PROGRAMME NEWS - Update on progress around the world

AUSTRALIA

Nutrition Improvement in Vietnam

The Australian Government through its Australian International Development Assistance Bureau (AIDAB) has approved a grant of US$1.1 million to FAO to undertake a nutrition project in Vietnam. The project is a combined nutrition agriculture programme which will focus on nutrition improvement of the population with special reference to vitamin A deficiency. The three-year project will commence in January 1991. The immediate objectives of the programme are as follows.

1. Identification of dietary deficiencies in qualitative and quantitative terms in selected provinces, with the National Institute of Nutrition as the main responsible organization.

2. Identification and propagation of most suitable species and varieties of horticultural crops to be grown in home - gardens so as to correct the identified nutritional problems, with the Ministry of Agriculture and Food (MOAF) as the main responsible organization.

3. Promotion of horticultural crops production with growers, with MOAF as the main responsible organization.

4. Promotion of the distribution and the consumption of foods to achieve dietary adequacy and prevent deficiency diseases, including vitamin A deficiency, with the National Institute of Nutrition as the main responsible organization.

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Australian Food Composition Tables

Since 1981, the Australian Government through the Department of Community Services and Health, has been funding a major food analytical programme to update the national nutrition reference on the nutrient composition of Australian foods. A series of volumes under the title of Composition of Foods, have recently been published providing detailed nutrient data on some 1400 foods. The food groups included in the volumes are -

Volume 1 - Meats, fruit and vegetables, snack and take-away foods.
Volume 2 - Cereals and cereal products.
Volume 3 - Milk and milk products, eggs and fish.
Volume 4 - Fats and oils, processed meat, fruit and vegetables.
Volume 5 - Nuts and legumes, beverages and miscellaneous foods (to be published in December 1990).

For further details on the Australian Food Composition Tables contact Mrs. Ruth English, Chief Nutritionist, Commonwealth Department of Community Services and Health, P.O. Box 9848, Canberra, ACT 2601, Australia.

CANADA

Canada to Fight Nutritional Deficiencies

The Canadian Government is determined to fight vitamin A and iodine deficiency disorders that affect millions of children in the Third World annually. The new initiative was announced, on October 16th, the World Food Day, by the Minister for External Relations, Monique Landry.

The nutrition initiative, to which the Canadian International Development Agency (CIDA) will contribute $5 million over a three-year period, will be implemented through two channels. First, the resources will be provided to multilateral agencies already active in the field of nutrition, such as UNICEF and WHO, and to Canadian non-governmental organizations. Secondly, assistance will be given to developing countries to design and implement programmes to ensure intake of appropriate dietary levels of vitamin A and iodine by their populations.

For further information, contact: Isabelle Hundon, Special Assistance: Communications, Office of the Minister. Hull, Canada. Tel: 819-994 6161. Or Paule Parent, Public Affairs Branch, CIDA. Hull, Canada. Tel: 819-9536060.

(Source: Ministry of External Relations and International Development, Canada, communicated by Dr S. Rabeneck, CIDA)

Update on FAO’s Nutrition Country Profiles

As noted in previous issues of SCN News (nos 2 & 3) FAO has initiated since 1986 development of nutrition country profiles in response to the ever-increasing requests for current information on the food and nutrition situation of member countries. The profiles are published regularly and updated routinely. So far the profiles are completed for 90 out of 123 developing countries.

Nutrition country profiles are based on information prepared at the country level by nationals or national nutrition institutions, using the most recent information available. The information is then reviewed and put into the standard format by FAO in Rome. Related information is added from the FAO Food and Agricultural Information System (AGROSTAT), World Health Organization, UN population statistics and other referenced sources.

The profiles provide a concise overview in about 15 to 20 pages of the food and nutrition situation of a country. Brief explanatory texts and supporting data on the most relevant nutrition items are also included. Where possible, trends are shown, as well as differences between regions within countries. Supplementary information is included on a limited number of related topics, such as agricultural production and food availability, national economic events, population changes, access to services, and literacy levels.

Nutrition country profiles can aid governments and institutions to identify disadvantaged areas within a country, and in national, sectoral and project planning. They can be a useful teaching tool in nutrition and agriculture and can improve the capability of national institutions to represent food and nutrition information in the context of related events.

All profiles will soon be available on the FAO Agricultural Information Centre (WAICENT) for users with access to international computing networks. Copies of any of the profiles completed to date may also be obtained in print or diskette form by writing to the Food Policy and Nutrition Division, FAO, Via delle Terme di Caracalla, Rome, Italy.

(Source: ESN, FAO, Rome)

Eliminating IDD

The virtual elimination of iodine deficiency disorders (IDD) has been included within the Plan of Action adopted by the recent World Summit for Children at the United Nations, New York on 30 September 1990.

The IDD Task Force for Africa had its fourth meeting at Dar-es-Salaam (28 February-2 March 1990). This followed the Annual ICCIDD (International Council for Control of Iodine Deficiency Disorders) Board Meeting and was attended by representatives of five Anglophone countries. Particular emphasis was placed on the development of human resources. Two management training workshops (one Anglophone, one Francophone) have been organized for early 1991.

The Regional IDD Working Group for S.E. Asia held a meeting in Delhi (9-12 October 1990) at which good progress was reported by representatives of 6 countries. For the first time Mongolia reported recent goiter surveys indicating a significant problem. Other regional groups reviewed progress in the Middle East (Tehran 5-9 August) and in China (Beijing, 19-20 October).

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

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International Training and Support Programme for IDD Control

UNICEF has funded and ICCIDD has endorsed a project entitled “International Programme for the Control of Iodine Deficiency Disorders (IPCID)” which will be implemented beginning in January 1991 by the Emory University School of Public Health, and the Centres for Disease Control (CDC), Atlanta, U.S.

