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Family Foods for Breastfed Children
2000, iii + 52 pages [E]
Sw.fr. 11./US $9.90
In developing countries: Sw.fr. 7.70
Order no. 1930177
A practical guide to the introduction of complementary foods into the diets of breastfed children aged 6 to 24 months. Addressed to health workers in developing countries, the book translates the latest scientific knowledge into clear and simple messages suitable for use when counselling families and communities. Major emphasis is placed on the preparation of foods, based on the local staple, that are clean, safe, and nutritionally adequate for healthy growth and development.
The book deals with the period when a child continues to receive breast milk but also needs increasing amounts of other foods before graduating to the usual family diet. It shows that breast milk can continue to be an important source of nutrients until a child is at least two years old and how mixtures of family foods can meet children's nutritional needs during this vulnerable period. Information ranges from diagrams showing the energy, protein, and micronutrient needs of young children, through discussion of the nutrient value of common foods, to recipes for preparing nutritionally adequate meals based on the local staple.
Although major emphasis is placed on the messages that need to be conveyed to families, the book also helps health workers understand the underlying evidence that supports recommended practices. Particular attention is given to common misconceptions such as the need to prepare thin porridges or withhold food during illness that may need to be addressed in counselling sessions.
Using a question-and-answer approach, the book explains when to start complementary feeding, what to give, how much, and how often. Readers also learn how to encourage children to eat enough, how to keep food clean and safe, and how to feed sick children.
All recommendations and advice draw on the results of recent research on young child feeding, growth, and childhood illness, including diarrhoea. These studies are reviewed in a companion volume from WHO, Complementary Feeding of Young Children in Developing Countries.
"... Educators and researchers in the area of nutrition for young children will find this review a wonderful reference to have on their shelf. Although the focus is on developing nations, the thorough review and clear presentation of information make this an exceptional reference material document..." Journal of Human Lactation
"... Anyone involved with the scientific and programmatic aspects of complementary feeding will find this review useful..." Food and Nutrition Bulletin
Complementary Feeding of Young Children in Developing
A Review of Current Scientific Knowledge
1998, ix + 228 pages (English)
Sw.fr. 35./US $31.50; in developing countries: Sw.fr. 24.50
Order no. 1930141
This book provides a state-of-the-art review of what is known about the nutritional needs of young children and the specific feeding practices from the best time to introduce complementary foods to the preparation of appropriate meals that contribute to optimal nutritional status and healthy growth and development. Addressed to researchers as well as health professionals, the book responds to several advances in scientific knowledge that either confirm current recommendations for complementary feeding or call for changes. Practical implications for intervention programmes are also considered in detail. Although recommendations and advice have universal relevance, particular attention is given to the needs of children in low-income settings and to feeding practices that can be implemented by caregivers in the developing world. Findings from over 500 recent studies are critically assessed in this thorough, expert review.
The book has nine chapters. The first provides an overview of new findings and continuing controversies that influence such important issues as the optimal age for introducing complementary foods, the selection of an appropriate age group for targeted interventions, and the relative importance of various factors known to limit growth. Knowledge about the maturation of physiological processes relevant to child feeding is also briefly reviewed. Chapter two discusses the importance of breast-feeding in child-feeding regimens and addresses key questions concerning the duration of breast-feeding and the appropriate age for introducing complementary foods.
Against this background, chapter three provides a broad range of technical information on different aspects of complementary feeding, including the energy required from complementary foods at different ages, appropriate feeding frequency, the energy density of complementary foods, and the importance of their organoleptic characteristics as determinants of intake. Chapter four provides similarly detailed information concerning the protein and micronutrients required from complementary foods.
Since nutritional status is influenced by behaviours surrounding feeding as well as the nutritional content of foods, subsequent chapters review studies of caregiver feeding behaviours in developing countries and discuss food processing procedures from commercial approaches to simple measures in the home that help ensure the quality and safety of complementary foods. Chapter seven, which briefly reviews global data on child-feeding practices, is followed by an overview of recent intervention programmes, an evaluation of their impact, and a discussion of factors contributing to success. The final chapter provides a succinct summary of conclusions and recommendations for appropriate child feeding.
Nonserial publication of the WHO Regional Office for
the Western Pacific
Development of Food-based Dietary Guidelines for the Western Pacific Region
Introduces the concept of food-based dietary guidelines as a powerful new tool for addressing the changing nutrition needs of Western Pacific countries. Food-based dietary guidelines, which emphasize specific foods, dishes, and local cuisines rather than nutrients or food groups, are considered an especially promising tool for the development of culturally sensitive dietary advice easily understood by consumers. The book, which gives particular attention to diet-related chronic diseases, is issued at a time when Western Pacific countries are experiencing dramatic urbanization, population ageing, changing lifestyles, and a corresponding upsurge in the prevalence of cardiovascular diseases, diabetes, obesity, and other chronic diseases.
The book has four sections. The first introduces the concept and principles of food-based dietary guidelines and explains how they differ from traditional dietary recommendations. Section two profiles health and nutritional needs using illustrative examples taken from China, Hong Kong, Indonesia, Japan, Malaysia, the Pacific islands, Philippines, Republic of Korea, and Viet Nam. A general discussion of sociocultural issues that affect dietary patterns is followed by an explanation of the ways that food-based dietary guidelines can contribute to food safety and food security. The remaining sections alert readers to the possible negative effects of dietary recommendations on agriculture and the environment, and set out guidelines for developing and implementing culturally sensitive dietary advice.
Diet, Nutrition and the Prevention of Chronic Diseases
Report of a WHO Study Group
Technical Report Series, No. 797
1990, 203 pages [C, E, F, R, S]
ISBN 92 4 120797 3
Sw.fr. 26.-/US $23.40; in developing countries: Sw.fr. 18.20
Order no. 1100797
Records the consensus reached by a group of experts commissioned to examine the strength of evidence linking dietary factors to the development of several chronic diseases, including coronary heart disease, hypertension, stroke, cancer, diabetes, and osteoporosis. The experts were also asked to issue advice on prevention consistent with both the strength of scientific evidence and the magnitude of health problems associated with dietary factors. The persistent problem of nutrient deficiencies is also considered.
In a key achievement, the report issues a series of "population nutrient goals", put forward as a universal guide to the nutrient intakes needed to prevent all diet-related diseases and appropriate for application in all countries throughout the world. Lower and upper intakes are set for each of the main nutrient groups. Expressed as a proportion of total energy, this recommended "safe" range of intakes specifies the minimum intake of a nutrient needed to prevent deficiency diseases and the maximum intake that should not be exceeded in the interest of preventing chronic diseases. The report is explicit in its insistence on the need for a population-wide, as opposed to individualized, approach to the prevention of diet-related chronic diseases. The remaining sections explain why policies governing food production and supply are essentially agricultural policies driven by economic and political issues. Advice on the adaptation of these policies concludes the report.
"... crammed with authoritative information
about a major public health concern..."
Educational Handbook for Nutrition Trainers
How to Increase Your Skills and Make It Easier for Students to Learn
A. Oshaug, D. Benbouzid, and J.-J. Guilbert
Produced in collaboration with the Nordic School of Nutrition, WHO Collaborating Centre for Advanced Training in Nutrition, University of Oslo
1993, 322 pages [E, F*]
Sw.fr. 65.-/US $58.50; in developing countries: Sw.fr. 45.50
Order no. 1930048
An educational handbook for enhancing the skills of teachers of nutritionists, whether in formal courses or in workshops and seminars. Noting the need to upgrade the quality and relevance of training in nutrition and food science, the book emphasizes the concepts, organizational principles, thinking, and skills needed to develop curricula and training in line with priority nutrition problems in communities. Information in the handbook draws on the format and educational concepts introduced in Educational Handbook for Health Personnel, a standard text, now in its sixth edition, for training teachers in the health sciences.
