发展中国家儿童营养政策的经验和教训

在我国进行儿童营养干预和制定儿童营养政策的时候要充分借鉴其他国家的经验。在对一些发展中国家儿童营养政策回顾的基础上,通过经验和教训两方面的案例探索成功实施儿童营养政策的共同点。在儿童营养政策的领导和组织方面,要有坚定的政治承诺,并与其他公共政策紧密结合;在制度和机制设计方面,要保证可持续筹资、社区充分参与,并有针对母亲和儿童的食品补贴政策;在政策实施上,要保证其有效执行和发挥母亲在政策中的关键作用。     

利用CHNRI方法确定中国卫生政策优先研究问题

目的:运用儿童健康与营养研究(Children Health and Nutrition Research Initiative,CHNRI)方法,确定我国优先干预的卫生问题,为卫生政策制定者提供循证决策依据。方法:以我国医改与卫生事业发展"十二五"规划为背景资料,通过文献分析从中筛选出多项卫生政策研究问题,并采用CHNRI项目开发的设定优先研究领域的工具和方法进行优先问题选择。结果与讨论:研究筛选出的前10位优先研究问题主要集中在以下几方面:公共卫生服务相关研究、卫生经费的筹资及利用、重点人群和重点地区卫生政策相关研究、卫生信息化建设、医疗质量控制等,建议政府应在"十三五"期间加强有关问题的研究与干预。利用CHNRI方法确定卫生政策优先研究问题可行且有效,可为决策者提供循证依据。     

“改善中国最弱势妇女和儿童群体的营养、食品安全和食品保障”联合项目效果评估研究简

目的：评估中国最弱势妇女和儿童群体的营养、食品安全和食品保障项目的产出及效果,总结实践经验,为政府进一步应用推广提供依据。方法：采用案头审查和知情人访谈,从相关性、效率、效果、可持续性等方面进行评估。结果：项目活动与试点地区需求、国家政策和千年发展目标高度相关;管理模式和干预方法具有较高的效率;试点地区6～23月龄儿童生长发育指标、富含微量营养素食物消费比例、食品安全知识的认知、态度和行为、食品安全报道、当地企业食品安全生产等均有显著改善。干预的可持续性好,需进一步加强政策资金支持。结论：项目促进了联合国机构间、中国政府部门间以及技术机构间的合作,是解决目标问题的最佳策略。基本实现了主题窗口下的干预目标,并取得了显著的干预效果。部分成果已纳入了国家政策或被推广应用,具有较好的可持续性,国家或省级的政策支持是保证贫困地区项目可持续性的关键。     

世界卫生组织乙型肝炎控制目标和策略

预防接种与卫生和环境卫生一同促进着全球各国儿童的健康，每年从死亡线上挽救着数以百万的儿童，大大降低了因感染传染病而导致的残障。今天，计划免疫成为促进健康的最经济有效的方法之一，也为其它影响健康的干预措施，如补充营养和预防疟疾的实施提供了机会。然而，预防接种并未真正覆盖每个儿童。与发达国家儿童相比，一些发展中国家的儿童更不能得到计划免疫服务。最贫困的儿童接种的疫苗也较少，他们也最容易处于不安全注射的危险。在发展中国家，计划免疫难以实施多是由于政治承诺力度和投入不足，计划免疫常常受到薄弱的卫生服务体系的牵制。与此同时，在发展中国家急需研究、开发和生产新疫苗，但这方面的投入水平又较低。     

WHO关于儿童铅暴露防治的新行动

儿童铅暴露给全球带来了一系列公共卫生问题,在发达国家和发展中国家均影响着儿童的健康.该文回顾了有关铅暴露筛查与诊断、治疗、预防方面的最新研究成果,提出了最有效的健康行动是将环境和儿童发育相结合,同时加强相关部门的合作,共同制定和实施儿童铅暴露防治的公共卫生政策,以解决这一重要的公共卫生问题.     

