Family Health and Nutrition Schemes

(1)

UNITED NATIONS

ECONOMIC and SOCIAL COUNCIL

ECONOMIC COMMISSION FOR AFRICA Symposium on Rural Development

in Africa in "the 197O's Addis Abafca, 9-13 August 1971

3/CN. 14/SWCD/lKP. 33

22 July 1971

Original: ENGLISH ONLY

1 i

FAMILY HEALTH AND NUTRITION SCHEMES

prepared "by

WHO/ECA Liaison Office

-<A,

M71-1775

'K ■ ■•)■]

(2)

FAMILY HEALTH AMD NUTRITION SCHuJKES

prepared by LIAISON OFFICE

Introduction

The bulk of the population in Africa, over 75% live in the

rural areas and the effect of careful and informed health planning for the entire family and the relation of family health to community health are important factors in the individual, the community and the ■ ■. . economic development of the continent.

The family in turn is inevitably affected by the human and environmental conditions of the community whose life it shares.

Public health problems are therefore community problems which in the last decade the World Health Organization has attempted to solve by the application of general measures and the incorporation of preventive and curative services in the rural health centres. To achieve the

maximum impact on the rural communities however, it is clear that public health programmes should be integrated into rural development so as t'o achieve any material benefits and advancement which may accrue from

other activities in the rural programmes,, The unity of human society is therefore aptly described as "complex societies of social, biological, eoonoaio and political phenomena, characterised in this twentieth

century by the rapidity with which they change. Social advance takes place only when all sectors of a society improve. Sooiety fail to advance their whole front because a lagging neighbour necessarily holds back his faster fellow. His health cannot improve unless education also does; agriculture cannot improve without an advance in marketing, and

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and industry cannot grow without political and eoonomio development.

Nothing takes place in a vacuum. The backwardness of a fraction of society inflicts heavy penalties on related sectors and hence, by action and reaction, on the whole society,nl

Family health however cannot be entirely divorced from nutrition problems. Indeed it has been claimed that malnutrition has permanent effects on the mental development of individuals although there are insufficient data available to support this claim. But it is known that one of the direct consequences of malnutrition is retarded growth

which may lower productivity in adulthood.

In most countries the chief causative factors in laalnutrition are socio-economic and educational. A low purchasing power is characteristic of most of the countries in the Africa region as are inefficient

agriculture, insufficient mechanization, poor transportation, antiquated systems and inadequate facilities for food storage and marketing.

There is also widespread ignorance of elementary principles of.domestic

economy.

Basic Health Services

„ ..To aohieve the goals of a comprehensive family health service which will effectively involve the communities in the rural areas, WHO has ■ encouraged the establishment of Basic Health Services, a network of "

peripheral, intermediate, and central health units. Staffed by - adequately, trained professional and auxiliary personnel these units . should be. capable of performing groups of functions essential to.the.

1 Statement of tfHO Hepresentative ECA Hegional Conference on Education Training & Work Opportunities for Girls & Women in Africa, Habat,

20-30- May 1971 *

(4)

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health of-the people among the most important of which are the treatment of infection and early institution of preventive

measures* .

The peripheral health establishment being the first line of defence provides a permanent service within easy reach of the popiaation living in the rural area. Indeed it should be regarded as a community institution which should solicit the aotive

participation of the local population and should be staffed by trained personnel and so equipped as to extend their services to

the homes.

The whole system is to provide a national planned, coordinated and comprehensive service under a central organizing authority with such activities as medical care, maternal and child health, control of communicable diseases, environmental sanitation and health

education. . .

Maternal and Child Health .

Within the concept of family health, the World Health Organization expert committees have adopted the objective "that every child, wherever possible, should live and grow up in a family unit, with love and

security in healthy surroundings, receive adequate nourishment, health

supervision and efficient medical attention and be taught the elements

of healthy living." For maternal health the objective is Ho ensure

that every expectant mother maintains good health, learns the art of

child care, has a normal delivery and bears healthy children; that

maternity care in a wider sense begins much earlier in measures aimed

to promote the health and well-being of the young people who are

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potential parents, and to help them to develop the right approach to family life and to the place of the family'in the community.

It should include guidance in parent-craft and in problems associated with infertility and family planning."

The principal oonoern in the establishment of Maternal and Child Health clinics is to reach the community of the rural'area which eventually means a complete coverage of the whole population.

