International Conference on Nutrition
World Alliance for Nutrition and Human Rights
Health and the Environment
Misconceptions on Nutrition of Refugees
World Breastfeeding Week - Making Hospitals Baby Friendly
HIV and Breastfeeding
IUNS Awards
Low-Cost Newsletters and Journals of Interest to Nutritionists
Following two years of preparatory activities on nutritional problems worldwide, the International Conference on Nutrition (ICN), co-sponsored by the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO), took place in Rome from 5-11 December, 1992.
Almost 1400 delegates from over 160 countries were present at the Conference, including government Ministers of Agriculture and Health and senior policy-makers, as well as representatives of international and nongovernmental organizations. The participants gathered to discuss and then adopt a World Declaration on Nutrition and a Plan of Action, expressing the determination to eliminate hunger and reduce all forms of malnutrition, and designed to put nutrition at the forefront of development issues.
The need for an International Conference was born out of the realisation that serious nutrition related health problems still exist in many countries, as laid out in the Declaration:
· “In a world that produces enough to adequately feed everyone, 780 million people in developing countries - 20% of their population - still do not have access to enough food to meet their basic daily needs for nutritional well-being.· “More than 2,000 million people, mostly women and children, are deficient in one or more micronutrients; babies continue to be born mentally retarded as a result of iodine deficiency; children go blind and die of vitamin A deficiency; and enormous numbers of women and children are adversely affected by iron deficiency.
· “Hundreds of millions of people also suffer from communicable and non-communicable diseases caused by contaminated food and water. At the same time, chronic non-communicable diseases related to excessive or unbalanced dietary intakes often lead to premature deaths in both developed and developing countries.”
Speaking at the Meeting of the Preparatory Committee in August 1992, which preceded the International Conference, Dr Vulimiri Ramalingaswami, Secretary General of the ICN, said: “Poverty is the root cause of hunger and malnutrition which affects individuals and communities in multiple ways, often working in sinister synergy - low income, inadequate consumption, poor assets, powerlessness, low education, poor housing and sanitation, and proneness to infections.”
His Holiness, Pope John Paul II, who addressed over 1,000 delegates on the opening day of the Conference, spoke of “the scandal provoked by the paradox of plenty which constitutes the main obstacle to the solutions of the nutritional problems of humanity”, and urged participants “to make sure that no-one will be denied his daily bread and necessary health care.”
The Plan of Action adopted at the Conference contains “a wide range of detailed strategies” providing a basis for “national plans of action” which individual countries will aim to revise or prepare by the end of 1994. Actions to be considered by governments in efforts to improve nutrition are: (i) incorporating nutritional objectives, considerations and components into development policies and programmes; (ii) improving household food security; (iii) protecting consumers through improved food quality and safety; (iv) preventing and managing infectious diseases; (v) promoting breastfeeding; (vi) caring for the socio-economically deprived and nutritionally vulnerable; and (vii) preventing and controlling specific micronutrient deficiencies.
Dr Hiroshi Nakajima, Director General of the WHO, speaking at the Conference, emphasised the need for international cooperation in eliminating nutrition-related problems: “reforms to improve health and nutrition throughout the world cannot be carried out by any one international agency. We must obtain the full participation of all multilateral, bilateral, and nongovernmental organisations. In the implementation of programmes all of us are equal partners in what I shall call a 'planetary pact' for nutritional well-being”.
In a closing statement, Mr Saouma, Director-General of FAO said the Conference “opened a new area for dialogue and concerted action on a crucial problem for the future of mankind”.
“At a moment when the spotlights of the entire world are focussed on the dramas of hunger provoked in both Africa and Europe by nature and the folly of man, this Conference allowed us to take a new look at the fundamental issues of food and nutrition.” However, he added, “the answers could only be found through profound reflection and unfailing determination”.
Elected Chairperson of the ICN, Mrs Simone Veil - former Health Minister of France and former President of the European Parliament - told the closing session of the Conference: “I wish that the message of hope expressed here will be heard outside this forum and will find a response during the coming decade for the concrete realization of the commitments we have all made here.”
(Source: ICN Press Releases, 30 November - 11 December, 1992)
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ICN Goals Extracted from the World Declaration on Nutrition, December 1992 “18. We reaffirm the objectives for human development, food security, agriculture, rural development, health, nutrition and environment and sustainable development, enunciated in a number of international conferences and documents.1 We reiterate our commitment to the nutritional goals of the Fourth United Nations Development Decade and the World Summit for Children. “19. As a basis for the Plan of Action for Nutrition and guidance for formulation of national plans of action, including the development of measurable goals and objectives within time frames, we pledge to make all efforts to eliminate before the end of this decade: - famine and famine-related deaths;We also pledge to reduce substantially within this decade: - starvation and widespread chronic hunger, 1 The World Food Conference, 1974; the Alma Ata
Conference on Primary Health Care, 1978; the World Conference on Agrarian Reform
and Rural Development, 1979; the Convention on the Elimination of All Forms of
Discrimination Against Women, 1979, especially articles 12 and 13; the Innocenti
Declaration on the Protection, Promotion and Support of Breastfeeding, 1990; the
Montreal Policy Conference on Micronutrient Malnutrition, 1991; the Rio
Declaration on Environment and Development, 1992. |
A meeting was held in Oslo under the auspices of the Norwegian Institute of Human Rights and UNICEF, in July 1992, on nutrition and human rights. The following is taken from the meeting's report. The meeting discussed “... the need for a renewed effort to improve world nutrition and to ensure the supply of adequate food, through the promotion of relevant international human rights. It was decided that The World Alliance for Nutrition and Human Rights (WANAHR) should be established to provide a focal point for this effort.”
“... Access to adequate food is a human right, not an act of grace. The right to food is established in the Universal Declaration of Human Rights (1948), and the International Covenant on Economic, Social and Cultural Rights (1966). More recently, the Convention on the Rights of the Child (1989) and the Barcelona Declaration on Food Rights (1992) have re-affirmed the right. Nevertheless, the international community has failed to meet its obligation to respect, protect and fulfil this right, as demonstrated by the hundreds of millions of people who suffer from various forms of hunger and malnutrition. Included in this number are people who live in the world's richest nations.”
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The following statement was issued by the participants of the meeting on Nutrition and Human Rights in Oslo, 9-11 July, 1992. WORLD ALLIANCE FOR NUTRITION AND HUMAN RIGHTS 1. The Alliance will seek to pin the efforts of countries, bilateral and United Nations agencies, and other international organizations and NGOs working in the areas of nutrition, food, health, human rights and related disciplines Its terms of reference include the following objectives and purposes. TERMS OF REFERENCE 2. The Alliance, recognizing the difficulties and often the unwillingness of many countries and communities to provide and redistribute available and sufficient resources to ensure adequate nutrition for all, will seek, as a first step, to remove all possible obstacles which hinder the realization of adequate nutrition for all people and particularly for children. 3. The Alliance will seek to raise the level of priority for nutrition in the allocation of resources at the international, national and local levels. It will also urge governments to introduce into their domestic law such measures as are needed for ensuring adequate nutrition. 4. Considering that whenever food has been used as a weapon of war, throughout history and up to the present day, its worst effects have been on the civilian population, particularly on women, children and other innocent victims, the Alliance will promote the prohibition of food deprivation as a method of war. It will also advocate a total ban on the withholding of food for political ends when it deprives needy people of food. 5. Believing that obstacles to breastfeeding often serve as a human being's first hindrance to adequate nutrition, food and care, the Alliance pledges itself to further the principles of the INNOCENTI Declaration on the Protection, Promotion and Support of Breastfeeding (1990). 6. The Alliance will also seek to promote nutrition in a human rights context through research on this topic. Considering that nutrition is an outcome of adequate food, health and care, and can be seen as a reflection of the fulfillment of a wide range of human rights, the Alliance will also seek to develop a nutrition-based approach to human rights monitoring. INITIAL ACTIVITIES 7. In pursuit of these objectives, the Alliance envisages, among other things, the following initial activities: (a) calling on the Secretary-General of the United Nations to use his position and good offices to further the cause of adequate nutrition through the implementation of human rights;8. The Alliance plans to convene periodic meetings of individuals, representatives of NGOs, United Nations agencies and other organizations to discuss issues and joint activities related to nutrition and human rights. 9. The Alliance will work under the auspices of a broadly-based Executive Committee, with a small secretariat. It will establish Task Forces in such areas as research, monitoring, education and training, and, curriculum on nutrition, ethics and human rights. 10. The Alliance will seek funding from a variety of sources,
including bilateral agencies, foundations, United Nations agencies and others to
further its work. |
The aims of the Alliance (shown in the Box) include raising the profile of nutrition, as feasible with appropriate legislation; advocating a total ban on withholding food for political ends when this deprives the needy; promoting breastfeeding and fostering research; and nutrition in monitoring of human rights. Initial activities include asking the SCN to set up a task force on the topic.
The “Olso initiative” highlights the view that adequate nutrition is an ethical issue: people have a right to be well-nourished. This moral argument is gaining momentum, as commitments to eradicate poverty, hunger, and malnutrition (see SCN News # 7, p. 15). “The universally recognised human rights are drawn from four essential freedoms: freedom of speech, freedom of faith, freedom from want, and freedom from fear. Freedom from want, though widely recognized, has not been realized by a significant number of people in many parts of the world.” Freedom from hunger and malnutrition is a central part of freedom from want.
(Source: Norwegian Institute of Human Rights, Grensen 18, N-0159 Oslo, Norway, Tel. (47 2) 42 13 60 Fax (47 2) 42 25 42)
Can Energy Supplementation during Pregnancy Improve Later Child Growth?
For infants and young children in developing countries, malnutrition is still a common problem which results in growth retardation. In many countries, this problem is being addressed by investment in preschool-age child feeding programmes. Although such programmes undoubtedly have beneficial effects, the reported improvements in growth, assessed by anthropometric measurements, have often been surprisingly small.
It has already been suggested that maternal undernutrition during pregnancy could be an important contributory factor to postnatal growth retardation, and previous studies have looked at the effects of supplementation of both the diet of the mother during pregnancy and that of the child. A recently published study, however, has assessed the effect on child growth of improvements in maternal nutrition alone - with important results.
The study took place in Madura, East Java, where a random sample of pregnant women from three villages were given energy supplements in their last trimester of pregnancy (for 90-100 days). Women received either a high energy (HE) supplement of 465 kcal or a low energy (LE) supplement of 52 kcal. The development of the children of women who had complied for at least 90 days was tracked from birth to the age of five years. Measurements were taken of birthweight, the length at age 1 week, the weight and length every four weeks until age 12 months, and the weight and length every 3 months after that. Analyses have shown that HE children were significantly heavier than LE children up to the age of 24 months and that HE children were taller throughout the first 5 years. Weight-for-height (a measurement of wasting) was similar in both groups, but low height-for-age (stunting) was less prevalent in HE children.
