PUBLICATIONS

includes reviews of:

FAO/WHO - Requirements of Vitamin A, Iron, Folate and Vitamin B12 Hunger and Public Action New Seeds and Poor People Engendering Adjustment for the 1990s Human Energy Requirements Nutrition in the Elderly Other recent publications

Reviewed by C.J. Bates¹

The committee met initially in Geneva, in March 1985, under the chairmanship of Professor George Beaton, of the University of Toronto.

One of the new departures that was made was the subdivision of "requirement" into "basal requirement" (the amount "needed to prevent clinically demonstrable impairment of function" without providing any reserves), and "normative storage requirement" (which is the amount needed to maintain a reserve in the tissues - the actual magnitude of the desirable reserve for each nutrient being a matter for judgment). The term "recommended intake", used in previous reports, was replaced by the term "safe level of intake", which was: "that intake which both presents a very low risk of depletion in a randomly selected individual, and meets the normative storage requirement". It is important to realize that the figures can never represent absolute yardsticks for the "deficiency or sufficiency" of individual intakes, but should be seen in the context of probabilities of increasing risk, as intakes fall progressively further below the basal requirements. Deficiency per se can only be estimated by objective (i.e. clinical, physiological or biochemical) indices; not simply by dietary estimates.

For Vitamin A (retinol equivalents) the principal criterion used was the maintenance of liver retinol stores: above 10 micrograms (mcg) per day for the basal requirement, and above 20 mcg/day for the normative storage requirement. The safe level of intake of retinol equivalents for adults was set at 500 mcg/day for women and 600 mcg/day for men, which is somewhat lower than in previous recommendations. One difficulty that has been encountered in the interpretation of previous estimates of vitamin A requirements, by controlled depletion/repletion studies, has been that the very slow rate of status change at near-physiological intakes tends to result in an over-estimation of requirements.

For infants, and for pregnant and lactating women, respectively, the safe levels of intake were set at 350, 600 and 850 mcg retinol equivalents/day. Beta-carotene conversion factors and vitamin A toxicity were also discussed, and suggestions were made for future research effort.

For folic acid, the safe level of intake was set considerably below the recommended amounts of previous (1970 and 1972) reports: namely at 3.1 mcg total of folate/kg body-weight for adults, i.e. ca. 170 mcg/d for women, and 200 mcg/d for men. The 1970 report had used a "free" folate scale, but this is now generally considered unsatisfactory. The main argument against the older, much higher recommendations for folate was that careful studies of population intakes, coupled with investigations of the associated status indices, especially in Canada (and now confirmed in a number of other western countries), have indicated that the "usual" intakes observed in the region of 150-200 mcg total folate/d are not associated with any major or serious evidence of deficiency. Also, the biological availability of food folate polyglutamates now seems much greater than once believed. A "high risk" group for folate deficiency, however, is that of pregnant women, since megaloblastic anaemia in later pregnancy was relatively common, even in western countries, before prenatal supplementation was introduced. The safe level of intake for this group was therefore set at 7 mcg/kg body weight, or 370-470 mcg/d. For lactating women, and for young infants, the safe levels of intake were set at 5.0 and 3.6 micog/kg body weight, respectively.

For vitamin B₁₂, studies on vegetarian groups with very low intakes have revealed a remarkably low incidence of functional deficiency. This, and other evidence derived from studies on the controlled repletion of deficient individuals, led to a safe intake recommendation of 1 mcg vitamin B₁₂ per day for all addults, with 30-40% increase during pregnancy or lactation. 0.1 mcg/d was recommended for infants. These values are lower than those of the previous reports, and they imply that the intakes that are obtained from mixed diets, especially in Western countries, are considerably in excess of requirements. The safe range of intakes is clearly very wide for vitamin B₁₂, in subjects with a normal absorptive capacity.

Iron proved the most difficult of the four nutrients to find consensus opinion on, and a second committee meeting had to be convened, with Dr. Cook (from the University of Kansas) as chairman. Three of the more serious problems with iron are that different types of food contain iron with greatly differing biological availability; that requirements are heavily skewed by women with heavy menstrual losses; and that haem and non-haem iron pools are affected to different extents by other constituents of the diet. Comparison between basal iron requirement estimates in the 1970 and 1988 reports reveals a number of minor changes; however the safe level of storage requirement (though not tabulated in the new report) would be about double that of the previous report. The problems encountered in producing a concise and foolproof formula for iron clearly illustrate the difficulties (which apply to a considerable extent to all 53 micro-nutrients) that arise in producing a "single" figure for a nutrient recommendation - because of variations in the overall compositions of the diet, and in the purposes of the estimate.

