and treatment of diarrheal disease. The recommendations for nutrition assessment of very malnourished children are strongly developed. In contrast, the diagnosis and treatment of less malnourished children —who will be a large proportion of those to be managed—is less well thought out. The CIN, however, strongly supports the continued inclusion of, and attention to, moderately malnourished children in the SCI.

  • Another concern is the role of prevention of malnutrition in the SCI. The biggest concern is the appropriateness and feasibility of assessing child feeding practices and giving feeding advice to the mother or caretaker. Some components of the SCI feeding assessment and recommendations reviewed by the committee may be impractical and not feasible. The international community concerned with the SCI must give attention to the development of methods for identifying, facilitating, or establishing complementary community support systems and other means of supporting and achieving changes in child feeding practices. The committee recommends that these and related concerns be carefully addressed in the next phases of development of the SCI.

  • The nutrition community—including WHO and USAID—should be mobilized to become more involved in the development and validation of diagnostic tools, the feeding recommendations, and the effectiveness of the SCI, using a model similar to that followed so successfully in WHO's CDR (WHO, 1995). Experience in the diarrheal disease program has shown that the development of the nutrition components of the SCI will be a multiyear endeavor. The unresolved issues require a research agenda that would benefit from collaboration with one or more organizations that are capable of mobilizing scientists and the expertise required.

In conclusion, the committee recommends to USAID that it support endeavors to focus scientific expertise on resolving the outstanding questions concerning the nutrition components of the SCI. The more rapidly these are resolved, the more rapidly the SCI can be implemented, and the more effective it will be in reducing childhood malnutrition and its synergistic impact on child illness in developing countries.

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