“Conducting Small-Scale Nutrition Surveys a Field Manual”
“Children and the Environment”
“Food Security in Developing Countries”
African Council of Food and Nutrition Sciences (A.F.R.O.N.U.S.)
“Making Adjustment Work for the Poor: A Framework for Policy Reform in Africa.”
“Diet, nutrition, and the prevention of chronic diseases”
by Food Policy and Nutrition Division, FAO Rome 1990
Consistent with its objective to promote the integration of nutrition considerations into agriculture and rural development projects, FAO recently published a manual for conducting small scale nutrition surveys. The dearth of practical and user friendly nutrition survey manuals makes the publication of this FAO manual a most welcome development particularly for field planners, nutritionists and nutrition advocates. The main appeal of the manual is perhaps its style which is written in non-technical language (despite the rather technical nature of the topic), thus making it accessible for easy use in the field even by those with no experience in household surveys.
The manual provides clear definitions with respect to the recommendations on planning of the survey, the selection of survey content and variables that are likely to be important, preparation of the questionnaire, the collection, processing and presentation of results. The examples drawn to illustrate specific cases or problem areas reflect the experience of those involved in the preparation of this manual in a variety of country situations. FAO devoted considerable resources towards field testing the methods in six countries and the experience from these case studies provided insights into actual survey situations in real project settings.
Technological advances in the use of personal computers for processing surveys, are perhaps under-emphasized in this manual. Towards the end of the decade of the 80’s countries in the developing world have increasingly relied on personal computers to handle the processing of information. If an analyst decides to include food consumption data in the survey, the size of data that will be analyzed cannot be handled efficiently without access to computer. One practical reason for a speedy turn-around time is that the results must be communicated to project planners at an early stage of the planning cycle. It is quite safe to say that in the 90’s most of the users of this manual, who are likely to be government programme planners and nutritionists in the ministries of agriculture, health, or planning, will have access to personal computers in their departments; and therefore, it would do well for the users to address the format of the questionnaires with computerization in mind.
This manual is most useful where it is used in the conduct of project specific nutrition surveys which are designed as input into the preparation of agricultural and rural development projects. Results from these surveys are intended to promote immediate action on the part of planners with respect to nutrition implication of alternative project designs. The manual is also useful reference for other kinds of nutrition surveys with the inclusion of discussion of the basic survey principles and techniques.
Competing hypotheses of the likely impact of an agricultural project on nutrition will dictate the choice of survey content. The manual may err on the side of over-simplification. The analysis of food consumption and nutritional status cannot be easily reduced to simply comparing the nutritional status of target groups versus non-target groups, or of the ‘nutritionally disadvantaged’ versus those ‘not nutritionally disadvantaged’ groups. The field related to the commercialization of agriculture, for example, which is one of the main bulwarks of agricultural and rural development projects involves an understanding of changes in household allocation of resources and time resulting from external projects which ultimately impinge upon the nutrition of the vulnerable members within the household. Therefore the limitations as well as advantages of the type of data collection and analysis put forward in this manual should probably be recognized.
The manual should find wide use for those planning nutrition surveys in the field, and is a most useful contribution to practical efforts to provide relevant information for planning purposes.
Marito Garcia
A joint UNICEF/UNEP publication (1990), 73p.
The 1990s will be the decade of most children. It should also be the decade when environmental sustainability becomes a necessary integral part of future development strategies, rather than the latest rhetoric. Accelerating population growth rates in many countries now coincide with the adverse environmental consequences of years of social sector cut-backs due to debt and short-term adjustments. Linkages between population growth, child welfare and the environment can result in virtuous cycles or vicious ones, depending on the choices made now.
This short book describes these linkages and sets out some challenges for the future. As Julius Nyerere said “The most powerful contraceptive is the knowledge that your children will survive”. Once infant mortality rates begin to fall, and the nutritional well-being of children improves, population growth will stabilise; numerous examples bear this out. Concerted efforts to expand the outreach and improve the quality of health care systems may result in improved child survival rates and reduced fertility. Sustainability brings children to the forefront of development and highlights the need for “inter-generational equity”. On this a recent UNU study has proposed three basic principles, which are worth quoting here:
- each generation must conserve the diversity of the natural and cultural resource base, so that it does not unduly restrict future generations’ options. Each generation is entitled to diversity comparable to past generations;The Convention on the Rights of the Child of 1989 may provide a framework to monitor the adoption of such principles. Although linkages between children and the environment are not made explicit in the treaty, some of its provisions cannot be implemented without paying attention to the environment as an important determinant of child welfare.- each generation must maintain the quality of the planet so that it is passed on in no worse condition than it was received. Each is entitled to inherit an Earth comparable to the Earth which sustained its forebears;
- each generation should provide its members with equal rights of access to the legacy from past generations1