The goal of this programme is to offer the necessary consultative support to assist countries to develop the technical and scientific independence necessary to manage an effective IDD control programme. Ideally, countries will continue to participate in regional and global IDD control activities organized through ICCIDD and other international organizations. Host countries are invited to participate in this project at a cost of approximately $150,000, which covers all costs related to laboratory implementation and reagents for its first year of operation, training of three host country scientists, travel, expenses for all training and up to three workshops.

(Source: Dr. G.F. Maberly, Programme Director, IPCID, Emory University School of Public Health. Atlanta, Georgia, 30329 USA. Tel: 1-404-727 8720; Fax: 1-404-727 8737)

Long-term Effects of Early Nutrition

The International Dietary Energy Consultative Group (IDECG) convened a workshop on “Improved Protein-Energy Intakes in Early Childhood and Human Capital Formation: The Guatemalan Oriented Study” at the Rockefeller Foundation Conference Centre in Bellagio, Italy from July 30 to August 3, 1990. Additional financial support was provided from USAID. The workshop reviewed in depth the long-term results of an INCAP (Institute of Nutrition of Central America and Panama) intervention study from 1969 to 1989. In this study a nutritious supplement was provided to pregnant mothers and their preschool children in two villages. Another two villages provided comparative data. It was demonstrated that fifteen years later the children who received the nutritious supplement were about two centimeters taller, had a higher physical capacity, and performed significantly better on behavioural tests including the Guatemalan National Achievement Test. These recent findings will give new impetus to programmes for the prevention of malnutrition in the preschool child.

The proceedings of the 1989 IDECG workshop on “Activity, Energy Expenditure and Energy Requirements of Infants and Children”, held in Cambridge, Massachusetts, were published in November jointly with the Nestle Foundation (see Publication section of this issues).

(Source and more information from Dr. N.S. Scrimshaw, Food, Nutrition and Human Development Programme, Harvard Centre for Population Studies, Nine Bow Street, Cambridge, MA 02138, USA. Tel: 617-495-0417; Fax: 617-495 5418)

Research Thrusts of IFPRI’s Food Consumption and Nutrition Policy Program

The activities in the Food Consumption and Nutrition Policy Program at IFPRI seek to contribute to the knowledge and understanding of how public policies affect real incomes, food consumption, and the nutrition of low-income households and individuals within these, in order to assist in policy formulation and implementation.

In Pakistan, a study is currently under way on household-level food security and the effects of government policies, including price and subsidy policies. This is based on a longitudinal survey of 1,200 households in rural areas. In this research, IFPRI has been exploring the means by which households respond to short-term shocks in income. With 10-15 percent of total incomes coming from pensions and remittances and another 40 percent from non-farm activities, these rural households are shown to be integrated into the larger economy. Nevertheless, droughts and floods have greatly affected earnings of many of the households. Preliminary evidence indicates that household expenditures are cushioned from such fluctuations by savings and readily available consumption credit.

A new project examining cost-effective ways of implementing a rural food ration in Bangladesh was initiated in 1989. Effective targeting and nutritional improvement are key policy objectives, as well as developing an ability to respond to crises in food entitlements.

Studies on the effects of commercialization of smallholder agriculture have been completed in six countries cutting across different types of commodities, sectoral structures, and infrastructure situations: (1) shift from maize to sugar-cane in the Philippines, (2) introduction of export vegetable production in Guatemala, (3) shift from traditional swamp rice to high-yielding irrigated rice in The Gambia, (4) expansion of tea and potato production in Rwanda, (5) a follow-up study in Kenya on shift from maize to sugarcane, and (6) a similar study performed by HIID in Malawi.

Studies on the commercialization of agriculture in The Gambia, Guatemala, and Kenya examined the linkages among cash crop production, household income, food consumption, and health and nutritional status. Results indicate that income-generating schemes such as commercialization make a major contribution to alleviating the hunger problem. However, increased household income alone is insufficient to solve the malnutrition problem in women and preschoolers. Agricultural policies and programs must be combined with health and nutrition activities in order to bring about a significant reduction in malnutrition in the short term.

IFPRI studies on the effects of technological change in agriculture suggests that when the nutritional situation did not improve in areas where agricultural technology had improved, there was a deterioration in intra-household factors, particularly affecting women. For example, in areas in Zambia where households substantially adopted improved agricultural technologies, there was little improvement in nutrition and health status. Investigation revealed that work loads increased by 50 percent during peak work periods, whereas calorie consumption increased by only 30 percent in the study households. In addition it was found that women’s work loads were continuing to increase while their economic roles as decision makers were declining. These factors negated the positive effects of improved quality and diversity of food intake and improvements in sanitation resulting from higher incomes. This suggests that for net improvements to occur, alleviating the negative outcomes of intermediate factors must be considered.

Even in resource-poor countries, famines are the result of national and international policy failures - that is, failures to give priority to the planning, implementation, and management of famine prevention. IFPRI’s ongoing research for improved famine prevention policy aims to help correct such failures. During the 1980s, severe famines were largely confined to Africa. Sudan, and Ethiopia were two of the major problem cases. In 1989 famine conditions began emerging again in large parts of both countries. Famine deaths in Ethiopia between 1983 and 1985 have been estimated at more than 1 million, those in western Sudan at about 200,000 in 1984/85, and those in the war-stricken southern provinces at 200,000 in the second half of the 1980s.

In both these countries, continuing military conflicts were important contributing causes of famine. However, drought and other unfavorable weather conditions remain a chief trigger of famine crisis when public preparedness is lacking. IFPRI results indicate that a 10 percent decline in long-term average rainfall results in an 8.4 percent drop in total cereal production in Ethiopia and a 5.0 percent drop in Sudan. Responses are larger for individual crops concentrated in drought-prone regions. For sorghum, for example, the figures are 16 percent in Ethiopia and 7 percent in Sudan.