This is of prime.importance in the Africa region where there is shortage of personnel and other facilities, and where the distances to the clinics may be great with insufficient means of transportation, The present trend however is to integrate the Maternal and Child

Health services into the Basic Health Services which naturally allows for the-most economic and wide-spread use of available facilities, personnel,' supervision, supply-and transport, ....

Such integrated approach of Maternal and Child Health and Basic Health Services reflects the basic concept of family health where in

the peripheral centres of the rural community all members of the family can benefit from such activities as the recognition and ..

management of the most common diseases; health education with

emphasis'on nutrition, hygiene, childbearing, child rearing and.

family planning; examination of 8>peotant mothers and children with the identification of high risks and abnormalities and eventual referral"to other centres with more qualified personnel; assistance during delivery and post-natal period ensuring maximum safety and

also organised immunization services.

1. Fifth Report of the WHO iJcpert Committee on Maternal and Child

Health, Wld Hlth Org. techn. ^ep. Ser., 1969, Ho« 428

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Nutrition

The importance of nutrition to family health is basic. In, his report of the work of WHO in 1970, the Director-General made inter alia the following statement:

"The tasks of health services of course evolve with the social environment and call for constant readjustment. In WHO for instance we have recently felt the necessity to focus-attention on the needs of the basic social unit - the family - and to achieve a broad approach with emphasis on the quality of life.

Infant and ohild death rates have long served as valuable indices of health conditions; but the time has now come to consider the quality of life of the survivors. For example, out of 180 million children under five years of age in developing countries, probably a quarter show definite signs of proteins - calorie malnutrition.

WHO accordingly increased its activities in nutrition during the year and, .in cooperation with other international bodies1*" in particular FAO and UNICLiF, provided assistance to many countries.

It continued to test the new processed protein-rioh foodej several mixtures have shown very satisfactory results."

"Important responsibilities also lie in the health aspects of family planning. There is accumulating evidence that repeated pregnancies place a heavy burden on mothers and relate to both maternal and infant mortality. Optional child spacing will give the mother better opportunity to nurture each child, which in

turn should lead to better growth and development." 1

This statement reflects the great interest of WHO in nutritional problems particularly in developing countries. It has collected information on prevention of nutritional deficiency diseases, the development of food to combat dietary imbalance and the promotion of good dietary habits by health education.

1. Report of the Director-General on the Work of WHO in 1970. Twenty- fourth World Health Assembly 5 May 1971.

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Still, investigations have shown that malnutrition is quite often the underlying factor in infant and child mortality. Other vulnerable group include adolescent .girls, expectant and nursing mothers.

Although deficiency anaemias are still major problems, yet in recent years it has been recognised that one of the most wide spread

nutritional disorders in developing countries is the protein-calorie malnutrition (PCM). This term was introduced to describe the severe protein deficiency in young children known as kwashiorkbr and the extreme wasting of nutritional marasmus due to deficiency of protein

and calories.

While the importance of malnutrition should not be underestimated yet there is a close link between disease and malnutrition. Malnutri tion tends to lower the resistance to infection and infectious diseases exaggerate the efiects of malnutrition. This problem is of special significance to developing countries where infant diarrhoea measles and whooping-cough are almost inseparable among a large number of

young children, from malnutrition.

To raise the level of nutrition therefore it is necessary for

governments to have a sound national food and nutrition policy within

the framework of its socio-economic development and establish a research

programme on the effect of malnutrition in young children. Moreover

food distributing programmes to infants and school children should be operated under the- supervision of health authorities.

Environmental Health

A comprehensive family health programme must have a component of

environmental health prograiame in the promotion and restoration of

health and prevention of disease. In the developing countries and

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particularly in the rural areas., these programmes have mainly been confined to the provision of safe water supply and the disposal of ,

sewage. Important as these activities are, consideration should

also be given to other health needs which nay be of advantage to

socio-economic development.

In areas affected by sohistosomiasis, consideration should be given to the problem of water, food and soil infestation, as well as pollution by human excreta and ohemioal substances detrimental to human, animal and plant life. Housing and its immediate environment, in particular the public health aspect of residential, pubHo and institutional buildings should be given speoial attention.

