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Programme News

Agencies report on their activities in Nutrition

Interagency

WHO, UNESCO, UNICEF, the World Bank and Education International: Partners in Taking a FRESH Start to School Health

For health to be put high on the agenda of education reform and given the priority attention it deserves, policy-makers, community leaders, teachers, parents and students will need to be convinced that health contributes to the overall goals and purposes of the education sector.

In April, 2000, Education International, WHO, UNESCO, UNICEF, and the World Bank jointly organized a strategy session at the World Education Forum in Dakar, Senegal. The strategy session was aimed at raising the education sector’s awareness of the value of implementing an effective school health, hygiene and nutrition programme as one of its major strategies to achieve education for all.

This interagency initiative has identified a core group of activities, each already recommended by the participating agencies, that captures the best practices from programme experiences. Focusing initially on these activities will allow concerted action by the participating agencies, and will ensure consistent advice to country programmes and projects. Because of the focused and collaborative nature of this approach, it will increase the number of countries able to implement school health components of child-friendly school reforms, and help ensure that these programmes go to scale. The focused actions are seen as a starting point to which other interventions may be added as appropriate.

An effective school health, hygiene and nutrition programme offers many benefits:

· responds to a new need
· increases the efficacy of other investments in child development
· ensures better educational outcomes
· achieves greater social equity
· is highly cost effective.
Basic components of a school health programme should be made available together, in all schools. These would include:
· health related school policies

· provision of safe water and sanitation - the essential first steps towards a healthy physical, learning environment

· skills based health education

· school-based health and nutrition services.

Finally, the programme provides concise and sound reasons to foster effective partnerships between:
· education and health sectors
· teachers and health workers
· schools and community groups
· pupils and persons responsible for school health programmes.
Contact: Don Bundy, Principal Specialist in School Health, Human Development Network, The World Bank, 1818 H Street NW, Washington DC 20433, USA Fax: 202-522-3233 EMail: dbundy@worldbank.org Web: http://www.worldbank.org/or Anna Maria Hoffman, Programme Specialist, UNESCO, place de Fontenoy, F 75352 Paris 07 SP, France. EMail: am.barthes@unesco.org Web: http://www.unesco.org/

Food Insecurity and Vulnerability Information and Mapping Systems (FIVIMS)

FIVIMS is an inter-agency effort - by UN agencies, bilateral donors, selected NGOs and research organizations - to promote better information systems on food insecurity and poverty at country level. Formed in 1997 in response to a commitment in the World Food Summit Plan of Action, the technical secretariat for FIVIMS is at FAO.

FIVIMS objectives are highly compatible with the SCN’s three areas of strategic action, as described in the SCN Strategic Plan:

· Harmonised policies and programmes: In September, FIVIMS agreed with the UN Development Group Programme Network to begin integrating country-level FIVIMS work into the UN’s Development Assistance Framework/Common Country Assessment (CCA) process on a pilot basis. National FIVIMS would contribute to the monitoring and evaluation databases that are needed to improve the CCA activity over time. In addition, FIVIMS has committed to providing guidance on information systems best practices.

· Review of UN system response to malnutrition: FIVIMS country-level work will illustrate how sub-national data can be used in improved targetting of resources (food aid, nutritional interventions, other safety net programmes, poverty reduction programmes) to achieve the objectives in reduction of food insecurity and poverty to which all agencies are committed.

· Advocacy and mobilization: FIVIMS work, at country and global levels, helps maintain public attention focused on the progress made in meeting summit targets such as reducing the number of undernourished persons. As an example, FAO, as a contribution to FIVIMS, recently released the second issue of the State of Food Insecurity in the World, 2000 (see p 70).

The operational capabilities of the FIVIMS Secretariat have recently been strengthened through the start-up of two new trust fund projects. One is financed by the European Commission and will do initial FIVIMS work in eight countries in the Caribbean, Africa, and Pacific regions. The second project, funded by Norway, is focused on doing poverty mapping in a FIVIMS context and involves collaboration among FAO, United Nations Environmental Program - Global Resource International Database, and the Geographic Information Systems consortium of the CGIAR (Consultative Group on International Agricultural Research). Work on FIVIMS is also being undertaken in approximately ten technical divisions of FAO.

Contact: David Wilcock, Director, IAWG, FIVIMS Secretariat. For more information on FIVIMS, consult the IAWG FIVIMS website: www.fivims.net; or send an EMail to the IAWG FIVIMS Secretariat at: FIVIMS-Secretariat@fao.org. If you would like to be on the EMail list to receive the FIVIMS quarterly Newsletter, send an EMail to FAO’s Mail server (mailserv@mailserv.fao.org). Leave the subject line blank and put in the first line of the message the following: SUBSCRIBE FIVIMS-L You will then receive a confirming welcome message in reply.

FAO

Improvement of School and Family Nutrition Through Integrated Agro-forestry Systems

In Panama, a two-year project aimed at improving school and family nutrition through an integrated agro-forestry system was recently completed. The project demonstrated how involving students, teachers, parents and field workers can significantly improve food availability and nutrition at the community level on a sustainable basis. The project was implemented in collaboration with the Government of Panama, with the participation of regional and local staff from five ministries and the First Lady’s Office. The project had the technical support of many FAO divisions and services and was coordinated by the Food and Nutrition Division.

As a first step in implementing the project, a participatory rural appraisal (PRA) was carried out, involving the community and technical staff to assess the food and nutrition situation and needs of the 13 Integrated Demonstrative Units (IDU) located in the selected communities. The PRA was followed by participatory planning exercises.

A key element in the success of the project was the training of government field workers, teachers, parents and students themselves. To ensure the application of appropriate technology and improved utilization of the local resources, an extensive training programme was carried out for government field workers at the national level. The training activities were replicated with students, teachers and parents who received training through a series of workshops, illustrated talks, field days and demonstrations in the pilot villages.

Over 300 families participated in the educational and production activities. The project contributed significantly to strengthening the organization and integration of some of the participating communities. The IDUs in the 13 pilot communities carried out a variety of very successful production activities. A wide selection of fruits and vegetables were grown on the school grounds or in nearby plots. There were activities to promote small animal production, agro-forestry and worm raising as well. Environmentally friendly and sustainable techniques were also promoted by the project. Overall, the project helped to improve the food security situation in the 13 pilot villages and expansion of the approach to other low income communities throughout rural Panama is expected.

