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Dr. Hernán Delgado, Director of the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala, an affiliated institution of the United Nations University, was awarded the 1992 International Nathalie Masse Prize of the International Children's Centre in Paris. The prize is given to a person under 50 years of age who has carried out, alone or as a team leader, significant research on behalf of poor children, preferably in developing countries. It provides a cash award of F 50,000, which Dr. Delgado has donated to INCAP's endowment fund.
Dr. Delgado, a native of Chile, joined INCAP in 1972 and became its director in 1990. He holds an M.D. degree from the University of San Carlos in Guatemala and an M.P.H. from the Harvard University School of Public Health in the United States.
Since 1986 the Department of Human Nutrition in the School of Sciences at Deakin University in Geelong, Australia, has offered a Graduate Diploma of Human Nutrition which can be earned by correspondence. The course was developed in response to the needs of graduates working in a wide variety of areas in which some knowledge of nutrition is needed. These include public policy areas such as agriculture and health, the food and hospitality industry, and sport and physical education, as well as nursing, medicine, pharmacy, and teaching.
The course is designed to be taken on a part-time basis over a period of two to four years to enable even very busy professionals to get the best out of the programme. It consists of a total of eight semester units, of which seven are compulsory core units and the eighth an elective unit. The compulsory units include principles of nutrition, two units each in the areas of food science and applied nutrition, and one each in the areas of nutrition education and research methods. Electives are available in the areas of catering, anthropology, and third-world nutrition.
Because the course was designed to be of relevance to a wide range of professionals, it is also likely to be of interest to graduates working in other countries where a similar programme is not currently available or who because of the nature of their work or location are only able to undertake further studies by correspondence. Course brochures and information for students from outside Australia are available from the GDHN Course Advisor, Dianne Johnston, Off-Campus Operations, Deakin University, Geelong, Vic. 3217, Australia (telephone 052 272642).
Colloquium on growth promotion for child development
UNICEF's "child survival revolution" has for several years focused on four interventions, using the acronym "GOBI": growth monitoring, oral rehydration, breast-feeding, and immunization. Of these four, growth monitoring (GM), although widely adopted, has probably had the least impact on child health and child survival, because measuring a child's weight and plotting it on a chart serves no useful purpose for that child unless it leads to actions that actually promote good growth. All too often the weighing and charting have become the main GM activity, and little time and few resources have been devoted to counselling the mother or other actions to promote growth.
The title and content of a 1985 editorial in the journal Lancet posed an important question: "Growth monitoring: Intermediate technology or expensive luxury?" [1985;ii:1337-38]. Seven years later that question remains relevant. There are strong proponents and opponents of GM, and there is little scientific evidence to show that growth charts per se have improved child nutrition.
A group of experts met in Nyeri, Kenya, 11-13 May 1992, for a colloquium on Growth Promotion for Child Development and held a wide-ranging discussion on issues related to growth monitoring, growth charting, and growth promotion. The history and current status of growth monitoring and promotion (GMP) programmes were reviewed, and the results of recent research and country case studies were presented.
The colloquium unanimously adopted the following declaration.
The Nyeri Declaration on Growth Promotion for Child Development
"The participants in the Colloquium on Growth Promotion for Child Development in Nyeri, Kenya, 11-13 May 1992, recognize that it is morally unacceptable that malnutrition is a major contributing cause in 10 million out of the 15 million deaths of children in the world each year. The World Summit for Children and the International Convention on the Rights of the Child affirmed as a global ethic that the protection, development, and survival of the child is a human right. Nations should give priority to children in the allocation of resources.
"The Colloquium recognized that growth monitoring is being implemented in many countries for millions of children. Too often this monitoring has not promoted growth because the weighing and charting has not been followed by action.
"The Colloquium recommends that:
- growth promotion for individual children, involving information from and assessment by mothers, community volunteers, and service personnel, using (i) growth monitoring by weighing and charting to reflect the dynamics of individual growth in the early years of life, (ii) occasional weighing without the use of growth charts, and (iii) other methods of assessment, including traditional practices and measurements other than weighing;
- community-based nutrition surveillance, using periodic assessment of nutritional status, either by anthropometric or other surveys of populations in order to focus on children in greatest need. "
Commentary
This declaration calls for a concentration on growth promotion rather than on standard growth monitoring as currently practised. It suggests that for individual children growth promotion programmes should almost always first include assessment based on information from the mother, the community, and the health workers (or volunteers). Secondly, depending on local conditions and the availability of resources, the assessment should consist of either (1) growth monitoring by regular weighing and charting, (2) occasional weighing without the use of charts, the weight being used for diagnostic or other purposes, or (3) other methods of assessment of growth, and of causes of growth faltering, without weighing.
In each case the information from these assessments should lead to an analysis of the factors influencing the growth and health of the child, and then, most importantly, to appropriate advice and actions. This would be followed at intervals by reassessment, leading to further analysis and action. Programmes such as this could be either clinic- or community-based.