What exactly causes this effect is not discussed in detail by the authors of the study, but they do suggest that HE mothers may have had an improved breastmilk output and that their better nourished children were less likely to become sick.
These results may have important implications for the targeting of future supplementation programmes which aim to improve child development. As the authors say: “If supplementary feeding is an option as a component of maternal and child health services or of nutrition programmes, it seems more productive and cost-effective to target this intervention to pregnant women than to children.”
(Source: Kusin, J.A., Kardjati, S., Houtkooper, J.M., Renqvist, U.H. (1992). Energy Supplementation During Pregnancy and Postnatal Growth. Lancet. 340, pp. 623-26)
The Dangers faced by Children in the Americas
The following excerpts are taken from an interview published in Newsweek with Luis Rivera, deputy regional director of UNICEF for Latin America and the Caribbean, and coordinator of a recently published study “Children of the Americas”.
“What is the biggest danger to children's health in the Americas?
We are losing close to a million children under 5 years of age every year. That is the largest catastrophe in Latin America. The main causes of death are malnutrition and infection - the sinister alliance. A disease that normally could be fought by a healthy body gets a malnourished child into a set of potentially fatal complications. The main specific cause of death is childbirth complications, accounting for 32 percent of deaths of children aged up to 5 years old. In many poor areas of Latin America the infant mortality rate is increasing. There was a time in Latin America when infectious disease was the main cause of childhood death and respiratory disease the second. Now they are moving to second and third place and have been replaced by childbirth, which is related to malnutrition of mothers.
“What besides disease are the main threats to children?
There are at least 30 million children aged 10 to 14 working in Latin America; 15 million of them have to work in the street. Some of them have families, but many of them do not. They are exposed to criminal violence and accidents of all kinds. In Colombia, at least 2,000 of the 28,000 people killed last year in various conflicts were children. Throughout Latin America, at least 2 million children are exposed to armed conflicts. Our report says that children who join guerrilla organizations learn to kill before they learn to read and write.
“In Brazil and other big countries the internal inequalities are striking.
You find big gaps in society. Among the well-to-do people in Sao Paulo, for example, the infant mortality in a city neighborhood could be matched with Sweden or Norway. The same in Colombia, where in a wealthy neighborhood the infant mortality is 10 per 1,000 or less. But you go to the Pacific coast or an indigenous community, and the rate is above 100 - a 10-to-1 difference. A country with such discrepancies, such inequities, is a time bomb.
“If everybody in Latin America had access to potable water, how many of the health problems would be resolved?
Of the preventable health problems, 60 percent or more. There are an estimated 100 million people without adequate drinking water in Latin America. More people die of cholera than of AIDS in Latin America.
“Drinking-water access used to be a rural problem, but it's now an urban one.
The cities have exploded beyond the capacities of the infrastructure. Latin America has gone from 30 percent living in cities to about 70 percent now. Many of these people live in areas where it is very difficult to make streets, very difficult to put in sewer and water systems.
“Is there any country in Latin America where conditions are improving?
Chile, Costa Rica, even Cuba. Mexico is on its way to apparently big improvements. They have a meeting every six months on their national plan of action to improve the situation of children.
“What does UNICEF do to improve children's lives?
We contribute mainly two things: health education - because if you have better knowledge about infection, about care of water, you can do something. And trying to come up with simple technology as an intermediate solution, such as low-cost water chlorinators.
“Since the UN children's summit, have conditions for them gotten better or worse in Latin America?
In terms of hopes - better. But unfortunately it takes time to change reality. The only United Nations goal that has been satisfactorily achieved is immunization. But compare the cost and the technology of immunization versus providing water and sanitation. There's a huge difference. In Latin America we are receiving about one tenth of UNICEF resources - $100 million. You think with $1 per person per year you can provide adequate water for the 100 million people who need it? Where are the finances going to come from?
“Why, then, is there more hope?
A wealth of nongovernmental organizations have developed outstanding social technologies. In maternal mortality there is a safe child-delivery program from Bolivia, using low-cost technology. Colombia has more than half a million community child-care programs known as hogares comunitarios, with nutrition, some learning, some socialization. Mexico and Brazil have innovative protection and education programs for street children. Nineteen countries in Latin America have prepared their national plans of action, which include specific goals for the year 2000. These include reducing the child-mortality rate by one third, which would save 1.8 million lives, and reducing maternal mortality by half, saving 86,345 lives.”
(Source: Newsweek, 19 October 1992)
New Initiative for Displaced Populations
Following one and a half years of intensive research in collaboration with other UN organizations, nongovernmental organizations and bilateral aid agencies, WHO has launched an initiative “based on a process of integrating aid for all displaced persons, without distinction between the various groups”.
People who have been forced to leave their homes to seek refuge abroad for a variety of reasons including war, natural disasters, and less obvious but no less distressing forms of repression and violence, often find themselves deprived of adequate housing, food, water and sanitation and at present there is no international machinery offering a comprehensive and integrated approach to the problems of protecting and assisting displaced persons.
In order to address this problem, in the first instance a three year emergency preparedness programme entitled “Health and Development for Displaced Populations” has been set up, funded by the Italian Government. Within WHO the Division of Emergency Relief Operations is responsible, and an inter-agency committee with representatives from UNHCR, UNDP, WFP, ILO, UNICEF, UN/DHA, and nongovernmental organizations such as the Red Cross and WWF presides over its implementation.
Work on this programme is already underway in Central America, in collaboration with UNDP and has just started in Croatia, Mozambique and Sri Lanka.
(Source: WHO press release, 7 October 1992)
According to a report produced by the WHO Commission on Health and the Environment, following a two-year study on the links between health and environmental degradation: “Diseases related to the environment and to life-style, especially infectious diseases and cancer, kill an estimated 75% of the 49 million people who die each year. Some 2.5 thousand million people suffer from illnesses associated with insufficient or contaminated water and lack of sanitation.”
The report constituted the WHO's main contribution to the United Nations Conference on Environment and Development (the Earth Summit), held in June 1992. Below are excerpts from an issue of WHO Features, published in March 1992 based on the Commission's report:
“The Report highlights the leading health problems associated with a deteriorating environment.(Source: WHO Features, March 1992)· More than 2000 million people live in life-threatening and health-threatening environments. Much of the housing in developing countries lacks the most basic requirements for health. Poor housing leads to social and psychological problems, including alienation, drug abuse, family break-up and urban violence.“To address the many problems, the Commission urged that:· Growing urban populations are faced with threats to their health from numerous environmental sources. More than 1000 million city dwellers are exposed to high levels of air pollution. In children, increases in levels of lead in the blood and decreases in respiratory function are related to environmental conditions.
· Indoor air pollution from open fires is the largest energy-related source of ill-health. Biomass fuels (wood, dung and crop wastes) are used to meet the energy needs of 2.5 thousand million people, mostly in rural areas. They are burned on open fires in unventilated rooms, giving off smoke and chemicals that contribute to respiratory disease, long-term cardiovascular effects and cancer. Some 700 million women - with their children - spend most of their time in this environment and are at the greatest risk.
· In industry, serious health risks are faced by workers in small-scale or cottage industries, where accident rates and exposure to toxic chemicals are usually high. Health problems are most severe in developing countries, where fewer health standards are applied to limit workplace risks. Potentially dangerous industries are routinely located away from large populations in only a minority of countries.
· In agriculture, chemicals are widely misused, especially in developing countries where regulations and enforcement are more lax leading to some one million acute poisonings each year, excluding suicide.
· governments and international agencies should give high priority to reducing population growth, over-consumption and waste generation;· organizational changes should be made within government structures to give greater priority to community-based initiatives and participation;
· governments and aid agencies should give high priority to building up local capability for promoting health and environmental quality, using local knowledge, skills and resources;
· governments, international agencies and public and private institutions should develop national capabilities for the systematic monitoring of environmental effects on health, so that policies can be based on reliable and regularly updated information;
· the health profession should be at the forefront of moves to improve the environment and to inform governments and the public of the health implications of development policies and the costs and benefits to health and the environment of alternative strategies.”
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The following letter was published in the Lancet in late November, 1992. SIR, - We are disturbed by misconceptions about nutrition that seriously jeopardise the successful control of malnutrition in refugees and displaced persons. The United Nations coordinating body in nutrition, the UN Advisory Committee on Coordination, Sub-Committee on Nutrition (ACC/SCN), has a working group on refugees and displaced people, which met on July 7 and 8, 1992, and urged that we draw attention to these misconceptions. The group represents all the UN agencies concerned and several donor governments and non-governmental organisations. Although shortages of staff and money and inadequate organisation constrain the effective prevention and treatment of malnutrition among refugees and displaced people, the correction of misconceptions could save lives and safeguard health. Six serious misconceptions that need correction are: “Starving people can eat anything.” It is widely held that people who are starving will be very hungry and eat any food that can be supplied. This attitude is inhumane and incorrect. Even if hungry initially, people often do not consume adequate quantities of unvaried and unfamiliar foods for long enough. More importantly, starving people are often ill and may not have a good appetite. They will therefore languish in an emaciated state or get even sicker. Even someone well-nourished would fail to thrive on the monotonous diets of three or so commodities (eg, wheat, beans, and oil) that is all that is available, month in, month out, to many refugees and displaced people. And this is aside from the micronutrient deficiencies that often develop. This misconception starts, in part, from a failure to agree on explicit objectives for food assistance - which should surely be to provide for health, welfare, and a reasonably decent existence and help in attaining an acceptable state of self-reliance and self-respect. “Children with diarrhoea should not be intensively fed.” A view from many years ago, and from non-emergency situations, sometimes persists - namely, that children must be rehydrated (and diarrhoea prevented) before re-feeding. This policy is incorrect and, with severely malnourished children, it can be fatal. Any child with diarrhoea must be fed, if necessary with a liquid diet by nasogastric tube, at the same time as additional fluids are given. Even if the diarrhoea is profuse, some nutrients are absorbed and can start the recovery process. To begin feeding after rehydration will often be too late. “Refugees can manage with less.” This misconception dehumanises the refugee. It implies that, once uprooted, he or she no longer has the basic human rights to food, shelter, and care - that these are now offered as charitable acts and that refugees can (or should) make do on much less than non-refugees. In fact they will often need more than their normal food requirement at first if they have become malnourished and sick before arrival at a camp and need rehabilitation; and may suffer exposure from inadequate shelter. “Trading foods indicates that people do not need all of the rations.” If the only food source is provided by camp organisers, these rations have to be adequate in all nutrients. This requires a mixed food basket, including fruits and vegetables. If this cannot be ensured then trading may have to be encouraged if refugees are not to become undernourished and deficient in micronutrients. The fact that some foods may be traded, to add variety to the diet, is no grounds for reducing the ration. “A standard ration is suitable for all populations.” The recommended per caput calorie output for a refugee population should vary according to demographic composition, nutritional and health status of the population (allowing for an extra “catch-up” allowance where people are malnourished), the activity level the intake is intended to support, environmental temperature, and likely wastage in the chain from supply of food in a country to its consumption by individuals. In other words there is a range of requirements for dietary energy, which will depend on the circumstances, and use of a single figure is likely to lead to either deficit or wastage. The figure of 1900 kcal (commonly assumed to be of general application) often underestimates what is needed. “Energy adequacy means nutritional adequacy.” The diet needs to be adequate in both quantity and quality, meeting requirements for calories, protein, and micronutrients. Where refugees are completely dependent on the ration provided - for example, in the early stages of an emergency or in dosed camps, where trading for diversity cannot be ensured - the ration must be designed to meet the requirements of all nutrients in full. Often, a ration is designed to meet minimum energy requirements and micronutrients are left to look after themselves. How micronutrient needs are to be met must be made explicit, especially when the ration provided is calculated on the basis of fully meeting energy needs. Foods should be diverse and palatable, and the special needs of weaning children must be met. These and other issues are being addressed in a collaborative inter-agency revision of the 1978 manual The Management of Nutritional Emergencies in Large Populations, to be published soon by WHO. John Mason (ACC/SCN), Stuart Gillespie (ACC/SCN), Graeme Clugston (WHO Nutrition Unit), Peter Greaves (UNICEF Nutrition Cluster) (Source: Lancet, November 28, 1992, 340,
p.1354) |
Contributed by Robert S Chen, Alan Shawn Feinstein World Hunger Program, Brown University.
