PROGRAMME NEWS

Update on progress around the world

AIDAB and ACIAR's Nutrition Activities in 1989

The Australian International Development Assistance Bureau (AIDAB) has been involved in a number of nutrition activities in the current year, briefly described here.

Africa. A $12.5 million activity in Ethiopia through World Food Programme in the form of food aid (wheat and oil), part of which is used as food for work.

A special Southern Africa Non-Government Organization (NGO) Participation Programme includes two nutrition-related projects:

- in Botswana, Village Food Production, Gardening and Nutrition Training ($0.7 million);

- in Zimbabwe, a nutrition component in an Agriculture, Water and Immunization Project ($1m).

Indochina. It is planned to fund an FAO Vitamin A Deficiency programme commencing 1989-90 (estimated at $1.05 million). Several UNICEF projects in Vietnam amounting to $6.9 million over 4 years include nutrition components; one specifically focuses on iodine deficiency diseases.

Southeast Asia. A new programme of assistance in the health sector in Indonesia is being formulated which will include a primary health care focus including basic nutrition. Budgetary resources have been allocated for a health initiatives programme in Southeast Asia in which nutrition has been designated a priority area. Groundwork is proceeding on the development of appropriate activities.

Papua New Guinea. A large rural improvement project co-financed with IFAD includes a strong focus on improving nutritional conditions. The Government has recently requested Australian assistance with the development of an intersectoral plan of operation to provide for community-based nutrition improvement activities in targeted provinces. A programme of assistance is being developed.

South Pacific. Through AIDAB's Pacific Multicountry programme, support has been given to a Diabetes Prevention and Control workshop which will be followed up by further activities in the area of diabetes and other non-communicable diseases ($0.5m). Support is given to the South Pacific Commission for their regional nutrition programmes ($0.1m). In Vanuatu a maternal child health project implemented through Save the Children Fund (Australia) includes training in nutrition.

Other Activities. The Bureau's Food Aid programme focuses on relieving food shortages in general rather than meeting specific nutritional deficiencies. However, they do seek to maintain or improve the nutritional status of recipients through the supply and delivery of food commodities appropriate for each recipient and having a high quality exceeding international nutritional standards; and the supply of high protein biscuits as a supplement to usual food aid commodities where recipients show nutritional deficiency.

A high proportion of Non-Government Organization (NGO) activities funded under the AIDAB-NGO Committee for Development Cooperation project subsidy scheme are in the health sector, many with nutrition focus or components. Training scholarships in nutrition are also part of country programme aid. As part of the Bureau's health sector strategy, improved knowledge of and links with Australian nutrition experts are being developed.

The Australian Centre for International Agricultural Research (ACIAR) supported the following activities relevant to human nutrition:

- Publication of Monograph on "Chemistry of Tropical Root Crops: Significance for Nutrition and Agriculture in the Pacific".

(This publication is introduced in the Publications Section of this issue of SCN News).

- ACIAR is currently considering support for two projects related to Nutritional chemistry and analysis. One is to provide a method for assaying cyanide content of cassava that is both cheap and accurate, to facilitate screening of cassava varieties in breeding programmes; the other is to develop an assay for acridity in taro, also for use in breeding programmes.

- Fungi and Mycotoxins in Asian Food and Feed Stuffs: these have become a "hidden" chronic threat to human health and to the quality and value of animal feed stuffs in Asia. This project aims to study the distribution, prevalence and importance of postharvest spoilage fungi in cereals and also other durable food and feed stuffs in Asia. Researchers will identify the predominant spoilage and mycotoxigenic fungi in a range of important commodities in Asia, and will determine the factors affecting toxin production by these fungi. Better handling and drying procedures will reduce fungal load and mycotoxin production, reducing the losses amongst livestock attributable to mycotoxins in feeds. The improved procedures will also benefit human consumers.

