WO R L D HEALTH ORGANIZATION

Region.' Olllee for the Eastern M.dlterranean

EI4 R&GIONAL ADVISORY CXM4rrrEE O~ BIOMEDICAL RESEARCH Fourth Meeting

Tunis, 10-13 September 1979

Agenda i tern 7

THE R&GIONAL PROGJW-I.ffi RlR APPLIED NUl'RITION RESEARCH

ORGANISATION MONDIALE DE LA SANTE

Bur.au regional pour I. Mecllterran'e orientale

31 August 1979

An outline of the Regional Programme

for Action-Oriented Research

l.n Nutr1.t1.on

WHo/EMRO

1.- The Need for Act1.on-Oripnted Research

The evolution of the science of nutl etion l.n the last several decadas has

increasingly brought l.nto focus the bas1.c role played by nutr1.t1.on as a major

determinant of health. The last few years however, have wlotnessed such technical

advances that make nutrlot1.ona1 measures for d1.sease prevention and health promot1.on

widely practicable even under certa1.n restr1.ct1.ve cond1.t1.ons that characterise

the develop long world.

More recent studies, for example, have revealed that human requirements for

prote1.n have been cons1.derably over-estl.mated in the past, that for obtain1.ng

one's quota of daily prote1.n one does not have to rely on expenslove animal foods

and that these needs can be met from a Jud1.cious mix of foods routinely used

at home. The practical impllocations of these findings for the control of the

most widespread nutritional d1.sorder, protein-energy-ma1nutrlotion are thus obv1.ous.

Similarly, a series of simple technological measures have been evolved that would

help in the e1imlonat1.0n of other common nutritional deficienc1.es. Masslove doses

of vitamin A, admin1.stered at l.ntervals of 4 to 6 months could protect the ch1.ld

in its most susceptible per1.od of life from such serious sequelae like nutr1.tl.Onal

blindness. Prompt resort to early oral rehydration in the case of dloarrhoeas

will not only reduce infant and childhood mortality but also m1.tl.gate the

consequent malnutrition ant lot is a technique quite feasible at home. Small

supplement tablets of iron and folate can help combat yet another common problem

of anaemias in women as well as the1.r adverse effects on offspr1.ng. Furthermore,

fortification possibilities of a w1.de range of foods W1.th essent1.al nutrients

have also been perfected as blanket-measures aga1.nst a number of deficloency

disorders. .1 ••

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Wh~le ~n the long run, general soc~o-econom~c development and el~mLnat~on of

poverty would offer more lasting solutLon to the problem of malnutrLt10n, the

above are measures wh~ch are immediately pract~cable, many of them through the

health sectors and are well w1thin th~ means of 1ndLv1duals and communLt1es 1n

all develop~ng socLet~es.

Several countr1es,~ndeed, have been Lmplement~ng some of the measures with

vary1ng degrees of success. Some natLons, n fact, have succeeded 1n erad~cat1ng

dLseases lLke goitre and pellagra and minLmis~ng the Lmpact of others, ut~liz1ng

the known techn~ques. The questLon ar~ses therefore, as to why other countrLes have

failed ~n achLevLng the same results. ObvLously, there are several pract1cal

problems of local relevance and s1gnif1cance wh1ch need to be stud~ed and resolved

~n the~r respect~ve contexts. Purpose-or~ented research in nutr~t~on, thus gaLns

great ~mportance in order to translate the avaLlable knowledge 1nto programmes of

actLon, or to divise appropriate alternatLve technolog~es, if the 50% deaths Ln chLldren

under f~ve years, wh1ch are d~rectly or indirectly attr~buted to malnutrLt~on, were

to be s~gnLficantly reduced, 1f not totally prevented.

2.- The efforts of WHO

In the past several years, WHO has been supportLng app1Led nutr1t10n research

on an "ad-hoc" bas~s, wh1ch undoubtedly contr1buted to the development of some of

the technolog~cal advances ment10ned above. In v~ew of 1tS grow1ng 1mportance, the

subject ~s now be~ng approached on a more systematLc bas1s.

