PROGRAMME NEWS

AUSTRALIA

Update on AIDAB Nutrition Activities

The Australian International Development Assistance Bureau (AIDAB) supports the Primary Health Care approach to health (including nutrition), and is currently contributing through a number of different funding mechanisms in the countries in its region (mainly South East Asia and the Pacific). It is particularly focussing on the theme of WATCH (Women And Their Children's Heath) Activities have covered the countries in the following regions.

Africa. In addition to other African countries supported, AIDAB has funded projects in two countries: In Mozambique an agricultural project to improve food security (worth US$457,000 over 3 years) and in Tanzania a child survival project with nutritional impact (worth US$1.1 million over 5 years).

Indochina. As special NGO programmes, three projects in Cambodia and one in Vietnam have got financial support. In Cambodia: Rehydration, Immunization, Nutrition and Education Centre, (worth US$80,000); food production project (worth US$98,000); Health education, irrigation and village garden project have been provided. In Vietnam: a horticultural mixed food project (worth US$152,000) has been supported.

Southeast Asia. The ASEAN Australia Economic Cooperation Programme includes a Food Technology Research and Development Project (worth US$1 million). In Indonesia, a large flood mitigation and irrigation project in Northern Sumatra (worth US$54 million over a 9 year period), includes health and nutrition components.

South Pacific. Funding continues for the South Pacific Commission for the regional programme of technical assistance. A UNICEF implemented Family Food and Nutrition Project (in five countries) is partially funded by AIDAB (US$543,000).

Seminar Support and Research Grants

Attendance at conferences on Oceanic

Foods, Medical Research, Food Safety, Tropical Health and Nutrition and on Baby Foods Action have been funded. Funds are available to enable people to participate in conferences through the International Seminar Support Scheme.

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

IDRC Establishes Nutrition Unit

In January 1989, the International Development Research Centre (IDRC) established a Nutrition Unit in the Agriculture, Food and Nutrition Sciences Division. It is a Centre-wide Programme Unit, which integrates the nutrition-related work of all Divisions by means of an interdivisional committee, and develops the nutrition programme on a multidisciplinary basis.

The overall mission of the nutrition programme unit is to contribute to the improvement of community nutrition, and the nutritional status of the poor. In pursuit of this mission, the programme unit supports research which seeks to promote:

a) the development and implementation of methodologies for assessing the broad causes of community nutrition problems and promoting their use in nutrition intervention and rural nutritional programmes;

b) the formulation of national policies and action programmes for nutritional improvement;

c) integrated projects in nutrition, innovative research methodologies, and the dissemination of new and relevant information from various disciplines.

Generally, the Nutrition Unit's responsibility is to bring coherence and increased visibility to the Centre's nutrition programme. In particular, the Unit fosters coordination among the nutrition activities of the various Centre Divisions and promotes the incorporation of nutrition objectives into agriculture, health, social sciences, communications and information programmes. Through this coordinating mechanism, IDRC will direct increasing support to nutrition mainly in the form of multidisciplinary projects. The Nutrition Unit also has a divisional activity project budgets, which are used to expand and strengthen certain initiatives and to support the development of innovative approaches to nutrition research.

(Source, and for more information contact: Dr. Richard Young, IDRC, P.O. Box 8500, Ottawa. Canada K1G 3H9. Telex: 053-3753.)

Health and Welfare Activities

The Ministry of National Health and Welfare, has now released three nutrition reports entitled "Nutrition Recommendations"; "Action Towards Healthy Eating"; and "Nutrition Recommendations... A Call for Action", which is a combined summary of both reports.

"Nutrition Recommendations" reviews the scientific evidence on human nutrition from a public health perspective and provides recommendations to promote and maintain health and reduce the risk of nutrition-related diseases such as heart disease and certain types of cancer. In preparing these recommendations, a combined review of nutrient requirements and nutrient/disease relationships was undertaken by a Scientific Review Committee. This process has resulted in a book which provides nutrition recommendations and a full revision to the Recommended Nutrient Intakes for Canadians, last issued in 1983. The 208-page report provides the scientific basis for healthy eating. Its format allows the reader to refer quickly to particular nutrients. It is available for $18.95 Cdn. through Canadian bookstores or from the Canadian Government publishing Centre, Ottawa, Ontario, Canada, K1A OS9; the cost outside Canada is $22.75 US.

The publication "Action Towards Healthy Eating" was prepared by a Communications/Implementation Committee and contains an expression of the Nutrition Recommendations in a format more easily understood by the general public. These recommendations - Canada's Guidelines for Healthy Eating - advise consumers to enjoy a variety of foods; it emphasizes cereals, breads, other grain products, vegetables and fruits, low-fat dairy products, lean meats and foods prepared with little or no fat; to achieve and maintain a healthy body weight by regular physical activity and healthy eating; and to limit salt, alcohol and caffeine.