The final chapter of the report deals with some practical considerations of usage and interpretation. Clearly the 1988 report has come up with a number of new approaches and also some quite major changes in the numbers and their interpretation, and it has also highlighted several important areas of new research, needed to put future reports onto an even sounder footing than the present one. The Committee joined the Secretariat of W.H.O. in saluting Dr Edouard De Maeyer, who died in December 1988, and who contributed considerably to this, as to similar endeavours in the past.

MRC Dunn Nutrition Unit, Milton Road, Cambridge, UK

(Dr. Bates was a member of the Expert Committee that drew up the FAO/WHO Report)

by Jean Dreze and Amartya Sen. Wider Studies in Development Economics Clarendon Press, Oxford (1989), 373p.

The book is divided into four parts. The first attempts to disentangle the causative web of hunger and deprivation in the modern world. Sen's concept of household entitlements is re-iterated, before turning to consider factors affecting the nutritional status of individuals. How does a person's nutritional status affect his/her capability? Evidence relating to theories of adaptation is outlined, before concluding that a failure of basic capabilities of individuals related to nourishment alone demands actions over a much wider domain than simply food policies. Hence the need to keep the entitlement analysis broad. The final chapter in this section describes how society, class and gender all condition the genesis of hunger. Social relations are governed by "cooperative conflicts" both at the level of society and the household. Such a co-existence of cooperation and conflict is endemic in social relations - there have always been winners and losers, both sub-groups within populations and individuals within households. For example, in 1943, many rural landless labourers in Bengal starved as their wages became insufficient to buy food at prices related to the increased purchasing power of the urban population in the war economy. At the level of the household, an anti-female bias has been recorded in food provisioning and health care, while nonetheless individuals simultaneously cooperate to ensure their household is food-secure.

A major premise of the book is that famines and chronic hunger are preventable. If people die of starvation in the 1990s, it will be because of a massive social failure, whether or not the causal process was initiated by natural phenomena. The second part of the book is devoted to an analysis of the causation and prevention of famines, with much material being drawn from Africa and India, including case studies from Maharasthra (India), Cape Verde, Kenya, Zimbabwe and Botswana. Public action by the state may protect the entitlements of potential famine victims through the provision of employment in public works programmes. This was a notable success in the early 1980s in Botswana. Employment provision is a natural means of protecting entitlements and one that, while shown to be successful in India, has also considerable potential in Africa. It responds to the first requirement of people in a developing crisis -work, it self-selects, and may also be designed to generate community assets on public land. While the spade may be more powerful than the spoon however, it is not the only answer. The entitlements of different groups of people are too broad and varied to be protected through single interventions.

Other state actions for preventing famines include the provision of accessible health and social services. The efficient functioning of markets is a further important strategic goal as is the need to understand the linkages between the market and the state. The success of public works programmes for example will depend on whether the market can meet the extra demands generated by the wages it provides. The focus should not be either direct delivery by the state or free markets, but a flexible combination of both, as the situation warrants. As the authors remind us "the penalty of purism can be high".

Chronic undernutrition and deprivation are dealt with in the third part of the book which starts by considering agricultural policies, including cash cropping, diversification, industrialisation and the question of whether food self-sufficiency is invariably an appropriate overriding goal for such policies. The short and long-term trade-offs between economic growth and public support are then outlined with illustrative examples from South Korea (growth-mediated security) and Chile, Costa Rica and China (support-led security). An interesting chapter compares and contrasts the situation in China and India with regard to their histories with famines and famine prevention.

The final part of the book pulls together the themes and arguments of preceding chapters, and from this basis proposes an integrated view of the role of public action in preventing and eliminating hunger and deprivation. The types of appropriate actions by the state for the public have been described throughout the book. A primary role of the public itself will be to force the state to act in such ways - public action by the public. This will emerge with the democratic process, its effectiveness governed by the vigour of democratic practice. In true functioning democracies with a free press and public access to information, governments can generally not hope to survive long without responding as famine develops. Chronic hunger is more silent, but nevertheless can become more of a political issue through informed media exposure of state action or inaction as long as politicians remain accountable.

