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Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of stunting in young children from age 6 months. The design of effective programmes to improve infant and young child feeding requires a sound understanding of the local situation and a systematic process for prioritizing interventions, integrating them into existing delivery platforms and monitoring their implementation and impact. The identification of adequate food-based feeding recommendations that respect locally available foods and address gaps in nutrient availability is particularly challenging. We describe two tools that are now available to strengthen infant and young child-feeding programming at national and subnational levels. ProPAN is a set of research tools that guide users through a step-by-step process for identifying problems related to young child nutrition; defining the context in which these problems occur; formulating, testing, and selecting behaviour-change recommendations and nutritional recipes; developing the interventions to promote them; and designing a monitoring and evaluation system to measure progress towards intervention goals. Optifood is a computer-based platform based on linear programming analysis to develop nutrient-adequate feeding recommendations at lowest cost, based on locally available foods with the addition of fortified products or supplements when needed, or best recommendations when the latter are not available. The tools complement each other and a case study from Peru illustrates how they have been used. The readiness of both instruments will enable partners to invest in capacity development for their use in countries and strengthen programmes to address infant and young child feeding and prevent malnutrition., (© 2013 John Wiley & Sons Ltd.)

Background: Outbreaks of pellagra were documented during the civil war in Angola, but no contemporary data on the incidence of pellagra or the prevalence of niacin deficiency were available., Objective: The objective was to investigate the incidence of pellagra and the prevalence of niacin deficiency in postwar Angola and their relation with dietary intake, poverty, and anthropometric status., Design: Admissions data from 1999 to 2004 from the pellagra treatment clinic in Kuito, Angola, were analyzed. New patients admitted over 1 wk were examined, and urine and blood samples were collected. A multistage cluster population survey collected data on anthropometric measures, household dietary intakes, socioeconomic status, and clinical signs of pellagra for women and children. Urinary excretion of 1-methylnicotinamide, 1-methyl-2-pyridone-5-carboxymide, and creatinine was measured and hemoglobin concentrations were measured with a portable photometer., Results: The incidence of clinical pellagra has not decreased since the end of the civil war in 2002. Low excretion of niacin metabolites was confirmed in 10 of 11 new clinic patients. Survey data were collected for 723 women aged 15-49 y and for 690 children aged 6-59 mo. Excretion of niacin metabolites was low in 29.4% of the women and 6.0% of the children, and the creatinine-adjusted concentrations were significantly lower in the women than in the children (P < 0.001, t test). In children, niacin status was positively correlated with the household consumption of peanuts (r = 0.374, P = 0.001) and eggs (r = 0.290, P = 0.012) but negatively correlated with socioeconomic status (r = -0.228, P = 0.037)., Conclusions: The expected decrease in pellagra incidence after the end of the civil war has not occurred. The identification of niacin deficiency as a public health problem should refocus attention on this nutritional deficiency in Angola and other areas of Africa where maize is the staple.

Deficiencies in micronutrients such as iron, vitamin A, and iodine affect billions of people worldwide, causing death, disease, and disability. The UN World Food Programme (WFP) has long been recognised for its ability to deliver food to some of the most remote locations, under the toughest conditions: refugees in border camps, populations cut off by conflict, extremely poor and marginalised people like ethnic minorities, orphans, and widows. Relatively little, however, is known about its efforts to ensure that the food it delivers not only provides enough calories for immediate survival but also provides the vitamins and minerals needed for healthy growth and development. Much of the food delivered by WFP is fortified with iron, vitamin A, and other micronutrients before being shipped. But there are several reasons to mill and fortify food as close to the beneficiaries as possible. For instance, milling and fortifying food locally helps to overcome the problems of the short shelf-life of whole fortified maizemeal. It also enhances the nutritional value of locally procured cereals. And it can foster demand for fortified foods among local consumers beyond WFP beneficiaries, thus nurturing an industry with potentially significant benefits for the health of entire communities. This paper outlines three approaches by WFP to fortifying cereals in Afghanistan, Angola, and Zambia. It examines the challenges faced and the outcomes achieved in an effort to share this knowledge with others dedicated to improving the nutritional status of poor and food-insecure people. In Afghanistan, attempts to mill and fortify wheat flour using small-scale chakki mills were successful but much larger-scale efforts would be needed to promote demand and reach the level of consumption required to address serious iron deficiencies across the country. In Angola, maize has been fortified to combat the persistent occurrence of pellagra, a micronutrient deficiency disease found among people whose diets are dominated by maize. By providing fortification equipment to a commercial mill at the port of Lobito and using a vitamin and mineral pre-mix provided by UNICEF, this project has overcome many of the difficulties common in countries emerging from conflict to provide monthly fortified maize rations to some 115,000 beneficiaries. In Zambia, iron deficiency anaemia was a serious problem among camp-restricted refugees. WFP and its partners imported, installed, and trained workers in the use of two containerized milling and fortification units (MFUs), halved iron-deficiency anaemia, and reduced vitamin A deficiency among camp residents. In addition, WFP dramatically reduced waiting times for refugees who used to have their whole grain maize rations milled at small local facilities with insufficient milling capacity. The context and scale of each of the three case-studies described in this paper was different, but the lessons learned are comparable. All projects were succesful in their own right, but also required a considerable amount of staff time and supervision as well as external technical expertise, limiting the potential for scaling up within the WFP operational context. In order to expand and sustain the provision of fortified cereal flour to WFP beneficiaries and beyond, getting the private milling sector as well as governments on board would be crucial. Where this is not possible, such as in very isolated, difficult to reach locations, strong, specialized partners are a prerequisite, but these are few in number. Alternatively, in such contexts or in situations where the need is urgent and cannot be met through local flour fortification in the short term, or through local purchases of fresh foods, other approaches to improve the diet, such as the use of multimicronutrient formulations, packed for individual or household use, may be more appropriate. [ABSTRACT FROM AUTHOR]