“改善中国最弱势妇女和儿童群体的营养、食品安全和食品保障”联合项目效果评估研究

目的 :评估中国最弱势妇女和儿童群体的营养、食品安全和食品保障项目的产出及效果,总结实践经验,为政府进一步应用推广提供依据。方法 :采用案头审查和知情人访谈,从相关性、效率、效果、可持续性等方面进行评估。结果 :项目活动与试点地区需求、国家政策和千年发展目标高度相关;管理模式和干预方法具有较高的效率;试点地区6~23月龄儿童生长发育指标、富含微量营养素食物消费比例、食品安全知识的认知、态度和行为、食品安全报道、当地企业食品安全生产等均有显著改善。干预的可持续性好,需进一步加强政策资金支持。结论 :项目促进了联合国机构间、中国政府部门间以及技术机构间的合作,是解决目标问题的最佳策略。基本实现了主题窗口下的干预目标,并取得了显著的干预效果。部分成果已纳入了国家政策或被推广应用,具有较好的可持续性,国家或省级的政策支持是保证贫困地区项目可持续性的关键。     

海南省农村5岁以下儿童体格生长及营养状况分析

目的:了解海南省5岁以下儿童体格生长状况,为制定5岁以下儿童营养不良干预措施提供依据。方法:利用实施国家基本公共卫生项目—"0～36个月儿童免费体检项目"和"海南省儿童‘六.一’体检项目",通过建立全省儿童营养评价网络平台,收集32 943例儿童体检信息,利用WHO制定的Anthro version 3营养评价调查软件,参考WHO制定的《2006年5岁以下儿童生长发育标准》,使用Z评分法对32 943名5岁以下儿童的体格生长、营养状况进行评价。结果:海南省农村5岁以下儿童体格发育状况落后于WHO新标准,Z值均数的总体水平均为中等偏下,低体重发生率为11.8%,发育迟缓发生率为18.8%,营养不良的高发年龄为1～2岁和4～5岁。结论:海南农村5岁以下儿童体格发育与WHO新标准比较呈现落后的态势,低体重和发育迟缓的发生率高于全国平均水平,是今后公共卫生领域面临的重点干预问题。     

国外营养监测与营养调查的现况

营养监测和营养调查的目的是采用可重复的、系统的测量方法了解不同人群的膳食和营养状况，并分析不同地区、不同人群之间的差别或随时间变化的趋势。通过营养监测和营养调查，为国家和地区等相关机构制定健康政策与目标、决策并实施有效的营养干预计划等提供科学依据。本文总结了发达国家开展的营养调查与营养监测项目的基本内容与相关经验。     

0-5岁儿童营养不良及其干预研究进展

0～5岁是儿童生长发育的关键时期,此阶段出现的营养不良会影响整个生命周期的营养和健康状况,给个人和国家发展带来严重危害,因此实施营养干预是国家公共卫生领域中的一项重要措施。营养不良通常由多方面原因引起并产生多种影响,而营养不良干预措施的制定和实施还受到社会背景及国家政策等多重影响。本文回顾总结了近10年来国内外0—5岁儿童营养状况及其营养干预的相关研究,对营养干预措施的制定和实施过程进行综合分析。     

024 0～5岁儿童营养不良及其干预研究进展

0～5岁是儿童生长发育的关键时期,此阶段出现的营养不良会影响整个生命周期的营养和健康状况,给个人和国家发展带来严重危害,因此实施营养干预是国家公共卫生领域中的一项重要措施.营养不良通常由多方面原因引起并产生多种影响,而营养不良干预措施的制定和实施还受到社会背景及国家政策等多重影响.本文回顾总结了近10年来国内外0～5岁儿童营养状况及其营养干预的相关研究,对营养干预措施的制定和实施过程进行综合分析.     

Responsive feeding: implications for policy and program implementation

In this article, we examine responsive feeding as a nutrition intervention, with an emphasis on the development and incorporation of responsive feeding into policies and programs over the last 2 decades and recommendations for increasing the effectiveness of responsive feeding interventions. A review of policy documents from international agencies and high-income countries reveals that responsive feeding has been incorporated into nutrition policies. Official guidelines from international agencies, nongovernmental organizations, and professional organizations often include best practice recommendations for responsive feeding. Four potential explanations are offered for the rapid development of policies related to responsive feeding that have occurred despite the relatively recent recognition that responsive feeding plays a critical role in child nutrition and growth and the paucity of effectiveness trials to determine strategies to promote responsive feeding. Looking to the future, 3 issues related to program implementation are highlighted: 1) improving intervention specificity relative to responsive feeding; 2) developing protocols that facilitate efficient adaptation of generic guidelines to national contexts and local conditions; and 3) development of program support materials, including training, monitoring, and operational evaluation.     

