Joint Nutrition Support Programme
Inter-Agency Food and Nutrition Surveillance Programme
Effects of Iron Deficiency on Behaviour
WHO: Global Surveillance Through Anthropometric Measurements
UNICEF and WHO have fully committed $85.3 million in funding to 18 projects under their Joint Nutrition Support Programme (JNSP). Funded since 1982 by the Italian Government, the programme has three long term objectives: to reduce child and infant mortality and morbidity, improve child growth and development, and improve maternal nutrition. It seeks to do so through a strategy described as “multisectoral, preventative and developmental”. Country projects within the JNSP are designed and executed according to the principles of Primary Health Care, involving health sector development activities such as immunization and diarrhoeal disease control. They also promote nutritional objectives in sectors such as agriculture, education and social development.
In Burma, for example, the JNSP has been instrumental in the integration of nutrition-related activities, such as growth monitoring, nutrition education and the distribution of essential drugs, into the country's national primary health care system. In Haiti, the JNSP project is using social mobilization to increase public use of oral rehydration therapy, while in nearby Dominica and St. Vincent and the Grenadines project activities include the training of community workers and development of income-generating activities for women.
Projects in Africa
Almost half of the projects are underway in Africa. A multisectoral project in Mozambique is supporting household food production, use of improved crop varieties and agricultural training for women and promoting greater community awareness of nutrition issues. Two projects in northeast and southern Sudan seek to integrate services in health, agriculture, animal husbandry, water, education and social welfare. In Ethiopia, a project of multisectoral action is being tested as a model for other such projects throughout the country.
WHO and UNICEF report that almost 90 percent of the Joint Nutrition Support Programme's resources have been committed to such projects, the remainder being used for intercountry support activities such as public information, research, special programming for nomads and development of training methodologies.
FAO, UNICEF and WHO, with the ACC/SCN, have launched a five-year programme to help the rapid expansion of food and nutritional surveillance systems in developing countries.
The immediate impetus came from concern for the effects of economic recession and adjustment policies on nutrition of the poor. This was the topic of a symposium convened by the SCN in March 1986 in Tokyo, which called for better and more up-to-date information on malnutrition. A proposal for renewed inter-agency efforts in this subject was endorsed by the SCN in early 1987, and put to the UNICEF Executive Board in April. The programme was accepted, with a budget to be raised of $10 million for 5 years, aimed at assisting up to 40 developing countries.
During 1987, plans and organizational arrangements have been developed. As a first step, a report on recent trends in nutrition, with reference to economic adjustment, will be issued in mid-1988. This will draw on information from at least 20 developing countries. Regional meetings to draw up national plans and review needs are proposed for 1988 in Latin America, Asia and Africa. UNICEF is responsible for fund-raising, WHO and FAO will participate in project development and implementation.
This 5-year programme has both short and long-term objectives. For the former it is intended that existing data, e.g. on anthropometry, incidence of low birth weight, and access to food, etc., from a substantial number countries will be collated and analyzed with a view to producing a situation report by mid-1988. This report will provide an update to information given in the SCN's First Report on the World Nutrition Situation.
For the longer term the programme will attempt to strengthen the institutional capacity of some 40 countries to produce, analyze, and use food and nutrition data for the proper and integrated development of policies and programmes.
The major portion of the funding will be used to support institutions directly in individual countries, for work in those countries. The major required output is assistance within the country in developing nutritional surveillance - system's design, management, data interpretation, and information usage at different levels in policy and programme decision making. The implementation of the programme at country level will thus be primarily in the hands of these national institutions.
The programme was launched during the latter half of 1987; proposals from national institutes will be sought during the first half of 1988. Guidelines will be made available both directly and through a series of regional meetings, where consultation with potential participants will provide essential feedback on the management of the programme. Provisionally, these meetings are scheduled for September; in Latin America (organized by PAHO); for Asia, organized with WHO and UNICEF; and hopefully in association with a regional nutrition meeting planned in Zimbabwe, also in September. Further information can be obtained from Alan Kelly, ACC/SCN; and/or Beverley Carlson, UNICEF, New York.
