World Health Organization (WHO) · Technical Documents

Nutrition in maternal and child health

December 31, 1968 World Health Organization

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WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANT~

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU REGIONA~ DU PACIFIQUE OCCIDENTAL

WPft/mm/26 Rev. 3 29 April 1968 ORIGINAL: ENGLISH

NUTlOO'l!ION IN MATERNAL .AND CHILD llEALTH

COIl'rnNTS

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MATE:R:NAL NU'l:RlJl!ICJN' '" '" '" •••• '" • '" •••• '" '" '" •••••• '" '" '" .. '" '" • •

5. NUTRLTION EWCATION .AND TRAINIro ••••••••••••••••• 10 ANNEX 1 GUIDE FOR TREATMElff OJ!' MALNOUBISHED CHILDREN IN HOOPIT.ALS AND HEALTH ~ ANNEX :2 -

.... "' .. "'. '" '" "' .... "' .••. "' ......... "'. "' .... "' ... '"

13 19

~IPES FOR INF.lIN.rS AND TODDLERS ••••••••••

ANNEX 3 ANNEX 4 AlmEX 5 -

RECIPES FOR SCHOOLCHILDREN •••••••••••••••• Sc!-{E RECIPES WI.TH LEAFY GREENS •••••••••••• ~

35 55

SCME NUTRITION EWCATION

AND GUIDES •••••••••••••••••••••• 61 DJ:E'J;2 ...........................................

ANNEX 6 -

PACIFJ:C ISLAND

• ·vIPR/.392/67

DlTROIUCTION

The modern approach to nutrition is to realize that it is a complex affair in the social sense as well as the medical sense. The ordinary man is a farmer, and if his family is to eat better, he must grow more and better foods. In cities and towns, tlarents must learn to spend their cents as wisely as possible, and alw~s, parents need to know how to cater for the most vulnerable member of the family nutritionally; this usually means the youngest child. The new approach is best seen in applied nutrition projects. These begin with identification of the problem by surveys - not only of nutritional statuB and diets, but also of food production and availability, and existing supplementary feeding and nutrition education activities. To implement a programme in each of these areas, (surveys, food produc-tion, supplementary feeding and nutrition education), intensive training and co-ordination of personnel from the fields of health, education, agriculture and community development is needed. Applied nutrition is thus an integrated programme aimed at identifying and solving the actual nutrition problems in a pilot area. A pattern of practical activities reproducible elsewhere in a country is developed. The Philippine applied nutrition project (ANP) is now spreading to each re~ion in the country; currently to Cebu, next to Bulddnon, and there are already ANPs in Pangasinan and Isabela. Although the ANP is a four-legged animal involving four main disciplines, it is usef'ul. to see what can be done to improve nutrition through specifically MCH channels. As the Regional Maternal and Child Health Adviser is fond of saying, MCH is or should be more than 5C!1o nutrition. In tropical countries round the world, attention is being focussed on the nutrition of the toddl.er aged one to four years. It is in this age-span that nutritional deficiency is most likely to be manifest or latent. Seventy per cent of tht! toddlers in developing countries are usually estimated to be malnourished. In the following exposition, some liberty is taken in contrasting old and new approaches •

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WPR!mIrR!26 page 2 2.

N\lTRITIONAL DEFICIENCIES

2.1 The classi~al style emphasized nutritional diseases: beriberi, scurvy, rickets, and also a host of clinical signs like angular stomatitis and smooth tongues, supposed to indicate certain deficiencies. Some classical nutritional diseases and clinical signs do still occur. Mciny are rare now although some, such as infantile beriberi, still figure prominently in vital and health statistics. Comprehensive surveys have been done in several countries in the Region without revealing clear cases of beriberi or scurvy, or even tracing records of them in hospitals. (Of course beriberi does nevertheless occur sometimes, especially among pregnant or lactating women.) Bleeding gums are commonly seen, but have been shown to have no correlation with vitamin C status in these countries. In the Philip. pines, simple toothbrushing was shown to improve the gums enormously; the common condition is in fact chronic gingivitis. The modern trend is to give more emphasis to some other defiCiency syndromes, notably vitamin A and iron deficiencies, and protein-calorie malnutrition. For educational purposes, it may be stressed that foods rich in protein are commonly good sources of Bcomplex vitamins, and many foods rich in vitam1n A and iron are also excellent sources of vitamin C. (a) Vitamin A deficiency is a pressing problem in practically all tropical countries where rice is the staple food and green leafy vegetables are neglected. This applies to many countries in the Region. In China however, leafy vegetables such as pechay are an essential part of the daily diet. In the Philippines, vitamin A deficiency is relatively more common in the rice-bowl of central Luzon for instance, than in the Bicol or Ilocos regions where more leafy greens are consumed.> In New Guinea and the mountainous parts of Malaysia also, more leaves are consumed, and vitamin A deficiency ilS seldom seen. In any case, one needlessly blind eye, or worse, a pair of blind eyes, is a tragedy far outweighing a host of angular lesions of the mouth or doubtful tongues. There are probably 5000 neadlessly blind eyes in the Philippines from this cause. Vitamin A deficiency presents itself in different ways and at different ages in different areas. Classically it is not seen in breastfed infants and appears among older toddlers or schoolchildren whodo not eat their vegetables. This may be the case in Saigon, for instance, where the maximum incidence is at three to four years

of age. In Phnom-Penh, Cambodia, v.!.tamin A deficiency is seen even among infants belOW" six months admitted 'With general malnutrition. Normally, the liver stores of v.!.tamin A would be sufficient for the first few months of life, .but because the mothers' diets are so low in v.!.tamin A, the infants are apparently born 'With quite inadequate stores. There is a tremendous rev.!.val of concern over this vitamin round the world. Its deficiency has been overcome in Singapore by fortification of sweetened condensed milk. In rural areas it should be easily preventible with an adequate consumption of green leafy vegetables and yellow vegetables/fruit, as discussed below (page 8). (b) Iron deficiennx affects young children espeCially, because milk is insufficient in iron, and infants and toddlers seldom get adequate supplementary feeding before two years of age. Iron-deficiency anaemias are a major clinical. problem in paediatric wards, and in certain parts of many countries. It may in general be &lore prevalent in urban areas because of the relative scarcity of green leafy vegetables there. It is common in pregnant women.

Protein-calorie malnutrition (ro.l) is seen in two main (i) Marasmus, a deficiency of calories and all nutrients; the child is starved. In a bottle-fed baby, this ~ be simply due to insufficient miDc or excessive dilution; or else the nipple is inadequ.atel~,r perforated - this is the most common cause of all in Manila, according to Dr. Eugene StransbJ*, These children are commonly of any age up to about three years. The child is "skin and bone". Sometimes, of course, marasmus is secondary to tuberculosis, chronic diarrhoea or other causes • K~shiorkor, a deficiency of protein ~rimar1ly. This occurs because the young child needs relati vely more protein than the older, and he seldom gets enough of it. If his caloric intake is adequate, he may look plump, but this is due to oedema. Oedema is fluid retained in the body, usually due to protein deficiency in toddlers aged one to four. This sti.ll occurs occasionally even in Singapore where infants get enough rice plus sweetened condensed milk, but not enough protein-rich foods; and much more often in Saigon, and in rural. areas 'Where tubers form the staple diet, e.g. New Guinea. While sweetened condensed milk by itself has a more or less adequate amount of protein, it is insufficient when put with plenty of rice. Protein-rich foods are often too scarce or too expensive, and sometimes are denied to young children (e.g. fish in Malaya) •

.. (ii)

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*Paediatrician, formerly of the Philippine General Hospital.

wPR/NUTR/26 'Page 4 2.2 Toddler mortality is the more modern reflector of poor community nutrition status. Whi~e frank nutritional disease is not so common, toddlers on diets ~ow in all nutrients often succumb to mi~d illnesses euch as diarrhoea, respiratory diseases, meas~es, etc. In the Philippines the mortality among infants is estimated to be three times higher than in the United States of America, v;hereas among toddlers it is estimated to be twelve times higher. This ref~ects the poor diets of toddlers, especially between one and two years.

mer:

2.3 Growth retardation is another modern concept. It is now realized that the growth of chi~dren, especially infants beyOnd six months and toddlers, is co!lllllOnly retarded in nearly all tropical. countries. It is commo~ asserted in these countries that "we. are a small. people", but the well-fed Japanese and Chinese are aLready attaining average North American standards. While growth is severely retarded in parts of Indonesia and New Guinea, tlle situation in rural. Luzon and Malaya also leaves much to be desired. studies in Manila a few years ago showed that the children of uppel'income Filipino families al.so approach North American standards, whil.e middle and lower income group children fare much more poorly. It is interesting that the 10'\rincome children in Manila seenl even more retarded than those of the Bayambang area. The coup de grace in this situation is that there is evidence that such 'Physical retardation is accompanied by mental and intellectual. retardation as

wen.

3. 3.1 Breastfeeding

UlFANI' FEEDIm

The classical line was to start weaning at six months and wean the baby onto COWlS milk by nine months. However, for the vast m.ajority, millt is too expensive, and the child at best can get a little over-diluted sweetened condensed milk along 'With a predominantly rice diet. General practitioners in many countries in the Region 'Will ardently advocate weaning not later than twelvemonths. But present WHO policy is to prolong breastfeeding for at least twelvemonths and up to two years. Of course I due attention to maternal nutrition 1s necessary, and solid feeding of the infant must not be neglected. In fact, beyond six months, the breastf'eed1ng (or artificial milk) should be lool:ed on as the supplement to the solid food, not viceversa as is the coru"mn philosophy in the Region. Breastfeeding is best because it is cheap, safe, of almost ideal quality and nearly always av8:l.l.able, at least in rural areas. Bottle-feeding is dangerous for the baby, difficult for the mother, and expensive for the father. Breastmillt supplies im:portant protective antibodies. Breast~eeding also fosters a relationship of security and love between mother and child.

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A MALNOURISHED FAMILY

Protein-Calorie Malnutrition and Vitamin A Deficiency

Marasmus, Xerosis and Bitot spot

( Protein· Calorie and Vitamin A Deficiency )

Kwashiorkor: Protein Deficiency (without dermatosi s) Edema, Moonfoce, Parotid and Liver Enlargement

MOTHER is tired, weak and thin - hidden hunger. ( Father is working in the big city). BABY is bawling, famished and wasted, and has primary tuberculosis. The TODDLERS are listless, apathetic and inactive; they have pot bellies and flabby muscles. Sometimes they grope and stumble in the dark . As future SCHOOL CHILDREN they might be dull, drowsy and lazy; they will be thin and small for their age. Many of such toddlers will die before reaching school age, because of poor nutrition. WHO 80530

WPR/NUTn/26 :page 5 In ~ go~dgeneral hospital in this region a few years ago, it was found that so~ sixteen babies had to be taken off the breast for a variety of reasons during hospitalization of the mother. It was found, on follc'W'-up the ne..'Ct year, that fom'teen of these babies had died of diarrhoea. So it is well to remeraber that a bottle ~ be a death-sentence for a baby. In countries round the world, especially the more developed urban areas, breastfeeding has been on the decline in recent decades. In Singapore the declining situation is dramatic:* Percentage of Chinese mothers who breastfed for three months Upper and middle income 1951 1961 Lower incone

Among 1.tpper-income families this may be bad enough, but among lo'W'-income families it may be disastrous. To counteract this trend, a le~e of breastfeeding mothers was started in the United States of America a few years ago. o-Z course it is wel.l-lOlO'WIl that many mothers bottle-feed because they have jobs. But is this sound economy? How much is lost in terms of nutrition and security? These mothers formed a league which eventually bec$~e international - LA LECHE LEAGUE INTERNMIOlw:. (LLLI). ** It would do as much for nutrition in this region as any other single factor, if through some such voluntary association, mothers dedicated to motherhood as their first priOrity could set an example of breastfeeding and child care which would reverse the downward trend - perhaps not only in breastfeeding but also in family disintegration and juvenile delinquency. Doctors in western countries are also struggling to try to reverse these trends. Probably MCH personnel would be the best ones to encourage the establishment of similar societies in urban centrP.s in the Western Pacific Region. 3.2 Supplementary feeding

3.2.1 Animal protein The classical idea was that milk, meat and eggs are necessary for a balanced diet. For most of the world I s needy population this is a pipe-dream. All avail.able animal products are sold in urban markets for the -well-to-do; they are too expensive for the common man I sbudget, even if he produces them himself. *See: Wong Hock J300n (1961) J. Singapore paediat. Soc. ~ 14 Wong Hoel, Boon (1963) J. Singapore paediat. Soc. .2,.. 89

**La Lache

League International 9616 Minneapolis Avenue, Franklin Park Illinois 60131, U. S.A.

WPR/NUTR/26 page 6 (a) In less fortunate countries meat is consumed usually only once a year at an annual festival, or at best once a month. However, meat 1s often not slaughtered or stored in hygienic condition and poisoning from pork is common in New Guinea, for instance; therefore its use for infants is not generally recommended. However, chicken liver or other liver, taken from a freshly slaughtered fu~imal, is a most valuable supplementary food. (See Recipe 26, page 32) (b) Of the milk prodUcts, dried skimmed milk is often available through UNICEF or bilateral agencies. It is now commonly fortified with vitamins A and D. Even if not available by distribution, it is available in the market, and is usually the cheapest available form of milk. It is also the most effective one available for treatment of severe malnutrition. Use four level tablespoons of milk powder per pint of boiled water. Milk can often be given more effectively by mixing it with solid foods (e.g. mashed, banana, rice porridge) than as fluid milk. Acidified powdered milk is more expensive and not ~nerally necessary. Powdered milks are always preferable and cheapest, but if liquid milk is strongly preferred, it should always be evaporated milk. and never condensed milk.* (c) Fish. Fish is the most readily available and cheap form of animal prot;iU in many parts of the Region, especially isolated areas and small islands where milk and legumes are often scarce. Small soft fish eaten whole such as anchovies (Philippines _ dilis; Malaysia ikan bilis) are extremely rich in vitamin A and calcium as well as protein. Standard recipes can hardly be put forward but the following general principles apply: (i) Large fish. Perhaps the simplest method, alreadY used in some places and espeCially for older Qt~ldren,is for the mother to take a portion of any fish being cooked for the family and peel off some of the fleshy part, and feed it directly to the baby with her fingers (clean), alone or preferably together with any other food the baby will take, e.g. rice (porridge, or ordinary cooked rice). For infants aged 4-6 months, the fish should be mashed with a fork or between the fin~rs; for older infants this should be unnecessary. Fresh fish which has been cooked soon after killing and cleaning, and not contaminated by flies, is best. However, properly dried or smoked fish which has not been exposed to flies can be cooked until soft and handled in the same way. Shellfish could often be handled in the same way. ,Tinned (canned) fish is very suitable and although usually more expensive it has the adVantage of being safer hygienically; but it should not be kept for any length of time after opening the tin. Canned fish sometimes works out cheaper than fresh fish, per gram of protein, because all of it is edible. •

*The product CSM may be used instead of skimmed milk in the recipes given in Annexes 2 and 3. However. it supplies only half the amount tiprotein.

(ii) Small dried fish and small dried shriSPs, if ~ien1cally prepared and stored, can be boiled and then mashed (and sieved for 4-6 months infants), then mixed with any porridge, soup or other food being prepared. Fermented fish pastes such as bagoong (Philippines), blachan (Msl.aysia) Clill also be recommended for infants i f properly mashed and sieved; bacteriological tests have shown them to be relatively safe. (iii) Fish flour. This can be made from large dried fish as follows: Remove the skin and head, and shred the flesh from the bones. Toast very Ughtly in a pan, then pound to a f1ne flour, removing any bones missed. Repeat the toasting and pounding if necessary. Store in an a.1r-tight container. SrnsJ..1 dried fish and shrimps can be handled in the same way without removing bones, etc., if they are smsJ.l and soft enough. Instead of pounding, a grinder such as that used for legumes ccn be used (see page aOIq.

...

(iv) Recipes. In ~eneral' srnsJ..1 dried or fermented fish or shrimps prepared as in (lo1) or fiour prepared as in (iii) can be used instead of millt powder in all the recipes sho~m in the appendices, for people to whOm the taste of fish is acceptable 'Which means in practically all countries in the Region. Even a srnsJ..1 quantity of fish preparation will substantially improve the protein vsJ.ue of a vegetable mixture such as the dried bean/rice porridge. This is of particular importance for non-breastfed infants. Probably in cases where circumstances absolutely prevent breastfeeding (e.g. death of the mother), the best way of feeding 1s with a mixture such as the bean/rice/fish porridge, in the absence of milk. The preparations of mashed fish are suitable beyond six months; i f also Sieved, or if fish flour is used, they are suitable from

four months of age. 3.2.2 Vegetable protein* Modern research has shown that bsJ.anced mixtures of vegetable protein are just as good as animsJ. protein. Furthermore, when diets are suf'f'icient in calories but marginsJ. in protein, even secon~class proteins are apparently utilized more efficiently in the poorly-nourished than in the well-nourished individual. The vegetable foods rich in protein are the pulses or dried grain legumes such as mung beans or green gram, soybeans and peanuts. All these need special preparation for infants. The main methods for dried beans are: (a) (b) prolonged boiling, and mashing for infants below about ten months (and sieving for infants below six months); grinding or pounding the dried beans to a flour; then making porridge with rice flour, etc.

*Some

simple recipes are given in Annexes 2 and

For peanuts, gentle roasting is necessary and then grinding or pounding to ma.ke a paste or butter, to be mixed 'With banana, sweet potato, etc. Only mature well-dried peanuts free of mould should be used. Commercial peanut butter contains other oilS not well tolerated by infants. Coconut milk can also be used for infants in small amount, but the age at which this can be begun and the amounts tolerated are not known, nor 'With which foods it is best to combine the' coconut milk. Research should be undertaken on this question. Coconut milk is made by grating the mature coconut meat, putting it in a Sieve, pouring water on it and squeezing. Thick coconut milk contains about Jf., protein. It should only be used fresh, and preferably mixed 'With other foods such as mashed banana or rice porridge, rice/bean porridge, etc.