The publication also contains recommendations to implement Canada's Guidelines for Healthy Eating. The publication "Action Towards Healthy Eating and Nutrition Recommendations... A Call for Action" is available free of charge from the Canadian Government Publishing Centre, Ottawa, Ontario, Canada, K1A OS9.

(Source, and for more information please contact: Dr. S.W. Gunner, Food Directorate, Health Protection Branch, Health and Welfare Canada, Ottawa, Ontario, K1A OL2, Canada)

Caribbean Food and Nutrition Institute (CFNI)

Unequal access to goods and services including food and nutrition, with low domestic food production thus great dependence on imported foods have resulted in the co-existence of both under-and over-nutrition in the countries of the Commonwealth Caribbean. While large number of children suffer from energy-protein malnutrition and iron deficiency anaemia, many adults succumb to the ravages of the chronic diseases, which have gradually replaced the communicable ones among the leading causes of death.

CFNI was founded in 1967 as a means of adopting a regional approach to the solution of the nutrition problems of the English-speaking Caribbean countries, and as one of the mechanisms devised to improve the nutritional situation in a multisectoral manner. CFNI is a specialized centre providing technical support services in the area of food and nutrition directly in the delivery of technical cooperation to member countries. The budget of CFNI comprises a regular core component provided by PAHO and by the member governments.

Since its inception CFNI has adopted a holistic approach to the solution of food and nutrition problems, concentrating its attention on the community. During the first decade after its establishment, the size, nature, distribution and relative urgency of these problems were defined.

Technical cooperation activities are divided into two areas: "Food Availability and Consumption" and "Health-/Nutrition Promotion and Protection". In recent years, the first programme focused on increasing food and nutrition security at the household level and improving food and nutrition planning and coordination at local and national levels. The second programme is targeted to reducing the prevalence and incidence of obesity, diabetes and hypertension, iron deficiency anaemia, energy-protein malnutrition and dental caries, and to supporting institutional food service operations. CFNI has adopted six basic approaches to collaborating with its member countries: mobilization of resources; dissemination of information; training; development of standards; plans and policies; and direct advisory services.

During the last two decades, the Institute has built up an impressive record of assistance to its members to strengthen their capacity to respond effectively to national requirements in the area of food and nutrition policies and programmes.

Looking to the future, CFNI notes the demographic shifts now occurring; the growing awareness of the populations raising new expectations; and the economic crunch increasing hardship. In this last decade before the year 2000, the governments and the Institute have to maintain the gains and capture new ones, in spite of the odds. The recently launched Caribbean Cooperation in Health Initiative reaffirms the traditional principle of cooperation and provides a vehicle for action. Given the unique position which CFNI has achieved in the Caribbean, and the expectations of member governments, it plans to strengthen its leadership role in the Commonwealth Caribbean in food and nutrition.

(Source: Caribbean Food and Nutrition Institute, The Way Forward 1990-2000. November 1989. Kingston, Jamaica)

The Vitamin A Programme

FAO Assistance to the UN Ten Year Action Programme to Prevent and Control Vitamin A Deficiency, Xerophthalmia and Nutritional Blindness continued with advanced pace in 1988/89. As foreseen, the programme covered all four regions - Africa; Asia and the Pacific; Latin America and the Caribbean; and Near East. The objective is to increase the production of vitamin A and carotene-rich foods and ensure their increased consumption, primarily by agricultural-based interventions.

From the start of the UN Vitamin A Programme in October 1985 up to December 1989, FAO has spent some US$1.5 million for the programme. To date, 17 countries have been assisted in one way or the other, three more than foreseen in the FAO plan for the first five years of the programme. There have been 16 project proposals developed, ten of which are now in official channels.

During 1988, project formulation and implementation were carried out in 13 countries -Bangladesh, Burkina Faso, Brazil, China, India, Indonesia, Malawi, Mauritania, Nepal, Niger, Philippines, Tanzania and Vietnam. In 1989, activities were followed up adding new countries from the African region: Benin, Chad, Mali and Zambia.

Implementation of field projects, however, is lagging behind the plan made for the first five years, primarily due to budgetary constraints. This will change somewhat with the expected funding of six projects by the mid-1990. Meanwhile, more effective programme coordination within countries and between the UN agencies for better use of available resources, as well as more explicit commitments by donors for support of projects, should partially compensate this reduced pace of programme implementation and improve the efforts towards reaching the programme objectives.

