Jrkshop on Home and Village Prepared Supplementary Food Practices in Asia

ARCHIV GRAHAM no. 2 JRKSHOP ON HOME AND VILLAGE PREPARED SUPPLEMENTARY FOOD PRACTICES IN ASIA

MICHAEL GRAHAM AN àMJA.I WICHAIDIT ARES VALYAS IDRC - Lib 7 PROCEEDINGS OF WORKSHOP ON HOME AND VILLAGE PREPARED SUPPLEMENTARY FOOD PRACTICES IN ASIA EDITORS MICHAEL GRAHAM ANDREW ST(ICKEY SOMJAI WICHAIDIT AREE VALYASEVI VEIOPMENT qE,

FS PoUN LE wEo ORGANIZED BY THE INSTITUTE OF NUTRITION MAHIDOL UNIVERSITY, BANGKOK, THAILAND AND INTERNATIONAL DEVELOPMENT RESEARCH CENTRE OTTAWA, CANADA

28-30 OCTOBER, 1983 GARDEN ROOM, IMPERIAL HOTEL WIRELESS ROAD, BANGKOK, THAILAND First Printing 3,000 Copies April 1984

Published by: Prayurawong Co., Ltd. 58 Thetsaban 1 Rd. Bangkok 10600.

Telephone : 465.1412, 465-2718, 466-1358 PROCEEDINGS OF WORKSHOP ON HOME AND VILLAGE PREPARED SUPPLEMENTARY FOOD PRACTICES IN ASIA

Organizers of the workshop. Dr. Aree Valyasevi Dr. Sakorn Dhanamitta Mr. Christopher MacCormac Dr. Somjai Wichaidit List of Working Group Ms. Thara Viriyapanich Mr. Michael Graham Mr. Andrew Stuckey Mr. Smarthachai Santawanpas Mrs. Anya Maneechai Mrs. Songsri Prachaban Ms. Amara Sooksangpreng Ms. Chariya Tusnanchalie Objectives of the workshop ] . To share and exchange ideas, knowledge and experiences of supplementary food processing and distribution. 2. To develop guidelines for the production of supplementary food at various levels applicable to Asian countries. 3. To identify the needs for further development activities in the area of supplementary food processing and distribution. Table of contents Page Program Agenda ...... 1 Report from Dr. Aree Valyasevi ...... 3 Introductory remarks: Mr. Christopher MacCormac ...... 5 Welcome address: Dr. Natth Bhamarapravati ...... 7 Opening address: H.E. Preeda Pathanathabutr ...... 9 Introduction ...... 13 Curreni situation ...... 14 Ways to overcome constraints in the current situation ...... 15 Future research and development needs ...... 16 Recommendations ...... 17 Current situation on formulation and product development : M.S. Narasinga Rao ...... 19 Rural food technology F. G. Winarno & Yati Haryadi ...... 23 Distribution and promotion of supplementary food : Paichit Pawabutr 27 Case studies Thailand Sakorn Dhanamitta, Kraisid Ton tisirin ...... and Aree Valyasevi ...... 33 Philippines Josefa S. Eusebio ...... 38 Korea Soojae Moon ...... 41 Country reports Pakistan Tajammal Hussain ...... 47 Indonesia F. G. Winarno and Rizal Syarief...... 51 Sri Lanka B. V. de Mel ...... 53 India P. Pushpamma ...... 55

Thailand Pattanee Winichagoon, Paichitr ' Pawabuir, Sakorn Dhanamitta, Somjai Wichaidit, Aree Valyasevi ...... 59 Malaysia Zanariah Jiman ...... 63 China Ying Ch ang ...... 66 List of participants ...... 69 Programme October 28, 1983 08.30-09.00 Registration 09.00-09.30 Report from the organizer Prof. Dr. Aree Valyasevi Director, Institute of Nutrition Message from IDRC representative Mr. Chirstopher MacCormac Program Officer, IDRC Welcome address Prof. Dr. Natth Bhamarapravati Rector, Mahidol University Opening address Mr. Preeda Pathnathabutr Minister of University Affairs 09.30-10.00 Coffee Break 10.00-12.00 Chairperson: Dr. Aree Valyasevi Current situation on formulation and product development Dr. M.S. Narasinga Rao Rural food technology Dr. F.G. Winarno Distribution and promotion of supplementary food Dr. P. Pawabutr 12.00-13.00 Lunch 13.00-15.00 Chairperson: Dr. J.S. Eusebio Country reports Pakistan: Dr. T. Hussain Indonesia: Dr. F.G. Winarno Sri Lanka: Dr. B.V. de Mel India: Dr. P. Pushpamma Discussants: Dr. M.S. Narasinga Rao, Dr. S. Moon 15.00-15.30 Coffee Break 15.30-17.00 Chairperson: Dr. F.G. Winarno Case studies Thailand: Dr. S. Dhanamitta Korea: Dr. S. Moon

1 October 29, 1983 08.30-10.00 Chairperson: Dr. P. Pushpamma Country reports Thailand: Ms. P. Winichagoon Malaysia: Ms. Z. Jiman China: Dr. Y. Chang Discussants: Dr. J.S. Eusebio Dr. F.G. Winarno 10.00-10.30 Coffee Break 10.30-11.15 Case study Philippines: Dr. J.S. Eusebio 11.15.12.00 Small group discussion 12.00-13.00 Lunch 13.00-17.00 Small group discussion

October 30, 1983 09.00-10.00 Chairperson: Mr. C. MacCormac Presentation of small groups' reports 10.00-10.30 Coffee Break 10.30.12.00 Conclusion Development of guidelines & recommendations 12.00-13.00 Closing

2 Report Froin Dr. Aree Valyasevi

Your Excellency, Rector, distinguished guests, ladies and gentlemen:

The Institute of Nutrition, Mahidol University,has taken the opportunity to organize this workshop since, as you ail know, Thailand has the honour of hosting the Fourth Asian Congress of Nutrition, which will begin next week. There will be approximately 400 nutritionists from Asia, Europe, and America and another 500 from Thailand in attendance. The theme of the congress is "Better nutrition, Better life". In keeping with the Congress theme, this workshop on "Home and Village Supplementary Food Practices in Asia" is most relevant and serves as an excellent pre-congress deliberation. We ail recognize that Protein-Energy Malnutrition in infants and young children is one of the most important health problems in developing countries. One solution to this which has been employed in several developing countries is the provision of supplementary food to those suffering from severe and moderate malnutrition. However, this supplementary food was usually produced at a central location because production required sophisticated and expensive technology and often, raw ingredients were used which were unavailable in the rural areas. This centrally produced supplementary food then had to be distributed throughout the country to areas where it was needed. The problems inherent in a national distribution system are numerous. The expense of transportation is very high, and the logistics and management of such a system are difficult. The time consumed during distribution shortened the "shelf life" of these foods leading to wastage and low acceptibility. In light of these problems, presently the local, decentralized production of supplementary foods is being emphasized. Community involvement is a fundamental aspect of this, and once the technical requirements for supplementary foods formulation have been determined, the production, storage, and distribution of supplementary foods will require the development of appropriate skills and technology for rural areas, Maximum community participation is essential for the success of this scheme. 3 The programme of this workshop will present background papers on supplementary food formulation and development, rural food technology, and supplementary food distribution and promotion. In addition there will be country reports describing the status of supplementary food in several Asian countries and case studies detailing different implementation projects in Thailand, Korea, and the Philippines. After these reports the workshop will break into small groups to discuss these pertinent issues from the reports and discussions. This workshop is intended to lead to the development of some guidelines for the production and distribution of supplementary food at various levels applicable to Asian countries. Furthermore, the future needs in the area of supplementary food processing are expected to be determined here. These recommendations or guidelines can then be distributed to any other concerned organizations as well as be made available to the Fourth Asian Congress of Nutrition. It is our hope that we will be able to achieve these objectives during these three days of deliberations. I should like to take this opportunity to thank the IDRC for their generous support in bringing many of the participants to this workshop. Special thanks are given to the staff of the Singapore office, especially to Mr. Cristopher MacCormac. Finally, I would like to thank His Excellency, the Minister of University Affairs, for honouring us with his attendance at the opening ceremony of our workshop. Thank you.

4 INTRODUCTORY REMARKS Mr. Christopher MacCormac

On behalf of the International Development Research Centre (IDRC), I wish to extend a warm welcome to all of the participants here today. IDRC is pleased, and I know, fortunate, to be able to join with you as concerned scientists in your attempts to find solutions to the problems of malnutrition in Asia. Typically, this malnutrition is comprised of protein-calorie malnutrition, iron deficiency anaemia and vitamin A deficiency. These deficiencies tend to occur or are found most commonly in low-income groups and in those groups with relatively greater nutritional requirements i.e. infants, pre- schoolers, and pregnant and lactating women. The first two of these groups are made up of individuals who are especially vulnerable in society as they have little or no choice as to the kinds and quantities of the food they con- sume. The causes of malnutrition are many, and the relative importance of each can vary by location, income, public policy, and other reasons. The causes themselves are many but generally fail into the categories of food availability, incomes and prices of foodstuffs, consumer tastes and attitudes, patterns of food preparation, general health, and sanitary conditions. In the period since the Second World War, public and private institutions world-wide have developed and implemented numerous programs of agricultural and nutrition research, development projects, food transfers and food subsidies, food price policies, food fortification, health and nutrition education, formulated fonds and supplementary feeding. Few such programs are distinctly separate in themselves but contain elements of more than one such activity. I believe that this workshop will deal largely with the subject of supplementary feeding and formulated foods. In 1979 and again in 1980, two major studies were undertaken to review the effects of supplementary feeding projects. Case studies in Guate- mala, India, Colombia, Mexico, Canada, and the United States showed that positive results could be demonstrated, but that often these benefits were 5 Iimited. The results of these studies were also inconclusive as to the cost- effectiveness of such programs for large groups. What was conclusive however, was the need for further research on this subject; research in the fields of health, nutrition, and socio-economics and not necessarily in isolation. In aggregated form, the major research needs proposed were: (i) What is the minimum quantity of food that must be distributed, it's regularity and over what duration? (ii) What are the causes of and effects of food "leakages" i.e. shared and/ or substituted for other food in the diet? (iii) What are the benefits of supplementary feeding besides growth and birth rate? (iv) What are the criteria for developing an effective delivery system? (v) Are supplementary feeding programmes effective in isolation or should they be linked with other programmes? (vi) How can the community be involved in programme design and implementation? (vii) By what criteria should supplementary feeding programmes be evaluated? It is against this background of problems and issues that IDRC has been supporting research in Asia (and elsewhere) in the general area of "supplementary feeding". This is through research projects on improving the quantity and quality of legumes consumed in the traditional diets and in supplementing these diets. The on-going research efforts of Drs. Aree, Pushpamma, Eusebio, and Tipvanna, and their staffs, are an important step in furthering this research in Asia. In view of the fact that the IVth Asian Nutrition Congress will be held here in Bangkok immediately after this meeting, IDRC recognizes that the conclusions and recommendations developed here, as a resuit of your pre- sentations and discussions, will contribute significantly to the Congress.

6 WELCOME ADDRESS Dr. Natth Bhamarapravati

Your Excellency, the representative of IDRC, Dr. Aree, distinguished participants, ladies and gentlemen:

I am delighted to have the honour of welcoming all of you to Thailand for this workshop. And as all of you are expert in nutrition, there is no need to reiterate the importance of nutrition problems as a major deterent to national development among countries such as Thailand. It pleases me to say that we at Mahidol University have recognized the importance of and the challenge of nutritional problems and have built up an infrastructure after a number of years to make it possible for us to cope with this challenge; hopefully in a much more satisfactory manner. The theme of our university at present is to try to be competent from the molecular level to the community level and nutrition is one discipline that cuts through all of these levels. At the fundamental level we have programs in the department of biochemistry, micro- biology, and immunology which deal with nutritional problems from these basic science's disciplinary standpoint. We have a Center for Genetic Engi- neering and a Center for Biotechnology which hopefully will bring very important scientific resources to back up these fundamental studies in the years to coure. Units and departments of nutrition exist in the two medical schools and the school of Tropical Medicine and the faculty of Public Health. In addition, the Institute of Nutrition of which you know very well, thanks to the leadership of Dr. Aree, has become a pillar of strength of the University in coordinating the development of various nutritional programmes from the research, educational, and training standpoints. The application of the results of these activities will hopefully bring about a major improvement in the nutritional condition of our peoples in the near future. The effector mecha- nisms for the delivery of the results of research work is, of course, shared also by a number of units in the university. The Institute of Nutrition, as I have 7 mentioned earlier, plays a leading role in this effective delivery of nutritional service right to the peripheral level. We also have an ASEAN Center for Pri- mary Health Care Development which began operations in October 1982. Hopefully, this center will provide a research and development service to the Ministry of Public Health for an effective national Primary Health Care Pro- gramme. The Center could become an effective focusing point to integrate ail of the various technical activities at the village level, in fact, right through to community initiated and community supported primary health care. We also have the Institute of Language and Culture for Development which is concentrating on an effective study of the beliefs, traditions, and cultures of the village people. Cultural anthropology research programs have been set up to study the four regions of the country. Hopefully, the result of this could also be effectively utilized in further promoting nutrition delivery service. A Center for the Biology of Behavior is also being established. And this should have an important role in the clarification of the behavioral changes of the people in rural areas; not only in the field of nutrition but also toward other areas, where modernization and technology transfer are being implemented. With these various infrastructures of the university's from the molecular to the village level, we hope that we could be in a strong position to cope with the developing nutritional problems or evolution of nutritional development of the country in the years to come. We are very grateful that ail of the ex- perts in nutrition have made their time available to come to this workshop. and I understand that ail of you will be attending next week a very important Asian Congress of Nutrition which again is being organized under the able hands of Dr. Aree Valyasevi. I would like to thank the IDRC for supporting this workshop. IDRC has been in cooperation with and shares a strong interest in development with various research groups at Mahidol University and has given generous assistance to a number of our projects in the past. I would like to express my best wishes for your successful deliberation during this conference and I hope that your stay with us will be an enjoyable one. Thank you very much.

