Reducing Blindness from Retinopathy of Prematurity (ROP) in Argentina Through Collaboration, Advocacy and Policy Implementation.

Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.

Multisectoral approach to the delivery of health care in Jamaica

Examines the need for better integration of the public health sector with other sectors in the society. Critically examines the health status of the Jamaican population, the socio-economic environment and the development of health policy between 1950 and 1983. Five areas were researched for intersectoral co-ordination: Basic Services Programme for children jointly sponsored by UNICEF, PAHO and Government of Jamaica; the Pesticides Advisory Committee concerned with utilization of chemical and pesticides as it relates to plant protection, food storage and public health; the Nutrition Advisory Council which co-ordinates the development of food and nutrition policies; methods used for the efficient delivery of water; and methods used in the process of collaboration between the Ministries of Health and Education as attempts are made to include health concepts in school curricula and programmes. Concludes that almost all the projects and activities investigated have not performed as expected. Recommendations include the following: 1) clear goals and task specifications before the execution of any project or programme; 2) a common understanding and expectation of desired goals and objectives; 3) paying greater attention to the incorporation of potential beneficiaries into the planning and design stages of programmes. (Au)

Food consumption patterns in St. James - abstract

A household survey was conducted in March 1982 using a stratified random sample the population in 3 ecological zones: urban (U), Rural Lowland (RL, <1000 feet), and Rural Upland (RU, >1000 feet). Households with 10 acres of land and children over 3 years were excluded. This paper examines the patterns of food consumption and assesses the adequacy of the household's consumption by use of 24-hour recall conducted by trained Community Health Aides. One hundred and three different items were reported from the 301 households in the U (N = 82), RL (N = 118), RU (N = 101) zones. Fifteen items used by at least 15 percent of the sample contributed 80.8 percent and 68.7 percent to total calories and protein respectively, in the parish, Cereals contributed 32.3 percent, 36.5 percent and 30.5 percent to total calories while root crops contributed 12.7 percent, 15.0 percent and 33.2 percent in U, RL and RU respectively. The average househeld calorie satisfaction was not significantly different for the 3 zones (106 percent), 104 percent, 110 percent) nor the proportion of households with < 80 percent calorie satisfaction. The mean protein energy per cent was 13.7 ñ 2.3 for urban, 11.7 ñ 2.8 and 10.8 ñ 2.8 for the RL and RU zones respectively (p<.001). Households spending > J$3.00/2000Kcal were 63.4 percent in urban, 55.9 percent and 56.4 percent in RL and RU zones. The average weekly food expenditure per person was J$17.2 ñ 9.1, J$13.4 ñ 7.5 and J$14.6 ñ 7.2 (p<0.5): expressed as percentage of total expenditure: 52.7 percent, 66.2 percent, and 75.3 percent, in the U, RL and RU zones (p<.01). Elasticity of demand for calories consumption was negative in the urban area (r bar to second power = 0.360; p<.001) and positive in the combined rural zones (r bar to second power = 0.502, p<.001). Certain implications are suggested byu the data: 1. Very few food items can be used to construct a food basket which could be monitored once or twice yearly. 1. The urban dwellers consumed more "luxury" items hence more expensive calories than the rural dwellers. 3. Increased income has different effects on calorie consumption depending on income class and geographical location (AU)

Political constraints to nutritional improvement: the case of Guyana.

The processes generating malnutrition are examined with particular reference to Guyana. The theoretical framework includes the concept of limiting factors, which in this case means that the failure to alter a critical variable will prevent nutritional improvement, despite intervention in other variables. Among important factors found to cause malnutrition age low national production, inequitable income distribution, and maladaptive cultural practices. These are located in the economy of the country and in the institutions and ideas which support that economy. Power and politics therefore fundamentally affect nutritional outcome; and imperialist control of underdeveloped economies makes international relations an indispensible consideration. It is concluded that for Guyana the political process is the limiting factor which must be altered before significant nutritional improvement can occur.

The nutritional significance of root and tuber crop development as staples in the Caribbean community.

The competition between cereals and root crops as CARICOM staples is described. The move to substitute locally grown food for imported wheat is shown to favor root crop development in the region. Against this background, traditional nutrition-prompted objections to wheat substitution by root crops are examined. Evidence is cited to show the essential adequacy of protein in root crops, except plantain and cassava and for all humans except perhaps some infants. The low protein in cassava and plantain, it is proposed, can be easily overcome in the process of local root crop development. Finally, it is argued that there exists the potential to obtain cheap calories from root crops. This and the generation of economic activity among small farmers, concomitant with root crop development, are seen as possible indicators of good nutrition for the region in the future.

The nutritional significance of root and tuber crop development as staples in the Caribbean community

The competition between cereals and root crops as CARICOM staples is described. The move to substitute locally grown food for imported wheat is shown to favor root crop development in the region. Against this background, traditional nutrition-promoted objections to wheat substitution by root crops are examined. Evidence is cited to show the essential adequacy of protein in root crops, except platain and cassava and for all humans except perhaps some infants. The low protein in cassava and plantain, it is proposed, can be easily overcome in the process of local root crop development. Finally, it is argued that there exists the potential to obtain cheap calories from root crops. This and the generation of economic activity among small farmers, concomitant with root crop development, are seen as possible indicators of good nutrition for the region in the future