In the research area of ‘poverty alleviation’, IFPRI’s research has sought to identify employment and income sources of the malnourished poor, to identify dynamics of poverty “below the line”, and to arrive at policy priorities for effective integration of the poor into a productive growth and development process in different types of regions and countries. These issues were investigated in Kenya, Rwanda, The Gambia, Burkina Faso, Zambia, India, the Philippines, Sri Lanka, Brazil, and Guatemala. Reports on this research are expected in 1991.

(Source: IFPRI)

SIDA’s Support for Nutrition in Developing Countries

A great deal of attention has been given by the Swedish International Development Agency (SIDA) to breastfeeding in connection with the WHO/UNICEF global initiative for the 1990s (see SCN News No. 5 p. 36). At a meeting in Italy for senior policy makers, 30 July-1 August 1990, many of the participants expressed continued concern about promotion of breast-milk substitutes and frustration that so little is being done to support countries in developing, adopting, monitoring and enforcing codes of marketing. To help with this, SIDA has met with the Netherlands Ministry of Development Cooperation to discuss how both agencies, jointly with WHO, can provide increasing support in this area. Country case studies are planned, along with an international meeting in the Netherlands - a ten-year follow-up on the International Code of Marketing of Breast-Milk Substitutes. SIDA has supported for a decade one of the central offices of the International Baby Food Action Network, located in Geneva.

SIDA along with the Netherlands Ministry of Development Cooperation and the Commonwealth Secretariat, continues to support various regional nutrition activities in Eastern, Central and Southern Africa (ECSA). This includes a six-week course for mid-level nutritionists in the region. Based on the recommendations of a Dutch/Swedish evaluation, the fifth course (in 1991) is going to be offered only to trainers. A needs assessment for courses at this level has been done in the region and a training manual based on the course is being published both with Dutch support. Both Tanzania and Zimbabwe are developing plans for conducting training at mid-level locally. SIDA support was also provided to WHO (AFRO) for a regional consultative meeting to develop practical approaches to anaemia control in pregnancy; and to the ACC/SCN for its programme for reporting on the world nutrition situation (see “News and Views”).

Regarding “direct nutrition support”, bilaterally within the health sector, SIDA is now in its final three-year agreement period for institutional-building support to both the Tanzania Food and Nutrition Centre (TFNC), and the National Nutrition Unit in Zimbabwe. It is also in the final three-year support to the National Nutrition Surveillance Programme in Zambia. All three have been a part of health sector support and have lasted about a decade (17 years in the case of TFNC). Continued support to a limited number of national-level projects may be considered for TFNC in the future. Support to some other nutrition work within the health sector will be considered in the case of Zambia.

Regarding direct nutrition support within the agricultural sector, the work in cooperation with FAO on nutrition and food security within the field of forestry (see SCN News No. 3, p. 25-6) continues to expand. Also, since 1983, SIDA has supported an effort to institutionalize nutrition concerns within the area of farming systems research in Zambia. The Zambian Government has recently recognized the need for this by reorienting a government post along these lines.

IDD control, breastfeeding promotion, and community gardening with one or more specific nutrition-related goals (reduction of young-child malnutrition; school feeding; or reduction of vitamin A or iron deficiency) are important areas supported by SIDA in both Zimbabwe and Tanzania. Work related to national food and nutrition policies has been supported in those countries, as well as in Zambia. Two leading staff at TFNC have begun studies towards a PhD degree at Uppsala University with SIDA support, one on IDD and the other on breastfeeding. Furthermore, a Zimbabwean has begun a Master degree research on IDD also at Uppsala University with SIDA support. These are, however, part of large-scale projects and long-term institutional cooperation and not a routine type of support provided by SIDA.

SIDA continues to provide funds for the purchase of vitamin A capsules via UNICEF for the National Blindness Prevention Programme in Bangladesh. In addition, support is provided to a Sri Lanka-based NGO, Worldview International Foundation, for a communication and school garden approach towards increasing dietary intakes of vitamin A in Gaibandah District where the prevalence of xerophthalmia is high. It is hoped that this more sustainable approach will gradually replace universal vitamin A capsule distribution.

(Source and for more information please contact: Dr. Ted Greiner, International Child Health Unit, Department of Pediatrics, University of Uppsala, S-75185 Uppsala, Sweden. Tel: 46-18 665937. Fax: 46-18 515380)

Goals for 1990 Decade

A recent statement by the Executive Director of the United Nations Population Fund (UNFPA) highlighted the following objectives for the decade of 1990.

1) Make family planning a development priority, ranked alongside major economic investments, and with an allocation of not less than one percent of GNP in the countries concerned

2) Extend family planning services to 500 million women

3) Ensure that all women pay at least one visit to a health care facility during pregnancy

4) Reduce maternal mortality by at least 50 per cent especially in those countries where such mortality is very high (higher than 100 maternal deaths per 100,000 births)

5) Reduce infant mortality to 50 per 1000 live births - especially in those countries where infant mortality is high

6) Expand girls’ enrolment in primary school to at least 75 per cent. In countries where girls’ enrolment is particularly low, ensure that the ratio of girls to boys in primary school is at least 4:5

7) Expand girls’ enrolment in secondary school to at least 60 per cent. In countries where girls’ enrolment is particularly low, ensure that the ratio of girls to boys in secondary school is at least 3:5

8) Combat women’s illiteracy so that at least 70 per cent are able to read and write.