8 OPENING ADDRESS H.E. Preeda Pathanathabutr Ministry of University Affairs

It is my great pleasure to be here at this pre-congress workshop on "Home and Village Prepared Supplementary Food Practices in Asia". It is hoped that all the recommendations and guidelines from this workshop will be presented at the Asian Congress of Nutrition, of which you are already aware. It is recognized that the first years of life are crucial in laying the foundation of good health and improving the quality of life. The report of the Nutrition Division of the Department of Health showed that 36 percent of preschool children in Thailand fall into first degree malnutrition with 13 percent and 2 percent into second and third degree malnutrition, respectively. The problem is most serious in the rural poverty areas and the urban slums. During the Fourth Economic Developrnent Plan period, despite the implementation of many strategies embodied in the food and nutrition plan, certain strategies were not able to effectively solve nutrition problems. The provision of supplementary food from the central part of the country met only 30 percent of the total requirement and it was irregular. During the Fifth Plan Period (1982-1986) several targets have been set for the implementation of food and nutrition policies, such as: Provision of supplementary food High protein and energy food will be distributed to 230 thousand pre-school children with third degree protein-energy malnutrition through child nutrition centers. Promotion of high nutritive food production at local level High nutrient and protein supplementary food will be promoted through the dissemination of information and increased skills of the people for production with emphasis placed on those families whose members are malnourished in the 246 districts located in poverty areas. 9 Therefore, the objectives which have been laid out for this workshop are very sound indeed. I am very pleased to know that this workshop will contribute greatly to National Food and Nutrition Policies. It is essential for mothers to give supplementary foods in addition to breastfeeding. In the past, supplementary feeding programmes relying on donated food faced tremendous problems. Our present Food and Nutrition plan has therefore emphasized self-reliance and community participation for the production of supplementary food at the village level. Nutrition funds have been established by using supplementary foods as a tool to encourage the participation of the community. This has been quite successful. However every country has its own different aspects of the problem, and available resources. I hope this workshop will enable you to explore these differences, as well as to find common ground between us. The open discussions which will take place here over the next three days, will guide those of us seeking solutions to the problems which confront all of us in improving the nutrition of the rural poor.

I wish you great success during these three days of the workshop and a pleasant stay in Thailand. May I now declare this meeting open. Thank you.

10 INTRODUCTION

It is well recognized that protein-energy malnutrition is one of the most important health problems in developing countries. The prevalence of protein-energy malnutrition in Asia and the Middle East ranges from 20 to 80 percent of preschool children. During preschool age, nutritionally poor supplementary food and an unhygienic environment are principal causes of protein energy malnutrition in developing countries. One solution to this which has been employed in several developing countries was the provision of supplementary food to those suffering from severe and moderate malnutrition. However, this supplementary food was usually produced at a central location because production required sophisticated and expensive technology and often, raw ingredients were used which were unavailable in the rural areas. This centrally produced supplementary food then had to be distributed throughout the country to areas where it was needed. The problems inherent in a national distribution system are numerous. The expense of transportation is very high, and the logistics and management of such a system are difficult. The time consumed during distribution shortens the "shelf-life" of these foods leading to wastage and low acceptibility. In light of these problems, presently the local, decentralized production of supplementary foods is being emphasized. Community involvement is a fundamental aspect of this, and once the technical requirements for supplementary food formulation have been determined, the production, storage, and distribution of supplementary foods will require the development of appropriate skills and technology for rural areas. Maximum community participation is essential for the success of this scheme. In achieving this, it is realized that some guidelines for the production and distribution of supplementary food at the home and village level should be developed. Further- more, the future needs in this area should also be investigated. Therefore, this workshop on "Home and Village Prepared Supplementary Food Practices in Asia" was organized by The Institute of Nutrition, Mahidol University and the International Development Research Centre (IDRC). The workshop was held in Bangkok (28-30 October) with approximately 50 participants from 13 countries, mostly from the South East Asia region. The workshop programme presented background papers on supplementary food formulation and development, rural food technology, and supplementary food distribution and promotion. In addition, there were country reports, describing the status of supplementary food in several Asian countries and case studies detailing different implementation projects in Thailand, Korea, and the Philippines. After these reports the workshop broke into small groups to discuss the pertinent issues from the reports and discussions. The results of the workshop are summarized as follows:

13 CURRENT SITUATION Most Asian countries recognize the importance of supplementary food and have developed supplementary food programs. However, there still remains a certain lack of understanding about the specific rotes supplementary foods can play. Efforts should be made to educate the national populations about the importance of supplementary foods. However, supplementary food programmes have to be linked up with other programmes such as environmental sanitation, supply of clean water, etc., otherwise their impact may sot be felt. Most supplementary foods utilize raw materials such as cereals, legumes, and oil seeds, though some countries also use fish and other animal products for preparing supplementary foods. Most of the supplementary food produced at village level emphasizes only high protein and calorie content, not micro-nutrients and vitamins. Most of the indigenous traditional and fermented foods have not been utilized as important components in supplementary food production. Much of the supplementary food produced uses traditional methods of processing which can be tirne consuming, unhygenic, and produce foods of poor quality with low taste acceptability. In several countries supplementary feeding programmes have been in operation for only short periods and it is too early to evaluate the impact on nutritional status of supplementary feeding. Studies, programmes, and projects often do not have clear and specific objectives as bases for evaluation : i.e. a) as an intervention program to correct severe malnutrition (3rd degree). b) as a tool for nutrition education c) as an entry point/composent of development programs d) as a short-term measure during emergencies e.g. floods, droughts, etc. The objectives should be one or a combination of the above. Avail- able indicators for measuring impact and monitoring are limited. Those monitoring indicators used are usually concerned with nutritional composition, mainly energy and protein, and the effect of processing. Monitoring done in processing is mostly in regard to the processed mixtures, of equipment for roasting and grinding, and packaging and distribution. Usually, impact evaluation generally includes: anthropometry - Ht/wt for age acceptability of food formulations Regarding production, processing, distribution, and promotion:

- there is not an organized system of monitoring at village level economic feasibility is not included in the project 14 lack of local participation developed product mixtures are usually models only done on pilot scale political commitment is limited to the promotion of small and medium scale production Regarding feeding schemes: foods are distributed free to target beneficiaries, therefore subsidized - foods are mostly take-home system of delivery and also free for target beneficiaries children with second degree malnutrition are often not included in the distribution of free foods whereas often 3rd degree malnourished are given supplementary foods for free through various schemes

WAYS TO OVERCOME CONSTRAINTS IN THE CURRENT SITUATION To increase production of local raw materials to substitute for im- ported crops. - New suitable and nutritious food materials for supplementary foods should be introduced and encouraged. The development of appropriate processing methods. Need for designing, constructing and testing of appropriate machinery for village level supplementary food production. - Need to identify problems associated with different strategies of production and distribution. Encourage the use of mass media and other promotion techniques to motivate mothers to use supplementary food. There should be clear and specific objectives for each supplementary feeding programme and project as a reference for future evaluation. Pre-project surveys should be conducted in the project area, and collect the following information : a) major nutritional deficiencies b) causes of malnutrition c) food habits, acceptable foods for child feeding d) family resources, e.g. food availability, income, and purchasing power, etc. e) Potential scope of community participation in product development f) Survey sampling should use a minumum size based on the requirements for statistical analysis. 15 - Identify indicators for monitoring and evaluation

a) For evaluation : In addition to anthropometry, the following are suggested : - total development of the child e.g. mental, psycho- motor, etc. functional performance, mainly resistance to infection as measured by morbidity and mortality.

b) For monitoring : Indicators suggested are actual quantity of food consumed by target beneficiaries keeping quality of cooked food cooking practices including time of cooking and cost of energy sanitation and hygiene of food preparation and feeding economics of production including viable size of production unit quality control of raw materials at stage of procurement storage and shelf life community participation appropriate training of field staff

FUTURE RESEARCH AND DEVELOPMENT NEEDS 1. Research is to be conducted for identifying and testing indicators and parameters suitable for measuring the total development of the child for impact evaluation. 2. Methods of research should be developed allowing for community participation. 3. Simple and inexpensive tools for monitoring, eg, growth charts and health charts (for recording health status and treatment) should be developed. 4. Identifying the package of services required to derive full benefit of the programme. 5. Assessment of the relationship of developmental activities e.g. increased food production, employment, education, income-generation, local market systems development, etc, to existing levels of nutritional status. 6. Models of integration of developmental activities with supplementary feeding & nutrition education programmes should be tested. 7. Testing of the comparative cost-benefit effectiveness of supplementary feeding or nutrition education on development activities. 8. Identification and use of alternate and cheaper raw materials and development of simpler and appropriate technologies to produce food 16 supplements. 9. Adaptation of methods of germination and sprouting of cereals, legumes, etc. for the preparation of food supplements. 10. Research and development on the utilization of fermented (and other) foods for supplementary food production. 11. Studies to increase the storage life of the raw materials and shelf life of the finished product. 12. Study the appropriateness of the distribution of food supplements from a centralized location directly to the individual family. 13. Encourage joint efforts in research and implementation both among research institutions and implementing agencies in improving the nutrition status of the population. 14. To encourage joint research among research institutions in Asian countries in tackling malnutrition. 15. To create a mechanism for exchanging current and past information among research institutions, implementation organization and among Asian scientists. 16. A worldwide network on supplementary food and feeding information should be established with the support and cooperation of UN agencies e.g., UNICEF, WHO, FAO, UNESCO, etc.

RECOMMENDATIONS Inclusion of monitoring and evaluation plans in project proposais emphasizing process, output, and impact. Product development should be based on the nutritional needsand feeding patterns of the population to be served. In assessing the nutritional needs, emphasis should be given to nutrients, e.g. minerais and vitamins, in addition to energy and protein. Bulk, being the major constraint in feeding the infant with a cereal and legume based diet, high protein and calorie density products should be the major consideration. The quality of the product should be monitored at ail stages, from procurement to consumption in the following aspects : a) nutritional content b) microbiological quality c) toxicological safety Cost-effectiveness and cost/benefit should also be part of monitoring and evaluation. Training to ail concerned in implementation of the programme on the following aspects should be included. creating awareness in the mothers of the importance of supplementary feeding.

17 motivation techniques for increasing local participation. - handling of the production equipment, packaging, and distribution. quality control of the product. use of tools for evaluation of the program. The prospective donors for supplementary food research and programmes should consider taking appropriate action to meet the suggestions for cooperation made by this workshop.

18 CURRENT SITUATION ON FORMULATION AND PRODUCT DEVELOPMENT M.S. Narasinga Rao

To combat protein-calorie, iron, and vitamin A deficiencies various nutrition programmes have been started by the Central Government and State Governments in India. The major component of these programmes is the provision of a nutritious food supplement. In addition, prophylactic doses of vitamin A (twice a year), and the use of iron-fortified sait are practiced. The ideal solution to this problem is the provision of sufficient food to everybody, if necessary by Government subsidy. However, such a solution is beyond the financial capacity of the Governments. Therefore short range and long range solutions are needed. Various nutrition programmes corne under this category. The parameters one should look for in foods needed for the feeding programmes are: (1) the fonds should have adequate protein and calorie content; (2) the biological value of the proteins should be high; (3) the food should be acceptable to the recipient, and should as far as possible, be similar in form and taste to the foods ordinarily consumed by the community; (4) the foods should be preferably in a ready-to-eat form or should require minimum cooking; (5) when cooked the food should not be very bulky, in other words the calorie-density should be high; and (6) the cost should be reason- able. Perhaps one can add to the list, that the food should have a "prestige" value. Nutrition programmes are generally of two types. In the "take-home" type the food is given to the beneficiaries to be cooked and consumed at home. Such a procedure suffers from the disadvantage that the food is extensively shared in the family and the beneficiary does not get his due share. In the other type of programme, the food is centrally-cooked and served to the beneficiaries. This calls for a sanitary kitchen and a clean suppiy of drinking water. In India, several types of nutritious food supplements have been used, including: (1) Indian Multipurpose Food; (2) Bal-Ahar; (3) Corn-Soya-Milk (CSM); (4) Energy Food and (5) extruded foods.