(Source and for further information, please contact: Ms Ruth English, Principal Nutritionist, Commonwealth Dept. of Health, P O Box 100, Woden, A.C.J. 2606, Australia)

Health and Welfare Activities

Two years of work on Revised Nutrition Recommendations for Canadians has led to reports to Health and Welfare Canada from coordinated committees responsible for scientific review and communications/implementation. The reports include revised recommended nutrient intakes as well as dietary advice, guidelines and programme implementation suggestions; they will be published shortly by Health and Welfare Canada.

The Health Promotion Directorate, Health Services and Promotion Branch released the documents "Promoting Healthy Weights: A Discussion Paper" and "Canadian Guidelines for Healthy Weights" in response to concerns about weight problems. A programme is being implemented to integrate healthy eating, enjoyable physical activity and a positive body image to promote healthy weights.

A collaborative project resulted in the release of "Promoting Nutritional Health during the Preschool Years: Canadian Guidelines" in November. The guidelines were endorsed by 6 major associations.

(Source, and for more information, please contact: Dr S. W. Gunner, Health Protection Branch, Health and Welfare Canada, Ottawa, Ontario, Canada)

Traditional Food Crop Programme Expands to Asia Region

Traditional food plants are those accepted by a community through habit and tradition, as appropriate and desirable sources of food. These under-exploited traditional food crops can make a substantial contribution to meeting the nutritional needs of populations; both urban and rural, especially of low income groups and particularly at times of seasonal scarcity of staple crops. The case for promotion of traditional food plants rests on nutritional, ecological and economic arguments.

A broad promotional policy for increasing production and utilization of traditional but under-exploited food plants for human consumption was adopted by the member governments attending the 1985 meeting of the FAO Committee on Agriculture, based on recognition that these supplementary food crops are important in the nutrition and household food security of vulnerable groups and that they have income generating potential. In November 1985 the Food Policy and Nutrition Division of FAO, initiated activities related to the "Promotion of Under-exploited Food Plants", the strategy being consisted of four major elements: advocacy; publications; workshops; and applied field projects.

Initiating the programme in Africa, an Expert Consultation was convened by FAO in Harare, Zimbabwe, which was followed by the preparation of a policy paper entitled "Promoting Under-exploited Food Plants in Africa", and a resource book on "Traditional Food Plants", with special reference to arid, semi-arid and sub-humid lands of Eastern Africa. In extending this programme to other regions, FAO commissioned case studies in 1989 on selected food plants from national experts in Bangladesh, Indonesia, Nepal, Pakistan, the Philippines, and Thailand. These provided background for the first intercountry workshop in Asia on the "Promotion of the production and consumption of under-exploited traditional crops of nutritional importance for vulnerable groups", held in Kathmandu, Nepal, in September 1989.

Representatives of participating countries in the programme - senior agriculturalists, planners and nutritionists - showed keen interest in the topic as it falls well into their own government policies on food diversification, household food security and improvement of nutrition. National workshops are planned in 1990 in Bangladesh, Nepal, Philippines and Thailand. Projects in Nepal and Pakistan will begin to support field programmes for promoting growing traditional crops in vegetable gardens - particularly aimed at helping women activities - and for seed production and extension training.

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

Vitamin A Technical Assistance Programme (VITAP)

This year Helen Keller International, a US private voluntary organization (PVO), received a five-year grant from USAID's Office of Private and Voluntary Cooperation to develop a vitamin A centre of excellence. This centre, the Vitamin A Technical Assistance Programme (or VITAP), provides technical assistance to PVOs to strengthen existing vitamin A activities and to expand vitamin A programming. Vitamin A deficiency is known to cause nutritional blindness, the major cause of childhood blindness in the developing world. It is also associated with the child's increased vulnerability to diarrhea, respiratory infection and measles complications. Vitamin A is now seen as a child survival tool.

Some of the services VITAP offers are: workshops and orientation seminars; consulting and advisory services; development of training and education materials and dissemination of current literature and information on vitamin A.

VITAP targets 20 countries, located in Africa, Asia and Latin America, all designated by WHO as countries with a significant public health problem in vitamin A deficiency.

