malnutrition in Equador Laurel Zachs & Michael Golden 12.01.2000
Info needed on earthquake preparedness Ellen Girerd-Barclay 21.01.2000
feed PFEDA Dominique Bounie 18.02.2000
nutritional support for people with HIV Marlou Bijlsma 22.02.2000
Re: nutritional support for people with HIV Dominique Bounie 30.3.2000
Wellcome, TIH-CD-Rom on Nutrition Michael Golden 22.02.2000
Refugee fertility patterns Kim Sanwogou 23.02.2000
early termination of breast-feeding John McLennan 08.04.2000
Breast shape David Morley 09.04.2000
Food supplementation for moderate malnutrition/growth failure Liana Steenkamp 11.04.2000
CDCynergy-international micronutrient version Emily A. Bobrow 02.05.2000
Relief food analysis Joe Aylward 04.05.2000
household food security and nutrition information on Angola Maren Lieberum 23.05.2000
Pakistan - rapid appraisal of drought situation Kate Godden 03.06.2000
osmolarity and osmolality in carbohydrates feeds Liana Steenkamp 11.06.2000
Fwd: HIV/AIDS data in less developed communities Dominique Bounie 30.06.2000
Mauritania André Briend 07.08.2000
FW: Urban agriculture and nutrition Florence Egal 17.08.2000
Family Rations in Feeding Centres Peter Hailey 23.08.2000
MUAC for pregnant women Naomi Klaas 24.08.2000
antibiotics during community based therapeutic care Steve collins 13.09.2000
which version of EPINUT Jean Gladwin 04.10.2000
Anemia in Senegalese malnourished children André Briend 06.12.2000
Zinc and diarrhoea Dominique Bounie 13.12.2000

Date: Wed, 12 Jan 2000 16:54:09 +0000

From: Michael Golden <refugeesatabdn.ac.uk>

Subject: malnutrition in Equador


Dear Dr Golden

I am currently working in a Center for Malnourished Children in Equador.

I would like to know what standards or measures are currently used to identify the different states of malnutrition. The Center where I work uses a % of normal weight using the Ecuadorian growth chart.

70% III grade malnutrition
70-79% II grade malnutrition

Ecuador is experiencing a dire economic crisis that keeps our Center for Malnourished Children full of kwashiorkor and marasmus. Who should I alert about the situation? The situation is worsening and I am afraid of a larger scale of malnutrition country-wide.

Thank you for your time and attention,


Laurel Zaks MPH RD
Cuerpo de Paz, Casilla 17 03 635, Santo Domingo de Los Colorados, Pichincha, Ecuador, South America


Dear Laurel,

We will arrange for the recent WHO manual on the treatment of severe malnutrition to be sent to you. The Spanish version of the manual is not yet published, but I understand it will be so shortly, at which time you should be able to get it through WHO regional office or from Mercedes de Onis in Geneva.

The internationally accepted criteria for admission and discharge are given in the manual. It is critical to use weight-for-height for management of severe malnutrition. I think that the Ecuadorian growth chart is a weight-for-age chart. All weight-for-age charts are inadequate for this purpose and admission and discharge criteria for marasmus must be based upon weight-for-height.

Clearly, you should first alert the Ministry of Health in Ecuador and also the UNICEF country office.

It would be useful to know the numbers of children with each type of malnutrition admitted per month and their outcome.

The last national figures in the WHO database for wasting are from 1986 when between 0.6 and 3.8% of children were below -2 zscore weight-for-height (less than -3 zscore, or severe malnutrition is not available), which does not indicate a major problem with marasmus. There is a major problem with stunting, however, with the 1991-92 survey showing prevalences from 30 to 65% in the different provinces. And if you are using weight-for-age charts there may be a problem with definition of marasmus.

However, abundant kwashiorkor is very worrying - in none of the surveys has oedema been looked for and there does not seem to be any more up-to-date information. The Ecuadorian national authorities may therefore be quite unaware of the problem you are facing with severe malnutrition. Clearly, there should be a survey conducted in your area to determine if the impression that you have gained from admissions to your centre reflects a deteriorating situation in the country or whether it is due to some other factor.


Prof. Michael H.N.Golden
Dept of Medicine and Therapeutics, Univ of Aberdeen, Foresterhill, AB9 2ZD. Scotland, (UK)
Tel +44 (1224) 681 818 ext 52793/53014, Tel(direct) +44 (1224) 663 123 527 93, Fax +44 (1224) 699 884

Date: Fri, 21 Jan 2000 10:51:45 +0000

From: egirerdbarclayatunicef.org (Ellen Girerd-Barclay)

Subject: Info needed on earthquake preparedness



The UN system in Nepal is currently preparing an earthquake preparedness plan the Kathmandu population as a whole. As a member of the Food, Water and Hygiene/Sanitation Task Force, I've been given the responsibility to help develop plans and guidelines for preparedness in the three areas (food-water-sanitation/hygiene) for home, school and office.