Latin American and African Versions of FAO’s Home Gardening Training Package

Food security has been defined by FAO and WHO as “access by all people at all times to the food needed for a healthy life”. Access to a nutritionally adequate and safe diet at all times is one of the most basic rights of every individual, yet for a significant number of households, it remains difficult to achieve. If, however, households have some land and labour, and are able to complement these with seeds, improved tools and the appropriate information, they can further develop their land and obtain more nutritious foods. In many humid and sub-humid areas of Asia, Africa, and Latin America people often cultivate compound farms or home gardens, sometimes referred to as backyard or kitchen gardens. Home gardens have an established tradition and are an important source of household food supplies. They can supplement food needs during the lean seasons and generate income. When a home garden is well-managed, even a small plot of land (e.g. 30 to 40 m2) can make a substantial contribution to household food needs and nutritional wellbeing.

In 1995, FAO published a training package for preparing field workers in Southeast Asia. This training package was designed for agricultural extension agents as well as other field workers who are involved with nutrition, home economics, health and community development. It aimed to strengthen their ability to promote home gardening as a step toward enhanced food security and better community and household nutrition.

At the request of nutritionists and agriculture professionals in Africa and Latin America, the Food and Nutrition Division has created three new versions of this successful training manual. The Latin American version of the material “Mejorando la nutrición a través de huertos y granjas familiares. Manual de capacitación para trabajadores de campo en América Latina y el Caribe” is completed and under distribution. It includes animal and vegetable production. FAO is supporting the implementation of national and regional training workshops utilising this manual in Central American countries (El Salvador, Honduras and Nicaragua) addressing professionals and field workers from different fields and public and private sectors. Versions for Africa will be published in English shortly and French next year. While these versions retain the general outline and the easy-to-follow training approach of the Southeast Asia version, they have been fully revised to include the eating patterns and agro-ecological, climatic and sociocultural conditions found in rural and periurban Africa and in Latin America.

FAO, 2000. Mejorando la nutrición a través de huertos y granjas familiares. Manual de capacitación para trabajadores de campo en América Latina y el Caribe. FAO (forthcoming in English and French). Improving nutrition through home gardening: a training package for preparing field workers in Africa.

Contact: Luciana Ciaffi, Office of Director, Food and Nutrition Division, FAO. Web: http://www.fao.org/es/esn/

HKI

Helen Keller International

The fifth meeting of Nutrition Focal Points of the Economic Community of West African States (ECOWAS) was held in Bamako September 25-29, 2000. The meeting included over 100 participants and was opened by the Minister of Health from Mali. A delegation from the conference held an audience with the Prime Minister of Mali to discuss the importance of nutrition in the development of the region, and the future of the focal points network. The Organisation de Coordination et de Coopération pour la Lutte Contre les Grandes Endémies (the regional health organization for francophone West Africa) which has organized the meetings to date, was dissolved in December, 2000 to make way for the new West African Health Organization, under the auspices of ECOWAS. As Mali currently holds the position of president of the OCCGE and president of the ECOWAS, the meeting was very timely and the Prime Minister ensured the delegation of Mali’s commitment to improving nutrition in Mali and the region. The meeting included a one-day technical update on breastfeeding, a review of country programs, stands set up by countries and partners, identification of technical themes for the next meeting, recommendations for strengthening the network regionally and in-country, and development of recommendations to be implemented in the coming year. The evaluation showed a strong level of satisfaction among the participants. This effort is supported by a number of partners including several USAID-funded projects (MOST, BASICS II, SARA, SANA and LINKAGES), UNICEF, WHO, and Helen Keller International. The next meeting will be held in Ghana in Septem ber 2001.

In preparation for the Nutrition Focal Points meeting, the LINKAGES project collaborated with MOST and Helen Keller International to produce an issue of their “Facts for Feeding” series entitled Breastmilk: A Critical Source of Vitamin A for Infants and Young Children. The document is available in French and English, and copies have been sent to all field offices.

In Niger, a survey to evaluate health workers’ training needs in nutrition was carried out in the three districts of Diffa. As well, at the horticultural and nutritional site of Gabougoura, 15 varieties of vitamin A-rich sweet potatoes are being evaluated for palatability. Both of these projects are funded by the Danish Cooperation.

In Mali, The Ministry of Health and the Regional Directorate supported a suggestion to organize Regional Micro-nutrient Days in the four circles of the Koulikoro Region not covered last June. This took place in November in conjunction with the second round of the National Immunization Days (NIDs). As a door-to-door strategy was used, Helen Keller expects a better coverage for iron/folate than the 56% obtained during the first days in June, where the distribution was done from fixed posts. Better compliance is also expected than the 69% achieved the first time. Iron tablets have been supplied, and the costs will be supported by the Micronutrient Initiative (MI).

In Burkina Faso, HKI participated again this year as a member of the National Organizing Committee in the preparations for the year 2000 NIDs. Vitamin A capsule distribution was included in the first round of NIDs that took place in October with a door-to-door strategy. This activity is funded by the MI.

In Mozambique, Mr. Jose Caetano joined HKI as the Provincial Coordinator to oversee the MI-funded activities in Manica Province. Mr. Caetano has just returned to Mozambique after having lived in Europe and the United States for the past 25 years.

Preliminary data from the July distribution of vitamin A in Mozambique has been released by the Ministry of Health indicating a coverage rate of 78%. This distribution was done through a fixed-post campaign that lasted for four weeks.

The Mozambique office will receive an additional $200,000 for the Life Cycle cooperative agreement from the global bureau of USAID. These funds will allow HKI/Mozambique to provide technical nutrition support to the new bilateral child survival/maternal health project managed by John Snow, Incorporated.

In Cameroon, during September 2000, the National Survey on Vitamin A Deficiency and Anemia continued training of data collectors and sensitization of selected communities. Funding for this survey comes primarily from UNICEF, Task Force SIGHT and LIFE and the WHO. Technical assistance is being provided by HKI and Centre Pasteur, Cameroon.

In Morocco, activities of the USAID MOST Project continued. Two local consultants are looking at issues concerning fortification of wheat flour with iron and folate. The report on the qualitative survey on micronutrients carried out in Agdz has been finalized.

In Guinea, field work for the National Iron Deficiency Anemia Survey (Enquête Nationale sur l’Anémie Ferriprive en Guinée) began in September. Six teams left for 40 days of field work to conduct the survey. Unfortunately, problems occurred in the areas bordering Liberia and Sierra Leone. The team covering the Forest Region is having serious problems in conducting the survey. Other teams have been obliged to replace certain clusters too close to the border for security reasons. A supervisory mission from the central level took place, and five out of six teams have been visited. They are all progressing according to schedule. Radio announcements in French and local languages were aired for three weeks on national and rural radio. The survey is funded by USAID with additional support from the WHO, UNICEF and the World Bank.

During the first round of NIDs in Guinea, vitamin A capsules (provided by UNICEF) were distributed to children 6-59 months of age. HKI has produced 1,500 T -shirts carrying the NIDs logo and a vitamin A message on the back. A vitamin A radio programme was prepared to be aired on national radio. Support for NIDs is funded by USAID.