3.2.3 Leafy greens and ¥7llow vegetables/fruit The classieal idea was that fruits are the symbols of "good nutrition". While they are usually good sources of v1.tamin C, they are often poor in other nutrients; however, papaya, manggo, cantaloupe (Cucumis melo), persimmon (Diospyros kaki) and tiesa (Lucuma nervosa) supply prov1temin ~. Food composition tables show that dark green leafy vegetables are extraordinarily rich in nutrients. Ma..'1Y of them are quite useful as sources of protein (about 51» but more specifically they are rich in provitamin A, iron, sometimes calcium, thiamine, riboflav1.n, and ascorbic acid. The richest varieties are common ones which are often not specially cultivated but rather gathered from the home gardens ( weeds!) or fields or forests when nothing el.se is available. For instance Rorse-radish-tree or ilrumstick l.eaves (Moringa oleifera) Amaranthus and other types of spinach Swamp cabbage (Ipomoea aquatica) ("kangkong" in several countries) Taro leaves (Colocasia spp.) Pecha:y or Chine se cabbage (Brassica chinensis) (CDrk green varieties) Sweet potato tops (Ipomoea batatas) Besides these, yellow vegetables (pumpkin/squash, yellow sweet potato and especially carrot) are good sources of prov1.tamin A. It ~ take some time to promote the idea of leafy greens for infants. Nevertheless in the Borneo states of East Malaysia this is being quite successful1y done. Mothers have responded to the suggestion and demonstration of putting kangkong leaves into -porridge for the baby. As with legumes, they should be mashed for infants bel.ow about ten months, and sieved for those below six months.

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WPR/NUTRf26 page 9 3.2.4 ScheduJ.e

In many countries the basic pattern of infant feeding is not bad at all., but most of the foods are started too ~ate, especialJ.y the protein-rich ones and ~eafy greens. Since grolrth retardation in near~y all. countries in the Region 8:ppears after six months, supp~ementa.ry feeding with a variety of foods (not the stap~e food only, such as rice, maize or sweet potato) should begin by about four months, incLuding mashed yellow vegetab~es and some form of fish and legumes. The strategy is to establish acceptance of a variety of foods before six months; it may be more difficult later, and a.DyW8iy too late. A scheduJ.e is given in Annex 5 including some practical. hints on feeding the baby. 4. MATERNAL wrnrrION

It is amazing how much the mother's needs can be sacrificed physiologically to the needs of the foetus or infant in extreme Circumstances, with surprisingly little evidence of harm to the mother. Yet the baby's nutritional. status at birth - bOdy weight, fat, and especiall.y stores of iron and vitamin A - are importantly influenced by the mother's diet in pregnancY. In lactation, the fat and protein of the milk are slightly influenced by the mother's diet, the vitamin Po mare so, and the water- soluble vitamins much more so, thiamine concentration being notably important. Formerly, attention was focussed on a great many fads, fancies, taboos and traditions rela:ting to diets in pregnancy and lactation. Many of these have little nutritional. influence either way, but if a mother is denied all animal foods or certain animal foods during pregnancy, or the early weeks of lactation, her heal.th may be significantly impaired. Fai~ure to consume leafy vegetables and fruit will certainly affect the milk composition. The best approach is to try to find some beneficial. positive traditions or bellefs and buUd on them. For instance, faith in mung beans as a beriberi-preventive is widespread; the use of chicken and drumstick leaves (~i:>ringa) in the first week after delivery; and certain kinds of leaves (.Amaranthus, etc.) are believed to promote breastmilk production. On the other hand, mothers sometimes eat only rice and sa.J..t, sugar or ginger after delivery, and mung beans are sometimes restricted after delivery for fear of causing itch or even infantile beriberi. Peanuts and eggs are beneficial. foods al.so known to be restricted after delivery, in some areas in the Philippines, and certain leafy greens because they are believed to inhibit lactation. Sour fruits are al.so cormnonly restricted in the early lactation period, and likewise pum:pkinlsquash.

wpR/wrn/26 page 10 So, many of the available resources are denied to mothers just at the criticaJ. time. Many of these factors could be overcome by educationa.l means, but not by frontal attacl~ - merely to deny existing beliefs will not change them. One has to circumvent or get around them. For instance, mung beans could be promoted during lactation in combination with an acceptable kind of leafy greens. Unacceptable leafy greens could be reconnnended in combination with grated coconut and meat or other acceptable foods.

Prestige and P2Pula:rit~. These, together 'With price an~ availability, are the chief factors governing food consumpt~on. MCH workers, health worl{ers and teachers in general, can do a great deal for maternal and child nutrition by setting a good example themselves. If they frequent the tow markets and bring home green leafy vegetables for instErlce, the rest·of the urban community "Will see it and be 1ln:pressed. Better still i f they can keep gardens and grow these "poor-manls plants". Noreover, the rural. people 'Will see that these simple vegetables have a market value I so they will become interested in gro"Wing and eventually eat1.ng them "themselves. It rns:y be more effective in the long run to build up the prestige of these simple but nutritious foods among the elite, than to go directly to rural areas and urgp the rural people to grow and eat them. In any case, both a:pproaches should be attempted. *

NUTRITION EWCATION AND TRAnUm

The foregoing remarks have tried to indicate ~t should be the priorities in the nutrition education through health channels in most parts of this region. MCH workers are familiar 'With the techniques. Mostly it is done incidenta.l1y, during _ (a) (b) consultations in the clinic, and home visits.

.. •

Sometimes it is undertaken as part of a series of mothers I classes. In mothers I classes it sometimes happens that the main focus is on maternal nutrition during pregnancy. Perhaps her nutrition during lactation shOuld be given equal. weight and her infant t s nutrition even more. Al"WB\fs, the s iJJIple and inexpensive things should be promoted. A technique of particular value is the use of simple visual aids as ill.ustrated in Annex 5 - chalkboard and flannel board, w.i.th accompanying bar-charts, pictures, cut-outs, etc, Every MCH centre should be equiyped w.i.th these (approximate cost $2) I and a set of simple utensils for cook1.ng demonstrations (cost $5) and a sieve I mortar and pestle and grinder for preparing infant

*To

this end, some recipes are show in Annex 2 and 3.

WPR/l-.TtJI'R/26

pages 11/12 foods (cost of grinder: approximately $8). Food and cooking .demonstrations should be accompanied wherever possible by actual practice in the preparation, especially of infant foods, by the mothers themselves. Demonstrating actual foods is better than any picture or model! With each district or regional health ~~it, training in applied nutrition is the neces6ary prerequisite for an active programme along these lines and effeotive co-operation with the other agencies which should be involved in nutrition promotion. The establishment of nutrition councils is valuable as a means to this end (not as an end in itself). Evaluation of all phases of the programme should be an integr~ part of the planning. Training programmes are needed extending from the central level by several successive steps down to the basic functioning unit, f~ rural health unit, where the key personnel for nutrition promotion are the physicians, the public health nurses and the midwives. •

Finally, it may be emphasized that the regularity of ~CH clinics, and particularly their extension into remote rural areas, can do much to improve nutrition. ~H work brings to light early deficiencies before they are t~o advanced and prevents malnutrition by promoting a general nutritionconsciousness among mothers. The early detection of malnutrition, low body weight, and failure to gain weight, are essential contributions of health workers. These matters are discussed elsewhere.*

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*Jelliffe, D.B. (1966) The assessment of nutritional status of the community. WHO Monograph No. 53.

ANNEX 1 GUIDE FOR TRE:ATMEl1"I' OF MALNCURISlIED CHILDREN m HOSPITALS MID llEALTH CENI'RES 1. PRINCIPLES

1. 2.

Avoid delay - severe malnutri ti~m is a medical. emergency. Feed a. high-energy, high-protein diet. Aim at 100-200 caJ.ories ) per kilogram of body ..>eight per day. 4-8 grams protein)

3. Use soft diets first, such as those suitable for normal infants aged 4-6 months (Annex 2) • Later, use recipes for toddlers or school.children (Annex 3).

4. •

Foods:

(a) (b) ( c)

rice, maize J ~et potato J bananas - for caJ.ories sldnnned milk, egg, fish, meat, dried legumes for protein dark green leafy vegetables ) yellow vegetables ) for vitamins/mineraJ.s yellow fruUs )

Feed frequently (4-6 times daily).

FOODS

Milk*

l. 2.

Four level tablespoons sld..mrn.ed milk poWer per pint (480 cc) of boiled 'Water. Mix poWer into 'Water by beatitlg with fork.

3. Use immediately; do not store.

(It breeds bacteria.)

4. Ew:rporated 'Whole milk is suitable. Sweetened condensed mil.."t is not, and filled mDl" is doubtful..

5. 6.

Use a cup, if possible. If a bottl.e is used, sterilize it. strain the milk i f powdered milk is used. Perforate the nipple adequately

'*CSM may be the

used, and has the same calorie content; but to reach same protein level, double the quantity speci.fied must be used.

WPR/mm/26 Annex 1 page 14 w.l.th a heated needle (canclle-flame). Milk should drip out drop by drop ..'hen bOttle is inverted. Too much or too little interferes 'With feeding.

~antit;r

Offer 1/2 cup (4 oz. or 120 cc) per kg body weight daily} or say 1 cup 3 times in one day, for 5 kg child.

Milk powder mB\V also be used by simply mixing w.I.th solid

foods (cooked rice, mashed banana, etc.); (1 level tablespoon per kg body weight daily). B.

Rice 1. 2. Rice gruel 1 cup 4 times daily - thin at first, then thl.cker. Cooked rice 1/2 cup 4 times daily for 5 kg chUd (with supplements). Vary the diet with ground maize gruel, banana, sYreet potato, oatmeal, etc. (Raw weights: one cup ra.r rice makes a little more than 2 cups cooked~). Ba.ne.nas and sweet potato may be whole or mashed. For severe malnutrition, mashed ripe bananas are best; later cooking bananas are satisfactory. Use nearly t'Wice as many cups of these foods as of cooked rice. l'llRy take only half these quantities at first. Recovery should still occur but w.l.il be slower.

3. The chl.ld C.

other supplements boiled or scrambled 1 egg ... 6 grams protein '" approx. 5 oz. milk 2. Fish:

boiled or steamed, or canned. For severely malnourished children, pass thrOugh grinder before cooking 'With rice. (Shrimps like'Wise; peel off the shells if large.) as stew, or dried meat, ground, then cooked with rice; or canned.

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wPR/NUTR/26 .Annex 1 pase 15 '"

4. Vegetable proteins (dried beans J * peanut, soybean): (a) Use Recipes for Infants (Annex 2). (Especially recipes 1, 5, 10, 11, 12). (b) (c) Start with bean/rice porridge. Proper grinding with cereal grinder, or fine pounding, is essential, to mru(e the legumes digestible. Use 1/2 - 1 tablespoon of' dried bean per leg body wight.

(d)

Leafy greens I yellow vegetables/fruit: Include frequently, especially: (a) (b)

dark green leafy vegetables** carrot, yellow sweet potato, pur.1pldn (squash) ripe manggo, papaya, yellow-cored bananas.

(c)

*Such

as: green gram or mung beans (Phaseolus aureus) lima beans (Phaseolus lunatus) if known to be non-poisonous variety hyacinth beans (Dolichos lablab) winged beans (Psophocarpus tetragonolobus) pigeon peas (CajanllS cajan) peas (Pisum satbum) cowpeas (Vigna sinensis) as: horse-radish-tree leaves (Moringa oleifera) (drumstick) amaranthus species swmp cabbage (I:romoe.c. ftquatico.) taro leaves (C.locasia ~p.) pechay, Chinese cabbage {Brassica chinensis} dark green varieties swet potato tops (Ipomooo. batatas) sayur manis (Sauropus n.t:d...~'Us)(Malaysia)

** Such

WPR/NlJrR/26 Annex 1 page 16

. SAMPLE MElID

Approximate Nutriti;-;;:;:~'=jl Foods and Quantities · Ca 1 or~es

(0) ! rams

Protein

I Vitanlin A (I U) i

".~

6 a.m. Rice Egg

I 1/2 cup (cooked) 1 pc.

180 80

560

10 a.m. Rice Pumpkin Milk

1/2 cup 1/2 cup 1 cup

180 20 40

4 700 2

other vegetables 2

E.m. Yellow sweet potato 1 pc. (large) (mashed) Dried beans (4 tbsp. ravT; ground before boiling, or mashed afte~ boiling) 1 cup milk

120

800

100 40

8 4

6 E.m. Rice Fish Dark green leaves other vegetables

1/2"cup (cooked) 1 :pc. no.tchbox size 1/2 cup

180 40 10

4 4 1

1000

------_._---_.. T<JrMtS (BIlProx.)

~-J 1000 -----.----., ----38

3000

WPR/rnYrR/26 Annex 1 page 17

3. A. Feeds

ROUTINE FOR HOSPITAL

-Frequent small feeds at first. Gavage-fpMlng with milk if refuses to feed; 1 oz. hourly at first, later increase. Soft (infant) recipes for first few days. During recovery, continue feeds 4 times daily.

Anaemia (Hb below 10 grn/100 ml) Colloidal iron 1/2 tap. daily or 1 tep. Ferri et Ar.1lt.on., Cit. J 3 times daily. Vitamin B12 if megaloblastic anaemia. Transfuse if Hb below 8 gm/100 ml.

Vitamins Usually unnecessary. Vitamin A/D capsules twice daily if dryness of cOnjunctiva, or Bitot spots are present.* Dryness or ulceration of cornea (xerophthalmia,. keratomalacia) Vitamin A palmitate (oily solution) 50 000 I.U. per kg body weight intramuscularly, on admission (urgent).

Infections (Respiratory tract, otitis Media, Diarrhoea, etc.) Treat with antibiotics, as directed by paediatrician, where possible.

Diarrhoea Sugar/Saline: Sugar Salt Potassium salt (Citrate, chloride or other) Water Boil the mixture Molasses/Saline: Molasses Salt vlater Boil the mixture 2 heaped tbsp. 1 level tsp. l/lf tsp.

1 pint 2 tbsp. 1 tsp. 1 pint

( f'.)

Hild diazrhoea

Give milk and also sugarI saline (or. rolJJ.or-;,...::;jgr, - • ro) J 1/2 cup (4 oz.) of each per kg body weight daily. Use gavage (slowly) if necessary. Introduce solid foods on second day; discontinue sugar/saline or molasses/saline. *..t~ll severe cases Qf _1:ln:.S:lio:;:-~:or llit:lout si3DS i!l t:le eyes s:10uld

nevert:leless recei vee'. 10 ca';?sules of v.i.ta;:u.n :'l/D i:1::1etiately an ~?reve:1ti va :C.lCe.SUl"~.

WPR/NlJr.R/26 Annex 1 page 18

Intravenous therapy is n~cessary. For small children, about 100 rrJl/J;g body weight daily, 1/3 N saline in 510 glucose. (Or other regime as directed by paedi&trician.) Begin oral rehabilitation within 24 hours, as soon as vomiting is controlled. F.

Recover;( 1.

Weigh child on admission and once or twice weekly thereafter. Lose of oedema may cause initial loss of weight or stationary weight. TheTeai'ter expected gain is 100-200 (3-1/2 - 1 oz.). gIn

3. l~.

weekly

Early progress is indicated by improved appetite, smiling and better humor, 10s5 of apathy. Keep in hospital 2 - 3 months if possible and advisacle at least until weight gain is more than 1 kg (2-1/41bs). If the child loses oedema, measure weight gain from the minimal weight recorded.

OUTPATIENl' ROUTINE

For a child unable to be admitted: 1.

Examine and weigh. Insist on return visit after 2-3 days, then once weekly for review. Give advice on cause and nature of illne~s. Look for signs of vitamin A deficiency eSJ)ecially, and treat this !.r necessary, as well as proteincalorie deficiency. Feedine;. If available, give the mother skimmed milll: powder (172 kg or 1 lb.) per week, for 5 kg child. Give advice on preparation of milk; demonstration and practice. Advise on use of other animal foods, legumes, leafy/yellow vegetables. Encourage mother to bring dried legumes for grinding. Dried beans should be lightly toasted before grinding, and stored in air-tight jar. Give recipes as a handout to mothers who can follow them.

3 . Follow- up Malnutrition case register. House-visit during following week. Check progress and weigh each week for first month, then e~er.v 2 or 4 weeks. Encourage mother to continue bringing legumes for grinding.

vTPR/UUTR/26 page 19

ANNEX 2

SAMPLE RECIPES FOR !NFAl'lTS (AND TODDL3RS)

Quantities are Sfecified for 1 serving (for home use) and for 10 servings \ for use in group feeding, vill~e nutrition station, etc.) Some useful equivalent measures are:

1 tsp. = 5 gr&ns (water) 1 tbsp.