19 Indian Multipurpose Food (MPF) This product contains three parts of edible groundnut flour, one part of Bengalgram (Chickpea) flour, and is fortified with minerais and vitamins. MPF is prepared as follows. Groundnut kemels are cleaned to remove foreign matter, lightly roasted in an electric roaster, and the cuticle is removed. The decuticled kernels are crushed in an expeller. The cake that is obtained is coarsely ground and the grits (0.42.1.27 mm) are separated. The groundnut cake grits are roasted until a pleasant aroma is developed. Bengalgram dhal (split legume, free from husk) is cleaned, roasted in a revolving electric roaster, and finely ground. Spices such as coriander seeds, black pepper, cinnamon bark, turmeric, and asafoetida, are mixed together, lightly roasted in the presence of a little hydrogenated fat, and coarsely ground. A mixture containing vitamin A, D, thiamine, riboflavin, and calcium phosphate is prepared in groundnut flour. Vitamin A and D are not water soluble and are added after dissolving in hydrogenated fat. The food has a high protein content (40%). The main disadvantage of the food is that it is not ready-to-eat and needs to be cooked into an acceptable food. Extrusion cooking of MPF has been attempted; however, it has not been extensively used.

Bal-Ahar and CSM Bal-Ahar is a blend of unroasted ingredients prepared by grinding and mixing. The ingredients are either wheat flour, groundnut flour, and skim milk powder or wheat flour, groundnut flour/soyabean flour/Bengalgram flour. Minerais and vitamins are added the same way as in MPF. CSM is a mixture of corn, soyabean, and milk supplied by CARE. The nutritive values of Bal-Ahar and CSM are similar. Like MPF, Bal-Ahar (and CSM) needs cooking into an acceptable food. Further, the shelf-life of Bal-Ahar is not high. Because of these limitations, MPF and Bal-Ahar have not been extensively used in nutrition programmes. Although foods such as MPF and Bal-Ahar suffer from these draw- backs, completely precooked and dried foods such as bread and biscuits would be costly for nutrition programmes, but they do have a "prestige" value. An alternate to completely precooked and ready-to-eat products are foods prepared from roasted ingredients that are sweetened with unrefined or refined sugar. Roasting partially gelatinizes the carbohydrates in the cereals and pulses and makes them more easily digestible, develops a pleasant aroma that makes the food more acceptable, and reduces insect infestation. Using these concepts, several types of "Energy Foods" have been developed at CFTRI. The preparation of the food is simple and does not

20 involve sophisticated and costly equipment. The steps involved are: (1) pre- cleaning of the cereals and pulses; (2) roasting of the ingredients; (3) grinding; (4) blending of the powdered ingredients; (5) adding a vitamin premix, iron sait, and minerais; and (6) packing. In its profile this Energy Food is similar to some traditional Indian foods. It can be consumed either in the powdered form or mixed with a little water (or milk). Extensive child feeding experiments have shown that it can be used in a porridge form as a cheap weaning food for children in the age group 6-24 months. Products of this type have several advantages: (1) locally available raw materials are used cutting down transportation costs; (2) they can be blended into locally acceptable foods; (3) processing is simple and can be adopted at any level, from factory to village (or individual household); and (4) packaging into smaller units may be avoided if the food is used locally. If production is done on a small scale, it can also generate employment. However, quality control and prevention of adulteration and misuse may pose operational problems. Energy Food has been extensively used in nutrition programmes in India and it has been produced and utilized by Mahila Mandais (Ladies Clubs) to help solve nutritional deficiency problems at the community level. Another approach that can be used at the community level is the adaptation of germination or rnalting to develop a malted weaning food. The process has several advantages: (1) it allows partial predigestion of starch and protein; (2) the viscosity can be reduced to any desired level depending upon the extent of germination, making the process especially suitable for foods for very young babies; (3) proper aroma is developed during the kilning process; (4) the enzyme phytase hydrolyses phytin to available phosphate; and (5) elaboration of vitamin C and lysine is reported in many cereals. Some limitations of the method are: (1) long processing time and the need for adequate sun drying or mechanical drying facilities; and (2) the need to debran the cereal or legume. The malted weaning food is prepared in the following way. The grains, ragi (Eleusine coracana) and green gram (Phaseolus radialus) are germinated for 48 hr and 24 hr, respectively, after which the materials are dried in a hot air oven at 65°C and the shoots and rootlets are removed by hand rubbing. The bran from green gram is removed by abrasive milling in a rite huiler mill while bran is removed from ragi by moisture conditioning and grinding in a plate grinder. The weaning food is then formulated by blending malted ragi and green gram flours in the proportion 70:30. The product has been widely tested in hospitais and children's institutions, and is now being produced and marketed. Materials other than ragi and green gram can also be used, for example, sorghum, maize, pearl millet, and wheat. Again there is a wide choice of raw materials for formulations and 21 the technology is applicable at any level of operation. There are about 250 million preschool and school-going children and pregnant women and lactating mothers in India. It is obvious that no centralized agency can cater to the needs of such a large number of beneficiaries. It is imperative that a choice of technologies should be available for meeting the nutritional needs of these people. Such technologies should be capable of using locally available raw materials and be simple so that nutritious foods can be developed and consumed locally.

REFERENCES

1. Subramanyam, V., Rama Rao, G., Kuppuswamy, S.. Narayana Rao, M., Swaminathan, M. Standardization of conditions for the production of Indian Multipurpose Food. Food Science, 1957; 6, 76. 2. Prasannppa, G., Chandrasekhara, H.N., Kailas Vyas, Srinivasan, K.S., Gowri, V., Indira A.S. Murthy, Chandrasekhara, M.R. Precooked Bal-Ahar and Indian Multipurpose Food. J. Food Sci. & Tech. 1972; 9, 174. 3. Rajagoaplan, R., Rama Rao, G., Narayana Rao, M., Subramanian, N. Groundnut protein concentrates. Proc. Intnatl. Sym. on Protein Foods and Concentrates, Mysore 1967; 150. 4. Narasinga Rao, M.S. Vegetable Protein Products in Food Industries 1979, Chemical Engineering Education Development Centre, Indian Institute of Technology, Madras, 10. 5. Desikachar, H.S.R. Technology options for formulating weaning foods for the economi cally weaker segments of populations in developing countries. Food and Nutrition Bulletin, 1982; 4, 57. 6. Malleshi, N.G., Desikachar, H.S.R. Formulation of a weaning food with low hot-paste viscosity based on malted ragi (Eleusine coracana/ and green gram (Phaseolus radiafus). J. Food Sci. & Tech. 1982; 19, 193.

22 RURAL FOOD TECHNOLOGY F.G. Winarno and Yati Haryadi

In an evaluation study by the Applied Nutrition Program conducted in 1972-1973, nutrition problems in eight out of 26 provincies were studied from the standpoint of socioeconomics and family food habits. The study recommended that nutrition improvement programs should give priority to pregnant and nursing mothers and children below the age of two years. Among the indigenous food technologies available in Indonesia, fermented foods make a remarkable contribution to the diet of the people as a source of protein, calories, and some vitamins, especially for the middle and lower income groups. The technology of traditional fermentation is simple and has an extremely low cost of production as compared with other products made using the same material. Other food technologies that have been practiced routinely at the village level are drying, salting, smoking, pickiing, and intermediate moisture foods.

FOOD FERMENTATION TECHNOLOGY Fermented foods are an important component of Asian diets, and Indonesia has a wide variety of fermented foods. A fermentation product called tempeh, was developed in Indonesia in which soyabeans are soaked, dehulled, partially cooked, and inoculated with mold belonging to genus Rhizopus. Tempeh is perhaps the best food developed through traditional fermentation and was the first "quick cooking" food developed in the world. It needs only 3 minutes for frying and 10 minutes for cooking to prepare for consumption. Tempeh is considered to be the best and cheapest protein source in Indonesia as it contains over 40% protein on a dry weight basis. Tempeh is one of the first vegetable foods shown to contain nutritionally important amounts of vitamin B-12 essential for proper formation of erythrocytes and prevention of pernicious anemia. 23 Indonesian tempeh contains about 30 ng B-12/g, which means that an average tempeh consumption/person/day of 60 g is adequate to meet 60 % of daily vitamin B-12 requirements (3ug of vitamin B-12/day for adults). Tempeh has beneficial effects on patients with disentery and the antibacterial activity of growth inhibitors produced by Rhizopus oligosporus during tempeh fermentation have been reported. Peanut presscake has been used for a long time as an animal feed, but in Indonesia peanut presscake has been used as human food by converting it to a fermented food called oncom. Oncom is prepared by allowing the mold to grow on peanut presscake for approximately 48 hours and is a daily food of some 25 million people. Like other fermented foods, the fermentation of oncom is carried out with traditional methods in homes and small scale industries. The active microorganisms in oncom production are Rhizopus oligosporus, which produces black oncom, and Neurospora siiophilla, which produces red or orange oncom. The enzymes produced by the mold pene- trate deeply into the substrate, making the proteins, lipids and other components more digestible and at the same time changing and improving the flavor. Oncom also produces vitamin B-12 in substantial amount, but the source of vitamin B-12 in this product is not known and needs further investigation. Tauco is another fermented food from soyabean. Indonesian tauco is similar to Japanese miso. In Indonesia, tauco is consumed only in limited amounts and serves mainly as a nutritious condiment. Aspergillus oryzae is a key microorganism involved. In Indonesia, soyabean sauce is called kecap, but unlike tempeh, tauco, and oncom, kecap is produced in large factories. Kecap is produced as sweet kecap or salty kecap and its maximum protein content is believed to be not more than 10%. Cassava tubers and glutinous rice are sources of starch converted to a sweet food called tape by fermentation using active microorganisms such as yeasts and molds. Both cassava and rice tape are popular foods in Indo- nesia. Through fementation cassava could be converted into sweet and tasty products. Food fermentation is not restricted to agricultural products of plant origin. The most popular fermented food from animal origin is peda, which is marine fish fermented by lactic acid bacteria. For some time, it has been questioned whether fermentation improves nutritive value and, in view of the recent interest in mycotoxins, it has been asked if mold fermented products are wholesome and free of toxins. Most of these femented foods have been produced and consumed by the people for centuries. If the procedures for food fermentation are properly followed there is no reason for this concern. Organoleptic acceptability of fermented food is generally higher than for the cooked and raw material and during 24 fermentation, undesirable substances are degraded and some important nutrients are formed.

NON-FERMENTED FOOD TECHNOLOGIES Traditional non-fermented technologies make an important contribution to the diet of the people and Indonesians use these methods to preserve food products. Soyabean curd, called tahu, is a non-fermented product from soyabean. It has an alkaline composition that may promote good health. Soya- milk is solidified with calcium sulfate to make tahu, which is widely consumed, especially in urban areas. Tahu is unique because it is relatively free of chemical toxins and contains abundant lysine, an essential amino acid that is deficient in many grain products. Soyamilk is not yet as popular as tahu or tempeh, but efforts are being made to promote soyamilk at the village level through extension pro. grammes conducted by many agencies and government departments. Soya- milk with a protein content of 2.5 to 3.0%, PER of 2.3, and NPU of 63 is a good substitute for cow's milk. A new process using Na3PO4 to reduce the beany flavor has been developed. Bananas are produced in abundance in gardens and fields. Therefore a traditional method to preserve bananas has long been practiced in villages. The final product is called "sale pisang". Peeled bananas are sundried for 2-3 days without adding any ingredients and develop a sweet and fragrant flavor. It is believed that during drying enzymatic changes take place. In the arid and semi-arid areas, cassava is produced abundantly instead of rice and is the main staple. Traditionally people in these areas preserve cassava as a dried chip called "gaplek", which takes more than 7 days to prepare by sundrying. This drying method produces conditions favourable for mold growth and thus decreases the quality of the product. A new method using a manual cassava chipper can produce gaplek within two days. This machine has been introduced to many villages in Java, Sumatera, Kalimantan, Bali, and Lombok. Although gaplek is a poor source of protein it is a good source of calories, and thus plays a key rote in the diet of the people. Fortification to improve its nutritive value is therefore necessary. Preserved eggs were developed centuries ago in several oriental countries. These products are very popular for low and medium income families in Indonesia. Clean eggs are packed into a paste usually consisting of clay (brick powder or rice hull ash) and sait in a ratio of 1:1-and then sufficient water is added. This process for making salted eggs takes about 12-13 days. Due to the high sait content the product has a relatively long shelf-life. 25 Another important traditional food is dodol, which is an intermediate moisture food produced in the village. Many varieties of dodol are produced using different raw materials such as fruits, glutinous rice, pumpkin, and sweet potato. Due to its moisture content this product usually has long self life. Although non-fermented foods are important in the Indonesian diet, little attention has been given to their nutritional role.

