NEWS AND VIEWS

The Lesser Child
Famine in Sudan and Ethiopia
Goals for Children and Development in the 1990s
Can Vitamin A Save Lives?
Global Immunization Update
UNHCR and WFP issue guidelines on use of milk powder.
The Protection, Promotion and Support of Breastfeeding
Recent & forthcoming meetings
PLUS News from International Union of Nutritional Sciences (IUNS)

A mother’s grief Photograph: Courtesy of Children’s Hospital, Islamabad, Pakistan. This picture tells two stories: most obviously, about the often fatal consequences of bottle-feeding; more profoundly, about the age-old bias in favour of the male. The child with the bottle is a girl - she died the next day. Her twin brother was breastfed. This woman was told by her mother-in-law that she didn’t have enough milk for both her children, and so should breastfeed the boy. But almost certainly she could have fed both children herself, because the process of suckling induces the production of milk. However, even if she found that she could not produce sufficient milk - unlikely as that would be - a much better alternative to bottle-feeding would have been to find a wet-nurse. Ironically, this role has sometimes been taken by the grandmother. In most cultures, before the advent of bottle-feeding, wet-nursing was a common practice. “Use my picture if it will help”, said the mother. “I don’t want other people to make the same mistake.” Source: UNICEF.

The Lesser Child

The photograph on our cover - reproduced with explanation above - is horrifying. Another baby girl dies unnecessarily. The Department of Women and Child Development, Government of India, with assistance from UNICEF, has produced a compelling account of the plight of “The Lesser Child”.

“In a culture that idolizes sons and dreads the birth of a daughter, to be born female comes perilously close of being born less than human. Today the rejection of the unwanted girl can begin even before her birth: prenatal sex determination tests followed by quick abortions eliminate thousands of female foetuses before they can become daughters. Those girls who manage to survive till birth and beyond find that the dice is heavily loaded against them in a world that denies them equal access to food, health, care, education, employment and simple human dignity.

“Born into indifference and reared on neglect, the girl child is caught in a web of cultural practices and prejudices that divest her of her individuality and mould her into a submissive self-sacrificing daughter and wife. Her labour ensures the survival and well-being of her family but robs her not only of her childhood but also of her right to be free of hunger, ignorance, disease and poverty.

“We expect tomorrow’s woman to become the pivot of social change and development. Yet today we deprive her of her rightful share of food, schooling, health care and employment, then marvel that she does not come running to get her children immunized, or when she refuses to send them to school or practice good nutrition, hygiene and birth control... Unless the girl becomes a priority in health, nutrition and education policies, can there be Health for All by 2000, or universal elementary education, or social justice and equality? It is already late. But perhaps not too late.”

A number of key statistics are used to illustrate the problem. The sex ratio (females per thousand males) is shown to have declined during this century, for example from 972 in 1901, 950 in 1931, and down to 933 in 1981; variations in the sex ratio between states is also illustrated, with a high value of 1032 in Kerala, dropping to below 800 even in some states (although migration may account for some of this, it clearly does not account for all). Anthropometric data also tell a sad tale: data quoted from one area show, for example, these differentials for growth retardation (adding mild, moderate, and severe). In infants, the prevalence among females was estimated at 79%, versus 43% in males - almost double; in one to two year olds, these figures became 86% compared with 63%; and preschoolers 72% against 65%. This also illustrates that the effects are particularly severe in the first year of life, and suggests that girls become relatively better able to look after themselves as they grow older. The morbidity patterns quoted, from rural Tamil Nadu, show much higher incidence of diseases such as respiratory infections among young girls; poignantly, the only condition in which boys are more affected than girls is dental caries, perhaps resulting from the observation made in “The Lesser Child” that “although there are great variations in feeding practices across the country, it is generally true that boys eat better than girls even in privileged families. Sons are more likely to be given milk, eggs, meat and fruit in their diet. As they grow older, boys spend part of their earnings on food and snacks while girls continue to eat the same unvaried diet at home.”

The book, though short, makes the compelling point very clearly and repeatedly. But it continues to suggest that not only long term changes must be brought about, particularly through education, but that there are also programmes that can be effective now. “The glaring disparity between male and female infant mortality rates, if plotted on a map, shows a clear belt running across the north-western part of the country, with a few pockets elsewhere, and this is where immediate health and nutrition interventions must now be focussed”.

“Through a haze of heat and pain, Sushma hears the dai mutter ‘Another daughter’ and bursts into uncontrollable sobs. Throughout her third pregnancy she has fasted and prayed for a son. Burdened by the guilt of having two daughters, she has supplicated every deity she knows, praying to Shiva, to Santoshi Mata, even walking to the outskirts of the village to prostrate herself at the grave of the Pir Baba. Now the sound of her mother-in-law’s wailing fills the air...” Source: “The Lesser Child”, p. 4.

“The ICDS (Integrated Child Development Services) network is clearly one effective response to the problem of early neglect of young children. Through its immunization, nutritional supplementation and pre-school education components (which now reach ten million children) it can offset the discrimination a girl faces at home and can lay the foundation for health physical and mental development. But an urgent answer has to be found for meeting the needs of girls in the 6-14 year age-group, for this is when they have either dropped out of school or are too old for ICDS and are nobody’s concern. They have to wait until they are 15, which is when they become another target group that the health system recognizes - “women in the reproductive age-group”. Perhaps it is time to enlarge the scope of ICDS projects so that they can include girls between the ages of 6 and 14 years. This is an important period in a girl’s life, when major biological, psychological and social changes take place... repeated adolescent pregnancies, common in many parts of rural India, arrest this growth spurt and prevent full physical maturation of the girl, affecting not only her own health, but also the survival and development of her offspring.”

Everyone’s Concern

Although the book is specific to India, the issue extends far wider. Indeed, the same thoughts are exactly right for many other places, whatever the child’s gender. The book finishes like this.

“An integrated and holistic approach to the girl-child’s development is essential for the creation of a new environment in which she can be valued and nurtured. Our search for brave new efforts to give the girl-child her due, to allow her to evolve to her full potential, involves a process of social mobilization that will make her everyone’s concern: the media, the family and the community, as well as government and voluntary agencies. By supplementing formal schooling with non-formal education that conforms to local needs and constraints; by enlarging the ambit of child development programmes with the creation of new channels to reach adolescent and pre-adolescent girls; by reinforcing constitutional mandates through widespread awareness of the rights of girls: these are only some of the ways in which we can empower the girl child to enter the mainstream of economic and social activity. And help her to walk out of the maze of neglect in which she has been lost for centuries.”

Source: “The Lesser Child”, Dept. of Women and Child Development, Ministry of Human Resource Development, Govt. of India, with assistance from UNICEF.

Famine in Sudan and Ethiopia

The famine now worsening in Sudan and Ethiopia may be the most severe for decades. The reports are sickeningly familiar. Successive years of drought, large numbers of displaced people, war - all lead to a “rapidly deteriorating situation in Sudan, and a continuing emergency in Ethiopia”. This was reported more and more loudly in the latter part of 1990, but were enough people listening? “Massive international assistance will be required in 1991 in Sudan and Ethiopia” - FAO, December 1990. The 1990 harvest in Sudan was compared to 1984’s, then the “most devastating drought and famine of recent times... the effects could be far worse (this time) because then people had more resources, but now these are totally depleted... the government has virtually no grain reserves, nor resources with which to address this need”. UN agencies, bilaterals (the US-supported Famine Early Warning System, for example), and many non-governmental organizations have all called for action. The need for cereals in Sudan is estimated to be at least one million tonnes but the maximum internal carrying capacity for relief food is judged to be only about 300,000 tonnes. Even if the gross deficit were met by aid and imports, distribution would be a nightmare.

This time, there is no question that adequate information is available, and diverse sources confirm each other. On the ground, widespread crop failure due to drought has been observed. Satellite information has helped, and shown the extent in areas with less information. Many reports from NGOs confirm the picture: local stores empty, people collecting wild foods, distress sales of last possessions, and increasing malnutrition. Prices of livestock have plummeted, due to their poor condition and the economic situation; at the same time prices of staple grains have risen sharply. Thus the terms of trade for those dependent on livestock have collapsed.

Indicators of malnutrition in young children show high levels of wasting. In late 1990, prevalences of around 25% (as <80% weight-for-length) were being reported from around Khartoum. Now we hear accounts of up 30% and more, presumably still rising; nutrition surveys are continuing. We have no information on mortality rates. But with possibly 10 million people affected, in Sudan and Ethiopia, many deaths are likely.

Now, with the Gulf crisis, shipments of food may be halted for an unknown period. WFP has appealed for accelerated pledges and delivery of emergency food aid for Sudan, adding that this is “vital for the survival of millions of people. Situation in some parts of the country now desperate.” For Ethiopia, WFP has appealed to donors for immediate action to secure a food pipeline to Ethiopia... “the consequences of major disruptions will be irreparable.”

(Sources: FAO, WFP, SCF, FEWS, others)

Goals for Children and Development in the 1990s

The World Declaration on the Survival, Protection and Development of Children and a Plan of Action for its implementation in the 1990s came out following the World Summit on Children held in New York from 29 to 30 September 1990 (see SCN News No. 5 p. 27).

As announced in the Summit, with the right policies, appropriate institutional arrangements and political priority, the world is now in a position to feed all the world’s children and to overcome the worst forms of malnutrition, - to halve protein energy malnutrition, virtually to eliminate vitamin A deficiency and iodine deficiency disorders and to reduce nutritional anaemia significantly. Yet, the Summit heard that hunger and different forms of malnutrition contribute to about half of the deaths of young children. More than 20 million children suffer from severe malnutrition, 150 million are underweight and 350 million women suffer from nutritional anaemia.

The Summit emphasized that improved nutrition requires adequate household food security, a healthy environment and control of infections, and appropriate maternal and child care. The most essential needs are: provision of adequate food during pregnancy and lactation; promotion, protection and support of breastfeeding and complementary feeding practices, including frequent feeding; growth monitoring with appropriate follow-up actions; and nutritional surveillance.

