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Books received

A global, regional and country assessment of child malnutrition. Beverly A. Carlson and Tessa M. Wardlaw. UNICEF Staff Working Paper No. 7. UNICEF, New York, 1990. 128 pages.

A global assessment of malnutrition in children under five has just been completed by UNICEF, based on data available as of 1 January 1990. The analysis is based on nationally representative data from 76 developing countries accounting for 83% of the under-five population of the developing world, excluding China. The data, which come from a variety of sources, refer mainly to national malnutrition prevalences in the 1980s, with half the countries having data for 1985 or later, although for a few countries data from the late 1970s are used in the absence of more recent estimates.

This assessment of child malnutrition has two objectives: first, to provide an estimate of the magnitude of malnutrition in children; and second, to assess the availability of data for measuring the problem. The first section of the paper describes briefly the method of assessing malnutrition, which is through the measurement of nutritional status in children under five and the calculation of anthropometric indicators of nutritional status.

The second section of the paper summarizes the global magnitude of child malnutrition, for the developing world as a whole and by major continental regions. In addition to the global and regional prevalence of child malnutrition, several major national dimensions of the problem for countries having these data were investigated. These include severity, progress towards achieving targets, disparities between urban and rural areas, prevalence by sex, and prevalence by age, including regional patterns.

A section analyses the coverage and prevalence of malnutrition by country and UNICEF region. This section ranks countries by prevalence, showing those which are relatively better and those relatively worse. It also provides a comparative regional overview of the availability of data by country and in terms of child population. All of the basic data used in the analysis are contained in the country tables for every country with data.

The information provided in this assessment can be used as a framework from which to orient actions in countries and for regional strategies on both surveillance and programme aspects. It should be noted that while national surveys are the method of choice for the unbiased assessment and monitoring of malnutrition prevalence, the tools of growth monitoring and promotion and growth faltering will play the major roles in individual action as well as community and programme surveillance in specific contexts.


The effects of undernutrition on children's behavior. David E. Barrett and Deborah A. Frank. Food and nutrition in history and anthropology, volume 6. Gordon and Breach, New York, 1987. 347 pages. US$88.00.

The effects of malnutrition on learning and behaviour have been the subject of intense interest over the past 20 years, as evidenced by the number of excellent prospective studies, national and international conferences, and books and monographs, most of them referenced in the foreword of this volume. This book is an ambitious and successful attempt to review critically all that has been learned about this subject up to about 1986. The volume provides a comprehensive account of the effects of energy-protein deficits on the behaviour of children, with initial attention on methodological issues. Sixty of the 347 pages report on a study carried out between 1969 and 1977 by the Institute of Nutrition of Central America and Panama (INCAP) that showed the adverse effects of early malnutrition on behaviour at school age in an economically and socially disadvantaged population.

One strength of this book is its analysis of the implications of the evidence for covariation between malnutrition and environmental variation. The authors conclude that the effects of malnutrition on behaviour are likely to depend on a number of conditions in a person's life-not only the age at which malnutrition occurs and its duration and severity, but also the response of the care-giving environment to the malnourished individuals. Evidence from a wide variety of studies of children with a history of under nutrition shows long-term changes in activity, cognition, and social responsiveness. These adverse effects can be moderated, however, by a more stimulating physical and interpersonal environment. While this volume is not a substitute for earlier publications, it is a useful addition.


Postive deviance in child nutrition. Marian Zeitlin, Hossein Ghassemi, and Mohamed Mansour. United Nations University Press, Tokyo, Japan, 1990. 162 pages. US$30.00; developing country price: US$15.00.

There are children who grow and develop well in impoverished environments where most other children suffer from malnutrition, retarded growth, and chronic illness. Positive deviance refers to these exceptional children, who are important as examples of successful child care behaviour and community support systems that can be applied when designing policies and programmes aimed at the malnourished. While other studies have concentrated on the socio-demographic and physiological variables with normal growth, this state-of-the-art study focuses on the psychosocial and behavioural aspects. The reader will also find here information on the influence of caretaker-child interactions, individual characteristics, and social support systems on child growth. Also provided are programme recommendations, a guide for future research, and a pilot project model. This is an important and original study for scientists and others interested in the new positive-deviance approach in nutrition.


Intra-household resource allocation: Issues and methods for development policy and planning. Edited by Beatrice Lorge Rogers and Nina P. Schlossman. United Nations University Press, Tokyo, Japan, 1990. 213 pages. US$35; developing country price: US$17.50.

Stressing the importance of understanding how resources are distributed within the household in order to design successful and effective development programmes, this three-part study first considers several conceptual frameworks related to household resource distribution. It then examines different methods for collecting the information needed for analysing household resource allocation, emphasizing the need to combine quantitative and qualitative methods and long- and short-term perspectives. Finally, the study focuses on such key variables as how members of a household allocate time, individual food consumption, and household flexibility in adapting to external economic and social changes. Of particular interest is the featured sample approach to incorporating intra-household analysis into the design and evaluation of development plans.