Unorthodox in its approach, the book challenges nutrition teachers to increase their skills so as to make learning easier for students and more relevant to the tasks they will perform in their daily work. To this end, the book adopts a task-oriented, problem-based approach designed to help teachers rethink attitudes, reorient teaching objectives, modify curricula, and master the appropriate skills. Details range from a table showing the weaknesses of commonly used tests, through a list of the teacher's functions in nutrition training, to advice on how to devise nutrition-related problems as a learning aid. The importance of producing graduates who are able to respond to nutrition problems in the community is repeatedly emphasized.
The book has five main chapters, each introduced by a series of learning objectives. Within each chapter, theoretical information is presented and followed, wherever appropriate, by exercise sheets, tests, charts, diagrams, lists of key points to remember, practical examples, warnings, and occasional congratulations.
An Evaluation of Infant Growth
WHO Working Group on Infant Growth
1994, 83 pages [E]
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1930067
Alerts clinicians, researchers, and public health professionals to weaknesses in the current international reference used for over a decade to monitor the growth and nutritional status of infants. The document reports the research findings of a WHO study designed to assess the growth patterns of infants fed according to current WHO recommendations, and the relevance of such patterns to the development of growth reference data.
Among its objectives, the study aimed to determine whether currently used reference data are an adequate tool for assessing infant nutritional status, screening for problems, and targeting interventions. The study specifically questions whether the infant portion of the NCHS-WHO reference, which is based on the Fels Longitudinal Study on the growth patterns of predominantly Caucasian, middle-class, artificially fed infants, should continue to be used to assess the adequacy of infant growth. The question takes on particular importance in view of both the many established benefits of breast-feeding, and growing evidence of significant healthy deviations from currently accepted growth references.
The study assessed the growth of breast-fed infants living under favourable environmental conditions indifferent parts of the world. In one of its most important conclusions, the study found that infants fed according to WHO recommendations and living under conditions that favour the achievement of genetic growth potential grow less rapidly than, and deviate significantly from, the current reference. While it is probable that differences in growth patterns in the first 4-6 months are due mostly to technical inadequacies of the current reference, this is unlikely to be true of growth differences in later periods. The report placed particular emphasis on the risks associated with misdiagnosis resulting in premature introduction of complementary foods.
Feeding and Nutrition of Infants and Young Children
Guidelines for the WHO European Region, with Emphasis on the Former Soviet Countries
WHO Regional Publications, European Series, No. 87
2000, xv + 288 pages [E]
ISBN 92 890 1354 0
Sw.fr. 82./US $73.80
In developing countries: Sw.fr. 57.40
Order no. 1310087
Sets out the scientific rationale for the development of national nutrition and feeding recommendations for infants and young children in Europe. Although major emphasis is placed on recommended intakes for specific nutrients, the book also offers advice on a range of additional factors that contribute to good feeding practices and need to be addressed in national policies. Particular attention is given to conditions in countries of the former Soviet Union, where recommendations on infant nutrition and feeding practices are outdated and urgently require revision.
Intended for use by policy-makers and nutrition experts in European countries, the book responds to a number of traditional dietary practices that have adverse effects on nutritional status, particularly in relation to iron deficiency anaemia. Recommendations and advice also take into account mounting evidence that optimum infant and young child feeding can reduce the risk of some of the most prevalent adult diseases, including cardiovascular disease, in European populations.
The book has twelve chapters. The first outlines nutrition-related health problems in young children and reviews what is known about feeding practices, duration of exclusive breast-feeding, and introduction of complementary foods in countries of the former Soviet Union. Subsequent chapters set out recommended nutrient intakes for energy and macronutrients, vitamins, and minerals. To provide a standard for assessing the adequacy of diets, recommended nutrient intakes issued by the European Union, the United Kingdom, the United States, and WHO are presented and compared. For each nutrient, recommended intakes are further explained through the inclusion of information on the nutrient's physiological function, food sources, requirements, and the health consequences of both insufficient and excessive intakes. A separate chapter is devoted to recommendations for the control of iron deficiency, which remains an important health problem throughout Europe.
Breast-feeding and alternatives are covered in the most extensive chapter, which reviews the latest data on the many nutritional and non-nutritional benefits of breast-feeding, and discusses the importance of maternal nutrition, practical aspects of breast-feeding, and situations where alternatives may be preferable or necessary. Chapter eight, on complementary feeding, answers a number of questions about the physiological need for complementary foods and the timing of their introduction, and lists some of the best foods to prepare for infants.
Subsequent chapters underscore the importance of caring practices as fundamental determinants of good nutrition and feeding, and offer advice on the interpretation of measures of attained growth as a tool for assessing nutritional status. A brief chapter on dental health explains the need to limit the intake of sugar, provide daily tooth care, and ensure appropriate fluoride intake. The book concludes with a chapter on food safety, which includes advice on the prevention of diarrhoea and food- and water-borne diseases.
Field Guide on Rapid Nutritional Assessment in Emergencies
WHO Regional Office for the Eastern Mediterranean
1995, iii + 63 pages [E]
ISBN 92 9021 198 9
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1460013
A spiral-bound guide describing a simple step-by-step procedure for carrying out a rapid survey of nutritional status in emergency situations in Eastern Mediterranean countries, where natural and man-made disasters have been common. Emphasis is placed on the steps required to make quick but reliable estimates as a basis for subsequent action. Throughout, checklists, model forms, reference charts, and tables are used to facilitate rapid data collection in emergency situations.
Decisions concerning the recommended minimum sample size, survey participants, and the level of analysis needed were made with the goal of striking a balance between the methodologically appropriate and the logistically feasible. The recommended method is based on simple anthropometric data and limited to children of preschool age. The result is a series of steps, appropriate to field conditions, that can be followed by individuals with little statistical or epidemiological training, and can produce the essential data needed for immediate decisions and interventions.
The guide has eight chapters, moving stepwise from selection of the survey subjects and sample, through collection of data on weight-for-height, to the recording, analysis, and interpretation of results. Further practical guidance in provided in a series of eight annexes, which include examples of systematic and cluster sampling, the CDC/WHO normalized reference table of weight-for-height, mean Z-scores and corresponding prevalences below -2 Z scores, a list of equipment, and advice on using Epi-Info software for data analysis.
Food and Health Data
Their Use in Nutrition Policy-Making
edited by W. Backer and E. Helsing
WHO Regional Publications, European Series, No. 34
1991, xii + 171 pages [E, F, G]
ISBN 92 890 1125 4
Sw.fr. 26.-/US $23.40; in developing countries: Sw.fr. 18.20
Order no. 1310034
A multi-authored study of the ways in which data on food and nutrient consumption can be used to assess a population's food intake, detect dietary inadequacies, and develop food and nutrition policies that promote healthier eating. Addressed to nutrition researchers and policy-makers, the book explains how data from food balance sheets, household budget surveys, and studies at the individual level can be used to produce an accurate picture of a population's eating habits. Because the reliability of food data can be compromised by many factors, the book gives special attention to the weaknesses and limitations of data from each source, alerting its readers to common errors of application or interpretation. By providing a critical assessment of the use and misuse of food data, the book aims to help policy-makers know what types of data can be used with confidence when assessing trends and setting objectives.