While there is nothing particularly new in the authors' analysis of hunger and deprivation, their skill lies in their systematic exploration of the many facets of the problem, all extensively referenced. Regarding solutions, they readily admit there are no easy ones and never succumb to the urge to over-generalise; both theses and proposals are exhaustively backed by detailed country case studies of successful approaches. The association made between the spread of democracies and the food and health security of populations, again while hardly new is made in an invigorating way. Unlike past abstract generalisations about the political will of governments, here it follows a detailed history of more technical approaches to the problem and arrives at a particularly opportune moment after a decade ending with the process of democratisation accelerating in several countries.

This book should be invaluable in stimulating thought on the hunger problem as well as providing an excellent resource of past experience with various approaches of dealing with it. It will be essential reading for policy makers, economists, social scientists and all those seriously concerned with actions to reduce future hunger and deprivation.

-S.G.

Footnote: Worth looking out for in the near future will be a series of three volumes under the overall title "The Political Economy of Hunger", edited by Dreze and Sen, to be published by Clarendon Press. Successive volumes will cover "Entitlement and Well-being", "Famine Prevention" and "Endemic Hunger".

by Michael Lipton with Richard Longhurst (Unwin Hyman: London) 1989, 464p.

The chapters of this enlightening book are organized chronologically, focusing in turn on the physical characteristics of plants, the impact of modern varieties on the poor, mediated by effects on labour, wages, employment, consumption, food prices and nutrition, and the implications for future research strategies. The conventional analysis generally assumes that "poor people" can be affected as small-farm households, whereas evidence increasingly suggests that poor people at nutritional risk are more likely to be agricultural labourers. What happens to the latter group when aggregate food output rises? Food prices may be restrained, but this in turn allows employers to restrain wages thus lowering labourers' real incomes -a "second round" effect further catalyzed by population growth. The financial and socio-political system in many areas where modern varieties have taken off is also conducive to the substitution of wage labour by innovations such as weedicides and threshers, etc. Thus, unemployment may also rise after a time. These are just two possible effects, and this book's major contribution is that it systematically explores the complex web of interactions and the knock-on effects of the spread of different modern varieties in different areas. In Chapter 6, it reassembles the evidence to explain the "Modern variety-poverty mystery", and considers whether certain institutional structures or changes are needed, before scientific findings can be adapted, developed or communicated. Or can technical change itself steam-roller through such obstacles and itself transform society?

Returning to the effects of modern varieties on the poor, consider purchasing power. In India, modern variety-fuelled increases in output caused first a reduction in imports, then a small net increase in exports, and finally, a build up of 25-30 million tons of foodgrains in government stocks (in order to avoid catastrophic collapse of producer incentives). During this period, the incidence and severity of hunger hardly changed. The poor could not afford this extra food. Where the poor's purchasing power does not rise sufficiently quickly to absorb production increases, thus preventing domestic price decreases, the government may decide to artificially maintain production incentives by setting a higher price to larger farmers for staples. These staples may be used to supply the urban population, restrain imports or they may even be exported. The labouring rural poor will not benefit unless built-up stocks are used in emergencies and nutritional support schemes e.g. food-for-work, infant feeding.

Consider political power. Modern varieties per se have not caused mechanization, although their introduction without consideration of social realities probably has. New technology should be designed with respect to prevailing socio-political systems. Research design for poverty-reducing modern varieties should differ as between the type of land (humid, semi-arid) and the type of poor people (small farmers, landless labourers). Asking whether small farmers lag behind large farmers in adopting modern varieties, acquiring inputs, and increasing their per-acre yields - the starting point of much research - is asking the wrong question. Crucially, mention of land quality, non-farm income sources and the number of family members does not appear in such a simplistic analysis: a family's livelihood is more than its land, and its land (if any) is more than simply acres.

In addition to vulnerable households, there are vulnerable individuals within households. Modern varieties should be planned so as to generate extra income for mothers. This will improve the survival prospects for female children in the poorest households where food allocation decisions are geared to ensuring the overall survival of the family i.e. biased to wage-earners. Surprisingly little is known about how the types and timings of modern varieties contribute to small children's special nutritional needs.