An adequate diet is an obvious human priority. Meeting this need requires employment and income generating opportunities, dissemination of knowledge and supporting services to increase food production and distribution. These lie within broader national strategies to combat hunger and malnutrition. Overall goals for children and development in the 1990s will provide opportunities for improving the quality of life and virtually eliminating preventable diseases that have afflicted tens of millions of children for centuries. Actions are proposed to be taken in the following areas. Child health; food and nutrition; role of women, maternal health and family planning; role of the family; basic education and literacy; children in especially difficult circumstances; protection of children during armed conflicts; children and the environment; and alleviation of poverty and revitalization of economic growth.

The Summit formulated the following major goals - reproduced in the box opposite - through extensive consultation in various international forums. These major goals for children survival, development and protection are recommended for implementation by all countries where they are applicable, with appropriate adaptation to the specific situation of each country.

Canada’s Commitment

One month after the Children’s Summit in New York and on the occasion of the World Food Day, Canadian Ministry of External Relations and International Development announced a new initiative to join the battle against two of the world’s widespread nutritional deficiencies - vitamin A and iodine - from which many children are suffering. While damage to physical and mental growth as consequences of these deficiencies are substantial, the costs for their treatment and prevention are quite small, particularly in the light of their tremendous positive impact on child wellbeing and survival. The initiative to tackle these problems was called, by Monique Landry, Minister for External Relations and International Development, “just one demonstration of our commitment” to take concrete actions to improve conditions of children. The Canadian International Development Agency (CIDA) will contribute $5 million over three years to the efforts to combat vitamin A and iodine deficiencies in the Third World countries. (see also Programme News section, under Canada in this issue).

(Source: Minister for External Relations and International Development, 16 October 1990)

The International Vitamin A Consultative Group (IVACG) was established in 1975 to guide international activities aimed at reducing vitamin A deficiency in the world. Through its international meetings, IVACG provides a forum to foster the interchange of ideas, the presentation of new research findings and survey data, and discussion of action programmes.

Ecuador will be the site of the XIV IVACG Meeting in June 1991. The theme of the meeting is community-based interventions. The programme includes brief presentations of selected research reports on this topic and new research findings related to the effect of vitamin A status on morbidity and mortality and assessment of vitamin A status.

More information may be obtained from Laurie Lindsay, R.D., IVACG Secretariate, The Nutrition Foundation, Inc, 1126 Sixteenth Street, Washington, D.C. 20036, USA. Tel: 202-659-9024. Telex: 6814107 “NUFOUND”, Fax: 202-6593617.

(Source: IVACG)

Can Vitamin A Save Lives?

A number of investigations on the effect of vitamin A in preventing child sickness and death are under way, with more results regularly being published. Many of these were launched following findings of a significant reduction in child mortality following vitamin A dosing in Indonesia, by Sommers and colleagues. At that time, the SCN’s Advisory Group concluded that similar effects might be expected elsewhere, at least under similar conditions (see SCN News, No. 1). Several groups and agencies started urgently to investigate further. IVACG in 1989 concluded that a ‘fundamental breakthrough’ might be seen when all results are put together (SCN News, No. 5, p 33-34).

At a WHO/UNICEF meeting in December 1990, at which future strategies for vitamin A deficiency control were considered, the results of data from these studies were summarized by Dr Barbara Underwood. We reproduce here the summary table she presented to the meeting. Of the five results then available, in four there was evidence for reduction in child deaths in the group receiving vitamin A. Still, further results are going to be very important, as well as analysis of such matters as the underlying conditions where the effect is strongest - eg existing nutritional deficiencies - and the best methods of increasing vitamin A intake.

Summary of Published and Ongoing Vit. A. Intervention Trials

	Design: Masked/ Placebo	Age Range		Mortality
			n	Ascertainment	Effect Reduction suppl. vs non
LOW DOSE	Yes	0 - 11m	1370	weekly	72%
Madurai		12 - 35m	6400		54%
(8333 IU/WK)		> 36m	7688		37%
					(117 deaths)
Indonesia	Yes	< 1y	1700	11 mo follow-up	11%
MSG-A		1 - 5y	6200		45%
1/4-1/2 PDA					(186 deaths)
HIGH DOSE	No			9 - 11 mo follow-up	Rel. risk
200,000 IU/6 mo		< 12m	4000		1.2
ACEH		12 - 23m	4000		1.2
		24 - 35m	4000		1.8	34%
		36 - 47m	4000		0.8
		48 - 59m	3600		1.6
		60 - 71m	5000		3.5
					(128 deaths)
Hyderabad	Yes	< 1y	3500	3 mo follow-up	No
		1 - 2y	3500	Only 1-5 yr olds
		2 - 3y	3600	used in analysis
		3 - 4y	3600
		4 - 5y	1400
					(62 deaths)
Thailand	No	1 - 6y		Not determined
In Progress
Sudan	Yes	preschool	30,000	6 mo
Nepal - Serlahi	Yes	~ 4 mo - 6y	25,000
Ghana	Yes	0 - 6y	>16,000
Indonesia - Muhilal	No	0 - 11 mo	3300	monthly	39% (126 deaths)
Nepal - Jumla	Yes		?
Indonesia - Morvita	Yes	6 - 48 mo	~ 700

Malnutrition-Infection Statement Following the publication of the ACC/SCN State-of-the-Art paper on “Malnutrition and Infection”, in October 1989 (see SCN News Nos. 4 and 5), the SCN considered and approved a statement, drafted by the Advisory Group on Nutrition. This was endorsed by the Administrative Committee on Coordination (ACC) of the UN system. This statement is reproduced here. “The combination of malnutrition and infection - the ‘malnutrition-infection complex’ - remain the most prevalent public health problem in the world today. “A state-of-the-art paper on the inter-relationship between infection and nutrition has recently been published by the SCN. This examines the scientific basis for defining the relationship between infection, diet, and nutritional status and their effects, particularly on young children. It also explores the implications for the design of programmes, both those directed at general improvement of health conditions as well as those specific to infectious disease control and the prevention of malnutrition. “Infections adversely affect nutritional status while nutritional status affects the severity of infections. In conditions of poverty and social disadvantage, populations are simultaneously exposed to a high infectious load in the environment and to inadequate food intake. This double hazard particularly affects infants and pre-school children with their immature immune systems and high nutritional demands for growth. Most infections result in a measurable but temporary decline in nutritional status. In normal circumstances, a good diet during illness and the recovery period can ensure that infections do not adversely affect health and development in a permanent manner. Under conditions of dietary inadequacy recovery is often incomplete, resulting in both impaired growth and increased vulnerability to subsequent infections arising from depression of the immune system. This effect becomes circular resulting in progressive decline in health status leading at least to permanent stunting and underdevelopment, and often to early death. “The health impact of diarrhoeal disease, measles, pneumonia, malaria and intestinal parasitism can be prevented or reduced by nutritional measures. Early and continued breastfeeding, active feeding during infection, vitamin A supplementation, food hygiene and safe and nutritious weaning foods all contribute to this preventive effect. Iron, zinc, and iodine supplementation also have an identified role where the deficiencies are prevalent. Likewise the nutritional status of disadvantaged populations can be enhanced or maintained when infectious disease control measures such as immunization, personal hygiene, improved water supply and sanitation, deparasitization and early treatment with antibiotics for severe respiratory infections are put in place. Programme design should consider the synergism and the enhanced programme impact to be achieved when appropriate nutrition and infectious disease control are implemented together. Coordination, therefore, between programmes and sectors is required.” (Source: Report of the ACC/SCN 16th Session, 19-23, February 1990, Paris)

Undernutrition and Low Birth Weight - Important Risk Factors for Pneumonia

“National programmes for the control of acute respiratory infections are being advised to support nutrition and maternal and child health/family planning programmes including the promotion of breastfeeding, since undernutrition and low birth weight appear to be the most important risk factors for pneumonia in children” according to a WHO Executive Board Report, November 1990. As well as biological factors (like malnutrition and low birth weight) affecting the incidence and severity of pneumonia, the Report cites environmental (e.g. indoor air pollution, cold exposure) and behavioural factors as other likely risk elements. The Report examines the progress and current status of the programme - established in 1982 - for the control of acute respiratory infections.

Acute respiratory infections now account for about 4 million out of the estimated 15 million deaths that occur annually in children under five years of age in developing countries. They comprise 30-40% of all visits by children to health facilities, and 20-40% of hospitalizations. Their control, thus, would save many lives and much resources.

The report emphasizes the need for conducting relevant studies in order to quantify the importance of risk factors in incidence, severity and outcome of acute respiratory infections in young children. The significance of vitamin A deficiency in this regard is currently under investigation. A case-control study initiated in 1989 in Brazil is to assess potential importance of different risk factors. For the control strategies the programme, with the collaboration of the London School of Hygiene and Tropical Medicine, is making an analysis of available information on the effectiveness, feasibility and cost of interventions in order to prevent or reduce risk factors for pneumonia.

Not enough is known about the clinical signs and etiological agents of pneumonia in severely undernourished children. For this reason, the programme will support - among other research topics to be undertaken - studies to provide the necessary knowledge of signs and etiology of pneumonia in undernourished children. The current clinical guidelines of the programme recommend “hospital admission and parenteral therapy in view of the wide range of etiological factors that may be involved”. Timely and appropriate case management is the main strategy for reducing deaths and morbidity, while immunization is regarded as a specific strategy for preventing acute respiratory infections caused by measles, pertussis and diphtheria.

(Source: Control of Acute Respiratory Infections. Report by the Director-General - Executive Board, Eighty-seventh Session. World Health Organization, 11 November 1990)

Global Immunization Update

Worldwide coverage of childhood immunization against diphtheria, measles, pertussis, poliomyelitis, tetanus and tuberculosis stands at 70% for children under the age of one year, WHO reports. Massive immunization programmes in highly populated countries such as China, Indonesia, India, Nigeria and Pakistan are a major reason behind this global success.

