Dear all:

Another reference is David Pelletier who looked at nutritional surveillance systems for 
New York State and did some excellent work for UNICEF that pointed out that malnutrition 
is 60% of the underlying cause of morbidity and mortality in developing countries.

It dawned on me that I never heard a single discussion in the international nutrition arena 
on the differences between nutritional surveilland and famine early warning.

If you are trying to prevent famine, weight is a very bad indicator.  By the time you see 
significant wasting in a population it is too late.  Good famine early warning systems use 
other indicators that are reasonable predictors of a later increase in wasting.  If the 
famine early warning system does its job you should not see the increase.  An example of 
this was in Kenya where the famine early warning system picked up agricultural 
indicators of risk and the problem never hit the news because they staved off a famine 
before it happened.

I hadn't thought about it but when I talk to parents, I always tell them to look for the 
other signs of intake in this order:

1) swallowing: via seeing, hearing and the feel of the suck on the breast --- this is the 
first indicator that the baby is doing well
2) behavior:  a contented baby versus a lethargic or always rooting baby ---- is the next 
indicator that the baby is doing well
3) output:  adequate stooling and peeing --- comes after the baby has taken it in and 
there is a bit of a lag
4) weight:  is a late term indicator, if 1), 2) and 3) have been monitored appropraitely --- 
the weight should not be an issue.

Nutritional surveillance can be a famine early warning system, but it can also be data 
collection for other purposes.  Sometimes those purposes get out of hand and it becomes 
a system that drives itself --- data collection for data collection's sake or for a few driven 
individuals that want the data for research. 

Best Susan.

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