Changes in American opinion about family planning

A 1998 public opinion survey conducted in the United States indicated high levels of support for many family planning policies, including US health insurance coverage of family planning services and US sponsorship of family planning programs in developing countries. To gauge changes in opinion on these issues since then, some of the 1998 questions were asked in an omnibus 2003 survey. The results indicate continuing high support for requiring US health insurers to cover family planning services (87 percent in 1998 and 84 percent in 2003), but some loss of support (from 80 to 69 percent) for US sponsorship of family planning programs in developing countries. Opinion remains divided on the policy of prohibiting nongovernmental organizations from receiving federal funding for performing or actively promoting abortion services. The authors explore several possible explanations for these findings, including the role changing presidential policy may have had in shaping opinion regarding family planning aid for developing countries.     

Toward healthy longevity. Lessons in food and nutrition policy development from Finland and Norway.

For a variety of health, economic and social reasons, many countries are increasingly concerned about diet-related health problems impairing the quality and length of life. This article presents an analysis of the implementation of food and nutrition policies in Finland and Norway which are intended to address both the supply and demand aspects of food and dietary issues. The purpose was to identify policy problems and illustrate ways they have been addressed in order to be useful to other countries involved in developing such policies. The paper is based on on-site studies conducted in 1990, 1987, and 1980. Major findings indicate mixed progress due in part to problems in implementation. These include: development of an effective strategic capacity for planning, advocacy, coordination, and evaluation; integration into the health services system and other policy sectors; development of decentralized infrastructure for deploying policy; accuracy in public information on food and nutrition; the use of government market power, and social equity in the distribution of policy benefits and costs.     

Effects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students

This research investigated the effects of a nutrition education program on dietary behavior and nutrition knowledge among elementary school-aged children participating in a Social Cognitive Theory-based nutrition education program. Participants included 1100 second-grade and third-grade students selected by convenience-type sampling from public schools in Alabama. A preassessment and postassessment control group design assessed dietary behavior and nutrition knowledge using Pizza Please, a specially designed interactive evaluation tool. A 2 x 2 mixed analysis of variance was used to analyze data. Children in the treatment group exhibited significantly (p < .001) greater improvement in overall dietary behaviors such as consumption of dairy products, fruits, and vegetables, than children in the control group. Children in the treatment group exhibited significantly (p < .001) greater improvement in nutrition knowledge, including Food Guide Pyramid understanding, nutrient-food association, and nutrient-job association, than children in the control group. Results suggest that nutrition education programs that teach positive dietary messages potentially can improve dietary behavior and increase nutrition knowledge in children.     

Overview of nutrition reference and dietary recommendations in Japan: application to nutrition policy in Asian countries

The nutritional needs of Asian populations have changed dramatically in the last century. The role of nutrition, not only in preventing diseases associated with deficiency, but also in preventing lifestyle diseases such as cardiovascular disease and cancer, has become increasingly clear. Japan established the world's first nutrition institute almost 100 years ago, and initially focused on combating malnutrition and food insecurity. The current focus is prevention of lifestyle diseases, and along with revised dietary reference intakes, Japan has launched a program of Shokuiku (eating education) for children and families. As developing countries are simultaneously facing continuing undernutrition and increasing obesity and lifestyle diseases, collaboration in research and programs is urgently needed to prevent disease through nutrition intervention. This symposium and the Asian network are initial steps toward integrating nutriology into Asia-wide nutrition-based public health research and programs such as Japanese Shokuiku (eating education).     