Eight abstracts were submitted by HKI with partners based on HKI work in Africa for the meeting of the International Nutritional Anemia Consultative Group which will be held in Vietnam in February 2001. The titles of abstracts with the name and EMail of the contact person are:

· National baseline survey on iron deficiency anemia in Guinea: A comprehensive study of children, adolescents and adults. Lina Mahy. hkigui@eti.net.gn

· Distributing iron through a campaign approach: The experience in Mali. Mohamed Ag Bendech. mab.hki@spider.toolnet.org

· Increasing demand for iron/folate in peri-urban Mali. Mohamed Ag Bendech. mab.hki@spider.toolnet.org

· Community - based distribution of iron/folate in Niger. Hamani Harouna. hkiniger@intnet.ne

· Improving iron supplementation in a child survival program in Niger. Ferdows Brah. hkiniger@intnet.ne

· Assessing quality of iron/folate services provided by health workers in Niger. Hamani Harouna. hkiniger@intnet.ne

· Cameroon national survey on anemia. Nancy J. Haselow. hki-cam@camnet.cm

· Flour fortification with iron in Morocco: A preventive strategy toward iron deficiency control. Houda Bel Hadj. Hdelhadj@cms.org.ma

A copy of the workshop report can be obtained from Mohamed Ag Bendech, Regional Nutrition Advisor, Email: mab.hki@spider.toolnet. org HKI’s support for this effort is provided by USAID and the Micro-nutrient Initiative. Additional copies of Breastmilk: A Critical Source of Vitamin A for Infants and Young Children are available from the Nia-mey office by contacting Harouna Koché, Information Manager Email: hkiniger@intnet.ne The Mozambique office is currently preparing the Portuguese version.

IFPRI

International Food Policy Research Institute

IFPRI Evaluates Mexico’s Largest Rural Poverty, Health and Nutrition Intervention

In early 1998, IFPRI was asked to assist the Government of Mexico in the evaluation of its largest rural antipoverty program. In 2000, The National Program of Education, Health and Nutrition (PROGRESA) was directing support to 2.6 million families in extreme poverty, or almost 40% of all rural families in Mexico. IF-PRI’s task was to assist the government of Mexico in determining whether PROGRESA had an impact on the rural poor.

After 18 months of fieldwork and analysis, the findings of IFPRI’s evaluation are now emerging. After just three years, the poor children of Mexico in the rural areas where PROGRESA is currently operating are more likely to enroll in school, are eating more diversified diets and getting more frequent health care. The evaluation findings suggest that PROGRESA’s combination of education, health, and nutrition interventions into one integrated package can be an effective means of breaking the intergenerational transmission of poverty.

In the area of health and nutrition, PROGRESA brings basic attention to health issues and promotes health care through free preventative interventions, such as education on hygiene and health, immunizations, and growth monitoring. Nutrition promotion includes the distribution of nutritional supplements, education in breastfeeding and complementary feeding and cash transfers for the purchase of food. Receipt of monetary transfers and nutritional supplements are tied to mandatory health care visits to public clinics. The program targets its benefits to children under five, and pregnant and lactating women.

What is perhaps most innovative about PROGRESA - a feature that has captured the attention of development practitioners throughout the world - is the critical mechanism PROGRESA has used to deliver its resources. PROGRESA gives money exclusively to mothers. Mexico has taken the lead in implementing an anti-poverty intervention that recognizes that mothers effectively and efficiently use resources in a manner that reflects the immediate needs of the family.

Some of the findings:

· Improved livelihood security for the poor depends on improving early childhood health care. Frequency and duration of illness have profound effects on the development and productivity of populations. The IFPRI analysis indicates that improved nutrition and preventative health care in PROGRESA areas have made younger children more robust against illness.

· PROGRESA increased the number of first visits to the health clinics in the first trimester of pregnancy by about 8%. This shift to early pre-natal care significantly reduced the number of first visits in the second and third trimester of pregnancy. This positive change in behavior could lead to a significant improvement in the health of babies and pregnant mothers.

· The results of the evaluation show that median food expenditures were 13% higher in PROGRESA households when compared with control households. This increase was driven largely by higher expenditures on fruit, vegetables, meats and animal products - foods particularly dense in essential micronutrients. Median energy intake had also risen by 10.6%.

· The nutrition of preschool children is of considerable importance not only because of concern over their immediate welfare, but also because their nutrition in the formative stages of life is widely perceived to have a substantial and persistent impact on their physical and mental development and on their health status and productivity as adults. In 1998, survey results indicated that 44% of 12-36 month old children in PROGRESA regions were stunted. Data suggest that PROGRESA has had a significant impact on increasing child growth and has reduced child stunting; increasing by 16% the mean growth rate per year (corresponding to 1 cm) for children who received treatment in the critical 12-36 month age range.

PROGRESA is still in its early stages. Many of the impacts of the program are likely to manifest themselves in the future. Clearly, the simultaneous intervention in the health and nutrition of underfives from poor households today will positively reinforce school attendance, performance and attainment of children tomorrow. Thus, in addition to the benefits measured after three years of operation, it is likely that PROGRESA will have additional benefits in future years.

Contact Emmanuel Skoufias EMail: e.skoufias@cgiar.org

An Operational Evaluation of the Government-sponsored Community Day Care Program in Guatemala

IFPRI has been collaborating with the government-sponsored community day care program Programa de Hogares Comunitarios (HCP) in Guatemala since 1998. The program, which is under the Ministry of Social Works of the First Lady, provides care, food and early child stimulation to almost 10,000 preschoolers throughout the country.

IFPRI carried out an operations and impact evaluation of the program, and established a partnership with IN-CAP (Instituto de Nutrición de Centro-América y Panamá) to provide training and technical assistance in the areas of child feeding and nutrition. Key findings from the operations evaluation are presented here.

The evaluation focused on the urban slums of Guatemala City, which host approximately 25% of all the hogares in the country. The main reason for the urban focus is that women who live in marginalized urban areas are under increased pressure to work outside their homes in income-generating activities, and thus the scarcity of childcare alternatives can be a severe constraint to the household’s livelihood, food and nutrition security. The HCP has great potential to alleviate some of these constraints and the evaluation sought to explore this potential.

Program background

The HCP was created in 1991 as a non-traditional child care alternative whereby a group of parents select a woman from the neighborhood and designate her as the madre cuidadora (care provider). Her task is to receive and care for up to ten children in her home, from Monday to Friday, from 6am to 6pm. During their stay in the hogar, the children receive care and affection, hygiene, early child stimulation, and food (two meals and two snacks).