1 Weiss, E.B. (1989) In Fairness to Future Generations. UNU, Tokyo.
The second chapter tracks the different environmental threats to a child’s health throughout its growth, from the womb to adolescence. Before birth, the foetus is susceptible to a variety of pollutants, whether industrial, agricultural, or those chosen by the mother e.g. alcohol or tobacco. AIDS is a new threat. Perinatal transmission of HIV is placing a tremendous strain on the health care facilities of many poor African countries. After birth, the child may be protected to some degree by the mother’s breast milk, but becomes increasingly at risk from the malnutrition-infection complex as complementary foods become necessary. Respiratory diseases may be precipitated by indoor and outdoor pollution. In cities, atmospheric lead concentrations can adversely affect intelligence and behaviour even before clinical symptoms are manifested. Young children are a readily exploitable and cheap labour force in many poor countries; often subject to a wide variety of pollutants in the work environment. Street children and those at war are at particular risk.
Child development and environmental protection are emphasised throughout as being mutually inclusive goals, and overall development will need to build on these two platforms to ensure its sustainability. The 1989 Convention on the Rights of the Child and the forthcoming global conference on the environment in Brazil in 1992 are two crucial opportunities for bringing this thinking into the mainstream.
S.R.G.
“Food and Nutrition in the African Rain Forest”
UNESCO
The rain forest covers the equatorial and tropical climatic zones of central Africa, from the Congo basin to Cameroon, including Gabon and the southern part of the Central African Republic. In this very complex environment, plant and animal species show a great deal of variation. As an outcome of this, feeding strategies among populations occupying these areas are as diverse. These are pleasantly shown and discussed in a recent English edition of Food and Nutrition in the African Rain Forest, published with financial backing of the French Ministry of Cooperation and Development under UNESCO sponsorship.
The information provided in this edition is based on selected data from the research team in food anthropology “Anthropologie Alimentaire Differentielle” (CNRS, Paris). In these studies before biological aspects of nutritional anthropology are investigated, a quantitative approach has been used by measuring both the natural and cultivated resources of foods, and by weighing actual food consumed in order to allow comparisons between and within studied populations. The study subjects were also interviewed on their food preferences. By combining the biological and anthropological aspects of food consumption and nutrition, using similar population samples, new insights are provided into interpretation and analysis of various feeding strategies of African forest people. Of special interest is the finding that even in the rain forest where food availability and production are assumed to be reliable and homogeneous, seasonal variations in diet appear to play a primary role. It is also emphasized that unlike some urban areas of the tropics protein deficiencies are not an important problem in this environment.
The book edited by C.M. Hladik, S. Bahuchet and I. de Garine and published in 1990, is formatted along the following topics. The rain forest and the hunter-gatherers; Cultivating the forest; Food processing and consumption; Physiological and biomedical aspects of food surveys; and Socio-cultural aspects of food and nutrition.
For more information and to order a copy at 60 French Francs (about US$11), please contact the Librairie de l’UNESCO. 7, Place de Fontenoy. 75700 Paris.
M.L.
IDS Bulletin (July 1990)
Vol. 21, No. 3
While we have rarely reviewed journals as such in the past, this bulletin merits inclusion as it provides a useful collection of current views on food security issues and options, at a time when the concept is increasingly being utilised by governments and development agencies. It comprises nine papers presented at a workshop held in April 1989 at the Institute of Development Studies in Sussex, U.K. Following an overview, the bulletin is divided into two main sections. The first deals with themes in food security and includes case studies from Ethiopia, Sudan and Indonesia, following initial discussion of the relationship between nutrition and food security. The second section is devoted to agency views of the subject, those of the World Bank, European Community, Food and Agriculture Organisation, and the U.K.’s Overseas Development Administration. It thus makes explicit (for these organisations at least) what had hitherto been assumed as the meaning of “food security” - a fundamental step in removing the confusion that has surrounded the subject and one that paves the way for realistic options for action.
