SCN 28^th Session

This section of SCN News provides summary reports arising from our most recent annual session which was hosted by the World Food Programme in Nairobi from 2-6 April. We are especially grateful to Professor Ruth Oniang’o of Jomo Kenyatta University for disseminating information about the SCN to the nutrition community in Kenya and elsewhere in the eastern Africa region. As a result we were pleased to welcome a large number of nutrition professionals working in academia, for NGOs and for local government, many for the first time. Attendance was the highest in the 24-year history of the SCN. There was active audience participation and rich debate throughout the week. The week opened with a plenary discussion of the SCN’s next Report on the World Nutrition Situation, followed by a PROFILES presentation by the Kenya Coalition for Action in Nutrition. The rest of the first day was taken up by parallel meetings of NGOs/civil society, bilateral partners, and UN agencies. These parallel sessions allowed time for each group to discuss matters of particular concern to their constituencies. The SCN Symposium on Nutrition and HIV/AIDS took place on the second day, April 3. The Symposium was opened by Dr Sam Ongeri, Minister of Public Health for Kenya, and the keynote address was given by Dr Peter Piot of UNAIDS. Other speakers were Minister Dlamini of Swaziland, Oliver Saasa of Zambia, Sophia Mukasa Monico of Uganda, Stuart Gillespie of IFPRI/Washington DC, Ms Lucy Thairu from Kenya gave the Dr Abraham Horwitz Memorial Lecture. An informal meeting on nutrition support for people living with HIV/AIDS was held in the evening. This resulted in concrete commitment for follow-up action including regional training on the development of national guidelines. Eight of the SCN’s Working Groups were convened on April 4 and 5. Their reports are summarized below. Working Groups tackle substantive areas deemed of greatest importance by the collective SCN body. SCN participants can at any time submit proposals for new working group themes to the SCN Chair for consideration. This helps to ensure that priority issues are addressed. The last day of the SCN session, April 6, was taken up with discussion of conclusions arising from the Working Groups as well as separate reports from the parallel meetings. The full report is available on our website. SCN Symposia and Working Group meetings are open to all; please join us next March in Berlin.

ACC/SCN Working Groups

Nutrition of school-age children

An extraordinary meeting of the Working Group on Nutrition of School-age Children was held during the 28^th Session for two reasons. Firstly, there is an enhanced focus on school feeding and food-for-education as a result of recent new initiatives. Secondly, there is increasing UN activity on school health and nutrition as a result of the launch of Focusing Resources on Effective School Health (FRESH) Partnership at the World Education Forum in Dakar, Senegal. Country programmes using the FRESH framework and supported by all four original partners are now being rolled out in at least 11 countries in Africa. The Working Group reported follow-up to recommendations of last year in four areas: preparation of a technical review of the health and nutritional status of school age children globally, compilation of good practices for school-based health and nutrition services, increased access to knowledge in the area of school nutrition and health via the internet, and harmonization of partner agencies’ approaches to nutrition in the education sector, with special regard to the place of food in the FRESH framework.

The Working Group recommended that:

· WFP should coordinate an expert technical group to address outstanding challenges in creating effective school nutrition and health programmes. The expert group should comprise representatives from the appropriate agencies, participating countries, NGOs and technical institutions. Challenges to be addressed should include the economic and social benefits of school feeding, methods to identify high risk groups for feeding, exit strategies for food aid assisted school feeding, community based approaches, and monitoring and evaluation.

· WFP and the World Bank should work together, and with other partners, at country level in Africa where there are opportunities to explore the joint roles of WFP and Bank projects for mothers and infants (IMCI and reproductive health), underfives (early childhood development projects) and school age children (FRESH and school feeding projects).

Contact: Don Bundy: dbundy@worldbank.org

Capacity development in food and nutrition

Progress over the one year existence of this Working Group was reviewed. Based on recommendations made last year, focus was placed on capacity development efforts in Africa. Africa faces many challenges with 47.3 million preschool children stunted. More than 50% of preschool deaths are related to malnutrition. The nutrition situation in many parts of Africa is deteriorating due to economic downturn, HIV/AIDS, reduced public sector spending and limited capacity to plan and implement effective programmes. Workshops were held in each of southern, eastern and western-central Africa over the past year. UNU and IUNS were facilitators. The workshops addressed the development of learning cooperatives, mechanisms for effective intra- and inter-regional cooperation, and training needs. Action plans were prepared through intensive consultation, and were driven by African professionals. The goals of these action plans are to inspire African leadership in nutrition to meet the challenges of combating malnutrition in a sustainable manner, drive national level nutrition agendas, and mobilize support for the sub-regional action plans and cooperation of stakeholders.