Collaboration with the International Vitamin A Consultative Group (IVACG) continued in 1988/9; two task forces met on guidelines for simple dietary assessment of groups at risk of inadequate vitamin A intake, and on nutrition education/communication programmes with emphasis on vitamin A. The report of a joint FAO/WHO expert consultation on the requirements of vitamin A, iron, folic acid and vitamin B12 was published in English as well as French in 1989 (see publications section of this issue).

(Source: Second Summary Progress Report on the FAO Vitamin A Programme, January 1988 - December 1989)

New Co-ordinating Research Programme

The International Atomic Energy Agency (IAEA) is planning to start on a new Co-ordinating Research Programme (CRP) to study the bioavailability of iron and zinc from human diets, using isotope techniques.

IAEA is interested in supporting these studies because in many population groups affected by the essential micro-nutrient deficiencies it is not an absolute lack of the element in the diet rather its poor availability in the body. Better identification of factors affecting bioavailability is required as well as the means to improve it by simple dietary modification and fortification using food products of the kind that may locally be available in developing countries.

The main focus of the proposed CRP will be on iron nutrition. High priority will be given to studies in developing countries relating to the planning and/or support of appropriate local intervention programmes for the alleviation of iron deficiency. These include (i) food fortification (selection of suitable vehicle for fortification; type and level of fortification required; monitoring of effectiveness) and (ii) dietary modification (selection of appropriate local foodstuffs containing bioavailable iron; reduction in the amount of substances inhibiting the absorption of iron etc.). Studies of iron supplementation (e.g. with pills) however, are considered to be less suitable for inclusion in the CRP. Among such projects, priority will be given to research proposals which also include the concurrent study of zinc nutrition in the same target populations. Topics of particular interest with respect to zinc bioavailability, include (i) interactions with calcium and phytate, (ii) enhancement of bioavailability by fermentation, and (iii) effects of lectins. The primary target population groups of interest in each country are those that are considered to be primarily at risk of being iron deficient. This is to be decided locally by each participating institute.

IAEA is interested in supporting the use of isotopes techniques in studies of the kinds outlined above and is able to provide modest funding (around US$ 20,000 for each developing country institute, spread over 4-5 years).

Applicants in developing countries should provide, in the first instance, an informal pre-proposal in the form of a letter including description of the work to be performed (in no more than one page typed single-spaced). The information provided should include: (1) name and address of the applicant (if possible including telephone, telex or fax numbers), (2) the names of any other institutes in the country that will collaborate in the project, (3) some background information on relevant national programmes (existing and/or planned) to alleviate iron deficiency in the country, (4) a summary of the proposed work to be done within the framework of the CRP, with emphasis on what it is hoped to achieve during the first year and on how the target population group(s) for study will be selected.

After a preliminary selection from the pre-proposals, the identified institutes will be invited to submit more detailed proposals on forms that will be provided by IAEA. The final selection will be made on the basis of these formal proposals.

Further information on the purpose and scope of the CRP, and on the use of isotopes techniques may be found in the report of a Consultants' Meeting, which is available from IAEA on request.

Enquiries and pre-proposals may be addressed to Dr Robert M. Parr, Head, Section of Nutritional and Health-Related Environmental Studies. IAEA, P O Box 100, A-1400, Vienna, Austria. Telex: 43 1 2360 1657; Fax: 43 1 234564.

(Source: IAEA, May 1990)

Report of Further Activities

The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) reports on recent activities undertaken at global, regional and national levels in order to control various disorders related to iodine deficiency.

Following the establishment of an International Working Group for control of IDD in China, the first meeting of the group was held in Beijing on 26-27 November 1989, with WHO and UNICEF representatives. The major technical issues and funding support were discussed. Also the possibilities of using iodine supplies from Japan were considered.

The Third Meeting of IDD Task Force for Africa (Francophone) was held from 11 to 14 November, 1989, at UNICEF, Abidjan. The meeting was attended by representatives of 17 countries.

ICCIDD has provided consultants for National IDD Control Programmes in Africa (Botswana, Ethiopia, Malawi, Mali, Lesotho, Zimbabwe), and Latin America (Bolivia, Guatemala, Mexico). Consultancies (rapid assessment) were carried out in Central America with JNSP (Joint Nutrition Support Programme) support.

In the Middle East, a Regional WHO/UNICEF IDD Working Group was established and met (May, 1989) with representative of 9 countries, at WHO, Alexandria.

"Report on IDD in Europe", published in the Bulletin of the World Health Organization, has revealed major IDD problems in a number of European countries.

A "WHO/ICCIDD Consultation on IDD Assessment Methodology" was held at WHO, Geneva (23-26 October, 1989). A handbook is being prepared.

