ISSUE No. 2 BREAST OR BOTTLE weamng toods based on local products; better health education, training and information on infant feeding; and We were delighted that so many readers commented on the the preparation of an international code of marketing tin of baby milk powder in the picture from the Philippines practice. The International Baby Food Action Network is on page seven of the fist issue of Diarrhoea Dialogue. acting as a watchdog meanwhile to discourage milk power Everyone needs to be very much aware of the dangers advertising which influences mothers not to breastfeed involved when bottle-feeding becomes fashionable in parts their babies. Obviously there is still a long way to go but the of the world where the milk powder will inevitably be way is becoming more clearly signposted. Papua New mixed with unsafe water in an unclean bottle, in insufficient Guinea seems to have got off to a flying start by making amounts. Poverty and ignorance are to blame, not the feeding bottles available only on prescription.(*) We hope mothers, if bottle-feeding replaces breastfeeding and the to hear what is happening in other countries to help meet feeding bottle becomes the baby-killer through diarrhoea1 the WHO/UNICEF recommendations. disease and malnutrition. 1 Code of marketing practice 1980. The Lancet vol I: 1239-1240 WHO/UNICEF 1979 Joint WHO/UNICEF meeting on infant and young child feeding. WHO, 1211 Geneva 27, Switzerland 2 Aidou J et al 1979 Bottle-feeding and the law in Papua New Guinea. The Lancet ~011: 155 WHO READS DIARRHOEA DIALOGUE The first and most important group we aim to reach are the primary health care workers - those who are actually caring for children with diarrhoea. Within this group, there will be people with little or no knowledge of English. We hope that their trainers will help here by passing on the information in the newsletter and translating useful articles (see note on page two). Secondly, we are aiming at health planners and administrators who need to know about the dimensions and nature of the diarrhoea problem, so that they can apply their management skills to combat it. The third group are scientists and research workers who require information about new methods and techniques being tried out in other parts of the world, but may not have the opportunity of seeing all the relevant journals and papers. Finally, we hope to reach all those who have a general interest in health matters. In each issue of the newsletter we intend to have items that will be of interest to all these groups. If you feel that the balance is wrong, let us have Better health eduaNio0 00 infant feeding. your views. WHO photo by J. Abcede. Response to the first issue of Diarrhoea Dialogue has Diarrhoea Dialogue is well aware of the many sides to the shown that the newsletter is reaching all of its target baby food controversy; later issues will highlight some of groups. Many of you have written to us already to give your these. Meanwhile it is good to see that the 33rd World views on the content, design and future development of the Health Assembly in May endorsed the recommendations publication. We have been delighted and encouraged by from the WHO/UNICEF meeting on infant and young your response and the evidence that the newsletter will child feeding, held in October of last year.(‘) These ask for serve a real need. promotion of breastfeeding; work on the development of W.A.M.C. and K.M.E. In this issue . 0 Jon Rohde discusses the importance of drinking in diarrhoea AHRTAG 0 what are the signs of dehydration? Appropriate Health Resources 8 0 news from Bangladesh, Turkey and The Gambia Technologies Action Group Ltd 0 questions and answers Diarrhoea Dialogue 1 news n n n news n n n news n n n news n n n Oral rehydration ORT in Turkey Several interesting results emerged bibliography from an oral rehydration therapy (ORT) field study carried out in Ankara last year. Auxiliary nurse midwives were assigned to give ORT at home and to teach mothers to use the fluid. The ingredients were provided pre-packaged, mostly by UNICEF. The study was preceded by an in- formation drive to educate the mothers on the need for early administration of the rehydration fluid and the im- casual factor in weanhg diarrhoea. portance of feeding a child suffering WHO photo by J. Mohr This is a very valuable review, which from diarrhoea. Members of the United Kingdom summarises 133 publications dealing The mothers’ acceptance of ORT Medical Research Council Dunn Nutri- with oral therapy of diarrhoea. The was high. It was found that consump- tion Unit carried out a study in Keneba, contents are set out in chronological tion of the oral fluid increased when its a subsistence farming community in order under five different