Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain.

It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions. The study was designed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age. In a controlled trial, 418 infants 4 mo of age were individually randomized to one of the four groups and followed until 12 mo of age. The first group received a milk-based cereal and nutritional counseling; the second group monthly nutritional counseling alone. To control for the effect of twice-weekly home visits for morbidity ascertainment, similar visits were made in one of the control groups (visitation group); the fourth group received no intervention. The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk (P < 0.001), 1739 kJ at 38 wk (P < 0.001) and 2257 kJ at 52 wk (P < 0.001). The food supplementation infants gained 250 g (95% confidence interval: 20--480 g) more weight than did the visitation group. The difference in the mean increment in length during the study was 0.4 cm (95% confidence interval: -0.1--0.9 cm). The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages (P < 0.05 at all ages) but no significant benefit on weight and length increments. Methods to enhance the impact of these interventions need to be identified.

Surgical extraction of guinea worm: disability reduction and contribution to disease control.

Surgical extraction of Guinea worm prior to eruption through the skin has long been performed by traditional healers in India. Using modern aseptic techniques under local anesthesia, unerupted worms can be completely and painlessly removed in several minutes. As a result, the average number of working days lost due to a single worm is reduced from three weeks or more to three days. In the field, the procedure results not only in a dramatic decrease in Guinea worm associated disability, but also in an improvement in detecting cases, and appears to reduce disease transmission.

Principles and strategies of programming for adolescent girls.

PIP: In consort with the focus on women's enrichment and status improvement in developing countries, the following principles and strategies are discussed: decentralized planning, maximizing schooling, experiential learning, avoidance of exploitation. Planning must involve adolescents and women and be consistent with cultural influences and patterns. Girls also need to be encouraged by parents to stay in schools as long as possible, with minimizing the attractions of staying out of school, and provision for dropouts to return. Experiential learning through interaction, observation, and enjoyment is the best method and will work best with the disadvantaged and neglected, and enable women to, for instance, understand the importance of breastfeeding, immunization, or hygiene. The program which may involved service is not to be exploitative, be a convenience, and benefit her. The content needs to be flexible and suitable to the age such that nutrition must be taught before menarche and at the first sign of breast development, and when bone growth is at its peak. School feeding programs are of proven benefit. Goals can be satisfied without being rigid and allowing for dream time also. The shape of a better tomorrow will depend upon these women. Adequate funding is always necessary, and something for nothing doesn't work without adequate food, useful learning materials, and attractive incentives such as a culturally appropriate items of clothing, confidence and prestige building are a must. The challenges are to provide formal schooling and the concomitant self-esteem building and public recognition of women's competence. Seclusion of pubescent girls in purdah needs to be eliminated and replaced with programs of responsible, mature and positive interaction with older women, who provide leadership skills and linkages to larger society. Interactions between girls is also important with village based continuing education, and practical self-guided curricula. Vocational training in marketable skills contributes to the economy and independence. Awareness of legal rights and utilization of resources available in primary health care needs to be encouraged. Changes need to be made in family perceptions that allow women educational growth without neglect of family chores and responsibilities. Health programs need to assess adequate intake of iron and folic acid, and nutrition starting at menarche, and proper hygiene. Reproductive information must be provided.^ieng