PROGRAMME NEWS

Agencies and Governments report on their activities in nutrition.

Canadian Foreign Policy Statement

Following a year-long consultation with Canadians on every aspect of Canada's international relations, the Canadian Government has issued a foreign policy statement entitled "Canada in the World", which sets out three key objectives to guide Canada's foreign policy: promotion of prosperity and employment; protection of global security; and projection of Canadian values and culture.

On the subject of international development assistance, to which a section of the statement is devoted, the Government emphasizes that "International Assistance is a vital instrument for the achievement of the three key objectives being pursued by the Government. It is an investment in prosperity and employment. It connects the Canadian economy to some of the world's fastest growing markets - the markets of the developing world. And, in the long-run, development cooperation can help lift developing countries out of poverty. This means that it contributes to a stronger global economy in which Canadians, and other peoples, can grow and prosper. International Assistance also contributes to global security by tackling many key threats to human security, such as the abuse of human rights, disease, environmental degradation, population growth and the widening gap between rich and poor. Finally, it is one of the clearest international expressions of Canadian values and culture - of Canadians' desire to help the less fortunate and of their strong sense of social justice - and an effective means of sharing these values with the rest of the world".

The statement lays out the purpose and six program priorities of Canada's Official Development Assistance (ODA) Program:

"The purpose of Canada's ODA is to support sustainable development in developing countries, in order to reduce poverty and to contribute to a more secure, equitable and prosperous world.

To achieve this purpose, Canadian ODA will concentrate available resources on the following six program priorities:

Basic Human Needs: to support efforts to provide primary health care, basic education, family planning, nutrition, water and sanitation, and shelter. Canada will continue to respond to emergencies with humanitarian assistance. Canada will commit 25% of its ODA to basic human needs as a means of enhancing its focus on addressing the security of the individual.

Women in Development: to support the full participation of women as equal partners in the sustainable development of their societies.

Infrastructure Services. to help developing countries to deliver environmentally-sound infrastructure services, with an emphasis on poorer groups and on capacity building.

Human rights, democracy, good governance: to increase respect for human rights, including children's rights; to promote democracy and better governance; and to strengthen both civil society and the security of the individual.

Private Sector Development: to promote sustained and equitable economic growth by supporting private sector development in developing countries.

The Environment: to help developing countries to protect their environment and to contribute to addressing global and regional environmental issues."

In consultation with Canadian partners the Government will:

· sharpen the development focus of private sector linkage programs, including the Canadian International Development Agency - INC (CIDA-INC), while ensuring greater coordination among DFAIT, CIDA, the EDC and other departments and agencies by holding regular project-by-project consultations on CIDA-INC activities;

· develop a framework for a renewed relationship between CIDA and Canadian voluntary organizations based on the principle of complementarity of action;

· expand the number and range of personnel exchanges between CIDA and its Canadian partners, especially NGOs;

· seek ways to ensure the effective participation of Canada's academic and professional communities in development assistance programs; and

· improve coordination among government departments at the federal, provincial and municipal levels.

· better integrate objectives such as respect for human rights, poverty reduction, social and gender equity, and environment into the work of multilateral institutions;

· increase accountability and transparency; and

· improve developmental and cost effectiveness.

· work with developing countries and their people to help them participate more fully in the international system and global economy; and

· establish new ways to build longer-term linkages between Canadians and developing country partners to enhance their self reliance.

(Source: Government of Canada (1995). Canada in the World. Government Foreign Policy Statement.)

Most FAO activities aim at promoting and ensuring the nutritional well-being of populations. The range of action encompasses the whole food chain from production to consumption. FAO is increasingly stressing the overall problem of food security which is still paramount in many countries and has to be urgently addressed in the long-term view of development. Seventy-eight countries, with an estimated total population of 3.5 billion people have been identified as "Low Income Food Deficit Countries" (LIFDCs) where growth in food production is lagging so far behind growth in food requirements that they have to rely increasingly on food imports to teed their population. FAO is launching a Special Programme to assist these LIFDCS to rapidly increase food production in order to stem the growing incidence of food insecurity and undernutrition on their people.

From another perspective, the consequences of the GATT agreement on food trade and food prices and on the overall food trading area will have a relevant impact on the nutritional status of many populations. FAO, especially through its quality control activities and the Codex work, is assisting the developing countries to comply with these new requirements.