The book consists of ten original papers authored by experts in the fields of nutrition, dietary research, epidemiology, and statistics. Papers discuss the uses of epidemiology to detect diet-related diseases, describe the limitations of data contained in food balance sheets, and explain how to use data from household budget surveys and dietary surveys to obtain more detailed information.
The special problem of estimating nutrient intake is covered in two papers. The concluding papers compare dietary data from different sources in order to illustrate their differences and similarities, and discuss the use and misuse of dietary recommendations, stressing the important distinctions between dietary requirements, recommended intakes, nutrient goals, and dietary guidelines.
Global Prevalence of Vitamin A Deficiency
Micronutrient Deficiency Information System Working
Paper, No. 2
1995, x + 116 pages [E]
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1930073
A report on the global distribution of vitamin A deficiency, including the latest estimates of prevalence for each country where this deficiency is known or suspected to occur. The report responds to the need to identify populations with subclinical deficiency, as well as those with xerophthalmia, in order to quantify the at-risk population and design interventions in line with the true magnitude and severity of the problem. The report was compiled by WHO from the vitamin A portion of its Micronutrient Deficiency Information System, which also maintains data on iodine and iron.
The report has four sections. The first provides a concise state-of-the art summary of what is known about vitamin A deficiency, its causes, and its multiple effects on health. Also described are the underlying epidemiological features that characterize most situations where vitamin A deficiency occurs as a public health problem, and the technical and methodological issues that arise when attempting to estimate prevalence.
Against this background, the most extensive section presents summary tables showing the most recent prevalence data by country and by region. These tables, accompanied by explanatory notes on data sources and study designs, also categorize the level of public health problems caused by vitamin A deficiency as mild, moderate, or severe. Section three presents more detailed national and subnational prevalence data specific to ocular signs and symptoms and the serum retinol levels detected. The report concludes with full bibliographic references to all data sources used for the estimates.
The Growth Chart
A Tool for Use in Infant and Child Health Care
1986, 33 pages [Ar, E, F, S]
ISBN 92 4 154208 X
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1150252
Explains the features and uses of a simple visual chart for monitoring childhood growth and detecting changes in nutritional and health status. The first part of the book introduces the basic principles and procedures for measuring changes in growth and knowing when these changes signal a deterioration in health. Highly practical information on the design and use of growth charts is then presented on the basis of what has been learned from extensive field experience with a WHO prototype chart developed in the 1970s. In order to ensure that growth charts are understood and properly used by community health workers, the book alerts programme managers to specific problems of design, presentation, recording, or interpretation that should be considered when developing or adapting a chart for local use. Illustrations show the WHO prototype chart and modified versions that have been developed to meet special needs in different developing countries.
The second part provides guidelines for training health workers to use the chart effectively. Information ranges from important points to stress when teaching weighing procedures to actual examples of cases where growth information might be misinterpreted.
"... gives good practical guidelines for
designing and using growth charts..."
Journal of the Society of Community Medicine
"... very well and clearly written...
beautifully produced... a most useful production..."
Tropical Diseases Bulletin
Guidelines for a National Programme for the Control of Iodine Deficiency Disorders in the Eastern Mediterranean Region
EMRO Technical Publication, No. 12
1991, x + 40 pages [E]
ISBN 92 9021 036 2
Sw.fr. 11.-/US $9.90; in developing countries. Sw.fr. 7.70
Order no. 1450012
Presents technical and practical guidelines that can help countries in the Eastern Mediterranean region develop national programmes for the control of iodine deficiency disorders. Guidelines respond to the alarming prevalence of iodine deficiency disorders in this part of the world, despite the availability of inexpensive, simple, and effective techniques for prevention and control.
Guidelines for the Management of Nutrition Programmes
A Manual for Nutrition Officers
WHO EMRO Technical Publication, No. 15
1990, xi + 165 pages [E]
ISBN 92 9021 099 0
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 1450015
A practical manual designed to assist the managers of nutrition intervention programmes in Eastern Mediterranean countries. In 17 chapters, the book takes its readers through virtually every step involved in planning and implementing effective interventions, whether to combat malnutrition, provide disaster relief, or protect populations from chronic diseases linked to nutrient excess. Each chapter describes one particular responsibility and then issues guidelines for solving the relevant management problems. Details range from an explanation of why nutrition managers so often fail in their tasks to a tabular presentation of actions and expected outcomes for each step in the planning of a nutrition programme. Indicators for use in evaluating interventions are also presented and explained. Information in the manual is equally appropriate for central and for local nutrition planning.
Guidelines for Training Community Health Workers in Nutrition
1986, viii + 121 pages [Ar, E, F, S]
ISBN 92 4 154210 1
Sw.fr. 16.-/US $14.40; in developing countries: Sw.fr. 11.20
Order no. 1150256
A task-oriented manual for the training of community health workers in nutrition. Information and instructions are presented in two main parts. The first features chapters introducing the purpose and uses of the guidelines, the skills necessary to make the trainer a more effective teacher, and the basic facts about foods and nutrition which the health worker should be taught. The second part reproduces nine training modules addressing the most urgent nutritional problems of mothers and children. Focused on a single topic, each module includes information on learning objectives, basic training content, and the various training methods appropriate for that module. Each module concludes with a set of practical training exercises that can be used for either the practising of skills or the assessment of how well these skills have been mastered.
The book is intended for use in conjunction with Nutrition Learning Packages.
"... carefully developed and based on practical
experience... will be invaluable both to experts new to the field and to those with
established training programs..."
"... could be read in its entirety with benefit
by all medical students, nurses and community health workers ... a very useful resource
for those who are actually teaching. There are many good ideas in the exercises and the
diagrams are excellent..."
Tropical Diseases Bulletin
1998, available as a set of three manuals [E]
Sw.fr. 16./US $14.40; in developing countries: Sw.fr. 11.20
Order no. 1930135
1998, 36 pages [E]; WHO/FRH/NUT/CHD 98.1
Click here to view this document online.
|A Guide for Health Care
Managers and Supervisors
1998, 36 pages [E]; WHO/FRH/NUT/CHD 98.2
Click here to view this document online.
|A Review of HIV
Transmission through Breastfeeding
1998, 28 pages [E]; WHO/FRH/NUT/CHD 98.3
Click here to view this document online.
This set of three manuals offers the latest expert advice, from WHO, UNICEF, and UNAIDS, on recommended safe practices for infant feeding when the mother is infected with HIV. Citing firm evidence that HIV can be transmitted through breast milk, the manuals respond to the urgent need for guidance when advising infected mothers as well as formulating sound public health policies. With this need in mind, the manuals identify the wide range of precautions and policy options needed to reduce the risk of HIV transmission through breast milk while ensuring that the nutritional requirements of infants born to HIV-infected mothers are adequately met.
Although recommendations and advice have universal relevance, particular attention is given to options for infant feeding in resource-poor settings where infectious diseases and malnutrition are the leading causes of infant mortality and where artificial feeding may be hazardous as well as prohibitively expensive. The manuals also offer abundant advice on ways of ensuring that breast-milk substitutes reach only those infants who are at risk of HIV infection and thus do not undermine the unique advantages of breastfeeding for the majority of women and infants. Other key messages include the vital importance of confidential counselling, the right of every mother to decide how she wishes to feed her child, and the need to protect infected mothers from stigmatization and discrimination.
The first manual aims to help decision-makers formulate sound public health policies that are appropriate to both local resources and the stage of the HIV/AIDS epidemic. Drawing on the latest scientific knowledge, the manual explains how mother-to-child transmission occurs, identifies factors that influence the risk of transmission, and discusses the advantages and disadvantages of specific preventive measures from artificial feeding to the use of wet-nurses or modified cow's milk in terms of their costs as well as their safety in different resource settings.