In the opening paper, Simon Maxwell offers a definition of food security and outlines the scope of future policy. Five issues are highlighted as being particularly important for the 1990s: the meaning and measurement of food insecurity, structural reform of food systems, improved targeting in sub-Saharan Africa, the future of food aid and the strengthening of rural and urban safety nets. Philip Payne goes on to consider different indicators of malnutrition, their relation to food security concerns and their value and role in assessing overall food and health situations of populations.
Food security analysis and planning has in the past been bedeviled by excessive ideologising at the expense of pragmatism. The need for a more focused case-by-case approach is well demonstrated in the first section of the bulletin where the problems facing countries such as Ethiopia and Sudan are compared with those of Indonesia. The Ethiopian National Food and Nutrition Strategy aims to increase food production through a conservation-based strategy in the face of demographic and environmental pressures. In Darfur in Western Sudan, food security has been approached through the targeting of interventions geared to reducing vulnerability and sustaining livelihoods. This goes further than protecting current income and consumption levels, and can be made geographically specific, administratively self-targeting and supportive of community-based mechanisms. While food security planning has particular relevance and priority in these two countries, in Asia the twin goals of self-sufficiency in staple foods and their equitable distribution have been approached through price policies and selected market interventions. Indonesia’s BULOG agency provides one example. It uses floor producer prices and ceiling consumer prices to buy or sell rice as required to stabilise prices. Recent problems with unstable prices, it is suggested, may be ironed out by permitting rice imports at the margin to balance the domestic market. Increased resources for rice R and D and improved efficacy of input use may also be necessary to maintain self-sufficiency. While these are all legitimate food security concerns, the nature, severity and magnitude of problems clearly differ between countries.
The final section reveals agency views on food insecurity and the type of actions to address it in developing countries. In the World Bank construct, elements of action plans include the macroeconomy, the microeconomy (households), food availability, food consumption and market intermediation. The strong relationship between food insecurity and poverty is emphasised by most agencies. The World Bank believes poverty can be mapped through defining the food insecure, while ODA locates food security concerns within a broader set of poverty issues. ODA stress the danger of donor resources being diverted from successful poverty-alleviation efforts to food security programmes if the problems are viewed as being separate. FAO considers practical aspects and proposes a methodology for formulating national food security programmes. Using a multi-criteria table as a basic tool for assessing projects, this approach addresses common issues, while allowing flexibility for determining specific policies in relation to a country’s political, socio-economic and environmental conditions.
Taken as a whole, the bulletin is a valuable documentation of experiences with food security programmes in the 1980s, It highlights the range of possible interventions, offers elements of successful initiatives and illustrates well the nuts-and-bolts issues as they apply to several countries. This move from generality to specifics in particular is refreshing and should now be built on.
To obtain a copy please contact: The Institute of Development Studies, University of Sussex, Brighton BN1 9RE, United Kingdom.
S.R.G.
AFRICAN COUNCIL OF FOOD & NUTRITION SCIENCES - A.F.R.O.N.U.S.
The first Report of the African Council of Food and Nutrition Sciences (A.F.R.O.N.U.S.) has been published following its formation by the Third Africa Food and Nutrition Congress, which was held in Zimbabwe from 5 to 8, September 1988. The Council - a continent-wide organization of workers in all areas of food and nutrition in every African country - aims at initiating and coordinating activities in the field of food and nutrition in Africa. This publication is the compilation of Special Committee Reports by the Secretary General, including Resolutions and Recommendations adopted at the Food and Nutrition Congress. Also included is information on food and nutrition policy and planning in Africa; training and workforce development for food and nutrition in Africa; a list of Food and Nutrition Training and Research Institutions in Africa, with Cooperating institutions from other regions; and a list of contact persons and institutions throughout the region.
The report of the African Council of Food and Nutrition Sciences is planned to be produced every four years following the Food and Nutrition Congress.
For more information please contact: Dr. T.N. Maletnlema, AFRONUS General Secretary WHO Subregion III, P.O. Box 5160, Harare, Zimbabwe. Tel: 728991; Telex: 6221 WHOSRO ZW.
M.L.
“Community Nutrition Research. Making it Rapid, Responsive and Relevant.”
Edited by Jenny Cervinskas and Richard H. Young. IDRC, Canada.
The International Development Research Center (IDRC) of Canada should be commended for having organized and sponsored a workshop on community nutrition research at the 14th International Congress on Nutrition, held in Seoul, Korea, August 1989. It has also produced a succinct and informative report including presentations and discussions on a rather new approach to research in nutrition and other social disciplines that is worth reading.