If anyone has already developed plans or guidelines that our team could use as reference materials for food preparedness, or any articles related to the subject, I would appreciate it if you could forward them to me. Most of the information available to us at present is for post-disaster/emergency relief, but so far we have found very little on pre-disaster preparedness, and particularly on pre-earthquake preparedness, at any level.

To forward electronic files, please use my email address: egirerdbarclayatunicef.org

Please forward copies of any written materials to:

Ellen Girerd-Barclay, Regional Adviser, Nutrition and Health


From outside the USA: UNICEF-Regional Office

PO Box 5747 PO Box 5815, Grand Central Station Lekhnath Marg, New York, NY 10163-5747 Kathmandu, Nepal


Thank you all, and best wishes for a Happy New Year.



note added: I looked at earthquake preparedness on the www - there were 7246 sites, mostly domestic USA.
However, the person who should be able to help is Dr Claude de Ville de Goyet at PAHO Headquarters - Mike G.

Date: Fri, 18 Feb 2000 19:35:44 +0100 (MET)

From: PFEDAatuniv-lille1.fr (Dominique Bounie)

Subject: feed PFEDA


Dear all,

I take the opportunity of the recent exchange of emails between Florence Egal and Samimata Wade to remind you that the PFEDA website (http://www.univ-lille1.fr/pfeda) warmly welcomes any information that you want to share with other field or organizational workers : - calls for meetings, conferences, seminars, workshops + corresponding proceedings or acts

- list of trainings and training materials, with precise registration conditions, fares, etc

- job opportunities, consultancies and missions - annoucement of new books or studies - related to emergencies and/or development - if possible with a short summary or analysis; field or organizational reports

- electronic documents with their Internet address - adresses of organizations and of field resource persons, ...

Presently, PFEDA archives also the past contributions to NGONUT and the past issues of the Humanitarian Times, an independent not-for-profit periodical sent free-of-charge to non-governmental organizations in over 100 countries (subscription to HTimesatemail.msn.com).

PFEDA is run by the University of Lille and, therefore, is fully independant from any group or organization. Our only objective is to help an efficient diffusion of free technical information between users and to enhance the interactivity between them.

Any suggestions to improve this website and its related services + propositions of support or collaboration are welcomed.

'wish to hear you soon



Dominique BOUNIE, Mr. : lecturer in Food Engineering IAAL (Institut Agro-Alimentaire de Lille - Lille Institute of Food Industries) Boulevard Langevin, Campus Universitaire de l'USTL (Université des Sciences et Technologies de Lille), 59655 Villeneuve d'Ascq Cedex - FRANCE
Tel : +33 (0)3 28 76 74 11, Fax : +33 (0)3 28 76 74 01
email :

Date: Tue, 22 Feb 2000 10:45:11 +0000

From: Marlou Bijlsma <pzaagatmango.zw>

Subject: nutritional support for people with HIV


Dear colleagues

On behalf of FAO Rome I am currently reviewing programmes and education materials on nutritional support for people with HIV.

We are specifically interested in those programmes and materials that are relevant to sub-Saharan Africa.

We want to compile and compare existing information, education and communication materials used in the area of nutrition and HIV. Apart from developing recommendations on how to improve and add on to the existing materials it will also allow us to identify gaps in the availability of existing materials. Identified gabs will assist FAO to develop its strategy in the area of nutrition and HIV.

With this letter I would like to request you to answer the following questions

In what way are you/ your institution involved in nutritional support for people with HIV?

What information, education and communication materials are you using?

-for people with HIV

-for care givers

-for health professionals

What are the strong points of the materials you are using?

What are the limitations of the materials you are using?

What additional information would you require for your programme?

Could you send me a copy of the materials you are using?

On your request I could send you our nutrition guide for people with HIV in return. This guide was developed in Mutare, Zimbabwe, in cooperation with the local AIDS support organisations.

Hoping to hear form you. In this part of the world where anti retrovirals are not accessible, nutritional support becomes even more important to improve health and quality of life for people with HIV.