Monitoring Progress Towards Child-related Development Goals for 1990s

The World Declaration on the Survival, Protection and Development of Children was adopted as a result of the Summit for Children held at United Nations Headquarters in New York on 29-30 September 1990. The Declaration of the World Summit calls for promoting ratification and implementation of the Convention on the Rights of the Child adopted by the United Nations General Assembly in 1989. For effective implementation of the proposed Plan of Action, concerted cooperation will be required at levels of international community and individual countries.

As a specialized leading agency for children’s welfare and well-being, UNICEF is requested to prepare a consolidated analysis of the plans and actions implemented, globally and at individual country levels. This will be done through the close collaboration with the concerned agencies and other United Nations organs. The General Assembly of the United Nations, through the Economic and Social Council, will be fully informed of the progress made on child-related development and any additional action required during the 1990 decade.

(Source: World Declaration and Plan of Action. World Summit for Children, United Nations, New York, 30 September 1990)

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Staff Training on the New Nutrition Strategy

The Executive Board of UNICEF approved in April this Year a new nutrition strategy for UNICEF. As this strategy introduced a number of new concepts, training of UNICEF field-staff was deemed necessary. A training package was therefore developed by the Nutrition Section and the Training Section. The training package consists of a Coordinator’s Guide and a Participants’ Manual. The training is divided into eleven sessions, consisting of:

1. Global Perspective
2. The problem of malnutrition
3. The Triple A approach
4. The conceptual framework
5. Lessons from previous or existing nutrition oriented programmes
6. Some useful definitions and methods in nutrition Assessment, Analysis and Action.
7. Triple-A at the national level
8. Triple-A at the district level
9. Triple-A at the community level
10. Affordability, sustainability and replicability
11. PIDB aspects (programme/project coding)

By the end of the training, participants will be able to:

- understand the general nature of the problem of malnutrition and to assist in the identification of the specific causes of malnutrition in a particular society

- understand and use the new UNICEF strategy on nutrition

- use some of the more important techniques in assessing and analyzing the problem of malnutrition

- find information about technical and other details that may be required for nutrition-oriented programme preparation

- in collaboration with the Government, prepare a nutrition-oriented programme in the format required by UNICEF.

(Source: UNICEF, November 1990. Strategy for Improved Nutrition of Children and Women in Developing Countries, a UNICEF Policy Review, 1990, 1, and UNICEF Nutrition Strategy Training Package: Nutrition in Child Survial, Development and Protection, Participants’ Manual; and Co-ordinator’s Guide, available from Dr U. Jonsson, UNICEF, 3 U.N. Plaza, New York 10017, USA.)

Pellagra Outbreak Among Mozambican Refugees in Malawi

The United Nations High Commissioner for Refugees (UNHCR) health advisors have reported 16,200 cases of pellagra - from March to September 1990 - among the 800,000 Mozambican refugees in Malawi. The disease has been primarily noted among camp dwellers who are more dependent on external food rations donated by the international community, and less so among the spontaneously integrated populations. Among camp dwellers, some 5% of the total population have been affected. This illustrates the dependency which displaced populations have on food rations and supports the proposal for fortification of all emergency and food aid. Médecins sans Frontières and their collaborative organization (Epicentre), have collected epidemiological information in order to confirm the outbreak and the impact of the collective response.

The deficiency disease pellagra is due to insufficient quantities of the B-vitamin niacin or tryptophan (which is metabolized to niacin) in the food aid ration; insufficient quantities of groundnuts and beans are distributed with the maize-based diet. Outbreaks occur at a time when the food and cash resources of the main food channelling organizations WFP and UNHCR are severely restricted. In response to the outbreak an unprecedented collaborative effort has been initiated among non-governmental organizations (NGOs) and the UN to both prevent and treat new pellagra cases, showing the essential pro-active role which the NGOs can play to ensure timely and efficient response to dramatic problems in feeding programmes.

As a short-term measure, millions of niacin and B-complex tablets have been purchased by Médecins sans Frontières, France, Save the Children Fund, UK and UNHCR, and an overall prophylactic supplementation programme has been initiated. Likewise all three organizations have purchased more than 3000 MT of groundnuts, and distribution commenced in August 1990 to affected populations.

For long-term solutions, Save the Children Fund will be donating fortification equipment and funding the necessary expertise to locally fortify maize meal with B-vitamins, which the Government of Malawi, UNHCR and WFP will support as an ongoing preventive measure.

(Source: A. Berry-Koch, Nutritionist, Programme and Technical Support Section, UNHCR, Geneva. November, 1990)

International Food Intake Directory (INFID)

The United Nations University (UNU) is continuing to compile a directory of dietary intake data from developing countries which also have disease-specific morbidity and mortality data. The compilations are intended to facilitate epidemiological analysis of the relationship between diet and chronic diseases. They should prove useful to professionals within the country for the analysis of dietary trends and the development of dietary guidelines and other educational materials.

This project is designated INFID, to stand for International Food Intake Directory. More data exist than can be obtained by computerized literature searches or abstract journals. For instance, data published in local journals, reports of government ministries, or information which simply has never been published at all cannot be traced in these ways. Lack of awareness or access to these data is a serious handicap to epidemiological analysis as well as national nutrition and food policy formulation. Any institution or individual prepared to take responsibility within a country for collaborating in this effort should contact Dr. Nevin S. Scrimshaw, Director, UNU International Food and Nutrition Programme, Harvard Centre for population Studies, 9 Bow St. Cambridge, MA 02138, USA.

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Rapid Assessment Procedures (RAP) for Nutrition and Health Related Programmes

The rapid Assessment Procedure (RAP) guidelines have been widely adapted for use in planning, evaluating, or improving a wide variety of programmes including nutrition and primary health care, community health needs, water improvement projects, diarrhoeal disease, respiratory infections, leprosy, epilepsy, immunization, nutrition surveillance, food aid, food supplementation, AIDS related behaviour, dietary habits of the elderly, motherhood practices, and emergency relief. The experiences in the broad use of this methodology were reported and discussed at a conference at PAHO Headquarters in Washington, DC, USA, November 12-15, 1990, convened by UNU in cooperation with UNICEF, WHO, IDRC, and several voluntary agencies. The proceedings of this conference should be available in 1991 from the UNU, International Food, Nutrition and Development Programme, 9 Bow Street, Cambridge, MA, 02138 USA.

