PROGRAMME NEWS

BELGIUM

Formation of the National Nutrition Council

Recently a National Nutrition Council (NNC) has been formed by the Government of Belgium. The Council was formally installed on 3 July by the Minister of Health, and its mandate is to provide advice to the government on nutrition-related issues like formulation of a food and nutrition policy. There are 40 members, from a wide range of disciplines connected with food and nutrition, appointed by the King, with Prof. H. Henderickx, from the University of Ghent, as the chairman. The Council's first task would probably be to organize the Belgian participation in the International Conference on Nutrition (ICN). The Ministry of Health has been officially invited by the Ministry of Foreign Affairs to be the focal point for the ICN preparations. In this regard, the Secretary General of the Ministry of Health, Mr Van Daele, will be acting as the ICN focal point.

Since February 1991, an ad-hoc Working Group of several nutritionists - all of them members of NNC - has been meeting regularly at the Ministry of Health, to work on a Belgian paper for the conference.

(Source: I. Beghin, Nutrition Unit, Prince Leopold Institute of Tropical Medicine, June 1991)

FAO

The Food Policy and Nutrition Division of FAO provides member countries with advice, information and technical assistance for "the achievement of adequate nutrition for all population groups, primarily through assessing and monitoring the nutrition situation and subsequently assisting in the formulation and implementation of national food policies and nutrition interventions while ensuring quality and safety of food supplies". This work is directed not only to eliminating hunger and poverty but to improving nutritional status and ensuring improved access to adequate and dependable supplies of good quality and safe foods at afford able prices for all population groups for present and future generations. Current activities include the following:

- contributions to advanced knowledge of a range of technical issues including human energy and nutrient requirements;

- food composition tables (linked with labelling activities and oriented towards agro-industry);

- new methods for assessing/monitoring the nutritional situation of the population, as part of efforts to set up global systems to monitor year-to-year changes in nutritional status;

- nutrition implications of food aid and emergency feeding programmes in cooperation with WFP;

- promoting locally produced food/traditional food plants, especially with high vitamin A content;

- international food standards, limits for food additives, residues and other contaminants developed by the FAO/WHO Codex Alimentarius Commission, and links between Codex and General Agreement on Tariffs and Trade (GATT);

- monitoring and control of food quality and safety systems;

- activities as the technical focal point for the FAO/WHO International Conference on Nutrition.

(Information and Source: Food Policy and Nutrition Division, FAO, Via delle Terme di Caracalla, 00100 Rome, February 1991)

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FAO Vitamin A Programme -Progress Report and Future Outlook

The FAO's plan for the first five years as contribution to the "UN Ten Year Action Programme to Control and Prevent Vitamin A Deficiency, Xeroph-thalmia and Nutritional Blindness" was officially launched at the WHO Headquarters in Geneva in October 1985. The objective of FAO's contribution to this UN Programme is to increase the production of vitamin A and carotene rich foods and ensure their proper consumption. The strategy for the achievement of this objective is to support governments, and particularly their ministries of agriculture, in taking long-term measures to increase production of appropriate vitamin A rich foods and ensuring their distribution and availability throughout the year. Therefore, initially two priority activities were emphasized by FAO: 1) sensitizing of government staff, particularly those of the agricultural sectors, to appreciate their role in the overall effort to prevent and control vitamin A deficiency, and 2) technical assistance to governments to formulate project documents for submission to donors. Progress in the first five years was reported in the Third Summary Progress Report - covering the First Five Years (1986-1990) - of the FAO Vitamin A Programme (published January 1991) which up-dates information on the specific country and regional activities given in the earlier reports dated February 1988 and February 1990 (for the latter see SCN News No. 5, under FAO, Programme News section).

Coordination of the required technical contribution of other units within FAO, particularly those responsible for horticultural crops and seed production, palm oil production, rural development programmes, women's programmes and the development of support communication programmes, was mandated to the Food Policy and Nutrition Division of FAO.

A substantial contribution was made by FAO to the UN Ten-Year Programme during the first five years of programme implementation. In spite of the shortfall of some US$3,500,000 due to internal budgetary constraints, and insufficient support by donors and governments, it proved possible to initiate programmes and actions in 18 countries of the four regions with vitamin A deficiency as a public health problem. These were Bangladesh, Benin, Burkina Faso, Brazil, Chad, China, Haiti, India, Indonesia, Malawi, Mali, Mauritania, Nepal, Niger, Philippines, Tanzania, Vietnam, and Zambia. Other activities included establishment of valuable contacts in collaboration with other international agencies, development of regional cooperation, and sensitizing agricultural sectors of some governments to facilitate programme expansion in the years to come.

The main programme constraint was lack of resources. This slowed down the momentum of the programme within the countries, and brought the required agricultural inputs even further out of tune with ongoing health-oriented interventions. In addition, the paucity of funds reduced the possibility of supporting the non-governmental organizations, especially national ones, willing to cooperate with FAO. Generation of further resources during the next five years remains a challenge for the FAO Vitamin A programme.

As for the future outlook, three new long-term projects will start in 1991, and new project proposals for Bolivia, Brazil, Ecuador or possibly Haiti and Peru will be developed. Promotion for the growing of fruit trees (mango, papaya) for schools, communities, and women's groups will be undertaken. It is hoped that this could involve blind people through collaboration with the World Union of Blindness. During the next five years FAO will promote the following major programme elements:

- generation of funds to support within FAO projects or outside in-depth studies on the impact of long-term agricultural and educational activities on the dietary habits of project beneficiaries and, where possible, on the vitamin A status.

- external budgetary support will be sought and budgets of planned projects will include funds for the preservation, processing, and storage of carotene rich foods at household and community level.

- further attention will be given to communication techniques through mass media to educate the public through effective nutritional messages for preventing vitamin A deficiency in their children.

- technical cooperation between countries will be strengthened.

FAO/WHO

Preparations for the International Conference on Nutrition (ICN) Progress Report

An International Conference on Nutrition (ICN) is to be co-sponsored by FAO and WHO, to provide the world community with an opportunity to look critically at the continuing problems of hunger, malnutrition and diet-related disease and how they can most effectively be addressed, and will be held in Rome in December 1992.

