Appendix A

USAID's Request to the Committee

◆ ◆ ◆ ◆ ◆

MEMORANDUM FROM SAMUEL G. KAHN DATED 17 MARCH 1994

To: NAS/IOM/BIH, Christopher P. Howson

From: USAID/G/RD/N, Samuel G. Kahn

Subject: Committee on International Nutrition

The first meeting of the CIN is scheduled to take place this April 14 and 15. The topic is “Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States (NIS).” Accompanying this memorandum are background documents and information which are submitted to assist the Committee in addressing the proposed issues. Included are a memorandum (Klement to IOM, through G/N) which concisely describes USAID's nutrition efforts in the NIS, and four loose-leaf binders containing protocols, questionnaires, instructional manuals, trip reports, country profiles, other information, and an index to the loose-leaf binders. (Note: additional documents are forthcoming on the anemia studies in Kazakhstan and Russia, Binder III, Section B.)

Based on the background information, documents, and the knowledge of individual members, the Committee is requested to make recommendations as to:



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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Appendix A USAID's Request to the Committee ◆ ◆ ◆ ◆ ◆ MEMORANDUM FROM SAMUEL G. KAHN DATED 17 MARCH 1994 To: NAS/IOM/BIH, Christopher P. Howson From: USAID/G/RD/N, Samuel G. Kahn Subject: Committee on International Nutrition The first meeting of the CIN is scheduled to take place this April 14 and 15. The topic is “Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States (NIS).” Accompanying this memorandum are background documents and information which are submitted to assist the Committee in addressing the proposed issues. Included are a memorandum (Klement to IOM, through G/N) which concisely describes USAID's nutrition efforts in the NIS, and four loose-leaf binders containing protocols, questionnaires, instructional manuals, trip reports, country profiles, other information, and an index to the loose-leaf binders. (Note: additional documents are forthcoming on the anemia studies in Kazakhstan and Russia, Binder III, Section B.) Based on the background information, documents, and the knowledge of individual members, the Committee is requested to make recommendations as to:

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities interpretation of nutritional status and identification of potential issues of at-risk populations in Russia; indicators and methodologies that would be adequate and optimal for conducting nutrition monitoring systems in the NIS; and how USAID may programmatically apply the current findings.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities MEMORANDUM FROM JULIE KLEMENT DATED 14 MARCH 1994 To: Committee on International Nutrition/Institute of Medicine Through: USAID/Office of Nutrition From: Julie Klement, USAID/ENI/NIS/DIHHR, Chief of Health Programs Subject: USAID's Nutrition Survey and Surveillance Activities in Russia and the Newly Independent States (NIS) Background As part of the United States government's effort to work with the Newly Independent States (NIS) of the former Soviet Union as they make the transition to democracy and a free market economy, the U.S. Agency for International Development (USAID) established a Task Force in April 1992. In late 1993, as the emergency reaction to the break-up of the Soviet Union lessened, the Task Force merged with the Europe Bureau in an effort to streamline the Agency. However, it is clear that the 15 republics of the NIS continue to be in a state of social, political, and economic upheaval. Concerns are increasing regarding worsening health and living conditions; four of the republics are in a state of civil conflict. The USAID/NIS Office of Emergency and Humanitarian Assistance (EHA) is responsible for coordinating emergency food and medical activities. To date, nutrition activities supported by USAID in the NIS have been initiated primarily by EHA, thus focusing on emergency health conditions and immediate food security problems, However, as USAID shifts focus away from short-term emergency responses to health and nutrition problems, the Office of Democratic Initiatives and Health and Humanitarian Resources (DIHHR) is responsible for longer term health programs which focus on institutional development. The strategic objectives of DIHHR's program include: promoting vaccine and pharmaceutical security; supporting health care financing and service delivery system reform; strengthening health information and response capabilities; supporting women's reproductive health; and addressing selected critical country- or regional-specific health problems. Description Health/Nutrition Early Warning System USAID initiated early warning systems in the NIS to help monitor health and nutritional deterioration as a result of the increasingly precarious country situations. In September 1992, USAID entered into an Interagency Agreement (IAA) with the Centers for Disease Control and Prevention's (CDC) Emergency