The World Food Conference 1n 1974, emphas1zed the need for app11ed nutritLon

research related to econom~c, cultural, social and medical aspects, referrlng to

the Lmportant role of FAO, WHO and UNICEF ~n arrang1ng an ~nternat10nally coord~nated

programme 1n th1s respect. The World Health Assembly in 1977 discussed Lhe subject

of nutr1t10n at 1ts techn1cal sess~ons and requested the D~rector-General to further

develop and strengthen the nutr1t10n programme of the Organ1zat10n. In response to

Resolut~on WHA 30.51, "An Act1on-Or1ented Research and Development Programme 1n

Nutr1tlOn" was formulated, wh1ch was approved by the World Health Assembly and

endorsed by the Global AdvLsory Comm1ttee on Med~ca1 Research 1n 1978. The latter

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appointed a Sub-Committee on nutrition to further elaborate the programme.

The Report of the ACMR Sub-Comm~ttee on Nutrit~on which met in February 1979,

has already been circulated under Agenda item no.5.

The programme proposed by the ACMR Sub-Comm~ttee is broad-based and compre­

hensive. In brief, it ~dentifies the follow~ng areas as 1mportant and in

consonnance with the nature and magn~tude of nutr~t~onal problems encountered

in develop~ng countrLes'

a) development and propagat~on of suitable home-based weaning foods for infants

and young children;

b) studies on the interrelat~ons of infect~ons (including d~arrhoeas) and

malnutrition,

c) impact of maternal malnutrit~on on the mother and ehild and ident~fication of

action at commun~ty level to offset adverse effects,

d) development and appl~cat10n of methods at the community level for the prevention

of nutritional blindness, anaemias, rickets and goitre,

e) identification of the nutrition component of the bas~e health package and

development of strategies for its delivery through primary health care, within

the available ure.~ns.

Recognizing that Lmmed~ate action on all fLve areas ment~oned above may not

be possible, the Sub-Committee suggested setting-up of pr~orLtLes as pertinent

to different regions. It however, expressed the view that areas (a) and (e)

deserve high priority.

The Regional Committee of the EMR has long been interested ~n the kind of

nutrition research that ~s geared to aetLon programmes. In 1968, it urged the

governments of the reg~on to promote programmes for the development and distri­

bution of weaning foods (EM/RC 18 A/R.13). It also singled out el1mLnat~on of

nutritional disorders in the vulnerable groups as one of the pr~orities ~n the

Fifth General Programme of Work (EM/RC 20 AIR 3). And support to actLon-oriented

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research ~n nutrit~on has been one of the targets of the S~xth General Programme

of Work, ~n order to accelerate accompl~shment of the above goals.

3.- S~tuat~on ~n the EMR Countr~es

3.1 Nutritional D~sorders All the def~c~ency d~seases common to the develop~ng

world occur ~n countr~es of the reg~on, although ~n varying degrees of sever~ty

and ~ntens~ty. The most frequent of them is prote~n-energy-malnutr~t~on ~n ~nfants

and todlers, the more severe forms of wh~ch are seen 1n I to 4% (or more) of ch1ldren

below five years ~n a major~ty of the countr~es. Anaem~as could be graded as the

next problem of concern affect1ng, on a conservat1ve estimat~on, more than a quarter

of women ~n ch~ld bear~ng age as well as ch~ldren. S~gns of v~tamin A def1c~ency

preva~l to a degree vary~ng from country to country, however, they are cons~dered

to be less severe and less frequent in th~s reg~on compared to certain other reg~ons.

R~ckets dur~ng the wean~ng per~od is often reported from some countr1es but ~s

considered to be mild and trans~ent, mostly based on cl~n~cal f~nd~ngs. Go~tre st~ll

cont~nues unabated ~n the long known endem~c reg~ons of Pak~stan, Afghan1stan, Iran,

Iraq, Lebanon, Egypt, Libya, Sudan and Soma11a.

The availab~l~ty of food ~s not cons~dered a major problem in most of the

~v~nLLL~~, wh11e thel~ are occas~onal per~ods of scarc~ty ~n a few. However, the

common denom~nator beh~nd the ch~ldhood malnutr~t~on in all the countr~es seems to

be the w~despread ~gnorance about the types and amounts of foods that can be used

for wean~ng and subsequent feed~ng of ch~ldren upto 3 to 4 years.