The emphasis on food security parallels the assistance provided by FAO to over 100 countries in developing their National Plan of Action for Nutrition (NPAN) as called for by the World Declaration on Nutrition. To date 33 NPANs either in final or draft form have been prepared and made available to FAO. Approximately another 20 NPANs are expected to be available by the end of 1994. These NPANs provide an appropriate and articulated framework for stimulating the multisectoral activities required to improve the nutritional well-being of the populations in the developing countries.

Linked to the development of these NPANs, FAO has provided support to the Geneva-based NGO Working Group on Nutrition to develop a document entitled "Promoting the Role of NGOs in Nutrition, Guidelines for Implementing the International Conference on Nutrition (ICN)" in order to foster the involvement and activities of NGOs in the follow-up of the ICN and the implementation of NPANs. The document illustrates activities of several NGOs throughout the world undertaking effective food and nutrition projects that address the different themes of the ICN and thus contributes to reach the goals set by the World Declaration on Nutrition.

Other more specific activities include the work on Fats and Oils which provides updated information on the topic. The Food and Agriculture Organization of the United Nations and the World Health Organization convene expert consultations to provide advice to developing and developed countries. "Fats and Oils in Human Nutrition: Report of a joint expert consultation" reviews the most recent scientific information on this crucial topic and presents the experts' recommendations. Key issues which may influence consumption, health, food production and processing, food marketing and nutrition education are discussed. The report contains recommendations about desirable minimum and maximum intakes of fats; maternal and infant nutrition; essential fatty acids; saturated, unsaturated and isomeric fatty acids; antioxidants; and scientific and programmatic needs, an extensive bibliography is included. The English version of the report will be available early 1995 while the French and Spanish versions will be available later during the year.

In response to the request expressed by the countries during the March 1994 Tunis meeting, FAO is strengthening its programme on food composition. The importance of food composition work in order to provide accurate and reliable data for government, industry and international agencies work and planning in food and nutrition is paramount. FAO organized a meeting, jointly with the UNU, in September 1994 in Accra, Ghana, to promote the involvement of African countries in food composition work. In 1995, other meetings will be organized to discuss the formulation of national food composition programmes in different countries and to prepare and implement projects aiming at strengthening the regional cooperation concerning food composition activities.

In the field of food quality and safety, FAO's programme includes policy and technical advice to member countries in the assessment of the effectiveness of their food control systems and activities in assuring consumer protection and in promoting the production and trade of good quality and safe food. It also covers the provision of technical support to developing member nations in strengthening their capabilities in food quality control with particular emphasis on training of food control managers, inspectors and analysts and in the orientation of food handlers and consumers on hygienic practices in food processing and preparation. Over 30 field projects are currently being executed by FAO in this field in various parts of the world.

The social, economic and nutritional significance of street foods and their quality and safety problems have been the subject of several studies carried out by FAO with a view of assisting member countries in their evaluation of this informal sector and in promoting appropriate practices in the handling, preparation and vending of street foods. More recently FAO organized a Sub-regional Workshop on Street Foods for French-speaking African Countries (Cotonou, Benin 24-28 November 1994) during which the street food situation in this sub-region had been reviewed and analyzed and specific recommendations were made to improve the quality and safety of street-vended foods.

The Codex Committee on Food Labelling is currently elaborating Guidelines for Use of Health and Nutrition Claims in view of the need for harmonization in this area, in order to prevent consumer deception regarding the nutritional quality or health-related effects of foodstuffs and nutrients and to help the consumer to make an informed choice. The Committee is also considering Recommendations for the Labelling of Foods which may cause hypersensitivity reactions (allergy and intolerance).

The Codex Committee on Nutrition and Foods for Special Dietary Uses is elaborating an Annex on the Iodization of Salt to the Codex Standard for Food Grade Salt and will be reviewing the Standard for Formulated Supplementary Foods and in Particular Processed Cereal Based Foods for infants and young children, with special emphasis on the need to facilitate the preparation of such foods from locally available raw materials in developing countries.

Guidelines for Dietary Supplements (especially vitamins and minerals) are also under consideration, while the Provisions for Vitamins and Minerals in Codex standards are under review, as well as the Guidelines on Inclusion of Nutrition Provisions on Nutritional Quality in Food Standards.