Increasingly, biological, social and operational scientists have become interested in community based nutrition research to obtain information useful for programme formulation, implementation, and evaluation. The methods used have been adapted from farming systems and natural resource management programmes; - Rapid Rural Appraisal (RRA); others are based on anthropological information collection techniques with different objectives, among them, identifying people’s behavior with reference to specific conditions - Rapid Assessment Procedures (RAP); still others, examine community health care programmes.
A common denominator is that these methods are essentially qualitative, rapid and can be considered complementary to quantitative, structured, surveys when appropriate. Furthermore, both RRA and RAP are research-action oriented and serve as the bases for active and informed community participation for the solution of food and nutrition local problems, and other social issues.
There is a clear need for more case-studies that will improve the methodologies, define better the people’s role, improve the health and nutritional status of mothers and children and ensure continuity and sustainability of actions and outcomes. The IDRC Report on Community Nutrition Research is a valuable contribution to reach these objectives.
A. Horwitz.
“Low Cost Farming in the Humid Tropics An Illustrated Handbook”
This small and easy-to-follow handbook is written to encourage the economical ways of increasing food supplies through low cost farming. As cited in the introductory section of the book “this handbook describes and illustrates proven farming techniques that will minimize or eliminate dependence on costly purchased inputs”. The book, written by Paul Sommers - a UNICEF Project Officer - is designed to guide families with an approach to increasing their daily food availability with the lowest cost to their budgets. Although it has first been published in 1983, those looking for low-cost ways of increasing food availability - particularly at household levels - may still find the approach of this hand-book useful.
To order a copy contact: Island Publishing House, Inc. Sta. Mesa P.O. Box 406, Metro Manila, Philippines. Tel: 474744, Telex: 0126 MERCOING PN.
M.L.
“Garden to Kitchen Newsletter”
This is a quarterly publication of the UNICEF Pacific Regional Family Food Production and Nutrition Project (See SCN News No. 5, p. 45). It is written for Pacific Island field workers involved in community-based activities “sing examples from practical experiences. The aim is to suggest simple, practical and low cost solutions to many farm problems and to encourage healthy and nutritious eating practices based on locally grown foods and productions for all family members. Although it is mostly circulated in the Pacific, limited copies can be distributed outside the Pacific on request. Write to Family Food Production and Nutrition Project, UNICEF Pacific Operations, c/o UNDP, Private Mail Bag, Suva. Fiji. Tel: 300-439. Telex: FJ 2227.
M.L.
“Intra-household Resource Allocation”
UNU Information on household dynamics influencing nutrition and health under poverty and crises are provided in this publication. Such information is necessary in order to avoid negative consequences of development programmes while promoting their positive effects. Published by the United Nations University as Food and Nutrition Bulletin Supplement 15, the book is based on a workshop held in October 1983 on “Methods of Measuring Intra-household Resource Allocation”. The workshop was funded by the United States Agency for International Development (USAID) that focused on the practical application of methodologies from the disciplines of anthropology, economics, and psychology to the analysis of household resource distribution issues.
The first paper in this document stresses the need to include intra-household issues in designing development programmes to avoid their unanticipated negative effects. The main body of the book is a three-part study. Part one sets the background and considers different conceptual approaches to the subject. In Part two methodological approaches to measurement of intra-household food and health related behaviour are discussed by analyzing various ways for collecting necessary information. The measurement of key variables such as how household members allocate resources including time and food and how they respond or adapt to external economic and social changes or interventions are included in Part three. One approach to incorporating intra-household issues into the design and evaluation of development programmes is given in a table form in an appendix to the book.
This document is edited by Beatrice Lorge Rogers and Nina P. Schlossman. It provides required information and guidelines - in an applied manner - for drawing up appropriate policies to reduce malnutrition prevalence and its effects on social and economic development.
To get more information and to order a copy please write to the United Nations University Press, Toho Seimei Building, 15-1 Shibuya 2-chome, Shibuya-ku, Tokyo 150, Japan. Telex: J25442
M.L.
“Infant Feeding The Physiological Basis”
WHO
As a supplement to volume 67 (1989) of the Bulletin of the World Health Organization this book reviews the physiological development of infants during the prenatal period and first year of life, and the implications for complementary feeding. Knowledge of the physiological basis of child development is necessary for suitable feeding practices particularly because nutritional requirements are determined by the degree of functional maturity. The physiological basis and nutritional aspects of pregnancy and lactation are described in length. Of particular interest is description of those very rare circumstances in which the infants can not or should not be breast-fed. Other chapters deal with the recommended techniques for feeding and care for the low-birth-weight infant and effects of acute infection on the infant and child.