In a number of countr~es, the o~l resources have generated new ~ncomes. Urban

m~grat~on ~s tak~ng place at rates faster than hous~ng construct~on. Agr~cultural

and food produc~ng occupations are stead~ly being bacr~f~ced. The markets ~n all

these countr~es are flooded w~th processed foods among wh~ch a number of m~lk formulae

and art~f~cial baby foods are the most prom~nent. The ready ava~lab~l~ty of these

foods coupled w~th poor not~ons of hyg~ene and lack of gu~dance on the~r use are fast

lead~ng to abandonment of breast feed~ng, ~nfant~le d~arrhoeas and marasm~c malnutrit~on_

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Of the estimated 50 mill~on ch~ldren under 5 years of age ~n the 23 countr~es

of the region, approximately 2 m~ll~on die every year. Some recent stud~es in the

region show that malnutr~t~on ~s the underlying or associated cause ~n 50% of the

deaths in this age group. Thus, w~th proper attent~on to the nutr~t~on of th~s

segment alone, about a million l~ves can be L, ved annually.

3.2 Applied Nutrit~on Research, Efforts and Potent~al~t~es • Nutr~t~on research or~ented

to facilitating action at the commun~ty level has often been carried out ~n this reg~on.

The very first trials to explore the usefulness of massive doses of v~tam~n A as a

prophylactic measure were conducted in Jordan ~n the early s~xt~es, although the

results of the initial exper~ments were ~nconclusive Stud~es have also led to the

development of several weaning mixtures based on local foods (eg."supram~ne" ~n Egypt,

"lubina" in Lebanon, "saha" in Tun~sia, "shadam~ne" ~n Iran, "faffa" ~n Eth~op~a), but

none of them has really taken roots and become commerc~ally viable so far. Najjar's salt

mixture as means for prevent~on of severe dehydrat~on ~n young children has been tr~ed

at the rehydration/nutrition centres of UNRWA w~th some degree of success but ~ts use

has not spread widely in the reg~on. These exper~ances however, served to ~nd~cate

the need for alternative approaches.

More recent efforts ~n th~s regard seem promis~ng. The health serv~ces research

studies in Iran (West Azerba~Jan and Kavar V~llage ProJects) have establ~shed the

feasibility of training and ut~liz~ng village .orkers for rendering certa~n health

and nutrition services to the community. Of part~cular ~nterest ~s the demonstrat~on

in the West Azerbaijan studles that it is not only possible to promote use of oral

rehydration salts at home in early diarrhoeas, but such a measure would also lead to

positi~e weight gains and continued nutrltional benefits among the rec~p~ent children.

Yet another study of conslderable local slgnlficance is the one ~n Wad Mldanl, Sudan,

related to the development and propagation of home based d~ets for proper wean~ng of

infants. However, these stud~es are Just the beginnings ~n the d~rectlon of actlon

programmes. They need to be further extended and ~ntensi~ied to confirm some of the

findings where necessary, to adapt them to d~fferent situations and to work out the

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methods for repl~cat~on w~th~n the ava~lable means.

Interest1ng as they are, the present stud~es are centred around few ~nd~vlduals

or ~nst~tut10ns 1n th1s Reg~on Compared to certa1n other WHO Reg10ns, lt must be

adm1tted that EMR lags beh1nd both 1n the manpower and fac1l~t1es needed for the type

of research act1v1t1es contemplated. As a good part of the proposed act1vltles

w1l1 have to be carr1ed out at the local (or country) level, development of research

capab111t1es becomes one of the priority is~ues.

4.- Outl1nes of the Proposed Programme

The bas1c strateg1es ment10ned by the Global ACMR Sub-commlttee on Nutr1t1on,

namely, that the programme should a1m at 1dent1fY1ng, fac1l1tat1ng and promot1ng

act~on at the comrnun1ty level even under the preva111ng SOC1o-econom1C constra1nts

and that ma1n emphas1s should be d~rected to 1nfants and young ch1ldren who const1-

tute the most cruc1al and vulnerable group, are equally appl~cable to th1S Reglon

~n the 11ght of the preval11ng sltuat1on.

All the f1ve broad areas 1dent1f1ed by the above Sub-comrn1ttee for furtherance

of act10n-or1ented research are, no doubt, very 1mportant and relevant to the

problems ~n EMR to a greater or lesser extent However, 1n V1ew of the l~m1tat10ns

in resources espec~ally w1th regard to research capab111t~es 1n the Reg10n, 1t would

De pruoent to focus 1mmed1ate attent~on on the most lmportant problems, where

practlcal appllcatlon of knmvledge through organLZed programmes seems feaslble

ThlS tantamounts to laYlng stress In the comlng years on two lmportant areas,

namely, ~dentlt~cat~on, development and propagatlon of nutrltlonally adequate, In­

expens1ve, locally ava~lable and culturally acceptable reclpes as weanlng foods

for ~nfants and young chlldren, and development and dellvery of a package of bas1c

health serV1ces 1nclud~ng an effectlve "nutrltlon component", to the poorer communl­

tles, through pr1mary health care (as h1ghllghted by the Global AC}m Sub-commlttee)

Research ln other areas could be supported where faclllt1es eXlst or become avallable.