The authors show how inappropriate the crop research menu of the past has been, with its excessive concentration on protein content, quality and consumer acceptability. This has produced costlier grain and diverted research resources away from goals of dietary energy and robustness. Protein research is unlikely to benefit human nutrition, except in the few areas where unsupplemented root crops or bananas are exclusively used. The focus should be on raising yields in ways that necessitate increases in labour demand.

The "green revolution" was not, in fact, a revolution at all. Unlike the Neolithic or medieval agricultural revolutions, it did not transform society. Rural power structures not only remained but facilitated the increased flow of benefits to rural elites further strengthening their economic positions. Urban elites have also benefitted through their increased access to a price-restrained staple foods.

Most research on modern varieties has been carried out in Asia, particularly India. African experiences and opportunities are different and four proposals for changes in research strategy for poverty alleviation in Sub-Sahelian Africa are presented in Chapter 7. More commitment and sustained funding for modern variety research systems by governments is needed. Research should consider poor people's crops e.g. cassava, yams, sweet potatoes, bananas, as well as employing "farming systems" analyses. Finally, macro-level links between agricultural research and public policy on crop mix, population change and the role of irrigation need to be forged.

Only technology directly available to the poor - either because unavoidably labour-intensive (yet profitable), or because concentrated on crops (or areas or assets) that remain in the control of the poor - is, in the authors' judgement, likely to lastingly overcome the "population threats" to poor people's food entitlements. To quote the late Bernard Schaffer: "in assessing agricultural research on the poor, appropriate technology matters, but the power to appropriate technology matters most".

-S.G.

"Engendering Adjustment for the 1990s"

Report of a Commonwealth Expert Group on Women and Structural Adjustment, (by M. Chinery-Hesse et al., 1989) Published by Commonwealth Secretariat, Marborough House, London SW1Y 5HX.

The Group's special concern for women is expressed in the first paragraph of chapter one: "....in most eras, in most places, women have borne a disproportionately larger share of the work, and have received a disproportionately small share of benefits from work - of income, of food, and of services". And that "the essence of women's distinctiveness lies in the multiplicity of their roles". The Group refers to four of these distinct and relevant roles as producers, home managers, mothers and community organizers (chapter two).

The Report documents the fact that although women benefitted from economic progress (and maybe more so from social progress), in most regions of the world from 1950 to 1980 (measured by e.g. significant increases in life expectancy, literacy and employment rates), their position remained unequal to that of men. It is against this background that the economic crises of 1980s and the structural adjustment polices had their foremost impact on women, particularly in the poorer communities, partly through deteriorating prices and incomes relationships.

The information provided through nine case studies specifically carried out for this Report in a selection of Commonwealth developing countries (Bangladesh, Jamaica, Malaysia, Nigeria, Sri Lanka, Tanzania, Trinidad and Tobago, Zambia and Zimbabwe), as well as the relevant available literature, were carefully examined by the Group. The impact of crisis and adjustment programmes on women is discussed in chapter three of the Report. Yet to draw more attention to the seriousness of the situation in which women are placed, extracts from the findings of the case-studies or from elsewhere are shown in boxes throughout the book.

In reviewing measures taken to protect women's position during the course of adjustment programmes (chapter four), the report notes that while the awareness is growing, women have benefitted only incidentally from such small actions.

The Group's recommendations and strategies for change are included in the final chapter of the book (chapter five). On the basis of the evidence gathered, and realizing the fact that short-term stabilization measures have too often been in conflict with longer-term development goals, causing hardships severe enough to invalidate the process, it is suggested that adjustment policies should employ a much broader approach incorporating three general principles: an emphasis on social equity and economic growth as well as efficiency; full integration of women into the decision-making processes; and a supportive international environment.

Listing areas to be given priority consideration for action, the Group recommends policy goals for a new adjustment policy in which neglected areas are incorporated, shifting the main focus of the adjustment programmes from short-term stabilization to longer-term developmental goals. The Report stresses that "adjustment with a human face is not enough, what is required in the last decade of the century is development with a human face"

-M.L.