Present knowledge in nutrition. Sixth edition. International Life Sciences Institute ((ILSI)-Nutrition Foundation, Washington, DC, USA, 1990. 532 pages. US$30.00. Order from the International Life Sciences Institute-Nutrition Foundation, 1126 16th St., NW, Washington, DC 20036, USA.

This paper-back compendium of current knowledge on human nutrition has become the most authoritative and up-to-date summary of human nutrition knowledge readily accessible to developing country professionals. Previous editions have been translated into other languages and widely distributed. Although this edition is larger (532 21 x 28 cm pages), and hence more expensive, it should be available in all institutions that teach nutrition or have a need for accurate information on human nutritional requirements or on the role of nutrition in chronic diseases.

Thirty-five chapters, written by authorities in each field, consider individual nutrients as well as body composition, hunger and appetite, and obesity. Five chapters deal with special needs during pregnancy and lactation, infancy, adolescence, aging, and exercise. Important new information is contained in the chapters dealing with coronary heart disease, hypertension, diabetes mellitus, osteoporosis, renal disease, liver disease, and cancer. The chapters on evaluation of nutritional status deal with dietary surveys, interpretation of dietary and biochemical data, nutrition monitoring, and the nutrient composition of foods.

There is also much new information in chapters dealing with special topics such as enteral and parenteral nutrition, nutrient-drug interactions, alcohol, immunity, toxicants in foods, and genetic disorders. Unfortunately, the chapter on dietary standards and guidelines discusses only principles and gives little of recent recommendations. It would have been helpful to have a chapter summarizing recent recommendations, such as those of the US National Academy of Science publication Diet and Health and of "Nutritional Goals for Health in Latin America" (see Food and Nutrition Bulletin, vol. 11, no. 1 [Mar. 1989], pp. 4-20).


Nutritional status assessment of the individual: Proceedings of a national conference sponsored by the Food and Nutrition Council of the American Health Foundation. Edited by G. E. Livingston. Food and Nutrition Press, Inc., Trumbull, Conn., USA, 1989. 479 pages. US$125.00.

There has been no recent summary of nutritional assessment methodologies despite continuing technical progress. One is overdue and the focus of this volume on assessment of the individual is particularly welcome. As Hegsted points out, however, determination of the dietary intake of an individual has such a high variability that "modifying risk associated with inappropriate diets is best accomplished, not by dealing with the individual, but by dealing with the family, or better still, with the community". Moreover, due to constraints imposed by the state of the art of nutritional assessment, survey data cannot be used to diagnose the nutritional status of individuals.

Six chapters deal with various aspects of food intake assessment, three with anthropometric criteria, and eighteen are concerned with biochemical criteria for the various nutrients as well as dietary fibre and cholesterol levels. Anthropometry for infants, children, adolescents, and adults are also well covered. The role of genetic background in health risk assessment, the assessment of lifestyle, and communicating nutritional information also receive attention.

This volume effectively identifies available methodologies and indicates their advantages and limitations. Mostly, however, access to the references cited is necessary to obtain sufficient details for actually carrying out the indicated assessments. There is still a need for a self-contained manual on nutritional assessment methodologies for use where library facilities are limited.


Famine, its causes, effects and management. Edited by John R. K. Robson. Food and nutrition in history and anthropology, volume 2. Gordon and Breach, New York, 1981. 170 pages. US$50.00.

The newspaper headlines of the last two decades are stark reminders that famines still occur despite the overall adequacy of world food supplies. In order to prevent famines in the future, there is a need to understand the mechanisms of their cause. The first section of this book reviews the theory and ecology of famine, stressing that environmental factors alone, whether droughts, floods, or crop failures, do not explain modern famines; wars, politics, poverty, and other social factors are always involved.

The second section deals with the physiology of acute starvation and the role of disease, while the third section considers issues of food supply, food aid, and coping strategies during famines. Three views of recent famines in Bangladesh are presented as case studies. The book concludes with insights on a study of a millennium of Russian famines and on the adjustment of food behaviour during famine. The book is a welcome addition to the growing literature on famine. Its value lies, however, in helping to conceptualize and evaluate famine. For the practical details of dealing with famines, the book Drought relief in Ethiopia: Planning and management of feeding programs, a practical guide, by Judith Appleton (reviewed in FNB vol. 12, no. 1 [Mar. 1990]), based largely on dealing with the Ethiopian famines, is recommended.


Hunger in history: Food shortage, poverty, and deprivation. Edited by Lucile F. Newman. Basil Blackwell, Cambridge, Mass., USA, 1990. 409 pages. US$39.95.

Hunger is one of a set of seemingly intractable global issues. After two initial chapters to examine what is known or can be inferred about prehistoric patterns of hunger, this comprehensive book attempts to document the prevalence, causes, and consequences of hunger throughout recorded history. It examines hunger in the ancient Mediterranean, and Chinese and Mayan societies as well as in recent centuries and decades. In reviewing historical patterns, it asks and offers answers to the question of why hunger occurred throughout history and why it persists today in a world of plenty.