3 3 1

2 2

4 1 1 1

1 1 1 1 1

grams (water) grams dried beans or rice level teaspoon (t sp.) make 1 level tablespoon level tbsp. ma.1re 172 breal(fast cup (large}(approx. 120 cc.) cup = 240 cc. cups make 1 pint (a~prox. 500 cc.) pints make 1 liter {1000 cc.} pints or 4 liters make 1 gallon cups make e;pprox. 1 liter (volume) or 1 kg. (lreight) ganta ~ approx. 2.2 kgs. of solid foods (e.g. rice, dried beans) liter of water weighsl kg. = 2.2 lbs. large breakfast cup holds 200 cc. water (as drunk) large breakfast cup holds 250 cc. water (briLlful) large breakfast cup brimi'ul holds 170 - H30 g of cereal or small grains (green gram, other dried beans) condensed mill~ can holds 300 cc. water evaporated milk can holds 400 cc. water beer bottle holds 300 cc. large pineapple juice can = 1 liter small ice cream can = 1/2 gallon (2 quarts) large ice cream can = 1 gallon (4 quarts) small petroleum can = 1 gallon (4 quarts) large petroleum can = 5 gaJ.lons

= 15 = 10

Skimmed millt powder nowadays is often enriched with vitamin A. No allo1re.nce has been made for this in the figures sholm for the Nutrient Content. In markets and stores, a small can is sometimes miscalled a er" . Some suitable common, low-cost vegetable foods rich in nutrients

iil1r

Protein and B-vitamins (sometimes calcium)

WPR/Nt1I'R/26 Annex 2 page 20 Vitamin A, vitamin C, irun (sometimes calcimn) Horse-radish-tree leaves (Moringa oleifera) Amaranthus and other types of spinach Swamp cabbage (Ipomoea aquatica) Taro leaves (ColOCasia sPP.) Pechay, Chinese cabbage (BrasSica chinensis) (dark green varieties) Sweet potato tops (Ipomoea batatas) Carrot, pumpkin, yellow sweet potato Manggo, papaya, banana with yellow core Preparation of fish flour This can be made from large dried fish as follows: Remove the skin and head, and shred the flesh from the bones. Toast very lightly in a pan, then pound to a fine flour, removing any bones mis~ed. Repeat the toasting and pounding i f necessary. Store in an air-tight container. Small dried fish end shrimps can be handled in the same way - without removing bones, etc., if they are small and soft enough. Instead of pounding, a grinder such as that used for legumes (see illustration, p. 2OA) ean be used. Preparation of infant foods in general (a) Gl'inding. Fine pounding or grinding or m~hing and sieving is often necessary. For home use, a mortar and pestle may be used. For quantity preparation of dried beans and cereals, a grinder made of stone (traditional style) or iron (cemmercial) is convenient. See illustrations attached. (b) Mashing and sieving. For older infants (7-12 months) many foods can be thoroughly mashed with a fork. For younger infants (4-6 months) they shOUld be mashed and then sieved or strained. (c) Pu~ping. For soft-cooked vegetables, cheap light-weight vegetable mills or grinders are available and very effective. NarE

•

The recipes which foLlow are intended only as guides and samples. In each country, further recipes based on a wider variety of locally available foods should be oompUed, using local names for these foods.

•

t ~ , ! , , , i

, , • •

COMMFR,.CtAL

CO"'R.N GRHI{DER.

• , , t

..,

•

, , I I I

G'"R. I t{ DE R

""! I I I

.' I I

, I

.! -, I I

•i I

~_._.-.- -'-'-'-'- '-.- .... -.-.-.-.--- .. ..

- -..-.---....-----.--~-- ....--.,-.--.. --.

..•

-.-.-.,- ..~.- .... -,-.- .... -.-.-

- ..- ....... - ... ~-,- -_.

wPR/NUTR/20 ~

Annex ::: page 21 INDEX TO LWANT FOOD RECIPES (To be used once, twice or three times daily) Larger infants carl tal~e double theee quantities

. A.

Dried beans l. Dried beans rice porridge

2. Dried beans gruel 3. Boiled dried beans with milk 4. Dried bean mash with yellow 90 sweet potato, or tubers or sago 5. Mixed vegetable/dried beans puree 80 B. S2Ybeans 6. Soybean/rice porridge 120 7. Soybean soup 60 8. Soybean puree with coconut miDt 250 9. Ground soybean with fish 85 10. Mixed vegetab1e/soybean puree 90 c. Peanuts 11. Ground peanut ball 170 240 12. Peanut /b8IlB.DB. mash 13. Ground peanut with milk 220 D. Fruits 14. Scraped papf1\Y8. 15 15. Scraped mango 15 16. Scraped ripe banana 30 E. ~ 17. Soft boi1ed egg 80 18. Soft egg custard 120 200 19. Egg/sweet potato mash 20. Egg/rice soup 140 F. Tubers and sB&o (See rec?re 4 above.) Also: 21. Tuber nsh porridge 80 22. Baked tuber with fish or dried beans 80 23. Sago Ifish porridge or C!r:I.ed beans 100 G. Donated and 1ocal. foods 24. RoUed 'Wheat porridge 80 25. Rolled 'Wheat porridge/egg 160 ~6. Rolled 'Wheat porridge!liver 100 27. Rolled 'Wheat porridgeldried beans 130 28. Rolled 'Wheat porridge/pumpki.n 80 29. Rolled 'Wheat porridge/mixed vegetable 80 120 30. !e11ow sweet potato/miDI:

Calories 140 (170)* 50 ( 80)* 70 (100)* (120)-* (110)* (150)* ( 90)* (120)*

Protein Vitamin A (IoU.) 5.1 (G.O)* 20 20 3.9 (6.8)* 3.9 (6..':)* 20

l,.o (6.9)* 4.4 (7.3)* 7.3 (10.2)-:<6.2 ( 9.1)* 9.4 10.0 6.6 ( 9.5)* 8.3 8.8 11.2 0.2 0.1 0.4 6.2 9.1 7.5 7.3 (10.2)* 5 5 4 2.0 8.2 4.7 5.1 3.3 (8)* (D)* (7) -x(4.9)* (11.1)*

160 900 20 400 20 20 900 10 300 10 130 750 190 560 560 1640 560 200 200 200

(170)* (uo)* ~1l0)*

170)* (110)* (190)* (130)* (160)* (110)* (no)*

(7.6)* (8.0)* (6.2)*

6700 380 800 300

4.5 (7.4)* 6.0

•

*If miDI: or fish fiour 1s 1nc1uded.

9.§l:1 may be used instead. If used 1n the same quantity, the calorie content will be the same, but the protein content is mid-wy between the t;;o levels sJ;lecified.

WPR/NUTR/26 Annex 2 page 22

•

INFANT FEEDING RECIPES (For infants 4 - 12 months) The left-hand column gives the quantity for one serving (home use). The right-hand column gives the quantity for ten servings (feeding stations) • 1.

DRIED BEAUS-RICE PORRIrGE Dried beans Rice Water *Milk 1l0Vlder or fish flour Brown sugar 1.

For one 2 2 1 1 1 tbsp. tbsp. cup tbsp. tbsp.

For ten

1-\

It cup

cup

8 cups ( 4;. gallon)

2/3 cup 2/3 cup

Prepare dried bean flour and rice flour from well- dried beans and rice, by pounding or grinding (with recommended cereal grinder). If thorough drying in sunlight is not pOSSible, heatillg gently over a low fire helps to yield a fine flour. (Flour of dried beans or rice may keep for one month in an air-tight container, if the grains are first slowly toasted for fifteen minutes until golden brown, then ground or pounded and quickly stored in the air-tight container. )

•

Blend dried bean flour and rice flour in small amount of cold water. Boil remaining water and add mixture, stirring constantly

to prevent scorching.

4. 5.

Add sugar and milk, or fish flour. * Cook for fifteen minutes more to a soft custard consistency, adding more water if necessary. (The stool may be more bulky and softer than usual but this is not harmful.)

6. Serve warm to infants four months of age and over. **

*If

available.

** Although

this mixture is in general recommended to begin only after four months, in circumstances where no breast milk or artificial milk is available, it is known that it can be tolerated by infants even in the first month of life, if begun initially in small quantities.

•

WFR/NtJrn/26 Annex 2 page 23 2.

DRIED BEANS GRUEL Dried beans Milk powder or fish flour

For one 2 tbsp. 1 tbsp.

For ten l~up

Salt Water 1.

~ tsp. 1 cup

2/3 cup 1 tbsp.

8 cups or 2 quarts

Prepare dried bean. flour as in Recipe l. Stir tlris flour into boiling water to make gruel of desired thickness and boil fifteen minutes.

3. Add milk or fish flour, and salt to taste. Serve warm to ini'ants four months and over.

3. BOILED DRIED BEANS WITH MILK Dried beans or fish flour Milk powder or fish flour (or any milk available) Sugar Water 1. 2.

2 tbsp. 1 tbsp.

cup

2/3 cup 1/3 cup

tbsp. 1 cup

8 cups

Clean, wash and cook the dried beans in enough water until pulpy (one hour or more) . Add. the sugar and milk (dissolved in remaining \/ater) and boil

for 15 minutes; alternatively, add fish flour and a little salt; omit sugar; boil.

Pass the mixture through a sieve or grinder for infants 4-6 months; for infants 7-9 months, mash only.

Serve warm.

4. IELLCM SWEET PGrATO/DRIED BE./INS MASH Sweet potato (yellow) * Dried beans Milk powder** (or any milk a.vailable). Sugar Water 1. 2.

2 tbsp. 2 tbsp. 1 tbsp. 1 tsp. 1 cup

l~ cup

cup

2/3 cup

1/3 cup 8 cups

Boil dried beans until soft (1/2 - 1 hour).; mash. Boil sweet potato until soft (10-20 minutes); Remove skin and

mash.

Mix these ingredients.

For infants 4-6 months, pass through

a sieve.

4. 5.

Mix the sugar and milk with water, add to other ingredients,

and simmer 5 minutes more, stirring constantly. Serve warm to infants and toddlers (6 months and over) .

yam or cooking banana may be used instead, but these supply *Taro, no vitamin .A. They usually need to be gra.ted rather than mashed (see footnote to Recipe 22). For infants over 6 months, grating the cooked tuber (or maslring) will suffice. For infants 4-6 months, sieve also. Cassava may also be used but is poorer than any of those mentioned above.

** If

available.

1,lPR/WJrR/26 Annex 2 page 2!~ 5. ~J) VEGEl'ABLE/DRIED BEANS

pu:m:;:;

For one ~cup

For ten

Sweet potato (yellow) (mashec:) Dark lea:fy greens Dried beans Water Salt Milk powder* (or any milk available) or fish flour

2 tbsp. 2 tbsp.

li cup 2'2 Cl:.p

l! cup

llaup !-/tdp

12 cups 1 tbsp.

1. 2.

Boll dried beans until soft

H· -

1 hour); mash. Remove

Boll sweet potato uutH soft (10-20 minutes). sk1n and. l:lash.

3. 4.

Boil the dark leafy greens vlith a little water and salt for 5 minutes. Mash.

M:I..x all these ingredients and. pass through a sieve (for infants 4-6 months). cook for another 5 minutes) stirring constantly.

5. Add the milk (dissolved in one-half cup water) and 6. Serve Y1artn to infants four months and. over.

•

*If available. 6• SOYBEAN/RICE PORR:IDGE

Soybean Rice Salt Hater Milk pOvlder (dissolved in small amount of water) or any milk available or fish flour 1.

2 tbsp. 2 tbsp. i- tsp. l~ tbsp. 1 tbsp.

i'2 cup cup 1 tbs'p.

12 cups 2/3 cup

Pre'pare rice flour as in Recipe 1, or add washed rice in step 3. Put soybeans in excess 1mter. Remove the imperfect beans (which float). Soak overnight or about twelve hours. Drain** • Boil in clean water until tender (1-2 hours). Pound or pass soybeans through a grinder. Boil again for five minutes, after adding rice flour if this was prepared separately (step 1). Y1arm to infants (over 6 monthS) and toddlers.

5. Serve

*If available, sugar may be added as in Recipe 1. *ilThe water used for soaldng may have a slight bitter and beany taste 1 therefore change the water before cooking.

lfPR!m.:rr:R!26 Annex 2 page 25

SOYBEAN SOUP

For one tsp. cup 4 cup

For ten 1." cup 1 tbsp. 1

Soybeans Salt Vlater Any dark leafy greens 1.

2 tbsp.

8 cups

~ cups

Prepare soybeans as in Recipe 6, steps 2 and 3. Boil. the dark leafy greens in a small amount of water (three minutes).

3. Pass cooked soybeans and leaves through grinder.* 4. 5. Cook for five minutes more. Serve warm to infants six months and above.

*As 8.

used for maize, made of stone (traditional style) or meul (commerci'll).

SOY.BEllN PUREE WITH COCONUT MILK

Soybeans Coconut milk Salt

tbsp.

cup tsp.

It 1

cup c1lJ?s tbap. steps 2 to

1. 2.

Prepare soybeans (ground) as in ReCipe Add coconut milk to soybeans.

3. Cook for five minutes. Add salt. 4. 9.

Serve warm to infants six months and above.

GROUND SOYBEAN WITH FISH

Soybeans Water Fish flakes with broth Salt 1. 2. 3.

2 tbsp. l~ c1lJ?

tbsp. tap.

cup 121 cups 22" cups 1 tbsp.

Prepare soybeans (ground) as in Recipe Add the salt and flaked fish. Mix well, and cook five minutes more.

6, steps 2 to 3.

Serve warm to infants six months and over.

WPR/wm./26 Annex 2 page 26

.. •

lO.

MIXED VEGETABLEJSoYBEAN PURF~ Same as in Recipe 5, but use soybeans instead of dried beans. L 2.

Prepare soybeansas in Recipe 6, steps 2 to 3. Boil the yellow sweet potato until tender. the skin.

Remove

Boil. the darl, leafy greens with a little water (3 minutes).

4. Mash and sieve, or pass the soybeanB,swet potato and dark leafy greens through the grinder.

5. Add milk (dissolved in small amount of water) or fish flour.

6. Cook for another five minutes, add salt and stir constantly.

Serve warm. to infants six months and over. For one FtI;t"

•

QROUND PEANUT BALL

ten

Peanuts, shelled 1.

2~cup

Slo'Wly bake or toast selected mature -well dried 1>eanuts (withou.t lfin'1l.dt;)untU golden brown . (at least ha.lt' hour). Do not allow to burn. Remove the sUn (optional). grinder. Wash hands and form ground peanut into balls.

3. Pound or grind. finely, using pestle and mortar or corn

4. Feed one whole ball daily to infants over six months, or toddlers, along With any other food. (Divide into 2 or 3 :portions, if' not all consumed at once.) Note: Ground peanuts sh<:lUld be stored in clean, tightly covered containers, vrb.en preparation is not consumed in one serv1.ng. Conmercial peanut butter is not recommended for infants because the ingredients (coconut 011, etc.) and th~ ~ity can not be controlled.

wPR/rruTR/26 Annex 2 page 27

12.

PEANIJT/BANANA MASH** peanuts, shelled Bananas, ripe* 1. 2.

For one cup 1 piece

For ten 2l!cups 10 pieces

Prepare ground peanuts as in Recipe 11. Peel the bananas and mash smoothly with a fork. Blend with the finely ground peanuts. Serve to infants five months and above in divided portions if necessary. (For infants below five months, add a little boiled water to make a creamy conSistency. )

*Preferably 13.

a variety with yellow core (containing provitamin A).

GROUND PEANUT If.[TH MILK Peanuts, shelled ''later Milk powder (or any milk ava.llable) 1. 2. 2 tbsp.

1 cup 1 tbsp.

1'" cups 10 cups 2/3 cup

Bake and pound or grind as in ReCipe 11. Dissol.ve the milk in warm water.

Mix with peanuts.

3. 14.

Serve to infants five months and over.

SCRAPED PAPAYA Ripe pap9¥a 4 tbsp.

2~ cups (~pap9¥a)

Scre;pe briskly with back of spoon and feed the resulting puree directly to infants three months and above with or ~Ti.thout sugar.

15.

SCRAPED MANGO Ripe mango

tbsp.

5 pcs.

cut one slice of mango from each side of the core. Scrape 1 as for ripe papaya. Avoid the fibres. ~"*

Although this mixture is in general recommended to begin only after 4 months, in circumstances where no breast miU: or e.rtificial miD, is available, it is lmown that it can be tolerated by infants even in the first morrth of lire, if begun initially in small quantities.

WPR/NW!R/26 .Annex 2 page 28

•

16 •

SCRAPED RIPE BANAN.A Yellow ripe banana

For one 1 pc.

For ten 10 pcs.

(As for ripe papaya) 17. S~

BOILED :mG

Egg 1.

1 pc.

10 pcs.

Boil the egg for three minutes.

Remove·l!ind place in cold 'Water. the whole egg to infants six months and over.

3. Feed yolk to infants four months and over; 18. SOFT roG CUSTARD

• 1 pc.

Egg* Milk powder (or any milk

10 pcs.

available) Water Sugar 1.

1 tbsp. ~ cup 1 tsp.

2/3 cup

il'

'5 cups cup

SUr the yolk and white of the egg thorout<hly.

Dissolve the mill, and sugar in warm water. this rrrL"(\;ure to the egg.

.Add

3. 4.

strain into a cup and steam until firm over water that is gently boiling.

• Serve warm to infants four months and over.

*Use yolk only 1 for infants 19. ]oo/SWEErl' PCfrATO MASH

4- 5 months old.

Yello1f sweet potato mashed Egg, soft cooked Salt

~cup

5 cups 10 pcs. 1 tbsp.

%tsp.

1 pc.

1. 2.

'Blend the mashed sweet potato, salt and soft cooked egg until fine in consistency. Serve warm to infants six months and over. Strain~ for i.nfants 4-5 months.

WPR/WJ!R/26 Annex 2 page 29

20.

EGG/RICE SOUP Rice Chicken or meat broth Egg yoD>: Milk powder (or any milk availabl.e) dissol.ved in sm.aJ.l. amount of 'Water (or fish fl.our) Sal.t l.. 2.

For one

For ten l.'2 cup 5 cups l.0 pes. 2/3 cup l. tbsp. l

! cup l. pc. l. tbsp.

2 tbsp.

ts-p.

Boil. the rice until. tender. Add the chicken or meat broth.

3. When the rice becomes pul.py, pass through a strainer and cook again.

4. Mix egg, sal.t and milk together, add to rice soup. 5. 6. Cook five minutes tlOre. Serve to iDf'ants four months and over.

21. TUBER/FISH PORRIrGE Taro or yam (cooked; lDB.Shed or grated) 2 tbsp. Taro l.eaves (cooked; mashed)· 2 tbsp. 1 1.., cups

l:} cups

Fish (a) fresh (edibl.e portion) ~ tbsp. or ( b) canned Coconut cream 2 tbsp. (or: skimmed milk powder if availabl.e ) l. tbsp. mixed with a l.1ttl.e 'Water) l.. 2. 3.

l./3 cup l.~ cups 2/3 cup

Boil. the taro ( with fresh fish* if this is used) until. 60ft; mash or grate.