headings: taste was good. Some of the locally The Gambia. They discovered that a history, clinical trials, composition, made mixtures were not found to be as high proportion of food consumed by impact and implementation. Each palatable as the one supplied by infants and young children was over- paper, study or letter is reviewed, often UNICEF, and this was reflected in the grown with bacteria. More thorough with a short comment on the relevance acceptance of fluid by the children. caoking methods failed to prevent con- of the authors’ conclusions. Some Another interesting observation was tamination, the most effective solution articles naturally cover several topics the clear preferences of the mothers to being to eat the food as soon as possible and there is adequate cross-referencing. use ready-made packages rather than after preparation. It provides important reference text the “pinch and scoop” method. Unfortunately, the conveniently thin for field and research workers con- In the Turkish experience, the use of gruels given to infants when breast- cerned with diarrhoea1 disease. Could ORT can be increased bv: feeding has stopped are not only poor it be improved in any way? It contains 0 participation of the community in nutritionally but also easily contami- indexes by author and country, but not the programme nated. During the rainy season when by subject. An alternative to a subject 0 provision of the ingredients in pack- diarrhoea1 illness is at a peak, levels of index might be to break down the five ages carrying health education food and water contamination are also major titles into sub-titles for the main messages to the mothers greatest. The seasonal nature of in- areas covered. 0 distribution of the packages through tensive farming also results in a lower- Even with the concerted efforts of grocers’ stores, in addition to the ing of the standards of child care at this individuals and organisations all over health services, to ensure availa- time. the world, diarrhoea1 disease and its bility Barrel1 R. A. E., Rowland M. G. M. serious consequences are likely to be a 0 inclusion of ORT in the curriculum 1979 Infant foods as a potential source problem for many years. Readers of of medical students and adopting of diarrhoea1 illness in rural West Diarrhoea Dialogue have already been this method of treatment in hos- Africa. Transactions of the Royal asking for an annotated bibliography pitals. Society of Tropical Medicine and about diarrhoea1 disease. This publi- Bertan M., Egeman A. 1979 ORT: Hygiene ~0173 (1): 85-90. cation meets that need and will be of the Turkish experience. WHO practical value well into the future. Chronicle ~0133: 132. However, because knowledge about Reproduction and prevention and management of diar- rhoea is constantly increasing, the translation bibliography will need to be revised Infant foods and We are happy for readers to translate and updated every year or two. It is and reproduce articles or abstracts good to know there are plans to do this. weanling diarrhoea from Diarrhoea Dialogue in their own Free copies of the bibliography are In rural areas of The Gambia where publications with a suitable acknow- available from PAHO, 525, Twenty- there may be a shortage of firewood, it ledgement to AHRTAG. Please send third Street, N. W., Washington D.C., is common practice to prepare enough us a copy! Many of you have written to 20037, U.S.A. infant foods to last all day rather than ask whether the newsletter will be Baumslag Net al 1980 Oral for one meal. The food frequently published in other languages in the rehydration therapy: an annotated becomes contaminated, especially future. Translation into French, bibliography. Pan American Health during the rainy season. This con- Spanish, Portuguese and Arabic is Organization. ~~112, Spanish and tamination may be a casual factor in being planned and we will keep you English, free. weanling diarrhoea. informed about availability. 2 Diarrhoea Dialogue, issue 2, August 1980. Produced quarterly by AHRTAG at 85 Marylebone High Street, London Wl M 3DE. news n n n news n n n news n n n news n n n panied by fever, vomiting and abdomi- hospital for a ten day follow up. Age, Stickiness and nal pain. The rate of secondary infection socio-economic status and neighbour- ranges from 20-25 per cent. In hos- hoods were matched in selecting con- sickness pitalized cases, the mortality rates for trols. Two to three pieces of soap and A symposium held at the Ciba Founda- severe shigellosis have been from 10 to earthenware pitchers for carrying tion in May discussed the relationship 15 times higher than for cholera - water were supplied to the study between the adhesion of micro- indicating that simple rehydration is families.