Following the ICCIDD Executive Board meeting at UNICEF in October 1989 in New York, a meeting was held with USSR representatives at which a preliminary plan for a gathering in Tashkent was drawn up.

The proceedings of the IDD Symposium held at the 14th International Congress of Nutrition in Seoul, Korea during August, 1989, has been published. Other recent ICCIDD publications are introduced in the Publications section of this issue of SCN News.

The Executive Board of UNICEF (April 1990) and the World Health Assembly (May 1990) have accepted the objective of elimination of IDD as a major public health problem by the year 2000. The ICCIDD was given much credit for this major step within the UN system as a result of its work since its inauguration in 1986 in Kathmandu. The ICCIDD believes that, with increased funding, escalation of the effort along already established lines will enable this great objective to be accomplished.

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

Africa: A Priority for IFPRI

The International Food Policy Research Institute (IFPRI) was established to identify and analyze alternative national and international strategies and policies for meeting food needs in the world, with particular emphasis on low-income countries and the poorer groups within those countries. IFPRI's research is conducted on the complex issues associated with food production, distribution, consumption and trade. The urgent and long-term nature of problems in Africa, their complexity, the relative lack of knowledge about them and the critical role of food policy in alleviating these problems make Africa a priority for IFPRI. IFPRI's research in Africa greatly contributes to its overall research objectives concerning the identification of improved technology policies, poverty alleviation, and sustainable development strategies. In 1977, IFPRI released "Food Needs of Developing Countries: Projections of Production and Consumption to 1990". This report was one of the first publications to draw attention to developing food gaps on a country-by-country basis for Africa. Subsequent research by IFPRI in collaboration with African policy makers, researchers and other development analysts has culminated in a recent book, "Accelerating Food Production in Sub-Saharan Africa" (published for IFPRI by the Johns Hopkins University Press), which sets out approaches and research priorities for improving the African food situation.

To conform with these priorities, IFPRI has increased its commitment to research on Africa. In 1986-88, 18 projects were completed and in 1989 there are 25 ongoing projects. The projects involve 18 countries and fall into 5 research areas that concern labor productivity, commodity priorities, technology adoption, macroeconomic policies and agriculture, and the effects of policies on the poor. IFPRI is collaborating on virtually all of these projects with staff from African universities and research institutes, government senior analysts and policy makers, and centres in the Consultative Group on International Agricultural Research (CGIAR). The Institute has also been involved with the organization of food policy conferences and seminars in Cote d'Ivoire, The Gambia, Kenya, Nigeria, Senegal, Zambia and Zimbabwe. IFPRI is currently involved in collaborative research agreements with national research institutions and universities in 14 countries in Sub-Saharan Africa. These are Burkina Faso, Cote d'Ivoire, Ethiopia, The Gambia, Kenya, Malawi, Niger, Rwanda, Senegal, Sierra Leone, Sudan, Zaire, Zambia, and Zimbabwe. During the course of the research effort, national researchers frequently spend time at IFPRI. Some IFPRI staff are posted to the African countries, and staff at headquarters spend substantial time in African countries.

* * *

Income, Nutrition and Health

The IFPRI Projects on Sub-Saharan Africa in the areas of income, nutrition and health, during 1989/90, covered the following topics.

* The impact of technological changes in agriculture on rural welfare: policies to enhance the short-and long-term effects on growth and equity.

* Seasonality in agriculture - its significance for nutrition and productivity in the context of technological change.

* Effects of selected policies and programs on consumption patterns and child survival.

* Nutrition, health and agriculture linkages - implications for policy

* Food consumption and nutrition -implications of changes in maize price and marketing policies in Zambia.

* Food consumption and nutritional effects of technological change in Zambia.

* Trade-offs between various food and agricultural policy options and their effects on poverty alleviation and nutritional improvement in a West African setting.

* Famine in Africa: the consequences for rural people and policies to assist in the transition to sustained development.

(Source: IFPRI and Sub-Saharan Africa; January 1990. IFPRI, 1776 Massachusetts Avenue, N.W. Washington, D.C., 20036, USA).

Strategies For 1990s

In the next decade the Institute of Nutrition of Central America and Panama (INCAP) will aggressively develop and implement strategies and cooperative activities which result in the practical application of science and technology in solving the food, nutrition, and related health problems affecting the Member Countries.

The Institute will focus on studies and cooperation related to food and nutrition security, which represents one of the basic contents of social security for the region. The accomplishment of food and nutrition security is fundamental for the improvement of the conditions of severe poverty affecting the region, and for the realization of the human potential of the population.

