The State of the World's Children 1998: Focus on Nutrition

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The Silent Emergency

1. Gillespie, Stuart, 'Increased Maternal Mortality Risk', section 5.1 in Major Issues in Developing Effective Approaches for the Prevention and Control of Iron Deficiency: An overview prepared for the Micronutrient Initiative and UNICEF, work in progress, September 1996 (first draft).

2. Draper, Alizon, 'Child Development and Iron Deficiency: Early action is critical for healthy mental, physical and social development', The Oxford Brief, Opportunities for Micronutrient Interventions, Washington, D.C., May 1997.

3. World Bank, World Development Report 1993: Investing in health, Oxford University Press, Washington, D.C., 1993, p. 77, col. 1.

4. World Bank, Enriching Lives: Overcoming vitamin and mineral malnutrition in developing countries, World Bank, Washington, D.C., 1994, p. 2; 'Total GDP Table 1995', World Development Indicators 1997
(CD-ROM), International Bank for Reconstruction and Development/ World Bank, Washington, D.C., 1997.

5. Draper, Alizon, op. cit., p. 1.

6. Maberly, Glenn F., 'Iodine Deficiency in Georgia: Progress towards elimination, Summary Report', The Program Against Micronutrient Malnutrition, Atlanta, April-May 1997, p. 1, col. 3.

7. Martorell, Reynaldo, 'The Role of Nutrition in Economic Development', Nutrition Reviews, Vol. 54, No. 4, April 1996, p. S70.

8. In accordance with international terminology recommended by WHO, readings that are three or more standard deviations from the reference median (based on a reference population of American children) are referred to as 'severely malnourished', while those between two and three standard deviations are called 'moderately malnourished'.

9. Young, Helen and Susanne Jaspars, Nutrition Matters: People, food and famine, Intermediate Technology Publications, London, 1995, p. 17.

10. UNICEF, 'Food, Health and Care', UNICEF, New York, updated edition, November 1996, p. 13.

11. Draper, Alizon, op cit., p. 1.

12. What Governments Can Do: Seventh annual report on the state of world hunger, Bread for the World Institute, Silver Spring, 1997, p. 8.

13. Ibid., p. 10.

14. Philip, W. et al., 'The contribution of nutrition to inequalities in health', British Medical Journal, Vol. 314, British Medical Association, London, 24 May 1997, p. 1545.

15. 'Children at Risk in Central and Eastern Europe: Perils and promises', Economies in Transition Studies, Regional Monitoring Report, No. 4, UNICEF, International Child Development Centre, Florence, 1997, p. 43.

16. Fogel, Robert W., 'Economic Growth, Population Theory and Physiology: The bearing of long-term processes on the making of economic policy', The American Economic Review, Vol. 84, No. 3, The American Economic Association, Nashville, June 1994, pp. 369-395.

17. Grantham-McGregor, Sally, 'A Review of Studies of the Effect of Severe Malnutrition on Mental Development', The Journal of Nutrition, Supplement, Vol. 125, No. 8S, The American Institute of Nutrition, Bethesda, 1995, p. 2235S.

18. Cole, Michael and Sheila R. Cole, 'Prenatal Development', The Development of Children, Scientific American Books, New York and Oxford, 1989, p. 72.

19. Nash, Madeleine J., 'Fertile Minds', Special Report, Time, Vol. 149, No. 5, 3 February 1997, p. 52.

20. Landers, Cassie, 'A Theoretical Basis for Investing in Early Child Development: Review of current concepts', Innocenti Global Seminar on Early Child Development, UNICEF International Child Development Centre, Florence, 1989, p. 4.

21. Hanson, Lars A. et al., 'Effects of breastfeeding on the baby and on its immune system', Food and Nutrition Bulletin, Vol. 17, No. 4, United Nations University Press, Tokyo, December 1996, p. 384.

22. De Zoysa, I., M. Rea and J. Martines, 'Why promote breastfeeding in diarrhoeal disease control programmes?', Health Policy Planning, Oxford University Press, 1991, 6:371-379, as cited in 'A warm chain for breastfeeding', The Lancet, Vol. 344, No. 8932, 5 Nov. 1994, p. 1239.

