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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
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Consideration of the Nutrition Components of the Sick Child Initiative

Committee on International Nutrition

Food and Nutrition Board

Board on International Health

INSTITUTE OF MEDICINE

Lindsay H. Allen and Christopher P. Howson, Editors

NATIONAL ACADEMY PRESS
Washington, D.C. 1995

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
×

National Academy Press
2101 Constitution Avenue, N.W. Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

This study was supported by the U.S. Agency for International Development under the terms of Grant No. HRN-5110-G-00-3043-00. The opinions expressed herein do not necessarily reflect those of the U.S. Agency for International Development.

Additional copies of this report are available in limited quantities from:

Food and Nutrition Board

Institute of Medicine

2101 Constitution Avenue, N.W.

Washington, DC 20418

Copyright 1995 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
×

COMMITTEE ON INTERNATIONAL NUTRITION

LINDSAY H. ALLEN (Chair),

Department of Nutrition, University of California, Davis, California

KENNETH H. BROWN,

Department of Nutrition, University of California, Davis, California

JEAN-PIERRE HABICHT,

Division of Nutritional Sciences, Cornell University, Ithaca, New York

EILEEN T. KENNEDY,

Center for Nutrition Policy and Promotion, Washington, D.C.

JOANNE LESLIE,

University of California-Los Angeles School of Public Health, and Pacific Institute for Women's Health, Los Angeles, California

GILBERT A. LEVEILLE,

Research and Technical Services, Nabisco Food Group, East Hanover, New Jersey

Liaison to the Committee

ALFRED SOMMER (Food and Nutrition Board),*

School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland

Staff

CHRISTOPHER P. HOWSON, Project Director

SUSAN M. KNASIAK, Research Assistant

JAMAINE L. TINKER, Financial Associate

*

Member, Institute of Medicine

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
×

FOOD AND NUTRITION BOARD

CUTBERTO GARZA (Chair),

Division of Nutritional Sciences, Cornell University, Ithaca, New York

JOHN W. ERDMAN, JR. (Vice Chair),

Division of Nutritional Sciences, University of Illinois, Urbana, Illinois

PERRY L. ADKISSON,

Department of Entomology, Texas A&M University, College Station, Texas

LINDSAY H. ALLEN,

Department of Nutrition, University of California, Davis, California

DENNIS M. BIER,

Children's Nutrition Research Center, Houston, Texas

FERGUS M. CLYDESDALE,

Department of Food Science and Nutrition, University of Massachusetts, Amherst, Massachusetts

MICHAEL P. DOYLE,

Department of Food Science and Technology, University of Georgia, Griffin, Georgia

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center Hospital and Tufts University Schools of Medicine and Nutrition, Boston, Massachusetts

SCOTT M. GRUNDY,

University of Texas Southwestern Medical Center, Dallas, Texas

K. MICHAEL HAMBIDGE,

Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado

JANET C. KING,*

U.S. Department of Agriculture Western Human Nutrition Research Center, Presidio of San Francisco, California

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio, Texas

ALFRED SOMMER,*

School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland

STEVE L. TAYLOR (Ex Officio),

Department of Food Sciences and Technology, University of Nebraska, Lincoln, Nebraska

VERNON R. YOUNG,

School of Science, Massachusetts Institute of Technology, Cambridge, Massachusetts

Staff

ALLISON A. YATES, Director

BERNADETTE M. MARRIOTT, Associate Director

GAIL A. SPEARS, Administrative Assistant

JAMAINE L. TINKER, Financial Associate

*

Member, Institute of Medicine

Member, National Academy of Sciences

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
×

BOARD ON INTERNATIONAL HEALTH

BARRY R. BLOOM (Cochair),*

Howard Hughes Medical Institute, Albert Einstein College of Medicine, Hastings-on-Hudson, New York

HARVEY V. FINEBERG (Cochair),*

Harvard School of Public Health, Boston, Massachusetts

JOHN H. BRYANT,*

Moscow, Vermont

JACQUELINE CAMPBELL,

The Johns Hopkins University School of Nursing, Baltimore, Maryland

RICHARD G. A. FEACHEM,

London School of Hygiene and Tropical Medicine, University of London, England

JULIO FRENK,*

Fundación Mexicana para la Salud, San Jerónimo Líce, Mexico

DEAN JAMISON,*

University of California, Los Angeles, California

EILEEN T. KENNEDY,

Center for Nutrition Policy and Promotion, Washington, D.C.