In addition to providing initial training for the madres cuidadoras, the program provides furniture and supplies for ten children, and cooking equipment. On a monthly basis the program gives approximately $1 per child per day to the madre cuidadora for purchasing food, gas and educational material. The program also gives her an incentive of $3 per child per month, which is complemented by a $5 per child contribution from the parents.

Key findings of Operations Evaluation

Design and Operations

· The program is generally well designed, and responds to a great need for alternative child-care in the urban slums of Guatemala City. Overall the program is operating quite effectively, although delays in payments occur at times.

· The main constraint to operations is the lack of co-operation from parents, not only in helping out in the hogares, but also in complying with their required payments and monthly contributions to the hogar.

· Management of the hogar is usually a family enterprise. Various family members are actively involved in helping with domestic chores and with playing and taking care of the children, without remuneration. Clearly, madres cuidadoras would not be able to run their hogar without help from family members.

· Madres cuidadoras and their helpers are generally affectionate, caring and attentive to children’s needs. Quality of care varies, however. Thirty-three percent of madres were observed yelling at children and 13% were observed hitting children. These unacceptable behaviors occurred in the presence of field workers, and are likely to be worse in the absence of visitors.

· Madres cuidadoras have extremely busy days, spending a large proportion of their time in food preparation, child feeding and child care, with very little time left for educational activities.

Attitudes and perceptions of the main implementers and users of the program:
· Madres cuidadoras are generally very positive about the program, they enjoy their work and perceive a great benefit from being able to work while taking care of their own children. They deplore the low level of participation of beneficiary parents. Their other concern is the high expectations from the program that they carry out psycho-pedagogical activities for which they do not feel adequately trained, motivated or remunerated.

· Beneficiary parents are extremely positive about the program, they are very appreciative of the madres cuidadoras’s excellent work, and are grateful to the program for its assistance. They suggest that the program should operate on Saturdays (when most of them work), and they also recommend a change in the program norms which restricts the number of young infants to one per hogar (because of the high children/caregiver ratio).

Conclusions

Our evaluation found that the HCP is a carefully designed and well implemented program that is much appreciated by both its users and its implementers. Our main recommendations to strengthen the program are: 1) to develop specific activities to promote greater participation of parents and communities; 2) to consider hiring specially trained staff to carry out the psycho-pedagogical activities instead of over-burdening the madres cuidadoras; 3) to include a health component in the package of interventions; and 4) to strengthen the training and re-training of madres cuidadoras to ensure high quality services. These areas should be prioritized in order to maximize the program’s effectiveness, impact and long-term sustainability.

Contact: Marie Ruel at IFPRI EMail: m.ruel@cgiar.org

INACG

International Nutritional Anemia Consultative Group

The International Nutritional Anemia Consultative Group (INACG) is being guided by a newly appointed Steering Committee. The members are: Lena Davidsson, Swiss Federal Institute of Technology Zurich, who is the chair; Suniti Acharya, WHO South East Asian Regional Office; John Beard, The Pennsylvania State University; Eva Hertrampf, Universidad de Chile; Marion Jacobs, University of Cape Town; Sean Lynch, Eastern Virginia Medical School; and Rebecca Stoltzfus, Johns Hopkins School of Public Health. Frances Davidson, Office of Health and Nutrition, U.S. Agency for International Development, serves as the Secretary of INACG.

The Belmont Conference on “Iron Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem” was cosponsored by INACG in May 2000 with the World Health Organization and the Edna McConnell Clark Foundation The proceedings of the conference held in Belmont, Maryland have been submitted to the Journal of Nutrition for publication.

A Study of Factors Influencing Operational Issues for Iron Supplements for Infants and Young Children, edited by Dr Alizon Draper and Dr Penelope Nestel, was recently published by ILSI Press for the Micronutrient Global Leadership project. The publication describes the results of studies carried out in four countries: Ghana, Nepal, Peru, and Sri Lanka, designed to explore behavioral and sociocultural factors that may influence the acceptability and use of iron-containing supplements for infants and young children aged below five years.

The publication is available free to developing countries and for US $3.50 to industralized countries. Orders may be placed by sending an EMail to hni@ilsi.org or by sending a facsimile to 202-659-3617

IVACG

IVACG to Celebrate Silver Anniversary in Hanoi

The International Vitamin A Consultative Group (IVACG) will celebrate its 25th Anniversary in Hanoi, Vietnam on 12-15 February 2001. The meeting theme is “25 Years of Progress in Controlling Vitamin A Deficiency: Looking to the Future”. The meeting sessions will focus on the current state of knowledge surrounding vitamin A deficiency and successful strategies for controlling this public health problem.

The meeting is being organized jointly by the IVACG Secretariat, based at the ILSI Research Foundation, and the Local Organizing Committee of the Vietnamese Ministry of Health, chaired by Dr Tran Chi Liem. Primary support for the meeting is coming from the Micronutrient Global Leadership project of the Office of Health and Nutrition, Bureau for Global Programs, Field Support and Research, U.S. Agency for International Development. Assistance is also coming from the Task Force SIGHT and LIFE of F. Hoffmann-La Roche Ltd. and numerous other organizations.

A series of recommendations, generated by a meeting of experts held in Annecy, France in late October 2000, will be offered for discussion. These will form the basis of future action steps aimed at meeting the goals of the World Summit for Children. In addition, 140 poster presentations on a variety of vitamin A-related issues will be available for viewing.

New IVACG Publications

Three new publications are available from the IVACG Secretariat. These are:

· IVACG Task Force report on Combining Vitamin A Distribution with EPI Contacts

· IVACG Statement on the Status of the Studies on Vitamin A and Human Immunodeficiency Virus Infection

· IVACG Statement on Delivery of Vitamin A Supplements with DPT/Polio and Measles Immunization

For additional information about the XX IVACG Meeting, please visit the IVACG website at: www.ilsi.org/ivacginv.pdf Copies are available free to developing countries and for US$3.50 to developed countries. Copies can be requested by EMail at hni@ilsi.org or by facsimile at +202 659 3617.

IZiNCG

The International Zinc Nutrition Consultative Group

The International Zinc Nutrition Consultative Group (IZiNCG) was officially launched at the first Steering Committee meeting held in Stockholm, Sweden, coinciding with the international conference on Zinc and Human Health (June 12-14, 2000). IZiNCG has been established to promote improved zinc nutrition in vulnerable populations, primarily in low-income countries, and to provide related technical assistance to governments and international agencies. The group is under the administrative support of the UNU Food and Nutrition Program, IUNS, and the International Nutrition Foundation (INF). The IZiNCG steering committee is comprised of eight members with expertise in human zinc nutrition and metabolism, nutritional epidemiology, and public health nutrition programs. The committee is chaired by Ken Brown, Director of the Program in International Nutrition at the University of California, Davis and is co-chaired by Juan Rivera, of the National Institute of Public Health, Mexico.