Based on the figures released by WHO, immunization coverage is now 74% for three doses of poliomyelitis, 72% for DPT vaccine (diphtheria, pertussis and tetanus), and 68% for measles vaccine. However, coverage of pregnant women with a second dose of tetanus toxoid (to protect newborns against tetanus) is still only 27%.

Over 400,000 cases of poliomyelitis are thought to be prevented annually through immunization. Immunization also prevents 2.6 million deaths per year from measles, pertussis or neonatal tetanus. Moreover, the immunization services themselves have been established in most developing countries where they did not exist only 15 years ago. Now such services can deliver some 2.5 million immunizations every day of the year. Also the number of the children missing second and third doses has markedly declined.

In these achievements the 167 Member States of WHO, WHO’S Expanded Programme on Immunization (EPI), and the United Nations Children’s Fund (UNICEF) played a significant role supported by governments, the World Bank, the United Nations Development Programme (UNDP), the Rockefeller Foundation, Rotary International, the Save the Children Fund and other organizations.

The goal of WHO is to increase global immunization of infants to 90% by the year 2000.

(Source: World Health Organization Features, No. 147, September 1990)

Important steps towards the development of “super vaccines” have already been taken. Approaches such as microencapsulation (biodegradable microcapsules release the entrapped antigen after injection in a way to mimic repeated injections) and live-vaccine carriers (unrelated live viral or bacterial vaccines will be carriers to deliver a second vaccine) are some of the new techniques - made available through recent advances in molecular biology, immunology and biotechnology. The main objective is to improve the existing vaccines and to develop new ones for diseases against which no immunization is yet possible. Evidently man is not far from producing a new generation of vaccines which can give effective immunization to a variety of bacterial or viral diseases, in a single dose taken orally. The target viral diseases are measles, rotavirus, poliomyelitis, hepatitis (A, B, C, E), dengue and Japanese encephalitis, and acute respiratory viral diseases. Among bacterial diseases targeted by the programme are tetanus, bacterial meningitis, bacterial diarrhoeal diseases, pneumococcal pneumonia and tuberculosis.

Progress towards achieving these goals has been made possible through a programme specifically devoted to vaccine development against viral and bacterial diseases established in 1984 by WHO. In 1990, UNDP joined the programme which has been expanded to include research on vaccines against viral and bacterial diarrhoea. The Children’s Vaccine Initiative was launched by WHO, UNICEF and UNDP at the World Summit for Children in 1990. With the programme for vaccine development playing an essential role, the Initiative calls for a major acceleration of the development of essential vaccines for children by the year 2000.

Since 1984, 230 research projects have been supported in 28 countries. It is expected that by 1995, at least six improved or new vaccines will be available, and by 1999, eight vaccines will be integrated into a single dose “multivalent vaccine” and several others will be single-dose vaccines that can be given at the same time, soon after birth.

To reach the 1999 targets, an estimated global amount of $20-30 million would be needed annually. It is hoped to provide facilities for strengthening research capabilities in vaccine oriented lines in developing countries to enhance participation of scientists from these areas.

(Source: Executive Board Report, 87th Session. World Health Organization, 21 November 1990)

Poor compliance has often been reported as a problem in field iron supplementation programmes to deal with iron deficiency (see first article in this issue). The most common reason for the poor compliance is the gastrointestinal side-effects particularly experienced at higher iron doses. The frequency of these side-effects is correlated with the amount of absorbed iron. For example, the severity of symptoms is shown to be increased with the addition of iron absorption enhancers like ascorbic acid. Various preparations are available with delayed-iron release properties. Unfortunately, however, these compounds decrease side-effects at the expense of lowering the total amount of iron absorbed from the supplement, as iron release can be delayed too much and the iron excreted. Such preparations, therefore, are blamed on the grounds of reduced iron absorption and increased cost.

A recent report (see source) on the gastric delivery system (GDS) for iron supplement challenges some of these problems. In this alternative method, the supplement is retained in the stomach for a much longer time, while its iron is gradually released from a hydrocolloid matrix into gastric solution. This is done by altering the hydrodynamic properties of the supplement compound; in a word, it floats in the stomach. The approach is particularly suitable for substances (like inorganic iron) which are more acid soluble. Ferrous sulphate is, therefore, incorporated into a gastric delivery system because it polymerises and precipitates as the gastric contents are alkalinised shortly beyond the pylorus. GDS is reported to be retained in the stomach of healthy subjects for 5-12 hours.

A controlled double-blind trial in 200 women has revealed many of the advantages of this new method. The side-effects are reduced, while absorption of GDS iron compared with ferrous sulphate elixir is three times higher. A major advantage is that a single 50 mg GDS iron capsule daily delivers the same dose of absorbed iron as conventional ferrous sulphate given three times per day, i.e. the maximum amounts of ferrous sulphate generally recommended for supplementation. The cost is low and the material could be sold in bulk and encapsulated regionally. Thus, using GDS iron for supplementation programme adds no more cost than that of conventional methods. Finally, since GDS retains iron in the stomach until the bulk of the meal has left, the inhibitory effects of typical cereal-based diets of many developing countries on iron absorption do not occur. It is, however, stated that “the GDS advantage might not occur if ingested when in fasting state and might be reduced with meals containing a high content of meat or ascorbic acid, which promote iron absorption”.

An extensive field trial in Jamaica is currently testing this new preparation for iron supplementation in pregnant women.

(Source: Based on “Gastric Delivery System for Iron Supplementation”. By Cook, J.D. et al. (1990). The Lancet, Vol. 335, 1136-1139)

Esther Ocloo, an entrepreneur and co-founder of Women’s World Banking, has been named by the Hunger Project as winner of the 1990 Africa Prize for Leadership for the Sustainable End of Hunger. She received $100,000 award, jointly with General Olusegun Obasanjo, former head of state of Nigeria and internationally respected statesman, writer and farmer. The Africa Award Ceremony was held in New York on September 27.

As the first woman to ever win the award, Dr. Ocloo’s work is regarded as critically important in ending hunger in Africa. The Hunger Project recognized Dr. Ocloo’s tireless efforts to empower African women, who have the primary responsibility for feeding Africa, who grow 80% of the food and use their incomes for feeding their families. She is the co-founder of Women’s World Banking, a worldwide organization which provides access to credit and promotes entrepreneurship among women all over the world. It provides economic opportunities much needed by women, particularly in Africa, in order to raise the standard of living for themselves and their families, and to become more productive and self-reliant.

In Africa about 30% of the total food production per year is thought to be lost as post-harvest waste. It is even estimated that if this waste, which occurs before produced foods can reach the market, can be avoided, Africa can probably feed itself. Training thousands in food-preserving technology on the request of the African Training and Research Centre for Women of the UN Economic Commission for Africa (ECA), in order to reduce post-harvest waste in food production is yet another illustration of Dr. Ocloo’s direct participation in efforts to increase food availability and ending hunger in Africa.

Mrs. Ocloo was the key founder and first woman president of the Federation of Ghana Industries. She has also been the first female Executive Chairperson of the Ghana National Food and Nutrition Board; is a member of the Ghana National Council on Women in Development; and a senior advisor on food processing industries. She has founded the International Federation of Business and Professional Women, an organization devoted to empowering women in business and professions. She has also actively supported and served as director of the Opportunities Industrialization Centre in Accra which trains young underprivileged people for business employment. By founding or supporting many local, national and international organizations, she has worked to provide assistance at the grassroots level to enable the poor to work for a better life.

The Africa Prize was initiated in 1987 by the Hunger Project - an international, non-profit organization with activities in 37 countries - with the aim of promoting the achievements of African leaders on every level who are engaged in the struggle for Africa’s economic viability.

(Source: The Hunger Project. One Madison Avenue, New York, 10010. Tel: 212-532 4255; Fax: 212-532 9785)

The Third National Congress of Hygiene and Epidemiology took place in Havana, Cuba from 24 to 27 October 1990. Nutrition received particular attention in this congress. Topics emphasized included: food and nutrition surveillance and its relation to environmental health; the need for research and training in food and nutrition surveillance; the regional network for the Americas and national experiences. The congress examined the experience in Peru where food and nutrition surveillance at the level of the microregions has been quite successful as a tool for basic planning at the local level. Also, the Cuban experience in surveillance - which is a well established and carefully implemented system taking into consideration food safety, consumption and biological utilization - was examined.

The congress also had a special section which examined the relation between food safety and tourism. This area of work is receiving more attention lately since tourism is a vital source of foreign currency for many of the participating countries. Although a national event, many participants came from other countries, including staff from WHO and the Pan American Health Organization (PAHO).

(Source: Dr. C.H. Daza, Coordinator, PAHO, 5 December 1990)

Nutrition and health interventions - now a routine operation in many parts of the world - do indeed make a difference not only to the well being of beneficiaries themselves but also towards lowering medical expenditures. Evaluation of a massive nutrition and health-related intervention in USA has convincingly revealed that the programme improves birth outcomes and is highly cost-effective. Substantial health benefits offered by the programme were evident since 1986. The primary objective of the recent evaluation by the Department of Agriculture was to translate those findings into money. This was done by determining the savings in medical costs for newborns and their mothers during the first 60 days after birth from participating in the Special Supplemental Food Programme for Women. Infant and Children (WIC).

The WIC Programme - authorized by Congress in 1972 - provides food supplementation, nutrition education, health care and social services referrals to low-income pregnant women, and to their infants and children up to age five, in order to improve their nutritional status and pregnancy outcome. The Programme has become one of the largest public health programmes for low income pregnant women and their children. It has grown from a $750 million programme that served 2 million women and children in 1980 to an estimated $2.1 billion programme serving 4.5 million in 1990.

Medicaid, a joint federal and state programme is the nation’s primary medical-reimbursement programme for low income individuals. Since 1987, it has increased the income eligibility standards for pregnant women and children in order to qualify more of such women below the poverty level.

The basic analytical approach to measuring savings in Medicaid costs was to compare the medical costs of WIC participants and non participants. For accurate comparison of the costs, other characteristics of the two groups that might account for the observed medical cost differences were identified and taken into account. The cost-effectiveness analysis showed that the benefits of prenatal WIC participation exceeded the costs of providing WIC benefits. In fact for every dollar spent on the prenatal WIC programme, the associated savings in medical costs during the first 60 days after birth ranged from $1.77 to $3.13 for newborns and mothers combined and from $2.84 to $3.90 when only the savings in relation to newborns are considered.