ARTHUR KLEINMAN,*

Harvard Medical School, Boston, Massachusetts

WILLIAM E. PAUL,

National Institute of Allergy and Infectious Diseases and Office of AIDS Research, National Institutes of Health, Rockville, Maryland

PATRICIA ROSENFIELD,

The Carnegie Corporation of New York, New York, New York

THOMAS J. RYAN,

Boston University School of Medicine and Boston University Medical Center, Boston, Massachusetts

SUSAN C. M. SCRIMSHAW,*

University of Illinois School of Public Health, Chicago, Illinois

JUNE E. OSBORN

(Institute of Medicine Liaison),* The University of Michigan School of Public Health, Ann Arbor, Michigan

WILLIAM H. FOEGE (Ex Officio),*

Carter Center, Emory University, Atlanta, Georgia

DAVID P. RALL,

(Institute of Medicine Foreign Secretary),* National Institute of Environmental Health Sciences, Washington, D.C.

Staff

CHRISTOPHER P. HOWSON, Director

KIMBERLY A. BREWER, Research Assistant

DELORES H. SUTTON, Project Assistant

JAMAINE L. TINKER, Financial Associate

*

Member, Institute of Medicine

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
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◆ ◆ ◆ ◆ ◆

Preface

Over the past 2 years there has been a growing awareness of the potential value for the U.S. Agency for International Development (USAID) to have a standing capability in the Institute of Medicine (IOM) for a more flexible, less costly response to agency needs for advice in the areas of nutrition, food, and health science policy. With support from USAID, the IOM responded in October 1993 by establishing the Committee on International Nutrition (CIN) under the aegis of the Food and Nutrition Board (FNB) and the Board on International Health (BIH).

The CIN's mandate is to answer questions of interest and concern, evaluate current nutrition activities undertaken by the agency, and make recommendations for future activities based on this review. Topics are chosen through systematic consultation with the Office of Nutrition in USAID's Bureau for Research and Development. Representing the areas of human nutrition, maternal and child health, epidemiology, economics, and program design and evaluation, the committee's six members will convene three times to produce brief reports that review specific programs, research projects, or project designs. With an initial project life of 18 months, the CIN is designed to be flexible (that is, capable of responding to specific nutrition concerns that arise abruptly) and to provide quick report turnaround.

This report is the result of the third meeting of the CIN, which was held on 19–20 January 1995. The purpose was to comment on the nutrition components of the World Health Organization's (WHO) initiative to integrate the management of childhood illness. This is often called the “Sick Child Initiative” (SCI). The report was requested by USAID's Office of Health and Nutrition, a primary funding source for the initiative, on 8 December 1994. The CIN wishes

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
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to emphasize that the report was not requested by WHO and that WHO was not represented at the CIN meeting. Also, in spite of a major effort on WHO's part to share its latest documents with the CIN, the committee is aware that it did not have access to much of the relevant documentation. This report, then, does not represent a thorough scientific review of WHO's contribution to the nutrition components of the SCI. Rather, it should be viewed as a series of general observations concerning the draft documents available to the committee that are intended to expand the process of thinking about how to combine nutrition assessment, treatment, and advice into the integrated management of sick children and the maintenance of adequate nutrition and health.

CHARGE TO THE COMMITTEE

The initial charge to the committee by USAID was as follows:

Drawing on the scientific and technical knowledge of individual members, background information and other pertinent data, the Committee is requested to make recommendations as to: (1) practicality of the nutrition components of the (SCI) algorithm; (2) whether the nutrition components of the algorithm should or should not be modified, and if to be modified, how; and (3) the additional information or data required to improve the performance of the integrated management of childhood illness algorithm's nutritional effectiveness.