Can world hunger be significantly reduced in the 1990s? More than two years into the decade, the clock is now ticking on the Bellagio Declaration's ambitious goal of ending at least half of the world's hunger by the year 2000. The Declaration, devised by 24 scholars, experts, and practitioners who met in 1989 at the Rockefeller Foundation Study and Conference Center in Bellagio, Italy, identifies four achievable goals for overcoming hunger in the 1990s: 1) eliminating famine deaths; 2) ending hunger in one half of the poorest households; 3) cutting malnutrition among women and children by half; and 4) eradicating iodine and vitamin A deficiencies.
Fortunately, there is progress to report and promising experience to share. At the fifth annual Hunger Research Briefing and Exchange and the associated awards ceremony for the 1991-92 Alan Shawn Feinstein World Hunger Awards (Brown University, 8-10 April, 1992), researchers and practitioners reported on a diverse set of successes in reducing hunger around the world. These ranged from early efforts to rebuild food security in areas of Central America and Africa, where peace has finally begun to emerge, to the remarkable accomplishments of integrated nutrition and rural development programmes in Asia. What is most striking is that there are numerous excellent examples of programmes that have succeeded in “scaling up” - those that have engaged hundreds of thousands or even millions of people in effective efforts to reduce hunger. In Thailand, as reported by Kraisid Tontisirin of Mahidol University, a decade of integrated multisectoral efforts focused on malnutrition have helped to eliminate severe protein-energy malnutrition among children and to cut mild and moderate malnutrition by half. In Pakistan, the Aga Khan Rural Support Programme (AKRSP) has spurred the creation of more than 1,500 village organizations and 500 women's groups, leading to positive economic, social and nutritional benefits for hundreds of thousands of people in the northern areas of that country. According to a recent World Bank evaluation, “once a government decides to pursue local-level programs of rural development, AKRSP can provide a proven approach, complete with a workable model and implementation method.”
The variety of approaches is also encouraging. Briefing participants reported on several different programs to support microenterprise development, including “Credit with Education” activities sponsored by the Freedom from Hunger Foundation and “Trickle Up Enterprise Zones” organized by the Trickle Up Program. Innovative ways have been developed to educate and assist people using the radio, through seed distribution, and by working with the educational and primary health care systems. For example, the Developing Countries Farm Radio Network, winner of the 1991-92 Feinstein Merit Award for Communication and Education, has reached more than 100 million listeners in 94 countries, with informative scripts on health, nutrition and agriculture. Seeds for the Americas, a partnership of business, foundations, and NGOs, has worked with many different local groups to help start more than 50,000 family gardens in Latin America and the Caribbean. Marcia Griffiths of the Manoff Group emphasized the importance of building mothers' self-confidence as a key to improving their care of children, especially during the critical breastfeeding and weaning periods. A “three-pronged” intervention programme based on nutrition education, targeted supplements, and food fortification has proved effective in reducing vitamin A deficiency in Indonesia, as described by Ignatius Tarwatjo of the Indonesian Ministry of Health. One feature of many of these efforts has been careful attention to monitoring and information needs as part of both short- and long-term decision making.
Further progress towards the Bellagio goals will very much depend on adapting to and working with change. Robert Kates, Director of the World Hunger Program, emphasized in his opening keynote address at the Briefing the need to find “common cause” among the differing agendas of hunger, population, and environment; between the competing needs of east and west, north and south; and between short and long term solutions. Thomas Weiss and Larry Minear reported on the Brown University/Refugee Policy Group project on “Humanitarianism and War”, which is developing principles and policy guidelines for aid practitioners in situations of armed conflict. Rapidly evolving norms for human rights, national sovereignty, and even “environmental rights” are providing new opportunities to put principles into practice in the delivery of humanitarian assistance and the protection of the basic human right to food. Rapid restoration of food security is itself critical to maintaining and strengthening peace and democracy “after the wars”. But this can be a difficult challenge in areas still plagued by violence and social and economic inequity, as emphasized by Carmen Monico of the Cordes Foundation, who accepted the 1990-91 Feinstein Merit Award for Public Service on behalf of the repatriating villagers of El Salvador.
Greater optimism about the future was reflected in remarks by Ronald Roskens, Administrator of the US Agency for International Development, and actress Audrey Hepburn, UNICEF Goodwill Ambassador. Roskens highlighted the potential after the end of the Cold War for significant progress in health, education, child survival, economic growth, political freedom, and hunger, emphasising the leadership role that the US can and should play. Hepburn, as Honorary Chairperson of the Feinstein awards ceremony, spoke eloquently of civilization's rare “second chance...to build a strong and promising future for our children” now that “the old order has come tumbling down”.
Nevertheless, much remains to be done. Preliminary results presented by Marito Garcia of the ACC/SCN illustrate how large and difficult the task of reducing child malnutrition by half by the year 2000 may be. James Ingram, former Executive Director of the UN World Food Programme and winner of the 1991-92 Alan Shawn Feinstein Award for the Prevention and Reduction of World Hunger, underscored the many institutional limitations that persist in the relief and development community and the need for institutions focused solely on humanitarian assistance. International consensus on ending hidden hunger has grown, but the challenge is now to develop specific national strategies to eliminate micronutrient deficiencies throughout the developing world.
The Briefing also served as a forum for discussion of the recently released Medford Declaration to End Hunger in the US (see box), drafted by a committee representing US hunger organizations in Medford, Massachusetts in 1991. The Medford Declaration - inspired by discussions regarding the Bellagio Declaration at the 1990 Hunger Briefing - is an initiative to end domestic hunger in the US by 1995 and achieve economic self-reliance for most American households by the year 2000. Strikingly, many of the themes and approaches evident in international efforts to reduce hunger - for example, the provision of credit and the problems of scaling up - were echoed strongly in discussions about how to end hunger in the US. It is expected that comparisons between developed and developing countries will figure strongly in the sixth annual Hunger Research briefing and Exchange, tentatively scheduled for April 1993.
[A detailed report on the fifth Hunger Research Briefing and Exchange is available from the Alan Shawn Feinstein World Hunger Program, Box 1831, Brown University, Providence, RI 02912, USA. The text of the Bellagio Declaration in English may be obtained via electronic Mail from Robert Chen@brown.edu or in English, Chinese, French, German, Portuguese, or Spanish from the World Hunger Program.]Dutch Guidelines for The Use of Milk Products in Food Aid
The following extract is taken from a publication of the Netherlands Government setting out guidelines for the use of milk products in food aid. The information is directed towards decision-makers at policy level and agencies involved in the selection of commodities.
“A. GENERAL
1. These guidelines are designed to define the role of milk products in food aid and are based on a consideration of factors such as relevance to development, nutritional content, economic value, cultural effect, health hazards and possible misuse of milk products compared to alternatives.
2. Only the milk products Dried Whole Milk (DWM), Dried Skim Milk enriched with vitamin A (DSE) and Infant Formula can be considered as commodities for food aid, but the need is limited. There is no use for condensed and evaporated milk products.
3. These guidelines apply particularly to all forms of food aid programmes.
B. POSSIBLE USES OF MILK PRODUCTS:
4. Infant formulas replacing breast milk can be used for medical reasons on prescription only; they are only allowed for hospital use and take-home rations. To be provided with clear instructions for preparation and use in cup and spoon-feeding, under the guidance of medically trained professionals. Other uses for Infant Formulas are not permitted.
5. DWM or DSE (the latter preferably together with oil) can be used as liquid high energy/high protein food for rehabilitation of malnourished children (and convalescent patients in exceptional cases). For hospital use only.
6. DWM or DSE can be used for take-home rations only by populations for whom milk is traditionally an essential part of the diet (pastoral nomads). Adequate instructions for safe use and precautions against use as breast milk substitute or bottle feeding have to be provided. In all other situations the use of DWM or DSE for take-home rations is not allowed.
7. DSM can be used in feeding programmes for pre-school children as a protein-rich component of blended foods, mixed before distribution, only in situations where no local alternative is available and milk use will not disturb food habits. The blend should not contain more than 10% DSM in weight. Blended foods for on-the-spot feeding and take-home rations are allowed provided that clear instructions for preparation are given.
C. USE OF ALTERNATIVES
8. The use of DWM or DSM/oil as recombined/reconstituted milk for on-the-spot feeding has to be discontinued and replaced by the use of blended foods.
9. In feeding programmes for weaning children or preschool children, either for on-the-spot feeding or for take-home rations, high energy/protein porridge mixes are highly suitable commodities, because the target groups are easy to identify. These porridge mixes should consist of blended foods, mixed before distribution. Excellent recipes based on local commodities are available in the literature. Blended foods with or without milk powder are available from processors in industrialized and developing countries. Preference must be given to local or triangular suppliers.