While targeting the PVO community, VITAP promotes a collaborative approach in combatting vitamin A deficiency by seeking the participation of the Ministry of Health, local AID missions, UNICEF, WHO, FAO and other relevant agencies. Workshops organized by VITAP typically receive technical input from both WHO and UNICEF. During the past year, VITAP has served as a catalyst in bringing PVOs/NGOs, international, bilateral and government organizations together to develop national strategies and implement programmes.

The first year of the project was spent in: staff recruitment; developing a baseline directory of PVOs; setting up a computerized system for monitoring and tracking vitamin A activities; establishing a data bank of available technical consultants; creating a library of publications; and development of a semiannual newsletter.

Technical assistance in vitamin A deficiency assessment, social marketing and overall programme guidance was provided to a number of countries. Exploratory visits were made to Benin, Chad, Ghana, Haiti, Malawi, Nigeria, Tanzania and Zambia. Workshops were held in Africa, Central America and the United States.

One of the early project goals will be to work with WHO's Nutrition Unit in revising the classification system for vitamin A deficient countries. Presently, members of the VITAP staff and the Nutrition Unit are collecting information on vitamin A in all countries where vitamin A deficiency is a suspected or documented public health problem. The objective is to establish a systematic data collection and a formal review process for determining vitamin A deficiency status of WHO member countries.

Over the five-year period, VITAP will increase the bank of technical personnel who specialize in vitamin A activities. At the end of the grant, outcomes will include: a computerized roster of vitamin A consultants; an increased number of PVOs with skills in vitamin A programming; an increased number of vitamin A field projects; and a comprehensive library of materials and publications.

For further information, please contact: Ms Anne Ralte, VITAP Deputy Director, Helen Keller International, 15 W 16th St, New York, NY 10011, USA.

ICCIDD

Highlights of Activities in 1989

In 1989, the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) had several meetings and experienced a considerable escalation of interest and enthusiasm throughout the year. Some highlights are given below:

A WHO/UNICEF/ICCIDD Inter-country Meeting was held in Delhi (9-16 March) with the establishment of a Regional IDD Working Group for South East Asia.

On 26 and 27 April an ICCIDD/Ministry of Public Health (MOPH) Consultation was held on the National IDD Control Programme of the People's Republic of China. This led to the recommendation of an International Working Group for IDD Control in China. The recommendation was accepted by the MOPH and Mme S F Gao convened the first meeting which was held in Beijing on 15 May 1989.

A National Consultation on the IDD Control Programme in Indonesia was held in Jakarta (7-9 August 1989). This meeting arose from the Delhi meeting. It reviewed progress in the control of IDD, especially in Java, where some 3.75 million injections of iodized oil have been given out of a total of 10 million in the last 5 years (1985-1989). Improvement in IDD prevalence had occurred in a number of provinces, but the more remote provinces (as Lombok Island and Kalimantan) had failed to improve. An international working group was formed and had its first meeting in Jakarta on 9 August.

An IDD Symposium was held at the XIV International Nutrition Congress in Seoul (10-25 August). Papers were presented on Iodine Deficiency and Brain Function (Dr T Ma, China); Communication and the National IDD Control Programme in India (Dr C S Pandav, India); Global Monitoring (Dr G Clugston, WHO, Geneva); and The Global Strategy for Elimination of IDD by the year 2000 (Dr B S Hetzel, ICCIDD).

(Source: Dr B. S. Hetzel, Executive Director, ICCIDD, CSIRO Division of Human Nutrition, Kintore Avenue, Adelaide 5000, Australia)

International Dietary Energy Consultative Group

The International Dietary Energy Consultative Group (IDECG) was established in Geneva on 3 September 1986 under the sponsorship of the United Nations University (UNU) and the International Union of Nutritional Sciences (IUNS) and with the endorsement of the United Nations ACC/Sub-committee on Nutrition.

The IDECG has been established for the study of dietary energy intake in relation to the health and welfare of individuals and societies. The foundation meeting in Geneva, attended by scientists from research institutions and international agencies, defined the following as specific objectives for IDECG:

- The compilation and interpretation of relevant research data on functional and other consequences of deficiency, change or excess of dietary energy.

