The U.N.'s Development Forum was created in 1973 following a resolution that cited the need for the United Nations to rally public opinion in support of development.

230 Million Women in Developing World Suffer from Nutritional Anaemia

Sorne 230 million women in the developing world, between the ages of 15 and 49, are estimated to be suffering from iron-deficiency anaemia, "one of the most fre- quently observed diseases in the world today."

This is a finding of a recent re- view. published in the World Health Organization's statistical quarterly.

that brings together information on the prevalence of anaemia in a total population of 464 million women.

Essentially what the report shows is that about half of ail wom- en in developing countries-that is, 230 out of 464 million-are anaemic, suffering from a defic- iency of one or more essential nutrients. chiefly iron. and, less frequently, follate.

Among areas covered are Africa, Asia, with the exception of China (for which no information was avail- able). and Latin America.

"Because of its deleterious consequences. and because it is so widespread. nutritional anaemia in women is one of the nutritional deficiency diseases that must be given high priority," the report states. "Most nutritional anaemia can be prevented."

The report. by WHO statistician Erica Royston, also shows that there is a higher percentage of anaemia among pregnant women.

"From the information collated."

she says, "it would seem that

WHO Photo

Anaemia highest among preg- nant, but can be prevented.

about half the non-pregnant women and nearly two-thirds of the pregnant women have haemo- globin concentrations below those laid down by WHO as being indic- ative of anaemia."

This is due to the dramatic in- crease in nutrient requirements.

during pregnancy that are needed.

not only to replace body losses, but also to provide for the needs of the fetus and placenta.

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"The need cannot be met by diet alone. but is derived at least partly from maternai reserves." the report says. "When these reserves are already low-from malnutrition or frequent pregnancies-anaemia results."

Women in the Third World have.

on average, twice as many children as women in the industrialised world. the report states. "At any point in time. every sixth woman aged 15 to 49 years in a developing country is pregnant. compared with 1 in 17 in developed countries."

This is the situation, region-by- region. in the developing world :

• ln Africa, 63 per cent are anaemic out of 15.1 million preg- nant women. as against 40 percent anaemic out of 77.1 million non- pregnant women.

• ln Asia, the figures are 65 per cent anaemic out of 43.2 million pregnant. and 57 per cent anaemic out of 253.2 million non-pregnant women.

• ln Latin America. figures are 30 per cent anaemic out of 9.6 million pregnant, and 15 per cent anaemic out of 65 million non-pregnant women.

Mild. or moderate, anaemia may

"impair well-being, may reduce maximal work capacity, and ad- versely affect work performance."

the report says, even though it is

"more or less well tolerated."

Few women. however. can func- tion normally with severe anaemia, which may manifest itself clinically in "anorexia (loss of appetite). las- situde, giddiness. breathlessness.

oedema (swelling) of the legs, and soreness of the tongue and of the corners of the mouth."

The report cites two major reasons why women in the repro- ductive ages are singularly at risk of anaemia.

Firstly, "regular menstrual blood losses constitute a continuing drain of nutrients, which have to be re- placed." About 40 ml of blood each month, "equivalent to an average daily iron loss of 0.6 mg," is lost each month by a healthy women.

Secondly, "pregnancy increases the requirements of the woman's body to mee.t the needs of the growing fetus."

Yet. more often than not, diets in the developing world are inadequ- ate for the needs of pregnancy, or to replace menstrual blood losses ..

Anaemia can also be caused, or aggravated by, parasitic diseases.

the report adds, the two chief culprits being intestinal parasites

and malaria. •

Development: Less Confidence Today

The U.N.'s Development Forum was created in 1973 following a resolution that cited the need for the United Nations to rally public opinion in support of development.

Recently, Peter B. Stone, its editor for ten years, summarised changes in thinking over the decade-from confidence then, to less than certainty now. An excerpt tram his interviewwith

"Development people are now in a state of profound self- doubt. T en years aga there wer,e several schools of thought that had confident prescriptions for development: if only you followed those prescriptions the Third World would bloom.

"They called for a wide range of things- from classic revolution and land reform, to

multinationals and leaving it to them. Today not one of those schools advances

prescriptions with one-tenth the confidence it had 10 years aga.