Two features of this publication to which many experts in this field have contributed make it particularly useful. Firstly that while it is published in English, a short French summary accompanies every chapter. Secondly is the addition of three annexes to the book. They include: check-list for evaluating the adequacy of support for breast-feeding in maternity hospitals, wards and clinics; studying the weaning process; and suggested further reading.
This supplementary edition of the WHO Bulletin published in 1990, is edited by James Akre, Technical Officer in the Nutrition Unit, Division of Family Health of WHO, Geneva. It would be useful for nutritionists, nurses and midwives as well as general practitioners, obstetricians and paediatricians and those in schools of public health.
To obtain a copy at SF 22.-contact WHO Distribution and Sales, 1211 Geneva 27, Switzerland.
M.L.
“Crucial Elements of Successful Community Nutrition Programmes”
USAID
The proceedings of the Fifth International Conference of the International Nutrition Planners Forum (INPF) on “Crucial Elements of Successful Community Nutrition Programmes” is published under the same title. The conference was held just before the 14th International Nutrition Congress in Seoul, Korea in August 1989. It was sponsored by the Office of Nutrition, Bureau for Science and Technology, U.S. Agency for International Development under the auspices of the INPF.
The proceedings briefly discuss six major programmes from Bolivia, Brazil, India, Indonesia, Tanzania and Thailand plus another 7 case-studies which were presented in this conference. It brings together in a summarized manner the main issues related to these successful experiences and identifies common characteristics that contributed to their overall positive impacts. The aim was to highlight the elements considered to be necessary to be built into the nutrition intervention programmes under various settings for successful outcomes.
This publication is available in both French and English languages from the United States Agency for International Development, Bureau for Science and Technology, Office of Nutrition, Washington, D.C. 20523.
M.L.
“Iodine Deficiency Disorders A Strategy for Control in the Eastern Mediterranean Region”
A priority area in the nutrition strategy of Eastern Mediterranean Regional Office (EMRO) of the World Health Organization is iodine deficiency disorders control. A recently constituted Working Group for Control of Iodine Deficiency Disorders endorsed a Regional strategy for the period 1990-99, published as World Health Organization Eastern Mediterranean Region Office Technical Publication No. 16.
The main objective of the strategy is to reduce the prevalence of IDD in all countries of the EMR, by the year 2000. Efforts have already been taken to assess the extent and magnitude of the problem by compiling available prevalence data from the Member countries. The Regional Office has, in 1990, published the regional control strategy for IDD in the EMR. The publication, edited by Dr. Kalyan Bagchi of the Nutrition Unit at EMRO, contains a Summary of IDD prevalences in the area, the types of available technical assistance for IDD control, and plan of action for country and intercountry activities in the preparatory and expansion stages of the IDD control strategy.
The publication is recommended to be used in conjunction with its companion document, EMRO Technical Publication No. 12, in order to get a thorough view of the problem in its entirety.
To get a copy contact: Eastern Mediterranean Regional Office, World Health Organization, Alexandria, Egypt.
M.L.
“The Doubly-Labelled Water Method for Measuring Energy Expenditure. Technical recommendations for use in humans.”
A consensus report by the International Dietary Energy Consultancy Group working group; Ed. A.M. Prentice. IAEA, Vienna, 1990, pp 301.
The doubly labelled water (DLW) method was first used to measure energy expenditure in humans in the early 1980s, when the increase in precision of the necessary instrumentation reduced the amount of DLW required per subject to an almost affordable level1. The method was rightly hailed as a major advance in the assessment of human energy expenditure, as it is safe, simple for the subject and provides information on energy expenditure under free-living (as opposed to laboratory) conditions for periods of 10-21 days. The results should therefore reflect normal energy requirements of individuals and populations more closely than results obtained by the traditional more intrusive or restrictive methods.
1 around £260 per 50 kg subject in 1991.It appeared to many people that the DLW method would supersede all other methods for assessing energy requirements.
In the late 1980s, however, it became clear that there were a large number of possible sources of error and technical pitfalls in the method. The IDECG working group was convened in 1988 to allow the principle users of the method at that time to openly discuss alternative approaches to the use of the technique and calculation of results, and to provide recommendations for optimum use of the technique.