Preparations for the ICN are progressing along two parallel tracks. Globally, preparations for the ICN should be seen as part of an on-going process designed to strengthen the commitment and ability of individual governments, various agencies and non-governmental organizations, and the private sector to address nutrition problems. The Directors-General of FAO and WHO sent a joint Official Communication to all member countries in March 1991, announcing the ICN and inviting them to initiate country-level activities towards the preparation of the Conference.

These country preparations are to be complemented by a series of regional/sub-regional meetings designed to discuss food and nutrition problems common to each region and the means to address these problems. The outcomes of these national and regional activities will contribute significantly to the deliberations during the ICN.

Overall, the technical and administrative preparation for the ICN is under the direction of a Joint FAO/WHO Steering Committee, chaired jointly by Special Representatives of the Directors-General. Dr V. Ramalingaswami, Professor Emeritus, All India Institute of Medical Sciences, has been named as the Secretary-General of the ICN. The first meeting of the Steering Committee was held in December 1990 with subsequent meetings being held on a quarterly basis. The Steering Committee provides guidance on all aspects of the Conference's preparation and monitors the progress made. Day-to-day coordination of the organizational aspects of the ICN is carried out by the FAO/WHO Joint Secretariat in Rome. The technical preparations within FAO are being coordinated by the Food Policy and Nutrition Division under the direction of the Assistant Director-General of the Economic and Social Policy Department. Technical guidance is also provided by the FAO Interdepartmental Task Force on the ICN, which was established in 1990. Similar arrangements are in place within WHO to provide their agency's inputs. An Advisory Group of Experts (AGE) has also been formed to provide scientific guidance and advice on the technical issues, themes and background documents for the Conference.

To coordinate country-specific activities and to facilitate communication with the ICN co-sponsors, each Member Nation has been encouraged to nominate a national focal point. The table summarizes responses so far of National Focal Points designated. As of 6 September, a total of 88 country focal points have been designated - 53 from the health sector, 10 from agriculture, 4 jointly from both sectors, and 21 from other ministries or nutrition institutes.

Each country has been requested to prepare a country paper summarizing the country's nutrition situation, including the extent and causes of nutrition problems, past experience in addressing them and plans for future action. It is hoped that this process will catalyse action within various sectors at the country level towards ICN preparations and participation, but, more importantly, in assuming strong implementation of actions to improve nutrition, following the ICN. Country papers will also be utilized to contribute to a series of technical consultations at regional or sub-regional level.

An intersectoral approach is considered crucial for preparing the country paper and, especially, for implementing related follow-up activities. Member Nations have been encouraged to establish national coordinating committees, or use existing or already planned mechanisms and procedures, to bring together the various ministries, agencies, non-governmental organizations, academia and members of the media and the private sector whose activities are relevant to nutrition, to provide a forum in which the multifaceted nature of nutritional problems and their solutions can be more effectively addressed. Many countries have formed such committees and have held, or are planning to hold, national seminars or workshops to involve all relevant participants in the ICN preparations and related follow-up activities.

Number of National Focal Points (NFP) by Region as of 6 September 1991

Region*	No.NFP nominated at 6.9.91	% of Member Nations with NFPs
Africa (46)	30	65
Asia (22)	14	64
Europe (29)	14	48
Latin America and the Caribbean (33)	12	36
Near East (18)	8	44
North America (2)	1	50
Southwest Pacific (10)	9	90
TOTAL (160)	88	55

* In brackets the total number of Member Nations in a region

An underlying principle of the preparation for the ICN is that it builds upon country-level experiences and leads to activities aimed at preventing and alleviating malnutrition at the national as well as the regional and international levels. One of the key mechanisms for linking the ICN to country and regional-specific activities will be through ICN regional and sub-regional meetings, which are scheduled to be held during the first quarter of 1992. ICN meetings have been tentatively scheduled for SE Asia (Bangkok), Anglophone Africa (Nairobi), Francophone Africa (Dakar), the Caribbean (Kingston), Latin America (Mexico City), the Western Pacific (Manila), the Near East (Cairo), and Eastern Europe (Bratislava).

The primary purpose of these ICN regional and sub-regional meetings will be to provide a technical forum for assessing the nutrition problems common to each region, for evaluating various policies and programmes, in particular those related to agriculture, health, economic and social development and their relationship to nutrition. Relevant national and regional strategies for ensuring nutritional well-being will be discussed and will provide the basis for regional-level contributions to the Plan of Action to be adopted by the ICN. Countries will be invited to send delegations of high-level technical representatives from appropriate government agencies, academia, consumer and other NGO groups and the private sector. International NGOs interested in various ICN regional meetings will also be invited to attend.

A principal background document for the ICN, "The Assessment and Analysis of Trends and Current Problems in Nutrition" will provide an overall technical review of the current nutrition concerns worldwide and efforts to address them. As a global assessment of the nutrition situation, the paper will include a summary of the preliminary findings from the Sixth World Food Survey and a review of experiences in programmes and policies affecting nutrition and institutional arrangements to improve nutrition at national and international levels. Findings from several case studies currently under way will contribute to this paper by highlighting particular issues and concerns within countries.

Themes developed for the ICN have evolved from discussions of the ACC Sub-Committee on Nutrition and careful consideration by FAO, WHO and other UN agencies. These themes include: Assessing, Analysing and Monitoring Nutrition Situations; Improving Household Food Security; Protecting the Consumer through Improved Food Quality and Safety; Caring for the Socio-economically Deprived and Nutritionally Vulnerable; Promoting Healthy Diets and Life-styles; Preventing and Managing Infectious Diseases; Preventing Specific Micronutrient Deficiencies; Incorporating Nutrition Objectives into Development Programmes and Policies. Papers for each of the themes have been commissioned to academia, national institutes, government agencies, and UN agencies. These papers will be aimed at a broad audience in the development community and will be one of the chief mechanisms for briefing policy-makers on nutrition problems.

Two Preparatory Committee meetings are envisaged prior to the Conference. The first Preparatory Committee meeting (Prepcom 1) is currently scheduled for early September 1992 in Geneva, for eight working days, and would include substantive discussions of the Assessment Paper. A summary of the results of previous Regional meetings would be available at Prepcom 1, where government representatives will consult their technical experts and NGOs to get advice prior to the Conference. Prepcom 1 could provide the primary mechanism for developing and refining the anticipated Plan of Action to be debated and adopted by the Conference Plenary.