REFERENCES

1. Prawirangegara, D. (1974). The National Policy on Nutrition Improvement in Indonesia. Presented at the International Meeting on the Control Vitamin Deficiency, November 25.29, 1974, Jakarta. 2. Samsudin (1971). Some aspects of Children Nutrition in Indonesia. Presented at Work- shop on Nutrition, August 28, 1971, Vienna. 3. Sajogyo (1975). Usaha Perbaikan Gizi Keluarga, ANP-Evaluation Study. Lembaga Penelitian Sosiologi Pedesaan Institut Pertanian Bogor. Indonesia 4. Winarno, F.G. (1978). Food Technology in Indonesia. Paper Presented The 6th South East Asia Seminar for Agricultural Education; Problems in Experiment and Practices of Food Technology and Marketing of Agriculture Products. 15.21 December 1978. Bangkok, Thailand. 5. Lieur, T.T.H., K.H. Steinkraus, and T.C. Cronk (1977). Production of Vitamin in Tempeh, a fermented soybean Food. Applied and Environmental Microbiol. 34(6) 773.776. 6. Van Veen, A.G., and G. Schaefer (1950). The Influence of the Tempeh Fungus on the Soya Bean. Doc. Nearl. et Indones. Morbis Trop. 2:270. 7. Wang, H.L., D.I. Ruttle, and C.W. Hesseltine (1969). Antibacterial Compound from a Soybean Product Fermented by Rliizopus oligosporus (33930). Proc. Soc. Exp. Biol. Med. 131: 579.583.

26 DISTRIBUTION AND PROMOTION OF SUPPLEMENTARY FOOD Paichit Pawabutr

Although Thailand is known as a food exporting country, malnutrition still exists, especially protein-energy malnutrition (PEM) among infants and pre-school children. PEM is caused because an insufficient quantity and quality of food is available for feeding children. This is because of such factors

as : poverty; lack of land for cultivation; lack of technology in cultivation; inter-and intra-family maldistribution of food; Jack of knowledge in selection and preparation of nutritious food for children; false food beliefs and practices; sociocultural influences, etc.

There is also an important relationship between malnutrition and infectious diseases. When a child is ill or suffers from an infectious disease there is a loss of appetite that will lead to an insufficient consumption of food and malnutrition and when a child is malnourished it can more easily be affected by infectious diseases. To solve the problem of PEM among infants and preschool children, supplementary foods high in protein and calories should be given to malnourished children. The Department of Health has coordinated its efforts with the Agri- culture Department, the Community Development Department, and the Ministry of Education to promote locally made supplementary foods. This promotion includes plans for persuading both government workers at all levels and villagers to use supplementary food. They wish to make the villagers realize and understand the importance of food for the health of their children. This coordinated promotional effort includes teaching the villagers how to establish their own home vegetable gardens, fish pond cultivation, 27 poultry raising, and the use of pulses and sesame for making supplementary food high in protein and calories. The villagers are taught that supplementary food increases the nutritive value of the food consumed by the family and learn the proper amount that should be given to meet the children's needs. Efforts are made to ensure that the supplementary food reaches the malnourished children. Most of the nutrition activities have been carried out by involving the villagers. To enable the villagers to identify nutrition problems, the village health volunteers (VHVs) and village health communicators (VHCs) are trained to weigh the children and carry on nutrition surveillance using weight for age as the indicator. Some of the mothers have also been trained by the VHVs and VHCs to weigh the children, which arouses village interest so that the knowledge, especially in the areas of nutrition education and appropriate feeding of children according to their age, will be accepted. Once the community is able to identify the problems themselves, the community sets priorities according to the severity of the nutrition problems and works to solve these problems.

SUPPLEMENTARY FOOD PRODUCTION Local promotion and production of supplementary food in the community makes the preparation and daily use of supplementary food more convenient for the mothers of malnourished children. It is also an opportunity for mothers to learn the nutritive value of locally produced supplementary foods. A "nutrition fund" can also be established based on the management system that already exists in the Village Drug Cooperative. This will become a supporting system to produce supplementary food for malnourished children in the village. Cooperation between Health and Agriculture emphasizes both the promotion and production of food for better nutrition within the village. The following steps are involved in implementing a village-level program. (1) Village Committee, VHV/VHC, and the Mother's Group join together to ask the villagers for cooperation in the form of money or supplies to establish a nutrition fund for the village. (2) Those villagers who are shareholders in the nutrition fund select a village nutrition and food committee that will administer and supervise food and nutrition activities within the village. The committee will also be responsible for the management of the nutrition fund. (3) VHV/VHC/Mothers Group and other villagers who are interested invite sub-district health workers and agricultural workers to demonstrate and provide training on how to produce small packages of supplementary food 28 at the village level. (4) VHV/VHC/Mother's Group and other interested villagers produce packaged supplementary food themselves in the village. Money to support this activity cornes from the Nutrition Fund. The production of supplementary food in the village allows the villagers to decide which recipe of rice, beans, and sesame they will use. Once they decide, they make the supplementary food following the formulae developed by the Division of Nutrition, Department of Health.

SUPPLEMENTARY FOOD DISTRIBUTION In the first step of production of supplementary food, the villagers receive assistance for the cost of materials from a revolving fund of the De- partment of Health. When buying supplementary food for the Child Nutri- tion Center and malnourished children in the village, locally produced supplementary food should be purchased. Thus, to fulfill this need for supplementary food, the village, itself, must make the supplementary food. The village can later sell supplementary food to>the government sector at a rate that will allow a moderate profit for the community nutrition fund. However, before the village can sell supplementary food outside its own community, it must solve its own malnutrition problem. This criteria enables the government to force the community to solve its own nutrition problem more quickly. The production of locally made supplementary food has two objectives: (1) to be sold to pregnant women, lactating women, parents who have malnourished children, and all other interested people at the price of B2 per 100 g package: and (2) to be given free to second and third degree malnou. rished children within the village for daily consumption. The children should eat about 50 g/day by adding it to the food they eat. The supplementary food made in the village can then be used to support weekly feedings in the village. These weekly feedings create a con- fidence in the villagers that the distribution of supplementary food is reaching the malnourished children. The feedings also guarantee that malnourished children are receiving supplementary food at least once a week. Mothers also have the opportunity to learn about nutrition and how to solve the malnutrition problems of their children. Implementation can be done by the VHV, VHC, and the Mother's Group. especially mothers of malnourished children. Each mother can support the feedings by bringing with her each week rice, different pulses, or money and also helping to organize the feeding of the children. To give these feedings further value, it is important that the VHV, VHC, and/or other leaders be there to provide nutrition education and answer questions about 29 feeding children. Extra money from the weekly feedings should be used to help establish a Nutrition Fund, that in turn can help to support future food and nutrition activities in the village. Weekly feedings, as well, provide the opportunity for the community itself to experiment and eat different food recipes and to understand and accept supplementary food more quickly. This will encourage them to sell supplementary food and earn money for the Nutrition Fund. Adjustments of the supplementary food recipes allow each locality to use food that they can produce themselves and this results in better implementation. For villages that are not ready to make their own supplementary food, they can use supplementary food bought from a village that already produces it. The village can then begin the following two activities within the village: (1) arrange weekly feedings; and (2) explain the value of supplementary food. Through the village committee, VHV, VHC, and interested village mothers, 2 or 3 mainourished children under 5 years of age are selected. The VHV must then give these children supplementary food every day with their regular food (50 g/day for three months). This will enable the villagers to see the results. From the fourth month on, villages that still have a large nutrition problem (any third degree children or more than seven percent of the children with second degree) can start to distribute supplementary food. Villages that do not have third degree malnutrition and have second degree malnutrition in less than seven percent of children can seil supplementary food. Through the village committee, the VHV, the VHC, and the Mother's Group, a Nutrition Fund should be established to sell supplementary food to second degree children for at least 6 months and to promote the food among first degree children, pregnant and lactating mothers, and others. The community organization then has a role in both the implementation of services and in deciding how to solve the malnutrition problems of the community. During the implementation period, community resources must be considered. Local natural resources must be used to establish a Nutrition Fund that will then support the food and nutrition activities in the community. The Department of Health supports the nutrition activities while the Agricul- tural Extension Department assists with food production. The government also provides assistance with accessories in the beginning, i.e child weight scales, growth charts, and the initial cost of materials to support locally made supplementary food, and with the organization of nutrition education.

30 CASE STUIDIES THAILAND PHILIPPINES KOREA

CASE STUDY THAILAND Sakorn Dhanamitta, Kraisid Tontisirin, and Aree Valyasevi

In a recent effort to alleviate protein energy malnutrition in infants and pre-school children in Thailand, the Institite of Nutrition, Mahidol Univer- sity, developed and tested several supplementary food mixtures. They are low cost, high-protein, and high-energy supplementary foods which are readily available for use at the village level. The formulation of seven supplementary food mixtures was based on the Thai Standard for Infant Foods. Protein, fat, and linoleic acid contents for all seven supplementary food mixtures meet the standard. After roasting, each ingredient was weighed and mixed proportionally with other ingredients of the mixture. The ground mixture was packed and sealed in small plastic bags of 100 or 250 g per package with 100 g providing approximately 450 kcal. The mixture is cooked in three times its volume of water, and boiled at 100° C for 10 to 15 minutes. The food mixtures may be kept for at least six to eight weeks without any evidence of spoilage of overgrowth of microorganisms.

ACCEPTABILITY AND PRODUCT DEVELOPMENT Approximately 90 percent of children under 2 years of age but only 52 percent of the older children found the mixes acceptable. Therefore, the food formulae prepared for the older age group were modified to provide a coarser texture, with various flavors. One product for older children consists of the same ingredients and composition, except the ingredients in this product were not,ground, but packaged as whole kernels. The three ingredients were roasted and placed in a cloth bag, soaked overnight and then steamed in the same container as the family rice, thus avoiding additional effort in cooking. Furthermore, the 33 food can be self-fed by the children. Further modification was done by removing the hull of the mungbean. This was found to increase the digesti- bility. In an attempt to improve the nutritional status of the rural poor in Thailand, the Institute of Nutrition, Mahidol University and the Reseach Center, Ramathibodi Hospital implemented a pilot project during 1976 in two villages of Nong-Hai and three villages of Trakarn in Ubon Province of Northeast Thailand. The infant supplementary food formulae that were developed by the institute played an essential rote in the implementation of the project. The seven supplementary food mixtures were introduced, fed, and distributed to second and third-degree PEM children in these project areas.

NUTRITION SURVEILLANCE Before the programme was implemented, nutrition surveillance using weight for age for infants and pre-school children was done in the villages between 1978 and 1980. Nutrition education was implemented at the village food processing center from the beginning of the supplementary food programme in Nong-Hai and was gradually increased according to the additional nutrition activities such as food preparation and demonstration.

VILLAGE FOOD PRODUCTION, PROCESSING AND DISTRIBUTION In 1978-1980, the village food production and processing outreach programme was initiated to determine the convenience and acceptability within villages of nutritionally adequate infant foods, based on the supplementary food formulae developed by the institute as well as other village foods. The impact on the nutrition status of the infants and pre-school children was also evaluated. A similar type of pilot project was also carried out in three other villages in Trakarn district, with the main emphasis on village food production and processing.

OPERATION OF VILLAGE FOOD PRODUCTION, PROCESSING OUTREACH PROGRAMME A village food processing center (FPC) was established in each village. The acceptability of the food processing tenter and the infant food formulae 34 as well as the processing method to be used by the villagers were investigated. The FPC was used to provide equipment for food processing such as : a platform balance; a metal pan for roasting; an electrical grinder for Nong- Hai, a manual grinder for Trakarn; a drying pan; and a thermal impulse sealer for Nong-Hai and candie flame for Trakarn for sealing the plastic bags. Vil- lagers were encouraged to bring the raw ingredients to the center to process the infant food or family foods as needed. Mothers of second and third degree PEM children brought their children to be fed twice a week at the village center. The food was prepared by these mothers, who took turns cooking the simple and nutritious food under the supervision of the field implementor. The village residents were trained and hired to manage the facility. The center keeps ail records and data on the project. Infant food packages which were processed at the center were distributed to the second and third-degree PEM children, so the mothers could prepare the food and feed their children on other days of the week. The first degree malnourished children could participate in the feeding programme on a voluntary basis but usually no food packages were offered to them. By processing supplementary infant foods from Iocally available sources at the village level, distribution and home delivery of infant food packages reached second-and third-degree PEM children easily, hence improving their overall diet.

The nutritional status of the 202 infants and pre-school children in Nong-Hai improved significantly. The proportion of normal, healthy children increased from 45 to 79%. The incidence of first-degree PEM decreased from 38 to 16%, second-degree PEM decreased form 16 to 6%, while third degree PEM, which had an incidence of 1 % disappeared altogether in eight months. In the 3 villages in Trakarn, improvement of nutritional status of infants and pre-school children during the 14 month period showed less favourable results when compared to the Nong-Hai programme. Since second and third degree malnourished children received intensive care as well as food assistance, they showed rapid increases in weight in subsequent mea- surements of the project. The improvement of nutritional status of the malnourished children in these three villages was noticeable following three to four months of the supplementation. However, after 14 months the overall nutrition evaluation showed no improvement inthe nutritional status of the children in the villages. Further analysis revealed that it was because many of the infants and pre-school children classified as "normal" at the beginning of the study became malnourished by the end of the year, and a few of those who had been classified as first-degree PEM became second-degree PEM.