In Vlew of the above conslderatlons lt 1S planned to undertake the followlng research

act~v~tles, wh~ch are adm1ttedly not exhaust1ve, durlng the next few years The

protocols and detalls of these proposals would be prepared durlng the next few months.

7

4.1 COLLECTION Am> EVALUATION OF DATA ON WEANING PRACTICES, DIETS USED FOR

WEANING AND ~CIPES ALREADY DEVELOPED BASED ON LOW-COST LOCAL FOODS. ,

Although it is generally accepted that malnutritLon is a serious problem Ln

the weaning age, informatLon has been very sketchy from the countrLes of the region

with regard to the feeding practLces and ciets used in this perLod. Such LnformatLon

L8 a basic prerequisLte for any research or action programmes Ln th~s Lmportant area.

Information on weanLng practLces shou j include the age of weaning, foods

preferred, mo1e of preparation, amount and frequency of feed1ng, local be11efs,

customs and attitudes to chLld feeding etc. Recipes used or developed locally

should be revLewed Ln respect of food LngredLents used, nutrLtional value, calorie

density, acceptability, dLgestibLILty and tolerance, keeping qualLty and cost per

1000 calories etc.

It should be possible to collect and compile the needed Lnformation in a reasonable

period of tune by extending modest support ~o Lnterested LnvestLgators, 1f poss1ble,

one from each country. Apart from provid1ng useful leads for future work, this

effort should help in due course 1n the prepardt10n of a brochure on rec1pes

suitable for weaning of infants and young chLldren in the d1fferent ethn1c groups

of countries in the region.

4.2 DEVF;LOPMENT OF SUITABLE WEANING RECIPES BASED ON. INEXPENSIVE, LOCALLY AVAILABLE

FOODS.

Much of recent research p01nts to the fact that food mixes Ln sU1table form and

proportions can be developed from resources normally available at home, which can be

effectively utilized as d1ets for weanLng Programmes of study therefore need to be

established which aim at (a) ident!fying local foods sU1table for the purpose,

(b) formulating appropriate mLxes and methods of preparatLon (c) test1ng theLr

nutritive value (where needed), and their acceptabilLty w1th a view to overcoming

any practical problems thst may be ident1tied, and (d) promoting wider use of those

found acceptable through appropriate demonstration and educational programmes. Such

studies are important to several countries in the region, however, pr10r1ty Ln esta-

blishing them should be given to the SLX most affecte~ countries, whicb have the ,

lowest GNP. .1 ••

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4 • 3 STUDIES ON THE PREVALENC§, 'llRENDS AND FACTORS A[:09SlGtM'ED WITH DECLINE 0 F

BREAST F'EED!N,.G AND _ IDENTIFICATION OF MEASURES FOR ITS PRESERVATION AND

PR®OTION Wh~le the general trend ~n several countr~es of the reg~on

is to continue breast feeding Ilpto 18 to 24 months, there have been some

disturbing 1nd~cat~ons that th1s pract~ce ~s fast declin1ng. In o~l export~ng

countries especially, a number of factors occurriqg together, such as a rap~d

urbanization, ~ncreased ~ncomes, easy acc', s~bility to a w~de range of art1fic~al

baby foods w~th little knowledge on the1r use, have all been contr~but~ng to

the neglect of breast feed~ng and to an ~ncreas1ng ~ncidence of marasm1C

malnutr~tion. It should be of urgent concern to these countries to prevent

this grave trend by undertak1ng thorough stud1es of the actual situation and

associated factors, which would prov1de leads for the type of action to be

taken.