BoU taro leaves and coconut cream (and canned fish* if this is used) 5 minutes, mash. Mix 'ldth other. above ingredients. Pass through sieve for infants 4-6 months and simmer again. Serve warm.

*.Al.ternativel.x:

use dried beans - ~round whUe dry (add these in step l.), or boil.ed and mashed {add these in step 2). may be done before cooldng and gives a finer texture.

**Grating

WPR/ImR/26

Annex 2 page 30 22. BAKED TUBER (WITH FISH)"lI-

•

For one 2 tbsp. 2 tbsp. ~ tbsp. 2 tbsp. 1 tbsp.

For ten 1~ cups

Taro or yam (raw) Coconut cream * Fish (canned or fresh, edible portion) Taro leaves (washed, finely chopped) Skimmed milk powder if' ava.il.able) mixed with a little water 1. 2.

l~ cups 1{3 cup L;.. cups 2/3 cup

Grate the taro or yam raw; as shown below. ** Mix with coconut cream. (finely chopped).

Add fish* and taro leaves

3, Moisten a clean banana leaf with coconut cream.

Place a suitable amount of the above mixture on the leaf, wrap and place in a hot stone or other oven for 1/2 hour •

•

.AlternativelX: such bundles may be slowly steamed or boiled with a little water in a billy-can, kettle or saucepan. Suitable for infants 4 months and over. The traditional methods do not include fish and leaves but these are very desirable additions.

Serve-warm,

*Alternatively:

use dried beans_ ground "While dry; or boiled or mashed. suitable grater is made by opening out an empty can of medium size , punching lots of holes through it from the inner side with a tw-inch nail, then placing it in an arched position as shown:

**A

The product is finer if the tuber 1.s grated 'When raw rather than "When cooked.

WPR/NUrR/26 Annex 2 page 31 23.

SIGO/nSH* PORRIIGE Dried sago Coconut cream Water Fish* (canned, or coolted fish, mashed) Taro leaves (washed, edible portion) (boUed 5 minutes, mashed) (sieved for infants) Skimmed milk powder (mixed with a little water) 1..

11'or cne

For ten

1 tbsp.

2 tbap. 1 cup ! tbsp. 2 tbap.

2{3 cup 1." cups 10 cups lf3 cup 1."'5" cups

Mix the sago with an equal. quantity of cold water

to form a smooth paste. 2.

Boil. the quantity of water indicated. Pour in the sago paste, stir and. mix till jelly-like. Add the coconut cream, fish* and taro Leaves, mix well.

Suitable for infants 6 months and over; sieve the leaves and fish first for infants 4-6 months.

*Alternatively, 24. Rolled wheat

use dried beans - boiled and mashed.

Milk po'Wder* (or any milk available) dissolved in c. little water, or fish flour

4 tbap. 1 tbsp.

~ cups

2/3 cup ;L tbsp.

Salt* Sugar*" Water 1. 2.

tap. 1 tap. l~cup

cup 12 CUPfl

Toast the rolled wheat until light yellow and pass through grinder. Boil water and add flour untU thick consistency. Add milk and sut or sugar to taste. m<mths.

4. Serve warm to infants over four

*Optional.

ilPR/NlJrR/26 Annex 2 page 32

25.

ROLLED WHEAT PORRJDGE 1-Tnn EGG Rolled wheat Egg Hilk powder* (or any mille available) or fish flour Sugar Hater 1. 2.

For one

For ten 2t cups 10 PCl3. 2/3 cup 2/3 cup 12 cups

h thsp. 1 pc. 1 ths]!. I tbsp. It cup

Prepare rolled wheat flour as in Recipe

24, item 1.

Mix the milk* and the previously beaten egg togetller and add to cooked 'Ilheat.

3. Cook for five minutes longer, constantly stirring.

Serve warm to infants four months and over.

*Hix the milk (dry) "With sUBar, add a little water, mix to creamy consistency. 26 • ROLLED WHEAT PORRIDGE 'If.l1'H LIVER Liver (Make sure this is fresh) or I chicken liver Rolled '-lheat salt I'later I inch cube Lf tbsp.

•

150 grams 1 2'2.cups 1 tbsp. 12 cups

lt cups

~ tsp.

1. 2.

Prepare rolled 1~heat porridge as in Recipe 21 :,. Boil the liver over slo\1 heat for ten minutes. Pass through strainer or grinder and add to porridge. minutes.

3. Return to fire, add salt and continue cooking for five 1, •

Serve "Warm to infants six months and over.

27.

ROLLED HHEAT PORRJIlGE WnH DRIED BEANS Dried beans (any variety) others as in Recipe 21, 2 tbsp.

Prepare dried bean flour as described for dried beans (Recipe 1). Add to wheat flour prepared as in Recipe 21,. Add to other ingredients and boil for fifteen minutes. Serve 1~arm

to infants over four months.

•

vJ.PR/NUl'R/2S Annex 2 pages 33/34 28. ROLLED T,l'REAT PORRIDGE }nTH SQUASH (PUMPKIN) Squash (mashed) or yellow sweet potato Others as in Recipe 24 1.

For one 2 tbsp.

For ten

oups

Boil. and mash the squash. Add to rolled wheat porridge, prepared as in Recipe 24. Serve warm to infants si.."{ months and over

3. 29.

ROLLED WHEAT PORRIDGE WJTH HIXED VEGETABLES Rolled ~Iheat S,leet potato (yellow) or squash Dark leafy greens ~"Jater

1: tbs)).

1. tbsp.

icup 2 cups 1 tbsp. 2 tbsp. 1. tsp.

2i cups 213 cup 2i cups 1.5 cups

HiDe powder (or fish flour) Dried beans Salt 1. 2.

2{3 cup 14 cup

1 tbsp.

Boil. dried beans first until soft. Boil. sweet potato (or squash) until soft. or cook separately. Peel.

3. Add dark leafy greens for 1.ast five minutes of step 1 1~ •

Mash, and pass mixed vegetables through sieve or grinder to make puree.

5. Prepare porridge (Recipe 24). 6. Add vegetabl.e puree and cook five minutes more. Serve to infants four months and over. ~HTH

7. 30.

YELIDlv SWEET POriITO OR FISH FLOUR

IvuLK

Yellow sweet potato (boil.ed) rlilk powder (or fish flour) iiater 1.

1+ tbsp. 2 tbsp.

cups cups

eups

10 cups

Boil the ye1.1.o1i s,leet potato in excess water until tender. Remove the skin. 118s11 "Hell.

3. 4.

Add the salt and milk dissolved in small amount of boiled water, or fish flour. Mix well. Serve warm to infants six months and over. infants 1;_ 5 months. Strain for

WPR/rruT.R/26 page 35 ANNEX 3

RECIPES FOR SCHOOLCHILDREN (and for pre-schoolchildren 1 - 6 years) The quantities specified are for 100 (school use) or 10 (practice, or sma.lJ.er groups) numbers, multiply by the appropriate factor. Some equivalent measures are: 1 tsp. 3 Q

2 2

8 4 1

1 1 1 1 1 1 1 1 1 1 1 1

grams water or 10 grams rice or dried beans level teaspoon (tsp.) make 1 level tablespoon. level tsp. make 1/2 breakfast cup (large) (a:pprox. 120 cc.) cup = 240 cc. cups raake 1 pint (ftQProx. 500 cc.) pints make 1 Hter {looO cc.) pints or 4 liters make 1 gallon cups make approx. 1 liter (volume) or 1 kg. -weight ganta = approx. 2.2 kg. of solid foods (e.g. rice, dried beans) liter of water weighs 1 kg. = 2.2. lbs. large breakfast cup holds about 200 cc. water (as drunk) large breald'ast cup brimful holds 250 cc. water large breakfast cup brimful holds 170 g. of cereal or small grains (dried beans, soy) condensed milk can holds 300 cc.water evaporated mille can holds 400 cc. water beer bottle holds 300 cc. large pineapple juice ran = 1000 cc. small ice cream can == a gallon (2 quarts) large ice cream can = 1 gallon (4 quarts) small petroleum (kerosene) can = 1 gallon (4 quarts) large petroleum (kerosene) can = 5 gallons grams water; 1 tbsp.

= 15

Skimmed mille powder nowadays is often enriched with vitamin A. Ho allowance has been made for this in the figures shown for the Nutrient Content. Some suitable common-law-cost vegetable foods rich in nutrients Protein and B-vitamins (sometimes calcium) ll,ung bear..s Qr Grecn gram (Phaseolus aureus) Lima beans (?w'seo1us lunatus) Hyacinth beans (Dolichos lablab) Hinged beans (Psophocarpus tetragonolobus) Pigeon peas (Cajanus cajan) Peas (Pisum sstivum) Cowpeas (Vigna sinensis)

WPR/tMR/26 Annex page 36 Vitamin A, vitamin C, iron (sometimes calcium) Horse-redisb-tree leaves (~oringa oleifera) Amaranthus and other types of spinach S,rentp cabbage (IpoHO€a ?f!.'!.lB±icc.) Taro leaves (Colocasia ~,) Pechay, Chinese cabbage~rassica chinensis} (dark green varieties) Sweet potato tops (IK9Scec baf~ce) Carrot, pumpkin, yellow sweet 'potato Mango, papaya, bananas with yellow core

NCTE

The recipes which follow are intended only as guides and samples. In each country, further recipes based on a wider variety of locally avail.a.ble foods should be compiled, usir.g local names for these foods,

•

WPRfnrmv26 Annex 3 page 37

INDEX OF RECIPES FOR SCHOOL (.AJ."ID PFE-SCHooLCHILDREN) Approximate Nutrient Content per Sernng Calories Protein Vit. A (I. U . )

A. Dried beans Dried beans with leafy vegetables Dried bean soup Dried bean stew Dried bean 'Pudding with milk* Dried bean{sticlty rice pudding 6. Boiled dried beans with milk* or fish 7· Dried beans and egg soup B. Sozbeans 8. Boiled soybeans (~ith milk) 9. Soybean soup 10. Soybean stew (with milk or fish) 11. Fried soybeans (with milk) 12. Savory soybeans (-with milk) 13. Toasted soybeans (with milk) 14. Soybeans -with coconut (-with milk) 15. Sprouted soybean stew (-with mille) 16. Soybean pudding 17. Soybean coclctail C. Peanuts 1. 2. 3. 4. 5. 18. 19. 20. 21. 22. Boiled pesnuts in shell (-with milk) Fried peanuts (-with milk) Boiled decorticated peanuts (s-weet) Peanut soup (-with milk or fish flour) Peanut dumplings (with milk 11 ") 280 250 220 370 370 180 270 130 190 140 210 180 150 230 140 330 250 (350*) (250) (440*) (250*) 16 11 9 12 12 8 12 12 12 10 10 W 10 11 9 12 10 (23*) (10) (18*) (15*) 1200 400 45 0 40 40 40 540 40 330 50 40 50 40 40 40 30 30

(200*) (260*) (216*) (280*) (250*) (220*) (300*) (210*) (320*)

(19*) (19*) (17*) (1 [)Eo) (17*) (17*) (18*) (16*) (17*)

270 (340*) 250 (320*) 180 (250*) 190 200 230 (300*) 330 (400*) 280 (350*)

13 (20*) 8 (15*) 8 (15*) 13 6

500

D. M1scet,laneous 23. Corn (with milk) 24. Chicken rice soup (with milk) 25. Pumpkin soup (with milk) 26. Tubers 1 etc.

sOrr

5 (12*) 9 (16*) 7 (l!,*)

610 200

E. Donated and local foods 27. Banana milkshake 28. Molasses milk drink 29. Rolled wheat porridge (-with milk) 30. Bulgur wheat porridge (with milk) 31. Bu1.gur wheat) vegetable and shrimp 32. Cream of vegetable soup with bulgur 33. Bu1.gur wheat soup lIith clam 34. Bulgur wheat 1 vegetables and snails 35. Bulgur wheat and rice (-with milk or fish flour) 36. Toasted bulgur wheat (-with milk or fish flour) 37. Bu1.gur wheat/maize with tripe * 120 130 120 120 250 220 200 240 6 11 5 5 10 6 6 6 300

(190*) (190*) (290*) (270*)

(12*) (12*) (13*) (13'(') 760 800 400 950

220 (290*) 220 (290*) 270 (340*)

5 (12*)

(12*) 8 (15i1-)

100

If milk powder or fish flour is included. CSM may be used instead. If used in the same quantity, the calorie content -will be the same, but the protein content mid-wa;v between the tvro leve) s specj.fied.

WPR/NfJrR/26 Annex 3 page 38 RECIPES FOR SCHOOLCHILDREN (Ar.D IT.E'6CEOOL) (Quantities to serve 100 or 10 persons)

•

Ingredients (and size of serving) 1.

Quantity For 100 For 10

DRIED BEANS WITH LEAFY VEnETABLES (1 cup) (and milk) , Dried beans Rice Dar:;: leafy greens (cleaned) Water (or rice washing) Dried fish (100 rom. long) or snails Ginger Fish sauce or fish paste Powdered milk* dissolved in a little water 1. 2.

2 cups 20 cups 2 cups 20 cups 3 cups 30 cups 5 gallons 10 cups 10 pes. 100 pes. 1 pc. 10 pes. 1 tbsp. 1 cup 1 cup 10 cups (4~ lb. pkt.)

•

Clean and wash the dried beans and rice. Heat the water, add washed dried beans and cook un'.;il nearly soft. Add rice, ginger and fish or snails. minutes longer. Cook twmty

* Add dark leafy greens and milk. Cook five minutes more.

*If available.

DRIED BEAN SOUP (1 cup) Dried beans Rice Mixed vegetables (diced) (Yellow' sweet potato, squash, okra) Dark leafy greens Water Oil or fat 20 cups ( l~ganta) ") 20 cups (" 10 cups

2 cups 2 cups 1 cup

2 cups 20 cups 10 cups 5 gallons 2 btls. (600 g.) 5 tbsp.

1. 2.

Wash the dried beans, cover with cold water and bring to a boil. vfuen tender, add the oil, salt, washed rice and diced vegetables.

Continue cooking until the mixture becomes pulpy. Add the leaves three minutes before removing from fire. desired, pass through sieve or grinder to obtain creamy consistency. If

•

wPR/NUTR/26 Annex 3 page 39

DRIED BEAN STEW ( 1 cup) . Dried beans Water Banana (cooking variety) Sweet potato (yellow) Rolled wheat or wheat flour* Salt Meat

For 100 20 cups (l~ganta) 4 gallons 50 pcs. (5 kg. as pnrchased) 50 pcs. (5 kg. as purchased) 10 cups 1 cup 1 l{€;.

F'-'r 10

2 cups 8 cups 5 pcs.

5 pcs. 1 cup 3 tbsp. 1 cup (150 g.)

1. 2.

Toast the dried beans lightly and grind finely. Put this and the meat into water and bring it to boil. weat and salt. Boil for 15-20 minutes.

3. Add the dried banana and yellow· sweet potato, rolled

*If

available.

4. DRIED BEAN PUDDING (1 cup) Drie:ibeans Glutinous rice Ordinary rice Coconut mille thick milk thin milk Sugar 1 brown Water Powdered milk* dissolved in small amount of water 1.

20 cups

10 cups 10 cups (5 coconut s) .1. gallon ~ gallons 10 cups (1.5 l~.) 4 gallons 10 cups (1 ph~.)

2 cups 1 cup 1 cup (~coconut) 1 cup

5 cups 1 cup

8 cups 1 cup

Toast the dried beans until brown. Grind it into halves or if there is no grinder, put the toasted dried beans on a winnowing basket and roll a bottle on it so as to divide the dried bean grains into several pieces. Grate the coconut and extract the milk by adding a little water and squeezing. Save this thicJe tlillt. Pour more water through coconut and sieve and collect thin milk in the kettle. Boil. the dried beans in this for 15-30 minutes. Add the ordinary and glutinous rice and boil it until soft (15 minutes). Stir several times during the cooking.

4. When almost done, add sugar to taste.

5. •

Serve hot with the thick coconut milk first extracted (or with milk* mixture) • Powdered millr* could take the place of thiclr coconut milk.

*If available.

l,fPR/NlJr.R/26

Annex 3 page 1:·0

• For 100 For ~O

DRmD BEAN/mICKY RICE PUDDDJG (l cup) Dried beans Glutinous rice \Tater Sugar (brown) Cocunut, grated from 5 coconuts

20 cups 2 20 cups 2 5 gallons 10 10 cups (1.51~g)1 20 cups (2 kg.)2

cups cups cups cup cups

Ilash dried beans and put in a kettle with two gallons cups water. Cook until soft in consistency (about one hour) •

Hash the glutinous rice and put in a kettle Vlith 2 gallons/ 4 cups water. Cook for 20-25 minutes. Mix cooked rice and dried beans and pack to one-half cup full to mould. Put moulded mixture on a tray or plate and garnish 'lith grated coconut and sugar.

3. ).,

BOILED DRIE:D BEANS WITH MILK (3/4/cup) Dried beans Hater Fat or cooking oil Salt Milk powder* dissolved in a little water; or fish flour, or small dried fish or shrimps. 20 cups (l~ ganta) 5 gallons 600 grams (2 btls.) 1 cup 10 cups (1 pkt.) 2 cups 10 cups 5 tbsp. 3 tbap. 1 cup

1. 2.

Clean and wash the dried beans thoroughly through several changes of water.

• Drain off water and put dried beans, salt and fat into a kettle ,dth 4 gallons/8 cups water. Boil vigorously for one hour or until soft in consistency, adding more water as necessary. Add milk or fish. Boil for 5 minutes. Serve it in individual bowls.

3. 4.

*If available.