10. Feeding programmes for pregnant and nursing mothers and convalescent patients should supply (potentially) indigenous commodities like cereals enriched with pulses, oil, fish or meat, to provide the additional energy and protein. There is no need for milk products in these cases.”
(Source: Guidelines for the Use of Milk Products in Food Aid Programmes Proposed by the Netherlands Government (1990), The Hague. Additional copies can be obtained from: Ministry of Foreign Affairs, DST/TA, PO Box 20061, 2500 EB The Hague, Netherlands.)
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The Medford Declaration to End Hunger in the U.S. We can end hunger in America, and we can end it now. Three decades ago a new President challenged our nation with two goals: to reach the moon and to end domestic hunger. We have reached only one of these goals. It is time to achieve the other. Hunger has no place in the new world tomorrow brings. It is a form of economic suicide. Hunger is also inconsistent with our conscience. If anything is un-American, it is hunger. We believe Americans have reached a consensus on ending hunger. We come to this consensus from many points of view. Many of us are moved by the belief that the United States is losing its economic leadership, and that we must invest more in our children and families to insure national productivity in a more competitive world. Others are moved by enlightened self-interest, pointing out that we either pay now or pay later for preventable problems. Still other citizens address domestic hunger out of strong or religious convictions. And many in the fields of education and health are moved by the crippling impact of hunger on the health and learning capacity of our children. From many walks of life, we are one people - a people who agree that we can eradicate hunger in our country. A people who believe we must do so. Abolishing hunger at home will require two steps. In the short term, we must use existing channels to see that food is available to the hungry on an adequate and consistent basis. If we fully utilize existing public programs in conjunction with the heroic efforts of voluntary food providers in local communities we can end hunger very soon. But we must move as a nation to end the causes of hunger as well. Many things can be done to increase the purchasing power of American households, and to fulfill the desire for independence and self-reliance which so characterizes our people. We can achieve this two-step goal before the start of the new century. We can begin with children...and we can virtually eliminate domestic hunger by 1995. Programs exist to insure that all Americans have enough to eat by 1995. Within months we can meet emergency needs by moving surplus foodstuffs into the communities of the nation as quickly as we ship goods to feed our military personnel overseas. Within two years we can fully use existing federal food programs to prevent hunger. We must begin with children. We can reach every needy child with the school lunch and breakfast program. We can start with the six million poor youngsters who often begin their school day with no food. We can fully use the highly effective Women, Infants and Children (WIC) program to help insure that poor mothers do not give birth to undernourished babies - protecting four million more youngsters who presently are at risk. We can expand the benefits of food stamps which help unemployed households make it through economically difficult times. And we can insure that no elderly citizen goes without the nutrients provided by Meals on Wheels and congregate feeding. These steps alone can virtually wipe out domestic hunger by mid-decade. We can achieve economic self-reliance for most American households by the year 2000. Promoting adequate purchasing power is the way to achieve the goal of a hunger-free United States. This nation will have defeated chronic hunger when its people achieve “food security” - regular access to an adequate diet through normal means. A variety of steps can be taken this decade to accomplish this end: market-based employment and training programs to build skills and expand jobs; making sure child care is available so parents can work; expanding concepts such as earned income tax credits and children's allowances so that the tax system strengthens families. The goal is to increase the purchasing power of employed heads-of-households so that work raises families out of poverty. The current window of world peace now gives us the opportunity to abolish domestic hunger. We can increase the competitiveness of our work force and protect the vital energies of our young. And we can assist emerging democracies of the world with pride because all Americans will enjoy the most basic fruit of our own democracy - freedom and family security. We stand at a special moment in history. Perhaps for the first time, our desire to end hunger is converging with the opportunity to do so. We have moved from ability to consensus. We now need the political leadership to achieve the long-held goal of an America free of hunger. Source: Center on Hunger, Poverty and Nutrition Policy,
Tufts University, Medford, USA |
On the second anniversary of the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (see SCN News No. 6), the World Alliance for Breastfeeding Action (WABA) with the support of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) declared 1-7 August, 1992 “World Breastfeeding Week”.
The theme this year complemented the “Baby-Friendly Hospital Initiative” (BFHI) launched by UNICEF and WHO in March 1992. The BFHI is a worldwide drive to promote breastfeeding of infants on a national scale and to terminate the supply of free and low-cost infant formulas to maternity centres and in the first reaction to this initiative more than 50 hospitals and maternity institutions in 12 countries (Bolivia, Brazil, the Ivory Coast, Egypt, Gabon, Kenya, Mexico, Nigeria, Pakistan, the Philippines, Thailand and Turkey) have made a commitment to support and protect breastfeeding.
Breastfeeding is the only natural method of infant feeding, is crucial for the physical and psychosocial well-being of the young child, helps in birth-spacing and protects women's health. Yet, some medical doctors, health workers and mothers had come to regard breastfeeding as a nuisance, and its practice had declined.
The aim of this initiative is, therefore, to mobilize health care services and staff to promote and support breastfeeding and to create a demand by women for hospitals that encourage breastfeeding. The long-term goal is to contribute to the attainment of the breastfeeding goal for the 1990s outlined in the Declaration and Plan of Action and adopted at the 1990 World Summit for Children. The Declaration stated that “all women should be enabled to practice exclusive breastfeeding and all infants should be fed exclusively on breastmilk from birth to 4-6 months of age.” It also added that children should continue to be breastfed past their second birthday “while receiving appropriate and adequate complementary foods.”
Collaborations between WHO, UNICEF, the International Association of Infant Food Manufacturers and individual companies have led to a commitment by industry to end free or low-cost supplied of infant formula to maternity wards and hospitals in all developing countries. The twelve above-mentioned countries ended supplies in 1991, and whilst WHO and UNICEF regret that there appear to be failures to comply in some countries, both agencies expect that there will be full enforcement of government bans in developing countries by June 1993.
The next step will then be to end free and low-cost supplies of infant formula that contribute to routine bottle-feeding in health care facilities in industrialised countries. “It is our fervent hope that this important goal can be met in all countries with the cooperation of all interested parties including the infant food manufacturers and distributors, by June, 1994” said UNICEF Executive Director, Mr James P Grant and WHO Director-General, Dr Hiroshi Nakajima. Mr Grant added “the extremely positive news for children and women everywhere at the close of 1992 is that the world has clearly navigated the turn back towards breastfeeding. The vast majority of the world's children will now be born into societies that, by government policy, protect every mother's right to give her child the best possible start in life.”
(Source: WHO Press releases, 13 March 1992, 31 July 1992 and 2 February 1993)
Positive Trends in Breastfeeding
“A study by the Institute of International Studies in Natural Family Planning (Georgetown University), which compares results from recent Demographic and Health Surveys and the World Fertility Surveys of the 1970s, concludes that despite increases in the level of urbanization, women's education, and use of contraception, the percentage of children ever breastfed and the duration of breastfeeding remain stable in most of the 15 countries surveyed. Urban and more educated women are now breastfeeding for substantially longer periods than previously, while there has been a small decline in the duration of breastfeeding among rural and less educated women. Six of the countries show an increase of three or more percentage points in the proportion of children ever breastfed. Two countries (Ghana and Trinidad and Tobago) show an increase of more than two months in the length of time children are breastfed.”
(Source: World Bank, November 1991)
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“He has been a strong boy since infancy. He breast-fed until he was two years old” 84-year-old Klavdiya Valisyevna Yeltsina, on her son, Russian President Boris Yeltsin, in “Semya”, Moscow. (Source: World Press Review, September 1992) |
On 6 November, 1992, the Director General of WHO announced the appointment of Dr Graeme Clugston as Chief of the WHO Nutrition Unit. Dr Clugston was previously medical officer in the nutrition unit, and before that Regional Nutrition Officer for South East Asia, based in New Delhi. He replaces Dr A Pradilla, who retired in July, 1991.
(Source: WHO Information Circular No. 90, WHO, Geneva)
Executive Director of ICCIDD becomes New Lieutenant-Governor of South Australia
Dr Basil Hetzel, who since 1986 has been the Executive Director of the International Council for the Control of Iodine Deficiency Disorders, was appointed on May 28, 1992 as Lieutenant-Governor for the State of South Australia. On announcing the appointment the Premier, Mr Bannon, said Dr Hetzel had made a significant contribution to the field of public health both within Australia and internationally.
(Source: The Advertiser, Adelaide, 1 April 1992)
Pinstrup-Andersen Named Director General of IFPRI
The Board of Trustees of the International Food Policy Research Institute (IFPRI), after an extensive and worldwide search, named Per Pinstrup-Andersen Director General of the Institute, effective from July 1, 1992. He succeeds Just Faaland, who retired from IFPRI last summer. Pinstrup-Andersen, a native of Denmark, was previously director of the Cornell Food and Nutrition Policy Program and professor of food economics at Cornell University.
(Source: IFPRI press release, October 10, 1991)
Jelliffes Foundation and Award
“The Jelliffes Foundation and Award have been established in admiration of the great pioneering work of the late Professor Derrick B Jelliffe and his widow E F Patrice Jelliffe in promoting the health and wellbeing of the world's infants and children, and in gratitude for the unfailing support and encouragement which the Jelliffes always extended to others who were trying to work for the same cause.
“The purpose of the Award is to continue the Jelliffes' lifelong action by supporting young persons who are doing valuable work for the health and nutrition of infants and children, and for enabling mothers to breastfeed.
“In the first phase, from 1 December 1992, appeals for contributions to the Foundation will be sent through various networks and channels to friends and admirers of the Jelliffes.”
For further information contact: Dr Elisabet Helsing, WHO Regional Office for Europe, 8 Scherfigsvej, DK-2100 Copenhagen, Denmark.
(Source: WHO EARPRO Announcement, 1 December 1992)
Folic Acid Supplementation Recommended to Prevent Birth Defects
In September, 1992, the United States Public Health Service issued a recommendation that all women of childbearing age should supplement their diets with extra folic acid, a B vitamin - a measure which could prevent the neural tube defects that occur in 1-2 of every 1000 babies born every year. This was the first time that a regular supplement has been recommended in this way.
It has long been suspected that folic acid is associated with neural tube defects - but it is claimed that the results of a Hungarian study (as yet unpublished) on a random sample of women who had not had a previous child with a neural tube defect, have shown that low doses of folic acid can prevent neural tube defects in the babies of these women.
Neural tube defects include anencephaly, where much of the brain is missing, and spina bifida, which results in paralysis of parts of the lower body. Spina bifida can be accompanied by hydrocephaly, a defect which prevents fluid from draining properly from the skull, sometimes causing mental retardation.