Convening this international group to lead efforts in reducing zinc deficiency globally is timely. This was highlighted during the closing session of the Stockholm conference. The conference, sponsored by the International Zinc Association, was attended by 135 participants from 37 countries including nutrition researchers, public health policymakers, and industry representatives. Papers given at the conference collectively illustrated the far-reaching effects of zinc deficiency on human health, with infants, young children, and pregnant and lactating women being among the most vulnerable. The adverse health consequences of zinc deficiency include childhood growth retardation, impaired immune function, increased rates of infections such as diarrhoea and pneumonia and subsequent increases in mortality rates, and adverse outcomes of pregnancy. New information on zinc in the global food supply compiled from FAO national food balance data was also presented, suggesting that 48% of the world’s population may be at risk of inadequate zinc intakes. Strategies to alleviate zinc deficiency were also discussed, including dietary diversification, food fortification, and supplementation.

The closing session of the Stockholm conference heard several agency representatives acknowledge zinc deficiency as a major public health concern and give support for the development of programs to address the problem. The need to integrate zinc into existing micro-nutrient and other public health programmes was stressed in order to address problems of nutrient deficiencies more efficiently.

At the first meeting of the IZiNCG Steering Committee, three major categories of activities for the first year of operation were identified that would serve the group’s goals:

· Advocacy: An important first step is to raise awareness among public health programmers and policy makers of the problems and magnitude of zinc deficiency. Thus, first year efforts will include communications with international agencies, governments, and other institutions with interests in public health and nutrition programs. Advocacy efforts will also be directed towards the collection and compilation of national level data on dietary zinc intakes, zinc and phytate content of local foods, and data on biochemical indicators of zinc status.

· Education: Educational materials including up-to-date information on zinc in human health and nutrition will be compiled and disseminated. Production of a technical document is currently underway that will include information on methods of assessing zinc status in individuals and populations and options and considerations for zinc nutrition interventions. The document is expected to serve both as an important advocacy tool and educational resource.

· Coordination with other micronutrient programs: The second IZiNCG steering committee meeting is scheduled in conjunction with the IVACG conference and INACG symposium in Hanoi, Vietnam, February 12-15, 2001. This will mark the beginning of formal discussions with other micronutrient consultative groups and others with interests in coordinated micronutrient programs.

Contact: Dr Christine Hotz, Executive Officer, IZiNCG Secretariat, Program in International Nutrition, University of California, Davis, California 95616, USA Tel: (530) 754 5985, Fax: (530) 752 3406, EMail: IZiNCG@ucdavis.edu Web: www.IZiNCG.edu

LINKAGES

The USAID-funded LINKAGES Project organized a one-day technical update on “Breastfeeding: Issues and Challenges in the New Millennium” for the Fifth Meeting of West Africa Nutrition Focal Points. More than 100 nutrition policy makers and programmers from 16 West African countries attended the meeting, held in Bamako from September 25-29, 2000. Presentations were made on optimal breastfeeding practices, HIV and infant feeding, breastfeeding and vitamin A, the economic value of breastmilk, and the Code of Marketing of Breastmilk Substitutes in West Africa. LINKAGES funded the rapid assessment by CRAN (Regional Center for Food and Nutrition) and IBFAN (International Baby Feeding Action Network) of nine West African countries’ experiences with policy, legislation, and enforcement of the Code.

Each participant at the Bamako meeting received a packet with 15 recommended readings. Included in the packet were LINKAGES’ most recent publications: FAQ on Breastfeeding and Maternal Nutrition; FAQ on The Lactational Amenorrhea Method; Facts for Feeding on Breastmilk and Vitamin A; and a computer-based slide presentation on Maternal Nutrition: Issues and Interventions.

LINKAGES supports other program activities in West Africa. In Ghana, LINKAGES works with the Ministry of Health, UNICEF, Catholic Relief Services, and the Ghana Red Cross to strengthen their capacity to promote exclusive breastfeeding and appropriate complementary feeding practices through a community-based, results-oriented behavior change approach. Nutrition policy analysis and advocacy at the national and regional levels is a key component of the Ghana program. In Togo and Burkina Faso, LINKAGES conducted two-week nutrition policy analysis and advocacy workshops for nutrition and health professionals from various ministries, universities, and NGOs. LINKAGES also works with two NGOs in Togo and the Ministry of Health in Burkina Faso to incorporate the promotion of exclusive breastfeeding into a community-based distribution system.

Copies of the presentations are available from LINKAGES. The publications, available in English, French, and Spanish, can be viewed on the website www.linkagesproject.org and ordered at link-ages@aed.org. Also available is a new training module for health and family planning service providers on LAM: A Postpartum Temporary Contraceptive Option for Women Who Breastfeed.

MARCH OF DIMES

Task Force on Nutrition and Optimal Human Development

The March of Dimes has established a task force to develop food-based dietary recommendations and implementation strategies for women of childbearing age, pregnant and lactating women and children to two years of age. The issue will also be considered from the perspectives of the minorities in the industrialized societies and the populations of the developing countries. The report will be aimed at health care providers and policy makers.

The Task Force intends to put the recommended nutrient intakes established by other organizations (as RDAs or other guidelines) into food-based approaches appropriate to each of the groups identified above. If food alone is judged insufficient, the Task Force will propose recommendations for nutrient supplements or fortification as well.

The five major public health priorities for the Task Force have been defined as:

· achieving optimal weight for women during childbearing years and during pregnancy and lactation

· decreasing the prevalence of low birth-weight infants and optimizing outcomes of all children during the first two years

· enhancing strategies to decrease sub-optimal breastfeeding practices and improve complementary feeding

· ensuring adequate micronutrient reserves in women before and during pregnancy and lactation and in children in the first two years of life

· ensuring practices geared toward food safety for both women and children

The Task Force process will include review of the report by partner organizations. The report is expected to be distributed to health care providers and policy makers in the US and abroad in late 2001. The March of Dimes plans to work with partners with global and/or regional interests on implementation.

Contact: Richard Deckelbaum, Columbia University, College of Physicians and Surgeons, 630 west 168th Street, PH-East-1512, New York, NY 10032 USA

EMail: rjd@columbia.edu

UNHCHR

The New Special Rapporteur on The Right to Food

By its resolution 2000/10, adopted on 17 April 2000, the United Nations High Commission on Human Rights (UNHCHR) decided to raise the profile and potential implementation of the right to food by appointing, for a period of three years, a new Special Rapporteur whose mandate will focus on the right to food. In September 2000 the Chairperson of the Commission on Human Rights appointed Jean Ziegler as Special Rapporteur. Mr Ziegler has a Doctorate in Law, Political Science and Sociology. He has worked for the United Nations peace-keeping operation in Congo (1961-1962) and was also elected as a member of the Socialist Party to the Swiss National Council (1971-1995). Professor Ziegler currently holds academic appointments at the Faculty of Economic and Social Sciences and the Institute for Development Studies at the University of Geneva, and at the University of Paris - Sorbonne.