Beyond INCAP's commitment to these important areas, the aim of the Institute is to be identified as a Central American Organization, genuinely interested in the efforts of integration and of peace. Without peace, it will be impossible to obtain food supply and availability in particular, or social security in general. Without peace, it is also impossible to imagine an adequate quality of life for the population as a whole. Without integration, it will be difficult to develop adequate resources and capabilities to confront the common and complementary food, nutrition and health needs, and to support socioeconomic development of the region.

The decade that is now beginning finds the Institute optimistic towards the future, with the firm conviction that what has been learned in the past 40 years, and what will be learned in the future, will be applied for the benefit of the Central American region.

(Source: Dr. Hernan Delgado, Director, INCAP, Carretera Roosevelt, Zona 11, Apartado Postal 1188, Guatemala, Guatemala, C.A.).

The Institute of Nutrition and Food technology (INTA) of the University of Chile, in collaboration with Pan American Health Organization (PAHO), UNICEF, USAID, and FAO is organizing an International Training Programme in Food and Nutrition Surveillance (PIEVAN) with activities programmed for the period 1985-91. PIEVAN is cosponsored by the Ministry of Health of Chile, the United Nations University (UNU) and the Latin American Society of Nutrition (SLAN).

The Third International Course, within this programme, on Food and Nutrition Surveillance (SISVAN 90), called "Dr. Martin Forman", in memory of the long time Director of the Office of Nutrition of AID who supported PIE-VAN from the beginning) was carried out from 16 to 19 May, 1990, in Santiago, Chile.

Future courses are planned. More information from: Dr. Sergio Valiente, Coordinator, Institute of Nutrition and Food Technology, University of Chile, Casilla, 15138, Santiago, Chile,

(Source: Dr. C.H. Daza, Coordinator HPN, PAHO, 525 Twenty-third Street, N.W. Washington, D.C. 20037, USA)

International Project on Child Health and Nutrition and School Participation

The second expert meeting on the UNESCO International Project on Child Health, Nutrition and School Participation, took place at the Wenner-Gren Centre Foundation in Stockholm, Sweden from 9-11 May 1990. An inter-disciplinary group of experts was convened by UNESCO to review progress and accomplishments of the project since its inception in September, 1988. Particular consideration was given to responding to the expanded vision of meeting "basic learning needs" for all children. These are set out in the World Declaration on Education For All and The Framework for Action for Meeting Basic Learning Needs, the World Conference on Education for All, Thailand (5-9 March, 1990). The Convention on the Rights of the Child has similar reference.

The three main components of the UNESCO project are:

a) planning, implementing, monitoring and evaluating in each of four countries (Zimbabwe, Kenya, Thailand and Jamaica) projects addressing the health and nutrition conditions of school age children and children's access to and participation in basic education;

b) furthering at the global level analytical work on the "education crisis" in developing countries and the extent to which child nutrition, health and welfare are contributing to present inequities in learning opportunities;

c) disseminating information on scholarly studies and analysis of children and their "right to optimal health" and "basic learning" and findings from country level experiences from different regions of the world.

(Source: Dr S. Van der Vynckt, UNESCO, Paris)

Strategy for Improved Nutrition of Children and Women in Developing Countries

UNICEF believes that freedom from hunger and malnutrition is a basic human right. Continued malnutrition is unacceptable. At its 1990 Session the Executive Board of UNICEF endorsed the following nutritional goals for the year 2000:

a) the control of protein-energy malnutrition, including the reduction of both moderate and severe forms in children under five years of age by one half of the 1990 levels and the reduction of the rate of low birth weight (less than 2.5 kgs) to less than 10 percent;

b) the control of micronutrient deficiency disorders, including the reduction of iron-deficiency anaemia among women of child-bearing age by one third of 1990 levels, the virtual elimination of iodine deficiency disorders and of vitamin A deficiency and its consequences, including blindness.

The strategy aims at empowering families, communities and governments to improve the nutrition of women and children on the basis of adequate information and sound analysis. The involvement of communities, particularly women, in planning, implementation and monitoring is crucial. Resources must be mobilized at all levels of society. The strategy is multisectoral and interactive to cope with changing environments and it encourages and facilitates participation through social mobilization. As nutrition is not seen as a sector but as an outcome of processes in other sectors, many of which receive UNICEF support, emphasis is given to the reorientation and focussing of existing and planned UNICEF-country programmes, rather than to launching new "nutrition programmes".

The conceptual framework emphasizes the potentially important roles of 1)household food security, 2)health services and disease control, and 3)maternal and child care, thus providing an improved opportunity for UN-agency collaboration. These three conditions, all necessary for good nutrition, are directly related to economic and social development policies. The strategy therefore facilitates the assessment, analysis and monitoring of the impact of economic and structural adjustments.