"Human Energy Requirements A Manual for Planners and Nutritionists"

By W.P.T. James and E.C. Schofield FAO. Published by Oxford Medical Publications

The manual is based on the work of W.P.T. James and E.C. Schofield with the cooperation of the Food Policy and Nutrition Division of FAO, and other individuals. Definitions and calculations of human energy needs, and the factors that can alter their magnitude, are covered. The Manual includes some methodological refinements made using computer modelling techniques. Based on these a microcomputer spreadsheet programme has been created. This demonstrates calculations step by step using illustrative data given in the programme. The Manual is accompanied by this micro computer software package which provides a means of calculating energy needs of populations or populations sub-groups.

The Manual is organized into eight chapters and contains 6 appendices. The first chapter gives some overview of energy requirements and allowances. Other chapters deal with the principles of energy balance and energy needs; different levels of analysis in estimating requirements; impact of urbanization and population structure; energy allowances in different physiological patterns and under various conditions; effect of different assumptions on estimated allowances; adaptation and survival on low intakes and special applications of energy requirements calculations.

As the main objective of this much needed manual has been to overcome the complexity of calculating energy requirements, it is written in a readily understandable manner. Good use of numerous diagrams and figures is made to enhance the clarity of the points made. It also contains a glossary in which the scientic terms - as meant and used in the manual - are defined.

The Manual is published by Oxford Medical Publications. For more information and how to obtain a copy write to: Food and Agriculture Organization, Food Policy and Nutrition Division, Via delle Terme di Caracalla, 00100 Rome, Italy.

M.L.

"Nutrition in Development: Concepts in Brief"

A Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) publication, 1990.

The second half of the booklet promotes a "nutrition-orientation" of all sectoral development activities. This should include a systematic analysis of the causation of undernutrition, the incorporation of nutritional objectives and the use of indicators of nutritional status in evaluation. Such an orientation means different things in agricultural, health, food safety, urban development and women's development projects, and the final section provides guidelines for operationalising this approach.

The clear presentation of key theses and conclusions on nutrition in development in this short booklet should provide a valuable touchstone for the staff of both GTZ and other agencies involved in designing development-policy strategies and activities.

GTZ address:

Deutsche Gesellschaft Fur Technische Zusasmmenarbeit GTZ GMBH, Dag Hammarskjold Weg 1-2, Postfach 5180, D 6236 ESCHBORN 1 bei Frankfurt Main, Federal Republic of Germany. -S.G.

Edited by Horwitz, A., Macfadyen, D.M., Munro, H., Scrimshaw, N.S., Steen, B. and Williams, T.F. Published by Oxford University Press, on behalf of WHO (1989); 294p.

Its scope encompasses the dimensions and nature of the problem, the biological and social aspects particular to this growing sub-group before moving towards appropriate strategies and interventions. The seven sections of the book cover, in turn, the epidemiological and social aspects of nutrition in the elderly, nutritional status assessment, nutritional requirements, main diseases of the elderly, nutritional factors influencing organ function, preventive medicine and public health aspects and, finally, research needs. An appendix provides a comprehensive listing of WHO publications on the subject.

By far the most important determinants of the nutritional status of the elderly are the environmental factors that influence nutritional requirements and nutrient intakes. As with younger adults, economic and political factors governing the social status of the elderly are fundamental as underlying determinants of nutritional risk; significant differences in the latter have been observed between socio-economic groups. Genetic and environmental influences also provide for a wide variation between individuals in physiological status, of which chronological age is not a particularly good predictor.

Several anthropometric methods for assessing nutritional status are described here, although a breakthrough is needed in relating such measurements to function. For the elderly, the ability to perform muscular exercise - to move around independently - is a priority and tests of this will need to be devised in order to come up with useful anthropometric indicators of risk. Dietary studies of the elderly are rarely carried out. Suggested methods are food-frequency lists to indicate groups at risk, and the diet history to identify such individuals, although future research will need to consider the validity and reliability of such methods.

In assessing the energy needs of the elderly, there is a need for an assessment of the amount and intensity of physical activity rather than energy intakes. Without activity, muscle tone decreases and physical, then psychological and social problems develop. The most important preventative measures ensuring the health and well-being of old people are likely to be the maintenance of moderate activity in later life, fostered by a change in attitudes in middle-age.