4.4 EVALUATION OF THE CONTENT AND MEANS OF DELIVERY OF NUTRITION SERVICES AS PART

OF THE EXISTING PRIMARY HEALTHCARE PROGRAMMES IN THE REGION-- Some of the

countr~es in the Reg~on, espec~ally Iran and the Sudan have already been ~nvolved

for the last few years ~n developing su~table systems of primary health care,

A careful exam~nation of these programmes w~th reference to the type of nutr~t~on

act~vities carr~ed out, the means of delivery of these act1v~t1es and the~r

~pact, the tra~n~ng of v~llage level workers, the manuals used by the later etc

should help to reveal ex~st~ng lim~tat~ons and prov~de clues for future mod~f~-

cat~ons in th1s approach.

4.5 STUDIES TO DETERMINE THE MINIMAL EFFECTIVE "NUTRI.TION COMPONENT" TO BE DELIVERED

AS PART OF THE BASIC HEALTH SERVICES PACKAGE THROUGH PRIMARy HEALTH CARE It ~s --- --

important to determ~ne essent~al feas1ble nutr~t~on component along w~th other

1mpo~tant elements like ~un1zation, early oral rehydrat~on, spac1ng of b~rths

and mother and child care, s~nce exclus~on of anyone of these serv~ces can offset

the benefic~al effects of the others. The poss~ble means of del~very of these

components togethe~in the context of resources ava~lable ~s also ~mportant

to perm1e their rep11cat1Qn on a w~der scale. Such stud1es need to be carefully

planned and promoted on a p1lot bas~s ~n all the countr1es ~nterested ~n develop-

~ng primary health care as one of its strateg~es for extend~ng health ser~~ces

9 to the unserved and under served.

4.6 DEVELOPMENT OF SIMPLE PROCEDURES FOR NUTRITIONAL SURVEILLANCE OF "AT RISK"

GROUPS AND FOR EVALUATION OF NUTRITION PROGRAMMES UTILIZING VILLAGE LEVEL

WORKERS: In order to ensure that the benef~ts of a nutr~t~on programme reach

the most needy segments, ~t ~s important to develop and evaluate simple methods

and procedures that can be applied by the v~llage level health workers to

identify the individuals "at risk" and ~,.., evaluate the results of act~on.

The feasib~lity of th~s approach in the actual village cond~t~ons should be

carefully tested. These studies could form part of the ex~st~ng health serv~ces

research projects, wherever poss~ble.

4.7 ALTERNATE APPROACHES TO THE TREATMENT AND PREVENTION OF SEVERE PROTEIN-ENERGY

MALNUTRTION Even at the lowest rate of inc~dence (1% among ch~ldren under

5 years), the total number of severe cases of malnutr~t~on would be so large that

no country can afford the needed paed~atr~c beds for the~r treatment. Furthermore,

once admitted the malnour~shed ch~ld is usually kept in the hospital for 4-6 weeks.

Shortage of hosp~tal beds, exhorbitant costs for hosp~talization, lack of time

and effort on the part of the hosp~tal staff to educate the mother on the root

causes of the problem call for an exploration of alternate approaches. An inter­

country research project is therefore proposed which aims at analys~ng the present

situation and devising appropr~ate stud~es on the feas~b~l~ty, methodology, esta­

blishment of criteria for adm~ss10n and discharge, and utilizat~on of facilit~es

outside the hospital {such as out-pat~ent clinics, health centres, rehab~litat~on

units, and primary health care),as alternat~ve approaches for ambulatory treatment

of advanced cases of PEM.

4.8 EFFECT OF EARLY ORAL REHYDRATION OF CHILDREN WITH DIARRHOEAS ON THEIR SUBSEQUENT

LONG-TERM NUTRITIONAL PROGRESS' Tr~als conducted as part of the health serv~ces

research project ~n West Azerba~Jan, Iran, have not only conf~rmed the f~nd~ngs of

others with regard to the feasib~lity and effectiveness of the use of oral rehy­

dration salts through community health workers (and mothers), but also showed

that the weight gains in children so treated were significantly h~gher S1X months

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• after the ep1sode, as compared to well matched controls. S1m1lar stud1es

need to be carr1ed out in the context of other s1tuat10ns (and resources)

espec1ally w1th a V1ew to ensure rep11cabi11ty of the technology,

4.9 DEVELOPMENT OF SAFE SUBSTITUTES FOR ORAL REHYDRATION FROM COMMONLY USED

HOME BEVERAGES Current packs of ORS though convenient, are not always 1n

ample supply. Besides, 1n V1ew of the large quant1t1es usually needed, the

costs to the governments are somet1mes su)stant1al. It should therefore be

useful to develop safer and equally effect1ve alternat1ves based on commonly

used soups, beverages or JU1ces at home.