"Everybody is doubtful. There is even a degree of cre- dence accorded to (those who imply) that development aid makes things worse in the recipient countries. But intellectu- ally, it is a challenging time

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More Than 1 OO Nations Act on Marketing Code

Since the World Health Assem- bly adopted the International Code on Marketing of Breast-Milk Substi- tutes in May 1981, more than 1 OO countries, out of WHO's total mem- bership. of 160, have acted to give effect to its provisions.

Status reports written 12 and 18 months later by Dr Halfdan Mahler.

WHO Director-General. show that countries have either adopted a range of measures suitable to national needs, have enforced them through legislation, executive decree, or ministerial decision, or are in the process of so doing. The reports are based on information received from governments.

Argentina, Morocco, Peru. and Trinidad and Tobago, the reports say by way of example, have al- ready adopted national codes. And draft codes are ready for submis- sion to legislatures in lndia, the Philippines, and Sri Lanka.

lndia's draft is titled "Infant Foods." rather than "Breast-Milk Substitutes," the report says, "to avoid creating the impression that there could be any real substitute for breast-milk."

The banning of advertising, in Mozambique and Saudi Arabia for example; the prohibition of dis-

tribution of free samples. as in the case of two Canadian provinces and two Brazilian states; and the regulating of labelling in many countries are among other meas- ures taken so far. Chile; for in- stance. requires labels on ail milk- based weaning foods to read :

"This food is not a substitute for breast-milk."

Papua New Guinea requires a prescription for the purchase of baby bottles. and prescriptions are needed in Guinea and in Libya for infant formulas.

Many countries have held semi- nars, workships, and interministe- rial meetings to disseminate infor- mation about the provisions of the code. Not only government officiais but also representatives of con- sumer groups and of the infant food industry participate in these consciousness-raising sessions.

ln Rwanda, the recommendation of one workshop is that "the princi- ples embodied in the code should be included in school curricula." •

10-Cent Sticker May Pinpoint Weak Links ln the

Cold Chain'

A vial of measles vaccine is good for about two months at 25° Celsius (60° Fahrenheit). At 37°C (99°F), its

life is reduced to no more than a week.

Though it is known that vaccines are sensitive to heat and light, it is not at ail possible for health work- ers in the Third World to tell just when vaccines deteriorate beyond use.

When the efficacy of a vial is suspect, then the question facing the health workers is whether or not to use its contents. But short of a lab test, which cannot be per- formed in the field, there is no way of determining potency.

Now that may be changing, thanks to a U.S. ten-cent. little red sticker that is being tested in the field.

Attached to the cap of each vac- cine ampoule-so that it cannot be missed-the sticker is treated with PTS (P-Toluenesulfonate), a chemi- cal that turns colour as it reacts to temperature over a period of time. When the vaccine reaches the min- imal potency, as recommended under WHO's biological standards, the sticker turns black, thus giving a clear and immediate warning to health workers.

WHO/PATH Photo

Reacts to time, temperature by turning from red to black.

Aptly named the Time-Tempera- ture Marker, the sticker is being tested in ten countries-Argentina, China, Egypt, Kenya, Nepal, Pakis- tan, Peru, the Philippines, Yemen, and Zimbabwe. The trials will deter- mine whether it is a practical and useful tool for health workers in the field, WHO officiais say.

The marker was developed by two United States organizations, Allied Chemical Corporation, a com- mercial company, and the Pro- gramme for Appropriate Technolo- gy in Health (PATH). a non-profit organization, which designed the prototype used in the tests.

Research is being financed by UK's Oxfam. Canada's International Development Research Centre, the Edna McDonnell Clark Foundation in the U.S., and WHO. •

Newsbriefs

• 'Breast-feeding-lt's the Modern Way'. Paradoxical as it may sound, that is the theme of a UNICEF-WHO calendar promoting the advantages of breast-feeding. The point being made is that while breast-feeding is as old as the human race, it is as modern as today. (See opposite page for related story).

• Fear of Feeding on Fish. Although fish is a basic food in Fiji, as elsewhere in the South Pacifie, fears are increasing among the islanders about eating fish. The reason: the risk of poisoning from a toxin-producing algae, which the fish eat and then pass on ta humans.

By shunning fish. which is a major source of protein, a serious nutritional problem is created, Dr Hiroshi Nakajima, Director of WHO's

regional office for the Western Pacifie told participants recently at a training course on fish poisoning held in Suva, Fiji. The poisoning also impedes the development of a fishing industry.