The Working Group recommended that

· Implementation of the sub-regional action plans should continue. Other efforts which are consistent with the overall vision of the African Capacity Development Initiative, such as the Information Technology project, West African Health Organization Initiative, and the UNICEF/IFPRI proposed project, can be integrated into these action plans.

· SCN member organizations should use this Working Group as a means to combine efforts and maximize potential impact.

· The new Dr. Abraham Horwitz Fellowship Programme, initially proposed for Latin America, should be expanded to other regions after evaluation of the response generated and the funding available.

Micronutrients

This Working Group reviewed progress in four areas: iodine deficiency disorders, iron deficiency anemia, vitamin A deficiency, and multiple micronutrient deficiencies. There has been major progress in controlling IDD, predominantly through iodization of salt. The main challenges for the future include providing special support to countries affected by IDD but which have no control programme in place, and ensuring sustainability of salt iodization. These two issues can be addressed through mobilizing the international community, developing partnerships of various stake holders including the salt producers, reinforcing the capacity of labs at all levels, and undertaking independent assessments of progress made by countries.

Regarding iron, the Working Group noted that there have been a number of important activities in the area of control of anaemia and iron deficiency over the past year. However, iron is still the ‘orphan’ among the three main micro-nutrients. The need to ensure a strong goal for reduction of anaemia in the outcome document of the UN General Assembly Special Session on Children (see p. 31) was discussed. A small group met after the Working Group meeting and formulated new wording to be conveyed to Dr. Kul Gautum, Deputy Executive Director, UNICEF.

Advances and evolution in thinking in the vitamin A area were reviewed by the Working Group. There is growing consensus to adopt a new terminology, vitamin A deficiency disorders or VADD, to replace both “clinical deficiency” and “sub-clinical deficiency”. The rationale for this change will be published by the International Vitamin A Consultative Group later this year. Estimates of people with VADD are not yet available. The new terminology implies a new approach to deriving estimates, especially for women and adolescents. On the programme side, much progress has been made towards controlling vitamin A deficiency via national immunization days and child health weeks. However, the need to pursue a package of approaches including supplementation, food fortification and dietary diversification was emphasized.

Food fortification was discussed and presentations made by the Micronutrient Initiative and FAO. It was noted that food fortification should be part of a broad development strategy, i.e., part of an overall health and nutrition strategy which includes dietary improvement, supplementation and public health measures. However, some participants expressed concern about an emerging global alliance for fortification. There may be value in taking a cautious approach because of issues related to market protection and liberalization of food trade. Some felt that too little attention is paid to food composition databases and that knowledge of indigenous foods is quite poor. Several noted that fortification efforts also need to emphasize technologies for small-scale fortification to target those who lack access to centrally processed foods.

The following areas were identified by the Working Group as requiring priority attention in the coming year:

· The Working Group should continue to support a series of, by now, well-publicized recommendations developed over recent years and aimed at sustainable IDD elimination. These include increased support to small scale salt producers and waiving excise duties on potassium iodate.

· Integrated programme packages should be developed to address all causes of anaemia, including iron deficiency

· As national immunization days are phased out, there is a need to develop other strategies to maintain high coverage levels of vitamin A supplementation

· Efforts to document the extent of VADD in adolescent girls and women need to be accelerated, and programmes developed to address the needs of these two groups.

· Community-based approaches integrating multiple interventions and various target groups should be developed and supported.

· At its next meeting the Working Group should focus on integrated approaches, including food-based approaches, rather than interventions involving single micronutrients.