Economic development itself depends to some extent on environmental improvement such ae malaria control in economically important areas or the attraction of industry to areas with good water supply. And many developing countries may link their major needs with environmental health programmes such as the use of waste water in agriculture, the development of fish farms in stabilization ponds and the use for irrigation purposes of the spare capacity of tube well in a water supply system. Dams specifically constructed for irrigation may be provided with devices for reducing flow values over spillways and spraying insecticides on water crests in order to control the breeding of eiauliidae vectors of onchocerciasis. Likewise, tryponosomiasis control programmes in areas newly open to agriculture will be of considerable benefit to the rural populations.

Health education must be an integral part of any environmental health programmes in order to educate the population in the principles of environmental health, to secure acceptance by the public for

community measures for improvement and to encourage close collaboration

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with health workers and the public. Such health education is a continuous process which is carr,sd out In the health units and maternal and child health clinics, schools, homes, factories, on-the-spot education of hygienic techniques to food handlers at their place of work and by various methods of mass media. It is particularly important however that personnel engaged in health education should be trained and competent in the technique.

Eduoation Training and Besearch ...

The question of education and training of health personnel has

been reflected in resolutions of several World Health Assembly meetings.

The report of the technical discussions at the 23rd World Health Assembly (1970) stated that too often, studies, for national health plan had not taken full account of health manpower requirement, and on occasions, plans for public health and fcr education of the various health professions had been drafted separately resulting in a failure to anticipate,the manpower needs of health services.

There are clearly not enough professional workers to meet the health needs of all families and the, effectiveness of health services depends on the quality of the staff. The type of staff to be trained are all

categories ,f professional personnel together with their auxiliaries.

The role of the professional eventually becomes that of a trainer and a supervisor. The auxiliaries on whom the population coverage"and referral principle depend require technical guidance and supervision from the professional staff. In the rural areas where there is a large untapped reservoir of intelligent young men and women with very little formal education, suitable training courses can make them become competent

auxiliaries in a relatively short period.

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The range of WHO medical research programme is very wide. But among other interests WHO has been ooncerned with studies in public health practice, organization of medical oare maternal and child'

health. It has supported research projects carried out by individuals, institutions and national research councils, but emphasis has been placed on collaborative research programmes, which involves coordi nation of efforts of workers in various parts of the world.

Recently a new addition to its research activities is the addition of the Division for Research in Epidemiology and communications

science whose functions include the development and application of new and existing operational research, epidemiologioal, behavioural and computer based techniques to appropriate publio health problems. All these activities are directed to the promotion of health, the

prevention and cure of disease.

WHO objective

The assistance of the World Health Organization in promoting a

comprehensive family health service is to protect and strengthen the

integrity of the family, improve the health of all its members,

increasing their work potential as to enable them to contribute to

the economic development. Its activities are not categorised into

urban and rural sectors, rather it pays more attention to the rural

population and promote the development of integrated national health

services of whioh the following schedule gives some of the current

WHO-*ssisted projects which have some relevance to rural development

and lend themselves to inter—agenoy cooperation.

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A Selected WHQ-assisted Projects in Africa

WflO Region

ECA-Sub Regions

Project

No. Description of Purpose. Sources of.

Funds v

AFRO Bast

AFRO

South

AFRO South

Botswana 0017

(1970-72)

Burundi

(1970-72)

0014

Cameroon

(1970-^72)

0010

Cameroon

(1970-72)

0028

CAR 00X5

(1970-72)

Chad

(1970-72)

0010

Comoro Archipel

ago

(1970-72) Congo(Dem.)

0008

(1970-72) Congo(Dem.) (1970-72)

0012

Congo(Dem.) (1970-72)

0014

Development of Basic Health Services To control communicable diseases and training programme for health

personnel UNICEF

To improve family health and nutrition Regular

and training of health personnel /

To strengthen and expand rural health services

To develop basic health services Regular

and train personnel UNDP/TA

and train staff /

To develop urban, and rural health services, especially Maternal &

Child Health and train staff To develop basic health services to complete study of malaria epidemiology

Smallpox Eradication. To assist in carrying out a smallpox eradication programme

To plan and develop environmental, health services and a sanitation' programme, especially water

supplies and waste disposal

including maternal & child health UNDP/TA

and to control malaria and train health personnel .,.. .

Regular

UNDP/TA

Regular UNICEF

(12)

ii -

WHO

Region ECA-Sub Regi ons

Project

No. Description of Purpose ^{Sources of}_Funds AtftO South

APBO South

AFRO Vest

AFRO West

ASRO

AFRO

South

Vest

West

AFRO Bast

A5E0 Bast

Congo(Denu) Development of Nursing Services.