Such defects can occur as early as the second week after a missed period, when many women are unaware they are pregnant, which is why it is recommended that all women of childbearing age should take 0.4 mg of folic acid per day.
Dr Steven Laubacher, executive director of the Spina Bifida Association of America said of these findings: “at our organization, we try to discipline ourselves to be reserved. But this points in the direction of a major, major breakthrough”.
(Source: The New York Times, 15 September 1992)
Vitamin C and Mortality
Recently published survey findings appear to lend support to two hypotheses concerning vitamin C: that this vitamin can play an important role in preventing cardiovascular disease, cancer and possibly other diseases; and that there are health benefits of intakes of vitamin C far in excess of usually recommended intakes, such as the US Recommended Dietary Allowance (RDA) of 60 mg/person/day.
Researchers at the University of California, Los Angeles, looked at whether the level of vitamin C intake had any effect on mortality rates amongst a nationally representative sample of 11,384 US adults aged 25-74. They began by monitoring the vitamin C intakes of the sample, both from food and supplement sources, during the early 70s. Deaths, and causes of death of the subjects were recorded over the subsequent 10 years. Each individual was then classified according to the amount of vitamin C consumed. The researchers used three possible levels of vitamin C consumption: (i) 0-49 mg; (ii) 50+ mg and no regular supplements, and (iii) 50+ mg and regular supplements. The number of deaths within each classification of vitamin C intake was counted and compared to the expected mortality rate amongst all US white adults.
Results showed that for those males in the highest category of vitamin C intake there were 35% less deaths than would be expected for all US white males. When the causes of death were isolated there were 42% less deaths from cardiovascular disease and 22% less deaths from all cancers than would be expected. The reduction in mortality was less marked in females.
In order to address the question of whether vitamin C was really responsible for these observations, the researchers controlled for ten other potential causes of lower mortality rates - race, history of serious diseases, education, cigarette smoking, exercise, alcohol consumption, calories, fat, cholesterol, and dietary vitamin A.
When all these factors were taken into account there were still significantly less deaths amongst males in the highest vitamin C consumption group than those in the lowest consumption group.
It is interesting to note that those in the highest intake group, who took supplements, were estimated by the researchers to be ingesting on average several hundred mg of vitamin C per day. Few surveys have as yet taken account of vitamin C consumed in such quantities in the form of supplements.
(Source: Enstrom, J.E., Kanim, L.E., Klein, M.A. (1992) Vitamin C Intake and Mortality among a Sample of the US Population. Epidemiology, 3, 194-202.)
Folate Deficiency and Cervical Cancer
After breast cancer, cervical cancer is the second most commonly occurring cancer in women worldwide. Deaths from the disease are largely preventable through early detection and treatment of the precursor “cervical dysplasia” (CD) - but in many developing countries, where adequate health care systems do not exist, mortality rates are often several times those in developed countries. Even where mortality is relatively low, detection and management of the disease places a heavy burden on health care systems, and so in all cases, a desirable alternative would be to prevent the cancer and its precursor from occurring at all. Many studies have thus concentrated on identifying the primary causes of the disease.
Much evidence has indicated that CD is caused by sexually transmitted infection with a strain of the human papillomavirus (HPV) - but the discovery that the virus does not always cause CD has led to the belief that other “host” factors may be involved, and risks associated with sexual and reproductive history, socioeconomic status, cigarette smoking, nutrition, immunity, and oral contraceptive use have been described by epidemiological studies.
A recent research project has looked at the role that nutritional deficiency may play in causing cervical dysplasia in young women. The researchers were particularly interested in folic acid deficiency due to reports that oral contraceptives can cause low blood folate levels. In addition, a 1982 study had noted beneficial effects of folic acid supplementation on women with mild or moderate CD and who were taking oral contraceptives. This study concluded that “either a reversible, localized derangement in folate metabolism may sometimes be misdiagnosed as cervical dysplasia, or else such a derangement is an integral component of the dysplastic process that may be arrested or in some cases reversed by oral folic acid supplementation.”
Using red blood cell (RBC) folate levels as an indicator of long-term nutritional status, the study found evidence that suboptimal reserves of folate (RBC levels below 660 mmol/l) are not alone significantly linked with increased risk of developing CD. In addition, in women with folate levels greater than 660 mmol/l, cigarette smoking, parity and HPV infection are not associated with a significant increase in risk. However, coexistence of multiple risk factors - low RBC folate concentrations, cigarette smoking, parity and HPV infection - were linked with increased risk of CD.
A biological explanation of the above findings may be that folate deficiency cannot by itself cause cervical dysplasia, but that cells deficient in folate may be more susceptible to the effects of carcinogens.
The authors are cautious about drawing firm conclusions about their findings, but suggest that replication of their study by independent investigators may be able to consolidate the existence of a link between folate deficiency and cervical cancer.
(Source: JAMA, Jan 22/29 1992 - Vol. 267, No. 4)
Vitamin A Therapy for Measles
Measles is regarded in developed countries as a fairly banal, self-limiting disease of childhood. In developing countries, however, it is a significant cause of childhood mortality. In 1989, for example, 45 million children were afflicted by measles and 1.4 million died as a result - this, in spite of the availability of a highly effective vaccine. Measles case fatality rates in developing countries are 20 times those currently reported in developed countries.
Deaths from measles usually result from the complications of the disease which include pneumonia, diarrhoea and croup. Other complications of the disease such as blindness (half of all cases of corneal blindness in Africa are directly linked to measles), otitis media, encephalitis and growth failure often result in permanent disabilities. The long-term and hitherto underestimated impact of measles is also serious because even if the child survives the measles attack, it has a ten-fold risk of contracting other infectious diseases and dying.
Measles complications are worsened as a result of the lowered levels of serum Vitamin A which occurs during infection with measles. Vitamin A functions, presumably, by protecting the immune system and epithelial tissue. When they fall below a certain critical threshold, the epithelial surfaces of the eye and the respiratory and gastrointestinal tracts lose their integrity, thereby allowing invasion of the measles virus and pathogens. The result is eye damage and eventual blindness, diarrhoea, pneumonia, croup and otitis media.
Recent studies in Africa have demonstrated that Vitamin A therapy reduces the death rate and complications of measles by about half. WHO, UNICEF and the International Vitamin A Consultative Group have issued guidelines on the routine administration of oral Vitamin A supplements to children. Two doses of 200,000 IU each are recommended for children 12 months or older: one at diagnosis and the other on the following day. Half the dose (100,000 IU each) is recommended for children 6-11 months of age or weighing less than 8 kg.
There are no special technical skills or experience necessary for the administration of Vitamin A supplementation, the operational requirements are few and the costs are minimal. A Vitamin A programme would, therefore, easily lend itself to being incorporated into existing primary health care structures. The Vitamin A Field Support Project, VITAL, is working to achieve this by formulating a Measles Training Module. “The package will contain information on: measles case management; an annotated bibliography of the scientific basis for Vitamin A in measles; training slides and accompanying text; a Vitamin A and measles treatment wall-chart; and information on Vitamin A procurement and maintenance of supplies.”
(Source: VITAL News, March 1992, Vol. 3, No. 1. For further information contact: VITAL, 1601 N. Kent Street, Suite 1016, Arlington, VA 22209, USA)
Fighting Micronutrient Deficiency with Double Fortification
A large proportion of the world's population, mainly in developing countries, is affected by deficiencies in micronutrients such as iron and iodine which result in problems of serious public health significance. Inadequate intakes of iodine lead to Iodine Deficiency Disorders, the manifestations of which are mental retardation, cretinism, goiter, deaf-mutism, short stature and an increased risk of death in childhood. Iron deficiency results in impaired immune response culminating in a higher incidence of infectious diseases, increased risk of maternal and foetal morbidity and mortality. Food fortification is one feasible prophylactic intervention for supplying the human organism with trace quantities of these important micronutrients, and salt is one of the most suitable vehicles because its consumption is universal, consistent and its sources of production are easy to regulate.
The technologies for the separate fortification of salt with compounds of iodine and iron have existed for over 60 and 20 years, respectively. However, double fortification is a relatively new concept. The challenge is to develop a formulation which is stable under various cooking, storage and environmental conditions, bioavailable, palatable, with good retention of nutrients, and affordable.
Stability is probably the most difficult exercise because the iodide and iodate salts are stable in an alkaline medium whereas iron is stable under acidic conditions. On mixing, the iodide/iodate is oxidized to free iodine which is lost as vapour. Two approaches towards stabilisation have been tested in India. The first uses a chelating polyphosphate to secure the stabilization of the compound mixture. The second relies on the identification of stable, neutral iron salts which are compatible with potassium iodide or iodate in a slightly alkaline medium. Both formulae require further testing to establish stability under various environmental conditions and bioavailability after cooking and prolonged storage. On satisfactory completion of these tests, community trials will have to be conducted to determine acceptability and efficacy of the fortified salt.
Salt quality is another technical requirement which is important. There are varying grades of feed salt and in order for it to be used in the double fortification process it must conform to certain minimum purity specifications. It must be dry and refined in order to avoid hydrolysis and ensure stability. Several developing countries will therefore need either upgrading of or complete introduction of refining, drying and packaging facilities before a double fortification programme can be integrated into the system. This has serious cost implications of capital investment which would increase the price of salt by as much as 25% - 200%, a price which would simply be unaffordable for consumers in many developing countries.
Even though the long-term health benefits accruing from iron and iodine fortification would far outweigh the actual expenditure, cost is a real determining factor in the consumers decision to buy the product. A double fortification programme would therefore need to resort to innovative economic and market incentives in order to increase the financial feasibility of the programme.
(Source: Report by M. G. Venkatesh Mannar to UNICEF, September 1991)
Bellagio Conference on Vitamin A Deficiency
Following the call by the World Summit for Children and the WHO/UNICEF Conference “Ending Hidden Hunger” for a reduction in childhood blindness and mortality by the worldwide control or elimination of vitamin A deficiency, scientists and health officials met at the Rockefeller Study Centre in Bellagio, Italy in February 1992 “to evaluate the scientific basis for these objectives and to examine the policy implications.” The meeting was chaired by Professor Abraham Horwitz, Director Emeritus, Pan American Health Organization, and Chairman ACC/SCN.
The following is extracted from a report by Dr Alfred Sommer on the meeting, published in the Lancet.
“Meeting participants unanimously concluded:
· Vitamin A is essential for normal health and survival.“The above conclusions were based on consistent evidence from studies in animals and man and emerging data on vitamin A regulation of gene expression, cellular differentiation, and immune status:· Vitamin A deficiency increases mortality among children from 6 months to 6 years of age; improving the vitamin A status of deficient children increases their chance of survival.
