The Food and Nutrition Program
Malnutrition in the Region of the Americas remains a very serious public health problem. Estimates in 1995 put the number of infants with low birth weight at over one million, while six million girls and boys under the age of 5 were seriously underweight due to the interaction between undernutrition and infection. Some 167 million people were at risk for iodine deficiency disorder; 15 million children under the age of 5 were suffering from some degree of vitamin A deficiency; and 94 million people were suffering from iron deficiency anemia (WHO, 1995).
The Food and Nutrition Program adopted the goals set out in the Declaration of the World Summit for Children and International Conference on Nutrition and used them as the foundation for the Regional Plan of Action on Food and Nutrition. This Plan aimed at helping to bring down the high prevalence of malnutrition in the region through technical cooperation in the design and execution of interventions to reduce the magnitude of the aforementioned problems.Objective
To contribute, through technical cooperation, to design, implementation, and evaluation of interventions to improve food security and the malnutrition situation in the Region of the Americas.
Areas of Action 1. Food Security
Understood as the guarantee that individuals, families, and the general population have access, in terms of quality and quantity, to the food they need for adequate intake and biological utilization to guarantee a healthy and socially productive life.
2. Prevention and Management of Malnutrition Problems
The prevention and management of malnutrition among individuals, families and the general population to reduce the high prevalence of nutritional problems.
The priority problems are:
The Plan Of Action identifies two areas of cooperation: one related to improving food security and the other to the prevention and control of problems associated with malnutrition.
Work in this area addresses access, intake and improvement of biological utilization of food. The three lines of action are identified as: promotion of breast-feeding, promotion of supplementary feeding, promotion and education to improve food access and intake.
Promotion of breast-feeding
As a priority for the next three years, the Plan proposes that at least seven countries design programs to promote exclusive breast-feeding for the first four to six months of life and continuation of breast-feeding until the age of 2. The experience acquired will make it possible to expand this practice to the rest of the countries in the Region of the Americas.
The experiences in the training of health professionals by UNICEF and USAID, using the Baby-Friendly Initiative from Wellstart, have had a very positive impact, increasing the number of women who begin breast-feeding immediately after delivery. However, only very modest increases have been achieved in the rates of exclusive breast-feeding for the first four to six months. In most countries the practice is discontinued after a few weeks. Similarly, attempts to increase the number of women who continue to breast-feed for two years have been met with little success.
Although women are well-informed, a number of factors militate against breast-feeding, such as, womens work environment; noncompliance with legislation to protect maternity; limited access and control of resources by mothers; lack of family and social support; and womens reproductive health and labor status.
PAHO in coordination with other governmental sectors, such as, NGOs, private sectors, international financial agencies and civil society, will gear its technical cooperation to supporting the health sector to ensure the design and implementation of integrated programs that promote exclusive breast-feeding of infants for up to four to six months and continued breast-feeding to the age of 2.
Promotion of supplementary feeding
The Program plans to target seven priority countries in the next three years and to work in the design and implementation of programs to promote activities that guarantee supplementary feeding during the first two years of life. This line of cooperation should go hand-in-hand with the promotion of exclusive breast-feeding and its continuation into the second year of life. These activities will subsequently be extended to the rest of the countries.
This line of cooperation promotes the introduction and use of appropriate supplementary food, taking into account the aspects of quantity, quality, density, and frequency, as well as the childs state of health. The familys access to food will therefore be considered, as well as the attitudes, behaviors, and knowledge of caregivers, in order to ensure that food reaches the child in the best possible form.
Promotion and education to improve food access and intake
Over the next three years, the Plan of Action proposes to foster promotion and education to improve access to and intake of food in at least six priority countries and, subsequently, in the rest of the Region. In this line of work, PAHO has been promoting the updating of national guidelines or standards for the feeding of young children, based on several recent position papers on the topic. This will make it possible to bring health workers up to date on practical aspects in this area.
Another aspect geared toward improved infant feeding practices and family diet is related to the preparation, development, and implementation of dietary guidelines. These guidelines, which consist of educational messages prepared and tested in specific account factors of access, population patterns, and the current epidemiological profile in nutrition and health.
Prevention and Control of Malnutrition Problems
While it is evident that the severe forms of protein-energy malnutrition have significantly declined in recent years, many children in the Region suffer from retarded growth and development, which translates into a high rate of children who have low height-for-age, a problem that shows up in the first three years of life.
The activities identified for preventing this phenomenon center on the promotion of exclusive breast-feeding for the first four to six months of life, continued breast-feeding for 24 months, and appropriate supplementary feeding for both healthy and sick children, aspects discussed in the preceding section on Food Security.