All the participants agreed that child growth, usually assessed by serial weighing, is a sensitive indicator of child health and nutrition. The colloquium heard from Drs. Satoto, Kraisid Tontisirin, and Carl Taylor about relatively successful GMP programmes in Indonesia, Thailand, and China respectively. These contrasted with experiences in several other countries where GM activities were often not followed by actions to improve growth or child health. It was the opinion of most participants that poorly done GMP programmes often use scarce resources, have large opportunity costs, and at worst serve as an alibi for not implementing more important nutrition-oriented activities. The proceedings of the colloquium will be published by IDRC in Canada. The views exchanged at the colloquium, and its declaration, point to alternative means to assist global, national, and local efforts to promote the good growth and development of children.
Participants
The participants in the colloquium were D. Alnwick, Y. Bergevin, J. Cervinskas, C. DeSweemer-Ba, S. George, N. Gerein, G. Harrison, L. Hendrata, J. Jitta, U. Jonsson, A. Kielmann, M. Latham, B. Ljungqvist, M. Medina, D. Morley, P. Ngui, G. Njera, D. Nyamwaya, R. Pearson, C. Puentes-Markides, M. Ruel, Satoto, C. Taylor, K. Tontisirin.
Earthwatch, a private, non-profit organization founded in 1971, will award more than US$2.5 million in field research grants this year to 150 projects around the world. It ranks with the National Geographic Society and the World Wildlife Fund as one of the largest private sponsors of field research expeditions in the world. Despite its size, Earthwatch is a little-known funding source in international nutrition circles. Over the next few years, however, its visibility is likely to increase markedly as the organization continues to expand its support of projects focusing on food and nutrition issues worldwide.
The mission of Earthwatch, as stated in its most recent publication, is "to improve human understanding of the planet, the diversity of its inhabitants, and the processes that affect the quality of life on earth." Accordingly, the organization supports field research in a wide range of disciplines, including marine mammology, archaeology, and folklore and musicology, as well as public health and sustainable agriculture. A major thrust of programme expansion efforts in recent years has been in the direction of research that investigates food and nutrition problems in their cultural, economic, and ecological context. Multidisciplinary approaches to topical issues that involve transnational collaboration on the part of the principal investigators have been especially targeted for support.
The most unusual feature of Earthwatch is the process by which it raises the funds to support field research projects. Based in Boston, Mass., USA, with field offices in Melbourne, Australia, and Oxford, England, the organization has more than 70,000 members, who join in order to have the opportunity to work internationally as non-specialist volunteer field assistants on field research projects. The volunteers who are chosen for participation in the projects pay for the privilege of assisting the principal investigators with their fieldwork. All of the funds awarded to principal investigators are derived from the contributions of the volunteers. Volunteers donate their money and time; researchers receive both funds and labour.
It is important to note that, while the volunteers are generally not trained in the researcher's specialty area, they are well educated people in their own right: one-third of them hold bachelors degrees, 40% hold graduate degrees, and 10% hold professional degrees. They range in age from 18 to 85, with an average age of 45, and most of them are English speakers.
Volunteers elect to join Earthwatch projects because they are interested in contributing to the solution of the challenging problems of our time. A guiding philosophy of Earthwatch as it matches volunteers with researchers is best expressed in these words of Albert Einstein:
It is of great importance that the general public be given the opportunity to experience, consciously and intelligently, the efforts and results of scientific research. It is not sufficient that each result be taken up, elaborated, and applied by a few specialists in the field. Restricting the body of knowledge to a small group deadens the philosophical spirit of people and leads to spiritual poverty.
Through the involvement of non-specialist volunteers at the field level, researchers have an opportunity to build a constituency of support for their discipline and for the kind of informed programmes and public policies that are well-grounded in the latest research findings.
How are Earthwatch-supported projects usually designed? Because the volunteers are not specialists in the field of project inquiry, they must be assigned tasks that are discrete and doable by an intelligent, enthusiastic novice. Volunteers have weighed and measured under-fives in anthropometric surveys, mapped villages for cluster sampling purposes, interviewed mothers about their food-consumption practices, collected seasonal prices of food items in local marketplaces, shadowed villagers in Cameroon on energy-expenditure surveys, and observed and recorded the daily activities of women in time-allocation studies. These are but a few examples of the possibilities for integrating volunteers into appropriate data-collection tasks. Often volunteers are paired with in-country counterparts, and activities are carried out as a cross-cultural team of two. The presence of outsiders in the field setting can serve as a real incentive for in-country personnel to perform well, and the visibility of research effort frequently is enhanced within the community as a result.
A typical Earthwatch-supported project incorporates volunteers into two or more consecutive two-week "teams" of anywhere from 4 to 15 volunteers. During the first two days of each team's tour of duty, the volunteers are oriented and trained for the tasks at hand; the remaining twelve days are devoted to data collection, daily debriefings, and quality-control sessions. Since Earthwatch grants are awarded on a per capita basis, it is important that at least 20 volunteers should be utilized on a project over the course of a field season. With this number of volunteers, the field grants become meaningful in amount and capable of underwriting basic field research costs. The grants are designed to cover the transportation of the principal investigator to the site, in-country transport, food and accommodation for staff and volunteers, stipends for in-country counterparts, and equipment and supplies. Earthwatch does not pay salary or overhead. Grants average US$800 per capita, and range from US$16,000 to more than US$100,000.