In interpreting these findings it must be borne in mind that the estimated savings associated with prenatal WIC participation are independent of the effects of prenatal care on Medicaid costs. That is to say that these savings are in addition to the savings on Medicaid costs associated with adequate or intermediate levels of prenatal care. However, such estimated savings are not independent of any unmeasured characteristics that might also affect medical costs and pregnancy outcomes. To the extent that WIC participants are a self-selected group of women, the estimated savings due to WIC participation may overestimate the true savings. On the other hand, the adequacy of prenatal care is also likely to be related to any such underlying differences between WIC participants and non participants. Moreover, the analysis was able to adjust the estimated savings in costs associated with prenatal WIC participation for the adequacy of prenatal care.

Currently 19 USA states and the District of Columbia have the WIC programme operating for the low income pregnant mothers. Based on the results of these evaluations, the other 31 states would seem to be better off to follow through rather than staying out - both morally and financially.

(Sources: The Savings in Medicaid Costs for Newborns and their Mothers from Prenatal Participation in the WIC Program. United States Department of Agriculture. Food and Nutrition Service. Office of Analysis and Evaluation. Vol. 1; and the New York Times Article “WIC: It Saves Lives and Money”, 1 November 1990)

UNHCR and WFP issue guidelines on use of milk powder.

Improper use of dried skim milk (DSM) has frequently been shown to impose risk to the recipients of food aid or feeding programmes as noted previously in SCN News (No. 4, p. 22). A policy statement proposed by UNHCR and discussed at a meeting organized by the ACC/SCN in April 1989 in Geneva, sets guidelines in order to regulate the distribution and use of DSM in refugee feeding programmes. This statement - reproduced here - is also recommended by the World Food Programme (WFP) to be followed in the case of all WFP-assisted refugee projects, whether approved as Emergency Operations or as Protracted Refugee Projects.

POLICY OF THE UNHCR RELATED TO THE ACCEPTANCE, DISTRIBUTION AND USE OF MILK PRODUCTS¹ IN FEEDING PROGRAMMES IN REFUGEE SETTINGS

1. UNHCR will accept, supply and distribute donations of milk products only if they can be used under strict control and in hygienic conditions, e.g. in a supervised environment for on-the-spot consumption.

2. UNHCR will accept, supply and distribute milk products only when received in a dry form. UNHCR will not accept liquid or semi-liquid products including evaporated or condensed milk.

3. UNHCR will accept, supply and distribute dried skim milk (DSM) only if it has been fortified with vitamin A.

4. UNHCR supports the principle that in general ration programmes protein sources such as pulses, meat or fish are preferred to dried skim milk. UNHCR notes that DSM pre-mixed centrally with cereal flour and sugar is useful for feeding young children especially if prepared with oil.

5. UNHCR will advocate the distribution of dried milk in a take-away form, only if it has been previously mixed with a suitable cereal flour, and only when culturally acceptable. The sole exception to this may be where milk forms an essential part of the traditional diet (e.g. nomadic populations) and can be used safely.

6. UNHCR will support the policy of the World Health Organization concerning safe and appropriate infant and young child feeding, in particular by protecting, promoting and supporting breast-feeding and encouraging the timely and correct use of complementary foods in refugee settings.

7. UNHCR will discourage the distribution and use of breast-milk substitutes in refugee settings. When such substitutes are absolutely necessary, they will be provided together with clear instructions for safe mixing, and for feeding with a cup and a spoon.

8. UNHCR will take all possible steps to actively discourage the distribution and use of infant-feeding bottles and artificial teats in refugee settings.

9. UNHCR will advocate that when donations of DSM are supplied to refugee programmes, the specific donors will be approached for cash contributions to be specially earmarked for operational costs of projects to ensure the safe use of this commodity.

¹ Any non-fresh milk product such as powdered, evaporated, condensed, or otherwise modified milk including infant formula.

* * *

Moreover, in order to assure the safe use of dried milk products in all types of WFP projects and operations, WFP has circulated the following guidelines to its country offices.

1. The WFP commodity list currently includes three types of dried milk products:

DSE-dried skim milk enriched with vitamin A;
DSP-dried skim milk plain (not enriched with vitamin A);
and DWM-dried whole milk which contains fat and vitamin A.

Country offices should be aware of the differences between these products.

2. It is important to note that DSE and DSP are not substitutes for fresh milk as the fat content has been removed. This commodity, therefore, should not be reconstituted as a beverage and consumed by itself, but should be consumed only with other foods.

3. The greatest danger in the use of dried milk products is their potential substitution for breast milk. This must be strictly guarded against in all situations. Dried milk products should not be reconstituted in feeding bottles for children of any age.

4. As vitamin A deficiency is an important public health problem in the majority of countries receiving WFP food aid, current WFP policy regarding the use of dried milk in non-dairy development projects is that it must contain vitamin A. DSE, rather than DSP, therefore, should be specified in all project documents and Plans of Operations and requested on RISIs.

5. In non-dairy development projects dried milk products should be used exclusively in on-site feeding situations, and even then only with the following stipulations: the food prepared with it is consumed on the spot under strictly supervised hygienic conditions, and nutrition education including demonstrations and instructions are provided on the appropriate use of this commodity.

6. Exceptions to the “on-site only” rule may be made in situations where milk is part of the traditional diet and assurance exists that the WFP-provided commodity will be safely used; i.e. never as a breast milk substitute;

only after boiling; and DSE only as an ingredient or with other foods, such as in tea or coffee, or as yoghurt with staple foods, and so forth.

7. Where the necessity for increasing dietary protein arises, blended foods can replace dried milk products.

(Source: Ms A. Berry-Koch, UNHCR; Ms J. Katona-Apte, World Food Programme)

The Protection, Promotion and Support of Breastfeeding

Innocenti Declaration

The Innocenti Declaration on the protection, promotion and support of breastfeeding (cited below) was produced and adopted by participants at the WHO/UNICEF policy-makers’ meeting on “Breastfeeding in the 1990s: A Global Initiative” co-sponsored by the United States Agency for International Development (USAID) and the Swedish International Development Authority (SIDA), held at the Spedale degli Innocenti, Florence, Italy, on 30 July - 1 August 1990 (see SCN News No. 5, p. 36). The Declaration follows.

RECOGNISING that

Breastfeeding is a unique process that:

* provides ideal nutrition for infants and contributes to their healthy growth and development;

* reduces incidence and severity of infectious diseases, thereby lowering infant morbidity and mortality;

* contributes to women’s health by reducing the risk of breast and ovarian cancer, and by increasing the spacing between pregnancies;

* provides social and economic benefits to the family and the nation;

* provides most women with a sense of satisfaction when successfully carried out; and that

* these benefits increase with increased exclusiveness¹ of breastfeeding during the first six months of life, and thereafter with increased duration of breastfeeding with complementary foods, and

¹ Exclusive breastfeeding means that no other drink or food is given to the infant; the infant should feed frequently and for unrestricted periods.

* programme interventions can result in positive changes in breastfeeding behaviour;

As a global goal for optimal maternal and child health and nutrition, all women should be enabled to practise exclusive breastfeeding and all infants should be fed exclusively on breast milk from birth to 4-6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond. This child-feeding ideal is to be achieved by creating an appropriate environment of awareness and support so that women can breastfeed in this manner.

Attainment of the goal requires, in many countries, the reinforcement of a “breastfeeding culture” and its vigorous defence against incursions of a “bottle-feeding culture.” This requires commitment and advocacy for social mobilization, utilizing to the full the prestige and authority of acknowledged leaders of society in all walks of life.

Efforts should be made to increase women’s confidence in their ability to breastfeed. Such empowerment involves the removal of constraints and influences that manipulate perceptions and behaviour towards breastfeeding, often by subtle and indirect means. This requires sensitivity, continued vigilance, and a responsive and comprehensive communications strategy involving all media and addressed to all levels of society. Furthermore, obstacles to breast-feeding within the health system, the workplace and the community must be eliminated.

Measures should be taken to ensure that women are adequately nourished for their optimal health and that of their families. Furthermore, ensuring that all women also have access to family planning information and services allows them to sustain breastfeeding and avoid shortened birth intervals that may compromise their health and nutritional status, and that of their children.

All governments should develop national breastfeeding policies and set appropriate national targets for the 1990s. They should establish a national system for monitoring the attainment of their targets, and they should develop indicators such as the prevalence of exclusively breast fed infants at discharge from maternity services, and the prevalence of exclusively breastfed infants at four months of age.

National authorities are further urged to integrate their breastfeeding policies into their overall health and development policies. In so doing they should reinforce all actions that protect, promote and support breastfeeding within complementary programmes such as prenatal and perinatal care, nutrition, family planning services, and prevention and treatment of common maternal and childhood diseases. All healthcare staff should be trained in the skills necessary to implement these breastfeeding policies.

Further information may be obtained from UNICEF, Nutrition Cluster (H-8F), 3 United Nations Plaza, New York, N.Y. 10017.

(Source: UNICEF, August 1990)

Recent & forthcoming meetings

First European Conference on Food and Nutrition Policy, Budapest, 1-5 October, 1990

This conference was organized by the World Health Organization’s Regional Office for Europe, in collaboration with the Hungarian Ministry of Welfare, and was co-sponsored by FAO and other international and national bodies. It was held to discuss the development of food and nutrition policies that explicitly take account of health.

A modern food and nutrition policy is not only designed to ensure an adequate supply of food at reasonable prices. It also has to consider the health consequences of changes in the amount and type of food consumed, ensure that healthy foods are available, and help populations make wise choices in using them. The conference discussed in detail experiences of countries where such policies already exist. Delegates from eastern and central Europe highlighted the great difficulties their countries were experiencing in supplying populations with a sufficient variety of food.