The Special Rapporteur shall report annually to the Commission on the accomplishment of the following main activities:

· to seek, receive and respond to information on all aspects of the realization of the right to food, including the urgent necessity of eliminating hunger

· to establish cooperation with Governments, intergovernmental organizations (in particular, FAO) and non-governmental organizations, on the promotion and effective implementation of the right to food, and to make appropriate recommendations on taking into consideration the work already done in this field throughout the United Nations system

· to identify emerging issues related to the right to food worldwide.

Professor Ziegler has been invited to visit Germany, Venezuela, Canada, France, Switzerland, Algeria and Italy (Rome food-based UN Agencies). In addition, he is working in close cooperation with FIAN International (Heidelberg), the Oslo-based University programme on food and development, the International Institute Jacques Maritain, Action contre la Faim and other NGOs interested in this field.

The Office of the High Commissioner on Human Rights will also organize, in 2001, a third expert consultation on the right to food, following those held in 1997 and 1998. This focus will be on implementation mechanisms at the country level and experts will be invited from all regions to share their experiences.

Contact: Carlos Villan Duran, Human Rights Research Project Leader, OHCHR, Palais des Nations, 1211 Geneva 10, Switzerland.

UNHCR

What does UNHCR currently do in the area of Nutrition?

The United Nations High Commission for Refugees (UNHCR), in assuming its protection mandate, works closely with the World Food Programme (WFP) and other partners to ensure that refugees are restored their dignity and right to food and nutrition. Refugees in exile often face serious problems in meeting their food and nutritional needs as a result of losing their traditional source of food and income. Hence, they become fully or partially dependent on external aid.

WFP shares with UNHCR the responsibility of meeting the food and nutritional needs of refugees. The aim is to ensure the restoration and maintenance of a sound nutritional status through the provision of food rations that meet the assessed requirements. The two UN organisations in 1994 established a Memorandum of Understanding (MOU) which was revised in 1997. This MOU clarifies the roles and responsibilities of each party and specifies working arrangements to ensure that both institutions operate as efficiently as possible.

At present WFP and UNHCR are in the process of revising the MOU for a third time to accommodate new developments and priorities in both organisations. Staff at all levels are involved in the process. This exercise will provide a good opportunity to evaluate the effectiveness and use of this important instrument.

As part of the ongoing restructuring process in UNHCR, the nutrition unit is part of the section concerned with Health and Community Development, which falls under the Division of Operational Support.

A new team of two nutritionists and one food aid officer runs the nutrition unit. The unit deals with food and nutrition related issues, and collaborates externally with WFP, WHO and other partners involved in delivering assistance to refugees and internally displaced persons worldwide, as well as relevant internal sectors at UNHCR headquarters. The unit plays an important role in the development of policies and guidelines in the field of nutrition - in particular needs assessments and monitoring.

Furthermore, UNHCR is aiming to improve its nutrition monitoring to include the assessment of micronutrient status. For instance in Tanzania, due to a high rate of anaemia, haemoglobin tests are included in the routine nutritional survey. The last one undertaken was in July 2000 for which a set of Haemocues and disposal accessories were made available to measure the haemoglobin of under fives and some mothers. In addition, UNHCR and CDC are conducting studies on the nutritional status of adolescents in Kenya and Nepal. UNHCR will to continue to promote the monitoring of other additional indicators of micronutrient status - particularly among children and women.

Contact: Zahra Mirghani, Senior Technical Officer (Food and Nutrition), Division of Operational Support, UNHCR, case postale 2500, CH 1211 Geneva 2 Depot, Switzerland. EMail: mirghani@unhcr.ch Web: Http://www.unhcr.ch/

WHO

Latest News from NHD's Micronutrients Team

During 2000, Nutrition for Health and Development (NHD) overhauled its three micronutrient databanks which together cover iodine deficiency disorders (IDD), vitamin A deficiency (VAD) and anaemia. Originally established in 1991, these databanks were launched to generate estimates on the magnitude and distribution of micronutrient malnutrition and to track each country's progress towards their elimination. What makes these databanks unique? They are the only ones in the world to systematically collect clinical and sub-clinical data on IDD, VAD and anaemia. However, just as with any initiative with a long life span, it becomes necessary to take stock at certain times and rethink one's approach. Catalysed by the massive spread and outreach of the worldwide web allowing more people than ever before to access information and data, NHD will be releasing its databanks on its website in the coming year. The ground work to allow this has involved: designing and moving the whole system into a new software program; paring down the indicators to those which are realistically possible to use in large-scale public health surveys; checking every piece of information with its hard copy (for the IDD databank that means over 60,000 fields of data have been rechecked and over 1,400 added); re-categorising less reliable data and carrying out comprehensive reference searches for any surveys not currently available and contacting countries for those remaining.

The IDD databank will be online in early 2001. The databank for vitamin A deficiency and anaemia will follow suit later in the year. Ultimately, by making the data easy to access, it will not only create the momentum for more accurate reporting and provide fuel for more powerful advocacy and understanding, it will also help to keep the world's attention on these deficiencies which cause such massive loss of individual potential.

Contact: Henrietta Allen, Technical Officer Micronutrients, Bruno de Benoist, Focal Point for Micronutrient, Nutrition for Health and Development, World Health Organization, 20, Avenue Appia, CH-1211 Geneva 27, Switzerland

WORLD BANK

The Iran Health and Nutrition project

The Iran Health and Nutrition project was approved in May, 2000 (US$ 21.5 million). The project, which is the Bank’s first nutrition project in Iran, is a follow-up of an earlier health project. The nutrition component is targeted at children under the age of two, and pregnant and lactating women. The nutrition activities include monitoring compliance with iron tablet consumption, and increasing functional nutritional literacy at the household level. A number of operational studies are also planned.

Bank’s Investment in IDD

An analysis of three major IDD projects in China, Madagascar, and Indonesia, was recently done. In all three countries, collaboration between the private sector for salt iodization, and the public sector for monitoring and evaluation, was proving to be effective. The paper An Analysis of Combating Iodine Deficiency: Case Studies of China, Indonesia and Madagascar, by Chorching Goh, will soon be published as an Bank Working Paper.