. .0011. . To train nurses and midwives and-to .

(1970-72) set up a central nursing unit and to

develop basic health and maternal

& child health services.

Congo(Dem,) Nutrition Programme * Assist in

0010 integrating nutrition activities

(1970-72) and training in nutrition at all

levels Dahomey

(1970-72)

0022

Equatorial Guinea

(1970-72)

0001

Gabon

(1970-72)

0020

Ghana 0005

(1970-72)

Guinea

(1970-72)

0012

Guinea

(1970-72)

0027

Ivory Coast

(1970-72)

0004

Kenya 0030

(1970-72)

Kenya

(1970-72)

0002

To implement the plan for basic health services including maternal

& child health activities and to develop environmental sanitation programme in urban and rural areas and train health personnel

To plan and develop health services

To develop basic health services, especially maternal and child care and to train health personnel

To control Schistosomiasis

To control Onchocerciasis

To implement antimalaria activities

To improve Maternal & Child health services and train paramedical personnel and social workers

To develop an epidemiological service for planning, coordinating

& evaluating programmes for the control of communicable diseases and train personnel

To improve rural water supply and excreta disposal

Regular

UNDP/TA

Regular UND?

Regular UNICEF

Regular

undp/ta

Regular

(13)

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WHO

Region ECA-Sub-

Regions Project

No. ^{Souroe of}

AFRO

Sast

AFRO

Bast

East

Sast

East

Vest

West

Kenya

(1970-72)

0016

Kenya

(1970-72)

0009

Lesotho

(1970-72)

0014

Liberia

(1970-72}* 0035

Liberia

(1970-72) 0033

Madagascar

(1970-72)

0023

Malawi

(1970-72)

0012

Mali

(1970-72)

0032

Niger

(1970-72)

0025

Nigeria OO79

(1970-72)

Nigeria

(1970-72)

0081

To strengthen and develop the "basio Regular

health services and train,health

personnel

To develop integrated nutrition Regular activities and train personnel

To set up integrated basic health Regular

services in urban and rural areas UNICBF

To control communicable diseases Regular

and train personnel /

To develop basic health services Regular

To organize health services, Regular especially maternal and child UNDP/TA

health, sanitation, nutrition and

health education work and train personnel

To develop the health services, with Regular

emphasis on maternal & child health, , communicable diseases and national

health planning'

To implement national health plan and. Regular establish a central environmental

health unit in training health personnel

In accordance with the national health

development plan to expand basic Regular health servioes

To develop the control of communicable

diseases and also to develop pattern

for integrated health laboratory UNEP/TA

servioes and train staff

To develop an epidemiological service

for planning, coordinating and UNDP/TA

evaluating programmes for the control

of communicable diseases

(14)

?Wf

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WHO ,v Region

ECA Sub- Regions

Project

No. Description of Purpose Source of

Funds AFRO

AFRO

West

Niger:a

(1970-72)

0082

. Nigeria

(1970-72)

0102

Nigeria

(1970-72) 0074

Nigeria

(1970-72) 0075

Nigeria

(1970-72) 0077

Nigeria

(1970-72) 0095

Nigeria

(1970-72)

0096

Nigeria

(1970-72)

0097

Nigeria

(1970-72)

0098

Nigeria

(1970-72) 0099

Nigeria

(1970-72)

0100

Nigeria caoi

(1970-72)

A project similar to Nigeria 0081 above

To develop epideiaiological services and train the necessary staff

To build up the rural health infra structure., environmental sanitation work and train personnel

To develop basio health services and train health personnel

Regular

Regular UNIC^F

Regular

undp/ta

Regular

undp/ta

Regular

Rivers State.To develop basic health Regular services and train health personnel UKICIiiF in both preventive and: curative medicine

Regular A project similar to Nigeria OO96 above UNICJiF

A project similar to Nigeria OO96 above

A project similar to Nigeria OO96 above.