The publication “Rapid Assessment Procedures for Nutrition and Primary Health Care; Anthropological Approaches to Improving Programme Effectiveness” by Susan C.M. Scrimshaw and Elena Hurtado in English is now in its second printing and is available from the Latin American Centre, University of California, Los Angeles, CA, 90024-1447 USA for $8.95 plus postage. Editions in Spanish, French and Portuguese are now also available for the same price. A 16 minute descriptive video in either PAL or VHS, can be obtained from Dr. N. S. Scrimshaw, Director, UNU (address as cited above) for $10 plus postage.

RAP Training Workshops were held in Portuguese in Sao Paulo, Brazil from 20 to 29 August 1990 and in English in Nairobi, Kenya in September, 17-22, 1990, which focused on the study of AIDS-related behaviour. A workshop was held in Cairo, Egypt, October 13-17, 1990, funded by the Ford Foundation, on family planning included a training unit on RAP.

Training Workshops in French are planned for Brazzaville, Congo, and Bobo-Dioulasso, Burkina Faso in early March 1991. Anyone interested in participating should contact either Dr. Jean-Claude Dillon, Institute National Agronomique, Paris-Grignon 78850, Thiverval-Grignon, France, or the local UNICEF Office in their country.

A Training Workshop in Spanish is being planned for Santiago, Chile, in the second quarter of 1991. Interested individuals should contact either Dr. Nevin S. Scrimshaw (at address quoted below) or the local UNICEF Office in their country.

(Source: Dr. N.S. Scrimshaw, Food, Nutrition and Human Development Programme, Harvard Centre for Population Studies. Nine Bow St, Cambridge, MA 02138, USA. Fax: 617-495 54418)

Action at International Level

The World Summit for Children, held from 29 to 30 September, 1990 in New York, released a World Declaration on the Survival, Protection and Development of Children and a Plan of Action for its implementation. This was signed and adopted by over 70 Heads of States plus senior Ministers of 80 others. Concerted national and international co-operation will be required for effective implementation of this Declaration. Action at the community and national levels is of critical importance in meeting the goals and aspirations for children and development. However, many developing countries, particularly the least developed and the most indebted ones, will need substantial international co-operation to enable them to participate effectively in the world-wide effort for child survival, protection and development. Accordingly, the following specific actions are proposed to create an enabling international environment for the implementation of this plan of action.

(i) All international development agencies - multilateral, bilateral and non-governmental - are urged to examine how they can contribute to the achievement of the goals and strategies enunciated in the Declaration and this Plan of Action as part of more general attention to human development in the 1990s. They are requested to report their plans and programmes to their respective governing bodies before the end of 1991 and periodically thereafter;

(ii) All regional institutions, including regional political and economic organizations, are requested to include consideration of the Declaration and this Plan of Action on the agenda of their meetings, including at the highest political level, with a view to developing agreements for mutual collaboration for implementation and ongoing monitoring;

(iii) Full co-operation and collaboration of all relevant United Nations agencies and organs as well as other international institutions are requested in ensuring the achievement of the goals and objectives of the national plans envisaged in the World Summit Declaration and Plan of Action. The governing bodies of all concerned agencies are requested to ensure that within their mandates the fullest possible support is given by these agencies for the achievement of these goals;

(iv) The assistance of the United Nations is requested to institute appropriate mechanisms for monitoring the implementation of this Plan of Action, using existing expertise of the relevant United Nations statistical offices, the specialized agencies, UNICEF and other United Nations organs. Furthermore, the Secretary-General of the United Nations is requested to arrange for a mid-decade review, at all appropriate levels, of the progress being made towards implementing the commitments of the Declaration and Plan of Action;

(v) As the world’s lead agency for children, the United Nations Children’s Fund is requested to prepare, in close collaboration with the relevant specialized agencies and other United Nations organs, a consolidated analysis of the plans and actions undertaken by individual countries and the international community in support of the child-related development goals for the 1990s. The governing bodies of the relevant specialized agencies and United Nations organs are requested to include a periodic review of the implementation of the Declaration and this Plan of Action at their regular sessions and to keep the General Assembly of the United Nations, through the Economic and Social Council, fully informed of progress to date and additional action required during the decade ahead.

(Source: World Declaration and Plan of Action on the Survival, Protection and Development of Children, United Nations, New York, 30 September 1990)

Child Survival in Developing Countries

Since 1985, the United States Agency for International Development (USAID) has joined a global push to improve the prospects for survival for the children of the developing world by dramatically expanding its efforts in this direction. The focus of the programme has been on inexpensive yet effective technologies to improve infant and child health, such as immunization; oral rehydration therapy; reducing high risk births, respiratory infections and other diseases; breastfeeding promotion and combatting malnutrition. USAID has long recognized the importance of improved nutrition to reduce infant and child morbidity and mortality, and has long supported agriculture and other programmes aimed at improving overall availability of foods, and nutritional status. Efforts have mainly been focussed to breastfeeding promotion; improved infant and child feeding practices; growth monitoring and promotion; vitamin A and other interventions to address major micronutrient deficiencies; as well as supplemental feeding of young children, pregnant and lactating mothers in order to reach those at greatest risk.