The report comprises 13 chapters which are without exception clear and constructive. All aspects of the technique are covered, from procedures for giving DLW to subjects, collection and preparation of urine Or saliva samples, analytical methods and calculation procedures with worked examples. Areas of current uncertainty are highlighted and the advantages and disadvantages of different approaches are discussed. The report also advises on notation, supporting information, and presentation of results for publication. Seldom has a complex method been made so accessible to potential new users, and any workers in this field would be well-advised to study this report in detail.
The question remains, however, of who can and should use the technique. The report gives estimates of the impact on the DLW technique of factors such as random analytical error, isotopic fractionation, diet composition (especially the carbohydrate: fat content and alcohol intake), weight gain (especially during fat deposition), weight loss, changes in energy expenditure and changes in the water source for food or drink. Each of these factors can be shown to produce errors of 5% or less under most conditions, but it is pointed out that the different errors may be additive and that they are likely to be greatest under extreme physiological conditions such as those seen in tropical climates, during rapid growth, during heavy physical activity or in clinical situations. Results obtained therefore need extremely careful treatment of samples and data.
The other remaining problem is the high cost of the DLW itself1, the analytical equipment2, and of the necessary skilled technical personnel and equipment maintenance. For these reasons the potential for DLW studies in the 1990s is unlikely to expand enormously, and a comprehensive set of estimates of energy requirements of different populations based on the results of this method remains a future hope rather than an imminent prospect.
2 around £80,000-£10,000 in 1991.
G. McNeill
Rowett Research Inst., Scotland
Published by The World Bank, Washington, 1990.
The damage that certain adjustment policies have caused to the welfare (including health and nutrition) of poor groups, is by now well known, but exactly what type of adjustment can “work for the poor”? The Social Dimensions of Adjustment (SDA) Program in Africa of the World Bank have looked hard at this and produced this useful study. The role for nutrition-relevant actions within such policies has also been outlined.
In the face of macro imbalances caused by domestic demand exceeding supply, countries differ with respect to how long they can postpone adjustment and protect social expenditures. In Africa, the room for manoeuvre is particularly limited; money markets are shallow and creditworthiness consequently low. In such a situation, adjustment cannot be postponed for long, although its inevitability should not preclude the careful choice of policy tools.
The study shows how the effect of macroeconomic changes on household welfare needs to be understood through a consideration of “meso” linkages - essentially markets and infrastructure. Markets may be formal or informal, while infrastructure is both economic (e.g. roads, irrigation) and social (health and education services). Adjustment offers an opportunity, once such linkages are understood, to set poor households on upward “income escalators”. A standard international trade model can be used to predict meso effects of adjustment policy.
In Africa, a critical determinant is likely to be the infrastructure, the deterioration of which has markedly slowed beneficial price signals to poor producers. In addition to meso linkages, welfare outcomes will be partially determined by the behavioural responses of household members. At the micro level, building a model that successfully incorporates such decision-making, with its inherent inefficiencies (e.g. gender bias) is seen by the Bank as a fundamental challenge. Relevant information at all levels is crucial. This will include national accounts and monetary data (macro), market data (meso) and household-level data (micro) on production, consumption and individual nutritional and health outcomes.
What type of adjustment benefits the poor? Firstly, a set of core expenditures should be determined. These can be economic geared to improving income-earning potential (e.g. extension and credit services, irrigation) as well as social (e.g. targeted food subsidies, integrated nutrition and health interventions, improved supply of basic educational materials). Secondly, monetary targets should be set for lending to the poor, particularly poor women, preferably with group collateral. Thirdly, as many African households produce tradable goods e.g. food, price rises through currency devaluation hold potential, although imperfect meso-level functioning of markets needs specific attention if such signals are to be transmitted to poor producers. Poor urban groups will also need protection through appropriately targeted food subsidies. A more labour-intensive growth pattern may be pursued through shifting output towards exports and efficient import substitution. While this is likely to affect wage levels and employment favourably in the medium and long-term, adverse interim effects will need to be ameliorated through the use of, for example, public works schemes. Nutrition-relevant interventions, whether interim or longer term, hold promise, provided they can be shown to be appropriate, feasible and cost-effective.