Concerning nutrition education activities, FAO is presently preparing documents and materials for a nutrition education programme. The campaign will bear the title "Get the Best from your Food". An "Expert Consultation on Nutrition Education for the Public" to be held in Rome in September 1995 is under preparation. With regard to the FAO Guidelines for Participatory Nutrition Projects, these are now also available in a French Language version. The Spanish language version is in print and will become available early 1995.

(Source: FAO. 1994)

From October 11 to 13, 1995, in Quebec City, some 1,500 people, approximately two-thirds of whom will be coming from abroad, will share their knowledge and agree on the steps to be taken to feed the planet throughout the next century. Those attending will include decision makers and practitioners who are concerned about world food security.

The Symposium commemorating the 50th anniversary of the founding of FAO is a practical event, resolutely facing the future. Participants will be able to examine case studies and share experiences in an atmosphere that is conducive to devising concrete solutions. The innovative aspect of this meeting lies in the fact that it is bringing business people and representatives of non-governmental organizations (NGOs) together with political figures, scientists and academics, all working in the fields of agriculture, fisheries or forestry. Such a gathering will inevitably provide numerous opportunities for conducting business.

The Symposium's program includes keynote speeches by renowned specialists and workshop discussions where cases drawn from the five continents will be studied in small groups. Three sub-themes will be considered separately: managing natural resources, managing markets, and managing know-how and technology.

From October 11 to 14, an exhibition will be presented in conjunction with the Symposium. Here, businesses and NGOs will have the opportunity to demonstrate their know-how and also their products and technologies in the field of sustainable agricultural, fisheries and forestry development.

For further information please contact: 1995 FAO Symposium Secretariat, 65 Sainte-Anne Street, Suite 100. Quebec, Quebec, Canada G1R 3X5. Phone: (418) 691 7849 Fax: (418) 691 7815.

(Source: Symposium Brochure, undated)

Adult Malnutrition: The Forgotten Dimension

Adult malnutrition is increasingly recognised as of major functional and health importance in many developing countries. There is a high prevalence rate of underweight in many Asian and African countries, e.g. India, Pakistan, Bangladesh, Vietnam, Ethiopia and Somalia. An IDECG-appointed task force developed in 1988 new criteria for identifying adult malnutrition. The condition is assessed by specifying different degrees of under-weight expressed as the body mass index (BMI = weight (kg)/height (m²)). Three grades of chronic energy deficiency were specified, marginal (BMI 17.0-18.4), moderate (BMI 16.0-16.9) and severe (BMI<16.0). A recent IDECG workshop, hosted and co-sponsored by FAO in Rome, has reviewed in great depth the functional correlates of chronic energy deficiency of the adult. Underweight adults have recently been found to have immunological deficiencies both of skin-mediated immunity and lymphocyte function, these changes being related to the BMI. Now, in collaboration with Prof. James of the Rowett Institute, Aberdeen, researchers at the National Institute of Nutrition in Rome have extended the 3 categories of underweight to 5 so that extreme and life-threatening cachexia can be defined. These new categories are suitable for use in prioritizing those in urgent need of refeeding when communities are exposed to famine conditions and food relief is limited. The BMI cut-off points are 18.5, 17.0, 16.0, 13.0 and 10.0. A further development has involved the generation of new standards for the mid upper arm circumference (MUAC) in adults living in the Third World. MUAC correlates with the BMI and the -1, -2, and -3 S.D. values correspond to BMIs of 16, 13 and 10; the MUAC values suitable for rapid screening are sex-specific.

The causes of underweight could be many but the paucity of food stores and the dependence of families on the daily procurement of food seem to be documented by monitoring changes in adult BMIs. The recognition that low BMIs signify food insecurity also now allows a new approach to policy making in relation to childhood malnutrition. A new approach has been developed linking children's and maternal anthropometry where households with an underweight child are identified as malnourished with food insecurity specified as the cause when the maternal BMI < 18.5. Where maternal BMI exceeds 18.5 then maternal care, immunisation and other sanitary or public health factors seem to be the dominant contributors to childhood malnutrition.

These studies on adults are continuing with further analyses of energy needs, agricultural development and the role of micronutrients. A new perspective on global nutritional problems is however emerging as we overcome the longstanding neglect of adult malnutrition.