· Vitamin A deficiency increases the severity, complications, and risk of death from measles. Improving vitamin A status before the onset of measles (prophylaxis), or after development of measles (treatment), reduces the severity of complications and associated mortality.
· Vitamin A deficiency increases childhood morbidity, particularly the severity of infectious episodes (eg, diarrhoea, pneumonia). Improvement of vitamin A status reduces the severity of infectious episodes.
· Vitamin A is essential for normal vision and ocular function. Deficiency results in nightblindness and other manifestations of xerophthalmia, including corneal destruction (keratomalacia) and blindness.
· Increased morbidity and mortality occur at levels of vitamin A deficiency less severe and chronic than required for nightblindness and xerophthalmia. Therefore, the definition of vitamin A deficiency for public health purposes must be revised and made more sensitive to milder degrees of deficiency.
· Tens of millions of the world's children are vitamin A deficient; one million or more needlessly die or go blind every year.
· Improving the vitamin A status of deficient children and treating all cases of measles with vitamin A, even in populations in which xerophthalmia is rare, can substantially reduce childhood disease and mortality.
· Increasing the vitamin A intake of deficient children through diet or supplementation is an important component of a comprehensive child survival strategy.
1. Progressive depletion of vitamin A in animals results in alterations in cellular differentiation and immune function, followed by severe infection, death, and in animals surviving longest, blindness.“Although the precise mechanisms by which vitamin A exerts its impact on mortality are yet to be determined, vitamin A is known to affect the expression of at least three hundred different genes, which in turn affect cellular differentiation, epithelial integrity, and immunological functions.”2. For over 60 years, clinicians have reported that vitamin A deficient children show histological changes of the respiratory and genitourinary tracts (among other organs) similar to those that precede xerophthalmia and an increased severity of infections that are responsive to vitamin A.
3. Childhood mortality has been associated with the severity of vitamin A deficiency, other factors apparently being equal, in both hospital and field observational studies.
4. The severity of measles complications and measles-associated mortality was reduced by at least 50% among children assigned supplemental vitamin A in hospital-based studies in England (1930), Tanzania, and South Africa, and in three community-wide prophylaxis studies in Nepal and India.
5. All six controlled community-based prophylaxis-mortality trials published in the past decade (two each in Indonesia, India, and Nepal) registered a reduction in mortality in the vitamin A groups. Pooling of the six trials (100,000 children and 1,000 deaths) in a meta-analysis yielded an overall reduction in childhood mortality (6 months to 6 years) of 34%. The impact observed in each was consistent with the 34% overall reduction. The probability that the vitamin A programmes reduced childhood mortality was highly significant. The consistency of these findings was particularly persuasive in view of variations in the underlying mortality and other health indices of the study populations and differences in the design and conduct of the six trials.
6. Cause-specific mortality was examined in three of the community-wide mortality intervention trials; in all three, there were striking reductions in deaths associated with diarrhoea (the major cause of death in children over 5 months of age) and measles.
7. In a study specifically designed to detect the impact on severity of subsequent infections (Ghana), vitamin A supplementation reduced the natural severity of both diarrhoea and pneumonia.
(Source: The Lancet, April 4, 1992, Vol. 339)
Successful Control of Children's Iron Deficient Anemia Through Fortified Drinking Water
Iron deficiency anaemia may be considered the most common nutritional disorder in the world affecting over one billion people, mainly in developing countries, although it also occurs in developed ones. It has severe nutritional and health consequences, impairing social and economic development. Use of iron tablets and food fortification to fight iron deficiency anaemia, although effective, has shown a coverage far short of requirements. A more available and widespread iron carrier is therefore needed, and researchers in Brazil have been working with drinking water as such a vehicle.
After physical-chemical and rat assays with iron enriched water, ferrous sulfate was added to the drinking water of a preschool day-care institution, in a trial that lasted one year. 30-50 preschool children, 2 to 6 years old were observed. Blood samples for haemoglobin determination were obtained from an arm vein. The initial blood sample was obtained from a group of 15 children and later a further 16 were added until the end of the experiment. Fine iron sulfate crystals were added to the drinking pot to supply 20 mg of elemental iron for each litre of water. The children had access to this water ad libitum and their mean intake was around 500 ml/day. Five and eight months after the iron addition two other blood samples of the same children were collected.
The initial mean haemoglobin level for the 31 children was 10.6 g/dl with 18 of them having values below the cut-off level for anaemia of 11.0g/dl. After five months' intake of enriched water, the mean haemoglobin was 12.1 g/dl with just one child with Hb less than 11.0 g/dl. The researchers concluded that “our data confirms the possibility of using drinking water as an iron carrier to deal with iron anaemia at community level. It is an easy, effective and practical way to supply iron and other nutrients to population groups”.
(Source: Contributed by J.E. Dutra-de-Oliveira, MD, Valeria P Vasconcelos, BS, Jacob F Ferreira, BS. Medical School Ribeirao Preto, University of Sao Paulo, 14049 Ribeirao Preto, SP, Brazil.)
Fact Sheet on Sex Differences in Health
The following quotes are taken from “Women's Health: Across Age and Frontier”, a background document for “Women, Health and Development” technical discussions at the 45th World Health Assembly.
· “Women's nutrition is a critical part of their overall health status. It is related among other things, to food intake during their lifetime, the nourishment they received before birth, their energy output and workload, their control over resources for household food security, and their roles in the food chain.(Source: Women's Health: Across Age and Frontier, WHO 1992)· “Households headed by women are the most economically disadvantaged. The growing numbers of these households and of single-parent families will aggravate conditions of poverty in both developed and developing countries.
· “A report from Bombay in 1984 on abortion after prenatal sex determination stated that 7999 out of 8000 of the aborted foetuses were females.
· “Studies in Bahrain, Oman, Tunisia and other countries show that the duration of breastfeeding is longer for boys; some studies in Latin America show that complementary feeding is begun earlier for boys than for girls.
· “Studies in Thailand, the Philippines and other countries show that the incidence rates of acute respiratory infection and of lower respiratory tract infection were only slightly higher for boys in community surveys, whereas many more boys than girls were found with those infections as inpatients or outpatients in hospitals.
· “Analysis of sex-specific mortality by cause in Latin America revealed an excess female mortality among children aged 1 to 4 years, with disproportionately more girls than boys dying from diseases preventable by immunization.
· “Major long-term complications of genital mutilation (female circumcision) include gynaecological, urinary, obstetric and marital problems. Millions of girls in many countries have undergone this procedure.
· “Studies of work patterns of men and women reveal differences in exposure to health hazards. Certain health hazards are particularly linked with women's roles, such as the burning of biomass fuels used in cooking and heating inside homes, the carrying of heavy loads of water or firewood, and use of household chemicals.”
The Last of the Smallpox Virus
In perhaps a very short time the smallpox virus which for many years claimed millions of lives will become truly extinct. The last episode of variola virus circulating in the wild was identified in October 1977 and today the only repositories for captive virus stocks are the Centres for Disease Control in Atlanta and the Research Institute for Viral Preparations in Moscow. Scientists at those institutions are working to identify the genetic sequencing of various strains of the virus and once this is completed, the international scientific community has given its consensus that the virus stocks be destroyed.
The CDC scientists have already sliced the DNA of a particularly virulent strain of the virus and inserted them into loops of bacterial DNA called plasmids. This facilitates study of the genetic code. The information thus obtained is stored on computer file and will ultimately be published.
The initiative to destroy the virus stores originated from developing countries who were uncomfortable at the thought that they were in the possession of superpower nations only. Those stocks at CDC actually belong to the U.S. Army, the Netherlands, Japan and England while those at the Russian institute are owned by the former Soviet Union, Brazil, India, Ethiopia and several other African and Asian countries.
To date, there have been no opposing arguments to what would be an unprecedented, intentional destruction of a life form from the universe. What also goes without argument is that the majority of the world's population is likely to have little or no protection from the disease. Routine vaccinations against smallpox terminated in the United States in 1971 and immunity starts to wane after about 10 years so people who have been vaccinated may no longer be protected. Cohorts born after the end of vaccination programmes have no immunity at all. The smallpox virus thus has the potential to trigger a worldwide catastrophe on a scale never before realised and its extinction would leave little regret.
(Source: International Herald Tribune, 14 May 1992)
“The breast-feeding of babies should be promoted and supported in all populations, irrespective of HIV infection rates.” This was the recommendation of a World Health Organization (WHO)/United Nations Children's Fund (UNICEF) consultation meeting which met in May, 1992, in Geneva to discuss HIV transmission and breast-feeding.
Approximately one-third of the babies born worldwide to HIV-infected mothers become infected themselves. Much of this mother-to-infant transmission occurs during pregnancy and delivery, although recent data confirm that breastfeeding is another route by which some transmission takes place. Fortunately, the great majority of babies breastfed by HIV infected mothers do not become infected through breastfeeding.
After carefully considering all the data currently available, the consultative group concluded that where infectious diseases and malnutrition are the main causes of infant death and the infant mortality rate is high, breastfeeding should be the usual advice to pregnant women, including those who are HIV infected. This is explained on the grounds that a baby's risk of HIV infection through its mother's breast milk is likely to be lower than its risk of death from other causes if it is not breastfed. Women in such circumstances who know that they are infected with the HIV virus and for whom alternative feeding might be an appropriate option, should consult their health care providers in making their decision on how to feed their infants most safely.
However, in settings where the main cause of death during infancy is not infectious diseases and the infant mortality rate is low, the advice to pregnant women known to be infected with HIV should be to use a safe feeding alternative for their baby rather than breastfeed. In these situations, voluntary and confidential HIV testing, including pre- and post-test counselling, should be available to women, and they should be encouraged to seek testing before delivery.
Stressing that when a baby must be fed artificially the choice of substitute feeding should not be influenced by commercial pressures, the group of experts called on companies to respect the International Code of Marketing of Breast-milk Substitutes. They agreed that in all countries, the first and overriding priority in preventing HIV transmission from mother to infant is to prevent women of childbearing age from becoming infected in the first place.
Technical and operational guidelines are being prepared by WHO in collaboration with UNICEF in light of the recommendations of the consultation, and the WHO Global Programme on AIDS is funding further research to learn more about the risk of HIV transmission through breastfeeding.
(Source: WHO Press Release, 4 May 1992)
Lead Poisoning - An Ever Present Childhood Threat
Recent press coverage has brought back into focus the problem of lead poisoning. Health officials have recognised from as early as the 1920s that lead poses a significant threat to health and the environment. At low levels of toxicity, it causes stomach pains and disturbances in behaviour, perception and concentration. At higher levels it causes permanent brain damage and death. Its use in the production of paint and water piping has already been banned and its use in car fuel is being phased out. Nowadays household paint contains lead in very minute quantities or not at all, and copper water pipes are installed instead of lead ones. Why, then, does lead poisoning continue to pose a threat, especially to the young?