The book suggests that the elimination of hunger may be attainable for the first time in human history because it is now possible to contemplate the end of food scarcity, famine, and mass starvation. It makes it clear, however, that changes that extend food entitlements to the marginal populations in which the bulk of the world's hunger occurs will be required. This book will be of interest to persons seeking to understand the continuing problem of world hunger and will also be valuable as collateral reading for students in nutrition courses.


Nutritional status in Ghana and its determinants. Harold Alderman. Social dimensions of adjustment in sub-Saharan Africa series, working paper 3. The World Bank, Washington, DC, USA, 1990. 36 pages. US$5.95.

Since 1983, a recovery programme has succeeded in boosting the failing economy of Ghana, thereby increasing household income and the health and nutritional status of its people. This report outlines the determinants of the nutritional status of Ghana's population. It presents nutritional levels by age, sex, region, and income group. Particular attention is paid to the health of pre-school children and adult women. The effect of repeated pregnancies among young adult women is also discussed.

This working paper and the following one are extremely well researched and presented case studies of the social dimensions of economic adjustment policies in two countries in Africa where they have been applied with considerable economic success and yet serious nutrition and health problems remain. They make excellent case studies for graduate courses that deal with food and nutrition policy.


Malnutrition in Côte d'Ivoire: Prevalence and determinants. David E. Sahn. Social dimensions of adjustment in sub-Saharan Africa series, working paper no. 4. The World Bank. Washington, DC, USA, 1990. 30 pages. US$5.95.

This report examines the characteristics and determinants of malnutrition among pre-school children in Côte d'Ivoire. Among the issues addressed by the author is whether raising household income reduces childhood malnutrition. This report also analyses the effect of factors other than household income on the nutritional status of children in Cite d'Ivoire.


Traditional food: Some products and technologies. Central Food Technological Research Institute (CFTRI), Mysore, India, 1986. 302 pages.

Although this book was published in 1986, it is reviewed here because its contents are useful to nutritionists and food scientists in other developing countries. There is no other convenient source of this wealth of information. The technologies involved in producing traditional foods are described by scientists from Asia (Burma, India, Indonesia, Japan, Korea, Malaysia, Nepal, Pakistan, the Philippines, and Thailand), Africa (Ethiopia, Nigeria, Senegal, and Sudan), and Latin America (Mexico). The volume can be obtained directly from CFTRI.


Elevated dosages of vitamins. Paul Walter, Hannes Stähelin, and George Brubacher. Hans Huber Publishers, Toronto, New York, Bern, Stuttgart, 1989. 245 pages. US$52.00.

While an extra intake of vitamins is sometimes necessary, the tendency towards excessive intakes and abuse of vitamins in many countries may be harmful. This volume is an authoritative compendium of the consequences of vitamin dosages higher than the internationally recommended dietary allowances as well as indications for high dosages for certain clinical conditions. It will be a useful reference source.


Health and revolution: The Nicaraguan experience. Richard Garfield and Glen Williams. Oxfam, Oxford, UK. 246 pages. Hardback: £24.95; paperback: £6.95.

The Food and Nutrition Bulletin has previously published descriptions of the evolution of nutrition and health delivery systems in Chile, Cuba, and Costa Rica, each developing successful programmes under very different political and economic circumstances (see Horwitz, FNB, vol. 9, no. 3 [Sept. 1987], pp. 1929). This small paperback produced under the auspices of Oxfam describes the efforts of Nicaragua to follow these precedents. The start, in 1979, was auspicious and the early achievements real. The book analyses both this period and the problems encountered in coping with increasing economic constraints and the instability occasioned by Contra rebel attacks. The issues faced are not unlike those in other countries suffering from severe economic constraints and civil wars.


Helping women improve nutrition in the developing world. Beating the zero-sum game. Judith S. McGuire and Barry M. Popkin. World Bank Technical Paper no. 114. The World Bank, Washington, DC, USA, 1990. 94 pages.

The argument of this monograph is that women in developing economies are so overburdened with domestic chores, market work, and reproductive roles that they cannot improve their own nutrition or that of their children without sacrificing family welfare. In order to create a "positive-sum game," communities, governments, and the international community need to make available time- and labour-saving devices, childcare, supplementary food and/or productive resources in order to promote their women's productivity, human resources, and household welfare, including nutrition. This is an expansion of the article "Beating the zero-sum game: Women and nutrition in the third world" published in the Food and Nutrition Bulletin (vol. 11, no. 4 [Dec. 1989], pp. 38-63, and vol. 12, no. 1 [Mar. 1990], pp. 3-11).


Evaluation of certain veterinary drug residues in food. Thirty-fourth report of the joint FAD/WHO Expert Committee on Food Additives. Technical Report Series, no. 788. World Health Organization, Geneva, 1989. 66 pages. (Available in English; French and Spanish in preparation.) Sw. fr. 9/US$7.20.


Prevention in childhood and youth of adult cardiovascular diseases: Time for action. Report of a WHO Expert Committee. Technical Report Series, no. 792. World Health Organization, Geneva, 1990. 105 pages. (Available in English; French and Spanish in preparation.) Sw. fr. 12/US$9.60.

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