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INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1990; 20(4):691-715.PAHO followed nutrition programs of Brazil, which have been supported almost exclusively from internal sources, since 1983 to provide technical assistance and to learn what may be applied to other countries. The PAHO program effectiveness evaluation study compared 2 ways of running nutrition programs which presumed that malnutrition was mainly caused by poverty--a subsidy of basic foods and direct distribution--between 1974-1986. 2 programs subsidized at least 4 basic foodstuffs with 1 program restricting the amount of food to identified families while the other allowed any family coming to stores in low income areas that participated in the program to take subsidized food. 2 other programs either gave free traditional commercial foods or specially formulated supplements to identified clients. The status of most well nourished or malnourished participants did not change despite intervals as long as 48 months. Moreover the nutritional status of a considerable percentage of participants deteriorated. Nevertheless moderate or severe malnourished children who started in a program tended to recover substantially, especially children >1 year old. Further the longer a client participated in a program the more likely the nutritional status would improve, yet frequent participation did not affect status. Thus the programs were more likely to cure than prevent malnutrition. Besides participants tended to not grow much, but weight status did improve. Those programs that also provided medical care and health education were more effective than those that just provided subsidies. This finding highlights how malnutrition is not just a problem of low income and low food consumption, but also a problem of poor health. The programs did not transfer benefits efficiently. In addition, the costs of securing the food, its poor quality, and insufficient volume discouraged beneficiary participation.
British Journal of Family Planning. 1984 Jul; 10(37):37.This editorial takes a broad, international look at the worldwide implications of decisions taken in the United Kingdom (U.K.) and the US with regard to family planning. National authorities, like the U.K. Committee for Safety of Medicines (CSM) of the US Food and Drug Administration, address issues concerning the safety of pharmaceutical products in terms of risk/benefit ratios applicable in their countries. International repercussions of US and U.K. decision making must be considered, especially in the area of pharmaceutical products, where they have an important world leadership role. Much of the adverse publicity of the use of Depo-Provera has focused on the fact that it was not approved for longterm use in the U.K. and the US. It is not equally known that the CSM, IPPF and WHO recommeded approval, but were overruled by the licensing agencies. The controversy caused by the Lancet articles of Professors with family planning doctors. At present several family planning issues in the U.K., such as contraception for minors, have implications for other countries. A campaign is being undertaken to enforce 'Squeal' laws in the U.K. and the US requiring parental consent for their teenagers under 16 to use contraceptives. In some developing countries, urbanization heightens the problem of adolescent sexuality. Carefully designed adolescent programs, stressing the need for adequate counseling, are needed. Many issues of international interest go unnoticed in the U.K. International agencies, like the WHO and UNiCEF, have embarked on a global program to promote lactation both for its benficial effects on an infant's growth and development and for birth spacing effects. It may be of benefit to family planning professionals in the U.K. to pay attention to international activity in such issues.