•

• 7•

"1PR/1'UJ:R/2S Annex 3 page 41 DRDID BEANS AIID :800 SOUP (1 cup) Ingredients as for Recipe 2 ~ith

For 100

For 10 2 pes.

eggs

20 pcs.

1. 2.

Prepare dried bean soup as in Recipe 2. Beat the ra,\-l eggs. l'dd into the soup by pouring dmm a 30-cm chopstick held nearly vel~ica11y und passed in spiral fashion over the mixture so that the ega; is thinly distributed throughout the rlhole. Mix and simmer for one minute.

BOILED SOYBEANS (.dth oi11,)(3/4 cup) Soybeans, dried Salt ;'later !.l1li, J?o~der~ dissolved in llater 1. 2. 20

CLIpS

2 cups

aup

2 tbsp. 12 cups 1 cup

5 gallons

10 cups(l pkt.)

Soak the beans overnight. \'Tash the beans once or t,dce and add to the l1ater. Boil gently ~ith cover for 1-2 hours. Serve hot with one cup of milk'f i\M salt.

*If available.

SOYBEAN SOUP (3/4 Ctlp) Soybeans, dried :later 20 cups ganta) 5 gallons 2 btls. (:,00 cc.) 1Q cups (1 Itg.)

(rl-

2 cupe 12 cups

Oil Tomato (chopped) Salt Yello~ sweet potato or squash, carrots (diced) Any leafy greens Garlic Flour Onion (chopped) Hill> po~der* dissolved in water; or fish flour or suJal1 dried fish or shrimps L 2.

5 tbsp. 1 cup

i- oup

10 cups (1 kg.)

2 tbsp. 1 cup

•

20 cups 20 cloves 1 cup 20 pcs. 10 cups (1 pl,t.)

2 2 3 2

cupe cloves thsp. pcs. 1 cup

Soak soybeans in water overnight. Hash and cook 1-2 hours. ~arm

3. Dissolve milk in 4• •

water.

Set aside. vegetab~es.

Saute the garlic, onions and soybeans, salt and flour

.Ac1d the

5. Hake thick or thin soup according to one t s taste.

Add the miDt or fish and leafy greens five minutes before removing from lire. Serve hot.

WPR/N£Jr:R/26 Annex 3 page 42

10.

SOYBEAN STEW ( with milk)

(3/4 cup) Soybeans Meat, or fish or snails

For 100 20 cups (l~ganta) 1 kg.

For 10

-2 cups 1 cup 2 tbsp.

Salt Water Milk powder*" dissolved in Water 1.

-ftcup

4 gallons 10 cups (1 pkt.)

10 cups 1 cup

5 gallons

10 cups

Boil the soaked soybeans for 1-2 hours, then add meat or fish and boil until tender (for snails, 15 minutes). Season with salt. Add the leafy vegetables five. minutes before removing from fire. Serve hot with 1 cup of mil1c* for each pupil.

•

*If available.

ll.

FRIED SO'YBEANS ( with milk*) (3/4 cup) Soybeans Water Oil (coOlting) Salt 20 cups (l*ganta) 2 cup~

5 gallons ~ cup

10 cups

3 btls. ;900 cc.) ~ cup 2 tbsp. 1 cup 10 cups (1 pkt.)

•

Milk powder*" dis solved in vlater ('Warlll)

5 gallons

10 cups

1. 2.

Soak soybeans overnight, and boil. 1-2 hours. Drain off the water. ildd salt. light yellow and crispy.

3. Fry in vegetabl.e oil until soybeans are

Eat fried soybeans with milk* (1 cup).

*If

available.

•

'fJ!R/WJTR/26 .

• • 12. SAVORY SOYBEANS (with m:Uk*) (3/4 cup) Soybeans Onions, minced Tomato sauce* Sweet pepper (red) Cooking 011 Water Salt Milk powder* dissolved in Water 1. 2.

Annex 3 page 43

For 100

For 10

10 cups (1 Gal.) 1 2 cups 5 btls. 1 10 pes. 1 2 btls. (600 cc.) 5 5 gallons 10 .~ cup 2 10 cups (1 pkt.) 1 5 gallons 10

cu'»

cup pc. tbsp. cups tbsp. cup cups

Soak soybeans overnight, add salt and boil 1-2 hours.

Heat the oil and add the onion and pepper. Cool~ for five minutes. Add the boiled soybeans and tomato sauce. Allow to simmer over the low fire until thoroughly heated. Serve warm or hot with millc* (1 cup).

*If ava.1la.ble.

13. TOASTED SDYBEANS (with m:Uk*) (2/3 cup) Soybeans Water SaJ.t 011 Milk powder* dissolved in Water 1. Soak soybeans in 'Water overnight. 20 cups (l~anta)

cup 1 btl. . 10 cups (l pl,t.) 5 gallons ~

1. gallons

2 cups

10 cups 1 tbsp. 3 tbsp. 1 cup 10 cups

Wash, drain and add salt. yellow and crispy. Serve with one cup milk.*

Boil for 1-2 hours.

3. Toast in vegetable oil until the soybeans are light 4.

*If available.

14.

SOYBEANS WITH COOONUT (3/4 cup) Soybeans, dried Coconut, grated Salt Sugar (wlUte)

20 cups (l~ganta) 20 cups

2 cups

2 cups 2 tbsp.

(5 coconuts) cup 10 cups 1 cup 10 cups

5 cups (3/4 kilo) ~ cup

Water Milk powder* dissolved in Water 1.

5 gallons

10 cups (1 pkt.)

5 gallons

Soak beans overnight. Drain and cook in boiling -water until tender. Add the seJ.t. When done remove from fire, drain and set aside to cool. Place in a platter. Hake a ring around the soybeans with grated coconut. Serve with one cup milk.*

*If available.

'I'lPR/NlJrR/26 Annex 3 page 44

15. SPROUTED SOYBEAN STEW (with milk) (l cup) Soybeans, dried Shrimps, shelled Fat (oil) Water Onions, diced Garlic, minced Pewdered miD~ dissolved in Water 1.

For 100

Fer 10

20 cups (l~ganta) 2 cups 1:- cup , 5 CupS' 2 'tUs. (600 cc.) 5 tbep. 10 cups 5 gallons 1 pc. 10 pcs. 10 pcs. 1 pc. 10 cups (1 pkt.) 1 cup 10 cups 5 gallons

Soak the ecybeans overnight. Drain off water and place in a container with holes. Cover the seybeans with cleth to lceep warm. Sprinr.le -water on the soybeans twice a day until the soybeans have a sprout of 2- 3 ems. long (about 2- 3 days). 10 cups of -water.

3. Saute garliC, onions, shrimps in oil. Add five gallon/ When water boils add the soybean oprouts and cook until tender. m:Uk* (1 cup) .

4-. Serve 'With Nete:

Soybean sprouts could alsO' be cooked for soup.

*If 16 •

available.

SOYBEAN PUDDIHG (1 cup) Seybeans, dried Bulgur wheat or glutinous rice Ordinary rice Thin coconut miD~ Thick cocenut Bre'Wtl sugar Water 1. 2. m1D~

14 cups (1 ganta)

ltcup 10 cups 1 cup 10 cups 1 cup 2 gallens 5 cups ( t ceconut) (5 ceconuts) 10 cups 1 cup 10 cups (1.5 kg.) 1 cup 10 cups 5 gallons

•

4. 5.

Toast the soybeans in medium heat fer twenty minutes until golden brown. Grind the toasted seybeans to' break them into halves, or in the absence of a grinder, place toasted soybeans in a 'Winnovlng basket and roll a bottle to break them into halves. Winnow to remove the husks. Extract the ~ by squeezing the grated ceconut. Strain and set aside thick extract. Repeat the process by adding excess -water to get 2 gallens/5 cups thin coconut miU:. Boil the soybeans 1-2 hours in excess water. Add 'Wheat, rice and thin coconut milk. stir the mixture to' prevent scorching until i t thicl~ens. When the rice is ceoked, add sugar and cook fer five more nrl.nutes. Serve 'With the thick coconut milk.

• •

WPR;NlJrR/26 Annex 3 page 45 17. SOYBEAN COCKTAIT, (1 1/2 cups) Soybeans Cooking bananas Papaya (large) Grated coconut Sugar (brown)

For 100 14 cups (1 ganta) 100 pes. 5.pcs. 20 cups (5 coconuts)

For 10

It oups 10 pes. 1 '2 po.

5 cups (3/4 kilo) 10 cups

(! coecrnut) cu.p :<:

2 cups

Powdered milk* dissolved in Water

5 gallons

1 cup 10 cups

1. 2.

Soak the soybeans overnight, boil 1-2 hours; drain. Boil the bananas (in skin); peel and dice. Dice the papaya. Mix all ingredients together and serve cold.

3. 4.

*It available. 18. BOILED PEANUTS IN SHELL (with mllk*)

(l cup) 3/4 kg. 2 tbsp. 1 gallon 1 cup

Peanuts in shell (dried) Salt Water Milk powder* d1neolved in Water 1.

7!kg.. 1 cup

10 gallons 10 cups (1 pkt.) 5 gallons

10 cups

Boil washed peanuts in water (plus salt) for about an hour, adding more water as necessary. Remove from fire and drain off the water. with 1 cup of milk per pupil. Serve warn

*If available.

WPR/wr.R/2.6 Annex 3 page 46

•

19. FRIED PEANUTS (~cup) Peanuts, shelled Cooking oil* Garlic Salt 1. 1

For 100

For 10 2 cups 1 lz-cups 1 clove 2 tbsp.

3.3

1'8

1 gallon 10 cloves 1 cup

Soak the shelled peanuts overnight. Remove the skin and dry it under the sun for an hour. Heat the cooking oil, add the garlic and peanuts.

3. Stir constantly to prevent scorching. Add salt. 4. Remove from the fire when the peanuts are golden brown.

*Most of this can be recovered and used again. 2.0. BOILED DECORl'ICATED PEANUTS WITH 800M Peanuts, shelledl Sugar (bll!Ow) Water 1. 2.

(~cup) 1

• 2 cups ." CUI>

3.3 kg. 5 cups 10 gallons

10 cups

Soak shelled peanuts in water overnight. Remove the skin and boil in fresh water for 2':>hours nth sugar. 1

3. Remove from fire and serve warm or cold. 21.

PEANUT SOUP (1 cup) Peanut s, shelledl Dried shrimps Sweet pepper, sliced Onions Salt Water Dark leafy greens 1.

3.3 kg. 10 cups (1 kg.) 10 pcs. 10 pes. 1 cup 3 gallons 2.0 cups

2 cups 1 cup 1 pc. 1 pc. 2 tbsp. 5 cups 2 cups

Boil the peanuts until soft (20-60 minutes) •

Add washed shrimps and prepared vegetables. for five minutes.

Simmer

3. Serve warm. ~

If fine consistency is desired, pass all ingredients through grinder and simmer again.

•

One kg. of peanuts in shell yields 670 grams of shelled peanuts (5 cups).

WPR/NUTR/26 Annex 3 page 47

22 • PEANUT:tlJMPLINJS (with milk*) (5-10 pcs.) Glutinous rice 1 Peanuts, shelled ~~

For 100 20 cups 1.5 kg. W~s

For

2 cups 2 cups l~

Water Milk "powder*" Water 1. 2.

5 gallons clissolved in 10 eups 5 gallons

10 cups 1 cup 10 cups

3. 4. 5.

6. 7.

Soak glutinous rice in equal quantity of water for 2-3 hours. Put it through a. grinder and grind finely. Add enough water to make a dough. Form small balls of dough and flatten to around 1/2 inch in thickness and t'WO inches long. Drop the c:i.rcul~ doughs in the boiling water fi va or more at a t:tme. Cooked dough rises to the top so they could be taken out of the boiling water. Toast the peanuts lightly and "pound or grind finely. Add sug~. Ron each cake in the peanut flour/fW€,ar zn:Lxture. Serve the cakes 'With a. cup of milk.* ava.1lab1e

*It' 23.

CORN SOUP WITH LEAVES (and milk*) Corn (mature fresh) Cooking oil G~lic, minced Onion, sliced Shrimps, dried Salt Rice wash~ or water M1.l.k povder* clissolved in water Dcrk leafy greens 1. 2. Shred corn grains from cobs. Saute garlic, onion, corn and washed shrimps. Season with noJ.t Or floh sauce. Cover !.'nd cool~ for 10 minutes. .Add rice 'WaShillg, leaves and the milk dissolved in warm water. 10 1 10 10 large cobs btl.(300 cc.} cloves pes. cups cup g6ll.cns cups(l plct.) cups 1 cob 3 tbsp. 1 clove 1 pc. ?t cup 3 tbsp. ; cups 1 oup 2 cups

5 1

3 10 20

3. 4.

5. Stir and boil fOr 5 minutes. 6. Serve hot.

*I f 1

a:va.Uabl.e.

One kg. of peanuts in shell y:!.e1ds 670 grams of shelled peanuts (5 cups).

'WPR/Jm!R/'2.6 Annex 3 page 48

24.

CHICKEN/RICE SaJP WITH MILK*

For 100

For 10

( 1 cup ) Whole chicken Cooking oil Garlic, sliced Onion, sliced Ginger, sliced Water Rice (ordinary) Rolled weat or Bu.lgur wheat

pc. 1 btl. (300 cc.) 3 thap. :'l"

2 pcs.

10 cloves 10 pcs. 10 pcs.

1 clove 1 pc. 1 pc.

3 gallons 6.6 l~. 20 cups 10 cups 1 btL 1 tbsp. 10 cups 10 cups 10 cups

5 cups 3 cups 2 cups 1 cup 4 tbap. 1 tap. 1 cup 1 cup 1 cup \

Fish sauce or soy sauce Monosodium glutamate l} (Vetsin, Ajinomoto) Green onions (chopped) f.1ilk powder* dissolved in Water 1. 2.

Cut the chicken into small pieces. Saute garlic and onion untU light brown and add chicken, ginger1 rice and weat. 10 minutes. Cook for about

•

Add half of the water and boil until chicken is nearly done. Add remaining water and mUk* and continue cookiIli until well done, stirring occasionally. Season with fish sauce or soy sauce.

5. Garnish with green onions.

Serve hot.

*If

available

Annex 3 page 49 25. PUHPKIN SouP twith milk*) (1 cup) Pork Garlic, crushed Onion, sliced Rice washing SaJ.t Rice Pumpkin Monosodium glutamate (Vetsin, Ajinomoto) Milk powderif dissolved in Water Onions, green, chopped 1. 2. For 100

wPR/NtJJ!R/26

For 10 1 cup 1 clove

1 kg. 10 cloves 10 pcs. 5 gallons 1 cup 6.6 kg. 20 cups 1 tbsp.

l pc. 10 cups 3 tbsp. 3 cups 2 cups 1 tsp. 1 cup lcup 2 tbsp.

10 cups 10 cups lcup

3. 4. 5.

Cook pork and "When tender cut into small pieces al'ld extract the fat. Saute garlic, onion and pork. Cook rice and pumpkin in rice washing and meat stock. Season with salt, pepper, vetsin. Add milk to mixture. Cover and boil for five minutes. Serve bot nth chopped green onions. available.

*If 26.

TUBERS, etc. Yams, taros, cooking bananas and cassava, are usually cooked in bulk (boiled, baked or ste8l1led). Cassava is poorer than the others. The principal. objectives are (i) to provide a su1'ficient quantity and (11) to ensure that this ;i.s taleen with some animal or vegetable protein supplement and some green leafy or yellow vegetable. Tubers may be as follows: (a) Replacing rice in many of the recipes (1, 2, 4, 7, 24, 25). The tubers may need to be cut into small pieces (diced) before or after cooking. With soybeans (recipes 9, 10, ll, 12, 13, 1 1" 15, 16, 17) ("WhOle or diced), With peanuts (recipes 18, 19, 20, 21) - whole or diced. Added to other soups and stew (e.g. reCipe 23). Replacing sweet potatoes (recipes 2, 3, 31, 32,

(b) (c) (d) (e) (f)

34). 4.

"Tith l.eafy vegetables and/or other vegetables and/or fish, meat, etc., as indicated in the recipes on Annex

The weight of tuber 'Which is equivalent calorically to a given weight of dry cereal. is about three times the amount of cereal..

vJPR/NUI'R!26 Annex 3 page 50

Z7. BANANA SHAKE (with milk*) (1 cup)

For 100 100 pes. 10 cups 5 gallons 2 tbsp. 5 cups (3/4 kg.)

For 10 10 pes. 1 cup 10 cups

Banana, yellow, ripe Milk powder dissolved in Water Salt Sugar 1.

't;sp ..

cup

Mash the bananna or force through a sieve. Add other ingredients and mix well.

2. 28.

MOLASSES MTIK DRINK (1 cup) Milk powder dissolved in Water Molasses 1. Milk and water should be cold. Mix together and stir in the molasses. 10 cups (1 pkt.) 1 cup 10 cups 5 gallons 1 cup 10 cups

•

3. Drop of vanilla may be added to each serving if desired. 29. ROLLED \-mEAT PORRIDGE (with milk*) - (It oups) Rolled wheat Milk powder* Water Salt Sugar* 1. 2.

4 gantas (50 cups 5 cups lD cups (1 pkt.)

1 cup

10 gallons 1 cup 5 cups

15 cups 2 tbsp.

•

?! cup

Bring to a boil eight ga11onsjl2 cups of water. Add the rolled wheat to the boiling water. Stir to avoid scorching. Add salt. ten cupsjl cup of warm water. to the rolled wheat. Add the mixture

3. Dissolve the powdered milk and sugar* in about

When done remove from fire and serve warm.

*If available.

•

WPR/lruTR/26 'PDge

Annex 3 51

30.

BULGUR WIlEAT PORR:I::ooE (with miDt) (3/4 cup) Bulgur wheat i-later Milk powder Sugar

For 100

For 10

40 cups 4 gallons 10 cups 5 cups

8 cups 1 cup

cups

Jr cup

Soak the bulgur in one gcJJ.rJn/2 cups of we;tcr for two hoOuro.