The sources of lead are both varied and many, and while toxic to life, in the manufacturing process lead is a very useful resource. It has unique properties of malleability, permanent shelf life (it never decays) and impermeability to water, electricity and radiation. It is used in the production of many everyday products, from bread bags to car batteries. It is still being expelled into the atmosphere from car exhaust fumes in countries like Greece and Portugal where unleaded gas is still a new concept, and from recycling smelters in developing countries like Brazil. Many old houses still have leaded-paint and lead water pipes in the plumbing.
Recent epidemiologic data has suggested that much lower blood lead levels in children than were previously thought can cause harmful effects including impaired development and lowered intelligence. Previously, health authorities believed that 400 microgrammes of lead per litre of blood was a safe threshold level, but the U.S. Centres for Disease Control recently issued new warnings that anything in excess of 10 microgrammes per litre of blood is dangerous - 40 times lower. This places at risk much of the population of inner city children living in old, crumbling buildings with peeling paintwork and those living in areas with antiquated water pipes. Cooking in and eating and drinking from some traditional pottery is also a hazard as acidic liquids will cause lead to leach out (only ceramics glazed at low temperatures in crude kilns are risky).
Lead poisoning continues because not enough is being done to prevent it. Prevention can be expensive - for example, in one region of Scotland, it was estimated that replacing lead pipes would cost 10 times the region's annual budget. In other instances, the issue has simply been ignored. Because it is widely assumed that lead poisoning is a malady of the past, many doctors do not look for it in their differential diagnoses.
The eradication of lead poisoning is possible even though the world will never be rid of the most abundant heavy metal in the earth's crust - what is necessary are stronger environmental laws, enforcement of these laws, lead screening as a regular part of children's check-ups and, more importantly, commitment on the part of all governments to tackle the problem.
(Source: Newsweek, 17 February 1992; American Journal of Public Health, 81 (6). 685-687, 1991)
In recognition of her outstanding work and dedication to nutritional science, Dr Barbara Underwood has received two awards from the International Union of Nutritional Sciences (IUNS) - the 1992 AIN Conrad A Elvehjem Award for Public Science in Nutrition and the 1992 Borden Award in Nutrition.
“The AIN Conrad A Elvehjem Award for Public Service in Nutrition, made available by Nabisco Brands, Inc. is given in recognition of Dr Underwood's long-standing dedication to the improvement of health in populations around the world through research and development of effective nutrition practices and policies. With a particular focus on the eradication of Vitamin A deficiency states, she has journeyed to many countries to serve as a consultant and to conduct collaborative studies... Dr Underwood had made a most important contribution to the assessment of vitamin A status in the community by her design of the retinol dose response method to estimate vitamin A liver reserves in vivo. The stimulating impact of her work is felt at both the national and international level.”
“The Borden Award in Nutrition is made available by the Borden Foundation and recognizes distinctive contributions to knowledge on the nutritional significance of any food or food component. Dr Underwood helped to develop a variety of improved methodologies for the assessment of nutritional status in regard to vitamin A in humans. Of particular note is the relative dose response test (RDR) which she developed and validated in a variety of clinical groups. Her work has helped define the impact of subclinical vitamin A deficiency in children on a worldwide basis and reinforced the continuing importance of nutrition in public health programs.”
Dr Underwood is currently on secondment from the NIH to the WHO Nutrition Unit.
(Source: IUNS Nutrition Notes, March 1992)
Cooperation in Food Science and Technology
The European Federation of Food Science and Technology, EFFoST, is a focus for European cooperation in this field. Its aim is to fulfill the needs of specialists seeking to identify European colleagues working in the area of food science, engineering and technology. EFFoST collaborates with national organizations active in these fields on a voluntary, not-for-profit basis and is also linked to the International Union of Food Science and Technology. By facilitating contacts throughout the entire European continent, EFFoST can foster closer collaboration between industry and government as well as the relevant professions and national societies.
EFFoST is in the process of developing a current awareness bulletin about future meetings planned by societies across Europe; a database of meetings that can be consulted to avoid conflicts of timing and subject matter; the means to offer information and independent, professional opinion to the European Commission and other national and international bodies; a directory of research, education and training; and workshops to explore European opportunities and future developments.
If you wish to be informed of the future activities of EFFoST, please write to the EFFoST Secretariat, SCI, 14/15 Belgrave Square, London SW1X 8PS, United Kingdom.
(Source: As quoted in the text)
1992 Nathalie Masse Prize
Dr Hernan Delgado, Director of the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala, was the winner of the 1992 International Nathalie Masse Prize. The 50 000 FF cash award is given by the International Children's Centre in Paris to a person under 50 years of age who has conducted, alone or as a team leader, significant research on behalf of poor children, preferably in developing countries.
Dr Delgado, a native of Chile, Joined INCAP in 1972 and became its director in 1990. He holds an M.D. from the University of San Carlos in Guatemala and an M.P.H. from the Harvard School of Public Health. Dr Delgado donated the award to INCAP's endowment fund.
Intrahousehold Resource Allocation Conference
The Conference on Intrahousehold Resource Allocation, jointly organized by the International Food Policy Research Institute and the World Bank, was held in Washington, DC, USA, from 12 to 14 February, 1992. The conference aimed to address two questions fundamental to poverty alleviation programmes and policies: (i) How can more complete information about intrahousehold resource allocation mechanisms alter policy design and, thus, enhance policy impact? and (ii) How can this information be obtained' The multidisciplinary conference - participants included economists, sociologists, anthropologists, and nutritionists, among others - addressed the following topics.
1. How best to characterize the web of economic and social relationships that surrounds the individual? A household may be an adequate characterization of this web in Latin America and Asia, but in Sub-Saharan Africa, family or kin may be more appropriate. This non-overlap of household and family was a recurring theme. It was also agreed that whatever the most appropriate characterization of the “web,” it had to be rooted in a wider community context.The conference stressed the importance of realizing that a particular intra-family allocation of resources has efficiency as well as equity implications for policy.2. How to analyze the web of relationships? The conference repeatedly emphasized the importance of multidisciplinary approaches to study the household, but how to best achieve that was less clear. The economist's reliance on deductive and quantitative techniques as opposed to the anthropologist's reliance on inductive and qualitative techniques was stressed. One promising area for future collaboration could involve the use of information on topics such as “respect,” incidence of domestic violence, and strength of the legal environment, that is collected in a qualitative manner and yet is acceptable to econometricians.
3. The economics of the household/family. The economist's initial view of the household - pioneered by Gary Becker 25 years ago as essentially altruistic and harmonious - has gradually weakened. There are simply too many empirical examples of within-household inequality that are hard to square with altruism. A long-overdue clarification of terminology such as “altruistic” and “bargaining” models, and a sense of the narrowness of the Becker “harmony” view of the household was achieved at the conference.
4. Policy relevance. The standard question associated with these within-household issues is no longer “does development stop at the door of the household?” but, rather “does the design of development policy stop at the door of the household?” Even this is a somewhat redundant question, as there are ample examples of the unintended effects of policy on different individuals within the household/family. If policy design has unintended effects, can it achieve intended effects? The answer will depend on the availability of individual level information for at least a sample of the affected individuals.
Abstracts of the 22 papers presented at the conference have been collected together in a volume of conference briefs that can be obtained from Dr. Lawrence Haddad, IFPRI, 1200 17th Street, NW, Washington, DC 29936, USA. Fax: 202-467-4439. Tel: 202-862-5600.
(Source: IFPRI, June 1992)
Food Insecurity and Malnutrition Workshop in Central America.
In June 1991, the International Food Policy Research Institute (IFPRI) in collaboration with the Food Security Program of Central America (CADESCA/EEC) organized a regional workshop on Measures to Reduce Food Insecurity and Malnutrition in Central America. This workshop, held in Costa Rica, provided a rare opportunity for different agents of change to sit down together and engage in a productive dialogue on food security and nutrition issues. Participants came from Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua. They included farmers' representatives; technical personnel from public sector agencies and nongovernmental organizations; officials from planning, health, and agriculture ministries; and representatives of international and regional technical agencies.
The objectives of the workshop were four: (1) identify factors relating to food insecurity and malnutrition at regional, national, and local levels in Central America; (2) critically analyze existing food security and nutrition measures and identify realistic alternatives; (3) define mechanisms and actions to strengthen and consolidate the Central American food security network; and (4) define the critical elements for the formulation of food security and nutrition projects at all levels.
The workshop arrived at several key conclusions and recommendations: (1) structural adjustment policies should place more emphasis on human development and basic needs satisfaction rather than on maximization of economic growth without social equity; (2) free trade processes in food, self-sufficiency in basic foods, and the role of food aid on food production should be analyzed within the Central American context to acquire a better understanding of these processes to promote regional integration with the aim of achieving national food security; (3) the public sector, private enterprise, nongovernmental agencies, and grassroots popular organizations should be seen as equal partners in the development process, and conditions to that effect should be created and strengthened; (4) planning, execution, and evaluation of food security and nutrition programmes and projects should be undertaken by popular grass-roots organizations, local governments, and nongovernmental organizations; (5) food security and nutrition projects should be designed and executed on a small-scale for maximum impact and should fully take into account local diversity in social, economic, cultural, and ecological constraints; (6) popular education and communication methods should be widely employed to promote and strengthen culturally-based good habits, greater technical capacity, and organization at grass-roots levels; and (7) programmes and specific projects should focus on assisting smallholder farmers with obtaining greater access to land, credit, appropriate technical assistance, training, organizational skills, efficient marketing systems, and rural infrastructure such as roads and small-scale irrigation works.
Through the inclusion of grass-roots organizations from five countries, the workshop provided a forum for the interaction between those who formulate and implement policies and those who are usually at the receiving end of top-down policies and programmes.
For more information, contact Dr. Maarten Immink, IFPRI, 1200 17 Street NW, Washington, D.C. 20036-1998, USA. Fax: 202467-4439. Cable IFPRI. Tel: 202-892-5600.
(Source: IFPRI, June 1992)
Congress on Obesity Management
Science will meet practice in Antwerp, Belgium, the venue of an international congress on the management of obesity organized by Obesitas Inc., with the co-sponsorship of the World Health Organization and the Ministry of Health of Flanders. Two kinds of experts will assemble on the premises of the University of Antwerp from 19-22 September, 1993: first, obese people themselves and their organizations and, second, researchers, clinicians, specialists, psychologists, nurses, nutritionists, dieticians, physical therapists, and others interested in the management of obesity.
