Food and Nutrition Bulletin

As the final chapter in a monograph by the same title, this article presents an overview of the evidence discussed in the book. It demonstrates that poor nutrition and health pose a significant educational problem and suggests means to address this problem. Nutrition and health conditions are reviewed in terms of the developmental period in which a child is exposed and the effect on school learning. A summary table of salient findings lists a number of nutrition and health conditions that are educational-risk-factors contributing to educational inefficiency.

It has been recognized for some time that nutrient intakes show large day-to-day variations within the same individual in industrialized countries. However, little attention has been given to the quantification of within-and between-person components of the variation in developing countries. Within-person variability determines the number of measurements of dietary intake per person that will be needed to adequately represent the dietary intake of an individual over a period of time. A large within-person variation relative to the variation between persons in the intake of a nutrient decreases the strength of the observed association of the latter with an outcome of interest.

This study quantified components of variation for 834 people of both sexes and various age groups and found that, although the diet in rural Bangladesh includes a limited number of food items-over 80% of calorie and protein intakes are provided by cereals, with rice being the main staple-the daily variability of nutrient intake in each individual over a year was as large as that reported for industrialized countries. The authors estimate that about seven days would be needed to assess total energy and protein intakes adequately, while much longer measurement periods would be needed for animal protein.

This study was designed to collect and analyse information on food fortification in the Caribbean and its possible modification to improve the health of West Indians. Foods already fortified and imported into the Caribbean are not included except for pre-ground flour. The data were obtained by visiting flour mills and supermarkets and by discussing fortification programmes with health and agriculture officials All 17 member countries of tile Caribbean Food and Nutrition Institute and the Pan American Health Organization (CFNI/PAHO) were included in the study.

This paper summarizes information on the characteristic-flaws in primary health care services, and their geographic patterns of occurrence, with reference to their local, medical, and bureaucratic contexts. The data are derived from published medical ethnographic reports, evaluations of programmes, surveys of physicians in developing countries, and some anecdotal reports. Several key issues emerge from this combination of sources. There is a lack of high-quality services in developing countries; most centres lack medicines, caring and skilled personnel, and convenient locations and scheduling. Also, the professional medical personnel are rarely sufficiently trained to communicate effectively with patients of different economic and ethnic backgrounds or to manage a health team of different backgrounds. The most successful programmes are those that have effective local leadership, adequate training, some curative potential, and powerful political will. The combined public health, medical, political science, sociological, and anthropological studies suggest no “cookbook” solutions as to what exact set of factors will make any programme successful. They appear to illustrate the effectiveness of flexible regional or local policies as opposed to global ones.

This paper discusses intervention packages and their costs, and then briefly overviews, from an economic perspective, the strength of the claim of health and nutrition interventions for school-age children on scarce resources. The authors conclude that, given what is known about the probable effect of health and nutrition interventions for learning and attendance, and given the relatively modest cost of a carefully designed, carefully targeted programme, the implication for educational planners is clear: more investment in child health and nutrition will pay off well for education. Cost-benefit analyses suggest that appropriate health and nutrition interventions in the schools are likely to prove to be very high-yield investments.

This paper utilizes recent findings to address, from the perspective of an educational planner, the question of how educational systems can intervene to improve the health and nutritional status of school-age children. Evidence is reviewed on the linkages between health conditions and three of the most important educational problems in developing countries-children who are unprepared to begin school at the usual age, the failure of many students to learn adequately in school, and the unequal participation in schooling by girls. It is clear that although less attention has been paid to the health and nutrition status of school-age children than to that of children of preschool age or of adults, existing data are adequate to identify several widespread problems among school-age children that have well established negative consequences for school participation and performance. These problems include chronic protein-energy malnutrition, iron-deficiency anaemia, iodine deficiency and intestinal helminth infection. It was also observed that a number of other infectious diseases, as well as disability, premature fertility, and substance abuse, are also likely to undermine the health and educational success of many school-age children.

The contribution of severe malnutrition to child mortality was examined in a rural Bangladeshi population of 200,000 under intensive demographic surveillance. In 1986–1987 one-third of all the deaths in children between 6 and 36 months of age were associated with severe malnutrition, and 79% of those deaths were associated with persistent diarrhoea. The relative risk of dying from diarrhoea among severely malnourished children, as opposed to those who were not severely malnourished, was 17. The attributable risk was 49%. For all causes of death combined, the relative risk was 8 and the attributable risk 30%. Sixty per cent of all deaths in this age group occurred during the five post-monsoon months. The risk of dying from severe malnutrition was more than twice as high among girls as among boys. The specific mortality due to severe malnutrition was significantly lower in the half of the surveillance area covered by an intensive mother-child health and family planning (MCH-FP) programme than in the half covered by the regular national health services, suggesting the programme's effectiveness.