Prepcom 2, on the other hand, would be kept as short and as flexible as possible and held, in principle, for two to three days in Rome immediately preceding the ICN Plenary. As regards the Plenary, a total of six days is tentatively proposed, to be held at FAO Head quarters in Rome in early December 1992, starting on a Saturday and finishing on a Friday. Two parallel commissions/working groups are envisaged. The main agenda items would comprise the Adoption of a Plan of Action and, if member countries wish, the Adoption of the Declaration.

Non-governmental organizations (NGOs) will be invited to participate in the ICN, and their early involvement in country and regional-level preparations has been encouraged. Because of their work, particularly in developing countries, on food, nutrition, and health issues, it is important that NGOs participate in ICN preparatory activities at country level. This will allow them to share their views and experiences with national authorities and have their concerns reflected in regional/sub-regional meetings and later at the Conference. This should facilitate their active involvement in the follow-up to the ICN during the implementation phase of the Plan of Action.

It is also envisaged that NGOs participate actively in the country and regional-level meetings. The participation of NGOs in the Conference itself will, of course, be subject to the decisions of the Preparatory Meeting of Member Governments on the general arrangements for the Conference. Accredited NGOs will be welcome to attend the Conference and to participate as appropriate and practical. In this connection, in view of the very many interested NGOs, it would seem inevitable that there should be selectivity in the representation of different classes of interest (food, agriculture, health, consumers, industry, etc.) as regards interventions, possibly based on their contributions at the country and regional level. In addition, during the FAO Conference in November 1991, the Ad Hoc Group of Representatives of International NGOs to FAO will be holding a meeting and the ICN is on their agenda to discuss their participation.

The ICN is not seen as an end itself, but rather as a step in the continuing process to strengthen the commitment and actions necessary to prevent and alleviate problems of hunger and malnutrition. Enthusiasm generated to date by the ICN preparatory activities in many countries is encouraging. It is evident from the progress reported here, that the process of preparing for the ICN has resulted in increased awareness of the scope and dimension of nutrition and diet-related problems. as well as an increased willingness among various public and private sectors to work together to address these problems. If these efforts continue, then a major goal of the ICN will have already been achieved.

Still, much more needs to be accomplished if lasting improvements in nutritional well-being are to be achieved. The ICN provides the world community with the opportunity to confront the problems of hunger and malnutrition and relate them to the underlying issues of inadequate food, health, and care and inequitable economic and social development. In this period of rapidly changing economies and political structures, this opportunity, placed before the world community, will provide an important step in the process of meeting the nutrition challenge.

(Source: FAO Conference document C 91/27, September 1991. For further information contact FAO/WHO Joint Secretariat, FAO, Via delle Terme di Caracalla, 00100 Rome)

IAEA

Human Nutrition Programme

The International Atomic Energy Agency (IAEA) was created in 1957 as a specialized Agency of the United Nations with the objective of accelerating and enlarging the contribution of atomic energy to peace, health and prosperity throughout the world. One of its programme areas, Human Health, comprises activities in nuclear medicine, applied radiation biology and radiotherapy, dosimetry, and in nutritional and health-related environmental studies (NAHRES). The Agency, as well as having programmes directly related to nutrition, has an extensive programme area on food and agriculture which is indirectly related to human nutrition. This latter programme is operated jointly with FAO and is designed to assist Member States in using nuclear techniques in their agricultural research and development to improve food production, reduce food losses, and protect the environment.

The objective of the IAEA programme is to promote the use of nuclear analytical techniques and isotope tracer meth ods in human nutrition research with special reference to nutrition problems in developing countries. The techniques supported include (1) neutron activation analysis (e.g. for the determination of trace elements in foodstuffs and human tissues), (2) radioisotope tracer techniques (e.g. for studies of the bio-availability of iron and other trace elements), (3) whole-body counting (e.g. for metabolic studies), (4) radioimmunoassay (e.g. for the determination of serum ferritin and vitamin B12), and (5) stable isotope tracer techniques (e.g. for studies of protein turnover using 15 N and of energy expenditure using doubly-labelled water).

A Coordinated Research Programme (CRP) is developed around a specific scientific topic, in which normally about 10-20 institutes (mostly from developing countries) are invited to participate. Research contracts - typically around $20,000 spread over 3 to 4 years of the programme - are awarded to such institutes. Also, every 1-2 years meetings for research co-ordination are organized.

The Agency's technical co-operation programme encompasses expert services and equipment, fellowships and training courses. Individual technical co-operation projects typically provide US$50,000-100,000 over a period of two years. Fellowship training (which may or may not be associated with a specific technical cooperation project) enables suitably qualified personnel from developing Member States to receive on-the-job training in another country. The duration of such training is normally between 3 and 12 months and all expenses are borne by the IAEA or a donor country.

Currently active coordinated research programmes relate to the following topics: 1) daily dietary intakes of nutri-tionally important trace elements, 2) applications of stable isotope tracers for studies of protein turnover and energy expenditure, 3) the bioavailability of iron and zinc from different diets (see SCN News No. 5. p. 47), and 4) assessing nutritional and environmental exposure to mercury in selected human populations. In addition, support for two technical co-operation projects in Cameroon and Portugal are currently provided.

A database of results for diet samples collected within the framework of the Coordinated Research Programme on human daily dietary intakes of nutri-tionally important trace elements continue to grow. These gave input data reviewed by the 1990 WHO/FAO/IAEA Expert Consultation on Trace Elements in Human Nutrition.

As part of the programme of information exchange, periodic bibliographies (presently 4 issues/year) are prepared, which are mainly for the benefit of CRP participants. These bibliographies summarize information on trace element analysis by nuclear techniques, application of stable isotope tracers, and fallout radioactivity in environmental and food samples taken from the IAEA's International Nuclear Information System (INIS) database. Another recent publication presents the results of a joint WHO/IAEA collaborative study on the composition of human breast milk.

New CRPs are expected to start during 1991/92, in collaboration with WHO, on 1) comparative studies of energy expenditure in selected human population groups using the doubly-labelled water method, and 2) collaborative research on osteoporosis in selected human populations. A Seminar for developing countries on isotope techniques in human nutrition research is expected to be held in India at the end of 1992. A new CRP on protein metabolism under conditions of marginal intake is under consideration for implementation in 1993.