Control of micronutrient deficiences
Another priority area of technical cooperation identified by the Plan of Action is the design of integrated programs to combat iodine, vitamin A, and iron deficiency.
PAHO will continue to furnish technical cooperation in a joint effort with other international organizations, especially UNICEF, to ensure that the countries guarantee universal consumption of iodized salt. Up to now all the countries except Haiti are fortifying salt with iodine. Of these, two (Ecuador and Bolivia) have been declared free of iodine deficiency disorders, and others, such as Canada, the United States of America, and Chile, have the problem under control.
PAHO is in a position to support countries in assessing the impact of iodine fortification of salt and to implement sustainable systems of quality assurance from the point of production to the final consumption of the iodized salt. The organization can also provide technical cooperation in determining the characteristics of salt consumption of iodized salt for the design and implementation of epidemiological surveillance systems for the early detection of the population at risk of IDD.
PAHO will continue to provide technical cooperation in a joint effort with the other international organizations-in particular, UNICEF and USAID-to enable more countries to execute national plans for the eradication of vitamin A deficiency.
In areas of high endemicity and as an emergency measure, PAHO can offer technical cooperation for the design and execution of programs to provide vitamin A supplements to children under the age of 5. In areas with subclinical deficiency, PAHO proposes vitamin A fortification of sugar or another low-cost food staple; here, the Organization can support the design of a system for quality assurance and food and nutrition surveillance. PAHO can also provide technical cooperation for the design of educational programs that promote a diversified diet to encourage the consumption of foods rich in vitamin A.
PAHO is proposing that in five years at least nine countries be designated priorities for the design and execution of national programs to combat iron deficiency and anemia.
The Organization is promoting a comprehensive strategy that identifies a series of interventions to be carried out simultaneously, since their impact and ease of execution differs over time. These include:
Prevention and control of obesity and chronic disease associated with diet
Over the next three years in at least two countries, the Plan will promote the design and execution of programs for the prevention of obesity in school-age children and adolescents, promoting a healthy lifestyles approach. This includes modules on diet and exercise and on how to deal with peer pressure, dependence-independence, body image, and the development of identity. At the end of this period it is proposed that these experiences be extended to the rest of the countries in the Region.
In view of the multiple causality of obesity, PAHO will promote a joint effort in programs design and execution among the health and education sectors, NGOs, the mass media, and the private sector. Within PAHO there will be close collaboration with the Program on Family Health, which is developing a component on adolescent health.
PAHO is also providing technical cooperation in the following areas aimed at modifying the prevalence of nutritional disorders:
National food and nutrition plans
PAHO will continue to cooperate with the countries in formulating national food and nutrition policies that include plans and programs that will result in a reduction in the prevalence of malnutrition problems.
Food and nutrition surveillance
This line has two components. The first is aimed at helping the countries to consolidate an epidemiological surveillance system for monitoring the food and nutrition situation at the national level, using a minimum set of indicators that will make it possible to monitor over time the epidemiological situation. The standardization of indicators, instruments, and cutoff points will also make possible to generate regional and subregional information. This line of work will coordinate with the Program on Health Situation Analysis (HDP/HDA). It is hoped that this type of system will be designed and executed in at least 10 countries of the Region over the next five years and subsequently expanded to the rest of the countries.
The second component is direct technical cooperation to enhance local institutional capability in data collection on the food and nutrition situation of individuals and populations, interpretation of the information, and action under the current programs to guarantee an information system that will provide an immediate response. This line of cooperation will contribute to a greater capacity to identify target population groups for the interventions, to take action on existing resources, and to improve skills in accessing and utilizing available resources.
Human resources development
PAHO is committed to support human resources training and development to foster competent leadership in the management of nutritional interventions. For this purpose, the Program will open two lines of action. One of them is an electronic information network with two types of services, a World Wide Web (WWW) page, and Listserv. These services will provide periodic, up-to-date scientific information on problems related to malnutrition and appropriate interventions for professionals, investigators, universities, and services institutions and will disseminate information on successful experiences and report on position papers and scientific publications. These services will facilitate rapid communication with the entire Region, and the information will be accessible in English and Spanish.
The second line of action centers on the formulation of an ongoing distance education plan, with core courses that can be constantly updated. These courses will be based on the assessment of the degree of knowledge, response capability, and leadership of the professionals working in nutrition .
Promotion and scientific research
The Plan of Action includes the promotion of scientific research in the most important areas of nutrition, employing and operational approach. Collaboration among research centers and between the centers and the Food and Nutrition Program will be promoted, as will information exchange between centers of the North and South and dissemination of knowledge in the Organizations line of technical cooperation.