- The identification of related research needs and priorities and the promotion of needed research.

- The publication of scientific and policy statements and other information on the significance of chronic deficiencies and excesses of dietary energy.

- The identification and promotion of appropriate and practical means of corrective action.

For further information, please contact: Dr B Schurch, Executive Secretary of IDECG, C/o Nestle Foundation, P O Box 581, CH-1001 Lausanne, Switzerland.

(Source: IDECG Newsletter, February 1989, No. 1.)

Technical Advisor in Nutrition

IFAD has recently appointed a Technical Advisor in Nutrition, to be based in the Technical Advisory Unit of the Project Management Department. The position is held by Ms Wenche Barth Eide, a national of Norway on leave from the University of Oslo, with long experience in international nutrition through research, training and advisory activities. One of the responsibilities of the nutrition advisor will be to participate in project reviews at all stages concerning the impact of IFAD projects on household food security and nutrition, and to develop a workable approach to incorporating nutritional considerations into IFAD-supported projects. As part of the latter, she will organize staff training in matters relevant to nutrition. The Advisor will liaise closely with the other Technical Advisors (agronomy, livestock, irrigation, credit, women in development, environment) to enhance the full integration of nutrition into the mainstream of IFAD's development efforts. The Nutrition Advisor will serve as the focal point for the contact between IFAD and the ACC/SCN.

PAHO

Food and Nutritional Surveillance

The Food and Nutrition Programme of the Pan American Health Organization arranged a planning meeting on food and nutrition surveillance in Cali, 7-10 November, 1989 directed primarily to formulate a Regional Training Programme.

The meeting was supported by the Inter-Agency Food and Nutrition Surveillance (IFNS) Programme and there were representatives from FAO, UNICEF, PAHO and WHO/Headquarters, as well as officials from member governments and institutions. Four training proposals were discussed, presented to IFNS by Costa Rica/INCAP, Colombia/University of El Valle, Chile/Institute of Nutrition and Food Technology (INTA), and the Caribbean Food and Nutrition Institute (CFNI). In addition, other technical issues were discussed such as the strategies to incorporate birth weights and school height censuses in surveillance systems, as well as the relationship between food security and nutritional surveillance.

(Source and details from: Dr C H Daza, Coordinator, Food and Nutrition Programme, PAHO, WHO Regional Office for the Americas, 525 Twenty-Third Street, N.W., Washington, D.C. 20037, USA.)

Education for All

The World Conference on "Education for All" will take place in Thailand, from 5 to 9 March 1990, under the joint sponsorship of UNDP, UNESCO, UNICEF and the World Bank. The USAID, Sweden, Norway, Finland, Denmark and the Asian Development Bank are other sponsoring agencies as well as Switzerland, Canada, IDRC, Bernard Van Leer Foundation and WHO.

A series of regional preparatory conferences are now being held to compare and to consolidate preparations undertaken at national levels for document presentation and to determine regional view points and priorities - required to be highlighted at the conference. The conference will arrange a number of concurrent activities including plenary sessions, a series of thematic and illustrative round tables and exhibition of various aspects of Education for All policies, programmes, and practice.

Nutrition, Health and Learning will be the subject of one of the Thematic Round Tables, organized by UNESCO in cooperation with the World Food Programme. The key issue to be addressed by this round table is that nutritional deficiencies and poor health in school children are among the causes of poor school enrollment, absenteeism, early drop outs and poor classroom performance; and that appropriate school-based nutrition/health interventions can result in significant increments in educational efficiency in many developing countries. A special study has been prepared which provides a review of evidence on the impact of nutrition and health on learning. Other discussion papers are being compiled. A country case study from Zimbabwe will be presented. The round table will be organized around a slide and video presentation with interventions from a number of distinguished personalities.

More details from: Mr. Wadi Haddad, Executive Secretary, Interagency Commission for the World Conference on Education for All. UNICEF House, 3 United Nations Plaza, New York, NY 10017, USA.