The second manual, addressed to health care managers and supervisors, offers a step-by-step guide to safe feeding practices for infants of HIV-infected mothers. Details range from instructions for feeding infants from a cup, through advice on when to give vitamin supplements, to the warning that provision of free or subsidized breast-milk substitutes to mothers may label them as HIV-infected and lead to discrimination.
The final manual provides an expert review of what is known and unknown about HIV transmission and breastfeeding. Findings from over 130 recent studies are critically assessed.
Indicators for Assessing Vitamin A Deficiency and their Application in Monitoring and Evaluating Intervention Programmes
1996, viii + 66 pages [E]
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1930093
Elaborates basic principles for the use of 24 specific biological and ecological indicators in the surveillance of vitamin A deficiency. The document is part of the recent international effort to eliminate vitamin A deficiency and its consequences as a public health problem by the year 2000. An estimated 2.8 million preschool-age children are at risk of blindness from vitamin A deficiency, and the health and survival of 251 million others are seriously compromised.
Addressed to managers of national programmes for the prevention and control of micronutrient malnutrition, the document offers abundant advice on the principles governing the use of biological indicators for surveillance, and explains the scientific rationale for each indicator, including its limitations and cutoff points for interpretation in terms of public health significance. For the first time, a series of ecological indicators that can be used to identify high risk areas is presented together with advice on cutoff points for their interpretation. Also included are indicators for monitoring progress towards achieving the goal of eliminating vitamin A deficiency as a significant public health problem by the year 2000. Annexed to the text are a ranking of countries according to the severity of public health problems caused by vitamin A deficiency, and several sample survey and reporting forms.
Infant Feeding: The Physiological Basis
edited by J. Akre
1990, 108 pages [Ar, E, F]
ISBN 92 4 068670 3
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 0036701
Establishes the scientific basis for addressing the many questions that surround the appropriate feeding of infants during their first year of life. Noting that adequate diet is more critical in early infancy than at any other time in life, the review considers what knowledge about infant physiology can contribute to the understanding of nutritional needs. More than 500 references to the literature are included. The evidence reviewed challenges several widely held assumptions concerning the need for proprietary formulas, the most appropriate time to introduce complementary foods, and the best feeding regimen for low-birth-weight infants.
The book has six chapters. The first examines the physiological mechanisms that operate during pregnancy, affect fetal growth, and govern the newborn's nutritional requirements. Chapter two provides a fascinating account of the physiology of human lactation. Health factors which may interfere with breast-feeding are discussed in the third chapter, which considers the case of infants with congenital and hereditary metabolic disorders, cleft lip and cleft palate, and different maternal illnesses, including infection with HIV. The fourth chapter, on complementary feeding, concludes that breast milk alone satisfies the energy requirements of the average infant for the first six months of life and that complementary feeding before that time can introduce a number of short- and long-term risks. The remaining chapters review the special needs of two particularly vulnerable groups: low-birth-weight infants and infants and young children during periods of acute infection.
"... should be considered the definitive work on
Nursing and Health Care
"... most firmly recommended..."
Nutrition and Health
International Code of Marketing of Breast-Milk Substitutes
Full text online (PDF format) under "Infant and Young Child Feeding Practices", English and French editions
1981, 35 pages [Ar, C, E, F, S]
ISBN 92 4 154160 1
Sw.fr. 4.-/US $3.60; in developing countries: Sw.fr. 2.80
Order no. 1150094
Presents a code, developed jointly by WHO and UNICEF, for the marketing of breast-milk substitutes. The code applies to the marketing of breast-milk substitutes, including infant formula, and other milk products, foods, and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable for use as a partial or total replacement of breast milk. The code deals in successive articles with information and education needs concerning the feeding of infants, advertising or other forms of promotion to the general public, and standards for product labelling and quality.
"... has brought to the forefront of public,
professional and political attention the significance of breast feeding and the need for
appropriate programs to promote this fundamental biological activity. These need to
include a substantial code to monitor the activities of the formula industry to avoid
unaffordable formulas being thrust with modern high pressure marketing tactics at
uninformed, unsophisticated populations where environmental hygiene and poverty make their
correct utilization impossible..."
The American Journal of Tropical Medicine and Hygiene
Iodine Deficiency Disorders
A Strategy for Control in the Eastern Mediterranean Region
WHO EMRO Technical Publication, No. 16
1990, ix + 24 pages [E]
ISBN 92 9021 117 2
Sw.fr. 2.-/US $1.80; in developing countries: Sw.fr. 1.40
Order no. 1450016
Presents a strategy and plan of action for the use of simple, low-cost technologies to combat the immense problem of iodine deficiency disorders in Eastern Mediterranean countries. Addressed to senior health administrators, the booklet has two main parts. The first presents facts and figures depicting the magnitude of the problem posed by iodine deficiency disorders in this part of the world. The second and most extensive part maps out a plan of action, including precise steps to be undertaken at stages from 1990 through 1999.
A practical guide to measures needed to ensure that the food and nutrition needs of disaster-stricken populations, refugees, or internally displaced persons are adequately met. Noting that nutrition is always a key concern in emergency management, the book offers expert advice based on both the latest knowledge in the nutritional sciences and advances in concepts of emergency management that stress preparedness and long-term recovery. The engagement of local health services and authorities is emphasized as the best strategy for building national capacity and ensuring rapid recovery.
The book covers the concepts, principles, and precise measures needed to ensure adequate nutrition in both the relief phase and the subsequent rehabilitation and development phases. Details range from a list of the equipment needed for a weight-for-height survey, through a diagram illustrating arrangements for ration distribution in camp situations, to instructions for preparing feeding mixtures for the treatment of specific deficiency diseases. Throughout, particular attention is given to conditions in developing countries, where inadequate nutrition and infectious diseases can make populations especially vulnerable to malnutrition in emergencies.
The book has seven chapters. The first, on meeting nutritional requirements, explains the importance of nutritional assessment as a fundamental management tool for calculating food needs, monitoring the adequacy of food access and intake, and ensuring adequate food procurements. The chapter also sets out recommendations for mean daily per capita intakes of energy and protein and for micronutrients and other specific nutrients.
The major nutritional deficiency diseases are covered in chapter two, which includes detailed information on the signs, symptoms, prevention, and treatment of protein-energy malnutrition, iron-deficiency anaemia, vitamin A deficiency, iodine deficiency disorders, beriberi, pellagra, and scurvy. Chapter three describes the methodology for measuring malnutrition. Information includes target audiences for assessment, advice on body measurements and clinical indicators of malnutrition, and precise instructions for conducting rapid nutritional surveys, individual screening, and nutritional surveillance.
Chapter four provides a detailed guide to the planning, organization, and delivery of general feeding programmes aimed at the affected population as a whole. Topics covered include basic requirements for suitable food commodities, principles of good organization and coordination, and the composition of a general ration calculated to meet the populations' minimum requirements for energy, protein, fat, and micronutrients. Guidelines for selective feeding programmes are presented in chapter five, which covers both the supplementary feeding of vulnerable groups and the therapeutic feeding of individuals suffering from deficiency diseases.
In view of the close link between
infectious diseases and malnutrition, chapter six offers advice on the organization of
services to ensure priority immunizations and to monitor and treat each of twelve
infectious diseases commonly seen in developing countries. The book concludes with advice
on the planning, administration, and logistics of emergency preparedness and response
programmes, emphasizing the need to detect vulnerability to nutritional deficiencies and
monitor early warning indicators.
