Implementing nutrition programs: lessons from an unheeded literature.
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The purpose of this study was to determine the effectiveness of the Supplemental Food Program for Women, Infants, and Children (WIC) for mothers and their anemic children under 5 years of age. Sample for the study was 50 anemic children, 25 in each of two groups. The interventions (treatments) for the experimental group included individual counseling, group nutrition classes, and provision of WIC food vouchers for purchasing foods containing essential nutrients that are deficient in the diets of this high-risk population. An initial dietary assessment was done, and hemoglobin and hematocrit measurements were taken. At the end of 6 months, each participant's diet was reassessed, and hemoglobin and hematocrit measurements were again taken. Results of the study showed a 1.8 gm change in the hemoglobin measurements of the members of the experimental group and a 1.1 gm change in the hemoglobin measurements of the members of the control group.
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This paper illustrates an evaluation model incorporating research techniques of both primary health care and social anthropology. The case in point is the Jamaican Government's Community Health Aide Programme, which employs over 1300 auxiliary health workers to serve the low-income population of the island. The study demonstrates a cardinal principle of the anthropological approach--a grounded and holistic understanding of the social and environmental context is necessary to translate data into useful information. The study demonstrates connections between the distribution of care, the power of the cosmopolitan medical profession, and the Jamaican political patronage system. Finally, the impact of the program is assessed on child growth measures against the background of the Jamaican economy as it evolved from 1970 to 1980.
A nutrient standard menu (NSM) planning method was developed for use in planning menus which provided one-third the Recommended Dietary Allowances for persons sixty years of age or older for nine indicator nutrients and calories, while restricting fat to less than 40 per cent of total calories. To eliminate manual calculations and make it easy for individuals untrained in dietetics or nutrition to use NSM planning, the nutrient composition of over a thousand commonly used menu items was listed in a menu planning manual in nutrient units which were one-tenth of the nutrient standard for the meal. Menus from third-party sources were monitored by selecting similar nutritionally analyzed menu items in the manual and adjusting the nutrient composition to conform to the portions actually served. Ten site managers of the Administration on Aging (AoA) evaluated the planning/monitoring method. The members of the group, on the average, were fifty-six years of age, had 1.6 years of education beyond high school, and had 4.6 years of foodservice experience. Approximately 83 per cent of the evaluators did not plan to monitor menus at their sites and had no formal training in dietetics or nutrition. Eighty-four per cent were able to plan menus satisfactorily after this brief introduction. The younger evaluators with more education grasped the concepts faster and were able to plan menus with greater accuracy. The data also indicated that previous experience in menu planning enhanced their ability to plan NSMs. Most felt the approach to be workable and applicable. Menu monitoring was more difficult for the evaluators. Seventy-five per cent were able to monitor menus satisfactorily, and all felt they could do so with more time. The data again showed that the younger individuals having more formal education were able to master the monitoring skills more easily.
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Pharmacists must make their own decisions as to whether they elect to participate in HPN programs. They need to determine the financial, social, and professional impact of an HPN program upon their institution. They need to consider the availability of these services from other hospitals or through private providers of home-health care. These guidelines are intended to help pharmacists make these decisions.