Further background information and details on USAID's initial request to the CIN can be found in the memorandum to the committee from Samuel G. Kahn, USAID Office of Health and Nutrition (Appendix A). In addition to this initial request, on the first day of the meeting Caryn Miller of the USAID Office of Health and Nutrition requested that two additional questions be considered: (4) how can nutritional components be monitored during field testing or introductions, and (5) what should the role be for those with experience and expertise in nutrition as field testing or introduction evolves?

During the 2-day meeting, the CIN reviewed background information supplied by USAID. The documents that will be referred to most frequently are: “Assess and Classify the Sick Child Age 2 Months up to 5 Years ”; “Advise the Mother”; “Treat the Child”; “Management of Childhood Illness,” February 1995 drafts; “An Integrated Approach to Management of Childhood Illness: Development and Research Activities,” 4 March 1994 draft; and “Integrated Management of Childhood Illness: Research Priorities,” January 1995 draft. These documents were all generated by WHO. Additional documents available to the committee are listed in Appendix B.

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
×

ORGANIZATION OF THE REPORT

The report contains four chapters and four appendixes. Chapter 1 provides background information on the SCI, the charge to the committee, and the scope of the committee's deliberations. Chapter 2 describes the nutrition algorithms in the SCI. In Chapter 3, the committee presents its responses to the five questions posed by USAID. Although the committee was not asked specifically to consider SCI in the larger context of health care and child welfare, it believes strongly that integration of SCI activities with other local resources for the treatment and prevention of illness and disease, including malnutrition, will be required for SCI to be most effective. Thus, the committee ends Chapter 3 with suggestions toward this end. The committee's overall summary and conclusions are presented in Chapter 4.

Appendix A contains the USAID memorandum outlining the initial charge for this third CIN meeting. Appendix B offers guidance for further development of the diagnostic screens used in the SCI and comments on the nutritional diagnosis and management strategies for the three categories of children that will be identified. Appendix C lists references to articles made available to the committee members, and Appendix D provides excerpts of important components of the nutrition algorithms.

ACKNOWLEDGMENTS

The committee gives special thanks to the USAID staff from the Office of Health and Nutrition, who gave graciously of their time in providing information for the report. These included Susan Anthony, Al Bartlett, Kevin Callahan, Eunyong Chung, Cate Johnson, Caryn Miller, Samuel G. Kahn, and Andrew Siderski. The committee also thanks the following individuals for their important contributions to the evidentiary base considered in the preparation of the report: Robert E. Black, The Johns Hopkins School of Hygiene and Public Health; Caryn Bern, Centers for Disease Control and Prevention; Joanne Csete, United Nations Children's Fund (UNICEF); Katherine L. Dickin, The Manoff Group, Inc.; Mary S. Lung'aho, WellStart; and Ronald Waldman, The Basics Project. The committee would also like to express its appreciation to the IOM staff who facilitated the work of the CIN: Christopher P. Howson, study director; Jamaine L. Tinker, financial associate; Michael Edington, managing editor; Caroline McEuen, copy editor; Claudia Carl, administrative associate; and Gail Spears, administrative assistant. The committee especially thanks Susan M. Knasiak, research assistant, for her help in conducting the third meeting and for her valuable editorial advice in preparing the report draft. Finally, the committee thanks Richard G. Seifman, formerly at USAID; Polly

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
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Harrison, IOM; and Catherine Woteki, formerly of the FNB, for their vision and hard work in realizing this project, and Allison A. Yates, FNB, for her collaborative support of the CIN's activities.

Lindsay H. Allen, Chair

Committee on International Nutrition

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Consideration of the Nutrition Components of the Sick Child Initiative. Washington, DC: The National Academies Press. doi: 10.17226/9542.
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