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The first trial issue of a newsletter (NAHRES News), describing some programmes of the Agency's Section of Nutritional and Health-Related Environmental Studies, together with other pertinent information came out in July 1991, This Trial issue No. 1 contains 1990's Annual Report of NAHRES, information about the current status of various CRPs, as well as plans for meetings and training courses. Attached to this newsletter is a bibliography on Trace Elements Analysis by Nuclear Techniques (section A), and Applications of Stable Isotopes (section B).

To obtain a copy of this trial issue and for more information please write to the Section of Nutritional and Health-Related Environmental Studies (NAHRES), IAEA, P.O. Box 100, A-1400 Vienna, Austria. Tel: +43 1 2360 1657, Fax: +43 1 234564.

(Source: Dr Robert M. Parr, Head, Nutrition and Health-Related Environmental Studies, IAEA, Vienna)

IDECG

International Directory of Energy Metabolism Scientists

The Secretariat of the International Dietary Energy Consultative Group (IDECG) has begun to compile an International directory of scientists concerned with biological aspects of energy metabolism. The compilation will be a useful information source for both beginners and skilled individuals in this field in order to exchange ideas and experiences, and will serve as a guide to organizations, institutions and scientific groups who require to know who is currently active in these lines of science. Questionnaires have already been sent to about 100 scientists known to be active in this field, and most of them have returned the requested information. Those concerned scientists who have not still received a questionnaire should contact the IDECG secretariat: Dr B. Schurch, Executive Secretary of IDECG, c/o Nestle Foundation, PO Box 581, 1001 Lausanne, Switzerland.

(Source: IDECG Annual Report 1990)

IFPRI

Food Security and Hunger Alleviation in Sub-Saharan Africa

The Food Consumption and Nutrition Division of the International Food Policy Research Institute (IFPRI), focusing on improvement in food security and alleviation of poverty and malnutrition in poor rural households in Africa, has recently undertaken two projects to help the food security situation in Sub-Saharan Africa. These projects are "Public works programmes for food security", and "Consumption credit for the rural poor in Sub-Saharan Africa".

1. Public Works Programmes for Food Security in Sub-Saharan Africa:

Public works programmes can enhance food consumption through creating employment for the poor in the short run and generating income-increasing assets in the long run. Nevertheless, the experience with such schemes is limited in Sub-Saharan Africa, despite the fact that they have been the key instrument to tackle food insecurity in Asia. The aim of this project is to find out the constraints to preventing utilization of these programmes as a tool for poverty alleviation.

This research - coordinated by Joachim von Braun, with Patrick Webb and Tesfaye Teklu - begins with a comprehensive review of the experience with public works programmes to date in Sub-Saharan Africa. Focusing on the goal of food security improvement for the malnourished poor, it identifies potential areas for expanded use of such programmes and generates policy conclusions that can feed into the formulation of strategies for reducing hunger in both rural and urban Africa. This research, a three year undertaking, is closely related to other programmes supported by bilateral and multilateral donors and NGOs. The project looks at four major questions:

- What lessons can be learned from the Asian and Latin American experiences with public works programmes that may be transferable to African countries and conditions?

- What lessons can be learned from those African countries that already have experience with these programmes?

- What latent potentials exist in Africa's diverse settings for programmes that can generate employment, skills, and assets for food crisis alleviation and for longer-term development, and how can these potentials be tapped in the context of weak institutions and poor infrastructure?

- How do different public works projects compare in terms of effectiveness with other instruments available for addressing food security problems?

In phase two, at least two of the above country cases will be selected for an in depth study of the potential for, and impact of, public works programmes for improved household food security. This phase will involve data collection and analysis at the household level to assess the net effects of these programmes (including food-for-work) on employment and consumption. The resulting analysis will provide guidance for setting programme priorities in different settings, given location-specific development and food security goals. The country studies will be followed by a comparative analysis that brings together broader review findings and leads to policy conclusions and suggestions for strategy formulation.

2. Consumption Credit for the Rural Poor in Sub-Saharan Africa

Lack of access to credit and savings schemes in the rural formal financial markets leaves poor and food insecure households with limited options for stabilizing food consumption. The major options available to the rural poor for coping with food shortages include income diversification, cash savings or holding of other liquid assets, emergency sales, inter-household borrowing within the community, and loans from other informal sources. Credit from formal lenders and progammes is mostly restricted to production purposes.

Based on recent experiences with credit projects in Sub-Saharan Africa which suggests that more information is needed on consumption credit, IFPRI has initiated research for better understanding of existing indigenous informal institutions at the household and community levels. Such understanding will assist in designing viable credit policies and innovative projects. Bottom-up informal systems can, when expanded to a critical mass, link up with the formal credit and savings systems of rural banking and cooperatives to create sustainable rural financial systems in Africa.

This research focuses on how to improve food security through enhanced rural financial intermediation. The major research questions are:

- What is the nature and scale of participation by the poor in formal and informal credit and savings systems? Is credit use differentiated according to socio-economic groups within the rural poor (i.e. gender, land-ownership, income structure)?

- What are the direct and indirect effects of access to credit and savings schemes on household productivity, income and consumption?

- How do existing formal and informal credit and savings options help to alleviate food security problems?

- What types of national, sectoral, and community level institutional arrangements, subject to different agro-ecological and socioeconomic conditions, promote credit and savings mobilization by the rural poor for reducing food insecurity?

- What are appropriate criteria for identifying group-based systems, going about their upgrading, and linking them into the formal banking system to arrive at viable approaches for effectively targeting sustainable credit and savings systems for the poor?

(Source: Rajul Pandya-Lorch, IFPRI, May 1991)

MEDECINS SANS FRONTIERES

Assistance to Populations in Distress

Médecins Sans Frontières was established in 1971 as a private international organization to provide assistance to populations in distress, to victims of natural disasters, collective accidents and war events, without any discrimination based on race, politics or religion. The association has six national sections - Belgium, France, Luxembourg, the Netherlands, Spain and Switzerland - which cooperate closely in the field and in logistical support, with each particular action falling under the responsibility of a section.