Contact Ritujit K. Chhabra, Operations Analyst, Nutrition. EMail: rchhabra@worldbank.org

Many thanks to all who contributed to this section

- we are always happy to receive material for inclusion - with the aim of promoting cooperation amongst UN agencies and partner organizations

WORLD HEALTH POLICY FORUM

New body faces global health crisis, and demands ‘revolution in world food policy’

Obesity, diabetes, cancer, as well as heart disease are now disabling and killing populations prematurely all over the world. These diseases are preventable. The World Health Policy Forum was launched at a recent meeting in Camogli, Italy, to address such urgent and important public health issues.

On behalf of the initial Forum members, Professor Paolo Toniolo of New York University said: ‘...health is a global issue. Human health is shaped by global forces’. He added: ‘...effective action needs governments, industry, universities, non-government organisations, and the media, working in partnership’.

In its first years the Forum will focus on food and public health policy. ‘As one example, we now know that plant-based diets protect against cancer and heart disease’ said Dr Toniolo. ‘So we must encourage production, and therefore consumption, of vegetables and fruits. This means a revolution in world food policy’.

He added: ‘Our discussions in Camogli show that decisions that may be crucial to global human health, for example concerning transgenic crops, are increasingly being made without democratic process. We need thriving private industry to serve the public interest. This is what the Forum is all about. The achievements of UN and other international organizations and of national governments in improvement of public health are well known. The Forum, new and highly flexible, will complement and magnify their work’.

Forum members came from all over the world to Camogli, and set out the Camogli Declaration on the vital importance of rational and progressive food policies to prevent disease and protect good health. Its text is printed on the next page.

Why the Forum?

Human health in much of the world continues to improve. But we face formidable new challenges. Real and perceived threats to human health now include explosive growth of populations and of cities; mass migrations; accelerating depletion of natural resources and damage to the environment; emergence of infectious epidemics, notably AIDS, and rapid rises of chronic diseases, including cancer; and irretrievable loss of valuable traditional culture and knowledge.

The major emerging public health issues at the beginning of the new century are not local or national. Human health is now largely determined by global forces, whose nature is not well understood. Current public policies tend to be fragmentary and focused on the individual. Coherent global strategies are needed, to ensure that political and economic policies are reconciled with the fundamental human right to good health and well-being, and other imperatives, including the sustenance, maintenance and development of the living and physical world, and of sustained employment, trade, tradition, culture, equity and wealth.

Currrently, accelerated global economic competition tends to create vast inequitable accumulation of wealth, without consideration of human health and other public interests. In rich countries, material well-being induced by booming economies, creates a false sense of security in the face of global health problems that know no borders. Economically less-developed countries do not have the resources to address such problems coherently.

Policies are now increasingly often agreed, funded and enacted by corporate interests. The shift from public to private influence and control in the fields of food, nutrition, agriculture, trade and development policy, is unlikely to improve human health or protect the environment. The current public systems designed to set policy agenda, to advise governments and to guide industry, are not adapting rapidly enough to deal with the accelerated pace of change in all areas of human activity. Old policies are being applied to new problems.

The new World Health Policy Forum, initially an individual membership organization, is independent of governments, international agencies, public or private corporations, and of sectional or special interests.

The founding members of the Forum intend to create, maintain and develop worldwide networks of leaders in public health. These networks will then work in partnership with key players in associated fields, and in the public and private sectors, in order to develop and agree on policy action plans that address urgent and important international public health issues. The purpose of the Forum is to guide governments and industry towards rational, progressive and sustainable policies that reconcile public and private interests.

Contact: Geoffrey Cannon, Executive Committee, World Health Policy Forum, 24W 12th Street, New York 10011, NY, USA. EMail: wphf@foster-science.org

The Camogli Declaration

We convened from around the globe in Camogli, Italy, September 24-27, 2000. We declare that, throughout history, the quality and nature of food supplies has influenced not just the health, but the fate of nations.

We further declare that sustainable food policies designed to improve human health are a prime responsibility of public policy makers.

Although nutrition science is still developing, enough is known to improve policy. Yet public health is often too low a priority on political agendas. New nutrition and food policies are urgently required to improve human health, which also recognize the social, economic and ecological context of health. In particular we emphasize that:

· food and nutrition play a central role in promoting health and preventing disease

· social and economic inequalities produce adverse effects on health

· inadequacy, lack of variety and poor quality of food affect health at all stages of economic development

· nutrition is rarely integrated with food and other relevant policies

· a concerted approach to food, nutrition, ecological sustainability and health is necessary.

We support the WHO Declaration of Alma Ata and the UN Covenant on Economic, Social and Cultural Rights. Adequate food, nutrition and health are human rights. Since the inception of these statements, the global food supply has experienced dramatic changes. These changes have had complex effects on people and the environment, including problems of nutritional excesses and deficiencies in both poor and rich nations.

The major causes of food insecurity and of nutritional deficiencies and imbalances are political and economic. On this basis, the role of the Forum is to engage with international and bilateral agencies, governments and non-governmental organizations and private industry. Together, we seek the enactment of policies that:

· Integrate health as a high priority

· Are ecologically sustainable

· Ensure the safety of producers and consumers

· Consider the effect of methods of food production on the livelihoods, and therefore the health, of those engaged in agriculture and related industries

· Use health promotion and the prevention of disease as fundamental strategies

· Use innovations in biotechnology in food production and processing only when compatible with the integrity of the environment and improvement of the nutrition, health and welfare of communities

· Build institutional competencies, professional education and leadership in food and nutrition sciences.

In pursuance of this Declaration of the World Health Policy Forum we, with the involvement of all relevant partners, commit ourselves to a fresh, creative, and innovative analysis of policy issues so as to devise and promote the most effective ways to protect and improve human health.

BRAC

Bangladesh Rural Advancement Committee

Nutrition Interventions: Challenges and Opportunities in the 21st Century

The Symposium on “Nutrition Stocktaking and the Challenges for the 21st Century” took place on 11 April 2000 during the SCN’s 27th Session in Washington, DC. The following is a summary of the address by Mr F H Abed, Executive Director of BRAC, Bangladesh

BRAC originally began in 1972 as a committee to aid thousands of Bangladeshi refugees. It has now evolved into the largest development organization in the world. BRAC's strengths lie in its pioneering leadership, entrepreneurial spirit, high calibre management, significant role in national development, and in the respect it has gained from the government, international donors and other NGOs. The organization's objectives are now defined as alleviation of poverty and empowerment of the poor. To attain these objectives, BRAC runs a Rural Development Programme, an Education Programme, a Health and Population Programme and an Urban Programme. BRAC’s development interventions are carried out through a holistic approach where nutrition is a cross-cutting issue. BRAC’s programmes promote household food security, crop diversification, income-generation and employment, so that families have the funds, knowledge and opportunities to meet their nutritional needs. BRAC’s development interventions are provided through 90,250 Village Organizations with 3.5 million members.