35 MONITORING AND EVALUATION This study clearly demonstrates the feasibility of producing nutritionally adequate infant foods in a community or at the village level. Four of the seven supplementary food mixtures which were formulated by the In- stitute were accepted. These were the mixtures of rice, legumes, and sesame, all of which were already available locally. The products appeared to be weil accepted, especially by young infants of 6.24 months. The products could aiso be added to many dishes of the habituai diet and were well accepted by all ages. The simplicity of these processing methods and facilities, which could be handled through community-based activities, were well accepted by the villagers. The resulting nutrition improvements provided a model of supplementary food formulation which is most relevant in terms of nutritional value, low cost, locally available ingredients, high acceptability, and simplicity of production or preparation, so that the foods can be handled, monitored, and evaluated through community-based activities. The adoption of this process as a community approach is very useful for the establishment of nutrition improvement programmes.

IMPLICATIONS AND FURTHER STUDY IMPLICATIONS In 1981 the Nutrition Division of the Ministry of Health, based on the results of the case study of the Institute of Nutrition, developed and adjusted seven supplementary food formulae using rice, pulses, and sesame or groundnut. The Ministry of Health has started similar field implementation programmes in approximately 30 villages in each of 3 provinces in the Northeast region; namely Ubon, Udon, and Korat, in 1981. Economic incentives were developed by promoting the supplementary food production as an income generating process for the community was facilitated by a small initial government contribution together with contributions from the villagers producing the "Village Nutrition Fund" which can support the food supplementation programmes as a self-help process yielding very successful results. From the latest survey in July-August 1983 by the Nutrition Division, Ministry of Health, there were 1668 villages which have regularly prepared and distributed local food supplements to second and third degree malnourished chiidren and 957 village nutrition funds have been set up.

36 REFERENCES 1. Ministry of Public Health. Thai Standard for Infant Food (Thailand. 1979). 2. Report of the Joint FAO/WHO ad Hoc Expert Committee on Energy and Protein Require- ments, WHO Tech. Rep. Ser. No. 522 (WHO. Geneva. 1973). 3. B. Mouleekoonpairoj. "The Forumlation of Rice-Based Supplementary Foods for Thai Infants" Thesis submitted for the degree of M.S. Nutrition (Mahidol University. Thai- land, 1980). 4. Krisid Tontisirin, M.D., Ph.D., Benjawan Moaleekoonpairoj M.S.. Sakorn Dhanamitta. M.D., D.Sc., and Aree Valyasevi. M.D.. D.Sc. "Formulation of supplementary Infant Foods at Home and Village level in Thailand". Food and Nutrition Bulletin. Vol.3. No.3. 1981. 5. Sakorn Dhanamitta, M.D.. D.Sc., Suwanee Virojailee. M.S.. and Aree Valyasevi. M.D.. D.Sc. "Implementation of a Conceptual Scheme for Improving the Nutritional Status of the Rural Poor in Thailand". Food and Nutrition Bulletin. Vol. 3. No.3. 1981. 6. Sakorn Dhanamitta, Kraisid Tontisirin and Aree Valyasevi "Improvement of Nutritional Status through Infant Food Formulation at Home and Village Levels". Proceeding of the Sixth World Congress of Food Science and Technology held on 18-23 September 1983 at Dublin, IRELAND.

37 CASE STUDY PHILIPPINES Josefa S. Eusebio

Indigenous legumes are a good choice for supplementary food because of their high nutritional value, acceptability, ease of preparation, availability, and low cost. Legumes are also usually available and comparatively inexpensive in areas where protein-calorie malnutrition is common. So, if mothers could be persuaded to give their children indigenous legumes regularly, they would soon see the positive effects and be stimulated to use more legumes. Seventeen legume-based home recipes previously developed and tested in the laboratory were tested for acceptability in a rural village. All the recipes in the form of viands and snacks utilized mungbean, ricebean, cowpea, and pigeon pea in both dehulled and undehulled form. A survey was conducted before and after the participatory training of mothers to determine whether there were changes in the frequency and quantity of legume consumed in the community. The supplementary feeding program using legume based home recipes was conducted for six months in the village to rehabilitate malnourished children. The malnourished children were identified through "Operation Timbang" (weight for age) done by the community (barangay) integrated development workers (B1DW) with the assistance of the mother leaders of the community. Mothers who were willing to rehabilitate their malnourished children joined the program. Each child was given a serving of a legume based snack that the mothers took turns preparing. The children were weighed monthly to determine changes in weight.

"Nutri-Pak" Production With the help of the Nutrition Center of the Philippines, the BIDW and mother leaders were trained to make "nutripak". Indigenous legumes, 38 rice, skim milk, and oil are the basic ingredients and the mothers are able to make "nutri-pak" in the village using a manual corn mill to grind the rice and legumes and a candie to seal the plastic bags. The production sequence is : procurement of raw materials; cleaning and storage; grinding of rice and legumes; sterilization; dispensing in individual packets; sealing; packing the individual packets in bulk; packing in tin cans; and storing. "Nutripak" has also become an added source of income in this rural community. A pack, which retails for 1.00 peso gives a 1-3 year old child approximately 1/2 of the RDA for protein and 1/3 of the RDA for calories. AIl the legume-based recipes were found to be highly acceptable; however, dehulled legumes were preferred to undehulled legumes. There was also a significant increase in the frequency of legume consumption after the foods had been introduced in the village. Among the legumes, mungbean and cowpea were the most popular, pigeon pea was least popular (Table 1). On average, a cup of raw legume is consumed 2 or 3 times a week per household. Through "Operation Timbang" (Weight for age) it was found that only 19% of the pre-school children in the community were normal and that the rest were mildly or moderately malnourished. Of the 108 malnourished children, only 21 % joined voluntarily in the supplementary feeding program. There was no incidence of severe malnutrition. After six months of supplementary feeding using legume-based recipes, there was a significant improvement in the nutritional level of the children. Five of the 19 children who previously showed first degree malnutrition became normal indicating that legumes can be used as supplementary foods for rehabilitation. In fact, plant protein combinations have been found to be comparable to animal protein when fed to malnourished pre-school children.

Table 1. Quantity (cups) of legumes consumed per week.

Pre-evaluation Mid-evaluation

Mungbean 88.25 99.75 Ricebean 10.75 17.12 Cowpea 14.50 25.75 Pigeon Pea 0.25 0

39 REFERENCES 1. Latham, MC. Human Nutrition in Tropical Africa. FAO. Rome. 1979 2. Aykroyd, W.R. and Doughty, J. Legumes in Human Nutrition. FAO. Italy. 1977. 3. FNRI Publication No. 137a. Nutritional Levels by Weight for Age in Degree of Malnutrition, Percent of Standard and Nutritional Lever. Food & Nutrition Research Institute, Manila. 1979. 4. Nutrition Center of the Philippines. Manual in the Production of Nutri-Pak. Unpublished. 1980. 5. Eusebio, J.S. et. al. Effects of Cereal Legume Diets on Protein Calorie Malnutrition in the Young, NSTA-UPLB Unpublished Terminal Report. 1983. 6. FNRI. Food Composition Table Recommended for Use in the Philippines. Handbook 1. 5th Revision. 1980.

40 CASE STUDY KOREA Soojae Moon

Timing of weaning is later in Korean rural and lower urban classes than in middle and upper classes. Weaning after the international standard of six months of age has adverse effects on the growth rate of children. This occurs because supplementary foods are not provided for the child during the weaning period; rather, the infant goes directly from nursing (or bottle feeding) to the cereals and solid foods of the adult diet. This situation has created an urgent need for an easy to prepare, low priced, highly nutritious supplementary food. The Korean Nutrition Improvement Center and the Home Science Research Institute of Yonsei University developed eight formulae prepared from rice, barley, soybeans, peanuts, perilla, sesame, and fish which are all plentiful and inexpensive items in Korea. These are being introduced to rural and poor urban children.

FORMULATION AND PROCESSING In general, the main ingredients used to prepare supplementary foods for the children of village level families must be foods grown in the fields and available locally. The basic standards for proposed supplementary foods were : nutritional criteria based on the Protein Advisory Group standard; price levels to be lower by half of the price of commercial supplementary food products on the market; ingredients to be available locally; the acceptability of the products was to be high and well accepted by babies; shelf-life was to be about 2 months without change in flavor during the hot, humid summer; and simple processing was to be used that did not require any special techniques for use at the home or village level. Using the PAG guidelines, eight supplementary foods were designed to improve the energy density of food eaten by Korean children.

Seven ingredients were used : rice, barley, soyabean, fish, peanuts,

41 sesame and perilla. Each of the ground ingredients were ground once more and then sieved. Koreans have traditionally used roasted rice flour or barley flour as a summer drink, so ail the mothers were familiar with the procedure suggested for supplementary foods. Ail they needed to do was to follow the simple instructions for mixing. When soyabean and fish were included in the supplementary mixture, the protein content increased up to 17 %, whereas rice-only contained only 6.5% protein. When milk, fish, or legumes were added to cereals like rice and barley, the result was that the chemical score or PER improved considerably. The average fat content of ail formulae was 12.3%, which is slightly higher than the PAG guide lines. Energy values ranged form 417 to 432 Kcal/100 g of formula.

EVALUATION AND DEVELOPMENT OF PRODUCTS The developed products were found to be good quality supplementary foods in terms of nutritional value, feeding performance, and production and had the additional advantages of sufficient acceptability and storage stability. The costs of these supplementary foods were much less than comparable commercial products, especially in terms of protein content per unit of food. About 120 g (dry weight) of the products supply almost haif of the daily energy requirements and about the same proportion of the Korean RDA for protein fora child (1.3 years). A pilot plant could be operated by one man and with an output of 100 kg per day, this would supply one supplementary feeding for about 800 children/day at village level nursery schools or day tare centers. Consumer feedback from these locations would be fairly direct and would allow for changes in the formulation. At a later stage, this knowledge and experience could be handed over to a larger plant.

PRODUCTION, DISTRIBUTION, AND PROMOTION Before distribution, promotion, and production were undertaken, mothers were surveyed and it was found that 91 % of the urban and 68% of rural mothers recognized the need for supplementary foods. Consciousness of the value of supplementary foods was higher where the economic standard was middle class or above and among those with a higher level of education. In rural and urban depressed areas the consciousness of the need to prepare special supplementary food was low and children only get breast milk or formula milk until they are able to eat the solid food of aduits. 42 Because the ingredients for these formulae are easily obtained in homes, professionals need only to encourage the mothers to feed appropriate supplementary food daily and educate them in the method of formula preparation. Three methods of promotion were devised: child nutrition education at the household level through mass media, especially TV; introducing supplementary foods to village housewives through the Better Nutrition Centres: and a programme at Yonsei University's Home Science Research Institute that provides nutrition education for low socioeconomic class mothers. The University's home visitation program not only promotes supplementary foods but also includes education of the mothers on their children's physical, emo- tional, and mental development. However, some mothers are unable to prepare supplementary foods because they have to work to earn a living. The solution is to develop and produce low-cost formulae on a commercial basis.

REFERENCES 1. A Surveyor's Report on National Nutrition, Ministry of Health and Social Affairs. 1977. 2. Yoon, D.J., Health and nutritional problems in Korean children, kureun .1. u/ \711rrilinn, 12:1-13, 1979. 3. Hong, S.M., A study of weaning and suppiementary foods in relation to family environment, Unpublished Master's thesis, Yonsei University, 1982. 4. Chun, S.K., A study on weaining practices of infants and preschool children in rural areas of Korea, J. u/ h"ureun Agrr. Educwiuu. 10:20.24. 1978. 5. Chun, S.K.; Uu, C.H.; and Jung. H.R., Study on the Nutrient Intake status and It's Socio- Economic Factors in Rural Children, The Research Reports of the Office of Rural Development Vol. 23:103.109, 1981. 6. Kim, H. & Park, J.J.: A food and nutrient intake study of rural Korean children in the weaning period, Korreau J. uf Nurr., 11:7, 1978.

COUNTRY REPORTS PAKISTAN INDONESIA SRI LANKA INDIA THAILAND MALAYSIA CHINA

COUNTRY REPORT PAKISTAN Tajaminal Hussain

Malnutrition among infants and young children is one of the major health problems in Pakistan. Infant mortality is 105 per thousand live births and about 80% of children under five suffer from diarrhoea and respiratory infections. Mortality in infants is due to inadequate food intake and infectious diseases. Unsatisfactory maternai nutrition is generally recognised as a factor causing low infant birth weight and the baby's state of health at birth is generally influenced by the mother's diet during pregnancy. The majority of mothers continue to breast-feed their children up to 2 years. At 18 months of age 64% of children are stil) being breast-fed and oniy 20% of mothers have stopped breast-feeding their children by one year. The prime weaning foods are wheat bread and other cereal preparations. Diluted cow, buffalo, and goat milk is usually introduced during the first six months. No solid food is introduced up to 6 months of age. Only 22% received solid food by the age of 1 year, while all families introduce solid food by the time children are 2 years of age. Most (86%) families do not give any animal protein to their children and depend on wheat as the major protein source. Wheat is also the main energy source, followed by rice and gur (concentrated sugar cane juice). Wheat atone is not capable of supporting maximum growth in children, because it has a low protein content and is deficient in lysine. The recommended level of protein intake for the country is 42.5 g/ day per person. The food balance sheet shows an estimate of availability of protein of 59.8 g/person per day. The accepted figure for the average daily energy requirement is 2354 calorie/capita and the 1982-83 food balance sheet indicates that the average per capita availability of calories is equal to the recommended daily energy allowance. However, a comparision of food availability with nutritional requirements can lead to a mistaken conclusion about the adequacy of the diet because food intake is not equitably distributed 47 in accordance with the nutritional requirements either at the household or individual level. One reason for this discrepency is the fact that food consumption is a function of income. The alarming nature of the problem has focused the attention of the government on trying to make rapid improvement in the health and nutrition of the masses. An expert nutrition working group was established, which suggested the following target for the 6th five year plan: elimination of third degree malnutrition; reduction of second and first degree malnutrition from the present level of 10% and 43% to 3% and 15%, respectively; anemia in pregnant and lactating mothers be reduced to less than half of the present level of 92-98%. New cases of goitre be reduced substantially or prevented: and the incidence of low birth weight babies be reduced to 25% of the present level. The expert group recommended specific nutrition interventions for the target groups. The interventions consist of both dietary and non-dietary programmes.