The assistance has mainly been in the form of medical doctors, nurses, mid-wives and other para-medical staff, mobilized shortly after a disaster to intervene rapidly in crisis areas. Longer-term actions have been conducted, assisting populations living in war or guerilla areas, such as in Afghanistan, Mozambique, Nicaragua, Sudan, Uganda, and elsewhere. In Malawi, for instance, in order to assist Mozambican infant refugees due to war, the association opened 10 intensive nutrition rehabilitation centres caring for 6000 infants in 1989. In 1990, Médecins Sans Frontières has operated numerous nutrition programmes for infants in African and Asian countries.

Famine early warning systems are established by the Médecins Sans Frontières in places with substantial famine risk. Warning signals such as delayed seasonal rain. massive arrival of refugees, increased food prices, emergency sales of livestock etc. are watched for. In case of doubt, a nutrition survey is undertaken on under-five-year old children by a medical team. More than 10% undernutrition among infants and young children confirms the existence of famine. At this stage, young infants are sent to special intensive nutrition centres made by the Médecins Sans Frontières, and general food distribution begins. Médecins Sans Frontières always has security stocks ready for distribution to any part of the planet.

The Association of Doctors Without Frontiers is financed mainly through private donations, sale of cards, etc. thus refusing allegiance to any political, economic, ideologic or religious power, in order to maintain complete independence and a state of strict neutrality.

(Source: Médecins Sans Frontières)

THE PHILIPPINES

Nutritional Guidelines For Filipinos

The development of nutrition guide lines for Filipinos was started in April 1990, by a Committee composed of experts in food management, clinical nutrition, nutrition education, dietetics, nutrition planning, policy formulation, and the academe. The Food and Nutrition Research Institute (FNRI), an agency under the Department of Science and Technology, spearheaded the formulation of these guidelines in collaboration with other government agencies and non-government organizations such as the University of the Philippines Systems (College of Medicine and College of Home Economics), Nutrition Center of the Philippines (NCP), National Nutrition Council, Nutrition Foundation of the Philippines, Makati Medical Center and other private practitioners.

The guidelines are developed to promote better health status through proper nutrition. It seeks to foster an adequate and balanced diet, desirable food and nutrition practices and healthy habits suitable for general public. It provides a handy reference for counselling and educational services on nutrition. The booklet recommends eating a variety of foods, breastfeeding, proper weaning, achieving and maintaining desirable body weight, eating clean and healthy foods and practising a healthy lifestyle. The NCP Deputy Executive Director of the Nutrition Centre of the Philippines, Mercedes A. Solon, recently participated in the development of these guidelines,

(Source: The Nutrition Centre of the Philippines Bulletin, October-December 1990)

UNICEF/ICCIDD/WHO

Assisting Governments in Implementing National IDD Control Programmes through IPCIDD

The International Training and Support Programme for the Control of Iodine Deficiency Disorders (IPCIDD), through a strong network of support from the international agencies such as UNICEF, WHO, and the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), is designed to assist governments in implementing iodine deficiency control programmes. The programme - as announced in the SCN News No. 6, p. 45 - is a collaborative effort of the Emory University School of Public Health, the Centers for Disease Control (CDC), and the Task Force for Child Survival of the Carter Presidential Center, in Atlanta, Georgia, and is supported by UNICEF. The aim is to help countries with a comprehensive epidemiologic and laboratory programme coupled, with appropriate interventions, to control iodine deficiency disorders (IDD). Participating countries are selected for their demonstrated level of political and resource commitment to IDD control, and the readiness of the national IDD programmes to benefit from the technical training and to contribute to the international effort against IDD.

IPCIDD is expected to be a major catalyst in eliminating iodine deficiency, one of the world's leading nutritional diseases. An estimated 1 billion people in 60 countries are affected by IDD which in children can lead to permanent brain damage and mental retardation, goitre, deaf-mutism, short stature, and retarded development of the musculo-skeletal system. Iodine deficiency is also associated with increased rates of perinatal and infant mortality. The problem is entirely preventable with iodine supplementation.

The first training programme began in May 1991. Experts in the fields of nutrition surveillance, field laboratory management, and public health programme management as well as consultants with special expertise participate in the training programme, which is organized into three major modules: epidemiology and data management; programme management; and laboratory methods and management. Countries participating in 1991 are Bolivia, China, Indonesia, Peru, Philippines, Rwanda, and Zimbabwe.

Information from Dr G.F. Maberly, Programme Director, IPCIDD, Emory University, School of Public Health, Atlanta, George, 30329, USA.

(Source: UNICEF, May 1991)

UNU

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

RAP training workshops in Brazzaville, Congo and Santiago in Chile have been successfully completed, and additional training workshops are now being planned for 1992 in several parts of the world. The 16 minutes RAP video is now also available in Spanish. Copies of both English and Spanish versions are available for US$12 and can be freely copied. Video tapes can be ordered from the UNU International Food and Nutrition Programme, Harvard Center for Population Studies, 9 Bow Street, Cambridge, MA 02138 USA. The RAP guidelines are now available in English ($8.95 plus postage), Spanish ($8.95 plus postage), French ($10.95 plus postage) and soon in Portuguese. These may be ordered from the UCLA Latin American Center, University of California, Los Angeles, CA 90024-1447 USA.

The papers from the International Conference on Rapid Assessment Methodologies for Planning and Evaluation on Health Related Programmes held at Pan American Health Organization (PAHO) headquarters in Washington, DC, in November 1990 are in editorial process and the volume is scheduled for publication early next year.

The Spring 1991 edition of the RAP News is now available. To obtain copies and/or to be put on the mailing list for future newsletters, please contact Dr Nevin S. Scrimshaw, UNU International Food and Nutrition Programme, Harvard Center for Population Studies, 9 Bow Street, Cambridge, MA 02138, USA.

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International Food Intake Directory (INFID)

The United Nations University (UNU) project to assist countries in the compilation and summarization in standard form of all dietary intake data available for the past 40 years is continuing and compilations are complete or in progress for 13 developing countries. It is expected that each set of summaries will be published locally as well as be available through the Cambridge Programme Office of the UNU Food and Nutrition Programme. The purpose of this project is to compile a directory of dietary intake data from developing countries which also have reasonable disease specific mortality and morbidity data. The compilations are intended to facilitate epidemiological analysis of the relationship between diet and chronic diseases. They should also prove useful to professionals within the country for the analysis of dietary trends and the development of dietary guidelines and other educational materials. Individuals and institutions not already participating in this project are encouraged to write directly to Dr Nevin S. Scrimshaw, Director, UNU International Food and Nutrition Programme, Harvard Center for Population Studies, 9 Bow Street, Cambridge. MA 02138, USA. Modest financial assistance is available to help participants with copying, postage, and other incidental costs that may be incurred in obtaining copies of this information.