Recommendations on intakes of protein, fats, carbohydrates, vitamins and minerals are described in separate chapters. These may differ from those commonly employed in the past for under-50 year olds, and it is not known to what degree extrapolation from the latter group's requirements is permissible. The elderly are more heterogeneous moreover with respect to socio-economic group, physical activity levels and food practice. Chronic disease, the effects of medication and/or institutionalization are other significant factors commonly conditioning individual need amongst the elderly.

The risk factors for four types of malnutrition - long-standing, sudden, specific and recurrent - along with recommendations for action against them are clearly presented. The elderly experience a higher frequency of illness than young adults, while studies have shown that improved nutrition improves immune response, and thus affects the burden of illness within this group.

Thirty-three priority areas for research are listed in the final chapter. These include the relationship between dietary practices and chronic disease, the extent to which lifestyle factors mitigate the erosion of tissue and organ function with ageing, and nutrient needs among the elderly. As well as biological research needs, there are important contributions to be made by anthropology to the understanding of the sociology of eating by the elderly. Research is also needed on strategies for nutrition intervention, based on risk estimates of nutritional deficiencies.

This publication will make an authoritative addition to the WHO series of guides on different aspects of ageing, for use in medical schools and schools of other health sciences around the world.

-S.G.

"A Field Guide for Adding Vitamin A Interventions to PVO Child Survival Projects: Recommendations for Child Survival Project Managers"

(Doris Storms and John Quinley, Editors, Published by the Johns Hopkins University, Baltimore, Maryland, December, 1989, pp. 39)

The guide book which resulted from the task force meeting is geared for PVO staff working in the field and includes recommendations in six areas:

1. Assessing the need for vitamin A interventions in the project area - Alternative methods of determining the extent of vitamin A deficiency are suggested including the use of secondary data sources, sample surveys, and physical examinations. Also included in the appendix are guidelines for selecting sample size to determine the prevalence of vitamin A deficiency from a survey.

2. Setting measurable objectives - The key message for project managers in setting objectives is to avoid objectives aimed at reducing morbidity and mortality since these are difficult to measure. Instead, objectives and indicators which are linked to program operations, such as vitamin A capsule distribution, are recommended.

3. Selecting the target population - The choice of a target population is discussed in terms of three important factors: technical, program, and safety. The technical and safety issues considered include vitamin A dosage and the interaction of vitamin A deficiency and other infections. Program factors considered are the existence of national policies on vitamin A deficiency and the target population for other Child Survival activities.

4. Choosing appropriate performance indicators by type of vitamin A intervention - Five basic intervention activities are discussed along with the essential indicators which can be used to monitor the progress of the activities. Emphasis is placed on the selection of vitamin A intervention activities which are compatible with the other Child Survival project interventions.

5. Incorporating vitamin A information into the Child Survival reporting documents - Specific guidelines are presented here for PVOs to document the justification for including vitamin A interventions in their projects and for reporting on the activities as part of their routine monitoring and evaluation.

6. Making current and up-dated information available to PVO staff- The task force assembled a list of essential information for PVOs intending to add a vitamin A component to their projects. Information is also provided on sources of technical assistance for the projects and the use of field-based workshops to improve networking and communication among projects.

(Further information: PVO Child Survival Support Office, The Johns Hopkins University, Institute for International Programs, 103 East Mt. Royal Ave., Baltimore, MD 21202).

Paula Yoon

"Guidelines for the Management of Nutrition Programmes: A Manual for Nutrition Officers"

WHO Regional Office for Eastern Mediterranean, Alexandria, Egypt, 1990.

To assist nutrition officers in proper management of nutrition programmes, the WHO Regional Office for the Eastern Mediterranean has recently brought out a manual as its Technical Publication No. 15. The manual, probably one of the first in its kind, is written by Dr. Kalyan Bagchi who believes that the manual would be useful for those who are responsible for managing nutrition and nutrition- related programmes at all operational levels, whether central, intermediate or peripheral. This easily readable book covers the most important issues related to proper management in 17 chapters. Each individual chapter is written and organized in a manner that can be used independently and without the need to recall previously presented information.