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Public Health Information Surveillance System (EPHISS) program to provide assistance to health officials in three of the NIS Countries (Kyrgyzstan, Russia, and Uzbekistan). The purpose of the IAA was to strengthen their epidemiological information systems and provide timely warning of disease outbreaks. The system in Russia was initially designed to include a longitudinal survey on nutritional status, food consumption patterns, and purchasing power of the Russian population. However, due to project delays and lack of response from the government of Russia, the food surveillance component of the system was never achieved. Instead CDC conducted nutrition assessments in Russia and Kyrgyzstan. (The results of these assessments are included in the accompanying documents.) In December 1992, an EPHISS activity was started in Armenia. It is the only EPHISS in the NIS that includes pediatric and elderly nutrition monitoring. An output of this activity in Armenia is the monthly publication of a public health bulletin and supplemental bulletins that report longitudinal trends for specific indicators (e.g., pediatric nutrition). (Selected bulletins and reports of the Armenian EPHISS are included in the document for review.) Nutrition Surveillance As an emergency effort to assist in stabilizing the immediate food security problems throughout the NIS, particularly of vulnerable population, to date, USAID has provided $45 million in food commodities in the NIS. As part of this effort, CARE was awarded a grant to distribute and monitor U.S. government commodities and coordinate with other U.S. PVOs. In addition, CARE was responsible for monitoring food security among certain vulnerable population groups and collecting quantitative and qualitative information which was not available from any other source in the NIS. This information was thought to help in the development of early warning indicators regarding future food security for certain target groups. CARE conducted survey on pensioners in four of the republics and a survey on children under two years of age and mothers in Russia. (Description of these surveys are provided.) CARE Pensioner Surveys CARE surveyed pensioners twice (at 6-month to 1-year intervals) in five Russian cities (Moscow, Yekaterinburg, St. Petersburg, Irkutsk, and Gargarin), Kazakhstan, Uzbekistan, and Armenia from April 1992 to April 1993. The objectives of the pensioner survey were to: (1) identify high-risk groups of pensioners; (2) identify risk factors associated with pensioner malnutrition; (3) assess main aid support systems and other coping strategies used by pensioners to adjust for decreasing food supplies; and, (4) identify the most effective means of coordination and delivery of international food and economic aid.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities CARE Under Two-Years-of-Age Survey In April 1993, CARE conducted a survey of children under two-years of age in three Russian cities and outlying rural areas (Moscow, St. Petersburg, and Yekaterinburg). The survey's objective was to determine the nutritional status of young children and mothers and their “perceived hunger.” (Preliminary results are available on the urban sample and are included in the documents for review.) Anemia Surveys High rates of anemia among women and children have been reported throughout the NIS; however, the etiology and extent of anemia in the NIS is largely unknown. The USAID office of Nutrition funded anemia studies in Uzbekistan, Kazakhstan, and Russia using micronutrient funds designated for the NIS region. These studies examine the prevalence of anemia and investigate the etiology of the disease. Preliminary results are available from the Uzbekistan survey and are included in the review documents. The two other surveys, Russia and Kazakhstan, are in their preliminary stages; scopes of work/protocols for these two surveys are included in the review documents. Russian Longitudinal Monitoring Survey In 1992, the University of North Carolina began the Russian Longitudinal Monitoring Survey (RLMS) to establish a baseline and monitoring system of a wide-range of health, nutrition, and economic indicators which would aid in monitoring the health and nutrition status of a representative national sample. The project was launched with initial funding from the World Bank as well as the Russian government. USAID provided bridge funding from April 1993 through June 1994. Additional funding for the RLMS is currently being considered. Rationale As a result of these various nutrition-related activities carried out by a variety of organizations (e.g., U.S. government, universities, and PVOs) using varied protocols and procedures, DIHHR has requested assistance from the Office of Nutrition to convene a meeting of experts through the Committee on International Nutrition (CIN)/Institute of Medicine (IOM) to review selected nutrition surveys and related surveillance activities in the NIS. The purpose of this meeting is to review the findings of the various surveys with regards to the nutritional status of populations at risk, to recommend future survey/surveillance activities to be undertaken in the NIS and to recommend operational application of these findings to develop health and nutrition delivery programs which address the problems.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Issues USAID requests the CIN/IOM to review the accompanying background documents and make recommendations as to: the nutritional status and identification of potential issues of at-risk populations in Russia (e.g., pensioners, women, and children); indicators and methodologies that would be adequate (minimal safety net) and optimal for conducting nutrition monitoring systems in the NIS; and, how can USAID programmatically apply the current findings.