(Source: Dr Nevin Scrimshaw, UNU. May 1991)

USAID

WINS - Women and Infant Nutrition Support

The Women and Infant Nutrition Support (WINS) Project funded by the USAID Office of Nutrition is designed to strengthen programming for women and young child nutrition in developing countries in order to promote physical and mental development in children. The WINS project intends to address the entire continuum of nutritional needs from birth through three years of age, i.e. from exclusive breastfeeding through weaning to the family diet.

The WINS Project applies strategic approaches, technologies, and lessons learned - over the past decade - from successful breastfeeding and young child nutrition projects carried out by USAID and other government and nongovernment organizations. Through the provision of technical assistance and training, the Project seeks to strengthen the institutional capacity of agencies currently engaged in nutrition activities. More specifically, the Project supports comprehensive infant and young child feeding efforts in at least four countries. It carries out collaborative inquiries with country institutions and researchers to test the feasibility of new approaches to solving breastfeeding and young child nutrition problems and conducts in country and regional seminars and workshops to disseminate new knowledge and relevant skills. It provides technical assistance in related programme and policy analysis and planning, project design, implementation, evaluation, and monitoring to USAID missions and host country institutions.

To accomplish this, the WINS Project draws on the expertise available through its consortium and its strong linkages with other activities within the USAID Office of Nutrition. The WINS Project seeks to strengthen the skills of country counterparts to more effectively design and implement their own programmes, through training and continuity of technical assistance provided by the WINS consortium and its network of in-country colleagues. Working in a collaborative mode, the WINS Project is designed to ensure a host country-based, cohesive approach, building on existing projects where appropriate, identifying and filling gaps in services, and bringing together a range of resources to enhance programme effectiveness.

The WINS project is managed by Education Development Center (EDC), which is a thirty-three year old nonprofit institution, known for its work in the fields of nutrition, health, education. and human resource development. EDC is assisted by the Tufts University School of Nutrition, the International Center for Research on Women (ICRW), and a consortium of other outstanding United States and international organizations.

For more information, please contact Ms Bibi Essama. Project Director, or Dr Nina Schlossman, Technical and Deputy Director at Education Development Center. Inc.. 1250 24th Street. NW, Washington. DC 20037. USA. Tel: 202-4660540: Fax: 202-2234059; Telex: 446154 WESI. Source: USAID.

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Nutrition Institution in Francophone Africa

The Nutrition Communication Network for Africa (RENA) will become a full African institution in July 1991. when its headquarters is relocated to the University of Benin in Lome, Togo. Since it was established in 1987. RENA has been working out of the University of Liege, Belgium, to provide its member countries in Francophone Africa with technical assistance and training in nutrition social marketing, while operating a clearinghouse for nutrition education materials. The USAID's Nutrition Communication Project (NCP) has been instrumental in moving RENA to West Africa by building its institutional capacity to conduct regional programmes in nutrition social marketing.

NCP recently brought in a new partner, the Center for Communication Research (CERCOM) at the University of Abidjan, to take responsibility for training in social marketing. The Office of Nutrition, USAID, plans to provide continued technical assistance to RENA and CERCOM with the expectation that they will soon become self-sufficient institutions in West Africa that can effectively promote good nutrition and help overcome the dietary problems that plague the region.

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Expansion of the ICDS Management Information System

The USAID's Vitamin A Field Support Project (VITAL) has extended its management information system into five more provinces in India at the request of the Indian Government. The improved data and data analysis capabilities provided by this information system has significantly increased the Government's capacity to expand health coverage and nutrition education services to a larger segment of the population. The Integrated Child Development Services programme (ICDS), which manages the information system, now provides services to close to half of the country. According to a recent national survey, villages served by ICDS had coverage rates at more than 60% for pre-school children receiving Vitamin A supplementation, as opposed to 10% in non-ICDS areas. The success of the system has been so great that the Government of India is now considering expanding the coverage even more.

VITAL subcontractor, Community Systems Foundation, is developing new and improved standardized monitoring tools to accommodate other components of ICDS services. This new Progress Reporting System will soon introduce state-of-the-art monitoring and evaluation software tools to manage vitamin A deficiency intervention programmes in India and in other developing countries.

(Source: Office of Nutrition. USAID, May 1991)

WFP

Operations in 1990

To fulfil the important role that food aid can play in overcoming the causes of poverty and hunger, it must be integrated into national development programmes, treated as a development resource by the government, and adequately backed by technical and financial support. A comprehensive approach to poverty alleviation is to promote the productive use of the most abundant asset of the poor - their labour - and to provide basic social services, such as primary health care, nutrition and basic education, as well as safety nets for some groups of poor people unable to maintain reasonable living standards without them. This approach has been the strategy of the World Food Programme (WFP) from the start. Through food-for-work, land settlement, agricultural production and community development projects, WFP helps mobilize and compensate the labour of the poor to construct rural infrastructure and undertake other economic and social development activities. Support to health and education helps governments provide basic social services. Emergency food aid for refugees, displaced people and victims of natural disasters help provide the safety nets.

Over its nearly 30 years of operation, WFP's contribution to the attack on poverty and hunger has become increasingly significant. At the end of 1990, WFP was assisting 278 active development projects with total resources from WFP valued at $3.24 billion, including commitments of $480 million in 1990 for 48 new development projects or expansions of existing ones, and budget increases for ongoing projects. The portfolio of development projects provides food to an estimated 75 million people.

Through 23 active operations worth $324 million WFP supported 6.6 million long-term refugees and displaced people in 1990, providing them with most of their basic food requirements.

Food aid worth $132 million was provided to some 5.8 million people in 20 countries through 32 emergency operations.

In 1990, disaster relief, including the feeding of long-term refugees, amounted to nearly half of all WFP food aid commitments - $336 million for long-term refugees and displaced people and $132 million for emergency operations, compared with $480 million for development projects.

At the end of 1990, WFP was assisting 92 human resource development projects, for vulnerable group feeding (mothers, infants, pre-school children) and feeding children at primary schools with $1.2 billion of WFP resources. Human resource development projects accounted for 56% of 1990 commitments with a total value of $270 million.