Add two ga:uons/4 cups of water to the soa.l~ed buJ.....,"llr =d boil for five minutes. Dissolve the cilk poWer and sugar in one gallon/2 cups of water. Add the milk. and sugar to the bulgur. Cook three minutes longer. Remove from fire and serve warm or hot.

3. 4.

•

3J-. BUIGUR WHEAT WITH VIDETABLES AND SHRIMP (1 cup) Bulgur 'Wheat Oil Dried shrimps Garlic, minced Onions, sliced Rice washing Pumpkin and yellow sweet potato. - diced. Darlc leafy greens cut into strips Salt 1.

40 cups

1. cups

1 btl.(300 c~

3 tbsp. 1 cup

10 cups 10 cloves 10 pcs. 4 gallons 10 cups 20 cups 1 cup

1 clove 1 pc.

•

10 cups 1 cup 2 cups

2 tbsp.

Heat oil. Saute garlic, onions, washed shrimps and bulgur. Add rice washing gradually. Add salt and cover. When the l:-ul.{;ur mixture s:l..mt:lers, add the yellow vegeta.bles and cook until tender. Add leaves and coole five minutes longer.

3. Remove from fire and serve warm. • •

wPR/mm./26 Annex 3 p.ege 52

•

32.

CREAM OF Vl!nmABLE SaJP WITH l3'UlGUR (~ cup)

For 100 40 cups 100 large cobs 10 cups 20 cups ~o cloves 10 pcs. ~O cups 4 gaD-ons

For 10

Bulgur Corn yellow (shredded) Pumpldn, diced (or yellow sweet pOtato) Ila.rk ~ea.fy greens (c~eaned) Garlic, minced Onions, diced Milk powder Rice washing (or meat stocl;: or fish stocle) Oil. 1. Shred grain of corn from cob.

4 cups 10 cobs 1 cup cups clove pc. cup 10 cups 2 1 1 1

2 b~.(600 cc.) 5 tbsp.

Cut the :pUliIpkin (or yellow sweet potato) into cubes.

• 3. Wash and pick the dark leafy greens. 4. Saute garlic, onions, bulgur and the vegetab~es together. Add salt, and the rice washing. Cook until. tender. Dissolve the }lOwdered milk into ten cups/l cup of water. Add this mixture and the leaves five minutes before rellJ)ving from fire.

33.

BUIOOR WHEAT SOUP WITH CLAMS (1 cup) Clams Bulgur Milk :powder Rice washing Salt Dark leafy greens cut into stri:ps 1. C~ean,

20 cups 40 cups ~O cups 4 gallons ~ cup 20 cups

2 cups

4 cups 1 cup

•

8 cups 2 tbsp. 2 cups

wash and drain the cl.ams. RernQve from

Cover with water and cook for five minutes. fire. Shell the clams. Set aside.

3. Cover the bulgur with rice w.sh:Lng. Cook until. tender. 4. Dissolve the milk. in ten cups/l cup water.

5. Add the leafy vegeta.bLes, before remo'll'ing from. fire.

cJ.ams, and

mi:L1~

five minutes

6 • Serve hot.

•

wPR/NUI!R/26 Anne-.x: 3 pag2S 53

34.

:BUIGUR WHEAT WITH VEm'TA:aLES A.TID SAUTED SNAILS (1 c~_

For 100 20 20 20 1

For 10

Snails Dark leafy greens (cleaned) Sweet potato, yellow Salt

Oil Garlic, minced Onion, sliced Ginger, sl.1ced Rice 'Washing Bulgur Water

1 10 10 10 2

40 3

cups 2 cups cups 2 cups cups 2 cups cup 2 tbsp. btl. (300 cc.) 3 tbsp. cloves 1 clove pcs. 1 pc. pes. 1 pc. gallons 4 CUlJS cups 4 cups 6 cups gruJ.ons

1. 2.

Wash snails and allow to drain. Saute garlic, onion and ginger. Season lrith salt. Add the rice washing. AJ..1.ow to boil. Cook for five minutes.

3. Add the yeJ.low sweet potato. 4.

Add the snails, cover and let boil for another five minutes or untu sweet potato is cooked. For boiled bulgur

1. 2.

Soa.k the bulgur in one gaJJ..tJn/2 cups of water for trIO hours. Add two gallons/4 cups of water and boil 5 minutes (with salt). Remove from fire and serve warm, "With sauted snails and vegetables.

35.

1lUILruR WHEAT AND RICE (with miJ.k*)

(374

cup) 20 cups 2 20 ctlps 2 1 cup 2 3 gallons 6 10 cups (1 101tt.) 1 5 gallons 10

Ordinary rice Bu.lgur

Salt Water Milk powder* dissolved in Water

cups cups tbsp. cups cup cups

1. 2.

Clean the rice of any dirt, etc.

Put the rice and bulgur together in a kettle. Add water and salt. Cover. Coole untu i t is done. It the rice is still hard, steam the mixture till the rice is tender. Serve with one cup of m11.k*. avaiJ.a.ble

3. 4. 5.

*If

vJPR/NUTR/26 Annex 3 page 54

•

36.

TOASTED WHEAT (with milk*) (3/4 cup) Bulgur \'iater Sugar Milk powder l. 2.

For 100 cups gallons cups cups

For 10 4 cups 10 cups 1 cup

40 5 10 10

1 cup

Dissolve the milk in warm water. Add the sugar and stir well until nissolved. Set aside.

3. Toast the bulgur until there are signs of puffs. 4. Remove from cooking utensils and put in individual dishes.

5. Cover with milk and sugar mixture. *If available 37.

BULGUR WHEAT)MAIZE SOUP WITH TRIPE (with mllk*) (1 cup) Tripe Water Bulgur wheat Corn meal Onion Pepper (sweet, red) Salt Fish sauce Cooking oil Garlic, diced Onion, leaves, chopped Milk powder dissolved in Water 1. 2. 1 kg.

.. cup cups cups cups pc. pc. tbsp. tbsp. tbsp. pc. cup cup cup

5 gallons 20 20 10 10 1 1 1 10 10 10 10

cups cups pcs. pes. cup cup btl. pes. cups cups cups

1 10 2 2 1 1 2

3 3 1 1 1 1

•

Clean tripe and cook until tender. Add bulgur-corn mixture to the liquid in which tripe was cooked. rapidly to a porridge consistency.

3y Make sure that there is enough liquid to cook mixture 4. Add tripe cut into small pieces, onion, pepper. salt and fish sauce. Fry garlic until brown and before serving scatter on

top of the soup together with finely cut onion leaves. add milk and simmer. *If available.

•

wPR/!rrJrn/26 page 55

•

ANNEX 4 SCME RECIPES WITH LEAi'Y GREElill A. SOME SOPHISTICM'EJ) RECIPES WITH LEAFY GREENS

PICADILLO WITH DRUMSTICK LEAVES

2 tbap. cooking fat 1 tap. minced garlic 2 tbap. sliced onion 1 ." cup cbcpp"'d tomatoes 1 cup ground beef or pork

4 cups rice washing 2 tsp. salt dash of pepper 3 cups drumstick leaves, washed and sorted

Saute garlic, onion and tomatoes. Add ground meat. Cover and cook 5 minutes over low heat. Add rice washing and bring to a boil. Season "With salt and pepper. .Add drumstick leaves. Cook 5 minutes longer. Six servings. 2. !:!§.H FLAKES GHOULASH 1 cup pure coconut milk,diluted nth 1 cup -water

1 cup dried fish (boiled, fla.1ted and fried in 1 tr:sp. M('\:dllg fet). 2 segments garlic, minced 1 medill."Il onion, sliced 1/8 tap. salt 6 cups drumstick leaves, washed and sorted 4 pcs. sweet pepper, crushed Boil coconut milk, dried fish, garlic and onion for 10 mimrtes. Season nth salt, stirring the mixture continuously. Add drumstick leaves and crushed sweet pepper. Cook 5 minutes longer. Serve hot. Six servings. 3. SHRIMP STEW

2 tbap. cooki.Dg fat 1 tap. minced garlic 2 tbap. sliced onion 1 tbap. ginger, cut into striJtS 1 tbsp. fish sauce

l-lt tap. salt 5 cups rice washings 12 pcs. fresh shrimps, trimmed 2 cups drumstick leaves, washed and sorted

saute the garlic, onion and ginger. Add fish sauce, salt and rice wstung. Bring to a boil and add shrimps. Cover and cook 10 minutes. Add drumstick leaves and COOlt 5 minutes longer. Serve at once. Six servings.

*Instead

of drumstick leaves, you can use any of the following leaves (chopped up; discard the stalks): Spinach - many local varieties e.g. Ama.ranthus, Basella, eta. Sweet potato leaves Swamp cabbage (kangkong) Chinese cabbage (darlt green) Bitter melon leaves Pepper leaves (any kind) Sayur Manis (VJ.al.aysia) (I'lauropus androgynus) Bean tops Pumpkin (squash) tips Portulaca

WPR/NUTR/26 Annex 4 page 56 4. THICK BE~SOUP

.. •

4 tbsp. cooking fat 1 tsp. minced garlic 2 tbsp. sliced onion 1 I cup sliced tomatoes 2 cup sliced boiled pork ! cup sliced shrimp 1 cup dried mung beans, boiled

1 cup "2

shri:m:p juice cup porlt: broth 3 cups water 4 tsp. salt dash of pepper 3 cups of drumstick leaves, washed and sorted

saute the garlic, onion and tomatoes. Add porlt and shri:m:p. Cover and cook 3 minutes. Add mung beans, shrimp juice, pork broth and water. Cover and bring to a boil. Season with salt and pepper. Add drumstick leaves and cook 5 minutes longer. Six servings. 5. FISH STEW ~ cup dried pigeon peas) boiled in 1 cup water 1 medi~size fish, cut

into slices and broiled 10 young lady t s fingers (okra!)

3 cups rice washing 2 cups green beans cut into

2" lengths cup fish paste "2 ~edium onion, sliced 2 large tomatoes, sliced

cut into 1" lengths 2 cups drumstick leaves washed and sorted

Jldd rice wash:ing to cooked pigeon peas. Boil and add green beans. Cover and coolt 3 minutes. Jldd fish paste, onion, tomatoes, fish and lady I s fingers. Cover and boil 2 minutes. Do not stir vegetables. Add drumstick leaves, cover, and cook 5 Llinutes longer. Serve hot. Six servings.

CRAB GHOULASH 1 big crab (boiled)

3 pcs. sliced tomatoes 1 tbsp. sliced onion 1 tbsp. green onion leaves

1 cup thick coconut mill>. 2 cups thin coconut miDe

(more if desired) 1 cup drumsticlt: leaves

Ginger or red pepper to 1 ts;? 8clt taste Monosodium glutamate (vetsin, ajinomoto) Boil crab; when coo:<;:ed divide into parts. Set aside. Put the thin coconut milk) tomatoes and onion in a coOking pot, and bring to a boil. Add the crab and let it boil for 3 minutes. Add the thiel;: coconut milk, followed by the drumsticlt: leaves and onion leaves. Season with fish sauce and monosodium glutamate em"l. r.()ok far r;.Ill'lther 3 minute s • Serve hot.

'flI'R./"}PJTR/26 Annex

page 57

7. GAllO-GADa Salad 1 large potato or sveet potato ~ cup spinach (cooked - iIny kind)

t cup green beans (cut in short pieces) pechay or other green leary vegetable or banana flower (sliced) 1 hard- bolled egg Slice the potato and hard-boiled egg.

1 cup bean sprouts

Boll the potato and peel.

Boil or steam the green leary vegetables briefly. Boll the bean sprouts and green beans briefly. Arrange 'With cooked bean sprouts in the middle.

Mix

~he green leafy vegetables and beans together and sprcnd over the bean sprouts.

Arrange the sliced potato and egg on top. Cover all with peanut sauce. Peanut sauce ~ I 1 1 1 I

Place in fridge.

cup peanut butter cup grated coconut garli~ sliced onion, sliced or more pieces of small red pepper tbsp. fermented fish paate juice of tamarind

Fry the pepper, garlic and onion (sliced) lightly. Grind the pepper and mix all together. Mix together the peanut butter'and grated coconut and about an equal quantity of hot lIater. Add the garlic, pepper, fish paste and tamarind. Simmer for about 20 minutes until it b~<)('rles thick. Allow to cool. Cover the salad with this sauce and keep in fridge.

•

add sliced cue cumber or any other rav vegetable, e.g • sliced cabbage, pecha-yo Also beancurd - fried and sliced.)

wPRjumRj26 Annex 4 page 58

POLYNESWi PAWSAMr Taro leaves, young (2 per adult, 1 per chUd) Coconut cream - 1 cup Salt to taste Optional: Onion (small, chapped) chillies juice of citrus fruit grated coconut

Prepare coconut cream (thick); add salt, onion, chillies and citrus juice as desired.

Clean the taro leaves, pulling off thick fibrous parts at the base. Fold about 6 leaves into a cup shape, pour in the liquid. Place on a breadf'ruit leaf and tie the tops. Eak.e in hot stone or other oven for 1/2 hour.

Alternativel'l! Prepare coconut cream, etc., as described. Roll the taro leaves into a cylinder, cut this into slices. Place the liquid and the leaves in a pan and simmer for 10 minutes.

Note (a) (b) Do not use stems of taro.

Some kinds of taro leaves .:.ause itching in the throat. Do not use leaves of the giant taro.

The leaves

much

have purple stems are usuallygcod.

Some varieties of leaf should be partly sun.-dried before cooking; local inhabitants know these varieties.

•

WPR/NOTR/26 Annex 4 pages 59/60

SOME SIMPLE RECIPES FOR GREENS

TASTY SPIlUlCR 1.. 2.

Boil a little 'Water and salt. Then add leafy greens (chopped up just before cooking). Also a little chopped onion and/or garlic. (These are more tasty if quickly deep-fried beforehand in oil.) Boil or steam for 3-5 minutes. if any, for soup. Keep excess water,

3. 4. ** 5. •

Add a little vegetable oil (soya, or Wesson - sunf'lower; or maize or peanut) or pork fat. Heat gently while stirring. Add some grated coconut for extra flavour.

A serving of this should cover a good part of your day's needs of iron, v:l..tamins A and C, and some B-vitarnins.

**(a) (b)

Alternatively, add 1 cup sour simmer gently.

mil1~

or coconut milk and

In addition, some prev:l..ously cooked and chopped-up pork, shrimps, r>.nchovies or squid may he ndded at this :point; it increases the flavour tremendously.

MIXED V'EUEl!1\BLES WITH LEAFY GREENS

Sayote Squash (pumpkin) Yellow sweet potato Carrots 1.

Fresh green beans Lady's fingers (okra) Eggplant Any green leaves (cleaned; chopped up)

Using just enough water, boil any or all of the above until tender (carrots tal~e a little longer than the others); then cut into slices (or slice first if desired). Add an equal quantity of 8...'1Y of the leaves mentioned above. Simmer for 3 minutes, add a little vegetable oil and simmer 2 minutes. If deSired, add a few small dried shrimps, and/or some grated coconut, pepper, ginger, etc.

2. 3.

,,-:'.'. I..,.. """"/ C_ r ,.,' ''":.x...". • .. '

., " .... ,I . .

pc";;:; , :)1 .:~t:!'{:X ~

SCl·;E HUmII'IOH C,Z){;,;N.P,IOlI HIITERIALEJ MID (!mF ;~:

1. The attached charts are il.lus·~~·D.t_.(ns ei.' !:o', :~C1\:! s1::')1e !1UtritiC;1 ec111C~rGio:1f'1 -d scan b e const ruc '·e~ • ro;'o+~ ,-.' '''~"l':' ~,'-c,<'i~': A-. -:c'~l.'·' L " ' , ,\;0) 1.,"" ',-he _ l •. ,~... ,,__'.', ... <.:>.,<._,; _,' ~~.,u) 1·-, ~ ... , ~ ',,~ ~ >roc'?llci blc materials an d 6.1. foods.

Similar 'oar charts ce.n be r,laCie on a larger scal~ from coloured Manila ,?sj:)er. F-',th sand~Japer stuck on the back these large bars can be placed effectively on 6. flannelgraph. Picture cut-outs of the 8:;»roj?r:le.te food can be placed below each bar, so that the bar indicates the relative nutrient content of that food (for a specified nutrient). This can be more easily appreciated by illiterates (and literates!). Members of a class can be tested afterwards to see if they can place 'ehe appropriate picture under each bar. 2.

handle

'\' "

plywood

flanneJ: ... chalkboard ( blackboard)

Fllpcharts can be hung in the middle of 'this device.

•

ENeLS.: bar charts

•

~""""'-'l /-. r' .... l '--~i 1,\" ..· ... "/~·-:

../\nr:ex

':l"c.e I~;; • Vo4;;:> ~~

:..~

SC.'HT~

YCI',:;I.:?ICH :-;r;UCllTIOH Hl\':'BillJ\LS ()F

PRcrEIN CON':.'Ei.U' G::'e.m.~ ci'

FOODS (as ,?urchased)

·~Co·;:·e~.:.. -\:~~:!:(~. (e~ }?i.l!"C~1':':_S;;t.~)

y )ro.::i~:3te v"2.1t'.es:

524 Dried Shl'1mp

391 Soy

360 L--. . ____ _

256 _. __ ~._.

244 .. -

126 ------

108 -.-.

102 . ._-

Skim

Peanut

Dried

--..

101

Dried Egg Fish

-- -..

Pork

Bread

r-D7I~-TTIG-J-~Maize Evap. Fresh dried Filled Fish Filled Milk ( small) Sweet Condo Rice

dried

Milk Powder

Shelled mung dried beans

Sweet potato

(green gram)

Milk

'. ,.

.Jo

-.,~ .". ;'~'!'! C:-,~-.-,- '():.

\,,_ . .J../ ~ ..... '

L ..... /

~nne1r "D D.