Management of Severe Malnutrition
A Manual for Physicians and Other Senior Health Workers
1999, vi + 60 pages
ISBN 92 4 154511 9
Sw.fr. 23.-/US $20.70; in developing countries: Sw.fr. 16.10
Order no. 1150465
Table of Contents
This manual provides expert practical guidelines for the management of severely malnourished children. Addressed to doctors and other senior health workers, the manual explains exactly what must be done to save lives, achieve successful management and rehabilitation, prevent relapse, and thus give these children the greatest chance of full recovery. Throughout, the importance of treating severe malnutrition as both a medical and a social disorder is repeatedly emphasized. As successful management does not require sophisticated facilities and equipment or highly qualified personnel, the manual also performs a persuasive function, encouraging health professionals to do all they can to save these children and meet their great need for care and affection.
Recommended procedures draw on extensive practical experience as well as several recent therapeutic advances. These include improved solutions of oral rehydration salts for the treatment of dehydration, better understanding of the role of micronutrients in dietary management, and growing evidence that physical and psychological stimulation can help prevent long-term consequences of impaired growth and psychological development. Noting that the physiology of malnourished children is seriously abnormal, the manual gives particular attention to aspects of management whether involving the interpretation of symptoms or the use of specific interventions that differ considerably from standard procedures for well-nourished children. Details range from the reasons why IV infusion easily causes overhydration and heart failure, through a list of treatments that have no value and should never be used, to the simple reminder that underarm temperature is not a reliable guide to body temperature in a malnourished child during rewarming.
The manual opens with a concise introduction to the principles of management during three phases: initial treatment, rehabilitation, and follow-up. Chapter two briefly discusses treatment facilities, explaining why hospital or other residential care is essential for initial treatment and when a child can be moved to a rehabilitation centre. Chapter three, on evaluation, provides advice on how to assess nutritional status, take a medical history, and conduct a physical examination. Some useful laboratory tests are listed, though the book stresses that such tests are not needed to guide or monitor treatment.
Against this background, the most extensive chapter gives detailed guidelines for initial treatment. Separate sections are devoted to hypoglycaemia, hypothermia, dehydration and septic shock, dietary treatment, infections, vitamin deficiencies, very severe anaemia, congestive heart failure, and dermatosis of kwashiorkor. Information includes instructions for the preparation of formula diets from a few basic ingredients, and numerous tables and charts for determining the amount of feed to give, at which interval, to achieve an acceptable daily intake of calories. Subsequent chapters provide equally detailed guidelines for rehabilitation, including emotional and physical stimulation as well as feeding, for follow-up, and for managing cases that fail to respond to treatment. The manual concludes with brief advice on the management of severely malnourished children in disaster situations and refugee camps, and of severely malnourished adolescents and adults.
Further practical guidance is provided in eight appendices, which use numerous tables, charts, sample recording forms, instructions for preparing feeds, and examples of easily constructed toys to help ensure that management is thorough, safe, and in line with the latest knowledge.
Evaluation of the malnourished child
- Assessment of nutritional status and criteria for admission
- History and physical examination
- Laboratory tests
- Principles of management
- Dehydration and septic shock
- Dietary treatment
- Vitamin deficiencies
- Very severe anaemia
- Congestive heart failure
- Dermatosis of kwashiorkor
- Principles of management
- Nutritional rehabilitation
- Emotional and physical stimulation
parents how to prevent malnutrition from recurring
- Preparation for discharge
Failure to respond to treatment
- General principles
- Problems with the treatment facility
- Problems with individual children
- Learning from failure
Management of malnutrition in disaster situations and refugee camps
- General considerations
- Establishing a therapeutic feeding centre
- Criteria for enrolment and discharge
- Principles of management
- Evaluation of the therapeutic feeding centre
Malnutrition in adolescents and adults
- Principles of management
- Classification of malnutrition
- History and physical examination
- Initial treatment
- Criteria for discharge
- Failure to respond to treatment
Nutrition in Developmental Transition in South-East Asia
SEARO Regional Health Paper, No. 21
1992, xi + 130 pages [E]
ISBN 92 9022 190 9
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1580021
Reports the findings of a comprehensive study of the impact of developmental transition on food patterns, nutrition, and health status in South-East Asian countries. Addressed to researchers and policy makers, the study evaluates trends over the past four decades in order to identify problems and causes, predict future trends, and develop an agenda of future priorities and goals. Specific nutrition programmes in individual countries are also critically assessed in a search for approaches that have proved their workability.
"... refreshingly free of sociological and
medical jargon ... This report needs to be read widely by leaders of public
Nutrition, Health and Development
ISBN 9275 115664
In developing countries: Sw.fr. 50.40
Order no. 1610566
This publication reviews the state of knowl edge on the
effects of health, nutrition, and stimulation on children's development and offers policy
recommendations in this area. The book's 18 chapters-written by leading professionals
working at the cutting-edge of nutrition research-deal with topics ranging from
generalized undernutrition, iron and iodine deficiencies, neonatal feed- ing, short-term
food deprivation, parasitic infection, and psychological deprivation. In addition, the
book evaluates results from early childhood interventions, including nutritional
supplementation and psychosocial stimulation, as well as interventions in later childhood,
such as school feeding and deworming programs. The authors focus on children in less
developed countries, but the material also touches on the problems of the many children in
developed countries who are at risk of many of the conditions addressed here.
This publication will become invaluable to policymakers and international agencies, and it will also be a prized tool for professionals working in health, nutrition, and education.
Joint WHO/UNICEF Nutrition Support Programme
1989, vii + 170 pages [E, F, S from PAHO]
ISBN 92 4 154251 9
Sw.fr. 30.-/US $27.00; in developing countries: Sw.fr. 21.-
Order no. 1150328
Presents nine packages of learning materials that can help health workers acquire skill in presenting the principles and practice of good nutrition to communities. Responding to the most common causes of poor nutrition in developing countries, each module follows a problem-oriented approach, featuring questions and answers, checklists, charts, games, stories, tests and exercises designed to make learning a participatory experience. Learning packages complement the modules in Guidelines for Training Community Health Workers in Nutrition.
The book gives particular attention to methods of teaching and learning that have proven their capacity to stimulate thinking, discovery, discussion, and the recognition and solving of problems. Learning aids range in nature from a nutrition "snakes and ladders" game to picture recipes for preparing weaning foods, from checklists for testing community traditional beliefs to stories showing the dangers of bottle feeding. Modules, each focused on a single topic, concentrate on ways of learning how to recognize and correct the causes of such common problems as nutrient deficiencies, deficiency-induced diseases, malnourishment, poor childhood growth, and diarrhoeal diseases.
"... The strength of this book is that it gives
objectives and techniques for different nutrition education tasks. The methods that are
advocated are appropriate, up-to-date and sometimes appeal to the fantasy of the
Acta Paediatrica Scandinavica
"... excellent ... will help health workers
promote good nutrition in communities ... The book, together with its companion volume,
are essential references for anyone involved in the training of applied nutrition
Catering and Health
Nutrition Research in South-East Asia
The Emerging Agenda of the Future
WHO Regional Publications, South-East Asia Series, No. 23
1994, is + 135 pages [E]
ISBN 92 9022 166 6
Sw.fr. 15.-/US $13.50; in developing countries: Sw.fr. 10.50
Order no. 1560023
A future-oriented report on the basic and applied research that will be needed to solve nutrition problems in South-East Asian countries. Research needs are identified for both persistent problems linked to malnutrition and emerging problems linked to rising affluence, changing lifestyles, increasing urbanization, and the ageing of populations. Throughout, emphasis is placed on the region's distinct nutrition needs, resources, and research capabilities.