The study concludes by stating that while there are real possibilities for protective adjustment, there are no easy answers. Both the analytical and empirical challenges raised by the plethora of macro-meso-micro interactions are formidable. The study’s intent was to provide a tool for assessing adjustment policy options and likely impacts which, bearing in mind qualifications, it has achieved. One major qualifier is the heterogeneity of Sub-Saharan Africa; such a tool will need refining for different countries. Nonetheless, its basic principle of identifying macro-meso interactions, then dealing with meso-micro effects remains valid.
S.R.G.
“Food and Health: Data Sources for Nutrition Policy-Making in Europe”
World Health Organization Regional Publications, European Series No. 34, forthcoming.
This includes the following topics: use of a nutrition information system; nutrition information system and data quality requirements; health impact monitoring; food balance sheets; household budget surveys; dietary surveys and the use of the results; problems and pitfalls of food-to-nutrient conversion; database requirements for calculations from food balance sheet data and household budget surveys; comparison of dietary data from different sources: some examples; and use and misuse of dietary recommendations to evaluate food intake.
To get more details and to order a copy write to Nutrition Unit, World Health Organization, Scherfigsvej 8, DK-2100 Copenhagen, Denmark.
“The Initiation of National Nutrition Policies A comparative study of Norway and Greece”
WHO, Europe
National nutrition policies are beginning to be developed in many European countries as rather new dimensions to national health policies. Nutrition patterns of communities, determined themselves by many different factors, can be influenced by such policies in the interest of health and well-being. How these policies can have the desired impact and what are the conditions for their optimum effectiveness, are illustrated in this study.
This book published in 1990 and written by Dr. Elizabeth Helsing, Regional Officer for Nutrition in WHO’S Regional Office for Europe, attempts to answer these and other questions by comparing the development of nutrition policy in two contrasting countries of Europe, Norway and Greece.
To order a copy at 96 Dutch Guilders (packing and postage extra), write to STYX-Publications, Postbus 1344, 9701 BH Groningen, The Netherlands.
M.L.
“Community Nutritional Assessment with Special Reference to Less Technically Developed Countries”
By Derrick B Jelliffe and E F Patrice Jelliffe. Oxford Medical Publications, Oxford University Press, Oxford (1989). 633 p.
This textbook is the successor of the now-classic “The Assessment of the Nutritional Status of the Community” by D. Jelliffe (WHO, 1966). Its strength lies particularly in the coverage of clinical and anthropometric assessment. In fact, it applies as much to individual assessment - the authors show some scepticism of population-based methods, and indeed statistics themselves (“it is notable that the seventeenth century term for what is now called ‘statistics’ was ‘political arithmetick’“). The detailed and authoritative treatment of basic methods of measurement and diagnosis, as well as interpretation by, for example, biological groups, will be an essential source of reference for many nutritionists, health workers, and others.
J.M.
“Manual of Epidemiology for District Health Management”
Edited by J P Vaughan and R H Morrow. World Health Organization, Geneva. (1989). 198 p.
This manual has been extensively field tested, and the product looks well worth it. It lays out clearly, with straightforward text, clear graphics, instructions and tables, much of what is needed for collecting and interpreting simple epidemiological information (including analysis by hand - as the authors say, up to 300 cases can usefully be handled without microcomputers). Chapters cover the principles and processes from survey design to data use for district health planning.
J.M.
“Activity, Energy Expenditure and Energy Requirements of Infants and Children”
Edited by Beat Schürch & Nevin S Scrimshaw. International Dietary Energy Consultancy Group. Proceedings of an IDECG Workshop held in Cambridge Massachusetts, USA, November 14-17, 1989.
From the introduction: “The first workshop of the International Dietary Energy Consultancy Group (IDECG) focused on the consequences of chronic energy deficiency for adult individuals and societies. It also recommended that IDECG give priority to the examination of all aspects of the relation between energy intake and physical activity in children. The second IDECG workshop was convened for this purpose - (and is the subject of this book).
“The Committee responsible for the 1985 FAO/WHO/UNU report on energy and protein requirements defined energy requirements for adults as “the amount needed to maintain health, growth, and an appropriate level of physical activity”. The Committee maintained that a definition of energy requirements makes sense only if one specifies “what for?”, i.e., an appropriate or desirable level of physical activity and energy expenditure for the particular population group under consideration.
“The 1985 Committee... concluded that the necessary information was not available to base recommendations for the energy requirements of infants and children on estimates of energy expenditure. Instead it continued to do so on the basis of information on energy intakes of infants and children growing normally.