One chapter is devoted to the importance of management training for nutrition officers. Topics covered under other chapters are: self reliance in combating malnutrition; nutrition units in the government sectors; nutrition officers and their responsibilities; planning a nutrition programme; general principles of planning; systematic steps in nutrition programme planning; problem definition - a prerequisite for programme planning; coordination for nutrition promotion - a national nutrition coordination committee; national nutrition policy; nutrition advocacy for programme support; intersectoral and intrasectoral integration for nutrition promotion; evaluation and monitoring of nutrition interventions; the role of nutrition officers in programmes for food safety; role of nutrition officers in disaster relief; nutrition training of health workers; role of international agencies in strengthening national nutrition capability. The book also contains 4 annexes with quick reference information. This book brings together most of what needs to be known for proper management of nutrition programmes.

To obtain a copy (at US$16) contact: WHO Regional Office for the Eastern Mediterranean. P.O. Box 1517 Alexandria, Egypt. Special prices are available for orders from member states of the region, from developing countries and for bulk purchases.

-M.L.

"Highlights on Breastfeeding"

Egyptian Society of Breast Milk Friends (ESBMF), December 1989, vol. 1 (3)

The annual conference of Association of Arab Paediatrics Societies (AAPS) had its latest meeting on 7 and 8 of December 1989 in Cairo, Egypt. Breastfeeding promotion and its effects on diarrhoea prevention and control and child survival were among topics discussed. Further information on the activities of ESBMF from: Prof. A.M. Eissa, Al-Hussein University Hospital. Al-Azhar, Cairo, Egypt. Tel: 915761.

-M.L.

"Food Aid in Emergencies"

A World Food Programme handbook, WFP. December 1989.

The handbook consists of two volumes. Book A provides general information and guidelines concerning the policies and principles for food assistance in emergencies, the role of WFP (in relation to emergencies) and the specific procedures by which a Government may request and, subject to approval, receive emergency assistance from WFP. This is equally relevant for WFP staff, Government officials and other agencies which might collaborate in the provision of food assistance in an emergency.

Book A should therefore be available to and be used by government officials and the personnel of other collaborating agencies as well as by WFP staff when assessing needs and planning responses to any emergency situation in which a request for WFP assistance might be considered.

Book B provides guidelines for WFP staff on the specific responsibilities of and actions to be taken by country officials and Headquarters in respect to assessments, preparing recommendations, mobilizing resources, submitting reports and various essential aspects of internal administration. It is essentially an internal WFP document.

Requests for a copy may be addressed to: Chief, Disaster Relief Service (ODR), World food Programme, Via Cristoforo Colombo, 426, 00145 Rome, Italy.

Oxfam - forthcoming.

Part one describes assessment stages and response options. The role of nutrition in assessment is explained, stressing the importance of looking at the wider picture, for example taking account of the livelihoods of people. This is an important element for understanding how situations of food scarcity and famine develop, particularly where people are still home-based, rather than displaced and destitute. In addition to measuring rates of malnutrition, a variety of new assessment methods, such as wealth ranking, are introduced, which are not always associated with nutrition surveys. The reader is guided towards the appropriate choice of methods to be used in various situations.

Different types of food distribution are described in Part two, dealing with the subject of targeting - about which there is little information in previous emergency field manuals - at some length. While a detailed section is devoted to general rations, selective feeding is described briefly since the latter is well covered in Oxfam's Practical Guide to Selective Feeding Procedures.

Part three contains a useful glossary and several technical appendices.

This field manual is due for publication in the summer of 1990. Please contact: The Oxfam Health Unit, 274, Banbury Road, Oxford, OX2 7DZ, England.

"Utilization of Tropical Foods"

FAO Food and Nutrition paper No. 47/1-8, 1989.

It is for these reasons that FAO - within its programme to promote underexploited traditional food plants from tropical areas - has published a compendium on technological and nutritional aspects of processing and utilization of tropical foods, both animal and plant. The document consists of eight separate volumes and covers the following subjects: cereals; roots and tubers; trees; tropical beans; tropical oil-seeds; sugars, spices and stimulants; fruits, leaves and flowers; and animal products. An index of scientific names at the end of each volume completes and facilitates the consultation of the series. The publication is meant to be a source of information basically on traditional products, their preparation and nutritional value, household processing, handling stages in processing and utilization of food plants growing in given ecological conditions for people of all levels with an interest in better utilization of these products.