Seasonality and Malnutrition: The Dimension of the Phemonenon

Climatic conditions remain to these days the main determinants of the periodic exposure of Third World farmers to seasonal energy stress. Researchers at the National Institute of Nutrition, Rome, Italy have developed an agro-pedo-climatic index which proved to be highly correlated with seasonal weight loss of adults in rural Third World. This index has allowed the estimation of the distribution and the prevalence of individuals at risk of seasonal energy stress. The estimate has been based on the combined use of an Index of Agriclimatic Seasonality and the anticipated biological damage associated with a given weight loss.

The order of magnitude of seasonal weight loss observed in most Third World rural communities is rather modest, as the seasonal drop in BMI is normally on average less than 1kg/m² and only in exceptional cases it approaches 2 kg/m². This might cause one to consider the exposure to seasonal energy stress as being of little biological significance.

Any weight loss involves both fat and lean tissue, however the quantity of lean tissue that is wasted depends also on the size of the body fat stores. Thinner, malnourished people, losing more muscle mass and other lean tissues than normal and obese persons, can withstand smaller body weight losses and a functional impairment is likely to occur earlier. Adults living in rural areas of Third World tend to have low BMI values. This places them in a precarious position and provides good reasons for suspecting that even a modest seasonal weight loss might have undesirable nutritional and functional implications.

Based on the above mentioned considerations, the expected seasonal loss of weight in each agro-climatic zone was predicted and the amount of weight loss tolerated at each BMI level without risk of functional impairment was estimated. On these grounds we calculated that, at the world level, the functional integrity of 408 million adults was periodically at risk because of seasonal energy stress.

Biochemical Markers of Growth: New Perspectives for Research on Stunting

Stunting is a condition strikingly common in poor areas of the world. It is associated with increased morbidity and mortality in childhood and leads to reduced physical work capacity in adulthood. Surprisingly, the physiopathology of the condition is still incompletely understood, and resources invested in research have been inadequate. The increased awareness about the importance of appropriate skeletal size and composition for long term health, stimulated by the high social cost of osteoporosis in the developed world, has provided an opportunity to expand our knowledge of skeletal growth and development. A major impediment in research on stunting is the unavailability of sufficiently early indicators. A lag time of several days to several weeks is in fact required before growth impairment can be detected by usual anthropometric measures. Missing the early stages of minor disturbances of bone metabolism that, in the long run, lead to stunting, makes it difficult to appreciate the causes and understand the mechanisms. Substantial advances in the field of biochemical indicators of bone metabolism should now allow the early diagnosis of metabolic abnormalities and the assessment of the response to nutritional, hormonal or pharmacological stimuli, with suitable sensitivity and specificity. Several markers of bone resorption and formation are currently available and potentially applicable to growth research.

Among the latest resorption markers, the crosslinking molecules of mature collagen pyridinoline, contained in bone and cartilage, and deoxypyridinoline, contained in bone and dentin, have been tested in a series of studies in children with normal and abnormal growth. In healthy children, the urinary output of collagen crosslinks follows a pattern that parallels the height velocity curve and is related to height velocity measured over short term periods. In severely malnourished children undergoing nutritional rehabilitation the rate of height gain could be predicted by a multiple regression equation, including the age, the weight for height and the urinary output of crosslinks at admission.

(Source: Contributed by Anna Ferro-Luzzi. Francesco Branca, and Gianni Pastore, WHO Collaborating Centre for Nutrition. National Institute of Nutrition, Rome, Italy)

16th IUNS International Nutrition Congress

IUNS would like to announce that the 16th IUNS International Congress of Nutrition will be held in Montreal, Quebec, Canada from July 27 to August 1, 1997. IUNS officers met with the Canadian International Congress of Nutrition (ICN) representatives in Montreal on September 22, 1994. The representatives included the Chairs of the Executive Committee. Scientific Programme Committee and other local supportive committees.

The scientific program will include 4 plenary lectures on global nutrition interest; 8 to 12 inter-disciplinary symposia based on themes presented from multi-perspective on each nutrition topic in order to integrate knowledge from a wide variety of disciplinary interests; and 16 to 20 sub-speciality symposia which will focus on leading-edge sciences in specific areas of nutrition that emanate from topics developed in the interdisciplinary symposia.

In addition, there will be 12 to 15 workshops per day for the first 3 days, debates by invited scientists on controversial nutrition and food science topics; and poster presentations.