Many of BRAC’s income-generation programmes increase the yield and diversity of food produced in rural areas. The Agriculture Programme provides training, technical assistance, and credit to promote the cultivation of vegetables, rice, wheat, and maize. The Poultry and Livestock Programme aims to improve the household food security of its 1.3 million female participants. These women are trained in modern animal husbandry methods which increase production and consumption of eggs and meat to improve the population’s protein intake. BRAC’s Fisheries Programme, in collaboration with the Bangladesh Fisheries Research Institute, promotes pond aquaculture and culture-based fisheries in semi-closed large water bodies which contributes to the availability of fish in local markets. In an effort to help rural milk producers market their produce at a fair price and meet the high demand for milk and milk products, BRAC has established a dairy plant with an extensive nation-wide distribution network.

In Bangladesh, the poorest 15% of the rural population consume less than 1600 kcals per day. This severely food-insecure population, comprised of roughly 20 million people, is unable to access market-based opportunities. Some form of real income transfer, coupled with income generation assistance where possible, is necessary. The Vulnerable Group Development (VGD) Programme is an example of one such targeted transfer programme. This programme provides short-term food assistance in the form of 30 kg of wheat per month for 18 months, to female headed, low-income households. BRAC collaborates with the World Food Programme by providing training, technical assistance and credit support to VGD programme participants. Since 1990, 800,000 women from the VGD have been mainstreamed into BRAC regular development programmes.

In 1993, with support from UNICEF, BRAC launched a community-based nutrition pilot initiative in Muktagacha sub-district to address the challenges of existing food shortages. It promoted long-term behaviour change through communication and education on intra-familial food preparation and distribution, and included food supplement demonstrations. The initiative was specifically targeted towards adolescent girls, pregnant or lactating women, and children under two years of age. Services were provided by community nutrition workers. BRAC’s micro-credit, employment and income-generation programmes were linked to these interventions. The initial data showed that after a food supplementation period of two years, adolescent girls had increased their body weights. Women had increased their pregnancy weight gains, and their infants had greater birth-weights. A follow-up study of adolescent girls, three years after graduation, revealed that nutrition education had a positive impact on their nutritional perception, knowledge and practice.

In 1993-94, the Government of Bangladesh and other agencies, including UNICEF and the World Bank, sought to intensify the focus on nutrition with community-based, comprehensive services. BRAC served as a member of the core team which conceptualized and designed the Bangladesh Integrated Nutrition Project (BINP). This model was successful in creating effective public-private partnerships and inter-sectoral coordination for nutrition. BINP has been implemented in 40 sub-districts, and NGOs play a major role in its implementation. The programme has now been expanded into a national nutrition programme.

The United Nations has recognized adequate nutrition and health care for all as basic human rights. Now the major challenge is to shift the focus of nutritional activities from a welfare approach to a rights-based approach. Significant progress on this issue has been made since the 1999 ACC/SCN Symposium. While nutritional interventions, such as supplementation, fortification, and education may accelerate progress, they will have only a limited impact if the other burdens of the world’s poor are not addressed. The focus must be placed on an integrated approach to food, health, agriculture, education, and water and sanitation, combined with sound social and economic policies.

IAEA

International Atomic Energy Agency

Consultant Meeting on Nuclear Analytical and Isotope Techniques for Assessing Nutrition-Pollution Interactions

The IAEA convened a meeting of consultants December 11-15, 2000 in Vienna to advise the Agency on technical and programmatic issues related to nuclear analytical and isotope techniques (NA&IT) for assessing nutrition-pollution interactions. The consultants were Rainer Gross (chairperson), Jan Kucera, Peter Stegnar, and Chai Zhi-fang. IAEA staff were Venkatesh Iyengar and Borut Smodis.

The group acknowledged the acute problems of environmental pollution and malnutrition, lack of international interest in pollution-nutrition interactions, and the role of NA&IT which is relevant to monitoring both environmental pollution and nutritional status.

Successful applications of nuclear and nuclear-related techniques in monitoring pollutants and their biological impact and in nutritional research have been demonstrated in several coordinated research programs organized by IAEA. Together with other appropriate analysis, NA&IT can help to define indicators of pollution-nutrition interactions.

The consultants recommended that IAEA should:

· review national and international guidelines for the assessment of environmental pollution

· seek to harmonize with other UN agencies methods for the assessment of environmental pollution, in particular methods of data collection and approaches to data interpretation and risk assessment

· develop a research protocol for a multi-center study of pollution-nutrition interactions which explains impacts on human development; IAEA should support the planning and implementation of this research

· raise awareness of the importance of the interaction between environmental pollution and nutritional status for the economic and human development amongst the scientific community, political decision makers and the public

· organize related technical cooperation projects, training courses and other activities on assessment of pollution-nutrition interactions

· provide access to the literature pertaining to pollution-nutrition interactions for research centers, in particular in developing countries.

Contact: G.V. Iyengar, Head, Nutritional & Health-Related Environmental Studies Section, IAEA, P.O. Box 100, A-1400, Vienna, Austria. EMail: V.Iyengar@iaea.org

IOM

Institute of Medicine

Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc

The Food and Nutrition Board in the USA has just released findings and recommendations on micronutrients that will guide policy makers, nutrition and health professionals and others for many years to come. The nutritional science of boron, molybdenum and vanadium (to name three) may seem far removed from the widespread micronutrient deficiencies that developing countries are tackling now with proven strategies. Also, setting dietary reference intakes for these nutrients is a costly proposition that few countries can undertake. Nevertheless, this release, and the full report that will follow, provides a wealth of information for all nutrition professionals, in all countries.

How much of these nutrients does one need on a daily basis to ensure good health? To answer that question the Board offers several categories of numbers that constitute the DRIs. The Recommended Dietary Allowance, or RDA, represents a daily nutrient intake goal for healthy individuals. There is no proven benefit of consuming levels greater than the RAD. The Adequate Intake, or AI, is also a goal for nutrient intake for healthy individuals, which is set when the scientific evidence in insufficient to determine an RDA. The AI is usually the amount found in a nutritionally adequate diet and individuals should use it as a goal for intake when no RDA exists. The Board also offers “tolerable upper intake levels”, known as Uls. These represent a ceiling - the largest amount of a nutrient that healthy individuals can take each day without being placed at increased risk of adverse health effects. This is the first time the Food and Nutrition Board as set upper levels for some of the nutrients included in this review.

Copies of the full report Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc will be available later this year from the National Academy Press. In the meantime a substantive press release is available at www.nap.edu (search Vitamin A in the title field).


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