From 1985 to 1989, a total of US$848 million from various funding accounts has supported child survival efforts in over 60 countries. According to Dr. N.W. Jerome, the Director of the Office of Nutrition, USAID, “...USAID provided more than $200 million for activities directed to enhance the prospects for the health and nutrition of young in 60 countries around the world” in 1989 alone. The Fifth Report to Congress on the USAID Child Survival Programme states that in 1989, 15% of the funds supported nutrition activities, including promotion of breastfeeding and improved weaning practices, growth monitoring and vitamin A activities.

In 1989, 127 USAID-assisted projects in 40 countries reported some activity supporting proper weaning and child feeding practices. The Dietary Management of Diarrhoea project also addresses proper feeding to be continued during this critical period. A new vitamin A field support project has been initiated in 1989. Currently vitamin A activities are under way in 24 countries through 64 projects. USAID has also supported activities in several countries to combat iron and iodine deficiencies. Research projects have provided valuable data on the epidemiology of risk factors associated with respiratory infections in 12 countries with the Agency’s support.

USAID is committed to continuing its contribution to child survival programmes in order to promote the health and survival of the children in developing countries.

(Source: Child Survival, A Fifth Report to Congress on the USAID Program. USAID, Washington, D.C. 1990)

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SUSTAIN in the Service of Food Industry

SUSTAIN (Sharing United States Technology to Aid in the Improvement of Nutrition) is a US private food industry initiative with the aim of upgrading the food processing industries in developing countries. Sponsored by USAID, this project utilizes the scientific knowledge and technical expertise of the U.S. food industry to solve food processing problems in developing countries with the goal of improving the quality, safety and nutritional value of locally grown and processed foods as well as increasing the quantity and affordability of these foods.

SUSTAIN has demonstrated that the U.S. private food industry is willing and able to share its expertise with the agribusiness community in developing countries. Its success has in fact reinforced the commitment of the Office of Nutrition to the growth of local food industries as a means of combatting hunger and malnutrition and promoting development.

The way in which the programme works is described in the SUSTAIN flyer as follows:

“A.I.D. missions and trade associations in developing countries publicize SUSTAIN’s goals and activities. Executives of U S companies with technical expertise and overall knowledge of the food industry serve as the SUSTAIN Board of Directors providing guidance and overseeing activities.

“Food related companies in developing countries submit their request to SUSTAIN either through the A.I.D. mission or a designated organization in their country. If no liaison has been established within a country requests may be sent directly to SUSTAIN or to A.I.D.’s Office of Nutrition. In practice, the company making the request prepares a clear and concise description of its problems. SUSTAIN then identifies an appropriate US company which has the required expertise to respond. SUSTAIN and the US company decide whether available information can solve the problem, or if a consultant should be sent. Information is provided at no cost. If a consultant is sent, the US companies responding to the request will provide the person to undertake the assignment. The consultant’s salary will continue to be paid by the company. SUSTAIN will provide international travel, brief the consultant etc. The local company will arrange and provide accommodation, per diem, and any in-country travel in local currency.

“Requests are diverse. Help may be needed to solve processing problems, to identify equipment needs and sources of new and used equipment, to train personnel in the use of equipment and new technologies, to find new uses for indigenous commodities, to establish or improve quality assurance procedures, to control insects and rodents in food processing plants, and to improve plant layout and materials handling.”

So far 165 requests for technical assistance have been received from companies and organizations in 26 countries.

For more information please contact: The Manager, SUSTAIN, National Cooperative Business Association, 1401 New York Avenue, N.W.; Suite 1100, Washington, D.C. 20005-2160. USA

(Source: SUSTAIN, 1989 Annual Report. USAID Flyer)

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Breastfeeding Strategy Within USAID

A “Breastfeeding for Child Survival Strategy” has recently been developed to guide expansion of the USAID’s activities related to breastfeeding promotion. The strategy seeks to foster breastfeeding by creating an environment of awareness and support for those women who choose to breastfeed their babies. The more specific goal of this strategy is to increase the percentage of infants who are i) breastfed within one hour of birth; ii) exclusively breastfed from birth through 4-6 months of age; iii) fed appropriate complementary foods in addition to breast milk by the end of sixth month; and iv) breastfed for one year or longer.

The breastfeeding component of existing programmes, including those to enhance child survival (see above), will be significantly strengthened to carry out the activities related to this strategy. Centrally funded projects that disseminate information and provide technical assistance and training on breastfeeding practices will also be used to achieve the goal of this strategy. USAID missions are encouraged to develop country-specific strategies and programmes. Based on an examination of USAID’s experience over the past decade as well as an analysis of potentially fruitful new directions the following approaches will receive priority attention.

i) Enhanced dialogue with policy makers - USAID will intensify its search for more opportunities to involve national leaders and policy makers in promoting breastfeeding.

ii) Increased international collaboration with WHO, UNICEF and other agencies.

iii) Further quantification of economic and health benefits from breast-feeding - a comprehensive review of current research on the costs and savings of breastfeeding in the developing world to estimate breastfeeding’s economic value under various settings.

iv) Training of health care professionals and associated reform of hospital procedures as one of the most tested and cost-effective ways to encourage appropriate breast-feeding practices throughout the health care system will be highlighted.

v) Community-based activities that emphasize primary health care, training of traditional health providers and community self-help will be strengthened in order to reach those who do not have regular contact with a formal health care system.

vi) Maternal nutrition - USAID will support maternal health and nutrition, partly through its new MotherCare Project, for promotion of successful breastfeeding.

(Source: Breastfeeding: A Report on A.I.D. Programs. May 1990. USAID, Washington. D.C. 20523)

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Vitamin A Field Support Project (VITAL)

The VITAL project was established by USAID to provide technical support to its missions, bureaus, offices and host country institutions and individuals to address two overriding objectives of the Science and Technology Office of Nutrition’s Vitamin A for Health Project: i) assess the prevalence of vitamin A deficiency among young children of the developing world; and ii) develop and implement viable cost-effective programmes to overcome the problem.