In a given context elements of the strategy will be identified through assessment and analysis and will include:

1) actions that address the manifestations and immediate causes of malnutrition, such as the promotion of breast-feeding, nutrition rehabilitation, the provision of certain essential drugs, the promotion of oral rehydration therapy, direct feeding programmes and distribution of micronutrients;

2) actions that address the underlying causes of malnutrition, such as immunization, the expansion and improvement of the primary health care delivery system, health and nutrition education and communication, family planning, household food security, improved feeding practices, maternal and child care, environmental sanitation and water supply, and literacy and education;

3) actions that address the basic causes of malnutrition, such as improved situation analysis, policy dialogue, technology assessment and development and advocacy.

(Source: UNICEF, New York; May 1990).

Rapid Assessment Methodologies

Relatively rapid assessment procedures, in this context for planning and evaluating programmes for the improvement of nutrition and health in developing countries, are increasingly used mainly by social scientists. There is a similar interest for judging the effectiveness of programmes for rural development and agricultural improvement. Qualitative approaches based on social science methodologies have been found particularly well adapted for such efforts. In particular anthropological methodologies can provide qualitative information on reasons for behaviour that is not obtained from conventional quantitative surveys and questionnaires. Used either alone or in combination with quantitative approaches the information obtained has proved useful both for programme planning and programme improvement.

UNU/UNICEF has published "Rapid Assessment Procedures for Nutrition and Primary Health Care" by Susan C.M. Scrimshaw and Elena Hurtado. These guidelines have been published in English and Spanish with French and Portuguese versions to be published by shortly. A training manual has been developed to accompany the guidelines and a 16 minute descriptive video is available. This is available at a cost of US$10 in either European (PAL) or U.S. format. Only one copy is needed since it can be reproduced freely.

The United Nations University (UNU), jointly with the UNICEF, WHO and PAHO is organizing an International Conference on Rapid Assessment Methodologies for Planning and Evaluation of Health Related Programmes, to be held at the PAHO Headquarters, Washington, D.C. from 12 to 15 November, 1990.

The conference is intended for persons in international, bilateral, voluntary and national organizations as well as academic institutions who are interested in the application of rapid assessment methodologies for either evaluating the effect of intervention programmes on household and community behaviour or for obtaining information for programme planning. Major emphasis will be on anthropological procedures.

The conference will report on the actual application of these guidelines and other similar methodologies that have been developed for programme assessment and improvement. Session topics will include:

Applications to programmes of nutrition and primary health care; Applications to programmes for the control of specific diseases; Use of rapid assessment procedures by UNICEF; WHO use of rapid assessment methodology for AIDS; Use of rapid assessment methodologies by other international and bilateral agencies; Use of combined methodologies in IUNS/WHO/UNU studies of the elderly; Use of rapid assessment procedures for the nutrition and health programmes of private voluntary and other agencies;

Use of rapid rural appraisal methodologies; Use of rapid assessment procedures for other development programmes; Training of professionals and paraprofessionals in the use of rapid assessment methodologies; Benefits and limitations of rapid assessment procedures and free communications.

Source, and for more information please contact: Dr. N.S. Scrimshaw, Food, Nutrition and Human Development Programme, Harvard Centre for Population Studies. Nine Bow Street, Cambridge, MA 02138, USA. Fax: 617-495 5418.

Nutrition At USAID

The United States' Agency for International Development (USAID) has established five development objectives for its overall programme. Four of these have direct or indirect programme implications for human nutrition. These are: 1) alleviating hunger; 2) improving primary health care/reducing health deficiencies; 3) increasing incomes; and 4) improving access to education.

The Agency's nutrition programme for the 1990's stresses the interactive relationship between nutrition and development; seeks ways to integrate nutrition into the agriculture, health, and education sectors: and emphasizes the role of the private sector in alleviating hunger and malnutrition.

Specific objectives of the Agency's nutrition programme are: a) reduction of protein-energy malnutrition in children under five years of age; b) reduction of micronutrient deficiency diseases and particularly iron deficiency anaemia in women of child bearing age and in under five year old children, and nutritional blindness and morbidity and mortality due to vitamin A deficiency; c) improving women's nutritional status, particularly that of women of child bearing age to improve their productivity, health and well-being and also to reduce the number of low birth weight babies and to provide reserves for breastfeeding; and d) expanding access to high quality nutritious foods at household level.

These objectives are to be reached through a number of field projects, defined as:

1) Functional Implications of Malnutrition;
2) Food and Nutrition Monitoring;
3) Nutrition education;
4) Combatting Iron Deficiency Anaemia;
5) Vitamin A for Health;
6) Women and Infants; and,
7) Food Technology and Enterprise.