Some 2,000 cases of fish poisoning caused by ciguatoxin were reported from throughout the region in 7987 a/one, officiais say, with symptoms of poisoning occurring generally 24 hours after a meal. Many of the cases had ta be sent ta hospital.

• Joining Up. Since the official declaration of the eradication of sma/1- pox worldwide was made in May 1980, the United States, along with

153 countries-at a saving of millions of dollars-has discontinued routine vaccination.

That policy however, does not apply ta military personnel, who are vaccinated on induction into service, and every five years thereafter. This was the case of a 19-year--old student. who was vaccinated for the first time in his life on 3 October 1982, on joining the National Guard in Tennessee.

Nine days later, "acutely il/ with chills and a temperature of 38. l°C (101.7°F)," WHO's Weekly Epidemiological Record reports, he was sent ta hospital, a victim of "disseminated vaccinia infection." Although he recovered, and there were no secondary cases. persan-ta-persan spread of vaccinia from military · personnel has been reported by Britain and Canada.

WHO is seeking ta determine just what the policy is of armed forces throughout the world. What is at present known is that a vaccination is not required on joining up in five countries-Denmark, Fin/and, Netherlands, Switzerland, and the United Kingdom. Chiefs--of-staff, please advise.

• Kicking the Habit. Among US high schoo/ seniors, drug use dropped for 12 out of 14 drug categories-including marijuana and cocaine- be- tween 1980 and 1981, indicating the possibility of a downward trend for the eighties, according ta figures from the US National lnstitute on DrugAbuse.

The use of Valium and similar tranquillizers also declined from a peak in 1975. ln addition, white 29 percent of seniors smoked cigarettes dai/y in 1977, the figures dropped ta 20 percent in 7987-al/ of which suggests a growing social disapproval of drug use in the country, health officiais are happy ta note.

• Reciprocal Health. Thus far, nine European countries are parties ta an agreement that provides for medical care ta each other's citizens. Those with health coverage in their native lands wi/1 also be covered during temporary residence abroad, under the European Medical Care Pact worked out by the International Labour Organisation.

The countries agreeing ta reciprocity are Fin/and, the Federal Republic of Germany, the German Democratic Republic, Hungary, Netherlands, Norway, Sweden, Switzerland, and Turkey.

• Stamps on Aging. So preoccupied are most Asian nations with other health problems that there is little awareness, according ta the UN Economie and Social Commission for Asia and the Pacifie, that the numbers in the 60-plus age group are expected ta increase by 102 percent by the year 2000 in their part of the world.

Now, a series of stamps has been issued by the Philippines post office, in an attempt ta raise awareness of the region's changing demographic make-up, and ta cal/ attention ta the needs of the aging.

ln the next issue

People who live in the siums and shanty-towns of the world's great cities face unique health hazards-problems that stem from over- crowding, lack of safe water, unhygienic living quarters, unemploy- ment and the stresses of urban life. The July issue of World Health will look at these problems and at attempts to solve them through the primary health care approach.

Authors of the Month

Dr Olayiwola AKERELE is Chief of the unit of Traditional Medicine at WHO headquarters in Geneva.

Dr Xavier LOZOYA is Director of the Unit for Biomedical Research in Traditional and Herbai Medicine, the Mexican Social Security lnsti- tute, Mexico City.

Mr Alastair ANDERSON is a freelance journalist specialising in develop- ment topics, and is based in Geneva.

Dr Piero COPPO is an Italian psychiatrist whose special interest is the study of traditional medicine in African countries.

Hakim Mohammed SAID is President of the Hamdard Foundation of Pakistan, an institution specialising in Tibb (traditional medicine), and former Adviser/Federal Minister in the Pakistan Ministry of Health.

Professor Norman R. FARNSWORTH is Director of the WHO Collaborating Centre for Traditional Medicine, and Research Professor of Pharmaco- gnosy at the University of Illinois, Chicago, USA.

Dr Fernando CABŒSES is Director of the Peruvian Museum of Health Sciences in Lima.

Mr Pape Marcel SENE is a journalist working with the Dakar newspaper Le Soleil in Senegal.

Dr Joseph HANLON is the correspon- dent in Mozambique for the BBC and The Guardian. Previously he was on the staff of the weekly jour- nal New Scientist.

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