(Source: Dr Susan van der Vynckt, Programme Specialist in Nutrition Education, Division of Science, Technical and Vocational Education, UNESCO, 7 place de Fontenoy, 75700 Paris, France)

Nutrition of Refugees

Training Video

UNHCR is in the process of developing a training video series entitled "How to Conduct a Rapid Nutritional Status Survey in Refugee Situations". The training set will include four videos which cover the areas of preparation and planning, principles of anthropometric measurement, sampling, and data analysis and interpretation. The videos will be accompanied by a users manual describing step by step procedures for rapid assessment of malnutrition in refugee populations. The complete training set is expected to be available from UNHCR by the end of the first quarter of 1990.

Milk Policy

A policy guideline has been issued by UNHCR concerning the safe use of milk products in refugee situations, following a meeting organized by the ACC/SCN. This policy has been endorsed by other concerned UN organizations (FAO, UNICEF, WFP and WHO) and has been circulated to all UNHCR field offices.

Deficiencies in Camps

Over the last ten years an unprecedented number of cases of nutritional deficiency diseases (scurvy, xerophthalmia and anaemia) have been documented in refugee camps (see SCN News No. 3, page 11). Hundreds of thousands of refugees, particularly in arid regions of Africa, have been affected. The largest number has been among children, pregnant and lactating women, and the elderly. This has had an extensive social as well as physical cost on refugee communities. To help combat this problem, UNHCR has prepared a discussion paper on the subject which analyses certain options available to food planners and donors. These options review: table distribution, fresh food purchase, monetization, and food aid fortification. Each option is discussed with regard to their advantages, disadvantages and relative merits. The most practical options should be initiated.

Copies of documents and further information can be obtained from UNHCR, Technical Support Service, Centre William Rappard, 154 rue de Lausanne, CH-1202 Geneva, Switzerland.

UNICEF

Innocenti Centre in Florence

UNICEF's new International Child Development Centre in Florence, Italy, became operational in September 1988. The host organization is the Istituto degli Innocenti which manages the foundling hospital (serving abandoned and needy children since 1445), and a number of innovative community-based activities for the benefit of children.

The primary purpose of this Centre is to strengthen the capacity of UNICEF and its cooperating institutions to respond to the evolving needs of children and to help promote an emerging global ethic for caring for children. The Centre provides a forum for international professional exchanges of experience and undertakes or promotes policy analyses, applied research and the dissemination of ideas towards the goals of child survival, protection and development.

The initial work of the UNICEF Innocenti Centre is concentrated in four major programmes areas: "National capacity building for child survival and development"; "Economic policies and mobilization of resources for children"; "Rights of the child"; and "Needs of the urban child".

An international Advisory Committee has been established. The Centre is also beginning to form consultative groups in each of the four major programmes areas designed to provide general advisory support and to maintain effective links both with other parts of UNICEF and with operating institutions and key resource persons.

The Centre will offer fellowships of varying lengths of time to recognized experts working within the major areas of the Centre's activities. Fellowships will be used to offer opportunities to professionals, especially from developing countries.

(Source: Innocenti Update, UNICEF International Child Development Centre Newsletter, April 1989, Nos 1 and 2. For further information, please contact: UNICEF, International Child Development Centre, Spedale degli Innocenti, Piazza SS. Annunziata, 12-50122 Florence, Italy)

Iringa - Improved Children's Nutrition

In contrast to what has happened in most of Africa, the Iringa region in Tanzania has enjoyed a significant improvement in the nutritional status of infants and young children during the last five years.

Between 1984 and 1988, it was estimated that severe and moderate malnutrition have been reduced by 70% and 32% respectively, according to a recently published report *. Moreover, such downward trends in malnutrition are being maintained. Similarly, infant mortality and child death rates considerably were reduced compared to the rates were recorded for Iringa in the 1978 Tanzania national census. Since these marked improvements were apparent only in the areas where the Iringa nutrition programme has been functioning, much of the observed improvements in the nutritional status has been attributed directly to the impact of this programme.