The aim of the congress is to give participants up-to-date scientific information about the causes and treatment of obesity; provide participants with an opportunity to exchange experiences; and, present researchers and clinicians with an opportunity to learn more about how the obese experience their own physical, mental and social situations. The scope of the congress ranges from scientific approaches to individual experiences and will thus focus on an epidemiological and sociological assessment of obesity in Europe; the economic aspects of various treatments, including formal and “alternative methods”; the cultural, socio-economic and psychological issues in the life of the obese and the potential of self-help groups or mutual support groups, non-profit organizations, and health care facilities.
(For further information contact, Miep Bekkers-van den Hoven, Obesitas vzw, Bunderbeeklan 19, B- 2950 Kapellen, Belgium)
The Lactation Resource Centre
Established by the Nursing Mothers' Association of Australia (NMAA), the Lactation Resource Centre (LRC) provides current information to people interested in breastfeeding. The LRC library, available to breastfeeding counsellors, health professionals, researchers, teachers, students and anyone else interested in lactation, contains over 7,000 journal articles, books and case histories. Staff trained in the biological and social sciences are on hand to help library users locate and interpret information, and although it is not usually possible to borrow material, there is a photocopying service available. Computer searches of the LRC database are available on a wide range of topics at minimal cost.
An annual subscription to the LRC costs $60 (overseas subscriptions cost an extra $30) and gives ready access to the LRC services plus, amongst other benefits, a subscription to Breastfeeding Review (the professional journal of NMAA) and an information pack entitled “Topics in Breastfeeding”.
For more information contact: The Lactation Resource Centre (NMAA), PO Box 231, Nunawading, Victoria 3131, Australia. Phone: (03) 877 5011; Fax: (03) 894 3270.
(Source: LRC leaflet)
Current Research into Eating Practices - European Interdisciplinary Meeting
The 16th annual scientific meeting of the Arbeitsgemeinschaft Ernahrungsverhalten (AGEV) on the subject of “Current Research into Eating Practices: Contributions of Social Sciences” will take place in Potsdam, Germany, on 14-16 October, 1993. The general topic under discussion will be the development and present state of social science research in nutritional behaviour in Europe.
The programme will focus on basic research and concentrate on theories, models, strategies, data collection techniques, and results and deficits of nutritional behaviour research by social scientists.
Specific subject areas will be as follows.
· Sociodemographic and socioeconomic factors and their impact on nutritional behaviour.A special issue will be “Change as a Topic of Social Sciences: Impacts of Political, Economic and Social Changes in Eastern and Western Europe on Nutritional Behaviour”.
· Economic and political factors and their impact on nutritional behaviour.
· Sociocultural determinants of nutritional behaviour.
· Psychosocial determinants of nutritional behaviour.
The AGEV, in collaboration with the German Institute for Human Nutrition and the World Health Organization Regional Office for Europe, hopes to bring together at the meeting social scientists and nutritional scientists concerned with social science aspects of nutrition behaviour research.
(For further information contact: AGEV, Postfach 10 01 06, D-W-8200 Rosenheim, Germany. Phone and Fax: 49 (0) 8031 68467.)
(Source: AGEV leaflet)
Refugee Studies Programme - International Summer School
The Refugee Studies Programme will - from 5-30 July, 1993, in Oxford, UK - hold a four week course for those who work with and for refugees and other forcibly displaced people.
The Refugee Studies Programme (RSP) was founded 10 years ago in 1982. It exists to increase understanding of the causes, consequences, and experiences of forced migration. To achieve this aim, it provides interdisciplinary research, training, publications and documentation on issues related to such migration.
The Summer School - designed for senior and middle managers who are involved with assistance and policy-making for forced migrants - will consist of four modules, each lasting a working week, and an additional, optional two-week private study programme. The four modules are:
· Refugees, International Relations, Assistance Agencies and Refugee Societies(For further information on this and other courses and conferences organized by the RSP contact: Refugee Studies Programme, Queen Elizabeth House, 21, St Giles, Oxford, OX1 3LA, UK. Phone: (0865) 270723 Fax: (0865) 270721.)
· International Refugee Law
· Psychological and Social Aspects of Forced Migration
· Principles, Approaches and Issues in the Management of Refugee Assistance
(Source: RSP leaflet)
Nutrition Society: Task Force on Overseas Members
The Nutrition Society (United Kingdom and Ireland) has produced a list of low-cost periodicals which it has asked SCN News to reproduce. This list may be photocopied. The Nutrition Society is unable, for financial reasons, to respond to requests for copies.
Nutrition Information Sheet Number 1 (1992) Low-Cost Newsletters and Journals of Interest to Nutritionists
The following English-language publications give up-to-date information on applied human nutrition. Most are free to individuals, institutions and/or libraries in “low-income” countries - but check before you order. Some publications are also free to workers in “industrialized” countries.
The Nutrition Society hopes to update this list in 1-2 years and so request readers to send copies of other relevant newsletters from their own countries or institutions to the Executive Secretary, Nutrition Society, 10 Cambridge Court, 210 Shepherds Bush, London W6 7NJ, UK.
PUBLICATIONS COVERING MAINLY NUTRITION
* means the item is particularly recommended by the Nutrition SocietyBMAC Update
- from Baby Milk Action, 23 St Andrew's St, Cambridge CB2 3AX, UK (breastfeeding, milk companies).
*Breastfeeding Briefs
- from International Baby Food Action Network/Geneva Infant Feeding Association, CP 157, 1211 Geneva 19, Switzerland (breastfeeding).
Cajanus
- from Caribbean Food and Nutrition Institute, Box 140, Mona, Kingston, Jamaica (community nutrition, food policy, Caribbean).
C-H-O International Dialogue on Carbohydrates
- from Advisa Medica, 526-528 Watford Way, London NW7 3YP - funded by the Sugar Bureau (carbohydrates, diet).
Food, Nutrition and Agriculture
- from Food Policy and Nutrition Division, Food and Agricultural Organization, 00100 Rome, Italy (food, nutrition, food policy, food regulations).
IBFAN News
- from International Baby Food Action Network, 310 E 38th St, Suite 301, Minneapolis, MN 55409, USA (breastfeeding, infant foods).
*IDD Newsletter
- from Dr J.T. Dunn, International Council for Control of Iodine Deficiency Disorders, Box 511, University of Virginia Medical Centre, Charlottesville, VA 22908, USA (iodine deficiency research, policies, country reports).
IFPRI Report
- from International Food Policy Research Institute, 1200 Seventeenth St. NW, Washington DC 20036-3097, USA (food security, food policy, research).
*Mothers and Children
- from Clearing House on Infant Feeding and Maternal Nutrition, American Public Health Association, 1015 15th St NW, Washington DC 20005, USA (nutrition/health of children and women).
*NFI Bulletin
- from Nutrition Foundation of India, 13-37 Gulmohar Park, New Dehli 110049, India (nutrition research, programmes, India).
Nutrition News
- from National Institute of Nutrition, Indian Council of Medical Research, Jamai-Osmania P.O., Hyderabad-500 007, A.P. India (for libraries only) (nutrition, India).
ORANA/VITAL
- from ORANA, 39 Ave Pasteur, BP 2089, Dakar, Senegal (monthly bibliography on Vitamin A).
*SCN News
- from ACC/Sub-Committee on Nutrition, c/o WHO, 1211 Geneva 27, Switzerland (nutrition, UN agencies).
Vital News
- from Vitamin A Field Support Project, 1601 N Kent St, Suite 1016, Arlington VA 22209, USA (vitamin A deficiency, projects).
Vitamin A News Notes
- from Helen Keller International, 15 West 16th St, New York, NY 10011, USA (vitamin A deficiency, VAD projects).
Vitamin A Sieve
- from Rodale Press Information Services, 33 E Minor St, Emmaus, PA 18098 USA (vitamin A, vitamin A deficiency).
*Xerophthalmia Bulletin
- from Dr D.S. McLaren, International Centre for Eye Health, 27 Cayton St, London EC1V 9EJ, UK (vitamin A, vitamin A deficiency).
PUBLICATIONS COVERING NUTRITION AND OTHER TOPICS
African Farmer
- from Hunger Project, 1 Madison Ave, New York, NY 10010, USA (food and farming).
Ageways
- from Help the Aged, St James Walk, London EC1R 0BE, UK (old people).
AIDS Action
- from Appropriate Health Resources and Technologies Group, 1 London Bridge St, London SE1 9SG, UK (AIDS).
ARI News
- from Appropriate Health Resources and Technologies Group, 1 London Bridge St, London SE1 9SG, UK (respiratory infections).
Community Eye Health
- from International Centre for Eye Health, 27-29 Cayton St, London EC1V 9EJ, UK (eye health).
Chetna News
- from Centre for Health Education, Training and Nutrition Awareness, III Floor, Drive-in Cinema Building, Ahmedabad 380 054, India (woman/child health and feeding, community health care).
Children in the Tropics
- from International Children's Centre, Chateau de Longchamp, Bois de Boulogne, 75016 Paris, France (child health).
Dialogue on Diarrhoea
- from Appropriate Health Resources and Technologies Group, 1 London Bridge St, London SE1 9SG, UK (diarrhoeal diseases).
Food Chain
- from Intermediate Technology Development Group (ITDG), Myson House, Railway Terrace, Rugby CV21 7HT, UK (food production, small-scale processing).
Footsteps
- from Tear Fund, 100 Church Rd, Teddington TW11 8QE, UK (health, agriculture, development)
Glimpse
- from International Centre for Diarrhoeal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh (diarrhoeal diseases).
Health Action
- from Appropriate Health Resources and Technologies Group, 1 London Bridge St, London SE1 9SG, UK (primary health care).
Health Lines
- from Oxfam, 274 Banbury Rd, Oxford OX2 7DZ, UK (community health care).
IPPF Medical Bulletin
- from International Planned Parenthood Federation, Box 759, Inner Circle, Regent Park, London NW1 4LQ, UK (family planning, mother/child health).
Mothercare Matters
- from Mothercare Matters, John Snow Inc., 1616 N. Fort Myer Drive, 11th floor, Arlington, VA 22209, USA (maternal and neonatal health/nutrition).
RAP News
- from United Nations Food & Nutrition Programme, 22 Plympton St, Cambridge MA 02138, USA (rapid assessment procedures).
Safe Motherhood
- from Division of Family Health, World Health Organization, 1211 Geneva 27, Switzerland (maternal health).
*State of the World's Children Annual Report
- from UNICEF, 3 UN Plaza, New York, NY 10017, USA (child health and care, statistics).
Compiled by The Nutrition Society's Task Force on Overseas Members who thank everyone who contributed information especially the Appropriate Health Resources and Technology Group, UK.
