analytical work. These were The National Agricultural Chemistry Laboratory, Department of Agriculture and Livestock, Port Moresby, Papua New Guinea; and the Institute of Natural Resources, University of the South Pacific, Suva, Fiji. In 1988 staff at these laboratories received on-site training in the analytical methods required by the programme and some pilot analytical work has begun. More information can be obtained from the Food Composition Coordinator, South Pacific Commission, PO Box D5, Noumea Cedex, New Caledonia. The OCEANIAFOODS contact is Dr Ruth English, Chief Nutritionist, Department of Community Services and Health, GPO Box 9848, Canberra ACT 2601, Commonwealth of Australia.

SIDA (SWEDEN) & FAO

Forests, Trees and People

In 1987 the Swedish International Development Agency (SIDA) and FAO launched a new programme in community forestry called Forests, Trees and People (FTP). The programme, which currently covers nine countries (Bangladesh, Burkina Faso, Ethiopia, Kenya, Nepal, Tanzania, Thailand, Vietnam and Zambia), is funded through FAO Trust Funds and SIDA. The International Rural Development Centre (IRDC), Swedish University of Agricultural Sciences (SUAS), coordinates the Swedish side of the programme. It is part of SIDA's Special Programme series and is thus a research and development programme with a strong emphasis on methodological development and community participation.

One area of importance to the FTP programme is to develop methods of addressing nutrition concerns also in forestry sector programmes. Thus nutrition issues of relevance to forestry have been addressed in a number of seminars and technical meetings for the FTP staff, both at international and national levels. Some nutrition studies and surveys have been carried out or are under way in several of the projects e.g. Tanzania, Thailand, Vietnam and Zambia. FAO in collaboration with the Khoen Kaen University, Thailand, has recently held a workshop on “Nutrition in Forestry” for forestry staff, nutritionists and planners from Bangladesh, Indonesia, Nepal, Thailand and Vietnam. IRDC/SUAS has planned a similar workshop in Africa. Major focus is on the use of nutrition data for targeting forestry project activities; finding more effective ways through which forestry projects, programmes and policies can address household food insecurity problems; and on identification of key indicators which can be used to monitor and evaluate the effect of nutrition-oriented forestry actions. In connection with this, SIDA/IRDC also assists the projects in Ethiopia, Kenya, Tanzania and Zambia in planning nutrition, food consumption or ethnobotanical surveys in their FTP projects.

FAO is preparing several publications on nutrition in forestry and some reports are also available from IRDC/SUAS. Further information and details can be obtained from Britta A. Ogle, IRDC/SUAS, PO Box 7005, 75007 Uppsala, Sweden or from Marylyn Hoskins, FAO - Forestry Division and Brian Thompson, ESN, FAO Headquarters, Rome, Italy.

UNESCO

New Initiative to Improve Education through Nutrition

Education sector budgets around the world have suffered greatly in the present prolonged recession and progress towards universalizing “basic education” is slow. Less than two-thirds of primary school age children go to school and no more than half actually finish primary education.

Education planners are re-examining education priorities and cost-benefits and shifting priorities in favour of expanding and improving primary education. Planners measure the efficiency of educational systems in terms of internal efficiency - what to do to maximize educational outputs given limited resources - and in terms of external efficiency - what kinds of outputs have most significant impact on overall national development. Efficiency factors focus almost exclusively on better educational planning, more textbooks, better teacher training. Malnutrition as an educational “risk factor” obstructing learning and jeopardizing the future educational progress of children is largely overlooked despite estimates that one out of every two to three children in developing countries suffers from moderate to severe nutrition/health problems, affecting school performance.

A new UNESCO initiative is designed to bring the Child Survival and Development Revolution into primary school classrooms. It has three main goals: (1) improve the nutrition and health of school-age children in developing countries; (2) improve the efficiency of educational systems in developing countries; and (3) strengthen public health understanding of the relationship between nutrition and health status of primary school children and learning outcomes.

The initiative will test the feasibility of strategic approaches and low-cost technologies designed to improve the nutrition and health of primary school children (i.e. de-worming, provision of iron, iodine, vitamin supplementation, targeting of food aid and school feeding). It will also support research to determine, for example, the extent to which educational deficits are exacerbated by nutrition and health factors, and the extent to which levels of non-attendance are related to specific nutrient deficiencies and other health problems. The third aspect of the initiative will involve creating a real constituency among Ministries of Education and Health for school nutrition and health through sensitization and information exchange.

