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References
The process we are describing, and the reports that we are presenting, in this special issue of the Food and Nutrition Bulletin are the work of Committee II/3 on Urbanization and Nutrition of the International Union of Nutritional Sciences (IUNS). The report has been more than four years in the making. Although it is based on the deliberations of participants and consultants at a working conference held in Wageningen, Netherlands, in March 1993, it has undergone revisions based on extensive consultations.
Three major realities are reviewed in the introductory articles. The first is the changing context of demography in the developing countries of Asia and Latin America in which life-spans have increased and fertility has decreased. As a result, the elderly population has begun to increase dramatically. A second consideration is that urbanization and rural-to-urban migration have accelerated over the last half-century. This has cut off many of the elderly from traditional extended-family support systems that characterize rural communities. The third is the lamentable state of the art of ageing research in developing-country settings. Interest in and experience with the study of ageing in third world populations has not kept pace with the rate of ageing in the third world.
Gerontology and geriatrics are emerging disciplines in industrialized countries. Peculiarities of the morbidity and mortality trends, environmental stress, and dietary habits of low-income countries present additional pitfalls and caveats for its study in that setting. The pilot Reconnaissance project and the CRONOS (Cross-Cultural Research on the Nutrition of Older Subjects) protocol discussed in this issue are part of an emerging movement to conduct multicentre surveys on the elderly.
Next, the predecessors of the Reconnaissance project are described. The EURONUT-SENECA study [1] included 19 sites in 12 European countries, and the IUNS study Food Habits in Later Life (FHLL) [2] studied six ethnic groups at 10 sites.
Among the countries included in these two studies, only the Philippines and China could be considered developing countries. The experiences in bringing these two multicentre studies on the elderly to fruition are reviewed in the context of how they might enhance the execution of a similar study exclusively based in low-income societies. In 1992, with financing from the European Commission, the Reconnaissance project, a parallel set of pilot studies using a common draft protocol, was conducted in five Asian countries (China, Indonesia, Malaysia, the Philippines, and Thailand) and three Latin American republics (Brazil, Guatemala, and Mexico).
Under ideal circumstances, before any protocol is drafted, qualitative rapid appraisal techniques and participation of the target population in its development would be desirable. After the Reconnaissance protocol was formulated, several consultants suggested that cultural differences among regions might influence the validity of the responses and their interpretation. Somewhat after the fact, an initial phase of rapid appraisal was added that used techniques of open-ended probing interviews both with key informants and with focus groups. The community was brought into the planning, and a unit of qualitative analysis was added. This technique has been described elsewhere [3, 4] and is summarized briefly in the protocol. The researchers for this qualitative rapid appraisal were nutritionists or physicians who did not have anthropological backgrounds or experience with probing interviews. However, they learned many important lessons about the attitudes of elderly populations and the reasons for their health-related behaviour. The professionals found this added dimension to community-level investigation to be rewarding. In the paper by Thamrin et al. [5], the readers can judge the usefulness of this addition to the original protocol.
The field experience of the collection of the prescribed common elements of the questionnaire and measurement procedures, conducted without previous intra-site standardization exercises, is recounted, and the lessons derived are enumerated in other chapters. A mid-process evaluation is a luxury that the two predecessor studies did not have available to them. At the meeting in Wageningen, participants and consultants were combined into working groups to apply the lessons learned in the Reconnaissance pilot study to a definitive protocol. Emphasis was on what was unclear, what was superfluous, what was redundant, and what was potentially offensive in the questions. The measurement procedures of the Reconnaissance protocol were then applied in the field in eight countries. Insights are provided into the reasons for the changes made.
What emerges is a protocol for a multicentre study of the elderly in developing countries presented as the final paper in this issue. The acronym for the protocol is derived from the ancient god of time, CRONOS. The real work is now ahead of us, to recruit and enrol research centres to join hands with IUNS Committee II/3 and do the hard work of collecting and reporting survey data that will allow us to learn more about how urbanization and ageing influence health and nutrition in developing societies.
Rainer Gross Noel
W. Solomons Joseph
G. A. J. Hautvast
1. de Groot LCPGM, van Staveren WA, Hautvast JAGJ, eds. EURONUT-SENECA. Eur J Clin Nutr 1991; 45(suppl 3)
2. Wahlqvist ML, Davies L, Hsu-Hage BH-H, Kouris-Blazos A, Scrimshaw NS, Steen B. Van Staveren WA, eds. Food habits in later life. Descriptions of elderly communities and lessons learned. Jointly published on CD-ROM by the United Nations University Press, Tokyo, and the Asia Pacific Journal of Clinical Nutrition, 1996.
3. Scrimshaw SCM, Hurtado E. Field guide for the study of health-seeking behaviour at the household level. Food Nutr Bull 1984;6(2):27-45.
4. Scrimshaw SCM, Hurtado E. Rapid assessment procedures for nutrition and primary health care. Anthropological approaches to improving programme effectiveness. Los Angeles, Calif, USA: UCLA Latin American Center, 1987.
5. Thamrin H. Rasad A, Solomons NW, Wahlqvist ML, Gross R. Analysis of the Reconnaissance project. Phase 1: The community. Food Nutr Bull 1997;18:248-55.