Nutrition, ethics and human rights

This Working Group convened its seventh meeting during the 28^th Session. The chair recalled that human rights thinking was new to the nutrition community in the early 90s. Over the years, this Working Group has been effective in promoting a human rights approach to food and nutrition programming. Follow-up to recommendations made last year was discussed. This included background work on the preparation of a manual on the interpretation and use of General Comment number 12 on the right to adequate food, and a new focus on benchmarks and indicators for food and nutrition rights programming and monitoring. Three international meetings have been held over the past year where the content and use of General Comment number 12 was discussed, e-groups have been established for the exchange of views and knowledge, and several countries have announced interest in organizing national seminars on the General Comment. A task force meeting was held, prior to the 28^th session, to review a draft paper on benchmarks and indicators. The task force felt that the draft paper would serve as a good basis for future work in this area.

The Working Group recommended that:

· Work on benchmarks and indicators for monitoring the realization of the rights to food, health and care to prevent hunger and promote good nutrition, should be intensified. The draft paper should be revised and discussed again next year. This revision can be accomplished via e-groups, an inter-sessional meeting at the time of the World Food Summit: five years later in November 2001, and specialist consultancies as needed.

· SCN member agencies should engage actively in work on benchmarks and indicators, notably FAO, UNICEF, WHO, WFP, UNHCR, the Bank and others. In addition, interested bilaterals and NGOs should join in this work and be open to financially supporting inter-sessional activities as needed. The SCN has a unique opportunity to combine the experience and expertise of member agencies in an integrated response to the continuing call from the human rights bodies of the UN, for indicators to improve national and international monitoring of economic, social and cultural rights in countries that are States Parties to the international human rights conventions.

· The Working Group should review the status of other rights-related work of relevance to nutrition within the agencies. This review will help to place the work of single agencies in the wider context of UN Reform as regards the revitalisation of human rights as a fundamental principle of all work of the UN system.

Breastfeeding and complementary feeding

The agenda of this Working Group was designed to include reporting on agency and other activities in follow-up to issues identified last year, exchange of information on scientific, programme and policy advances, and provision of advice to the SCN on these matters, as well as identification of critical issues for further discussion as part of one to two year work plan. WHO provided a progress report on the Infant and Young Child Feeding Strategy, and FAO presented a paper on infant and young child feeding emphasizing child feeding and household food security. UNICEF provided an update on the Code and implications of the Convention of the Rights of the Child (CRC). It was noted that progress on the implementation of the CRC is fundamental to infant and young child health and nutrition. WHO presented the results of a systematic review of published literature related to the optimal duration of exclusive breastfeeding. This work concluded that there is a scientific rationale for policy recommending exclusive breastfeeding “for six months”. Work undertaken by Wellstart underlined that infants may not be physically ready for foods other than breast milk prior to 6-7 months. A study on breastfeeding in four countries in Africa showed that there has been a reduction in support for breastfeeding as a result of fears and misinterpretation of the UNAIDS/WHO/UNICEF guidance related to HIV and breastfeeding.

The Working Group recommended that:

· The WHO should report back next year on progress towards the Global Strategy on Infant and Young Child Feeding, highlighting changes created through the planned open process and including input from bilaterals and interested UN and other agencies

· Implementation of the Code (especially new efforts in training and capacity in Code awareness), BFHI, ILO Maternity Protection Convention and aspects of the Innocenti Declaration should continue to be a focus of the reporting of the Working Group.

· The SCN Chair should write to the Director General of the WHO congratulating her on the process that led to improved recommendations on the duration of exclusive breastfeeding. The letter should also stress the importance of the Innocenti wording on the duration of breasfeeding “for at least two years”.

· The SCN should call upon all UN agencies to actively promote exclusive breastfeeding in all populations, and to report on the balance of attention given to this as compared to attention given to prevention of HIV transmission through breastfeeding.

· Preliminary data on morbidity and mortality outcomes among exclusively breastfed, mixed fed and artificially fed infants and their mothers in the UN-sponsored pilot projects for the prevention of mother-to-child transmission of HIV that provide infant formula should be presented as soon as possible. If outcomes among artificially fed infants are not better than among breastfed infants, this information should be disseminated and the feeding intervention should not be continued as part of the projects.

· Breastfeeding and breast milk should be taken into account in all work on household food security and in assessing women’s economic contribution.