Marlou Bijlsma
address PO Box MP 600, Mount Pleasant, Harare, Zimbabwe
phone +263 4 336421, e-mail

Date: Thu, 30 Mar 2000 10:05:21 +0200

From: Dominique Bounie <pfedaatuniv-lille1.fr>

Subject: Re: nutritional support for people with HIV


Dear Marlou,

Here are some training materials that may be of any of interest for your project :

- "Development Through Self-Reliance" (6679-P Santa Barbara Road, Elkridge, MD 21075, USA ; Tel: +1 410 / 579 4508, fax: +1 410/ 579 8412, email: dsratdsr-inc.com, website: http://www.catalog.com/dsr/film.htm) offers a free catalogue of African films and videos on social/health isues, such as AIDS, women's rights, etc..

- TVE (Television Trust for the Environment) & IT (Intermediate Technologies) produce "HANDS ON", a series of 60 short television features on sanitation, transport, food, forestry, energy, agriculture, micro-credit... issues in an environmental perspective (i.e. sustainable devlopment) with detailed multimedia backup (radio, web & printed info).

These media are broadcasted on BBC World. (contact: TVE, Prince Albert Road, London, NW1 4 RZ, UK. Tel : +44 (0)171 586 5526, fax: +44 (0) 171 586 4866, email: tve.distattve.org.uk)

'wish this may help you



Dominique BOUNIE, Mr. : lecturer in Food Engineering IAAL (Institut Agro-Alimentaire de Lille - Lille Institute of Food Industries) Boulevard Langevin, Campus Universitaire de l'USTL (Université des Sciences et Technologies de Lille), 59655 Villeneuve d'Ascq Cedex - FRANCE
Tel : +33 (0)3 28 76 74 11, Fax : +33 (0)3 28 76 74 01
email :

Date: Tue, 22 Feb 2000 14:16:05 +0000

From: Michael Golden <m.goldenatabdn.ac.uk>

Subject: Wellcome, TIH-CD-Rom on Nutrition

Cc: "Coyer ,Mr Chris" <c.coyeratwellcome.ac.uk>, publishingatcabi.org



The Wellcome Trust, Topics in International Health series, has just produced a CD-Rom on Nutrition.

It contains seven tutorials on many of the topics that we regularly discuss including: the causes of malnutrition: interactions between malnutrition and infection: anthropometry in individuals and populations: treatment of severe malnutrition: strategies to prevent malnutrition: recommendations for vitamin A and iron supplementation: strategies to prevent iodine deficiency disorders. There are also about 700 images that are available for individual use and teaching (for other purposes the copyright holder is given so that you can ask permission to use the picture) that illustrate many aspects of these problems.

The tutorials are easy to use and informative -and indeed some of the things said could form the basis of comment and discussion on ngonut - most of the authors are members of ngonut and we could have a lively discussion about any points that you disagree with - smile - provided that the discussion does not exclude any who do not have the cd-Rom (this I insist)!

The discs are available from CABI Publishing (NOT the Wellcome Trust) <http://www.cabi.org/CATALOG/CDROM/TIH/tih.htm> Email <publishingatcabi.org> CABI Publishing, CAB International, Wallingford, Oxon OX10 8DE, UK Tel: +44 (0)1491 832111, Fax: +44 (0)1491 826090

The costs!

Most of our members in developing countries would pay an all inclusive price of £20 (this is an 'Institutional' rate, as they do not expect individuals to purchase!).

Individuals and students world-wide pay £30.

Transition Countries (such as South Africa) pay £45.

Developed World institutions pay full price rate of £120

For some, this is still a lot of money. Chris Coyer of the Wellcome Trust is making enquiries with CABI for us to see if individual Ngonutters, particularly those from non-industrial countries, can get a further discount.

Perhaps a more important consideration would be the ability to pay in local currency and the mechanics of transferring funds from some places. Perhaps some of the International agencies, bilaterals or NGOs could help in this respect through their country offices, if there is sufficient interest amongst Ngonuts.

Anyway, can you let CABI know that you are an ngonut when you contact them.

If you are stuck and cannot get either the funds or the foreign exchange, I would still suggest that you to make email enquiries with CABI to register you interest, explain your situation and see if something can be done. If this is your situation, can you also let me know because, within reason, I will personally pay for our colleagues who are isolated, in the "bush", without any institutional affiliation or support to get hold of this type of cost-effective material.

The system requirements are a 486pc or better (pentium recommended), Windows 95,98 or NT, 16Mb of available RAM, monitor with 16-bit color, CD-Rom drive.

I know that other CD-Roms are being prepared at the moment and will be available soon - they also cover some of these topics, often in more detail and "build" upon the foundation that the TIH has set. The ones that I have seen are entirely complementary to this CD and will, in the future, augment this product admirably.