Although Europe is regarded as developed, there are still pockets of poverty and frank undernutrition where food is scarce and access to a necessary variety of food is unsatisfactory. At the same time, there are significant problems of over-consumption in other parts of Europe. It is because the resultant nutrition-related health problems concern the great majority of the population that WHO strongly advocates the development of broad national food and nutrition policies.

In their conclusions, delegates voiced serious concern that access to food, in terms of both quantity and quality, were still important major problems, notably in countries currently undergoing major changes. They stressed the need for coordinated efforts between countries and between international organizations to help remedy the situation, and they called upon WHO and FAO to support further work in the field of food and nutrition policies. A number of participants saw the development of such policies as the logical consequence of WHO’S strategy of Health for All, which the Region’s thirty-two Member States had adopted in 1984.

(Source: Dr Benbouzid, Nutrition Unit, WHO, Geneva)

In an Inter-regional Seminar on Health Education in Food Safety held 23 September 1990 in Islamabad, Pakistan, the need to initiate intensive health education was stressed. The Senate Chairman Mr. Wasim Sajjad, emphasizing the significance of safe food and water termed it “the most important need of the developing countries”. Speaking at the inauguration of the seminar at the National Institute of Health, he said that in a developing country like Pakistan the issue of food safety becomes more pronounced because contaminated and adulterated food and water is a serious threat to life. Statistically speaking, in Pakistan about 250,000 children under five years of age die every year due to diarrhoea, and about 60% of people face malnutrition, he said. Mr. Wasim stressed that Government would make all efforts to make the food safety programme an essential component of the national health care system. He expressed the hope that those attending the seminar would be able to evolve workable recommendations to tackle the complex issue of food safety, which will, however, require international collaboration. The workshop was organized by the Pakistan National Institute of Health and Ministry of Health with WHO, and attended by representatives from many countries and WHO regional offices.

(Source: The Pakistan Times, 24 September 1990)

A ‘framework’ paper for the forthcoming International Conference on Nutrition, entitled “Meeting the Nutrition Challenge” was issued by FAO and WHO in October 1990. This paper - available from the Conference Secretariat (see below) - covers the nature and dimensions of nutrition problems; principal factors affecting nutritional status; and approaches to improving nutrition. The approaches described address household food security, infectious disease, healthy diets and lifestyles, micronutrient deficiencies, caring capacity, and nutrition in development policies.

A joint FAO/WHO Secretariat has been established at FAO in Rome. Information on the Conference and invitations are being sent out through official channels of communication. The address of the joint ICN Secretariat is: FAO, Via delle Terme di Caracalla, 00100 Rome, Italy.

Environment Conference Preparations.

The United Nations Conference on Environment and Development (UNCED) will be held in Rio de Janeiro, Brazil, in June 1992 (1-12).

States will be represented at the level of Head of State or Government, and arrangements for the broad participation of non-governmental organizations especially from developing countries, have been made.

Maurice Strong has been appointed Secretary-General of the Conference - he had the same role in the 1972 UN Conference on the Human Environment, and was the first Executive Director of UNEP.

In calling for this conference in December, 1989, the UN General Assembly stressed the need to find integrated strategies that would prevent further degradation of the environment and promote sustainable, environmentally-sound development in every part of the world.

The issues to be addressed by the Conference will be organized in six principal components.

1. An “Earth Charter” or declaration of basic principles for the conduct of nations and peoples in respect of environment and development.

2. Agreements on specific legal measures, e.g. conventions for the protection of the atmosphere and biological diversity which would be negotiated prior to the Conference and signed or agreed to at the Conference.

3. An agenda for action, “Agenda 21”, establishing the agreed work programme of the international community for the period beyond 1992 and into the 21st century with respect to the issues to be addressed by the Conference, with priorities, targets, cost estimates, modalities and assignment of responsibilities, plus the means to implement this agenda; i.e.

4. New and additional financial resources.

5. Transfer of technology.

6. Strengthening of institutional capacities and processes.

Special measures are being undertaken to facilitate and support participation by developing countries in preparation for the Conference. A Voluntary Fund has been set up to support participation by developing country representatives in meetings of the Preparatory Committee and its working groups. In addition, extra-budgetary funding is being sought by the Secretariat to support the substantive contributions from developing country experts and institutions to the preparatory work.

The UNCED Secretariat has set up a global Electronic Information Network to provide all interested parties with access to information on the preparations for the Conference. This system is accessible through networks such as TCN and ECONET.

* * *

WHO has established a Commission on Health and Environment which coordinates with UNCED, chaired by Simone Veil (France). It is assisted by four technical panels, on: energy; food and agriculture; industry; and urbanization.

Panel reports are expected in mid-1991. The Commission’s report, based on these, will be transmitted to the World Health Assembly in early 1992, and will then constitute a major contribution to UNCED, and form the basis for WHO’S ‘global strategy for environmental health’.

For information on UNCED please apply to: UNCED, Route de Florissant 160, PO Box 80 CH - 1231 CONCHES, Switzerland. Tel: (00 41 22) 789 16 76

(Sources: UNCED documentation; WHO Executive Board Report, Jan 1991)

The newly structured SEAMEO-TROPMED (South East Asian Ministries of Education Organization Tropical Medicine and Public Health) Community Nutrition Training Programme is implemented by several faculties of the University of Indonesia. The objective of the training programme is to direct personnel of the region responsible for the management and supervision of community nutrition activities (projects/programmes/training/research) towards the improvement of the nutritional situation at the district to regional level.

Three degree programmes and two non-degree ones are provided. Degree programmes will lead to a) Master of Applied Human Nutrition (15 months), b) Master of Science in Applied Human Nutrition (2 years), and c) Doctor of Applied Human Nutrition (3-4 years). The non-degree programmes include: Advanced Training Programme in Management of Community Nutrition (6 months) and Field Research Programme for students of an academic programme at another institution (6 months to 2 years).

The TROPMED Center maintains several important professional links with Indonesian institutions, as well as with international institutions working in the South East Asian region, in North America and Europe. SEAMEO assists the Center in promoting links that enhance the quality of the training programmes. SEAMEO Community Nutrition Training Programme receives technical and advisory support from the Ministry for Economic Cooperation of the Federal Republic of Germany, through the German Agency for Technical Cooperation (GTZ), with supplementary support from the Canadian Government. In selecting research proposals, emphasis is placed on the applicability and adaptability of research to local needs and requirements in the field of epidemiology, management and communication.

For further information on the facilities available at the SEAMEO-TROPMED Center Indonesia and to obtain application forms, please contact: The Directorate of the SEAMEO-TROPMED Center Indonesia, University of Indonesia, 6, Salemba Raya, Jakarta 10430. Indonesia. Tel: 021-330205 and Fax: 021-3106986.

Dutch Government Supports SCN News

The Sub-Committee on Nutrition decided in 1989 that the Secretariat should seek additional funding for a number of the SCN’s programme activities. One of these is the regular production of SCN News. So we applied to the Dutch government for support. We are extremely pleased to report that in mid-1990 the Dutch government agreed to provide funds for one (of the two) annual issues of SCN

News, for the next five years. So this publication - present distribution 5000, and rising - now has a more assured future. We are most grateful to the Dutch Government - and to their representative at the SCN, Ms Elly Leemhuisde Regt, for helping this along.

SCN’s Programme for reporting on the world nutrition situation - support from SIDA, IDRC & FAO; SCN - IFPRI link

The SCN has begun a five year programme to continue reporting on the world nutrition situation. This follows publication of the First Report on the World Nutrition Situation in 1987, the Supplement in 1988, and the ‘Update’ report in 1989 (see SCN News Nos 2 & 4). Funding support for the first 2-3 years of this programme is being provided by SIDA (Sweden), IDRC (Canada) and FAO. We have appointed Dr Marito Garcia as Senior Project Officer, to be responsible day-to-day for the programme for reporting on the world nutrition situation. The first output aimed for is a report in trends in the six most populous countries not included in the 1989 ‘Update’ report: Brazil, Egypt, India, Mexico, Nigeria, Pakistan. These results, with those from 1989, will give direct estimates of nutritional trends for a majority of the populations of developing countries. At the same time, work is continuing - with Dr M Lotfi - on compiling information on women’s nutritional status. Reporting on the ‘6-country study’ and on women’s nutrition are intended in 1991. These will contribute, with other work, to a Second Report on the World Nutrition Situation in 1992.

This programme, starting in December 1990, is being done in collaboration with the International Food Policy Research Institute (IFPRI), based in Washington DC. Marito Garcia, as SCN Staff, is jointly a Research Fellow in IFPRI, in the Food Consumption and Nutrition Policy Programme, headed by Joachim von Braun. A memo of understanding was signed between Drs von Braun and Mason (SCN) in November 1990. This arrangement has many advantages for the programme, particularly in bringing in IFPRI’s extensive experience and renowned expertise in this area.

Increased Priority for Nutrition at World Bank

World Bank President, Barber Conable, at the 1990 Annual Meetings, said that the Bank was rapidly increasing its lending for nutrition. “We have intensified our support,” he said, “for efficient food production and for targeted nutrition programs to replace costly general food subsidies.” Better nutrition “directly addresses the basic causes and worst consequences of poverty... better health and nutrition raise peoples’ productivity and their ability to learn.” He cited nutrition as one of the indicators that could be used to measure progress in reducing poverty.

Japanese Executive Director Masaki Shiratori has added his voice, with a strong plea for more nutrition projects by the Bank. “Nutrition of children deserves our utmost attention,” he said, noting that “the Bank has been relatively silent on this subject.” He would like to see “more regular activities in this sector,” so that the Bank would have a more balanced lending program.

Refugee Nutrition Crisis - Symposium Planned

Severe nutrition problems among refugees have been causing increasing concern, as highlighted previously in SCN News. The Refugee Studies Programme in Oxford is planning an international symposium to highlight the problem and explore solutions. The meeting is planned for 17-20 March 1991, in Oxford. The following is taken from their announcement of the symposium, entitled “Responding to the Nutrition Problem among Refugees: the Need for New Approaches”.

The number of refugees who are dependent on external food aid for prolonged periods has increased dramatically in the past decade. At the same time global food and cash resources are dwindling.