The book has fourteen chapters presented in two main parts. Part one takes a brief look at the changes in nutrition-related health problems that have taken place in the region during the past four decades. Major changes identified include an end to large-scale famines, the total elimination of several major deficiency diseases, and the considerable reduction of many others. The chapter ranks anaemia, protein-energy malnutrition, and goitre as the most important enduring problems associated with nutrient deficiency, and looks at a number of emerging challenges.
Part two, which constitutes the core of the report, provides detailed chapters on 10 problems that should form the focus of future research. Each chapter opens with a state-of-the-art review of world knowledge, followed by a discussion of the current and future importance of the problem in South-East Asia, the issues that remain to be resolved, and the most fruitful lines for further study. Five chapters deal with problems of undernutrition: low birth weight, poor growth and development, iron/folate deficiency anaemia, goitre and iodine deficiency, and vitamin A deficiency. The remaining chapters focus on cancer, coronary heart disease and related diseases, osteoporotic fracture, nutrition of the aged, and food contamination.
Obesity and Poverty
A New Public Health Challenge
edited by M. Peńa and J. Bacallao
PAHO Scientific Publication, No. 576
2000, xi + 124 pages [E, S from PAHO]
ISBN 92 75 11576 1
Sw.fr. 44./US $39.60; in developing countries: Sw.fr. 30.80
Order no. 1610576
A collection of twelve research articles that explore the many complex links between low socioeconomic status and the growing prevalence of obesity in Latin America and the Caribbean. Authored by leading experts in the nutritional sciences, the articles cite compelling evidence that obesity in poor populations has strikingly different causes and consequences than obesity seen in affluent societies. All articles share a public health perspective aimed at identifying causative factors that can help shape effective policies.
The book opens with four articles focused on the economic, sociocultural, and environmental determinants of obesity. The first reviews the evidence of growing obesity in Latin America and the Caribbean, and considers why obesity is most prevalent in the poorest socioeconomic sectors, where levels of co-existing nutrient deficiencies may likewise be high. This question is further explored in the second article, which cites abundant evidence that energy-dense, nutrient-poor foods are chosen because they are cheap, produce satiety, and are widely promoted and readily available. Explanations for the increased vulnerability of poor women to obesity are also presented. Current theories of the causes of obesity are reviewed in the third article, which addresses the significance of genetic determinants, the distribution of body fat in obesity, and the influence of social factors, particularly socioeconomic status. The first part concludes with a study of the impact of increasing urbanization on patterns of physical activity.
Part two includes three case studies describing the epidemiological transition in Chile, Cuba, and Brazil, followed by a proposed typology for grouping Latin American and Caribbean countries according to different phases in the epidemiological transition. The two articles in part three review some of the special methodological problems raised in efforts to calculate the incidence and average duration of obesity and develop appropriate anthropometric indicators.
The two articles in the final part evaluate the evidence suggesting that malnutrition during fetal development and early childhood may increase the risk of obesity in later life. The public health implications, particularly concerning increased incidence of diet-related chronic diseases, are also critically assessed
Obesity: Preventing and Managing the Global Epidemic
Report of a WHO Consultation
WHO Technical Report Series, No. 894
2000, xii + 253 pages (available in English, French and Spanish in preparation)
ISBN 92 4 120894 5
Sw.fr. 56./US $50.40; in developing countries: Sw.fr. 39.20
Order no. 1100894
This report issues a call for urgent action to combat the growing epidemic of obesity, which now affects developing and industrialized countries alike. Adopting a public health approach, the report responds to both the enormity of health problems associated with obesity and the notorious difficulty of treating this complex, multifactorial disease. With these problems in mind, the report aims to help policy-makers introduce strategies for prevention and management that have the greatest chance of success. The importance of prevention as the most sensible strategy in developing countries, where obesity coexists with undernutrition, is repeatedly emphasized.
Recommended lines of action, which reflect the consensus reached by 25 leading authorities, are based on a critical review of current scientific knowledge about the causes of obesity in both individuals and populations. While all causes are considered, major attention is given to behavioural and societal changes that have increased the energy density of diets, overwhelmed sophisticated regulatory systems that control appetite and maintain energy balance, and reduced physical activity. Specific topics discussed range from the importance of fat content in the food supply as a cause of population-wide obesity, through misconceptions about obesity held by both the medical profession and the public, to strategies for dealing with the alarming prevalence of obesity in children.
The report has eleven chapters presented in five parts. Part one, which assesses the magnitude of the problem, explains the system for classifying overweight and obesity based on the body mass index, considers the importance of fat distribution, and provides an overview of trends in all regions of the world, concluding that obesity is increasing worldwide at an alarming rate. Chapters in part two evaluate the true costs of obesity in terms of physical and mental ill health, and the human and financial resources diverted to deal with these problems. Specific health consequences discussed include increased risk of cardiovascular disease, cancer, and other noncommunicable diseases, endocrine and metabolic disturbances, debilitating health problems, and psychological problems. The health benefits and risks of weight loss are also assessed.
Part three draws on the latest research findings to consider specific factors involved in the development of overweight and obesity. Discussion centres on factors, such as high intakes of fat, that may disrupt normal physiological regulation of appetite and energy balance, and the role of dietary factors and levels of physical activity. In terms of opportunities for prevention, particular attention is given to the multitude of environmental and societal forces that adversely affect food intake and physical activity and may thus overwhelm the physiological regulatory systems that keep weight stable in the long term. The possible role of genetic and biological susceptibility is also briefly considered.
Against this background, the fourth and most extensive part maps out strategies for prevention and management at both the population and individual levels. Separate chapters address the need to develop population-based strategies that tackle the environmental and societal factors implicated in the development of obesity, and compare the effectiveness of current options for managing overweight or obese individuals. Specific strategies discussed include dietary management, physical activity and exercise programmes, behaviour modification, drug treatment, and gastric surgery. While noting striking recent progress in the development of drug treatments, the report concludes that gastric surgery continues to show the best long-term success in treating the severely obese. The final part sets out key conclusions and recommendations for responding to the global obesity epidemic and identifies priority areas where more research is urgently needed.
Physical Status: The Use and Interpretation of Anthropometry
Report of a WHO Expert Committee
WHO Technical Report Series, No. 854
1995, x + 452 pages [E, F, S*]
ISBN 92 4 120854 6
Sw.fr. 71.-/US $63.90; in developing countries: Sw.fr. 49.70
Order no. 1100854
Presents comprehensive recommendations, developed in consultation with more than 100 experts, for the appropriate use and interpretation of anthropometry as a method with great potential to guide clinical decisions and public health policy. As the single most universally applicable, inexpensive, and non-invasive method available to assess the size, proportions, and composition of the human body, anthropometry reflects both health and nutritional status and predicts performance, health, and survival.
The report aims to give scientists, clinicians, and public health professionals a framework and context for the present and future uses and interpretation of anthropometry. Public health and clinical applications in all age groups, from infancy, through adolescence, to old age, are discussed and substantiated by more than 400 references to the literature.
For some groups, such as adolescents and the elderly, where previous research has been limited, the report provides a basis and impetus for future studies. For other age groups, such as infants and children, the report re-evaluates currently used reference data in the light of new knowledge and recommends important changes. Throughout, an effort is made to relate specific anthropometric indicators to the actions that can be taken on behalf of individuals or populations.
In a key achievement, the report sets out an extensive series of tabular reference data, recommended by the Expert Committee, that have not been widely distributed by WHO previously. Succinct summaries of recommendations for the use of anthropometry, in individuals and populations and for different age groups, are also provided.