Lectures such as McCollumn will also be in the program. The Chair, Dr Atkinson, of the Scientific Programme Committee welcomes any suggestions/comments and scientists interested in submitting a proposal to organize a workshop or/and poster presentation to contact the Scientific Programme Committee at the following address: Dr Stephanie A. Atkinson. Chair. Scientific Programme Committee, 16th IUNS/ICN International Congress of Nutrition, Dept. Paediatrics, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada.

IUNS Officers' Meeting

IUNS officers' meeting was also held in Montreal, Canada on September 21, 1994. Those in attendance were the IUNS Vice-Presidents, who are in charge of three commissions. The included: Dr. Vinodini Reddy (India) representing Commission I, Dr Stan Berger (Poland) for Commission II, and Dr Alain A Rerat (France) for Commission III. The three commissions have identified most of the chairpersons required for each of the commission's many committees. These chairpersons will work with the three Commission Vice-Presidents to nominate committee members, who will be knowledgeable about the committee's subjects and who represent the different regions. It is expected that the IUNS committees will be officially announced and begin scheduling activities in early 1995.

(Source: Communication with Dr Aree Valyasevi, President. IUNS. 21 November 1994).

First Steps: Policy Memorandum on Children in Developing Countries

Following the World Summit for Children in 1990, a Policy Memorandum on Children in Developing Countries has been published (dated April 1994) by the Development Cooperation Information Department. Ministry of Foreign Affairs, The Netherlands to set out a specific policy for children in the developing world. The following foreword taken from the memorandum, contributed by the Netherlands Minister for Development Cooperation, describes its context and outlines its content.

Throughout the world there are children who can take little pleasure in their childhood. Children are exploited, ill cared for, mistreated or abused: millions live on the streets and from them, suffer physically and mentally from the consequences of war, endure hunger or die of diseases that are readily preventable or treatable. Even so, other than in the charitable sphere, children are everywhere neglected as an explicit target group in multilateral and bilateral development cooperation, the general assumption being that they too benefit in full from international development efforts.

With this policy memorandum the Netherlands is one of the first countries to set out a specific policy for children in the developing world. Its title, First Steps, is in part a reference to this initiative in the international context. Children's right to a decent life, personal development and protection is fully recognised and promoted in Dutch policies for international development. Education, health services, personal and spiritual freedom, respect for the individual, opportunities for play and recreation: all these are pre-conditions for the realisation of that right. But children also have the right to be protected from exploitation, abuse and physical and sexual violence. The goal of policy must be to strengthen children's self-confidence and human dignity. Children must have a full place in society, while society in turn must be encouraged to abandon stereotypical views, prejudices and mistaken perceptions in respect of children.

This memorandum has as its foundation the declaration on the rights of children. In this context the Dutch government lays great stress on equality of rights between boys and girls. A central and recurring theme of this statement is resilience: children are able to survive very difficult situations. They can speak for themselves, and at the very least we must listen to what they have to say.

While this memorandum was drawn up in the first instance for the staff of the Ministry of Foreign Affairs, both at the ministry in The Hague and Dutch embassies abroad, it covers matters which are also of interest to the personnel of non-governmental organisations in the Netherlands and perhaps to others concerned with the fate of children in developing countries. A number of general areas of concern are considered; the intention is that these be incorporated into projects and programmes geared to the needs of children in developing countries. In addition each chapter includes concrete recommendations.

A section of the memorandum deals specifically with food and nutrition and includes the following policy proposals.

Current policies on food security, nutritional improvement, the qualitative aspects of food aid and the Food Security and Nutritional Improvement through NGOs Programme (VPO) will be maintained.

Emphasis will be placed on:

- nutritional supplements for breastfed children;
- monitoring young children's growth to detect malnutrition at an early stage;
- additional food and care during and after infectious illness;
- remedying micronutrient deficiency problems;
- nutritional education; and
- better nutrition for women.

Additional help will be provided for programmes to promote and support breastfeeding. The introduction of restrictions on the marketing of infant formula is highly desirable and will be pursued. Attention will be focussed on the countries of the former eastern bloc, where breastfeeding is coming under pressure from the unregulated marketing of infant formula.

Activities concerned with health care for schoolchildren will focus more closely on the provision of food (snacks and lunches) and micronutrients such as iodine and iron in areas where they are deficiency. School curricula need to put greater stress on food and nutrition.