23. Glick, Daniel, 'Rooting for Intelligence,' Newsweek, Special Edition, Newsweek, New York, Spring/Summer 1997, p. 32.

24. UNDP, Human Development Report 1997, UNDP, New York, pp. 164-165.

25. UNICEF, WATERfront, Issue 8, UNICEF, New York, August 1996, p. 16.

26. UNDP, Human Development Report 1997, p. 29.

27. United Nations, Progress made in providing safe water supply and sanitation for all during the first half of the 1990s: Report of the Secretary-General, United Nations, New York, A/50/213-E/1995/87, 8 June 1995, table 1, p. 5.

28. UNICEF, The Progress of Nations 1997, p. 12.

29. US Department of Agriculture study (1990) cited in Tufts University, School of Nutrition, Center on Hunger, Poverty and Nutrition Policy, 'Statement on the Link Between Nutrition and Cognitive Development in Children', 1995, p. 8.

30. Landers, op. cit., p. 7.

31. United Nations, The World's Women 1995: Trends and statistics, Social Statistics and Indicators, Series K, No.12, United Nations, New York, 1995, p. 108.

32. Holmboe-Ottesen, Gerd, Ophelia Mascarenhas and Margareta Wandel, 'Women's Role in Food Chain Activities and the Implications for Nutrition', ACC/SCN State-of-the-Art Series, Nutrition Policy Discussion Paper No. 4, United Nations, New York, May 1989, p. 37.

Approaches That Work

1. Gillespie, Stuart, John Mason and Reynaldo Martorell, 'How Nutrition Improves', ACC/SCN State-of-the-Art Series, Nutrition Policy Discussion Paper No. 15, United Nations, New York, July 1996.

2. 'International Code of Marketing of Breastmilk Substitutes', World Health Organization, Geneva, 1981, pp. 6-7.

3. UNICEF, The Progress of Nations 1997, UNICEF, New York, 1997, p. 21.

4. Micronutrient Initiative, Ottawa, facsimile dated 14 Oct. 1997.

5. Sommer, Alfred et al., 'Impact of vitamin A supplementation on childhood mortality: A randomised controlled community trial', The Lancet, 1986, Vol. 1, pp. 1169-1173.

6. Beaton, G. H. et al., 'Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries', ACC/SCN State-of-the-Art Series, Nutrition Policy Discussion Paper No. 13, United Nations, December 1993, p. 61.

7. Ross, David A. et al., 'Vitamin A supplementation in northern Ghana: Effects on clinic attendances, hospital admissions and child mortality', The Lancet, Vol. 342, 3 July 1993, pp. 7-12.

8. Katz, J. et al., 'Night blindness is prevalent during pregnancy and lactation in rural Nepal', Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, Journal of Nutrition, August 1995.

9. Gillespie, Stuart, John Kevany and John Mason, 'Controlling Iron Deficiency: A report based on an ACC/SCN workshop', United Nations, Geneva, February 1991, p. 4.

10. Alnwick, David, 'More for Less in Combating Iron Deficiency? Update on the Effectiveness of Weekly Supplements', Research in Action, No. 2, UNICEF, New York, November 1995, p. 1; Schultink, W. et al., 'Effect of daily vs. twice weekly iron supplementation in Indonesian preschool children with low iron status', American Journal of Clinical Nutrition, Vol. 61, American Society for Clinical Nutrition, 1995, pp. 111-115.

11. Layrisse, M. et al., 'Early response to the effect of iron fortification in the Venezuelan population', American Journal of Clinical Nutrition, Vol. 64, 1996, pp. 905-906.

12. Stoltzfus, R. J. et al., 'Epidemiology iron deficiency in Zanzibari schoolchildren: The importance of hookworms', American Journal of Clinical Nutrition, Vol. 65, 1997, p. 157.

13. United Nations, Progress at Mid-Decade on Implementation of General Assembly resolution 45/217 on the World Summit for Children: Report of the Secretary-General, United Nations, New York, A/51/256, 26 July 1996, p. 30, para. 130.

14. Lewnes, Alexia, Oral Rehydration Therapy: Elixir of life, UNICEF, New York, February 1997, p. 3.

Bringing Science to Bear

1. Piot, Peter, 'Fighting AIDS together', The Progress of Nations 1997, UNICEF, New York, 1997, p. 23.

2. Sommer, Alfred and Keith P. West, Jr., Vitamin A Deficiency: Health, survival and vision, Oxford University Press, New York and Oxford, 1996, pp. 41, 48, 66-70.

3. Roy, S. K. et al., 'Impact of a single megadose of vitamin A at delivery on breastmilk of mothers and morbidity of their infants', European Journal of Clinical Nutrition, No. 51, Stockton Press, 1997.