5 .'J

J:,,'>rm"'I"" "Gl'lT'l'i,F' ""C' toy'ens (." S V l\V~~~. ~L~·~ ~ ~v ~ ,~

''''~~',aS'~d) J~~'~~ ~

~!8,:e

3&3C': 0::1

Grllns of ')rotein "per peso (as {luI"chased) (1 Peso ., l'" S. f:;3 .ns) (k)j:-e1dr.1ate values) Be.ya·:1bang price~ a'~ hnry~s'i;; time: Je.nuary - June 1965

559 Soy

207 Dried mUIIG

263 Maize

213

210

123

115 Skim

101 Brea.d

77 ( small)

Peanut Dried Rice Shelled Shrimps (small)

Milk Powder

Fresh Dried Fish Fish

£L:--~-~t29 12i~] Sweet Condo Filled Eva.p. Filled Egg

Pork

Sweet Potato

beans (green gram)

Milk

Mill

(

•

iTPp./NurLIi~,

1\ nnex . 5 1?age 64

---~.

... c. !<'ol'u;:iur.-:(;e Vitt.; ~i:,

:'.

c-, _·~,_,;·~·t

cc' Gc·.C ,~.~

Lc~.i'y

[",1:'.\1 YclJ.n; V.

;·;i.,:'.~'l::f' :'J1CI,

F..:n:it:;

Intcr·"ticr.'" .l..... ....... V'i'-'" .., . . .

nrr ]• ,L,....

eel

r ' 1'urf"1~~ed) 01'''1 T· (c \ .c ... .. :. ...... _" " _.1l..'.1t.

(l{otJ)ylc(}_ .":'-'~l"'~;-~::!~: :.CigureL1.t b(lG~d (;~l the l'htlil)pinc fooo. cOLrgositifJH i;ablc~. T1-;·=;,r.:: i~ (;GnsirJ.erab,le ~tf3.1'i8t·ior:. bc;~:;'~,ref:l1 ditfr;l'ent f:q?ccilTteDS of e.!.JY ~np. ~',·ij.\(!.•

These fisures are Gerely tc e;ive an ic.ea of the relative value- net

::'(;1'

memorizatien.)

4600 3000 2900 ! 2Boo 750 tJDo1::""l-25 0 100 I Carrot Tare Drum- Sm.all Wild Sweet Bitter Pet- Swamp Sweet Manggo YeJlow Pump- Toma- Bana- Pap~ Eggt. na Rille plant leaves stic1c chili jute ~r Melon say caliJage potato (rip~ Sw-eet kin lbtato (squash) "Yellow leaves (red leaves leaves lea\es (Ch1- (Kang- tops , pepper) !lese kong cabbage) leaves)

l500ol110col 7600\ 6200

I 5600 I 5100

I I

11900~8OO I

••

vTPH/l'lUTR/26

Annex 5 LJae e 65

I 2 months (60 days +) 3 months

--, Thicker gruel 3-6 tbsp.

4 months

5 months

Th;tcker gruel

4-0 tb::p.

same 4-6 tbsp. same ,mashed cr thinly sliced, 16-8 tbsp.

Same - 2-3 tbsp.1 Add bOiled, I same mashed, straine~ 1/2leafy greens 1 tbap. ( 1 tbsp.) same 4 tbsp. 1

same

1/2 1 tbsp. same 1 tbsp.

1 - 2 tbs'll. (Cry BtlCunt) sc.r;e

IToasted 1..: finely pound.ed or ground, fed with mashed : Ibanana (Recipe 12)i i 1-2 tbsp. of recipel same 2 tbsp. of recipe Boiled and ground, with rice Or rice flour or vegetable lRecipe 6)b 1-2 tbsp.

6 months a

same

6 - 9 tbsp.

I .

whole I egg I

2 tbsp. (dry amount) same

Body- puilding foods are not aJ.l expected to be given in .ne day. food may be given aJ.one alternating with the others. brhese and other recipes are given in Annexes 2 and 3.

For children over 3 months, one body- building

. '

•

. .

.... nnex 5 ~ege 66

"l't-11ID1I' r. \ ~ ' . f " 1,Ir cO

SCHEruLE OF SUPPLEMENTARY FEEDING FOR INFAllTS (7-12 months) IN ADDITION TO l3REASTMlLK --.----------------,----~.-

AGE to begin feeding

--~---~-

ENETIQY FOODS

REGULATING FOODS

BODY-BUILDING FOODS

: I ~ ~

7 - 9 months

thick rice gruel or porridge

r L--

I Punrpldn (squash), yellow sweet : potato, 4 tbsp. I Leafy greens, boiled and mashed 1/2 - 1 tbsp. I Yellow fruits, 8 t·bsp.

I I I I

Egg, fish, poultry, meat, "mung-bean flour or mashed boileu mung- bean All soy and peanut recipes 1-2 tbsp. {raw ingredients}

10 - 12 months

Family rice

I over 12 months

Yellow fruits and vegetables, I same amounts. : Leafy greens, boiled, mashed if necessary; 1-2 tbsp. j

Same

~-------------------------------------

Full

family

meal

•

WPR/Nrm/26 Annex 5 page 67

PRACnCAL HINTS f'm SUl'PLEMEIflARY :FEEIl1:m FOR THE BABY

Usually the mothers know very well how to introduce nev foods, 'mich present no prob~em i f they are properly selected and properly prepared. Health workers should not over-emphasize such problems. But occasionally the following info1'lllB.tion may be usefUl. L

How to introduce a new food (a) Give heJ.f a teaspoonful of the prepared new food on the first occasion. Give the new food after breast or bottle feeding. The second trial of the new food should be g1 ven a da;y or so later, and the quantity increased to one teaspoon:tul. • The amount and the variety of new foods should be

(b) ( c)

• (d)

increased sl.owly 1 untU the ch1~d sho'WS he likes the new foods and has become aecustomed to their flavour and consistency. ( e) (f) Ney foods should be introduced one

at a time , waiting

several

before another is added.

Once the child bas acquired a taste for a new fOod, it should be given fe.1rly frequently so that the lilting for the food is not lost.

What the mother needs to be aware of 'When 1ntroducipg ssmJ-emente.r:£ foods

•

(a)

The baby lM\Y spit out the new f~ during his first experience vith i.t; - n.:nr-,:foods idll he iiiiferent in bOth taste and feel. Some babies are el.ow to accept new innovatwns; some

(b)

have a general. dLsl1k.e of even minor variations from the regular rout1.ne of feeding. (c) When additional new foods are introduced, the baby I!I8\Y refuse the new food; or me:y not take the 1'Ull amount offered. Forcing a baby to eat JIJB:Y cause him to reject the food altogether, or not twte the ~ amount. As supplementary foods increase in variety, the child w!ll take more interest in his food and also in his surroundings and Ms attendants. This itrliere5t is to be encouraged by:

(d) ( e)

wpR/NTJJ!R/26 Annex 5 page 6B

. ( i) letting him see the new food; allowing him to handle the feeding what it is like and how it feels; bo~l

(li) (iii) (iv)

to see

givi.ng him a s-poon and encou:raging him to feed himself by the eighth or ninth month; not discouraging his early messy efforts, recognizing that this helps the baby to be able to manage his feeding sooner by himself; realizing that sometimes a child will refuse food beca:use he wants to tal~e it himself and not to be fed - the solution may be for the mother and the child both to have s-poons and to spoon up the food alternately; permitting the baby to try to pick up some food and carry it to his mouth, when more solid foods are being introduced.

( v)

(vi.)

(f)

It is important to watch fer changes in the baby's stool. If the stools are loose and bowel movements more frequent, she may reduce the feeding of the last newly introduced food. If these symptoms continue or are getting worse, or if skin eruptions occur, she should seel~ medicsJ. advi.ce. Food hygiene: (i) (ii) (iii) (iv) (v)

(g)

A1'W8\\Ts give cooked foods, or fruits freshly peeled, e.g. banana. Feed freshly cooked foods.

• Protect the foods from flies. Left-over foods should not be given to babies. Cleanliness of hands and utensils: (a) (b) (c) (d) Hash hands with soap before preparing foods and feeding. (Baby I S hands too.) Utensils should be separated from general. use. Keep utensils in a clean place. Chopping board, pan, dishes and other equipment should be washed immediately after being used. Boll utensils for at least three minutes after each use and keep them dry and covered.

( e)

WPR/Nt71!E./ 26 Annex 5 page 69 There are many bacteria present on the mother I s hands and breasts but most of these are a normal and well tolerated 'Part of the baby1s environment frOm the first day of life onwards. The danger lies more in pathogenic bacteria from extraneous sources such as markets , or foods contaminated by flies.

3. Food selection • (a) Use green ~ \-:egetables 'Which are :freshly produced {in seasonr;-Irpossible. Select fresh eggs, fish and meat. If no animal food is available, use dried bea11s (prepared as described in the Recipes) instead, or in greater quantity. Use yellow fruits .nlen available .

(b) ( c)

•

(d)

A balanced meal. contains each of these categories , besides the

staple tood.

wPR/lIDTR/26 .Annex 5 page 70

•

C. General 1.

HINTS ON FOOD SELECTION AND PREPARATION

Use freshly-picked vegetables when possible. Avoid long storage (even in refrigerator) and exposure to stLDlight. Wash vegetables just before coo:cing. Cook whole ,Then possible. Cutting and slicing should be minimal. Avoid soalting; cook immediately. Put vegetables in water which is already boiling and salted. Include some leafy greens in every mixed dish, but add them last, 5 minutes before the others are ready. Cooll: for minimal time in a covered pot, until just soft not until everything is mushy and leaves are black! For the infant under one, mash his vegetables; if under six months, sieve through wire sieve or cloth. Use vegetable-water and rice-water from coolIed rice as drink for baby, or in preparing other dishes (soup, stev, sauce, gravy).

3. 4. 5. 6.

Serve soon after cooking. Avoid !;:eeping and re- heating cooked foods (it is unhygienic and nutrients are lost). Fresh fish have red gills, clear moist eyes, and the flesh does not "pit" when pressed with the finger. Clean whole fish or chicken before cutting in pieces. To clean, wiping is better than washing. All fish, meat, eggs and vegetables must be cooked not rav.

9. Use only fresh meats and fish.

10.

Rice

1. Selection: use undermilled white rice or bro1ffi rice with feVl broken grains. 2. Cleaning: picIt out extraneous matter by hand. once or twice only, gtlickly, without rubbing.

3. Washing:

4. Cooldng:

place in just enough water, already boiling and salted, and cover the pot.

5. Serve ,r.tthout delay. 6. Avoid keeping and re-heating; COOIL

only enough for one meal.

WPR/Ml'rn/26 page 71 ANIOOi: 6

PACIFIC ISLAND DIEI'S (Based on compilations of the Nutrition Section, South Pacific Health Service, Suva)

Because the foods available in the South Pacific are often quite different from those commonly available elsewhere in the Region, this annex is a compilation of recommendations for this area, supplementing those already given elsewhere.

LOCAL GREEN VEGErABLES

• The tropical types of green leafy vegetables are at their best during the hot wet SIlIllIlier months. These plants require a good deal of rain to make them grow quickly. The fresh young leaves should be soft and crisp. As a general rule it may be said that the more mature leaves of tropical vegetables tend to be tough and strong flavoured. When picking local greens like bele, tubua (churaiya) take the crisp tops and side shoots of the plant. In a few days the plants 'Will have put out new leaves.

~ (Hibiscus

Man1hot)*

•

This green is an excellent family stand by. It is a perennial and 'Will grow for several years, though it is a good idea to replant annually. Cuttings can be taken from the bundles bought in the market. Plant pieces about 6..8" long in good soil. Make sure that the garden is well drained but at the same time moisture can be maintained. Bele does well along the sides of a drain or on a contour.

How to use bele Pick the young leaves, tops and side shoots. Wash and place in boiling salty water and boil ,dth the lid on for about 5 minutes, turn over once during the cooking. Do not cook longer or turn the leaves more than once because a sti~ substance comes out of the leaves, giving an unattractive texture. Drain the leaves and add a little melted butter or margarine and a few drops of lemon juice. Bele ~

also be boiled for 3- 5 minutes in co.cenut cream •

. *11 Aibika" in New Guinea

wPR/1:UI'.R/26 Ar.l:l£:x 6 page 72 For children Bele is a good first green for babies. The young shoots are almost fibreless. Boil these for a feW' minutes and then push through a strainer or mash well VI1th a fork. Chopped bele leaves may be added to vegetable soups for children. 2. Cree;p1~ ~ina.ch (Basella rubra)

This spinach ma:y be grown as a bush or a cl:iJnber. If you do not have much s];lace in your garden it is a good idea to put up a climbing fence about three feet high. Plants may be grown from cuttings or seeds. Plant the stalks from a bunch of spinach. In the wet weather this VI1l1 take root in a few "reeks. This plant is best grown annually from cuttings or seeds. Spinach seeds readily and once established in a garden it is there for a long time. HoW' to use Pick off the larger leaves and shoots. All the leaves of this plant are tender so there is no need to avoid the older ones. Wash well and place in boiling salted water. Boil for 3-5 minutes. Do not cook longer because the leaves become sticky. Drain well and serve 'With melted butter or margarine and lemon juice or with miti. Cold spinach leaves make an excellent Salad. Mix with a little oil and vinegar dreSSing or thin mayonnaise. Cooked spinach leaves may be sieved and used to make a good cream soup. This is one of the best local green for babies. The leaves <:ontain no hard fibre. Boil for five minutes and sieve or mash. This leaf has a high iron and vitam5-n content, and is particul.ar1.y good for young babies and expectant mothers, for any member of the famil.y who has been 11.l and needs "building up".

3. Fern tips - ota (Athyrium esculentum) This ];llant belongs to the fern fam5-ly. The young shoots of ferns are eaten in many countries. There are two types sole. in the Fiji markets. The smaller ota is sold in thick buncll.es. The shoots or fronds are about l/8 - 1/4" in thickness. The chOice of ota depends on personal taste. The young green and brown shoots provide a crisp green ll'hich when cooked may be eaten hot with coconut cream sauce (miti) or butter and lemon sauce, or cold, 'With salad dressings. The shoots should be young enough to snap off, use the first 4-8 inches and discard the to\'Zh end of the stalk, as 'With asparagus. Wash ota shoots well and then place in a pot of bOiling sel.ted water. Let the ota come to the boil turn over once and bring to the boil and then remove and drain. The green stalltS should be quite crisp.

WPR/NrlTR/26 Annex 6 page 73

ota may also be prepared by cutting the stems lengthwise into small. pieces - alm.ost shredding, then co-..rer 'With bOlling salted water, leave for five minutes and drain. Ota prepared this ~ is delicious served cold ,dth a dressing or ni.. ..Nd "'lith tresh grated coconut chutney. The Fijian people use kora - which is a fennented fresh coconut to flavour this dish.Ota prepared this way is called ota seisei.

Ota can also be cooked like spinach. The fern like leaves should be stripped off the tough ribs and then bOned in salted water or coconut cream (1010) for about five minutes. Another tlPe of ota which has a larger frond and leaf is also sold in the market. This has a" stronger flavour than the first lrind but is prepared in the same ~. When cooldng both tY,pes of Fiji ferns be careful to avoid overcooking. The flavour and texture can be spoilt by bOiling for a long time.

•

Ota groVis along the banks of streams in the bush. It is difficult to find the right conditions in which to grow it in most gardens.

4. Taro leaves - Rourou (Colocasia esculenturn)* There are several tY,pes of rourou sold in the market. The leaves should be young and fresh. Older leaves tend to be tough and may contain an irritating substance which, if the leaves are not sufficiently cooked, will sting the mouth and throat. This substance is not poisonous but it can cause discomfort. The presence of this irritating substance in leaves to some extent according to the variety of plant, the place grown, and the c1:i.mate. In dry weather leaves tend to be tougher and stronger in flavour. As a general rule try to choose the smaller leHfed bunches with pale green stalks. If you have the red staDced variety be ca.ref'ul to remove the red vei.ns in the leaf'. How to prepare Pull the leaf off the stalk, p1ace in a large pot of boiling salted -water and cook till the leaf is soft - 5-10 minutes. Drain off the -water mash up with a fork and reheat with coconut cream or with a little butter or margarine, and a squeeze of lemon juice.

• •

If you thi.nk the leaves are a little tough or old, it is a goOd. idea to boil for about 15-20 minutes in plenty of water. Drain off the water and then boil for a few more minutes i.n coconut cream.

*Some •

Xanthosoma leaves (giant taro) are also Suitable, especially X. braziliens, available from the Fij1 Department of Agriculture. It grows easily in damp, semi-shady conditions and 1s resistant to pests.

WPR/NUT.R/26 Annex 6 page 74 DO NOT use the cooking water from older rourou or the red stalked variety. Rourou ma:y be flavoured with chillies, onion, coconut cream or lemon juice.

Amaranthus - Churaiya (Amaranthus viridis)

Two varieties grow in Fiji - one has small and the other large leaves. The small leafed churaiya is sold in bunches and is available throughout the year. The reddish stems are about 6" long. To use, strip the leaves off the tougher part of the stem and snap off the" top shoots. Hash well and boil in salty water for five minutes. Drain and flavour with a little butter, margarine or coconut cream. A little grated nutmeg or lemon juice adds to the flavour. The large leafed churaiya is sold in bunches 9-12" long. strip off the leaves and thrOlT away the stalk. Both types of churaiya grow easily from cuttings or seeds.

Swamp cabbage - ota karesi or Ha kumala (Ipomoea aquatica)

The leaves of this water plant are widely used in South East Asia. Swamp cabbage grows wen in Fiji. It is usually found growing in ponds or wet places. The leaves have a good flavour and a high food value, they are fairly loy, in fibre and are a gooa. green for young children. Cook in the same i;r'.:i OJ" c;,ur:nya.