When emergency aid is given the quality of the whole aid package must be carefully considered and improved. Guidelines are also needed for breastfeeding and the use of infant formula in emergency situations requiring humanitarian aid. Compliance with the Dutch guidelines for milk and milk products in food aid must be improved.

For further information please contact: Development Cooperation Information Department, Ministry of Foreign Affairs, PO Box 20061, 2500 EB The Hague, The Netherlands. Phone: (070) 348 6486.

(Source: The Government of the Netherlands (1994). First Steps. Policy Memorandum on Children in Developing Countries. Ministry of Foreign Affairs, The Hague.)

UNRISD Social Development News - Available Free to Interested Readers

UNRISD Social Development News is a bi-annual newsletter available tree from the United Nations Research Institute for Social Development (UNRISD). The newsletter, published in English, French, and Spanish editions, highlights the latest findings of UNRISD research programmes and international conferences, and provides summaries of newly released publications.

UNRISD is an autonomous research organization that engages in multi-disciplinary research on the social dimensions of contemporary problems affecting development. Current research themes include Crisis, Adjustment and Social Change; Socio-Economic and Political Consequences of Illicit Drugs; Environment, Sustainable Development and Social Change; Integrating Gender into Development Policy; Participation and Changes in Property Relations in Communist and Post-Communist Societies; Ethic Conflict; and Political Violence. UNRISD research projects focused on the 1995 World Summit for Social Development include Rethinking Social Development in the 1990s; Economic Restructuring and New Social Policies; Ethnic Diversity and Public Policies; and The Challenge of Rebuilding Wartorn Societies.

In order to be added to the mailing list for UNRISD Social Development News, send your name and address to: Reference Centre, UNRISD, Palais des Nations, 1211 Geneva 10, Switzerland.

(Source: UNRISD Press Release, June 1994)

OMNI

The Opportunities for Micronutrient Interventions (OMNI) Project was initiated in September 1993, with funding from USAID's Office of Health and Nutrition. During its first year, OMNI responded to the technical assistance needs of USAID Missions and Bureaus throughout the world, while simultaneously carrying out project planning and start-up activities. The majority of technical assistance requests were received from Latin America, with most countries expressing an interest in OMNI's technical support for developing comprehensive micronutrient policies and programs. Preliminary visits were undertaken to over a dozen countries to determine OMNI's potential role in assisting Missions and governments to develop micronutrient programs. These visits fostered a greater understanding of technical assistance needs and, in some countries, have led to the initiation of activities. In other countries, planning and discussions are moving toward commencement of program activities in the second year of the project. Short-term technical assistance, provided in this first year, has laid the foundation for the development of long-term programs in several countries. Below are examples of the diverse technical assistance that OMNI provided in its first year.

In Bolivia, OMNI developed a pilot project for the regional manufacture and distribution of sugar fortified with vitamin A.

In El Salvador, OMNI helped produce a comprehensive micronutrient strategy, which included plans for fortifying sugar with vitamin A. OMNI also organized a micronutrient donor committee meeting to coordinate micronutrient activities.

In Eritrea, OMNI worked with UNICEF and the government to review the Action Plan for Salt Iodization and recommended steps to improve the salt iodization system, particularly in the area of monitoring and quality assurance.

In Nepal, OMNI strengthened the biannual vitamin A capsule distribution campaigns and assisted in the development of a long-term strategy. Capsule distribution coverage of the October 1993 campaign (8 districts), the April 1994 campaign (12 districts) and the October 1994 campaign (16 districts) was reported to be 90% or better.

In Nicaragua, OMNI assisted in the preparation of a micronutrient country profile and conducted a feasibility study and review of legislation for vitamin A fortification of sugar.

In Sri Lanka, an OMNI team of experts designed a program for the iron fortification of wheat flour, which will be implemented in early 1995.

In Tajikistan, OMNI conducted an assessment of iodine deficiency and a feasibility study of salt fortification with iodine in collaboration with the Micronutrient Initiative (MI).

OMNI also conducted several comprehensive micronutrient training programs, established linkages with key stakeholders in the micronutrient arena; developed electronic networks for global communication and information dissemination through The World Bank's electronic population, health and nutrition publications; participated in or sponsored individuals to various international conferences to capitalize on information sharing opportunities; and funded over 70 individuals to the XVI International Vitamin A Consultative Group (IVACG) meeting that was held in Chiang Rai, Thailand, this past October.