Deaths and much suffering among refugees are often attributed to slow and inadequate response from the international community and, at times, poor organization. Starvation and nutrient deficiency diseases have been associated with the quality and quantity of food provided to refugees. The extent of, and reasons for, such deficiencies in relief must be more widely recognized and better understood if they are not to recur. Areas requiring particular attention and analysis include: nutritional needs and donor food baskets; co-ordination of international food relief assistance; the improvement of evaluation, communication and problem solving; and the roles and responsibilities of international organizations, donor governments and non-governmental organizations.

Protein-energy malnutrition regularly occurs in refugee populations - particularly in children under the age of five years - and there have been regular outbreaks of scurvy (caused by vitamin C deficiency) and pellagra (caused by niacin deficiency), sometimes on an epidemic scale. The unacceptably high rate of malnutrition among refugees in the developing countries, has long been a concern of operational agencies, academics and other professionals involved with refugees and has been regularly articulated by them over the years. Though less frequently, this problem has also drawn media attention. Nonetheless it is a problem which still remains largely unsolved.

The reasons for the worsening malnutrition among refugees are complex, and are not simply the result of a shortage of resources. Problems arise because of misconceptions among decision-makers about nutritional issues, shortcomings in the division of responsibility, failures of co-ordination and a lack of accountability within the international system, and the inadequate collection and use of information.

Nutritional quantity and quality It is widely believed that international food aid supplied to refugees is adequate in quantity and quality to meet nutritional requirements, and decisions about the supply of food aid rations are made on that basis. In fact, such rations are sometimes inadequate in quantity (i.e. dietary energy) and, where rations are composed only of foods from western intervention stocks, generally inadequate in quality - being deficient in their content of vitamin C, vitamin A, iron, and a range of other nutrients.

Evidence shows that nutritional problems are least where refugees trade or exchange portions of their rations to obtain a more balanced diet, or supplement them from paid work, gathering or agriculture. It is where refugees lack such opportunities and must therefore subsist on their distributed ration that nutrition problems arise. These problems are most serious in Africa where populations are most dependent on distributed food aid and where rations are generally the smallest. Consideration of these issues plays no part in current international decision-making and there is clearly a need for the re-examination of food allocation.

Division of responsibility The roles and responsibilities of agencies within the international refugee system are poorly defined. The host government is responsible for the welfare of refugees, but generally lacks the material and sometimes the technical resources to fulfil the obligations which this entails without external assistance.

Lack of co-ordination and accountability Food and financial assistance from donor countries may be channeled through UNHCR, WFP or voluntary agencies, or given bilaterally. Voluntary agencies vary widely in expertise and in numerical presence from refugee situation to refugee situation. Where it occurs at all, co-ordination is conducted by the host government or through informal efforts. Even where co-ordination is attempted, there is no system for ensuring that adequate rations are in fact supplied, nor is there any system of international accountability when they are not.

Information A specific organizational issue is the lack of an agreed system for the collection, flow and use of information. Information on food supply and nutritional status is collected by agencies, but there is currently no formal system by which this information may be introduced into donor/UN decision-making processes. Where nutritional conditions are poor, voluntary agencies have on occasion used the media as the only effective route of communication. There is a clear need to develop a system to ensure that information of an agreed type and quality is regularly collected, introduced and used in policy debate.

The objective of the Symposium is to establish the dimensions of the nutrition-related problems of refugees in developing countries, with a focus on Africa where the problems have the most serious consequences. On the basis of a review of the existing system of food (and other service) provision, and of the current international system of responsibilities, the Symposium will seek to recommend practical and solution-oriented proposals to alleviate the problems identified in refugee relief programmes.

The Symposium will attempt to establish the dimensions of nutrition-related welfare problems of refugees in developing countries. The object will be to uncover the reasons why this crisis has occurred and to develop possible approaches to solutions. The Symposium should lead to a clear statement of the problem and its roots.

A series of case studies has been commissioned for presentation at the Symposium. Issues to be addressed in these case studies will include the following.

- the nutrition-mortality link

- general ration failures, vitamin deficiencies and public health inadequacies

- the potential for rapid stabilisation of emergency situations through timely aid; the problem of the patchy response of aid

- agency roles and responsibilities; the lack of clarity of agency mandates

- problems faced by vulnerable groups

- how camp conditions create nutritional diseases even with fairly good rations

- the problem of registration and why confrontational relations develop between donors, agencies and host governments

- refugees’ dietary responses and their own resourcefulness

- the impact of repatriation on the provision of rations

- the potential for institutional capacity to monitor and respond to new situations.

Since the timing of the Symposium is subject to world events, those interested should contact, for further information, Refugee Studies Programme, Queen Elizabeth House, University of Oxford, 21 St Giles, Oxford OX1 3LA. Fax: (0865) 270729 or 270721

Conference on Food Standards, Chemicals in Food and Food Trade, Rome, 18-27 March, 1991.

Protection of the health and well-being of all consumers and the removal of unnecessary technical barriers to trade in food are important elements in expanding world agricultural production and in ensuring world food security. All countries need to assure that national food supplies are safe, of good quality, and available in adequate amounts at affordable prices. There have been major changes at the national level over recent years in the attitudes of many governments to food standards and other means of regulating and promoting the production of good quality and safe foods.

An intergovernmental conference on this topic will be held jointly by FAO/WHO in cooperation with GATT from 18-27 March, 1991 in Rome. Member countries of FAO and WHO and observers from international organizations concerned have been invited to attend. The conference - conducted in English, French and Spanish - will address besides food standards the topic of chemicals in foods and associated consumer concerns. The main aim would be to evaluate the work and outputs of the joint FAO/WHO Expert Committee on Food Additives (JECFA), and the joint FAO/WHO Meeting on Pesticide Residues (JMPR) as well as other ad hoc expert groups, to assess how they are being used by FAO and WHO member States and the Codex Alimentarius Commission (CAC). Questions which need to be discussed and resolved include technological justification as a part of evaluation; approaches used in assessing veterinary drug residues in foods; and practical methods of estimating intake of additives, pesticide and veterinary drug residues, or contaminants in foods.

Another theme of the conference will be food import/export control problems. While the need for protection of the consumer is now well recognized, the complexity of food import controls and the wide range of certification and other requirements of some food importing countries are creating difficulties for food exporting countries. A global meeting of representatives of national import and export food control authorities is, therefore, necessary to discuss the various means which would maintain the protection of the consumer while, at the same time, harmonizing, standardizing and where possible simplifying the food import requirements of importing countries.

More information from R.J. Dawson, Senior Officer, Food Quality and Consumer Protection Group, Food Quality and Standards Service, Food Policy and Nutrition Division. FAO, Via delle Terme di Caracalla, 00100, Rome. Tel: 0039657971; Telex: 610181 FAO 1; Fax: 57973152.

Symposium on Food and Nutrition in the Tropical Forest

An international scientific symposium is being organized by UNESCO and the CNRS (Centre National de la Recherche Scientifique, France), on the topic of Food and Nutrition in the Tropical Forest: Biocultural Interactions and Applications to Development. The symposium will be held at UNESCO House in Paris from 10-13 September 1991, in English and French with simultaneous translation. An international scientific advisory group is being formed to cooperate with UNESCO and CNRS in the organization of the symposium.

A range of biocultural themes will be addressed by 100 to 150 specialists involved in research and management related to food and nutrition in tropical forest environments. Current understanding and recent advances in respect to food and nutrition in tropical forest environments will be reviewed. The symposium will aim at identifying possible applications of such knowledge to development projects and processes in the humid forested zones of Africa, South and Central America, Asia and Australia. It is hoped to bring together existing information within a comparative perspective, with a view to producing, besides a main book, a range of syntheses for distribution to planners concerned with resource management and cultural development issues in humid tropics.

For more information please contact Dr. C.M. Hladik, Laboratoire d’Ecologie du Museum, 4, Avenue du Petit Chateau, 91800 Brunoy, France.

(Source: Dr. S. Van der Vynckt, ED/STE, UNESCO, France)

The IUNS Committee “Urbanization and Nutrition”, the Malaysian Society of Nutrition, South East Asian Ministries of Education Organization Tropical Medicine and Public Health (SEAMEO-TROPMED), and the Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) will organize from 11 to 14 September, 1991 in Kuala Lumpur, Malaysia, a pre-conference workshop entitled “Nutrition in the Metropolitan Areas”, on behalf of the Sixth Asian Congress of Nutrition. It is the objective of the Workshop to stimulate nutritional projects and programmes in research and intervention in the metropolitan areas of Asia. Information on this workshop can be requested from SEAMEO-TROPMED, University of Indonesia, 6, Salemba Raya, Jakarta 10430, Indonesia, or from the organizers of the Sixth Asian Congress of Nutrition. Tel: 021-330205; Fax: 021-3106986.

(Source: Prof. Asri Rasad, National Representative, SEAMEO-TROPMED Center, Indonesia)

This conference - the second in an annual series on Micronutrients and Health - to be held 25-26 March 1991, at the AFRC Institute of Food Research, Norwich, UK, discusses the analytical problems associated with the determination of trace elements in the context of their nutritional and other roles. It aims to bring together food analysts and technologists, nutritionists, biochemists, dietitians and the medical profession. The programme has been designed so that scientists concerned with the biological effects of trace elements can both appreciate the current limitations of the analytical methodology, and understand how these may be overcome in the future. The analyst should gain a comprehensive understanding of modern developments in this area. This diversity of participants should lead to stimulating discussion centred on the presentations from speakers of international repute.

Further information: Kay Russell, Elsevier Seminars, Mayfield House, 256 Banbury Road, Oxford OX2 7DH, UK. Telephone: 44 (0)865 512242 Fax: 44 (0)865 310981

(The conference fee is £287.50)

Iodine Deficiency in Europe A Continuing Concern

Apparently iodine deficiency continues to be a problem in at least 12 European countries, occasionally involving cretinism. Iodine intake is still on the borderline or clearly deficient in several European countries. For this reason, Iodine Deficiency in Europe will be the topic of a workshop to be held in Brussels, from 25 to 28 of April 1992. National and international organizations and agencies, including ICCIDD, WHO (Headquarters and European region) and UNICEF will sponsor the workshop.