A project similar to Nigeria OO96 above

Regular UNICBF

Regular TJNICEF

Regular UN1CISF

Regular UHICBF

J a

(15)

WHO Eegi on

ECA Sub- Hegions

Project

Wo. Description of Purpose Source-of

Funds AFRO

AFRO

West

South

AFRO South

AFRO West

AFHO West

AFRO

Sast

West

Nigeria , 0028

(1970-72)

0018

(1970-72)

Rwanda

(1970-72)

0011

Senegal

(1970-72)

0026

Sierra Leone

0029

(1970-72)

Sierra Leone

(1970-72)

0030

Swaziland

(1970-72)

0012

Togo

(1970-72)

0030

Togo GO 29

(1970-72)

To extend health education and sohool

health education services throughout ,Uffl3P/TA

the country

To set up integrated basic health

services in urban and rural areas Regular with emphasis on maternal & child oare,

tuberculosis control, work in environ mental health, health education and nutrition . .

To extend integrated basic health

services in rural areas on maternal and Regular child health & nutrition work; also to UNICSF train medical students & health personnel To develop basic health services in

maternal & child health, national tuberculosis control, treatment of malaria, training of personnel

To implement the national health plan particularly as regards the development of rural health services and train personnel

To develop an epidemiological service for the control of communicable

diseases, establish a vital health statistics unit & train personnel To develop basic health services and train personnel

To develop an epidemiological service and train personnel

To develop the basic health services in antimalaria activities, sanitation programme and train personnel

Regular

Regular UWICEF

Regular

T3NDP/TA

Regular

UKDP/TA

Regular

/

Regular

/

(16)

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WHO Region

ECA Sub- Regions

Project

Funds AFRO

AFRO

AF50

AFRO

Kaat

Bast

East

Sast

Bast

West

East

Inter-

Uganda - 0036

(1970-72)

Uganda

(1970-72)

0035

Uganda 0024

70-72)

To set up en -epidemiologioal and Regular1

statistical service responsible for the UNEP/TA

control of oomamnicable diseases and train staff

To develop basic health services giving priority to rural.health services

-.Regular UNICEF

To develop health education services UHDP/TA

for the whole oountry

Tanzania

(1970-72) ~O39

Tanzania

(1970-72)

0048

Uganda

(197^72) 0C44

Uganda

.(197O-72)

0051

Upper Volta

(1970-72)

0021

Zambia

(1970-72)

0014

AFRO 0156

(1970t72)

To control Schistosomiasis Regular

To develop epidemiological services for

the control of communicable diseases; Regular vital and health statistics health

services and.train personnel

To develop water supplies for small Regular communities and train personnel

To develop the centre for training Regular medical auxiliaries .

To improve maternal & child health and Regular

environmental sanitation and promote /

the extension of integrate^ health

services to the rural areas

To develop the health services in the Regular

rural areas UKICBF

Malaria training of public health personnel

Regular

(17)

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WHO 33CA Sub- Project

Region Regions No. Description of Purpose

Souroe of

Funds AFRO

AFRO

AFHO

2MR0

Inter- Country

Bast

AFRO

0094 (1970-72)

AFRO 0131

(1970-72)

AFRO 0178

(1970-72)

AFRO 0143

(1970-72)

AFRO 0215

(1970-72)

AFRO

t'245 (1970-72)

AFRO 0105

(1970-72)

AFRO 0243

(1970-72)

AFRO

0167 (1970-72)

Ethiopia

(1970-72)

0040

To assess the schistosomiasis problem Regular in various countries

To assist countries in identifying and Regular assessing the importance of fooi of UNHp/TA

onchocerciasis, the cause of prevalent communicable eye diseases and to advise an appropriate control

To study the trypanosomiasis situation

in affected countries

To assist governments in planning and carrying out mass smallpox vaccination

To assist countries of the Region in

studying local epidemiological prob lems and to recommend remedial

measures

To develop facilities for the training

of sanitary technicians

Training Centres for health servioe

personnel

Consultative Services for economic"

development projects

Consultative services, to assist cofcfttries of the regiojj to develop nutrition activities and promote training of health workers

To eradicate malaria

Regular

(18)

viii -

1 ," V

WHO Region

ECA Sub- Regions

Proj eot

Funds EMHO -Sa-at

EMEO

SKRO.

East

North

BBffiO

EMRO

East

North

wmo North

SMRO North

fiiIRO North

Ethiopia 0046 .

(1970-72)

iiithiopia

(1970-72)

0009

Libya 0012

(1970-72

& beyond)

Somalia

0002

(1970-72)

Libya.