The Center for Field Research is the programme development arm of Earthwatch. The Center's program officer, Catherine Schlager, is responsible for soliciting proposals in public health, nutrition, sustainable agriculture, and anthropology. Dr. Nevin Scrimshaw is advisor for the Earthwatch Food and Nutrition Program. Readers of the Food and Nutrition Bulletin who are actively engaged in or anticipate beginning field research projects in the near future are urged to contact Earthwatch. Please note that proposals are received and reviewed year-round and should be submitted one year in advance of field dates. The necessary proposal forms will be sent to all inquirers upon request.
For further information, contact Catherine Schlager, Program Officer, Center for Field Research, Earthwatch, 680 Mount Auburn St., PO Box 403, Watertown, MA 02272, USA; telephone (617) 9268200; fax (617) 926-8532.
Child development and nutrition in Nigeria. Federal Government of Nigeria, and UNICEF, 1992. (ISBN 92-8061081-1) 267 pages.
This is a comprehensive, well-written and illustrated monograph to provide students and adults with factual information on maternal and child nutrition and desirable practices for good health. It has an extensive supplementary reading list. While written for Africa, it can easily be adapted for any developing country, and this is freely encouraged. Available from UNICEF Nigeria, 11A Osborne Road, Ikoyi, Lagos, Nigeria.
Understanding the health and nutrition status of the children of Rwanda. Randall D. Schnepf. Cornell Food and Nutrition Policy Program, Cornell University, Ithaca, N.Y., USA, 1991. (ISBN 1-56401013-9) 98 pages.
Cornell Food and Nutrition Policy Program working papers. For information on ordering the following working papers, contact Nancy Kim, CFNPP Publications Department, Suite 420, 16th St. NW, Washington, DC 20036, USA; telephone (202) 8226500.
Prices and markets in Ghana. Harold Alderman and Gerald Shively. Working paper 10. 1991. (ISBN 156401-1100) 57 pages.
Nutritional status of Rwandan households: Survey evidence on the role of household consumption behavior. Randall D. Schnepf. Working paper 23. 1992. (ISBN 1-56401-123-2) 62 pages.
Testing the link between devaluation and inflation: Time series evidence from Ghana. Stephen D. Young. Working paper 24. 1992. (ISBN 1-56401-1240) 22 pages.
The political economy of economic decline and reform in Africa: The role of the state, markets, and civil institutions. David E. Sahn and Alexander H. Sarris. Working paper 25. 1992. (ISBN 1-56401-1259) 34 pages.
Incomes and food security in Ghana. Harold Alderman. Working paper 26. 1992. (ISBN 1-56401-126-7) 62 pages.
Food and nutritional adequacy in Ghana. Harold Alderman and Paul Higgins. Working paper 27. 1992. (ISBN 156401-127-5) 60 pages.
Food security and grain trade in Ghana. Harold Alderman. Working paper 28. 1992. (ISBN 1-56401128-3) 24 pages.
The adverse nutrition effects of taxing export crops in Malawi. David E. Sahn, Yves Van Frausum, and Gerald Shively. Working paper 29. 1992. (ISBN 1^ 56401-129-1) 31 pages.
Food subsidies and the poor. Harold Alderman. Cornell Food and Nutrition Policy Program Reprint Series.
World Bank working papers. For information on ordering the following working papers, contact the World Bank, 1818 H St. NW, Washington, DC 20433, USA.
Interrelations among child mortality, breastfeeding, and fertility in Egypt, 1975-80. John Marcotte and John B. Casterline. WPS 478. 1990. 52 pages.
Global indicators of nutritional risk. Rae Galloway. WPS 591. 1991. 17 pages.
Reaching people at the periphery: Can the World Bank's population, health and nutrition operations do better? Richard Heaver. WPS 81. 1988. 50 pages.
Microeconomic theory of the household and nutrition programs. Dov Chernichovsky and Linda Zangwill. WPS 82. 1988. 68 pages.
Improving women's and children's nutrition in sub-Saharan Africa. Olayinka Abosede and Judith S. McGuire. WPS 723. 1991. 30 pages.
Successful nutrition programs in Africa: What makes them work? Eileen Kennedy. WPS 706. 1991. 42 pages.
Interaction of infant mortality and fertility and the effectiveness of health and family planning programs. Howard Barnum. WPS 65. 1988. 36 pages.
Population, health, and nutrition: FY88 annual sector review. Population and Human Resource Department. WPS 273. 1989. 56 pages.
Does undernutrition respond to incomes and prices? Dominance tests for Indonesia. Martin Ravallion. Living Standards Measurement Study, working paper 82. 1991. 33 pages.