UNU are promoting research into the effects of “less than severe” iron deficiency on child behaviour. While severe iron deficiency anemia has been long recognized as a health risk, the functional significance of iron depletion and mild depression of hemoglobin levels remains uncertain. However, findings have suggested possible long-term effects, including an accumulated learning deficit among anaemic children and persistent lower levels of brain iron among individuals who were iron-deficient in infancy. There is also a suggestion that mother-child bonding may be affected because the behaviourally disturbed infant is less able to evoke positive stimulation from its mother.
“Suggestive links”
Following a request from the United Nations University (UNU) for an SCN-UNU sponsored conference on the behavioural consequences of iron deficiency, the AGN examined the issue at its meeting in Washington DC in August 1986. It found much evidence of association between iron depletion and psychological function/cognitive development, but no direct evidence that clearly established causation. It recognized “suggestive links” between iron depletion and other areas of functions, including work performance, immunologic competence and resistance to infection. It was decided to explore with UNU the possibility of a workshop to define research questions, develop competent protocols to address these questions and disseminate, after peer review, a research design report to potential investigators and interested funding agencies.
UNU is now preparing to organize and co-sponsor with the SCN a conference on iron deficiency, cognitive performance and behaviour.
WHO Nutrition Unit has compiled, analyzed and published data on wasting, stunting and growth failure in children from some 230 survey reports from countries all over the world. The results are presented in a consistent format, showing percentages below standard cut-off points, by age group. References to all sources are listed. An example of the data format is this:
The results, originally published by WHO region in the WHO Weekly Epidemiological Record, have now been put together in one document - “Global Nutritional Status” (NUT/ANTREF/3/87) - available from the Nutrition Unit, Division of Family Health, WHO, Geneva.
Table 1. Anthropometric indicators of nutritional status in the WHO African Region: prevalence of wasting and stunting. Tableau 1. Indicateurs anthropométriques de l'état nutritionnel dans la Région OMS de l'Afrique: prévalence de l'émaciation et du retard de croissance
|
Region, country, area |
Date of survey |
Number examined |
Age group (years) |
Wasted Emaciation |
Stunted |
Low |
Obese |
Notes |
Ref. No. b |
|
|
Month(s) |
Year(s) |
weight for height |
height for age |
weight for age |
weight for height |
|||||
|
Percentage below/above median |
||||||||||
|
-2 S.D. |
-2 S.D. |
-2 S.D. |
+2 S.D. |
|||||||
|
Botswana |
|
1978-79 |
136E |
0-0.99 |
2.0 |
24.7 |
18.8 |
|
2 villages in Central District |
0003 |
|
136E |
1 |
12.5 |
55.9 |
49.3 |
|
2 villages du District central |
|
|||
|
136E |
2 |
6.8 |
36.8 |
47.0 |
|
|
|
|||
|
136E |
3 |
5.7 |
46.1 |
44.0 |
|
|
|
|||
|
136E |
4 |
7.0 |
40.0 |
42.6 |
|
|
|
|||
|
Burkina Faso |
Jan.-Dec. |
1973-82 |
902 |
0-0.49 |
2.0 |
3.7 |
3.4 |
|
Mossi Tribe - Tribu des Mossi |
0142 |
|
1458 |
0.5-0.99 |
12.1 |
19.2 |
32.5 |
|
|
|
|||
|
2189 |
1 |
18.2 |
29.2 |
39.2 |
|
|
|
|||
|
1843 |
2 |
7.8 |
20.8 |
32.9 |
|
|
|
|||
|
1226 |
3 |
6.7 |
23.2 |
26.0 |
|
|
|
|||
|
470 |
4 |
7.0 |
28.1 |
28.9 |
|
|
|
|||
|
1974 |
225E |
0-0.99 |
7.4 |
24.2 |
25.2 |
|
|
0028 |
||
|
225E |
1 |
16.6 |
36.5 |
46.9 |
|
|
|
|||
|
225E |
2 |
12.1 |
26.3 |
39.7 |
|
|
|
|||
|
225E |
3 |
7.6 |
26.3 |
30.8 |
|
|
|
|||
|
225E |
4 |
12.9 |
25.8 |
38.7 |
|
|
|
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