· Complementary foods and feeding, related indicators, and training needs should be dealt with in depth by the Working Group next year, with a focus on both appropriate and adequate food and feeding behaviours.

· The SCN should request that all UN agencies report on support for, and progress in, community activities, programmes and advocacy for optimal breastfeeding behaviours. This would include appropriate nutritional, social and workplace support for all women of childbearing age, pregnant and lactating women.

· Early in the process of preparations for the 29^th Session, the Secretariat should remind Working Groups to interact with each other to ensure that issues of mutual concern are considered in all relevant meetings. The SCN Secretariat should also expedite the exchange of information amongst SCN members on meetings and strategy development on issues that might impact on breastfeeding.

Nutrition in emergencies

The Working Group reported back to the SCN on priority issues identified last year. A document entitled Infant and young child feeding in emergencies has been prepared, filling a need for practical guidance that can be used by both policy-makers and relief staff. The publication has been supported so far by 12 NGOs and two UN agencies; additional support is sought. Training modules for infant feeding in emergencies have also been prepared. The purpose of these modules is to prepare emergency relief staff to support appropriate infant feeding and to describe the process of applying operational guidance. Again, this work is the result of collaboration amongst a number of NGOs and several UN agencies. The Working Group had expressed serious concerns last year about the WHO’s pricing policy regarding a manual entitled Management of severe malnutrition. The manual is now available for downloading from the WHO website. The need to prioritize gaps in knowledge, skills and practice in emergency nutrition across agencies has led to the design of a tool (a matrix) to be applied by each agency involved in relief work. This process will help to identify areas in which new work needs to be initiated.

The Working Group will take on this new work in the coming year:

· Following a proposal to implement therapeutic feeding through a community based programme, interested individuals should contact the Working Group to collaborate in this initiative.

· A task force has been created to spearhead a proposal to prepare a technical review of the scientific basis and origins of current field practice, entitled The meaning and measurement of acute malnutrition in emergencies. The proposal will be reviewed for breadth, scope and content by the Working Group. The Working Group requested that potential authors contact the chair.

· To consolidate and share training tools and ensure these are accessible by non-technical, management and technical staff alike, a comprehensive strategy for training initiatives in emergency nutrition will be formulated.

Household food security

The Chairperson outlined the objectives of this meeting which were to take stock of what had been accomplished in the area of household food security since the last meeting, and to build consensus around a workplan to implement community approaches for achieving household food security and reducing malnutrition. The decline in the number of food insecure worldwide has been only 8 m/yr, while the target is 20 m/yr. The challenge is to find new strategies to accelerate the pace of improvement. FAO places emphasis on community-based approaches that provide a viable and practical means to rapidly reduce malnutrition. These approaches involve mobilizing communities to take advantage of existing services. Factors contributing to malnutrition in Kenya were discussed. One problem is the decline in consumption of traditional foods. Support for women’s groups in small scale food processing, to increase consumption as well as income, needs to be expanded

The Working Group recommended that:

· Partners interested in working within the broad framework of community-based strategies for household food security should be identified. Further, a Task Force should be created to guide work on this approach.

· A plan of action to incorporate community-based approaches into the UN Development Assistance Framework, the Common Country Assessment, and the ACC Task Force on Rural Development and Food Security should be drawn up.

· Countries, partnerships and alliances for assisting in the implementation of community approaches should be identified. A consensus meeting on community based nutrition programmes should be considered for later this year, and possibly an ACC/SCN symposium on this topic in the future.

· Operational research on best practices at community level should be encouraged. A stronger case should be made for increasing investments in this approach to encourage the mobilization of resources.

· The use of food aid for improving household food security should be explored.

Prevention of foetal and infant malnutrition

The Chairperson presented information on the new WHO global estimates of low birthweight, noting that data collection methods are improving. Sources are mostly surveys and hospital data. LBW is still prevalent in developing countries, the highest rates are seen in Asia. The new estimates show a slight improvement in the prevalence of LBW in some regions, although this could be because of better data. UNICEF supports LBW reduction programmes in eleven countries, offering an integrated package which includes provision of multi-micronutrient supplements.