For further information please contact: The OMNI Project, c/o John Snow Inc., 1616 North Fort Myer Drive, Arlington. VA 22209, USA. Phone: 703 528 7474 Fax: 703 528 7480. Email: omni_project@jsi.com.

(Source: OMNI Communication. 2 February 1995)

10 Years of the Nutrition Programme of the European Region

1994 marked the tenth anniversary of the Nutrition Programme of the WHO Regional Office for Europe (EURO). The following paragraphs, which look back over 10 years' work and achievements, are extracted from a contribution by Dr Elisabet Helsing, Regional Advisor for Nutrition, EURO in the EURO WHO Collaborating Centres for Nutrition Newsletter.

What did we set out to do?
In 1984 it seemed important to focus on how existing scientific knowledge about food and nutrition in the Region and outside could be made available to food policy makers in a reasonably systematic fashion. So food and nutrition policy formulation and implementation became the focus of our work, leading to the 1990 First European Conference on Food and Nutrition Policy in Budapest, a formal WHO Regional Conference with representation from the agriculture and food industries.

What has happened in this period?
In the 1970s only one country in the European Region actually had a food and nutrition policy. This was Norway, and Norwegian experiences doubtless contributed to the way in which we defined and worked with nutrition policies in the Regional Office. In the course of the 1980s, six more European countries joined the club: Denmark, Netherlands, Sweden, Malta, Finland, and Iceland. They all formulated national policy papers which were adopted by Parliament or Government, and which explicitly were aiming at influencing health by means of public health nutrition.

In the 1990s, it seems as if the investment of our first years of work is paying off. In July this year, we sent a questionnaire to all 50 Member States in the Region, asking each of them whether they had a formally adopted nutrition policy, very narrowly defined - in the country. This was done as follow-up to the 1992 International Conference on Nutrition and its Plan of Action for Nutrition. To our surprise and delight, out of 30 responders, 26 stated that yes, they had such a formally adopted policy. We do not know what is behind this explosive growth, but we believe that the International Conference on Nutrition and its preparatory conferences also did a lot to stimulate interest in the issue.

Where do we go now?
Having a policy is one thing, implementing it is quite another. Our analysis of the situation in the European Region has led us to conclude that priority number one in Europe at this point in time is to improve and increase advanced education in nutrition. If we compare Europe and the Americas, or Europe and Asia for that matter, we find that this Region has a very uneven pattern of education in nutrition. There are a number of countries on this continent where the current possibilities for an advanced education in nutrition are nil, to say nothing about public health nutrition. There are less than ten countries out of fifty in the Region where a young person wishing to make a career in this science can get a basic university level education and a specialization.

At the same time, the science as such is advancing very rapidly, and food consumers am as interested as ever in improving their health through eating a good diet. The public's thirst and hunger for information about nutrition, and the thin spread of nutrition scientists, has in fact created a market in the Region, where many amateur nutritionists are operating freely and happily, and where "health foods" claiming miraculous properties are making their unscrupulous producers rich.

In this situation your Regional Adviser has for the last five years advocated strengthening of teaching institutions, and creation of new ones, especially in the eastern part of the Region. We have started, in a modest way, to do our own consciousness-raising efforts through "hands-on" surveys of nutrition and food intake, the so-called Rapid Assessments of Nutrition, which are conducted by Eric Poortvliet (Consultant in the Nutrition Unit) who is working for us thanks to generous extrabudgetary support from the Netherlands. Here we combine courses in anthropometry and dietary assessment, the core methods of nutrition science, with surveys providing us with data on population groups of strategic importance for policy-making.

Schoolchildren and mothers
We have looked at schoolchildren in Kiev, Almaty and two sites in Moscow for three successive years, 1992, 93 and 94. We have just compiled data on women of reproductive age in Tadjikistan, Kazakhstan, Turkmenistan and Arkhangelsk. The project will continue in eight new countries next year. As the project progresses, we have the pleasure of seeing critical thinking being stimulated in the participating teams, and we find that our colleagues who carry out the studies are themselves continuing their activities beyond the modest inputs we were able to provide.

Breast-friendliness is spreading
In the past year we have together with UNICEF with whom we collaborate closely, had the satisfaction of seeing a significant increase in the number of countries with Government-supported activities in this field, improving the quality of maternity services by introducing small but significant changes in their routines, again underpinned by the scientific findings of the last few decades. We have data to show that it works in eastern Europe too.