The VITAL project provides valuable information resources to those working in the area of vitamin A, as part of its information gathering and dissemination strategy. These resources include a database of consultants with expertise in a broad spectrum of appropriate fields, including nutrition, programme design, implementation and management, evaluation and data analysis, vitamin A interventions, education and medicine. A Vitamin A library is being created focussing on programmatic materials, including reports on vitamin A intervention strategies, such as supplementation, fortification, home and community gardening and social marketing/education.

More information from Robert Pratt, Project Director, Vitamin A Field Support Project, 1601 North Kent Street, Suite 1016, Arlington, VA 22209. Tel: (703)8410652. Fax: (703) 841-1597.

(Source: VITAL NEWS, Vol. 1 No. 1, Spring 1990)

Policies and Programmes to Reduce Global Hunger and Malnutrition - Cairo Declaration

The sixteenth session of the World Food Council (WFC) was held in Bangkok, Thailand from 21 to 24 May 1990. The session reviewed the progress made in the implementation of the Cairo Declaration, which was adopted by WFC at its fifteenth ministerial session in 1989. The session also discussed new steps for pragmatic action to meet the growing challenges to fight hunger and malnutrition in the 1990s. At Cairo, the Council members had agreed to make every effort to achieve, in the 1990s, four broad hunger-alleviation goals:

i) the elimination of starvation and death caused by famine;
ii) a substantial reduction of malnutrition and mortality among young children;
iii) a tangible reduction in chronic hunger; and
iv) the elimination of major nutritional-deficiency diseases.

By adopting the Cairo Declaration, the member nations of the WFC committed themselves to put into place effective policies and programmes to reduce hunger and malnutrition in their countries and at the global level. As a step in that direction, policies were evaluated, and the findings of regional consultation reviews held in San Jose, Cairo, Bangkok and Paris between December 1989 and March 1990 were noted. The results from these consultations revealed a growing convergence in the perception of policy priorities among countries. There is now greater concern to make the improvement of the human condition a central objective of development, as stressed at WFC sessions at Beijing and Nicosia in 1987 and 1988.

To seize the historic opportunity that seems to be provided in 1990s, the members of the WFC agreed to work together towards the common objective with an increased sense of urgency and have identified practical steps to ensure that this decade’s opportunity will not be lost.

Given the growing convergence of perceptions of objectives and the means to meet them, the Council members can now move towards accelerated and more effective collaboration among themselves and with all interested countries to implement identified priority activities within the Cairo Declaration’s policy framework for the 1990s. In doing so, continuing support of multilateral agencies and non-governmental organizations is also required.

(Source: Report of the World Food Council on the work of its sixteenth session, 21-24 Supplement No. 19. United Nations, New York)

WFP Participation in Global Initiative on Breastfeeding

During the last ten years, there has been an increase in scientific evidence confirming the crucial importance of breastfeeding, particularly exclusive breastfeeding. Medical experts recognize that the most suitable food for all infants is breastmilk and that breast-feeding can continue for as long as mother and young child wish.

WFP can be a participant in initiatives supporting breastfeeding for the 1990s (see “Innocenti Declaration” in News and Views). Food aided projects can be instrumental in promoting breastfeeding. Food aid organizations such as WFP have policies and guidelines regarding the use of milk products in their projects (see also News and Views). WFP recommends strict adherence to these guidelines. Some of the recommendations in this context are the following.

- Breastmilk substitutes are not to be recommended for children under six months of age.

- Food aided supplementary feeding projects should not interfere with exclusive breastfeeding. Only children over six months of age are to be targeted to consume weaning foods, which have to be culturally and physiologically appropriate. Whenever possible, growth monitoring and nutrition education should accompany child health projects.

- Pregnant and lactating women benefit from supplementary feeding, as it results in increased birth weight, builds up resources for lactation, and supports the mother while nursing. Food aid commodities can be efficiently programmed for supplementary feeding.

- Most poor women in developing countries work in the informal sector, without any maternity benefits. These women cannot forego an income while nursing. Food aid can function as an income transfer to compensate women for the opportunity cost of breastfeeding.

- Health professionals as well as mothers in many countries may have to be motivated to participate in breastfeeding. Food aid can be used to improve both attendance and the quality of services at primary health care centers that emphasize breast-feeding.

- Many food-for-work projects employ women who are nursing mothers. They need facilities (e.g. shelter and supervision for the infants), as well as time to continue breastfeeding. Food aid resources can be used to provide the necessary conditions and encouragement for women who are breastfeeding (e.g. through the use of food or generated funds for shelter and supervision and to compensate for time spent nursing).

(Source: World Food Programme, August 1990)

WHO Collaborating Centres for Nutrition

As part of an inter-institutional collaborative network, WHO Collaborating Centres are formed with the aim of supporting regional or global resources in terms of services, information, research and training in order to improve human health and wellbeing.

The collaborating centres for nutrition are the following.

- WHO Collaborating Centre for Research and Training in Nutritional Immunology for Health Promotion, St. Johns, Canada; (to conduct collaborative research in the general area of nutrition and immunocompetence). Prof. Ranjit K. Chandra, Division of Paediatric Immunology and Immunology Laboratory, Janeway Child Health Centre, memorial University of Newfoundland, St. Johns.

- Danish Catering Centre, National Food Agency, Soborg, Denmark; (advocacy of the importance of mass catering in nutrition policy implementation) Dr Orla Zinck.

- Institute of Social Medicine and Epidemiology of the Federal Health Office, Berlin, Germany; (focal point and reference centre for nutritional epidemiology problems). Dr Lenore Arab-Kohlmeier, Department of Epidemiology of Health Risks (DDI).