DIETARY PROGRAMMES: Promotion of breast-feeding; increased availability of nutritionally good crops like pulses and legumes; fortification of atta (wheat flour) with iron, vitamins, and minerais; manufacture of weaning/supplementary food for distribution through the existing M.C.H. and ration shop systems; vitamini- zation of ghee (hydrogenated oil) with vitamin; installation of sait iodization plants; improving the food distribution system in remote areas for the transfer of food from food surplus to food deficient areas.

NON-DIETARY PROGRAMME: Establishment of an Institute of Human Nutrition at the federal capital; increasing income and reducing the cost of food; nutrition education through mass media, TV, radio, pamphlets, schools, colleges, and universities and the introduction of human nutrition courses in agricultural universities; immunization; diarrhoea disease control; child spacing; clean water and sanitation; establishing nutrition rehabilitation centres in urban slums; and rural and urban areas.

48 FORMULATION AND NUTRITIONAL EVALUATION OF SUPPLEMENTARY FOOD MIXES:

The Pakistan Council of Scientific and Industrial Research prepared a weaning food, "Protolac", based on wheat, bengal gram, and skim milk fortified with a vitamin and minerai mixture. Protolac had a high protein and energy content, was well tolerated, and supported growth in infants. But this food was not widely accepted among poor families because of its cost and lack of availability in rural areas. Because the high cost of weaning food is one reason for withholding solid food until the age of 2 years, the Department of Agricultural Chemistry and Nutrition, N.W.F. P. Agricultural University, Peshawar initiated a project with the assistance of UNICEF-Pakistan to investigate the formulation of food mixes for infants and children from locally available cheap protein sources. The mixes are intended to supplement the diet of infants and children, are made from Iocally available food sources, and show a high degree of acceptance. The mixes were tested in 20 integrated rural development programme centres in rural areas during the last 2 years. AII the mixes are capable of improving the nutritional status of children. Four supplementary food mixes were prepared for children age 2-6 years, while another five weaning food mixes were prepared for infants 6-24 months of age. In its preparation, no new technology is involved and no vitamins and minerais are added because it is to be prepared by mothers at home. The cost of these mixes cornes to less than Rs. 1 per 100 g.

FORMULATION AND PROXIMATE ANALYSIS OF SUPPLEMENTARY FOOD MIXES

Mix-1 Mix-2 Mix-3 Mix-4 Wheat flour (%) 40 40 30 - Bengal gram (%) 30 - 20 35 Groundnuts (%) - 30 20 35 Vegetable oil (%) 5 5 5 - Gur (raw sugar) (%) 25 25 25 30 Protein (gm) 11.5 13.4 13.9 16.1 Fat (gm) 13.4 14.0 12.7 15.4 Kcal 460 490 530 608 Cost/Kg Rs 8.5 9.0 9.0 10.0

1 SUS = Rs. 12

49 FORMULATION AND PROXIMATE COMPOSITION OF WEANING FOOD MIXES FOR INFANTS (6-MONTHS-2 YEARS)

Weaning Food Protein Fat KCaI Cost

Mix-1 Rice + Chana + Oil 11.8 14.1 421 (60:30:10) Mix-2 Rice + Mungbean + Oil 12.2 13.7 412 (60:30:10) Mix-3 Rice + Minced Meat + Oil 13.9 14.2 430 (60:30:10) Mix-4 Wheat Bread + Channa + Oil 13.6 13.2 394 (60:30:10) Mix-5 Wheat Bread + Minced Meat + Oil 14.8 15.4 418 (60:30:10)

50 COUNTRY REPORT INDONESIA F.G. Winarno and Rizal Syarief

To improve the nutritional status of indonesians, the Indonesia Nutrition Development Project (INDP) was instituted for a period of five years (1977.1983) with three purposes: (1) to strengthen and expand the existing nucleus of personnel and institutions to more effectively formulate and execute nutrition programmes, operational research, and manpower training; (2) to develop programs to improve the nutritional status of malnourished groups; and (3) through a combination of these actions, formulate and execute a more comprehensive food and nutrition program on a national scale. Also involved in the nutrition intervention programs were international agencies such as UNICEF, CARE, WHO, FAO, and the World Bank. Because of the high cost of operation and large infrastructural needs, the programs were restricted to a few selected areas in the hope that the message of good nutrition would spread. CARE is one of the most active agencies in providing supplementary food to malnourished children in the form of : Wheat-soyabean blend (WSB) soyabean fortified rolled oats (SFRO); whey-soyabean drink (WSD); and soyabean fortified sorghum grits (SFSG). CARE also produced a food supplement comprised of soyabean, rice, and other grains using an extruder cooker.

FOOD SUPPLEMENTARY PROGRAM THROUGH NIPP The NIPP program aims at introducing supplementary foods that are made from locally available materials that people can afford, appropriate technologies for processing these supplementary foods, and eventually the development of a small-scale industry. Under the supplementary food programme, a BMC (Bahan Makanan Campuran, Supplementary Food Mix) was developed and distributed to target groups. 51 Several cereal-legume based recipes, with and without the addition of sugar were developed and tested by CRDN (Centre for Research and Development in Nutrition). A rice-soyabean composition introduced in the form of a flour received instant acceptance after introduction in all NIPP villages in East Java and West Nusa Tenggara and later in other NIPP areas in Yogyakarta. West and Central Java, Bali, and South Sumatera. BMC production is done entirely by dry processing, which eliminates the risk of spoilage inherent in wet processing in a tropical environment. In the process, the soyabeans are roasted, which not only inactivates the trypsin- inhibitor but also reduces the moisture content to a safe level for storage and imparts a more acceptable beany flavor. Under these conditions, 10 kg of raw material mix (7 kg rice plus 3 kg soyabean) should produce 8.2 kg of BMC, although actual yields vary due to fluctuations in the quality of the raw materials. Rice-soyabean BMC has a calorie content of 363 kcal/100 g. BMC was formulated by CRDN and process development was carried out by FTDC (Food Technology Development Center). The following alter- native approaches for making BMC were investigated; pan roasting of soyabean, drum (gasingray) roasting of soyabean; extruder processing; and freeze drying. Freeze drying was included for comparative purposes for the possi- bility of manufacture at a central location at a later stage. Based on comparative evaluations, the gasingray process which is a kerosene fueled drum roaster was selected, improved, and fabricated. The soyabean and rice were milled and mixed in a hammer mill (gilham), and a mixer (pumix) respectively. These last two pieces of equipment were then developed and fabricated. The important attributes of the gasingray process of BMC are: the BMC is free of trypsin inhibitor; the equipment is simple and easy to understand; the capacity of the roaster (gasingray) is high enough (85 kg/hr) for a single unit to meet the needs of a large village in a NIPP area in the first year of the programme. Nineteen gasingray, 33 gilham, and 19 pumix units were fabricated and distributed by the FTDC in NIPP areas in seven provinces. At this point several hundred pieces of similar equipment have been fabricated by private companies and distributed not only to the NIPP but to other areas.

52 COUNTRY REPORT SRI LANKA B. V. de Mel

A comprehensive survey of the nutritional status of Sri Lankan pre- schoolers carried out in 1975.1976 (1) revealed that in the village and estate sectors as many as 39.1 % of those aged 6-59 months suffered from second and third degree PEM. A supplementary feeding program was initiated in 1973 because of a food crisis during that year. Later this program was expanded to include the whole nation and Triposha, a nutritionally wholesome supplementary food, was produced and distributed by the Ministry of Health in association with CARE. The Triposha programme is exclusively for undernourished pregnant and lactating mothers and children up to the age of five, who constitute 7 % of the population of Sri Lanka. The programme functions on three levels: in govemment hospitals throughout the country as treatment for malnutrition; in government health centres; and non-governmental organizations throughout the country as a public health service in conjunction with existing population control and immunization programme and as a blanket on-site feeding programme for the population at risk. By June 1982, the programme was reaching 647, 696 beneficiaries, or one million persons over the course of a year. For the fiscal year starting in July 1983, the monthly target is 650,000 beneficiaries. They will recieve 1.5 kg of Triposha per month (18 kg/year) during the period they are considered at risk. The cost in 1982/83 to the Sri Lankan Government through the Department of Health Services was Rs. 41,719,159 while a further Rs. 77,191,531 worth of inputs were received through CARE. This is an esti- mated cost per beneficiary of Rs. 75 or US$ 3 per year. Recent evidence suggests a marked improvement in the nutritional status of the pre-schoolers. The proportion exhibiting signs of second and third degree PEM has fallen from 39.1 % in 1975-76 to 17.2 % in 1980-82 53 (2). Again, whereas only 10.3% could be classified as normal in 1975.1976, by 1980-1982, 43.1 % fell into this category. The Gomez classification that was used is most suited for those aged under three, but unfortunately, a break- down by age group of the FNPPD/MRI data using this classification is not available. However, the disaggregated data we have suggest a marked improvement. Triposha is most effective when administered on site at creches and community centres. The improvement in the estate section where Triposha is administered on site is more marked than in the villages where Triposha is given to the mothers to be administered at home. The data were the result of a very thorough and comprehensive evaluation that closely monitored the progress of children receiving Triposha over a period of one year. Several independent surveys also point to the positive impact of the programme. Children were considered to be malnourished if their weight was less than 70% of the NCHS-CDC (also called the WHO or NAS) standard weight- for-age. Uniformly, the rate of malnutrition was found to be lowest for ail age groups in that segment of the population that had the longest participation in the programme. This simple figure is convincing graphic evidence that the programme is having a positive nutritional impact on its participants (3). Forty percent of the ingredients for Triposha are indigenously produced. The total composition is 59% maize; 27% full-fat soyabean; 12% non-fat dry milk; and 2% minerais and vitamins. Triposha is most effectively and economically produced through extrusion cooking. In the last 3 years there has been a marked increase in the input of indigenous ingredients in the production of Triposha. The Triposha programme is an effective, flexible, and cost-effective means of raising the nutritional status of the vulnerable group.

REFERENCES 1. MOH/CARE/CDC/USAID. Survey 1975/76 2. Food & Nutrition Policy Planning Unit of the Ministry of Plan Implementation's study, INPPD, MRI 3. Drake W.D. Community Systems Foundation in cooperation with USAID