Strategies for nutritional improvement

India has achieved self-sufficiency in the production of food grains, yet the production of milk, legumes, vegetables, oils and fats, eggs, and meat is far short of the needs of the population. The Indian diet predominantly comprises cereals, and the diets of expectant and nursing mothers as well as children are grossly deficient in protective foods. Serious nutritional inadequacies have resulted in low birth weight, retarded growth, and nutritional deficiencies (protein energy malnutrition in preschool children, vitamin A deficiency, iron deficiency in women of reproductive age, and iodine deficiency disorders among neonates and schoolchildren). General malnutrition is prevalent in 25% of the rural and 20% of the urban population. Deficiency symptoms of vitamin B complex and vitamin C are also not uncommon. 37% of the population of India lives below the poverty limit, the literacy rate is only 52.1% (39.4% for women), safe drinking water is scarce, nutritional ignorance is rampant, there is a lack of personal hygiene, and poor sanitation all account for malnutrition. A number of government and nongovernmental organizations' programs have attempted to raise the level of nutrition and the standard of living of the people. Some of them include the integrated child development services, special nutritional program, national vitamin A deficiency prophylaxis program, national anemia prophylaxis program, national goiter control program, midday meal program, special class feeding programs, universal immunization program, nutritional and health education through the mass media as well as the observance of world food day and world health day. The national health policy gives high priority to the promotion of family planning, the provision of primary health care, and the acceleration of welfare programs for women and children. As a result of policies and programs of health and nutrition, the infant, child, and maternal mortality rates have declined and life expectancy at birth has risen.     

Comprehensive mapping of national school food policies across the European Union plus Norway and Switzerland

Childhood obesity is a major public health challenge in Europe. Schools are seen as an important setting to promote healthy diet and lifestyle in a protected environment and school food‐related practices are essential in this regard. To understand what policy frameworks European countries have created to govern these practices, a systematic assessment of national school food policies across the European Union plus Norway and Switzerland (n = 30 countries) was carried out. The survey revealed that all 30 countries currently have a school food policy in place; a total of 34 relevant policies were identified, 18 of which were mandatory and the remaining 16 voluntary. Major policy objectives specified were those to improve child nutrition (97% of policies), to help children learn and adopt healthy diet and lifestyle habits (94%) and to reduce or prevent childhood obesity (88%). Most commonly (>90%), the policies offered food‐based standards for menu composition, and portion sizes were guided by age‐appropriate energy requirements. Lunch and snacks were the most widely addressed mealtimes for almost 90% of all policies examined. Other important areas covered included food marketing to children; the availability of vending services; training requirements for catering staff; and whether nutrition education is a mandatory part of the national curriculum. Evaluation was mentioned in 59% of the school food policies reviewed. Future analyses should focus on evaluating the implementation of these policies and more importantly, their effectiveness in meeting the objectives defined therein. Comparable and up‐to‐date information along with data on education, attainment and public health indicators will enable a comprehensive impact assessment of school food policies and help facilitate optimal school food provision for all.     

Local food and nutrition policy

Local food and nutrition policies (small-scale efforts to create food systems that respond to nutritional needs) are becoming more and more fashionable as a way of improving public health in Australia. Opportunities for local food and nutrition policies include urban planning, institutional catering, the private sector and local government. These policies are only feasible in organisational environments that are ready to receive them, although their chances of improving the population's food supply can be maximised by copying some aspects of successful policy programs of the past.     

Insights in Public Health: The Special Supplemental Nutrition Program for Women,Infants and Children: Strengthening Families for 40 Years

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a proven, cost-effective investment in strengthening families. As part of the United States Department of Agriculture''s (USDA) 15 federal nutrition assistance programs for the past 40 years, WIC has grown to be the nation''s leading public health nutrition program. WIC serves as an important first access point to health care and social service systems for many limited resource families, serving approximately half the births in the nation as well as locally. By providing nutrition education, breastfeeding promotion and foods in addition to referrals, WIC plays a crucial role in promoting lifetime health for women, infants and children. WIC helps achieve national public health goals such as reducing premature births and infant mortality, increasing breastfeeding, and reducing maternal and childhood overweight. Though individuals and families can self-refer into WIC, physicians and allied health professionals have the opportunity and are encouraged to promote awareness of WIC and refer families in their care.