"... clear and valuable practical instructions
... For anyone who uses anthropometry in routine practice, this book is
Journal of Paediatrics and Child Health
"... of value to nutrition students, nutrition
professionals, and other health care providers interested in evaluating nutritional status
using anthropometric data..."
Journal of the American Dietetic Association
Preparation and Use of Food-based Dietary Guidelines
Report of a Joint FAO/WHO Consultation
Technical Report Series, No. 880
1998, vi + 108 pages (English, French and Spanish)
ISBN 92 4 120880 5
Swiss francs 23./US $20.70;
In developing countries: Swiss francs 16.10
Order no. 1100880
This report provides an expert practical guide to the formulation and implementation of national dietary guidelines based on recommended foods and food groups rather than nutrients. Addressed to policy-makers and the nutritionists who advise them, the report aims to facilitate the use of food-based dietary guidelines as a sensible new way to help consumers make healthy food choices. Throughout the report, recommendations whether concerning the importance of food variety or the percent of dietary protein that should be of animal origin draw on the latest biochemical and physiological knowledge about human nutritional requirements in health and disease. Health problems related to both dietary insufficiency and excess are considered in this comprehensive report.
The book opens with an explanation of the many reasons why dietary recommendations based on foods are more effective as an instrument of public health nutrition than are guidelines based on nutrients. Readers are also reminded of the need to formulate dietary guidelines in response to specific diet-related health problems important in a country, and to ensure that recommendations are based on sound scientific evidence.
Against this background, the first main section establishes the scientific rationale for the development of food-based dietary guidelines, drawing on current knowledge in four main areas: nutrition science; food science and technology; educational, behavioural, and social sciences; and agricultural and environmental sciences. The section also compares different methods for assessing the nutritional quality of diets and explains each of the steps to follow when reorienting dietary recommendations from nutrients to foods. Methods of monitoring food and nutrient intake are presented and compared in the next section, which includes advice on how data from a range of sources can be used when setting dietary goals and formulating recommendations.
Section three provides detailed, step-by-step guidance on how to develop food-based dietary guidelines and ensure that populations understand them and follow their advice. The remaining sections explain how to transform guidelines into message and slogans and monitor their effectiveness in improving dietary practices.
In a key achievement, the second part of the report provides an expert state-of-the-art review of scientific knowledge, from animal, clinical, and epidemiological studies, about the relationship between diet, nutrition and health. Throughout this review, a special effort is made to identify areas where scientific data support firm dietary recommendations based on individual foods, food groups, and food combinations. Information ranges from advice on the use of nutrient densities in the development and evaluation of dietary guidelines, through data on the role of vitamins as chemopreventive agents, to a discussion of non-nutrient components found in fruit that may explain their capacity to prevent cardiovascular diseases and gastrointestinal cancers. The report concludes with examples of the ways in which foods and food groups have been incorporated into dietary guidelines in selected countries.
Principles of Nutrition Management in Primary Health Care
SEARO Regional Health Papers, No. 26
1995, vii + 43 pages [E]
ISBN 92 9022 195 0
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1580026
Sets out broad guiding principles for strengthening nutrition management in primary health care at national, provincial, and district levels. Addressed to health planners and managers, the booklet draws on extensive experiences with nutrition problems and programmes in South-East Asia countries. Advice on strategies and general lines of action is supported by alerts to frequent weaknesses in nutrition programmes.
The booklet has eight sections. The first three explain the importance of community involvement, integrated activities, and intersectoral collaboration. Information ranges from a description of the factors that influence a community's willingness and ability to become involved in nutrition promotion, through a discussion of mechanisms for collaboration, to the reasons why some specific tasks, such as the distribution of mega-doses of vitamin A, should be packaged into other, broader programmes. Other sections outline principles for the training of staff, the use of community education and the media, and the development of income-generating schemes. The booklet concludes with sections on the monitoring and evaluation of programmes and methods for generating political commitment.
Protecting, Promoting and Supporting Breast-feeding
The Special Role of Maternity Services
Click here to view the Ten Steps to Successful Breast-feeding
A Joint WHO/UNICEF Statement
1989, iv + 32 pages [Ar, E, F, S]
ISBN 92 4 156130 0
Sw.fr. 6.-/US $5.40; in developing countries: Sw.fr. 4.20
Order no. 1150326
Sets out the facts and lines of action that enable health services to achieve their full potential as part of society's first line of support to breast-feeding. Against the larger backdrop of community attitudes that variously sustain or restrain breast-feeding, the 32-page booklet translates the most up-to-date knowledge and practical experience about lactation into precise recommendations on care for mothers before, during, and after pregnancy and delivery.
The statement begins by listing 10 important steps to successful breast-feeding intended for application in every facility providing maternity services and care for newborn infants. Readers are told that mothers should be helped to breast-feed within a half hour of birth, that newborn infants should be given no food or drink other than breast milk, unless medically indicated, and that rooming-in should be practised 24 hours a day.
Particularly practical is a section devoted to individual care, which spells out procedures to follow at five important stages, from prenatal history-taking and counselling, through care during and after delivery, to what to do when a mother is discharged from the health care facility. Readers are informed that the risk of neonatal infection is in fact greater in the closed environment of a nursery than when infants remain with their mothers, and that exclusive, on-demand breast-feeding should be the norm throughout the clinic or hospital stay. The booklet concludes with a 20-point check-list that maternity wards and clinics can use to gauge how well they are protecting, promoting, and supporting breast-feeding.
"... a splendid, reader-friendly, non-scientific
booklet ... strongly recommended..."
Nutrition and Health
Strengthening Nutrition Through Primary Health Care
The Experience of JNSP in Myanmar
SEARO Regional Health Paper, No. 20
1991, 35 pages [E]
ISBN 92 9022 189 5
Sw.fr. 5.-/US $4.50; in developing countries: Sw.fr. 3.50
Order no. 1580020
Summarizes the objectives, implementation, and results of the highly successful Joint WHO/UNICEF Nutrition Support Programme (JNSP) in Myanmar (previously known as Burma). Initiated in 1983, JNSP aims to reduce infant and young child mortality, to improve child growth, and to reduce malnutrition in mothers. To date, the Programme has been implemented in 17 countries with widely varying results. The Myanmar project was distinguished from other JNSP projects because of its focus on the entire population, rather than on model districts or provinces, and its concentration on activities administered almost exclusively through the Ministry of Health. The Myanmar project was further characterized by a situation analysis which yielded detailed and precise recommendations on how to improve nutrition.
Towards a National Nutrition Policy
Guidelines for Countries of the Eastern Mediterranean Region
edited by K. Bagchi
HO Regional Office for the Eastern Mediterranean
1990, 65 pages [E]
ISBN 92 9021 118 0
Sw.fr. 2.-/US $1.80; in developing countries: Sw.fr. 1.40
Order no. 1450017
A practical guide to the development of national nutrition policies appropriate to conditions in the Eastern Mediterranean region. Noting that no country in the region has succeeded in developing a national nutrition policy, the book aims to help senior decision-makers and administrators rationalize and simplify procedures in a step-by step approach to policy formulation. Emphasis is placed on the need for a properly coordinated multisectoral strategy.
Trace Elements in Human Nutrition and Health
1996, xviii + 343 pages + 3 colour plates [E, F*]
ISBN 92 4 156173 4
Sw.fr. 85.-/US $76.50; in developing countries: Sw.fr. 59.50
Order no. 1150431
Issues authoritative recommendations concerning nutritional requirements and safe ranges of intake for nineteen trace elements important to human health. Representing the consensus reached by a large number of international experts, the book aims to give scientists and those responsible for nutrition planning a solid basis for assessing dietary intakes of trace elements, detecting deficiencies and excesses, and recognizing the clinical features of related disorders. Throughout, guidelines and advice respond to greatly expanded knowledge about the significant impact that even subtle differences in trace elements can have on health and disease.