54 COUNTRY REPORT INDIA P. Pushpamma

In the absence of ready availability of low cost complementary foods in the local market and due to the low awareness of the mothers in a great number of families, the infant is hardly introduced to any supplementary food before adopting an adult diet. Realizing the complexities involved in improving infant and child feeding practices, feeding programmes have been introduced by the Govern- ment to ameliorate the severe malnutrition of early childhood, especially for the children from the disadvantaged sections of the population. Considering the number of preschool children (40% of 100 million), below the proverty line, such feeding programmes, even if they are 100% effective can hardly make a dent in infant malnutrition because one insurmountable difficulty is reaching this age group. Experience with various feeding programmes suggests the need to improve the capability of the families to produce/purchase these complementary foods. For this purpose, several options should be provided to meet the needs of various sections of the population: (1) modification of the family diet; (2) home or village level production of simple Ready-to-Eat (RTE) or Ready-To-Mix (RTM) blended powders; (3) production of complementary foods at the industrial level; and (4) distribution of sub- sidised complementary foods through the public food distribution system. From the point of view of customs, practices, feasibility, and cost, it is most convenient for the mother to modify the family diet to feed the young child. However, there are limitations to this approach: (1) many families eat only twice a day and frequency of child feeding is a problem as is rapid spoilage; (2) the low nutrient concentration per unit volume of the common cereal based Indian family diet; and (3) the feeding of such family diets is irregular, infrequent, and inadequate both quantitatively and qualitatively. There is thus an urgent need to devise ways and means of making infant and toddler home diets as rich in nutrients as possible with the available time, cost, fuel, and utensils in poor Indian homes. 55 Indian mothers may have to use a combination of a modified home diet (two feedings) and ready-to-eat (RTE) or ready-to-mix (RTM) foods (two feedings) to meet the nutrient requirements of the infant/toddler. Several investigators have formulated calorie and protein rich RTEs mostly cereal/ pulse combinations for young child feeding. The transfer of RTE technology from the laboratory to households is not very encouraging. The factors res- tricting the regular acceptance of every day simple infant and toddler foods in low income groups are mother's working outside the home and poor purchasing power that precludes any planned dietary expenditure. A number of nutritionally balanced weaning foods were developed at the Central Food Technological Research Institute. These are reasonably priced, adapt themselves to preparations at the home or community level, and can be manufactured using a variety of raw materials available at the household level. The technology of preparation was simple, i.e. roasting, malting, puffing, flaking, chapathi making, and extrusion through a household vermicelli press, and was within the grasp of the common people. A well balanced mixture of cereal and legume in the proportion of 3:1 are suit- ably processed individually or together and mixed together to form the base mix for the weaning foods which can be cooked with 4-5 parts of water to form a semisolid slurry or paste that can be fed to the child. These formulae adapt themselves to regional tastes and preparations at home, community, or factory levels. A choice can be made in the raw materials used in the preparation depending upon the local availability and also with the type of technology at hand. The setting up of community level (village or block) food processing units appears to be the best compromise between the household level at one end and the large or industrial level at the other end. Bulk purchasing of freshly harvested produce, processing, packaging, and storage of weaning food processed at village level also reduces overhead charges considerably. A few local people can be trained in the processing, distribution, and marketing of weaning foods. This will help to create employment opportu- nities; however, nutrition education should be built into the operation to motivate the families and make them aware of the importance of weaning foods for young children. A constraint to such programs is the low purchasing power of a con- siderable number of families in India. Similarly, the importance of timely provision of adequate equipment, machinery, and financial backing cannot be sufficiently underscored. Deep fried items, such as muruku, mathia, and surtitype high-fat biscuits are suitable for community and village level production of weaning foods because they result in high calorie density products. Preparations such as laddoos, barfis, biscuits, and bun/bread-preparations made from RTE blends that have a shelf life of approximately 10-15 days at a time, could be 56 made in batches, which would substantially reduce the time necessary for preparation and distribution. Further, finger foods have much better chances of being served as a supplement because the mother may not cut back on the main meal at home if she believes that the child is only receiving a snack at the feeding centre. Biscuits are a universally accepted infant food in India and attempts are being made to popularize baked products made out of dehulled sorghum and pearl millet with locally available chick pea and sesame combinations. Bulk preparation is feasible in terms of fuel, time, ease of packing, storage, distribution, and minimum loss of nutrients in baking. Moreover, biscuits are a calorie dense food, with good keeping quality and acceptability, and are considered as a prestigeous complementary food in most parts of the country. While the need for production of complementary foods at the village and community level is undisputed, large scale production and distribution of these foods at subsidized rates is recommended as a prerequiste for promotion of complementary feeding in urban families. However, since the utilization of these complementary foods, even when they are readily available and within the purchasing power of the families, depends upon the awareness and attitude of the mother or mother sup- porter, nutrition education on appropriate infant and child feeding practices should be given priority in ail training programmes. Modern advertising techniques may need to be used to create a greater awareness of this vital aspect of nutrition especially in populations where the literacy level of women is low.

REFERENCES 1. Ackels. A.A., Gaylor, R.E. and Kuphal, E.E. Evaluation of low cost extrusion cooking in Sri Lanka: Special Report. Fort Collins, Colorado: Colorado State University (1977). 2. Brandtzaeg, B. Nutritional and technological evaluation of malted flours from ragi (Eleu- sine coracana): sorghum (sorghum vulgara) and greengram (Phaseolus aureus) for local processing of supplementary and weaning foods. UNO Report. UFTRI, My- sore (1979). 3. Damodaram. M. An investigation into the reasons why mothers do not utilise weaning

foods. Proc. Nutri. Soci. India (1980); 26: 56 - 58. 4. Desikachar, H.S.R. Production of weaning foods suitable for mass production and consumption in developing countries. Proceedings of the workshop on "weaning foods" held at APAU, Hyderabad, A.P. 1983 (in press). 5. Devadas R.P. Production of complementary foods at home and community level and also on large scale, suitable for different regions based on local materials and cultural practices. Proceedings of the workshop on "weaning foods" held at APAU, Hyderabad, A.P. 1983 (in press).

57 6. Gopaldas, T., Srinivasan, N., Varadarajan, L., Shingwekar, A.G., Seth, R., Mathur, R.S. and Bhargava, V. Project Poshak, Vol. I, CARE India (1975). 7. Gopaldas, T. Complementary and supplementary foods for young child feeding at the household, community, programme and Industrial levels. Proceeding of the workshop on "weaning foods" held at APAU, Hyderabad, A.P. 1983 (in press). 8. Indo-Dutch Project for child welfare - Chevella Block, Hyderabad District. Five year plans. 1973: 23.25. 9. Indian Council of Medical Research. Technical report. Series No.27. Studies on weaning and supplementary foods (1977). 10. Master, K. Acceptability trials with malted versus roasted RTE mixes on preschool children (1-5 years) and mothers of lower middle socio-economic group in Baroda. M.Sc. Thesis (unpublished) 1981. Department of Foods and Nutrition, M.S. University, Baroda.

1 1. Rao, N.P., Singh, D. and Swaminathan, M.C. Nutritional status of preschool children of rural communities near Hyderabad city. Ind. J. Med. Res. 1969; 57: 21-32. 12. Ropes. G.H. Nutrition in the Phillipines: Policies, program and politics. Master's Thesis, Cambridge, Massachusetts 1978. 13. Swaminathan, M.C. Calorie intake of preschool children when fed ad libitum. Ind. J. Nutr. Diet. 1970; 7: 337-340.

58 COUNTRY REPORT THAILAND Paitanee Winichagoon, Paichiir Pawabuir, Sakorn Dhana- mitta, Somjai Wichaidit and Aree Valyasevi

Proper feeding and supplementary food are important to alleviate malnutrition. Various strategies have been used during the past, such as establishment of feeding centers and centralized infant food processing, however, logistics and storage remain the major obstacles to reaching malnourished children. Basic and operational research and implementation projects have been carried out through the primary health care system.

RESEARCH AND DEVELOPMENT Formulation of home and village level supplementary food (1978) The formulation of supplementary food was based on the concept of using locally available raw ingredients. Since rice is a staple of the diet, it was used as the main ingredient. Protein sources were derived from either soyabeans, mungbeans, or fish meal. Groundnut and sesame provide fat as well as protein. Seven formulae of supplementary food were originally developed by the Institute of Nutrition, Mahidol University. Following field implementation of the promotion of village level supplementary food processing by the Ministry of Health, modifications were made using various kinds of beans (red bean and black bean) and skimmed milk. These foods showed comparable nutritive values to the original seven formulae. Recipes and manuals for making these supplementary foods were also developed by the Division of Nutrition, Ministry of Health. Development of a Simple Processing Procedure (1978.1980) Simple processing methods for the rice-legume supplementary food were developed so the villagers could process and cook the food themselves. Each ingredient is roasted using a household pan; proportioning is done by a scale or by volume using a typical bowl commonly found in the village; grinding is done either manually or with an electric grinder, and sealing of 59 plastic packaging bags is done simply by using a candie. The package could be kept for 6-8 weeks without producing an undesirable flavor or microbial spoilage and the food was cooked by adding water to the ground mixture and boiiing for about 10-15 minutes. Field testing for Taste and Processing Acceptability (1979-1982) This study determined the feasibility of producing nutritionally adequate infant foods in a community, particularly at a village food processing center (FPC). The acceptability of the supplementary food and the facilities at the FPC and operational requirements of the FPC were investigated. There was good acceptance and tolerance of the food, however, a variety of flavours are required to avoid monotony. The processing method was found to be simple and could be operated by rural villagers, who were encouraged to participate in the preparation of the food mixture. Several observations are noteworthy: (1) the food mixture must be prepared properly or the flavor will not be satisfactorily accepted; (2) since the mixture is a new food to a child, encouragement of the child to take the food is crucial; (3) as the supplementary food is introduced in the context of primary health care, the active rote of the village-based volunteers increases the use of the food substantially; and (4) because the food mixture is a new item of food to villagers, effective and regular nutrition education is crucial. Further Product Development (1980-1982) Though the food mixture was acceptable, subsequent research and field study showed that the food could be improved both in terms of texture, flavour, taste, and nutritional value. Flavour and taste can be improved by adding sugar, chocolate powder, or vanilla, etc. The addition of sugar also improves the energy value. A coarse texture may be produced by adding broken rice. Different cooking methods can also be used. Improvement of Processing Procedure and Equipment (1982) Despite the acceptability and feasibility of the village level food processing, some technical problems needed to be resolved. Research has looked at ways to improve various processing steps as well as to modify the equipment to increase efficiency. Economic Aspects of Village Level Food Processing (1981-1983) The objective of this study is to develop an economically and socially feasible system for processing the infant supplementary food at a centralized FPC in one village and marketing it throughout one subdistrict (10 villages). The food processing requirements of consumers and the impact of the FPC facility on the nutritional status of infants in the subdistrict will be determined. Implementation Since 1980, the supplementary food formulae developed by the Institute of Nutrition have been adopted by the Ministry of Health fora nation- 60 wide campaign. Raw materials varied according to local availability and recipes and a manual for the preparation of the supplementary foods were developed by the Division of Nutrition, Ministry of Health.

Pilot project : Nutrition in Primary Health Care (1981-1982) This project involved 3 provinces in the northeast in a holistic approach consisting of health, nutrition, agriculture, and income generation. Community participation was considered essential. Therefore, villagers were involved.in all of the interventions. Village health volunteers (VHV), village health communicators (VHC) and other village leaders were trained to be responsible for weighing the children in their own community and interpreting the data using simple growth charts. Many mothers, especially those of the malnourished children, were also encouraged to participate. Thus the problem was identified by villagers and from this point, the village level processing of supplementary food was introduced. The food produced was given free of charge to the moderately and severely malnourished children and excess production was sold to other children in the village as well as to nearby communities. Feeding of second and third degree malnourished children with this food on a regular basis showed substantial improvement within 3-4 months. This together with the income obtained from participating in the intervention programme served as a good motivation to the villagers. In addition, agricultural production was encouraged to supply adequate raw materials. Extension of Pilot Study (1982.1986) The pilot study has been extended to a larger scale since the beginning of the National Food and Nutrition Plan in the 5th National Economic and Social Development Plan (1982.1986). Nutrition in primary health care through its three main activities: growth monitoring using simple weighing scales and growth charts; nutrition education; and village level supplementary food processing are underway. Priority is given to the rural impoverished areas and the programmes were initiated in a similar manner to the pilot project just described. In villages where villagers are not ready to establish a food processing unit, the nutrition fund can be used to buy the food produced elsewhere to be given to second and third degree malnourished children. In any case, the village level food processing is considered a part of nutrition education given along with other nutrition information. Village level supplementary food processing is a good model for approaching a community. Good community participation is obtained. It also serves as a model for the managerial skills necessary for community self reliance. The availability of this supplementary food to the affected population, especially the moderately and severely malnourished has proved feasible. Impact evaluation is being conducted to appraise its effects on the

61 nutrition status of preschool children in rural communities. Research and development are being continued, because improvement of processing procedures and equipment are still necessary. In addition, the social and economic aspects of village food processing are being investigated and impact evaluation for nationwide implementation is being conducted for future planning of the programme.

REFERENCES

I . Tontisirin. K., ei al. Formulation of supplementary infant foods at the home and village level in Thailand. Food and Nutrition Bulletin 3 (3) : 37-40, 1981. 2. Nondasuta. A. Nutrition in Primary Health Care. Paper presented at Asian Regional Work shop on Effective Communications in Primary Health Care, Bangkok, Thailand, October 3.7, 1983. 3. Division of Nutrition, Ministry of Health. Innovative Village Nutrition Project, 1981-1982 (mimeographed, Thai) 4. Framework for Policy and Planning of Ministry of Health and Rural Impoverished Areas Planning for Nutrition Program for 1985 (mimeographed, Thai) 5. Division of Nutrition, Ministry of Health. Analysis of supplementary food formulae(mimeo graphed. Thai)

62 COUNTRY REPORT MALAYSIA Zanariah Jiman

An applied nutrition pilot project was launched in 1969 in Kuala Langat District, Selangor, and later expanded to other states as the Food and Nutrition Programme. The Ministries involved in the programme are the Ministry of Health, the Ministry of Education, the Ministry of Agriculture, and the Ministry of Information and the Ministry of National and Rural Develop- ment. An integrated approach through a four pronged strategy was approved as follows: improvement of the economy and food production; educational activities; health and sanitation activities; and supplementary feeding at clinics, preschool child care centres, and primary schools. Supplementary feeding of school children is considered a priority because the foods generally sold in school canteens are of poor nutritional value. The present school supplementary feeding programme provides about 400 calories through a "balanced" snack based on a formulation with five variations that uses local food stuffs and was developed by the Institute of Medical Research. The programme covers standard one pupils and about 1 /6 of those in standards two through six. In 1980, 250 ml of milk per student was provided by the Veterinary Services for two days a week in schools in 13 districts. Some of the objectives of the inclusion of milk in the school supplementary feeding programme were to: develop a milk drinking habit among children; provide supplementary feeding with proper control pertaining to its quality and quantity; minimise cost and effort with regard to transport, storage, and serving of foods; add variety to the menu and to the types of food used in school supplementary feeding programmes; and provide indirectly an outlet for the milk produced by the rural farmer, especially those in the Applied Food and Nutrition Pro- gramme areas. In 1980, the school supplementary feeding programme covered ail of Peninsular Malaysia, Sabah, and Sarawak through 6403 primary schools, 63 benefitting a total of 665,700 pupils at a total cost of M$19,975,000. Under the Ministry of Health, the MCH clinics are involved with supplementary foods (full cream powdered milk) for infants, preschool children, pregnant mothers, and breast-feeding mothers. This programme covers infants older than 6 months and preschool children (1-4 years old). Breast- feeding is encouraged for babies under 6 months. Priority is given to under- weight infants and children ( 20% deviation from standard weight), and children from families with socioeconomic problems, from large families, and from families receiving aid from social welfare. One kilogram of powdered milk is supplied every month for three months and extended for another 1.3 months if the nutritional status of the child is poor. Nutrition education is given to aIl mothers, who are advised to use the milk daily as a supplementary food not as a food substitute, and home visits are made by MCH nurses. Under the Ministry of National and Rural Development there is a supplementary food programme for children (4-6 years ol'd) at preschool child care centres. Parents pay M $3.10 per child depending on the ares. Since 1978, the children have been provided with milk by the Veterinary Depart- ment. The centres are provided with foods, such as rice, flour, sugar, and milk powder at a cost of about M$ 0.20 per day per child.