4.10 EVALUATION OF NUTRIENT SUPPLEMENT PROGRAMMES IN THE REGION, ESPECIALLY THOSE

OF IRON AND FOLATE TO PREGNANT WOMEN Although d1str1but10n of 1ron and

1ron + fo la te prepara t10ns seems to be tak1ng place through the MCH and heal th

serV1ces rctwork in several COUntr1eS of the reg1on, no ser10US evaluat10n of

th1s pub11c health measure has been made. A l1m1ted recent study 1n one of

the countr1es revealed that 1nsp1te of regular d1str1but1on of 1ron-folate

supplements, 30% of pregnant women st1ll rema1n anaemic. An evaluat10n of

these programmes should be encouraged to eluc1date their real 1mpact or short-

com1ngs 1f any wh1ch helD 1n improv1ng the1r 1mplementation. Also, p1lot

therapeut1c tr1als would be useful to determ1ne the level of supplements that

would be appropr1ate to d1fferent s1tuat10ns.

4.11 EFFECT OF IRON AND FOLATE SUPPLEMENTS TO PREGNANT WOMEN ON THE BIRTH WEIGHT

OF OFFSPRING It 1S cla1med 1n some quarters that 1ron and fol1c aC1d

supplements 1n the th1rd tr1mester of pregnancy lead to a sign1f1cant 1ncrease

1n the b1rth we1ght of the offspr1ng. In V1ew of the 1IDportant 1mp11cat1ons

that such a f1nd1ng may have for countr1es where low b1rth we1ght 1S a common

problem, test1ng the val1d1ty of th1s f1nding should be of w1de and 1mmed1ate

1nterest.

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4.12 EFFler OF PERIODIC DEWORHUfG OF CHILDREN ON THEIR NlmUTIONAL sTATUS

AND GROWTH: Some recent observations indicate that period~c deworming

of children infested with round-worms resulted in better growth. Studies

of this nature in relat~on to the commonly encountered parasites in the

region would be of great pract~cal value ~n devising appropr~ate act~on

progr_s.

5. Course of Action for Progr8llDlle develc ... ment

5.1 Regional Scientific Working Group on Applied Nutrition Research: To further

elaborate a regionally relevant and real~st~c programme of research and to

ensure sound technical support throughout the various stages of its develop­

ment, a Scientific Working Group on nutrit~on lS being constituted with

members drawn from a panel of nutrition experts available in the reg~on and

one or two co-opted from !MR/ACMR. The functions of this group would be

purely technical advisory in nature and its terms of reference would be:

to ident~fy research problems of pract1cal ~mportance in the held of

nutrition;

to determine priorities among the problems identified;

to define precise object~ves for the proposed research and develop

~ppropr~ate research designs and protocols,

to advise the Regional D~rector on individuals or ~nstltutions suitable

for undertaking such studies,

to advise on the technical soundness and su~tability for support of

applications for research grants, when requ~red,

to evaluate the results of research projects supported by the Organ~za­

tion and adv~.e on the~r practical lmpl~cations.

The first meeting of this group ~s planned to be held in early 1980 to

review the proposals outlined above (ltem nos. 4 I to 4.12)in order to

determina their relative importance and suggest any other areas or approaches

of particular ~nterest to !MR, identifying at the same t~me projects that deserve

to be implemented in the next 3-4 years. And especially, the group w~ll

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formulate spec1f1c proposals (1nclud1ng study obJect1ves, methods, des1gns,

suggest10ns on locat10n and costs) 1n relation to the selected pr1or1ty

projects for cons1derat10n of WHO and/or other potent1al donor agenc1es.

5.2 Ident1fication of research potent1a11t1es 1n nutr1t1on w1th1n the reg10n"

Through consultant V1S1ts to countr1es and consultat1ons w1th nat10nal

author1ties, efforts will be made to 1der Lfy workers, fac1lit1es and more

espec1ally opportun1t1es for act10n-or1ented research 1n nutr1t10n w1th1n

the countr1es of the reg1on.

5.3 Implernentat10n of selected pr1or1ty proJects" Subject to ava1lab1l1ty of funds,

the pr1or1ty projects will be supported through research grants. Where research

capab1l1t1es are 11m1ted, efforts w1ll be d1rected to develop the needed manpower

by 11nk1ng up research tra1n1ng awards w1th the grants.