(Source: From "AID's" Nutrition Programme, A Briefing Document." January 1990, The Office of Nutrition, Bureau for Science and Technology, Agency for International Development, Washington, D.C.)

AID MotherCare Project

This update on progress during the first year of the Maternal and Neonatal

Health and Nutrition Project, now known as "MotherCare", was provided by the project management.

Long-term projects Assessment visits were made to nine countries. Five countries under active consideration are: Bolivia, Guatemala, Indonesia, Jordan and Uganda.

Short-term technical assistance has been provided to Haiti for a national assessment of maternal mortality and perinatal outcomes. In Jamaica MotherCare designed a study of factors influencing women's choices of where to deliver in order to help find solutions for hospital overcrowding.

Applied Research Four studies are underway as follows: Peru - quality and content of prenatal care; Indonesia - a) improved delivery systems for tetanus toxoid immunizations and iron-/folate supplements, and b) low birth weight and perinatal mortality determinants; Grenada - elements and costs of maternity care. A study of the efficacy of the Kangaroo Mother Method of caring for low birth weight babies (breastfeeding and skin to skin contact with mother) is about to begin in Ecuador.

Worldwide activities Expert meetings were held on: a) neonatal tetanus elimination, b) reaching women, and c) maternal anthropometry. A report on "Assessment of Technology Needs at the First Referral Level" was written.

(Source: MotherCare Flyer, April 1990)

Food Aid For Women

In 1989, the World Food Programme allocated US$323 million to projects that directly involve and benefit women. This makes WFP the largest source of funds in the United Nations system for projects reaching poor, low-income, needy, unskilled and destitute women. Distributed through health centres, food rations help women to overcome nutritional deficiencies during pregnancy and lactation. Here are some examples.

In Burkina Faso, Niger and Mauritania, WFP family food rations are given to women when they come to rural health clinics for checkups.

At the Berta Caleron Hospital in Managua, the largest medical facility for women in Nicaragua, the meals for every patient are provided by WFP. The programme also provides food aid in some 50 provincial hospitals and clinics. In addition, pregnant women, nursing mothers and malnourished children coming for checkups at health centres in poor rural regions also receive food rations.

In Peshawar, Pakistan, public health officials noted that attendance at local health centres rose noticeably in response to the monthly food distribution. At the centres, women are weighed and tested for anaemia while their babies and children are weighed and measured. In most centres women are given advice on baby feeding, weaning practices, water purification, proper cooking methods and sanitation.

In Honduras, food aid helps groups of rural women setting up kitchen gardens and fish ponds. In Guatemala, food aid encourages groups of women in indigenous communities to grow vegetable.

* * *

Refugees Assistance Programme

WFP's support for refugees and displaced persons has increased sevenfold over the last ten years. Working closely with UNHCR, the programme currently feeds more than half of the world's estimated 12 million refugees.

In 1990 WFP will assist 2.6 million refugees plus another 830,000 displaced persons via special assistance channeled through ten projects. The projects' total cost is US$123.6 million, representing 346,000 tonnes of food plus transportation.

The projects seek to address the special needs of long-term refugees and displaced persons and provide follow-up to emergency operations carried out by WFP for at least one year. Many of these operations have, in fact, extended over several years. Given the continuing nature of such aid, WFP has tried to include, in addition to basic feeding, assistance for revenue-generating activities which will develop community infrastructure for both the beneficiaries and the host population. Here are some examples of activities planned or under way for 1990.

In Ethiopia WFP will provide assistance worth $12.5 million for some 350,000 Somali refugees in the southeastern region, and an additional $16.4 million for the 345,000 Sudanese in four refugee camps in southwest Ethiopia. In Malawi, 780,000 Mozambicans will benefit from a $45 million project. As part of the project, the programme intends to use food aid as an incentive for self-help activities such as bilharzia control and building community infrastructure. In Mozambique, as war has spread to practically all provinces, so have food shortages; WFP will continue its assistance to some 752,000 persons affected, providing US$18.7 million to pay for 45,000 tonnes of food and transportation. In line with the new approach, the project includes food-for-work schemes for local seed production, road and bridge repair, and rehabilitation of social services in rural areas. In Sudan, nearly 200,000 Ethiopian and Chadian refugees in reception centres will receive food aid worth US$ 5.9 million over a one year period. Among the beneficiaries are 27,000 expectant and nursing mothers, malnourished children and hospital patients who will receive supplementary feeding including dried skimmed milk. In previous settlement schemes, WFP aid helped to integrate refugees in the villages and towns of the region.