Core indicators are weight gain in pregnancy, birthweight, iron status and compliance. Informed consent is part of the protocol. Results will be available in about three years. A targeted programme aimed at reducing LBW amongst refugees in Tanzania was presented. Interventions addressed malaria and anemia and the quality of antenatal care; food rations were distributed. LBW was reduced from 33 to 14% in six months. The WHO antenatal care trial was presented. This trial (carried out in Argentina, Cuba, Thailand and Saudi Arabia) shows that a decrease in the number of antenatal visits does not adversely affect pregnancy outcomes. Working Group participants queried whether these results would pertain to regions with high rates of LBW. The merits of the life cycle approach to LBW were discussed in the context of work funded by the March of Dimes in the USA. The World Bank described a new initiative aimed at creating a global learning network. New evidence for the fetal origins of disease arising from a recent meeting in India was discussed.

Contact: Jelka Zupan: zupanj@who.int

An important breakthrough in the parallel meeting of Bilateral Donors at the ACC/SCN annual sessions The ACC/SCN bilateral parallel meeting that convened during the 28th session in Nairobi, expanded its representation to include staff from ministries of aid-receiving countries. Officers from the Gambia, Kenya, Mali and South Africa took part. This change reflects earlier discussions to more precisely define what constitutes a meeting of bilaterals. In the spirit of the African Nutrition Capacity Development Initiative, the concept has now been expanded from bilateral donors to bilateral partners. As a result, from now on, government representatives will attend the bilateral parallel meetings during the ACC/SCN annual sessions.

The ACC/SCN 29th Session including a one-day Symposium on Nutrition in the context of crisis and conflict will take place in Berlin, Germany Monday 11 through Friday 15 March 2002 Hosted by the Federal Ministry for Economic Cooperation and Development, Government of Germany, in collaboration with the German Foundation for International Development (DSE) and Deutsch Gesellschaft für Technische Zusammenarbeit (GTZ) Registration and programme details will be available on the SCN website http://acc.unsystem.org/scn/from mid October 2001

Nancy Jo Peck It is with enormous sadness that we report the death of Nancy Jo Peck on February 23, after a four-year illness. Nancy Jo trained as a biologist. It was personal experience that drew her to breastfeeding advocacy work. Nancy Jo was dismayed that the major Geneva hospitals in the 70s, when she breastfed her own infants, were so lacking in support and understanding for mothers and babies. Nancy Jo was a founder of IBFAN Geneva (GIFA) and served as a scientific expert for nearly 20 years. She was a key person in so many projects: she was the author of Breastfeeding Briefs (now published in five languages), and co-ordinated IBFAN’s work on Codex, WTO, the UN and the Convention of the Rights of the Child. Nancy Jo was a tireless and forceful advocate, extremely dedicated to the cause she believed in. She was especially active on the legislative side of IBFAN’s work. Her keen scientific sense and critical thinking added immeasurably to the achievements of IBFAN and the breastfeeding movement globally.

Vulimiri Ramalingaswami Professor Vulimiri Ramalingaswami, Rama, died on May 28, 2001 in a New Delhi hospital of cancer. Professor Ramalingaswami was closely associated with nutrition during all his illustrious career. He was active in the global IDD family since the 50s and was the first Vice-Chairman of the ICCIDD. He was the Director of the All India Institute of Medical Sciences, New Delhi for a period of 10 years from 1969 on. From 1979, he served in The Indian Council for Medical Research for a period of six years. He was also nominated India’s first National Research Professor. In recognition of his exemplary contribution to the health sciences, he received India’s highest civil honours - the Padma Vibhushan and the Padma Bhushan. He also became a Fellow of the USSR Academy of Sciences and a Fellow of the Royal Society. Professor Ramalingaswami had been in poor health for the last three months. He was alert and active till his last few days. He maintained a very keen interest in IDD and kept abreast of global developments. He was annoyed by the Government of India’s decision to lift the ban on the sale of non-iodised salt. He was a leading campaigner for its restoration. He leaves behind his wife Dr Prabha Ramalingaswami, his son Jagdish, daughter Lakshmi and their families, as well as scores of students, disciples and colleagues all over the world. Contributed by Madhu Karmarkar and Chandrakant Pandav and the ICCIDD