The core of the report, which has three parts, provides authoritative recommendations on the nutritional significance, requirements for health, and safe range of daily intakes for nineteen trace elements in three categories. These include essential elements, such as iodine and zinc, probably essential elements, such as manganese and silicon, and potentially toxic elements, such as fluoride, lead, cadmium and mercury, which may also have some essential functions at low levels.
Chapters in the final part provide detailed guidelines for the design and interpretation of research on trace elements. A chapter on analytical methodology concentrates on the problems encountered in determining trace elements in biological samples and dietary materials. The next chapter uses data from dietary surveys in 27 countries to discuss methods for assessing dietary intakes and to highlight problems of data interpretation. The final chapter offers advice on how to determine whether the dietary habits of specific communities will increase the risk of disorders related to trace elements.
"... essential for every nutrition
Food and Nutrition Bulletin
"...comprehensive and authoritative ... will be
essential reading for anyone needing to understand this rapidly developing field of
nutrition, including those formulating foods for infants and young children..."
Chemistry and Industry
Vitamin A Deficiency and its Consequences
A Field Guide to Detection and Control
1995, vii + 69 pages + 32 colour plates [C, E, F, R, S]
ISBN 92 4 154478 3
Sw.fr. 17.-/US $15.30; in developing countries: Sw.fr. 11.90
Order no. 1153050
A practical guide, now in its third edition, to the detection, treatment, and prevention of vitamin A deficiency and its consequences, including associated mortality, infectious morbidity, and xerophthalmia. Addressed to clinicians, nurses, and public health officials, the text has been thoroughly revised to reflect recent advances in knowledge. These include growing recognition of the importance of adequate vitamin A intake for normal child health and survival, and evidence that milder degrees of deficiency may have severe consequences, including increased mortality, before xerophthalmia becomes apparent in a population. In line with these advances, the guide offers advice on the detection and treatment of subclinical or marginal degrees of deficiency as well as on the emergency management of xerophthalmia and measles.
The guide has six chapters. Background information is provided in the first two, which describe the biochemistry of vitamin A metabolism and explain the complex relationship between specific serum levels and the physiological consequences of deficiency. The third chapter provides a detailed guide to the clinical classification and diagnosis of xerophthalmia. Recognition of the characteristic signs and symptoms of increasingly severe disease is facilitated through the inclusion of 32 colour plates. A chapter on epidemiology concentrates on the many factors that place children, particularly those from depressed rural communities and urban slums, at risk of vitamin A deficiency.
Of particular practical value is a chapter on assessment, which explains how well-conceived surveys, appropriate to local conditions, can guide the design of efficient and cost-effective interventions. A chapter on treatment provides schedules for vitamin A dosing in the emergency management of xerophthalmia, severe infectious episodes, and severe protein-energy malnutrition, and offers advice on dietary improvement, essential eye care, and the prevention of recurrence. The final chapter, on prevention, describes the wide range of options that can be followed to meet both short-term and long-term programme goals.
"... recommended as a definitive review of the
current knowledge and management of this condition..."
Journal of Nutrition and Environmental Medicine
"... outstanding and very practical ...
essential for all health workers concerned with vitamin A deficiency..."
South African Medical Journal
Vitamin A Supplements
A Guide to their Use in the Treatment and Prevention of Vitamin A Deficiency and Xerophthalmia
1997, vi + 28 pages [E, F*, S*]
ISBN 92 4 154506 2
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1152303
Provides concise, authoritative advice on the use of high-dose vitamin A supplements for the control of vitamin A deficiency and the emergency treatment of xerophthalmia and other conditions in high-risk groups. Now in its second edition, the guide has been updated and expanded to reflect the latest scientific knowledge, particularly concerning the safety and effectiveness of different dose schedules in different age and population groups. Recommended lines of action also draw on practical experiences gained in the recent international drive to eliminate vitamin A deficiency as a public health problem by the year 2000.
The guide is addressed to programme managers and administrators and aims to answer all practical questions concerning how much vitamin A should be given to different age and population groups, how often, and in what form. Details range from an alert to conditions that should be treated as medical emergencies, through advice on how to calculate procurement requirements, to the simple warning that oil-based preparations should never be injected.
The guide has five sections. The first explains the role of high-dose vitamin A supplements as a proven strategy for controlling xerophthalmia, preventing nutritional blindness and, among deficient populations, reducing the severity and case-fatality rate of certain childhood infections, particularly measles and diarrhoea. Factors influencing the choice of target populations, distribution schemes, and overall programme strategies are also briefly discussed.
Section two presents schedules, for universal and targeted distribution, for the prevention of vitamin A deficiency, xerophthalmia, and nutritional blindness in infants and young children. Questions about safety, side effects, and the potential hazards of overdosing are addressed and clearly answered. Subsequent sections give treatment schedules for xerophthalmia in all age groups and in the special case of pregnant women, and summarize the rationale for supplementation during measles.
Operational issues are discussed in the final and most extensive section, which includes information on the practical and technical advantages of different vitamin A preparations, sources of supplies and their costs, steps to follow in procurement planning, and various options for channelling delivery through existing health care services.
The guide concludes with a list of countries categorized according to the significance of vitamin A deficiency as a public health problem, a summary of the scientific rationale for vitamin A supplementation, and detailed information on the potency retention, at different storage temperatures, of commonly used vitamin A preparations.
WHO Global Database on Child Growth and Malnutrition
compiled by M. de Onis and M. Blössner
1997, vii + 710 pages [E]
Sw.fr. 50.-/US $45.00; in developing countries: Sw.fr. 35.-
Order no. 1930125
Presents and interprets the vast amount of data contained in the WHO Global Database on Child Growth and Malnutrition. The data, which indicate the growth and nutritional status of children under the age of five, have been collected by WHO since 1986 as part of its efforts to monitor global progress in combatting childhood malnutrition and to identify those groups in need of priority interventions.
Information is derived from population-based nutrition surveys of representative samples collected and assessed according to standardized procedures. The database currently reflects over 1700 nutritional studies and covers 84% of the world's total population of under-fives and 95% of this age group living in the developing world.
The book has two parts. Part one explains the importance of global nutritional surveillance and describes the origins and development of the database. Against this background, subsequent chapters summarize global, regional, and national situations and trends for key indicators of child growth and nutritional status. Numerous tables and selected maps are used to indicate the country-specific prevalence and geographical distribution of underweight, stunting, wasting, and overweight for boys, girls, and the two sexes combined in developing countries and developed countries; to classify countries according to very high, high, medium and low prevalence for each indicator; and to estimate global and regional trends over time. While noting important achievements in overcoming malnutrition among under-fives, the analysis concludes that global progress is entirely inadequate to reach the goal, set for the year 2000, of a 50% reduction in 1990 prevalence levels of moderate and severe malnutrition. Part one concludes with chapters describing the methods used in data collection and their standardized presentation, and offering guidance in the interpretation of the statistical tables.
Part two contains over 600 pages of data tables and references. Data on the nutritional status of under-fives in 173 countries are presented, disaggregated by rural and urban areas, by regions, and by sex and age group. Survey data indicate the percentage of children wasted, stunted, and under- and overweight. Each country data table is followed by relevant survey references and additional information useful in interpreting the data.