“With the development of the doubly-labelled water method and renewed interest in energy metabolism, a considerable amount of new information on children’s activities and energy expenditure has become available since then. The Steering Committee of IDECG therefore thought that it would also be useful and timely to reexamine the energy requirements of infants and children from the perspective of socio-cultural influences on their energy expenditure. This led to a consideration of possible effects in the other direction, the impact of involuntary restriction of dietary intake on activity and other aspects of behaviour”.
This book includes 18 original papers, and discussion on the implications for measurement, recommended intakes, prevention and treatment of under-and over-nutrition, and research.
This publication is available free of charge from the Secretariat of I/D/E/C/G, c/o Nestle Foundation, P.O. Box 581, 1001 Lausanne, Switzerland.
“Register of Development Activities of the United Nations System 1988”
Compiled by the Advisory Committee for the Coordination of Information Systems (ACCIS). 916 p.
The Register contains over 20,000 economic and social development activities current in 1988. Thirty four United Nations bodies and organizations provided project data which includes information on: reporting organization, activity identifier, project title, funding source, type of activity, executing agency, project years, and expenditure data. The activities are organized by country and development sector. The 1988 edition also includes a subject index for easy access to projects in specific countries.
The 1988 Register costs $40 US and can be obtained from: United Nations Sales and Publications, U.N., New York, NY 10017, USA or from: United Nations Sales and Publications, U.N., Palais des Nations, 1211 Geneva 10, Switzerland. As of early January 1991, the 1989 Registry is also available at a cost of $42 US.
P.Y.
“The Impact of Development Policies on Health. A review of the literature.”
By D E Cooper Weil, A P Alicbusan, J F Wilson, M R Reich and D J Bradley. World Health Organisation, Geneva, 1990.
This book is just out, and we have not had time to review it (we will try for SCN News No. 7). It looks very useful, and describes itself thus.
“This publication reviews the literature on the links between health conditions and development policies in five sectors - macroeconomics, agriculture, industry, energy, and housing. It identifies the immediate and underlying causes of ill-health in each sector and pinpoints major gaps in existing studies. In so doing, it provides a basis for future studies to examine linkages across sectors, assess sectoral connections that heighten health risks, and identify important areas for policy intervention.”
Obtainable from WHO: Price: Sw.fr. 31.-. Price in developing countries: Sw.fr. 21.70.
J.M.
Report of a WHO Study Group on Diet, Nutrition and Prevention of Non-communicable Diseases Technical Report Series, 797, World Health Organization, Geneva 1991, SwFr 26.-
The WHO Study Group met in Geneva from 6-13 March 1989. The task of the Study Group was “to provide recommendations that would help to prevent the chronic diseases that were related to the newly emerging dietary changes in developing countries, and to help in reducing the impact of these diseases in developed countries.”
The Report of the Study Group described and analyzed the dietary patterns and the changes of the nutritional and health situation of countries, evaluated the possible consequences of the “affluent” diet, and examined the relationship between diet and chronic diseases. The Study Group called attention to the importance of the national food and nutrition policies as an important tool for achieving population-based dietary changes.
The Report is organized into 8 chapters and contains 6 appendices. The first chapter gives the introduction and overview of the background and diet-related diseases, and population perspective. Chapter 2 documents the deficiency diseases and the changes of patterns of diseases in relation to changes in diet in the developing parts of the world. Chapter 3 summarizes the relationships between diet and chronic diseases including the risk of food contaminants, additives, biotoxins, mycotoxins in relation to chronic diseases. One of the most interesting and important parts of the report is the two next chapters dealing with the role of nutrients, and dietary energy in the development of specific chronic diseases, and assessing the relationship of particular foods and diets to certain diseases (alcohol, diets high in plant foods). On the basis of the preceding considerations of the relationship of diet to chronic diseases of the non-deficiency type the report summarizes “nutrient goals”.
These population nutrient goals practically are parts of national nutrition policy, and “represents the population average intake that is judged to be consistent with maintenance of health in a population. Health in the population is, in this context, marked by a low prevalence of diet-related diseases in the population”. The integrated approach of this report is followed by the explanation and derivation of population goals.
Chapter 6 gives background of the food and nutrition policy and experiences of promotion of health diets from some developed countries. The chapter 7 summarizes the conclusions and chapter 8 discusses the recommendations. Recommendations are made for action by WHO and by national governments to encourage the implementation of the food and nutrition policy.
G. Zajkas
Source: Navid Lotfi (from bubblegum wrapper).