WHO has over the years repeatedly been admonished by Member States in the World Health Assembly to take assertive action in breastfeeding promotion. Norway has now not only voiced this opinion, but also provided financial support for the Nutrition Programme in our efforts to bring the Baby-Friendly Hospital Initiative to all parts of the Region.

For further information please contact: WHO Regional Office for Europe, Nutrition Unit, Scherfigsvej 8, 2100 Copenhagen. Denmark. Phone: 45 39 17 13 62 Fax: 45 39 17 18 18.

(Source: WHO Collaborating Centres for Nutrition Newsletter No.5, WHO Regional Office for Europe. 1994)

Madagascar Nutrition and Food Security Project

Although attempting to measure changes in malnutrition is difficult in the short term, malnutrition in Madagascar villages appears to have dropped from 28 to 16 percent in the first year of the Nutrition and Food Security Project there, according to the project administrators. An interesting indicator of the penetration of that project to poor remote areas is the refusal of automobile rental companies to rent any more to staff travelling for the project, since tires routinely were punctured on trips to the innermost bush. The $32 million project features both a community nutrition effort, and income-generating activities in the same communities - both of which are needed to deal with Madagascar's severe food and nutrition problems.

Rwanda Emergency Recovery

A $50 million Emergency Recovery Credit for Rwanda, with a social fund-type framework, that will include a large nutrition component, has recently been approved. This is on top of the $20 million emergency grant to UNICEF, WHO, FAO, and UNHCR in August for their emergency operations there. A third of UNICEF's $10 million allocation is for a Nutrition and Food Security component (supplementary and therapeutic feeding, micronutrients, and seeds; additional seeds are included in the FAO and UNHCR projects).

Forthcoming Projects

New Bangladesh Nutrition Project

The Bangladesh Nutrition Project will be addressing the alarming insight (by Philip Gowers of the Dhaka Resident Mission) that food deprivation over the years may be leading to a smaller-sized population. (He found that the heights of average rural Bangladeshi 11-year-olds, for instance, had dropped steadily, at four points over four decades, from 134 to 127 centimeters. The same for weights.) In the pilot work leading up to this project, data showed that with nutrition interventions child size can be increased substantially. In what probably is an even more important achievement for later body size, the number of low-birthweights declined markedly as a result of the pilot interventions. In 1992, 52 percent of children in the pilot area weighed less than 2.5 kilos at birth. This figure was reduced to 43 percent in 1993 and to 36 percent in 1994. The work was financed by UNICEF, the World Bank's collaborator in this project, and carried out by BRAC, the Bangladesh NGO. A unique feature in this project is BRAC's large implementation role in certain geographic areas. Their results will be compared to operations conducted through government channels in other areas.

IDD in China

China is a country that takes seriously the notion that iodine deficiency affects IQ - and that a downward shift in IQ of the 37 percent of the population (425 million) who are at risk of iodine deficiency means that children do worse in school and lack the creativity and mental capacity to deal with the country's challenges. In response, an Iodine Deficiency Disorders (IDD) Control Project that would more than double China's salt iodization capacity, to eight million tons a year will be considered in June this year. Existing facilities would be modernized and additional capacity created. The project will be implemented by the China National Salt Industry Corporation and is the first Bank-assisted nutrition operation task-managed by industry division staff. (It also will be the Bank's first nutrition project dealing solely with micronutrients.) Total project cost will be $116 million. Again, UNICEF played an important role in preparation. Of worldwide iodine deficiency disorders, 40 percent are in China. If the project objective to eliminate IDD is met, China figures it could gain 480 million IQ points by the year 2000.

Mexico Essential Services Program

Nutrition plays a large part in a $1 billion Essential Services Program to assist Mexico in its current crisis. Being considered are expansion of the successful basic nutrition services to the rural poor that were launched under a 1991 Agricultural Sector Adjustment Project, already-tested targeted food subsidies for the urban poor, and a school nutrition program.

For further information please contact: The Population, Health and Nutrition Department, The World Bank, 1818H Street, N.W., Washington, D.C., USA. Phone: (202) 473 3782 Fax: (202) 522 3234.

(Source: World Bank (1995). New and Noteworthy in Nutrition No.25 (Office Memorandum), February 17, World Bank, Washington, D.C.)