Utilization of Tropical Foods - FAO Food and Nutrition Paper No. 47/1-8, 1989 - is a valuable addition to the FAO publications programme as a very useful and informative resource book which will certainly be in high demand for many individuals and institutions. These volumes are now available in English. French and Spanish editions are in preparation.

Copies (at US$6 each volume) may be obtained from Distribution and Sales Section, Food and Agriculture Organization, Via delle Terme di Caracalla, 00100 Rome, Italy.

-M.L.

"Famine Research and Food Production Systems"

University of Freiburg, Dept. of Geography.

-M.L.

"A Practical Guide to the Correction of Iodine Deficiency"

By: J.T. Dunn and F. Van der Haar, 1990
From the International Council for Control of Iodine Deficiency Disorders (ICCIDD)
Reviewed by B. Hetzel, ICCIDD Executive Director.

Successive chapters cover the importance of iodine deficiency, the detection of iodine deficiency, planning an iodine deficiency disorders (IDD) control programme, methods of iodine supplementation and programme operation. The book is enhanced by diagrams and colour photographs. The treatment given is concise, the operation of an IDD control programme is spelled out very clearly including intersectoral aspects, and the need explained for a national council for the control of IDD (NCCIDD) and the IDD control unit responding to it.

The book can be strongly recommended to all those undertaking in IDD control programmes. Publication was supported by the Dutch International Cooperation Programme.

* * *

Two other recent publications from ICCIDD, in addition to IDD Newsletter are:

*"The Story of Iodine Deficiency - An International Challenge in Nutrition", by B.S. Hetzel, Oxford University Press, 1989 (Oxford and Delhi). Available in paperback and hardback. The Delhi paperback costs 50 rupees (US$3.25). The publication is subsidized by ICCIDD.

* Introducing the ICCIDD, 1989. An ICCIDD Membership Directory with details of office bearers, senior advisors and constitution. The publication assisted by ADIAB.

"People, Food and Resources"

Sir Kenneth Blaxter, Cambridge University Press (1986, reprinted 1988); 118 pages.

Malthus is tackled early on. Contrary to his theory, the rates of natural increase of populations are not constants but variables, which doesn't help us much with long-term predictions of population growth. Demography is not an exact science and margins of error in forecasts are wide, but models do predict that the population of developing countries in fifty years will be at least 1.6 times that of today. The immediate future requirement of food expressed in terms of energy for the world's population is derived from the growth in population and the need to provide an equitable supply of food for each person. According to Blaxter, the product of these implies that the problem up to the year 2000 is to increase the supply of food by about 75% of its 1986 level. Beyond 2000, any predictions become highly tenuous.

In the past, there have generally been two means for increasing production: cultivating more land, and increasing the crop yield of a given land area. Both options have been environmentally expensive. Firstly, forests are being cleared at a terrifying rate - estimated by FAO in 1982 as 11.3 million hectares per annum (or the size of the U.K. every two years). While this cleared land is unlikely to be very productive, agricultural land that is fertile is being lost to the spread of urban areas in many countries. Secondly, land yields have been increased in a largely unsustainable way, through exploiting finite fossil fuel reserves in so-called "green revolutions". Malthus' pessimism was, to a large extent, dispelled in the nineteenth and early twentieth century by the first option, through the opening up of new lands in the Americas and Australasia. In the last fifty years, time has been bought by exploiting the second. As we near the end of the century, there are few signs of any additional means of postponing Malthus' vista.

While the book is logically set out and the problem systematically investigated, the author may have been overly preoccupied with the numbers game of people, food and resources at the expense of a deeper analysis of the social dynamics involved. Inequitable systems of food production and distribution keep more people hungry as a result of their inability to purchase food than as a result of their inability to grow enough of it.

The book ends by suggesting several steps to a brighter future, although these are formidable steps: population control and relocation of groups who have overrun their environmental carrying capacity; elimination of illiteracy; continued selective use of modern technologies, the development of appropriate food technologies, and a move to industrialization in rural areas. Two pages are set aside for the implementation of these actions. One hopes that, as we move toward the end of the millennium, the urge to make global hunger declarations (such as the 1974 one above) is curbed and energy rechannelled into regional analyses of food problems and the development of specific courses of action to overcome them.

-S.G.

When you can't bear it any longer....