- Department of Nutrition and Biochemistry, Athens School of Public Health, Athens, Greece; (dietary surveillance: the application of simple technologies to get information about dietary patterns and their relationship to dietary requirements). Professor T Thomaidis.

- WHO Collaborating Centre for Identification, Development and Propagation of Methods for Control of Nutritional Blindness and Anaemia, Bogor, Indonesia; (to collaborate in the development of surveillance system and measures for the control of nutritional blindness and anaemia). Dr Darwin Karyadi, Nutrition Research and Development Centre, Bogor, Indonesia.

- Instituto Nazionale della Nutrizione, Rome, Italy; (focal point for research on nutrition in the elderly). Professor Anna Ferro-Luzzi, Unit of Human Nutrition.

- Department of Human Nutrition, Agricultural University, Wageningen, the Netherlands; (to work towards the improvement of the standard of advanced training in nutrition in Europe and selected countries in other regions; a research component will be part of this programme). Professor J G A J Hautvast.

- Institute for Nutrition Research, University of Oslo, Norway; (to test new approaches to nutrition education in accordance with WHO methodology problem based learning; community based education), Dr Wenche B Eide.

- National Food and Nutrition Institute, Warszawa, Poland; (study of nutrition policy formulation and implementation in Poland, and Central and Eastern Europe). Professor Wiktor B Szostak.

- Institute of Regional Problems of Nutrition of USSR, Academy of Medical Sciences, Alma-Ata, USSR; (development of methodology for determining nutritional needs and assessing the nutritional status of individuals under different environmental and physiological conditions. Interchange of experiences on the above and related subjects with other interested institutions and workers). Professor T S Sharmanov.

(Source and for more information please contact Dr. E. Helsing, WHO Regional Office for Europe, Copenhagen; or Dr. D. Benbouzid, Nutrition Unit, WHO Headquarters, Avenue Appia, 1211 Geneva 27, Switzerland).

Operations in Nutrition

Support to nutrition projects and operations continues as one of the World Bank’s recently intensified activities. Some current examples are the following.

A $100 million loan proposed to help finance the Venezuela Social Development and Nutrition Project is probably the best example the Bank has to date of “adjustment with a human face”. In this project substantial resources that had been inefficiently used for generalized subsidies will be transferred to targeted nutrition programmes. Among other things, nutrition grants will be provided for school children, nutrition supplements and growth monitoring through health facilities. Moreover, a community pre-school day care programme with nutrition and social stimulation will be included in the project to free mothers to pursue additional opportunities for employment which will subsequently benefit household nutrition.

In Mexico help is provided in designing, implementing and evaluating a pilot nutrition project, together with enforcing the capacity of institutions responsible for nutrition. Development of nutrition programmes and projects for financing by domestic and external agencies will also be supported. This $17 million project is the Bank’s first Nutrition Technical Assistance Loan, and would run parallel to a new Agriculture Sector Adjustment Loan, which includes development of a food consumption and nutrition strategy. Also an earlier reported Basic Health Care Project, containing considerable nutrition delivery through the Mexican health system has been negotiated.

An Economic and Social Fund credit with nutrition as one of the largest areas of attention is under consideration for Haiti. The project would provide food supplementation through day-care centres and NGO health posts. Nutrition support is planned for Argentina, Ecuador and Honduras, among the other Latin American countries, while in Brazil nutrition sector work is near completion.

A new project featuring nutrition is proposed for Morocco, to the value of $20 million. This is expected to include both employment training fund and support for the implementation of better food and nutrition programmes.

A $50 million loan is under consideration in order to finance a nutrition project for Pakistan. In addition, growth monitoring and nutrition education will be part of a Family Health Project in Sind and Frontier Provinces.

In Egypt an earlier planned Social Fund Project, with a sizable nutrition component, had to be transferred to stress an emergency employment programme for returnees from the Gulf area.

The World Bank is becoming involved with nutrition-related issues in East European countries e.g. Poland and Hungary, as well as in the Soviet Union. In Hungary a nutrition education component may be included in a Bank-financed health project.

Preparations are under way for nutrition projects in the Philippines, India, Sri Lanka, Indonesia and Malaysia. The project planned for Malaysia will help to improve food safety, as there is increasing dependence on processed foods while food quality safeguards have not caught up with the marked change in eating habits.

A $5 million nutrition component is included in a new Zimbabwe Health Project proposal. As a part of a new project for Zaire, $2 million is allocated to fight iodine deficiency, among other nutrition activities. A $1.3 million nutrition education component is included in a food security project for Cameroon. Nutrition support is also stressed in projects designed for Burundi, Chad, Madagascar, and Togo.

An Agriculture Adjustment Operation in Kenya, is an example of how nutrition issues are increasingly being built into these types of projects. A $75 million credit is under negotiation, and the government is to complete a food security/nutrition strategy and adopt an action plan to pursue it.

In Ghana, nutrition support is provided to road workers, mostly women, in form of an on-site meal plus iron supplementation to increase their productivity and vitality. Nutrition education is provided to promote the use of their additional earned income in nutritionally beneficial ways. In Malawi, community-based activities like growth monitoring combined with nutrition education will be undertaken in some 2000 villages. Upon careful evaluation of such nutrition-related community activities, it is hoped to launch a nationwide programme in the country. The relationship of nutrition to AIDS is included in a study the Bank is undertaking in Uganda. And in Ethiopia, a recent food security mission has given recommendations on the ways to achieve self-targeting, to abolish subsidies on foods used mainly by the higher income households in order to produce more of a composite flour (a mixture of maize and wheat) for the benefit of the lower income groups. Getting greater efficiencies in the marketing chain, particularly reduced cost of handling and processing are among other points emphasized by the mission.

(Source: The World Bank, November 1990)

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Materials for Programme News were assembled and edited by M. Lotfi.