The goal of the workshop is to promote action to normalize iodine intake in the Western and Eastern European countries. The scientific objectives of the workshop are: to review the factors involved in thyroid growth; to discuss the methodology of evaluation of IDD in industrialized countries; to update the evaluation of iodine nutrition and goitre in Western and Eastern Europe; to evaluate the consequences of iodine nutrition on foetuses and newborn and pregnant women; to compare the European situation with the United States, Canada, Japan and Australia; to discuss the implications of the European situation in relation to nuclear hazards and to discuss and stimulate the possible prophylactic and therapeutic approaches in Europe. There will be state-of-the-art lectures and reports on the national situation in each European country by invited speakers, poster presentations by other participants, and time for discussions in round-table.

The deadline for receipt of abstracts in Brussels is December 1991 and for registration is March 1992.

For further information please contact Dr. F. Delange, M.D., Dept. of Radioisotopes, Hospital Saint-Pierre, Rue-Haute 322, B-1000 Brussels, Belgium.

Meetings on Food Crisis in 1991/2

Some of the meetings announced in the International Geographical Union Study Group Newsletter (see source), in the areas of populations and refugees food crisis are the following:

International Workshop on Population Movements, Food Crisis and Community Response. January 1991, Centre for the Study of Administration of Relief, New Delhi.

International Symposium: Responding to the Nutrition Crisis of Refugees, March 1991. Refugees Studies Programme, University of Oxford. (see previous article).

XVII Pacific Science Congress, Honolulu, Session on “Famine: Process, Vulnerability, Coping Strategies, Policy”, Honolulu, Hawaii, May/June 1991.

Fourth Annual Hunger Research Briefing and Exchange, World Hunger Program, Brown University, Providence, USA. April 1991. (see below)

(Source: Famine Research and Food Production Systems, International Geographical Union Study Group, Newsletter No. 3, December 1990)

The theme of this year’s Annual Hunger Research Briefing and Exchange, organized by Brown University, is “Implementing the Bellagio Declaration: Ending Half of the World’s Hunger by the Year 2000”. The Bellagio Declaration is an international call for action that stems from a meeting of 23 planners, practitioners, opinion leaders, and scientists, held in Bellagio, Italy, in November 1989 (see also Programme News section under WFC).

The meeting will focus on the four major goals of the Bellagio Declaration, with the aim of developing a consensus on implementing strategies. These achievable goals for overcoming hunger in the 1990s were identified as 1) to eliminate deaths from famine, 2) to end hunger in half of the poorest households, 3) to cut malnutrition in half for mothers and small children and 4) to eradicate iodine and vitamin A deficiencies. (See also articulation of goals in Programme News section of this issue under WFC.)

The Briefing - designed to encourage dialogue among researchers and practitioners concerned with alleviating hunger - will be held at Brown University in Providence, Rhode Island, on April 3-5, 1991, in conjunction with the awards ceremony for the 1990-91 Alan Shawn Feinstein Awards for the Prevention of World Hunger. It is cosponsored by the Alan Shawn Feinstein World Hunger Programme and Interaction, the American Council for Voluntary International Action. The meeting will be supplemented with an extensive exhibit of publications and a notebook of abstracts of recently completed ongoing research and project reports.

For more information please contact: Briefing Coordinator, World Hunger Program, Box 1831. Brown University, Providence, Rhode Island, 02912, USA. Tel: 401-863 2700, Fax: 401-863 2192

(Source: Fourth Annual Hunger Research Briefing and Exchange, Preliminary Announcement Flyer, December 1990)

PLUS News from International Union of Nutritional Sciences (IUNS)

We are pleased to have agreed with IUNS to regularly include information on IUNS in SCN News. This being the first time, we give some general background on IUNS and its activities. In future issues we plan to provide updates on this.

The International Union of Nutritional Sciences (IUNS) was elected in 1968 to membership of the International Council of Scientific Unions (ICSU), which is a non-governmental organization, formed in 1931 to promote international scientific activity in the different branches of science and their application for the benefit of humanity. It is composed of twenty scientific member unions, one of which is the International Union of Nutritional Sciences.

The objectives of IUNS are: to promote international cooperation in the scientific study of nutrition and its application; to encourage research and the exchange of scientific information in the nutritional sciences.

IUNS has sponsored fourteen International Congresses of Nutrition, the most recent having been held in Seoul, Republic of Korea, in August 1989.

The main scientific work of IUNS is done by its commissions, committees and working groups on special topics. There are five commissions, 43 committees and five working groups.

IUNS has special consultative status with FAO, WHO, and the United Nations Children’s Fund, is an associate member of the Council for International Organizations of Medical Sciences, and has signed a Memorandum of Understanding with the United Nations University. Close cooperation exists with UNESCO and with various ICSU bodies, and with the International Union of Food Science and Technology. IUNS and ACC/SCN have a reciprocal arrangement to attend each others’ meetings.

At present, IUNS has 64 National Adhering Bodies. The present officers are: President, J.E. Dutra De Oliveira (Brazil); President-Elect, A. Valyasevi (Thailand); Vice-Presidents, A.A. Rerat (France), A.S. Truswell (Australia); B.A. Underwood (USA); Treasurer, E. Menden (FRG); Immediate Past-President, M.K. Gabr (Egypt); Secretary General, J.G.A.J. Hautvast (Netherlands).

The Directory 1989-1991 of the International Union of Nutritional Sciences is available free of charge at the following address:

IUNS Secretariat
Miss Riekie Janssen, Executive Secretary
c/o Department of Human Nutrition
Agricultural University
P.O. Box 8129
6700 EV Wageningen
The Netherlands Fax: 31-8370-83342

Commission I: Responsible Vice-President: Barbara A. Underwood

I/1: The Nutritional Aspects of Food Standards. A.L. Forbes (USA). I/2: Biological Role of Different Fatty Acids in Human Nutrition. Joyce Beare-Rogers (Canada). I/3: Nutrition and Urbanization. R. Gross (FRG). I/4: Infant and Pre-School Child Nutrition Policy and Socio-economic Change. Marina F. Rea (Brazil). I/5: References of Growth and Physical Development. R. Trowbridge (USA). I/6: Assessment of Population Nutrition Status and Programme Evaluation for Developing Countries. L.F. Fajardo (Colombia). I/7: Nutrition Requirements in Pregnancy and Lactation. Janet C. King (USA). I/8: Nutrition and Development. Margaret R. Biswas (UK). I/9: Household Food Handling. B. Phithakpol (Thailand). I/10: Food and Nutrition in Africa. T.N. Maletnlema (Tanzania). I/11: Functional Consequences of Vitamin Deficiencies. K. Pietrzik (FRG). I/12: Nutrition in Schools of Home Science. R. Devadas (India). I/13: Nutrition and Aids. Chairperson to be decided. I/14: Nutrition Education and Training of Nurses and Auxiliary Health Workers. E.F. Patrice Jelliffe (USA). Liaison IVACG: B.A. Underwood (USA). Liaison INACG: T. Morck (USA)

II/1: Nutritional Terminology. F. Weber (Switzerland). II/2: Dictionary. C. Leitzmann (FRG). II/3: Dietary Recommendations for Populations and Individuals. A. Bruce (Sweden). II/4: Techniques for Measuring the Value of Foods for Man. D.A.T. Southgate (UK). II/5: Drugs and Nutrition. J.N. Hathcock (USA). II/6: Nutrition and Anthropology. Harriet V. Kuhnlein (Canada) and Isabel Nieves (Guatemala). II/7: National Nutritional Surveillance. Lenore Kohlmeier (FRG). II/8: Nutrition and Ageing. M.L. Wahlqvist (Australia). II/9: Mental Development and Behaviour. E. Pollitt (USA). II/10: Nutrition and Cardiovascular diseases. Chairperson to be decided. II/11 Nutrition and Obesity. Chairperson to be decided. II/12 Nutrition and Immunity. R.K. Chandra (Canada). II/13 Nutrition and Cancer. J.H. Cummings (UK). II/14 Nutrition Training in Schools of Medicine, Dentistry and Public Health. J.E. dos Santos (Brazil). II/15: Advanced Degrees in Nutrition Science. S. Berger (Poland). II/16: Nutritional Significance of Colostrum. D.B. Jelliffe (USA). Liaison Officer ICDA: A.S. Truswell (Australia). Liaison Officer ICCIDD: B.S. Hetzel (Australia)

III/1: Animal Models in Human Nutrition Research. A.C. Beynen (Netherlands). III/2: Food, Nutrition and Biotechnology. J.F. Diehl (FRG). III/3: Food Gardening for Improvement of Nutrition. Vera Ninez (Peru). III/4: Nutrition and Food Science in Schools of Agriculture and Veterinary Science. M. Vanbelle (Belgium). III/5: Nutrition and the Production of Fish. C.Y. Cho (Canada). III/6: Nutrition of Pigs. M.W.A. Verstegen (Netherlands). III/7: Nutrition of Poultry. Z. Nitsan (Israel). III/8: Nutrition of Ruminants. D. Sauvant (France). III/9: Influence of Drying and Smoking on the Nutritional and Functional Properties of Fish. P. Doe (Australia). III/10: Nutritional Consequences of Modern Trends in Plant Production. C. Costes (France). III/11: Nutritional Consequences of Modern Trends in Animal Production. W.G. Pond (USA). III/12: Pollution and Nutrition. S. Maletto (Italy).

FANS:	Sixth Asian Congress of Nutrition, Kuala Lumpur, Malaysia, 16-20 Sept. 1991.
SLAN:	Congress will be held in Puerto Rico, 22-25 Sept., 1991.
FENS:	Next FENS congress in Athens, Greece, May 26-28, 1991.
ISCN:	International Symposium on Clinical Nutrition in Heidelberg (Germany), 2-4 October, 1991.