FORTIFIED SUPPLEMENTARY FOODS Development and production of fortified nutritious foods that could be used in supplementary feeding was undertaken by the MARDI Food Tech- nology Division. Different types of biscuits/cookies, instant dehydrated porridges, and easily reconstituable soups have been developed. They were fortified with soyabean and fish protein concentrates and vitamin A and B complex. Field acceptability trials on the soyabean fortified cookies were carried out with preschool children. The trials showed that the soyabean cookies were favourably accepted by the preschool children. Peanut soups and soyabean and fish porridge with greens were prepared as dehydrated soup mixes yielding a porridge that was very much patterned after a child's diet. These products were nutritionally analysed and pre-tested in schools. This was followed by recommendations to the Ministry of Health for their feeding programme. Other Supplementary food products developed by MARDI were snack foods, instant noodles, and enriched infant formula. A nutritious snack food using the extruder process was prepared from 55% ground rice, corn, and soyabean grits and had a protein content of 12%. A food formula for infants/children using locally available materials was developed using soyabean protein isolate, sugar, and palm oil, and had a protein content of over 30%. Supplementary foods, especially in the rural 64 and poor urban communities, consist mainly of rice and not much emphasis is given to the infant's requirement for protein. Commercially available weaning foods are too expensive for the poor to purchase, so there is an urgent need to develop a low-cost nutritious supplementary food based on locally available materials. A high protein product studied at MARDI was "Tau pui", a protein- lipid film that forms on the surface of soyabean milk when its temperature is maintained at 85-90°C. This product is normally stored dry and rehydrated, flavoured, and fabricated into various forms. The protein content of tau pui is about 50%, fat content 14-52%, and ash 1.7.2.3%. One popular traditional snack food that was studied was "keropok" or crackers made from starch, water, and fish or prawns that has a protein content of 15%. Research on keropok production focused upon utilizing cheaper varieties of fish and the mechanization of the traditional process. Supplementary feeding by means of specially prepared protein rich products is one method of combating malnutrition, but this approach has specific problems arising from the fact that the products are processed foods. Arrangements must be made for their manufacture and distribution. A number of schemes throughout the world have encountered difficulty because of such factors as promotional problems, high price, and a lack of support from Government. Although milk may be one of the best supplementary foods in terms- of nutrient content, its domestic production is still not sufficient, and distribution remains a problem. Malnutrition due to the late introduction of supplementary foods and the inability of low income groups to purchase sufficient animal protein foods or high-cost supplementary foods calls for the development of nutritious supplementary food formulations based on cereals and vegetable proteins. Choosing the appropriate level of processing for a formulated food may determine the product's success. Processing can be done at the home, village, or industrial levels. The most effective means of reaching the target group is to involve them in the formulation of their own supplementary foods at home or in the village. Interventions can simultaneously serve as a means of organizing communities, introducing the supplementary weaning food concept, and promoting self-sufficiency.

65 COUNTRY REPORT CHINA Ying Chang

The growth curves of rural children in China usually deviate from that of the urban children after six months of age. The lack of proper supplementary food is considered to be an important factor that causes the slow down of the growth rate. The traditional practice in the past, especially in the rural areas, was that when the mother did not have enough breast milk, a rice flour and cane sugar mixture was usually fed to the babies. As the children grew older, cereals became the main item in their meals. Because the production of dairy products in China could not meet the enormous needs of the infants and children, scientists started a search for better supplementary food in the l 920s. This lead to the development of formula 5410 in 1953 at the Institute of Health, Chinese Academy of Medical Sciences. In this formula, soyabean flour was used as the main source of protein. The composition of the formula is: soyabean flour 28%O, rice flour 45.5%, cane sugar 16.5%, egg yolk powder 5%; soyabean oil 3%; degelatinized bone powder 1.5%; common sait 0.5%; riboflavin 5 mg/kg mixture; and potassium iodide 0.25 mg/kg mixture. Observations on the nutritive effect of this mixture on weaning rats as well as on babies showed that the mixture could promote normal growth equal to that of breast milk or fresh cow's milk. Metabolic studies on infants revealed that the nitrogen, calcium, and phosphorus of the formula were adequate to meet the requirements of growing children. In 1958, this formula was recommended for the whole country jointly by the Ministry of Health and Ministry of Light Industry (including Food Industry) of the government. This product can be obtained in the market, and its price is about 1 /3 - 1 /4 of that of cow's milk powder. Since then, based upon the principal composition of this formula, a number of different modified soyabean formulae were developed both in urban and rural areas with locally available food stuffs. Wheat flour, corn flour, or millet flour were used to replace the rice flour and whole egg was used instead of the egg yolk

66 powder. These preparations can be either made at home or at the local health station and distrubuted to the mothers or manufactured on a large scale with simple equipment by the local food factories and sold in the market. These kind of products are now used extensively in the home and in nurseries and kindergartens. In the 1960s, fresh fish meal and, later, fish protein concentrate were investigated for use as supplementary foods by the Shanghai Children's Hos- pital with success. In areas where soyabean and fish are difficult to obtain. a simple powdered mixture of rice and whole egg, with or without sugar. is recommended. AII these supplementary foods proved to be better than the traditional ones. The policy of one child per couple is now practiced in China. The parents are willing to buy the most expensive but not always the most nutritious foods for their child. Thus, the question now is how to help the parents choose the right foods, and it is a problem challenging ail of the child health workers.

REFERENCES

1. Coordinating Study Croup on the Physical Development of Children and Adolescents. and Institute of Pediatrics of the Chinese Academy of Medical Sciences. Studies on the physical development of children and adolescents in new China (in Chinese). Natl Med J China 1977;57: 720.725. 2. Chou CY. Studies on the use of soybean food in infant feeding in China and the development of formula 5410. Food Nutr Bull 1983: 5:43-52. 3. Maternai and Child Health Station, Jutung County. Kiangsu, and Institute of Health of the Chinese Academy of Medical Sciences. Preparation and nutritive value of a milk substitute. Chinese Med J 1979:101-106. 4. Institute of Health of the Chinese Academy of Medical Sciences. Preparation and nutritive value of several simple home-made supplementary foods. (in Chinese) Natl Med J China 1976;56:188-190. 5. Su TF, Jiang Y, Ye DT. Kong PQ. The supplementary effect of fish protein and soybean protein in infant feeding (in Chinese). Chinese J Pediatr 1964: 13:350-354. 6. Su TF. The nutritional value of fish protein concentrate (in Chinese with Eng Abstr). Acta Nutrimenta Scinica 1983;5:33-37.

LIST OF PARTICIPANTS

Dr. Ying Chang Dr. P. Pushpamma c/o Dr. Lo Ling Dean of Home Science Director of Foreign Affairs A.P. Agricultural University Chinese Academy of Medical Rajendranagar, Hyderabad 500-030 Sciences India 9 Dong Dan San Tiao Beijing China

Dr. M.S. Narasinga Rao Dr. Josefa S. Eusebio Head, Protein Technology Dean, College of Human Ecology Discipline University of the Philippines Central Food Technological at Los Banos College Research Institute Laguna, 3720 Mysore 570.013 Philippines India

Dr. Tajammal Hussain Dr. F.G. Winarno Department of Agricultural Secretary General Chemistry & Nutrition Federation of Asian Nutrition N.W.F.P. Agricultural Societies University Professor and Director Peshawar Food Technology Development Center Pakistan Bogor Agricultural University P.O. Box 61 Indonesia

Dr. Beatrice De Mel Dr. Soojae Moon Medical Officer/Nutrition College of Home Economics Medical Research Institute Yonsei University Baseline Road, Colombo 8 134 Shinchon-Dong, Sudaemun-ku Sri Lanka Seoul 120 Korea

69 Mr. Norman Snow Dr. Khursheed Jahan Manager Institute of Nutrition and Food Technical Division Science Australian Dairy Corporation University of Dhaka 576 St. Kilda Road Dhaka Melbourne, Victoria Bangkadesh Australia 3181

Mr. Christopher MacCormac Mr. Edward Weber Program Officer (Economics) Associate Director Agriculture, Food and Nutrition Post Production System & Sciences Division Agricultural Economics International Development Research Agriculture. Food and Nutrition Centre Sciences Division Asia Regional Office IDRC P.O. Box 8500 Tanglin P.O. Box 104 Ottawa. Canada Singapore 9124

Dr. Richard Young Mr. Michael Graham Agriculture, Food and Nutrition Regional Liaison Officer Sciences Division Communications Division IDRC P.O. Box 8500 IDRC Ottawa Asia Regional Office Canada Tanglin P.O. Box 101 Singapore 9124

Dr. Z. Jiman r. Aree Valyasevi Food Technology Division, MARDI. Professor and Director Sudang, Selangor Institute of Nutrition Malaysia c/o Research Center Ramathibodi Hospital Rama VI Road Bangkok 10400. Thailand

Dr. Sakorn Dhanamitta Dr. Somjai S. Wichaidit Professor and Director Associate Professor Research Center Institute of Nutrition Ramathibodi Hospital c/o Research Center Rama VI Road Ramathibodi Hospital Bangkok 10400, Thailand Rama VI Road Bangkok 10400. Thailand

70 Dr. Kraisid Tontisirin Ms. Pattanee Winichagoon Associate Professor Research Center Department of Pediatrics Ramathibodi Hospital Ramathibodi Hospital Rama VI Road Rama VI Road Bangkok 10400, Thailand Bangkok 10400, Thailand

Ms. Chittima Singhavanich Dr. Puangtong Tantiwongse Research Center Director, Nutrition Division Ramathibodi Hospital Department of Health Rama VI Road Ministry of Public Health Bangkok 10400, Thailand Sam Sen Road Bangkok 10200, Thailand

Mrs. Suparb Suanpan Dr. Chawalit Suntikirungruang Chief, Laboratory section Chief, Nutritional Deficiency Nutrition Division Diseases Control Section Department of Health Nutrition Division Ministry of Public Health Department of Health Sam Sen Road Ministry of Public Health Bangkok 10200, Thailand Sam Sen Road Bangkok 10200, Thailand

Dr. Wirapong Chatranon Dr. Anchalee Leesavan Associate Professor Assistant Programme Officer Department of Pediatrics UNICEF Siriraj Hospital 19 Phra Atit Road Bangkok 10700, Thailand P.O. Box 2-154 Bangkok 10200, Thailand

Ms. Sumalee Soontornnarurungsi Ms. Sumalika Piammongkol Department of Agricultural Home Economics Department Extension Faculty of Education Phaholyotin Road Prince of Songkla University Bangkhen Pattani Province, 94000 Bangkok 10900 Thailand

Ms. Bulan Phithakpol Mrs. Poungpit Dulyapach Institute of Food Research and Acting Director Product Development Agricultural Administrative Kasetsart University Agricultural Extension Department P.O. Box 4-170 Paholyothin Rd Bangkhaen Bangkok 10400, Thailand Bangkok 10900 Thailand 71 Ms. Pensiri Piansiripinyo Dr. Tipvanna Ngarmsak Chemical Technology Department Assistance Professor, Head Department Faculty of Science Department of Agricultural Products Chulalongkorn University Faculty of Agriculture Phyathai Road Khon Kaen University Bangkok 10500, Thailand Khon Kaen 40002, Thailand

Ms. Suvimol Tovivitch Mrs. Suvimol Tansuphasiri Assistant Professor Associate Professor Faculty of Humanities Department of Nutrition Chiang Mai University Faculty of Public Health Chiang Mai 50002 Mahidol University Thailand Bangkok 10400, Thailand

Ms. Penkwan Chompreeda Ms. Thara Viriyapanich Product Development Department Research Center Faculty of Agro-Industry Ramathibodi Hospital Kasetsart University Rama VI Road Bangkok 10903, Thailand Bankok 10400, Thailand

Dr. Paichit Pawabutr Dr. Robert Van Reen Office of the Under-secretary of State Department of Food Science and Ministry of Health Human Nutrition Sam Sen Road University of Hawaii at Manoa Bangkok 10200, Thailand Honolulu, Hawaii 96122 U.S.A.

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