Apart from nutrition the other discs in the series are also exceptional value, and very important to many Ngonuts (although, in general, most do not deal with how these diseases are affected by nutritional status, and whether different treatments and signs appear, or fail to appear, in the malnourished patient): The topics are:- HIV/AIDS, Leishmaniasis, Diarrhoeal Diseases, Leprosy, Schistosomiasis, Tuberculosis, Malaria, Sexually Transmitted Diseases, Trachoma, Sickle Cell Disease. The previous titles are being used by about 3000 people with 40% in developing countries.

I will review these other discs in the coming months for ngonut.

Happy viewing.


Mike Golden.
Prof. Michael H.N.Golden

From: "ICEC" <icecatmailhost.tcs.tulane.edu>

Subject: Refugee fertility patterns

Date: Wed, 23 Feb 2000 07:50:18 -0600


Dear Ngonutters:

We are looking for information on the fertility patterns of refugees and displaced persons particularly in the African regions. We'd be interested in general refugee fertility patterns as well. Does anyone know of any publications or resources where we might find that information?


Kim Sanwogou
Tulane School of Public Health, 1440 Canal Street, Suite 2200, New Orleans, LA 70118

Date: Thu, 30 Mar 2000

From: "John McLennan" <mclennjdatfhs.csu.McMaster.CA>

Subject: early termination of breast-feeding


Hello Ngonut persons,

We are analyzing data from a community study on duration of breast-feeding in periurban Santo Domingo. One of the frequent reasons for early termination of breast-feeding was mothers' concerns over "loss of figure" or "loss of breast shape (sagging of the breasts)". This has previously been noted as a reason for the failure to initiate breast feeding in some published studies. What I have yet to find is any data suggesting or indicating that prolonged breast-feeding can actually change breast shape.

One breast-feeding manual indicated that the sagging of the breasts was secondary to the pregnancy and not breast-feeding but there was no references given. The reason I am interested in this is to make recommendations to the health promotion groups in the area where our study was conducted. If this is a false belief and prolonged breast-feeding does not lead to changes in breast shape, then we could make this into an educational message. If it is true, then, frankly, I am not sure what the health education implications are. If anyone has input on this issue, I would be delighted. I will be heading back to Santo Domingo in June and would like to be able to pass such information along.



Dr. John D. McLennan
Canadian Centre for Studies of Children at Risk McMaster University.


Note added: Sagging breasts and striae gravidarum are thought of as being inevitable consequences of pregrancy in many cultures and through the ages - they are mentioned in Classic literature. There has been insufficient work done on this topic. There are undoubtably changes in the stresses to the skin and supporting structures with their expansion and also the nutritional requirements during pregnancy and lactation. Theroetically changes in shape should be related to nutritional effects on collagen or glycosaminoglycans: the two nutrients that are most clearly related to "collagen health" are vitamin C and Copper, both critical for collagen cross-linking of the lysine residues, and both of these nutrients are frequently sub-optimal in diets. Protein and sulphur are also important.

Recently J Nutr carried an article suggesting that the RDA for vitamin C be raised to 100mg/d and it is much higher is smokers or those exposed to oxidative stress.

I have no evidence for the statement - but when a mother's breasts sag progressively with each pregnacy and she gets extensive striae, I consider this to be a sign that she is, or has been, malnourished during pregnancy and lactation. I wonder if there is a relationship between these clinical signs in the mother and the wellfare of the infant?

Mike Golden

Date: Sun, 9 Apr 2000 10:39:32 +0100

From: David Morley <Davidatmorleydc.demon.co.uk>

Subject: Breast shape


Dear John, In W.africa where most infants at the time I studied children growing up were breast fed for over 2 years, the older children tugged on the breast. Some mothers could sling their breast oveer theeir shoulders to breast feed an infant riding on their back----but these are exceptional circumstances !! David

David Morley,Emeritus Professor of Tropical Child Health, University of London.
Tel: & Fax. 44 (0) 1582 712199.
Preferred Address; 51 Eastmoor Park, Harpenden, AL5 1BN. UK.

From: "Liana Steenkamp" <lianastatiafrica.com>


Date: Tue, 11 Apr 2000 17:08:26 +0200


Dear prof Golden

I am currently looking for guidelines(macro-and micronutrients) to evaluate specifications of food supplements used for treating children with growth failure/moderate malnutrition on feeding schemes. With existing products that has been used for the past 8 years (without any alterating to specifications), limited success in the treatment of these cases has been achieved. Before investigating other contributing factors relating to poor outcome to treatment, I would like to be sure that optimal supplementation took place and that inferior products are not linked to the poor outcome.



Liana Steenkamp
Dietitian, Eastern Cape, South Africa