WHO

Vitamin A Delivery through Immunization Programmes

Vitamin A deficiency is one of the most important types of malnutrition in the world today, along with protein-energy malnutrition, iron and iodine deficiency disorders. Over the past decade, the burden of over 2.5 million needlessly blind children, and ten million children and adults annually with other evidence of vitamin A shortage is concentrated in countries already facing a wide range of competing nutrition and health problems. Recent evidence shows that the equally sinister and far more prevalent results of poor vitamin A status lead to decreased resistance to infection and reduced chance of survival.

WHO's Expanded Programme on Immunization (EPI) recommends targeting young children in high risk areas, and those at greatest risk of blindness and death due to preventable malnutrition, for vitamin A prophylaxis through immunization services. In December 1988, the International Vitamin A Consultative Group (IVACG) meeting in Addis Ababa endorsed the potential contribution of immunization services to control strategies.

Using immunization programmes to distribute a micronutrient is a radically new departure for EPI which has focused on antigen delivery. But vitamin A supplementation is a sustainable and cost-effective measure to enhance the overall goal of increased child survival. EPI can, in countries with a serious vitamin A deficiency problem, contribute enormously to control of malnutrition and blindness in the critical years of early childhood, in at least two distinct ways:

- by providing a distribution mechanism for vitamin A supplements within the context of Primary Health Care, and

- through measles immunization, thus eliminating the most important single cause of rapid deterioration of body vitamin A reserves, as well as potentially blinding corneal lesions in childhood.

WHO's Breast-Feeding Data Bank

The WHO Nutrition Unit has created a Breast-Feeding Data Bank as part of its Nutritional Surveillance activities. The Data and Mali, both of which resulted in intensification of control strategies and decisions to prepare national policy documents. Implementation of supplementation through EPI in at least 2 countries in Africa, 2 countries in Asia and one country in the Americas is one of the immediate EPI-linked objectives for 1989.

The vitamin A dosing schedule within the EPI in countries where vitamin A deficiency is a problem of public health significance is as follows:

Vitamin A dosing schedule within the EPI: In communities where vitamin A deficiency is a problem of public health significance

Age of child	Vaccine	Vitamin A dose
birth or within 2 months of delivery	BCG and Polio	200 000 IU to mother
6 weeks	DPT 1 and Polio 1
10 weeks	DPT 2 and Polio 2
14 weeks	DPT 3 and Polio 3
6 months		100 000 IU to infant
9 months	measles	100 000 IU to infant
1-5 years	any EPI or health services contact	200 000 IU every 3-6 months to pre-school children

(Source: EPI Global Advisory Group Meeting, Abidjan, 17-21 Oct. 1988. Programmes for the Control of Vitamin A Deficiency: The Role of the EPI in New Initiatives for 1990s, WHO).

Table I.

PREVALENCE AND DURATION OF BREAST-FEEDING IN THE SOUTH-EAST ASIAN WHO REGION
Region, Country or Area		Year	Sample		Percentage breast-feeding										Median duration of breast-feeding in contns	Ref. no.	% Host. delivery
			Type	Size	Ever	At 3 months			At 6 months			At 12 months
						Fully	Partially	Both	Fully	Partially	Both	Fully	Partially	Both
BANGLADESH
		1978	R	910	99			99			97			97	27	0207
	Dhaka	1986 E	U					49 (12)								0329
	Matlab Thana	1974	R	1,414	99			86			83			77	30	0263
	National survey: WFS	1975-76	R	298	98			91			86			62	31	0153
	National survey: WFS	1975-76		325	98			91			86			62	31	0153
	Villages	1986 E	U		78						63					0839
	Villages	1986 E	R		89						67					0839
BURMA
		1975	R					99			99			64 E		1524
	Grater Rangoon	1969		1,223	99											0248

The aims of the Data Bank are to provide information for:

- monitoring prevalence and duration of breast-feeding and evaluating trends over time, and

- giving a useful tool for studying the interrelationship between breast-feeding and fertility, especially childspacing.

- only findings based on observations of 100 or more infants are retained unless the results obtained on smaller samples are exceptional in some way;

- while studies undertaken in previous years are included, priority is given to recent studies;

- prevalence rates, based on results for which the methodology is defined and calculations can be checked, are included, excluding studies that are obviously biased.