*Based on: JNSP in Iringa, Tanzania, 1983-88 Evaluation Report, WHO and UNICEF, Dar es-Salaam, October 1988.

A National Ad-hoc Planning Group was established with representatives from the Prime Minister's Office, the Ministries of Health, Education and Agriculture and the Tanzania Food and Nutrition Centre. The programme had the overall objectives of reducing infant and young children mortality and morbidity; achieving better child growth and development and improving maternal health and nutrition. Further, development of people's capabilities at different levels of society to assess and to analyze nutrition problems and to design appropriate actions, in order to solve them, was recognized as being fundamentally important for attaining the programme goals.

To reach these goals, the main programme components included: systems development and support; maternal and child health; water and environmental sanitation; household food security; child care and development as well as income-generating activities. The programme focus was on pregnant women and under-five year old children, being the most vulnerable section of the community.

The Iringa Nutrition Programme has continually grown and expanded. The original 168 villages covered by the programme has now been increased to 620 villages and townships in the whole region. Similar activities are being replicated in six other regions of Tanzania. However, in any replication process, specific characteristics of the concerned area should be considered carefully - as emphasized in the report. It is also stressed that while very substantial resource at all administrative levels have been mobilized by this programme and although resource mobilization and external inputs have been crucially important for the success of the Iringa Programme, analysis suggests how these can be reduced and/or replaced by local commitments from different levels in order to decrease dependency on external support.

The Iringa programme evaluations highlighted the achievements of the programme and at the same time recognized that feasible and affordable solutions to many of the health and nutrition problems in Iringa are yet to be found. Despite marked improvements, the region still suffers from high malnutrition and mortality in its children. Nevertheless, the experience gained confirmed that much could be done to improve nutritional status of the vulnerable groups by creating public awareness and strengthening the support services.

WORLD BANK

Expanding Support for Nutrition Programmes

Throughout 1989, the World Bank has continued to finance nutrition projects in a number of countries on the recognition of the importance of nutritional support during the course of economic adjustment programmes. Briefly, the main activities included the following.

The Jamaica Social Sector Development Project, approved in June 1989, encourages the government to target social spending on the poor and vulnerable groups, reducing general food subsidies and increasing targeted food stamps and nutritional assistance through maternal and child health care programmes. Nutrition and food-related programmes account for about 50% of the overall expenditure of the social well-being programmes supported by the loan.

The Structural Adjustment Loan for Venezuela, also approved in June 1989, provides nutrition inputs. Assistance in the form of either cash or food vouchers is provided through schools in low-income areas to school and preschool age children. Support is will also be given to nutrition programmes for preschool children through an expanded day-care system; school feeding programmes; and nutrition and health care for pregnant women and infants in low-income areas. The government focussed attention on the poor by using direct and targeted subsidy programmes instead of indirect ones benefiting mainly the affluent.

In Lesotho a Population/Health-/Nutrition project had a multifaceted nutrition component including a unique programme to promote village-based grain processing and stimulate domestic grain production. The activities are designed to complement those under a UNICEF-financed Child Nutrition and Household Food Security Project. A nutrition project in Mozambique has been approved.

The Sri Lanka nutrition sector report has been revised to take account of recent major changes in government food programmes. Meanwhile, a Sri Lankan Nutrition Working Group has been established to design and pilot-test community nutrition interventions in three service delivery areas covered under the recently implemented Health and Family Planning Project.

In India preparation is under way for two future nutrition projects for World Bank support. These may expand Bank-assisted nutrition operations in India to at least four other States as well as expansion of an existing project in Tamil Nadu, to cover the entire state.

Argentina recently requested Bank financing for nutrition, while as a result of an earlier proposal from Colombia, a Community Child Nutrition and Development Project is being prepared.

The World Bank has explored possibilities of including nutrition elements in projects. In Mexico nutrition studies have been done in the context of an Agriculture Sector Adjustment Loan. Discussions have been held with other countries including Bangladesh, Brazil (Northeast), Guatemala, Madagascar, Nigeria, and Philippines on prospects for nutrition operations.

(Source: The World Bank.)

- M.L.