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Assisting AIDS Victims

Rather than targeting infected individuals or their households, WFP contributed to the global AIDS strategy by concentrating assistance on communities and geographical areas that exhibit high prevalence rates of HIV/AIDS infection. For example, in Tanzania, food entitlements are targeted at households with high dependency ratios in Kagera region which is most affected by AIDS. Similarly in Uganda, 9500 orphans, 3000 foster families, 2000 hospital patients and 1800 AIDS counsellors and social workers will be assisted in Rakai and Masaka districts having 30% of the AIDS victims. In Malawi food aid is used for an incentive to increase awareness of AIDS, to attract infected patients to specialized clinics, and to promote income-generating activities. In Zambia, over 1700 hospitalized/home AIDS patients are provided with cooked meals. Furthermore, WFP has assisted five national non-governmental organizations in the Dominican Republic with resources to be used for the benefit of AIDS victims and their households.

(Source: Ms Judit Katona-Apte, Senior Programme Adviser (Human Resources), WFP, May 1991)

THE WORLD BANK

Nutrition and Educability

The World Bank has begun to promote more attention to nutrition and health needs of school children in its education projects. Currently there are five projects in which a substantial nutrition component has been included or is proposed for an up-coming operation.

These include: Brazil - Innovations in Basic Education; Burkina Faso - Education IV; Dominican Republic - Primary Education; Mozambique - Education II; and Pakistan - Sindh Primary Education Development. The aim of the Dominican Republic Primary Education Development Project would be to improve an existing school feeding programme through additional training, operations research, and community education and to take efforts to combat iron deficiency anaemia and parasites. In the Mozambique Second Education Project a component is included to study nutrition and health status, and to provide appropriate actions including deworming medicine, and iron supplementation, as required. School-based micronutrient and deworming programmes and introduction of nutrition and health in the school curriculum are included in the nutrition component of programmes for Burkina Faso.

Nutrition activities have been included in several other projects, for example: Bangladesh - Central Education Project; Madagascar - Education Sector Reinforcement; Mali - Human Resource SECAL; Nepal - Basic/primary Education; The Philippines - Elementary Education II; and Rwanda -Education Sector Credit.

A newly published World Bank Policy Paper entitled "Primary Education" by Marlaine Lockheed, recommends nutrition supplementation and health screening for students as a means of improving students' learning capacity.

In line with this increased attention to nutrition in relation to educability, an informal meeting was held at the World Bank on 13 December 1990, to discuss progress in the movement to increase education efficiency through improving children's learning capacity via better nutrition and health. The goal of the meeting was to reach a consensus on the next steps to take to stimulate increased interest and activity in this area.

(Source: The World Bank, May 1991)

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The Bank's Nutrition Lending Activities

The World Bank's nutrition lending increased sharply during the year 1990, when there was 46% more nutrition financing than in the previous ten years combined. The year 1991 is likely to show a 47% increase over last year, and a further 76% increase is projected for the year 1992. Thus, since reorganization the World Bank has enhanced its nutrition lending by twenty-fold in 1990-92, compared with the three years before.

Asia accounts for the largest volume of 1990-92 nutrition lending (44.1%). although South America, at 42.3% is not far behind. Africa constitutes 10.3%. Some current examples of the support provided to nutrition projects and operations are cited below.

Africa Scheduled programmes dealing with nutrition and food security in Chad and Ethiopia have been delayed by reason of political problems in these areas. A Health and Nutrition Sector Adjustment Project with a substantial nutrition orientation for Kenya, and a nutrition/food security project for Mozambique, are in the lending programme. A new approach to help with food security status is recently being prepared for testing in Malawi. Here, in addition to fertilizer, seed, and other production inputs, enough maize meal will be given to women farmers to feed themselves and their children through the next harvest. The intention is to prevent them from having to consume their seeds as food, and to help them break out of the poverty cycle. Nigeria's Minister of Finance confirmed agreement to include a nutrition project in the lending programme. Increasing food security and reducing malnutrition are among the objectives of the Zambia Northwestern Province Development Project Phase II. In addition to extension agents providing information and assistance on nutrition issues related to agriculture, a group of nutrition demonstrators will work in parts of the province to emphasize the project's special outreach to women.

Asia A $11 million nutrition portion of the Bangladesh Population and Health IV project includes support for vitamin A and iodine supplementation programmes, breastfeeding promotion, nutrition education, expansion of the Institute of Public Health and Nutrition, and strengthening of the National Nutrition Council.

The India Child Survival and Safe Motherhood Project includes for nutri tion about $38 million. This is 22% of the proposed $175 million credit. The project addresses iron-deficiency anaemia and vitamin A deficiency and supports several approaches to behavioural change, with special attention to feeding practices. Other state-specific nutrition operations were approved within the past year for Tamil Nadu, Orissa, and Andhra Pradesh, and a project is under preparation for Bihar and Madhya Pradesh.

Community Health and Nutrition III project is directed to five provinces of Indonesia, oriented toward specific nutrition and health problems of provinces and local areas.

Preparation for the Bank's first National Urban Health and Nutrition Project, in the Philippines, is moving along. An overall strategy and programme for delivering nutrition services is being formulated for presentation in a July workshop.

Latin America and Caribbean

The Primary Education Improvement Project in Chile includes a variety of nutrition and health interventions for 250,000 primary school students, and the feeding of 80,000 preschoolers. A Health and Nutrition Project, initially programmed at $80 million, is planned for Ecuador. A similar project to include food supplementation/nutrition intervention targeted at women and children under five is also under consideration for Guyana. The proposal followed an observed 100% increase in the cost of covering minimal daily nutrition requirements in the last 14 months. This is calculated as about 80% of the current minimum salary. Also, a programme giving 300.000 low-income pregnant and breastfeeding women food coupons at health centres will be given substantial support in a Social Sector Adjustment Project, currently being prepared in Honduras. Unlike other similar programmes, in this project the coupons can be redeemed at any store, not just government stores. Furthermore, while the programme is financed heavily by food aid, both World Food Programme and USA Government food assistance will be monetized so that resources can be more efficiently channelled to the project.