In Algeria WFP will provide food commodities valued at nearly US$3 million for 80,000 expectant and nursing mothers, disabled, elderly people and children, among refugees living in camps in the south. In Iran, WFP will assist 95,000 Iraqi Kurdish refugees through a one year, US$4.8 million operation that will provide 15,200 tonnes of food.

Finally, in a one year US$2 million project in the Philippines, WFP will provide 4,400 tonnes of food for 28,000 Indochinese refugees sheltered in three temporary centres while waiting permanent settlement.

(Source: Public Affairs and Information Branch, World Food Programme, 426 Via Cristoforo Colombo, 00145 Rome, Italy).

Update on Bank's Support For Nutrition Programmes

The World Bank operations continue supporting and financing nutrition projects in a number of countries. Here are some new initiatives.

Asia - In the second nutrition project in India, the successful Tamil Nadu Project will be expanded from the current 9,000 villages to a statewide programme covering about 20,000 villages. Moreover, children with moderate as well as severe malnutrition will be admitted into the programme.

The project will strengthen the referral system for children not responding to nutrition supplementation. Low birth weights will be addressed through improving maternal nutrition. Particular attention in this regard will be directed to the nutrition needs of adolescent girls in preparation for motherhood.

The third India nutrition project concentrates on the nutrition aspects of the Integrated Child Development Service (ICDS) in the states of Orissa and Andhra Pradesh. The project will be designed to help ICDS, a multi-faceted nationwide programme for 0-6 year olds, focus more efficiently on the nutrition of children less than three years old, without diminishing the programme's broader child development character. An important aspect of this project will be the efforts to mobilize women in poor communities. The second and third nutrition projects will cost US$260 million in the Bank financing.

A fourth India nutrition project, concentrating on the states of Bihar and Madhya Pradesh, but also taking into account national institutional issues, is currently under preparation.

A nutrition project is prepared for Bangladesh in which particular attention is being focused on prepregnancy monitoring and, relatedly, improving maternal nutrition. Also, a Poverty Alleviation and Rural Employment Project is designed to complement efforts by the World Food Programme to feed vulnerable groups. Further, a recently approved General Education Project includes school nutrition activities.

Latin America - The Social Emergency and Adjustment Project for Argentina is likely to be the largest single nutrition operation by the Bank to date in which US$200 million is the Bank share of the overall planned cost of US$510 million. It is estimated that 85% of this project will be for nutrition purposes. Components specifically included are nutrition rehabilitation of the malnourished, food supplementation for those at risk, improved targeting of school feeding programmes, and development of nutrition information systems.

Nutrition projects are also planned for Brazil, Colombia, Mexico and Venezuela.

Africa - The Social Dimensions of Adjustment Division Unit is now making a special effort to integrate nutrition policies and actions in the design of its programme. The newest nutrition project in the lending programme is for Kenya. The recently completed Kenya Food and Nutrition Policy Sector work provides an analysis of the food security situation, taking account of both individual-level issues of malnutrition and household-level food insecurity. The report proposes targeting food price subsidies to replace recently reduced general subsidies, continued support to the effective use of food aid to improve nutrition, and explores several options for direct nutrition interventions including targeted fortification directed at specific regions at high risk of micronutrient deficiencies.

Food security reports and assessments are completed or under review for Benin, Burkina Faso, Ethiopia, Ghana, Madagascar, Malawi, Nigeria, Rwanda, Sudan and Tanzania. Moreover, the earlier completed food security report for Mozambique in now complemented by the Population, Health and Nutrition Sector Report.

Egypt - A proposed Structural Adjustment Loan addresses issues related to food consumption and provides safeguards (for example protecting the subsidy on bread) to be accompanied by a Social Fund Project that addresses nutrition in several important ways - nutrition education, iron fortification, selective feeding, and targeted consumer food subsidies.

(Source: The World Bank)

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Micronutrient Initiatives

The World Bank is to consider an expanded role in combatting micronutrient deficiencies. The decision involves analysis of current and past efforts, and presentation of a policy paper that will be ready in July this year. Themes in this paper will include emphasizing that:

- Micronutrient deficiencies are a common problem with costly effects on human resource development, and technical solutions are available to address the problem.

- Sustainability should be a major consideration in choosing interventions. Cost effectiveness data will be reviewed and the advantages and disadvantages of alternative approaches considered.

- Long-term strategies will be stressed; fortification, increasing nutrient supply and demand; and consumer education - as potentially more suitable than short-term measures such as dosing.

(Source: The World Bank, May 1990)

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Material for Programme News was assembled and edited by M. Lotfi.