4. 'Zinc for Child Health: Child Health Research Project Special Report', Report of a meeting, Baltimore, Maryland, 17-19 Nov. 1996, Vol. 1, No. 1, June 1997, p. 8.

5. 'Improving Iron and Zinc Nutrition in Infancy and Early Childhood: Proceedings of the Bali Consultation Meeting for the Planning of Multi-Country Iron and Zinc Intervention Trials', in Bali, Indonesia, 4-6 February 1997, UNICEF, 1997, pp. 6-7.

6. Semba, Richard D., 'Will vitamin A supplementation reduce mother-to-child transmission of HIV?' Research in Action, No. 5, UNICEF, New York, July 1996.

7. Adamson, Peter, 'A failure of imagination', The Progress of Nations 1996, UNICEF, New York, 1996, p. 8.

8. Rasmussen, Kathleen M. and Michelle K. McGuire, 'Effects of breastfeeding on maternal health and well-being', Food and Nutrition Bulletin, Vol. 17, No. 4, United Nations University Press, 1996, p. 366.

9. Murray, Christopher J. L. and Alan D. Lopez (eds.), The Global Burden of Disease, Harvard School of Public Health, Cambridge, 1996, pp. 360-367.

10. Barker, David J. P., Mothers, Babies and Disease in Later Life, BMJ Publishing, London, 1994.

11. Law, Catherine M. and Alistair W. Shiell, 'Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature', Journal of Hypertension, Vol. 14, No. 8, 1996, pp. 935-941.

12. Law, C. M. et al., 'Thinness at birth and glucose tolerance in seven-year-old children', Diabetic Medicine, 1995, 12:24-29.

13. Hales, C. N. et al., 'Fetal and infant growth and impaired glucose tolerance at age 64', British Medical Journal, Vol. 303, 26 Oct. 1991, pp. 1019-1022; Phipps, K. et al., 'Fetal growth and impaired glucose tolerance in men and women, Diabetologia, 1993, 36:225-228; McCance, David R. et al., 'Birth weight and non-insulin dependent diabetes: Thrifty genotype, thrifty phenotype, or surviving small baby genotype?', British Medical Journal, Vol. 308, 1994, pp. 942-945.

14. Barker, op. cit.; Hales, C. N. and D. J. P. Barker, 'Type 2 (non-insulin dependent) diabetes mellitus: The thrifty phenotype hypothesis', Diabetologia, 1992, 35:595-601.

15. The Smallest Babies in the World, video, MRC Environmental Epidemiology Unit, Southampton, 1996.

16. A study of maternal nutrition and intrauterine fetal growth, King Edward Memorial Hospital Research Centre Annual Report 1995-1996, KEMHRC, Pune, 1996, p. 36.

17. 'Proceedings of the Third Annual Workshop on the Fetal and Early Origins of Adult Disease', meeting in Khandala, Maharashtra, India, September 1996, p. 6.

18. Fall, Caroline, Ranjan Yajnik and Shobha Rao, personal communication, 1997.

19. McKeigue, P. M., G. J. Miller and M. G. Marmot, 'Coronary heart disease in South Asians overseas: A review', Journal of Clinical Epidemiology, Vol. 42, No. 7, United Kingdom, 1989, pp. 597-609.

20. Among 201 four-year-old children born in Pune of known birthweight, those who were 2.4 kg or less at birth had mean glucose and insulin concentrations 8.1 mM (micromole) and 321 pM (picamole) respectively 30 minutes after an oral glucose challenge; in comparison children born 3.0 kg or heavier had a mean glucose concentration of 7.5 mM and a mean blood insulin level of 289 pM. From Yajnik, M. et al., 'Fetal growth and glucose and insulin metabolism in four-year-old Indian children', Diabetic Medicine, Vol. 12, 1995, pp. 330-336.

21. Congdon, N. et al., 'Pupillary and visual thresholds in young children as an index of population vitamin A status', American Journal of Clinical Nutrition, Vol. 61, The American Society of Clinical Nutrition, May 1995, pp. 1076-1082; Sanchez, A. M. et al., 'Pupillary threshold as an index of population vitamin A status among children in India', American Journal of Clinical Nutrition, Vol. 65, January 1997, pp. 61-66.

22. Mendoza, C. et al., 'Effect of Genetically Modified, Low-Phytate Maize on Iron Absorption from Tortillas', article submitted to Experimental Biology '97 (unpublished).

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