Recent IUNS Reports. These reports can be requested from the IUNS secretariat - the procedure is to write to IUNS who will quote you a price; then you can order from them if you wish.

IUNS Workshop on IUNS and the Food Processing Industry, Amsterdam, The Netherlands, 21 February 1986. European Journal of Clinical Nutrition (1989), 43, 733-736.

IUNS Workshop on Fostering Nutrition Among Countries, San Diego, USA, 26 April 1987. Food and Nutrition Bulletin, 11 (3), September 1989, 58-63.

Report Fourth Workshop on Nutritional Quality and Labelling in Food Standards and Guidelines. IUNS Committee 1/2 on Nutritional Aspects of Food Standards, January 9-11, 1989, Taxco, Mexico, 27 pp, xeroxed.

Report Meeting IUNS Committee II/12 on Nutrition and Physical Performance, Prague, Czechoslovakia, 1989, 5 pp, xeroxed.

The State of Food and Nutrition in Africa 1970s-1980s. IUNS Working Group II/3 on Food and Nutrition in Africa, 1989, 116 pp, xeroxed.

Guidelines for Training Nurses and Midwives as Lactation Counsellors. (1989) Ed. E.F. Patrice Jelliffe, Chairperson IV/6. This publication has been made possible thanks to assistance of UNICEF. ISBN 92 806 0036, 134 pp.

Proceedings International Symposium dedicated to the 640th Anniversary of Charles University: Nutrition, Metabolism and Physical Exercise. Jana Parizkova, ed., IUNS Committee II/12, 1989, 305 pp. Published by Universitas Carolina Pragensis. ISBN no. 80-7066-155-0.

Proceedings XIVth International Congress of Nutrition, Seoul, Korea 1989: New Era! Global Harmony Through Nutrition. Volume I: Keynote lecture, Plenary lectures, Symposium lectures. Kim Wha Young, Lee Yang Cha, Leed Ki Yull, Ju Jin Soon, Kim Sook He eds., 1989, 1052 pp. Order should be made to: Kim Sook He, c/o Dept. of Foods and Nutrition, Ewha Womans University, Seoul 120-750 Korea.

Proceedings XIVth International Congress of Nutrition, Seoul, Korea 1989: New Era! Global Harmony Through Nutrition. Volume II: Workshops. Kim Wha Young, Lee Yang Cha, Lee Ki Yull, Ju Jin Soon, Kim Sook He eds., 1989 345 pp. Order should be made to: Kim Sook He, c/o Dept. of Foods and Nutrition, Ewha Womans University, Seoul 120-750 Korea.

Special Issue of The Korean Journal of Nutrition, published by Bimonthly by the Korean Nutrition Society: The 14th International Congress of Nutrition, 22 (5), 1989, 327-417.

Directory of IUNS 1989-1991, 120 pp. See above.

Dietary Studies in Europe: 1. Dr. Lenore Kohlmeier, ed. IUNS Committee II/6 on Nutritional Surveillance. To be published by Smith-Gordon, UK. ISBN No. 185463 0466.

Nutrition Surveillance as the Backbone of National Nutrition Policy. Recommendations of the IUNS Committee II/6, Dr. Lenore Kohmeier, chairperson, pp. 26. To be published.

Provisional Scientific Program for Fifteenth International Congress of Nutrition, Adelaide, South Australia, September 26 to October 1, 1993.

The following elements of the Program for XV Congress were proposed by the Program Committee on 26 September 1990 and, after some amendment, were endorsed by the Executive Committee on 28 September 1990 at the Fairmont Resort, Leura, New South Wales.

2. MAJOR THEMES

2.1 Nutrition policies and programs, national and international. Policies and objectives, debt and finance, trade, technology, sustainable agriculture, resources, population growth, urbanization, surveillance, regional problems, health, specific nutrients].

2.2 Nutrition and the environment. Environment and food production, impact on sustainable agriculture, implications of the Greenhouse effect, Geophysical-/Biophysical program and world nutrition, toxic residues, oceanic pollution].

2.3 Nutrition through the life cycle. Pregnancy, lactation, infant, child and adolescent, aged].

2.4 Prevention of chronic disease. Obesity, cancer, cardiovascular disease, hypertension, osteoporosis, diabetes].

3.1 Nutrition and nutritional anthopology of aboriginal people. Nutrition and disease, nutrition and growth, indigenous foods, cultural effects on nutrition, nutritional anthropology, paleonutrition].

3.2 Cell biology and molecular biology of essential nutrients.

3.3 Nutrition and performance. Athletic, behavioural, cognitive].

4.1 Digestion of fibre in ruminants and non-ruminants.
4.2 Comparative nutrition including marsupials.
4.3 Nutrition of marine organisms, implications for humans.
4.4 Body composition - new approaches
4.5 Genetic sensitivity to nutrients
4.6 AIDS and nutrition
4.7 Nutritional treatment of chronic disease
4.8 Alternative and unorthodox dietary regimes
4.9 Nutritional consequences of substances of recreation and abuse
4.10 Antioxidants
4.11 Food hazards, food additives
4.12 Microbiological pathogens in food
4.13 Simulated foods, their impact on nutrition

5.1 Regulation of appetite
5.2 Sensitivity to food
5.3 Nutrient effects in the gastrointestinal tract
5.4 Childhood nutrition and adult chronic disease
5.5 Diet and pancreatic cancer
5.6 Oligosaccharides
5.7 Food colours, including carotenoids
5.8 Food flavours and appetite
5.9 Food labelling
5.10 Nutritional assessment
5.11 New methods for measuring metabolic rate
5.12 Measurement of complex carbohydrate
5.13 Vitamin A and Xerophthalmia
5.14 Fetal growth retardation

6.1 Nutrient data bases
6.2 Nutritional terminology
6.3 Food habits of the elderly
6.4 Food irradiation
6.5 Slimming diets
6.6 Clinical nutrition programs
6.7 Nutrition education for physicians
6.8 Nutrition education standards
6.9 Interaction of drugs and nutrients
6.10 Recommended dietary allowance
6.11 Safe ranges for trace elements in food
6.12 Nutrition and skin health
6.13 Cytokines

R M Smith, Secretary General, XV IUNS Congress of Nutrition, PO Box 10041, Gouger Street, ADELAIDE, South Australia 5000. Tel. 61-8-224-1800 Fax. 61-8-224-1841 Telex. 82242

Letter to IUNS Members from the IUNS President, Prof Dutra-de-Oliveira

This is my President’s letter regarding some 1990 activities and the 1991 plans.

1990 was a very special year because it gave us a new hope for the world with the opening of East Europe. Now, the perspective of a Gulf War is very dramatic for all of us. Let us pray for better and peaceful days, let us hope for a better understanding among all men and let us believe that Nutrition can be a link uniting mankind.

IUNS 1990 Activities

One of our main 1990 objectives was to increase IUNS and Nutrition visibility. IUNS cannot be restricted to the work of its Commissions and Committees and the patronage of the International Nutrition Congress.

As IUNS President I was invited to the WHO General Assembly in Geneva, where Nutrition Research was one of the subjects discussed. IUNS was present at the 3 preparatory meetings for the International Conference on Nutrition to be held in Rome at the end of 1992 and sponsored by FAO/WHO. We also attended nutrition meetings in Austria and Portugal.

Nutrition is still lacking a clear identity. Many times it has been considered a tool for other areas. I really believe we will be able to give Nutrition its place in the scientific world, as an area founded on sound basic and applied research. I acknowledge here the efforts of Vernon Young, the AIN President, fighting for a better recognition of nutrition or nutritional sciences in the States.

Who is Who in the World Nutrition

A Directory with a list of Nutrition Specialists seems to be a must in the area. Who are the people trained and working in nutrition in different countries? What are they doing? What about their publications? This is important for people in the area, for Governments, for the United Nations Organizations. Initial work on these lines was started by Manuel Amador, from Cuba, in relation to Latin America including: 1 - the names of people working in Nutrition, 2 - their areas of work and so on.

IUNS recognition of Nutrition Centres

During many years, several nutrition professionals have been trained in their own countries and abroad at well known nutrition centers of the advanced countries. How many of them are back in their countries and have a reasonable set up to carry on research and training?

We want to hear your opinion on having some local Centres recognized by IUNS to stimulate and further support their activities. Which parameters would be reasonable to evaluate the local group and provide the recognition? Stewart Truswell has drafted an initial proposal on this subject.

IUNS Fellows

It is our hope to identify and distinguish Senior Nutrition Scientists who enhanced nutrition research and/or performed outstanding services in different countries in an effort to bring out names and persons who have contributed to our science in different countries. The recognition of them could occur every 4 years during our International Congresses. Vinodini Reddy is helping us on this subject.

Committees

These have been the traditional IUNS bodies promoting research, information and cooperation among nutritionists. The 3 Vice Presidents are in charge of them, trying to stimulate their work. We hope for more international participation in this IUNS activity and an increase in quality and productivity.

Adhering Bodies

Although there was a low feedback to our call for participation from the Adhering Bodies, we are still looking forward to advice, suggestions and recommendations from them. Increasing the number of Adhering Bodies is also one of our main goals. Each one of the Council Members is in charge of a region. Please let them know about suitable country nutrition societies in your area.

International and Regional Meetings

Council Members were present in several scientific meetings in 1990. This activity is considered one of our priorities. If invited, IUNS will send a Representative to your Meeting in 1991.

International Congress of Nutrition

As it is known, Australia is the host to our International Congress, September 1993.

Besides the traditional format of Congresses, it has been proposed to hold a small number of tutorial courses, before or after the meeting, that would give a better opportunity to young scientists to receive specific training and to meet colleagues from other countries. Other suggestions for parallel activities are welcome. The Australian organizers are working hard and the program is well advanced. More input from the Adhering and Affiliated Bodies is called for.

Address re Congress: XV International Congress of Nutrition, The Secretariat, CSIRO - Division of Human Nutrition, Kinpore Avenue, Adelaide, South Australia 5000, AUSTRALIA.

Address of Prof Dutra-de-Oliveira: Faculdade de Medicina, 14.049 Ribeirao Preto, SP - Brazil.