(Source: The World Bank)

WHO

Programmes Against Child-killing Diseases

The World Health Organization (WHO) is now working with Member States to set up the Acute Respiratory Infections (ARI) Control Programmes similar to its Programme for the Control of Diarrhoeal Diseases. The aims of these two programmes are to reduce the number of deaths due to diarrhoea by half by the end of this decade mainly by treatment with oral rehydration salts; and to reduce deaths from pneumonia by one-third, through the timely use of simple oral antibiotics. As in the case of controlling diarrhoea it is intended to define standard treatment protocols based on simple clinical diagnosis that do not rely on laboratory or x-ray equipment.

Both diarrhoea and ARI are recognized as the two major childhood diseases in the developing world, which accounted for more than half of all childhood deaths in 1990 alone. Even those children who manage to survive often suffer varying degrees of malnutrition. Pneumonia, compared to diarrhoea, is much less recognized as a child-killer problem, thus efforts to reduce its fatal consequences have been less successful. Both these diseases become potent killers in an environment of poverty, malnutrition and lack of information. Widespread marketing of often useless anti-diarrhoeal drugs and cough and cold syrups frequently complicate the problem and result in wasting money and valuable time required for appropriate treatment.

WHO identifies four major problems which contribute to the 7.5 million deaths from diarrhoea and ARI annually. These are (1) insufficient health workers trained in the treatment of these diseases; (2) lack of awareness of the ultimate dangers of these diseases if left untreated; (3) lack of correct antibiotics or other medicines needed to effect the cure; and (4) poor nutrition.

Among the preventive strategies promoted by the WHO is encouraging mothers to breastfeed in order to give natural immunity and nutritional benefits to their infants.

Development and application of programmes to train both supervisory personnel and clinical and community-based health workers has been given much priority by WHO. To promote effective and practical solutions, WHO works in conjunction with national health programmes in the developing countries to train workers, educate families, and when possible to develop local capacity to manufacture the necessary medicines.

Both programmes have active research efforts that strive to improve the approaches to fighting diarrhoea and ARI, including the search for new vaccines against pneumonia and the major causes of diarrhoea. WHO is currently spending about US$17 million per year on the two programmes. An additional US$20 million per year will be needed by the middle of this decade in order to achieve the stated goals.

(Source: WHO Features. No. 159, June 1991)

WHO/UNICEF

Micronutrient Malnutrition Strikes One-Fifth of Humanity

On the initiative of the Director-General of the World Health Organization (WHO), Dr Hiroshi Nakajima and the Executive Director of UNICEF, Mr James Grant, several United Nations agencies together with North American international development organizations met under the auspices of the Task Force for Child Survival and Development for a global conference - Ending Hidden Hunger -in Montreal, Canada, 10-12 October 1991. This was a policy conference on micronutrient malnutrition. Representatives of some sixty of the world's most severely affected countries were active participants in the search for workable solutions to a major public health problem.

The meeting focused on nutrition deficiencies of iodine, iron and vitamin A. While rarely making the headlines, micronutrient malnutrition severely affects one-fifth of the world's population, hitting hard especially at young children and women.

Virtual elimination of iodine and vitamin A deficiency, as well as reduction of iron deficiency anaemia among women of childbearing age by one-third of 1990 levels, are goals that govern ments have adopted at both the World Health Assembly and the 1990 World Summit for Children.

Iodine deficiency is the world's leading cause of preventable brain damage. Properly called Iodine Deficiency Disorders (IDD), the condition is directly linked to goitre and a wide spectrum of mental and intellectual defects of varying degrees of severity including cretinism, paralysis and deaf mutism. It can also lead to stunted growth and development, miscarriages, stillbirth and infant deaths. Iodine-deficient soil, water and food can be determining factors. The Forty-third World Health Assembly, meeting in Geneva in May 1990 unanimously called for the elimination of IDD as a significant public health problem in all countries by the year 2000. The Montreal meeting should bring that goal closer to fruition. It is hoped that once the size and dimensions of the problem are properly understood by policy-makers in all corners of the globe, more funds will be released and the different sectors involved will be brought together.

Iron deficiency anaemia is probably the most common nutritional disorder. Worldwide, approximately one thousand million people suffer from anaemia which lowers the ability of the blood to carry the oxygen needed for vital bodily functions. It affects first and foremost pre-school children and women of reproductive age in tropical and sub-tropical regions. In developing countries, severe anaemia is an associated cause in one of every two maternal deaths. The condition deeply affects the physical, social and economic fabric of society.

The present situation is tragic because possible remedies have been well known for some time. Supplementation with ferrous sulphate tablets (often including folic acid) has been successfully field-tested in different regions. Dietary modifications can also play an important role in fighting iron deficiency; increasing the intake of haem iron from animal products (and vitamin C which increases its uptake) while, at the same time, reducing the intake of tea, coffee and some cereals, which are known to thwart the absorption of iron.

WHO considers the effective provision of iron supplementation during pregnancy and lactation to be the most practical and immediate way of resolving the problem of iron deficiency anaemia among vulnerable groups. In the Organization's view, the control of iron deficiency is an essential component of primary health care and the Safe Motherhood Initiative.

Shortage of vitamin A is the most common cause of irreversible loss of sight in childhood in developing countries. During the 1980s, more than 2.5 million children needlessly went blind. Unless treatment is provided up to 60% of children going blind in this way may die within a few months. On top of these horrifying statistics, every year at least 500,000 children are subject to serious eye damage. At this very moment, vitamin A malnutrition is causing more than six million children to suffer from night blindness or eye pathology.

When there is a shortage of vitamin A, the human immune system starts to lose its ability to ward off infection. Measles, one of the six major childhood diseases, is a striking example of how the damaging effect of vitamin A deficiency can lead to both blindness and increased mortality. By depleting reserves of vitamin A in the liver measles triggers rapid deterioration of the cornea. Half of all cases of corneal blindness in Africa are directly linked to measles. Thus the overall importance of vitamin A in child survival cannot be overestimated.

In summary, it can be said that problems and solutions are well researched and well known. What is needed is concerted action by all the parties concerned. The Conference on Ending Hidden Hunger urged accelerated action towards three daring, but achievable, goals for the 1990s:

- the virtual elimination of iodine deficiency disorders;
- the virtual elimination of vitamin A deficiency and its consequences, including blindness;
- the reduction by one-third of 1990 levels of iron deficiency anaemia among women of childbearing age.

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