0024 ■

(1970-71)

Libya

(1969-70)

0030

Libya 0003

(1969-71)

Libya 0002

(1969-71)

To revie-w -the- epi&emio.togical sitxiaiiioh/ "

assess the existing and potential-Health

& environmental hazards in the area of Awash Valley Development Programme and develop a pragmatic plan for priority 0 oriented network cf basic health services, also to assist in improving sanitary

facilities in-the context of community water supply,.schistosomiasis control &

domestic and industrial wastes disposal

To train staff for rural health services

Regular UNICKF

(USAID)

Funds-in To train staff for rural health centres trust

To develop rural health services based 3egular on malaria eradication programme MiiSA

undp/ta To assist planning & developing UNDP/TA

measures for the control of FT sohistosomiasis and in training

personnel

To assist in developing a national

environmental health programme and FT environmental health services,

including, water & sewage laboratories

To assist in training- nurses to provde Regular services in keeping with the needs of FT the country,and its socic—economic

developmento

To improve and strengthen the training

& services of maternal & child health TA training centre, to expand maternal &

child health services throughout the

country

(19)

- ix -

WHO JSCA Sub- Project

Region Regions No* Description of Purpose Source of

Funds BJIRO

SMRO

North

SKRO North

BUBO ^East

EMHO iiaat

North

EMHO North

euro North

Libya

(1969-72)

0012

Libya

(1969-71)

0020

Libya

(1969-71)

0007

Somalia

(1969-72

0013

& beyond)

Somalia 0008

(1969-72)

Sudan

(1970-72

0026

& beyond)

Sudan

(1970-72

0036

& beyond)

Sudan

(1970-72 0045

& beyond)

To aBsist in training maternal and ohild health auxiliary personnel

To assist the Ministry of Health In es tablishing services for the development of a oo-ordinated food & nutrition programme, training medical and auxiliary personnel in nutrition

To assist in training health auxiliaries

& paramedical personnel for staffing the health services, particularly in the rural areas

To develop rural health deiaonstration area and training of health personnel

IT

FT

Regular

To assist in training of various categories o£ health auxiliary personnel

Regular

To control Onchocerciasis and train Regular personnel

To assist in planning and administering Regular a national environmental health programme

in which emphasis is placed on the pro vision of community water supplies, on the disposal of domestic and industrial wastes and the health aspects of housing

To assist in the national community water Regular supply programme in rural areas UNICSP

(20)

ft

-WHO Region

ECA Sub- Regions

Project

Funds EMRO

"North

EMRO

EKRO

EJffiO

EMRO

Sudan 0020 .

(1970-72)

North

Inter- Country

Tunisia

(1970-71)

0036

Tunisia

(1970-72)

0018

Tunisia

(1970-72

0044

& beyond)

U. A. H.

(1970-72 0049

& beyond)

U. A. R.

(1970-72) UO64

BKRO

(1971)

0178 EMRO

0045 (1969-71)

To assist in establishing a nutrition Regular

division and setting up a demonstration UNDP/TA

area which will be used for training

national health personnel & for evalua ting the nutrition work carried out in rural areas

To carry out an epidemiological and Regular malapological survey of sohistosomiasis

in intensifying control measures and in training personnel

To assist in the establishment of an UKDP/TA

environmental health service, which will

study, plan and implement a national programme & train personnel

To assist with the establishment of an Regular

Institute of public health &, training UKDP/TA

of various categories of health

personnel

To design and test control measures to determine the most effective and

economical means of controlling schistosomiasis

Regular

To examine the public health problems

arising from environmental changes Regular

associated with the comprehensive Lake UNDP/ta

Nasser development scheme and to suggest remedial measures

To organise a seminar to discuss ways Regular and means of health education activities

in mass programme

To enable educators in various disciplines Regular

to attend educational meetings

(21)

f ■

\

WHO Region

BCA Sub- Regions

EMRO

emro

Inter-

Country

Project ffo.

KMRO 0128

(1969-71)

Description of Purpose source <yt Funds

To assist a selected number of Govern- Regular

ments of the Hegion in developing the

health components of literacy programme

0119

(1970-72)

To study the increasing pollution of natural waters resulting from the dis charge into them of water-borne sewage

industrial effluents.

Regular

Selected References

Hosa, Franz.

Bengoa J.M.

Wld Hlth Org.

Wld Hlth Org, Wld Hlth Org.

Wld Hlth Org,

Family Health

Hecent trends in the public health aspects of protein calorie malnutrition - WHO Chronicle Vol.24, No.12

December 1970