7. Water cress - !Caresi (Nasturtium sarmento sum) This green grows in the same way as Syl81rrp cabbage. It can be successfully cultivated in a disused drain or any other permanently wet place in a garden. The young leaves and stems may be eaten raw or cooked. Water cress for use in raw salads must be gathered from a clean stream or garden. It is very important to see that the plant is not growing in a stream that is contaminated by drainage from houses, latrines or from cow yards, etc. If in doubt about the place in which the cress has grown, use it in soups or as a cooked green vegetable. To cool~ place leaves and crisp tops in boiling salted water and boil for about 3-5 minutes. Drain and serve dressed with coconut cream, butter or margarine. Do not boil cress for longer than five minutes because it will become tough and stringy. Cooked water cress may be sieved to make a delicious cream soup.

•

Wild chillie leaves (Capsicum fructescens) and pigweed (Porlulaca)- Boro ni rokete.

The young leaves of the small chillie that grows vr.ild in Fiji makes a good green vegetables. strip the leaves off the stems, wash and boil in salted water for five minutes. Serve with a little coconut cream, butter or margarine. Wild portulaca has fleshy leaves which are very soft and make a delicious vegetable, prepared in the same wa:-:f. Pigweed is available even on dry atolls.

wpR/Nfm./26 Annex 6 pege 75

fYffipkin and sweet potato shoots

Take the crisp shoots off the plant and cook in same manner as water cress. These greens are particularly good served with coconut cream. Pumpkin tips make a good first green for babies. These should be sieved or very well mashed. Pumpkin tips can be available even on dry atolls. 10. Cassava leaves

Cassava leaves like other greens are a very good source of minerals and vitamins. Many people do not realize that they can be eaten. Certain kinds are sweet, others are bitter, local people usually Imow those which are sweet and safe. If in dGw>t about safety, try them on pigs first! Method of preparation

•

The young shoots are picked from the cassava plants. Thesl\! can be chopped up and boiled or put whole into a pot of boiling water for 5-10 minutes. After this time the water should be drained off and if the leaves were put in whole then they should be taken out and chopped finely with a good sharp knife. A good thick coconut cream should be boiled and ready for the chopped leaves. Boil this for 5-10 minutes again and then rerLlove from the heat. This can be served ..Tith any meat or fish as a. green. A very good dish can be obtained if sea shells or any tinned stuff is cooked with the leaves. This is often eaten amongst the Lauan people - known to them as Vakasakere.

11.

Green beans (Phaseolus vulgaris, etc.)

• •

Lops beans· grow all the year round. The flavour depends on correct cooking. Slice in diagonal slices, cook in boiling salted water for 7-10 minutes and serve with French dreSSing, melted butter or margarine. French beans grow throughout the year. Plain stringless variety. Prepare and cook as for long beans. Use these together with green leafy vegetables •

. •

WFR/mJrR/26 Annex 6 page 76

SlJPPLEM'ENrJIRY WEANl:ro FOODS FOR PACIFIC ISLAND INFAI:rrS

The 'WOrd "weanir.g" means to teach the child who feeds from the breast to eat foods in addition to mother's milk. The important 'WOrd in this definition is "teach". Young infants are very conservative in their tastes. The majority of babies are 9.uite happy to consume mille in sufficient 9.uantities for the first 6-7 months of life. v.'hen foods with different tastes and textures are given, the first reaction is to reject the new food. At this stage the mother must realize that the teaching programme has started; the baby has to be taught to accept the new flavours and textures in food. The best approach is to give the new food in strained and diluted form in small quantities. For example, one teaspoon of pawpaw juice may be diluted in three teaspoons of water for about t'WO days; after one or two days the baby will cease spitting out the juice. When this mixture has been accepted the amount of water may be decreased till the baby is taking pure pawpaw juice. The rule throughout the early months is to give a very little of the new food in small 9.uantities until the food is fully accepted. Let the baby become used to one new food before beginning on another. Sometimes it is a good idea to mi."'{ small amounts of a new food with one that is already accepted. In this way the baby is h~ aware that a new food has come into the daily meals - an example of this 'WOuld be to add egg yolk to mashed vegetable ~ strained banana to strained pawpaw. The attitude of the mother is of the greatest importance in teaching the baby to eat. The mother must be quiet and confident. She must not get Upset 'When food is spat out of the mouth. She should show pleasure 'When the baby eats the new food. Even small babies are alert to "i;he atmosphere in the home. When the mother is unhappy or worried, the baby soon reacts by crying and refusing to eat. It is most important that feeding ta"-es place in a quiet and relaxed atmosphere. The first six months of life should be regarded as an important learning period. During this time the main food is milk. In ae.dition, babies are eating small amounts of strained or mashed fruit, soft vegetables, sOUps and milk puddings and egg yolk. Sometimes a mother will complain that it is not 'l-rorth'While preparing such a small amount; of food. It must be explained to her that before six months of age the baby only needs very small amounts of the new foods. He could manage on mill~ alone, but during this time he should be learning to eat the foods that he will need to ensure good growth and health after six months of age. The baby who has been taught to eat the new foods during the first half year of life is happy to accept the egg yolk, mashed vegetables and other foods which are needed in the second six months.

•

WFR/N'JTR/26 Annex 6 page 77 Throughout the Pacific Islands it is usual to find babies growing very rapidly durj.ng the first six months. At this period in life they often surpass the Australian or Hew Zealand infants in speed of growth and gai..n in -weigbt. At six months a change takes place. The healthy happy Pacific Islander starts to lose weight, the gain in growth slo'\ol$ down. The child becomes irritable. He seems to pick up infections easily, and these reduce his strength.

•

The reason for this change in health and rate of growth, is lack. of the food he needs. Up to six months a baby can be adequately nourished on an ample diet of breast milk; one of the reasons is that a baby born from a well-nourished mother has a store of iron in his liver which supplies his need for haemoglobin during the first six months of life. After this age milk alone is not an adequate food to provide for the growth of flesh and haemoglobin. The baby ntUst have additional protein foods - like egg, fish, soft meats and soups, soups made out of pulses (dhal) and peanuts. . After this age the infa~tls output of energy incrsases. Rolling over, sitting up, crawling and attempting to wall~ greatly increase the need for energy-giving starchy foods. These should be soft mashed starchy roots or fruits _ br2c:"·.~·T','.it, ym.::::-, taro, s-weet potato, potato, rice and other suitable foods of this land. Well mashed banana is another excellent food. Puddir.,ss made out of grated cassava or rice, etc., cooked with milk or diluted c6conut cream and water and flavoured with pawpaw or ba..."le.na (Lote of Fiji or Vaisalo of Samoa) provide useful foods. At this age the infant also needs vitamins, particularly vitam:i.n A and vitamin C which are provided by soft ripe fruit and cooked green vegetables. The ntUch needed mineral 1ro,1 is obtained from green leaves and from meat or shellfish soup and egg yolk. The preparation of foods for young infants

•

One of the problems in preparing foods .1'01' babies under village conditions~ is to see that the food is hygienic and of a smooth texture. The three months old baby is used to the smooth bland flavour of milk. The introduction of foods of different textures the,t have a rough feeling on the tongue will cause h1.'ll concern until he gets used to the new food. In the Pacific Islands the traditional way of preparing first foods for infants~ was to strain frtd.t juiees through masi or tapa cloth~ and for the mother and grandmother to cbew the food till it was of the right consistency. The mixture was then fed on a finger or passed from the mother I s mouth into her infant I s mouth. A main problem of introducing foods into the yOUl1g infant I s diet is to find practical ways of preparing the food in a suitable fonn. The equipment needed to prepare food properly consists of tYlO small enamel bowls or cups~ a metal spoon~ a fork, a wire

•

WPR/lTUTR/26 .Anne.:~ 6 page 78 strainer, a bottle for boiled water. It is possible to replace enamel bowls with smooth cocormt cups, likewise a clean stone nay be used to pound food, in place of a forlc. The infant Dlay be fed with a clean cut coconut leaf or a shell in place of spoons. Straining of fruit juice and soups is best done with a metal strainer. These days many families own a tea strainer. If tlus is lC€1;>t clean it Llay be used for the baby's food. In place of a metal strainer the coconut fibre 'lhich grows round the tops of young pa.J.ms may be used, This should be scraped, then washed and boiled. The fibre is cut into squares and ]cept in a box or bag. It is not advisable to use cloth for straining juice because of the dii'ficulty in ensuring the cleanliness of this. Cocormt fibre is discarded after use, whilst sraall pieces of cloth have many uses in the home. The need for clean preparation of food cannot be over el;!phasized. It is important that this be fully discussed with mothers. The medical vrorker trust demonstrate the preparation of foods and show how equipaent is cleaned and stored away from flies and dust. Useful education progrm;]f!les may also be arranged by the Women t s Clubs. Mothers throughout the vrorld tend to COIJ;j?lain about tile preparation of the scall ~ounts of food needed by the baby. In the Pacific islands, many family foods are suitable for the baby. For example a little soft taro, yaa or rice may be taken out of the pot, mashed with the coolcing water or milk and given to the infant. Fish, meat soups, dhal (pulse) and green vegetable soups are suitable foods. In most cases there is no need to ;;1B.lce a special food. The daily family food just 118.13 to be stra.iDe(2 or nashed \~ till it is of the right consistency. The use of family food in the baby's diet should be discussed with mothers. In modern times the preparation of infant foods has received a great deal of attention and this has been encouraged by the l;JB.!J.ufacturers of special baby foods. The medical vrorker should discuss the family meals ,-lith the mothers and explain how the foods 'Which are used in the daily meals may be prepared for the baby. ABe at which to introduce foods There is no absolute rule about the age at which dii'f'erent foods should be given to the baby. This depends on several factors, such as the traditional weaning practices, the efficiency of the mother, the hygiene of the home and the rate of growth of the baby. In many traditional societies, between the fourth and sL'Cth months the mother begins to introduce supplementary foods in the baby's diet. It is always necessary to tal~e into account the existing traditional customs and, i f poSSible, to rely on them in order to promote smooth weaning habits. In addition, the age at which foods are introduced will depend on the ability of the mother to understand the importance of cleanliness. For example it vrould be unwise to suggest the use of uncooked fruit juice at the age of one month to .lamen living in primitive fly-infested villages. In this case, the addition of foods should be delayed till 4-6 months of age. It might be better to start the infant on cooked veGetable soups tal~en out of the family cooking pot rather than raw fruits.

•

WPR/r:.UI!R/26 Jlnnex 6 'pac;e 79 The rate of g:rowbh of the baby is aJ.so impOrtant. Big babies need more food than smaller ones. It is usual to start the former on strained banana, fruits and other starchy foods about 2-3 months. 1\ smaller child may start later. However, all. infants shoul.d be eating some soups and mashed vegetables by six months of age. milks contain no vitamin C.

The bottle fed baby nru.st be treated differently. Boiled and dried The baby nru.st have fruit juice dally to prevent the development of scurvy. Suitable foods for use duripg the first six mo~

Pawpaw provides the baby with vitamin C and vitamin A. It is one of the most important foods for infants in the tropics. I'e1I?aw juice may be given at a few weeks of age mixed with boiled water. • To prepare the juice place pieces of ripe fruit in a piece of boiled cloth or coconut fibre (vuJ..o in Fiji) and press out the juice with the fingers. This method should not be recommended unless the mother can be relied upon to boil the cloth or vuJ..o. A more satisfactory method is to press the flesh through a wire strainer. At 2- 3 months of age the infant should be having finely mashed or sieved pawpaw of tlrl.ck consistency. Fruits such as mango, tomato, cooked guava and other fruits of mild flavour may be prepared in the same WEI¥. I t is important to use fruit that has some black on the sldn.

•

Tlrl.s is one of the beet foods for young infants, This means that the starch hae been turned into sugar and the fruit is easy to digest. The fruit nru.st be quite soft. Ripe banana maltes a good food for the three months old baby. It should be mashed to form a soup. Lumps can be removed by putting through a wire strainer. Vegetables. Soft yellow or red vegetables like pumpldn, ca.:rrot and tomato and the leaves of edible green leaves -which contain little fibre may be given about 4-5 months. Green leaves from the following plants are particularly suitable for infants - creeping spinach (:sasella aJ.ba), bele or pele (Hibiscus !lIBllihOt), ferns like the ota dina of Fiji (Athyrium esculentum), churaiya or tubua. of Fiji (Amaranthus viridis) and the portulaca commonly lrnown as a garden weed in Fiji, and which is caJ.led te boi 1n the Gilbert & Ellice Islands. Most of these plants can be easily grown in a garden or found in the bush or amongst cultivated crops. Small pieces of cooked taro, yam

Ripe banana.

•

The starchy roots and frui.ts are usuaJ.ly started about 3-4 months. or breadfruit, sweet -pota.to

WPR/NUTR/26

Armex 6

page 80 or rice are mashed up with the soup from green leaves. When these foods are accepted, fish soup and meat soup may be mixed with the vegetable soup. Foods made from green coconut and the embryo of the germinating coconut may be given in the 4-5 months period. Cooked egg yolk, meat and fish soups are gradually introduced between 4-6 months of age. Foods after six months Between six months and one year of age the baby should. learn to take food three tiJnes a da¥. The milk feed is given first and this is followed by suitably prepared food. Drinks of fruit juice and boiled water, green coconut water or cool boiled water are given mid-morning and afternoon. The follOwing is a suggested routine for feeding after six months of age. Early a.m. ¥d.lk. Mashed root vegetable or ripe banana or cooked breadfruit mixed with fish or milk and 'later, or rice and fish or milk or a cooked "porridge" made from oatmeal or sharps or sorghum, fish or milk and water.

10 a.m.

Fruit drin1~ or water and mashed raw' ripe fruit. Milk. Meat soup or fish soup or soft cooked egg or soup made from dried peas or beans (dhal) or green vegetables mixed with root vegetable or rice. Milk. Same as morning or midday meal.

Midday

Night

When the baby starts to get a few teeth food need not be so carefully mashed. However, up till 16-18 months it is important to see that food is soft and easy to chew. The baby after one year of age The most difficult period arises when the infant ceases to be fed from the mother's breast. In many cases the protein content of his daily food is suddenly reduced. Unless protein is supplied from other foods the child will suffer. Unfortunately a belief has developed in the Pacific Islands that infants should be weaned at nine months of age - an age recommended in temperate cliJnates where cheap and plentiful supplies of cows milk are available.

•

wPRjNrJrn/26 Annex 6 page 81 Many Pacific Island 'WOmen a~ qu:1.te happy to extend the breast feeding period to eighteen months and sometimes longer. This should be encouraged as long as the child is receiving a mixed diet in additio.n to the mother's milk.

Mothers must be taught to provide substitute protein foods for breast milk once feeding ceases. Suitable soups and ste"s CtUl be made out of many local foods if these are prepared by the right method .. At the Fiji School of Medicine Department of Nutrition a number of useful reCipes, which provide protein for the child after one year of age, have been prepared. These recipes should be explained, and demonstrated to women's clubs and at infant welfare clinics. Mothers should also be made aware of the value of skim milk powder fOl' feeding infants after the weaning period. Dried pulses should also be used to a much greater extent.

•

Infants raised on the regime discussed in these pages do extremely well. !rhe deterioration in growth and standard of health does not occur at the weaning age, as long as suitable foods are given. The improvement of infant nutrition in the Pacific depends to a very great extent on educating the mother in the principles of basic nutrition, and teaching her how to prepare suitable protein foods for her child. C.

ADDITIONAL RECIPES FOR PACIFIC

•

MILK

These recipes are suitable for all the family, especiall;,' young children and invali,ds. Use 3 lettl tc.blcapoons nf B!:in l~": ~er per cup water, or 4 level tablespoons of whole milk powder per cup water. ( a) Banana r:Jilk drink 1 ripe banana 1 cup milk, either fresh or thick powdered milk (for thick mill~ use 1 cup water to 4 tablespoons miL~ powder) . Method 1.

Prepare milk.

Mash banana thoroughly. Pour mashed banana into milk and stir well. Serve in glass.

This is a good banana drink for babies and. sick people. The drink is very refreshing.

WPRjmmj26 Annex 6 page 82

...

(b)

Skim m:Uk drink with lemon flavour 2 cups -water

4 level tablespoons skim milk powder Lent:.n leaves or lemon grass

Method 1.

"'lash leaves and boil in water 5 minutes. strain. l~ 2

3. 4. (c)

cups of liquid with of milk powder.

level tablespoons

Add a little sugA.r to flavour.

Rice puddine; (made in two ways for babies 4-6 months) 1~4 cup rice 12 cup milk 2 tEe.epcon rogar

•

Method 1.

Ivash rice and cook slowly in milk. Do not boil fast because the mixture will burn. If the pudding is too dry add some water. Ada. sugar 'When cooked.

OR 2.

Hash rice and cook in -water. Add sugar 'When cooked and served with milk.

( d)

Cassava pudding 2 level tablespoons grated raw cassava 1 teaspoon sugar 1 cup milk

Method 1. Mix all ingredients together.

Cook over slow heat till boiling. Simmer ten minutes. Stir well to prevent burning.

This pudding could also be steamed in a banana leaf. (ai kovu, Fiji).

WPRfNa.:.'R/26 Annex 6 page 83 (e) Milk sauce for green leaves - use instead of coconut cream 1 cup milk, either fresh, or thick powdered milk (1 cup water to 4 tablespoons milk powder) 3 teaspoons lemon juice Little finely chopped onion Salt Method 1.

Prepare milk. During the beat:i..ng process add 1/2 teaspoon of lemon juice and beat, then add the rest slowly. Add finely chopped onion and enough salt to taste. Serve in jug or bowl, with cooked green leaves, fish or shellfish.

2. 3.

• (f)

At times coconut cream is hard to get, especially in town, so this method of making coconut sauce w-ith milk is usefUl to know. The taste is slightly different from the coconut cream recipe. Taro leaves (Rourou) in milk for children 2 cups milk, to 6 level Taro leaves, L1ttle onion Method either fresh or thick - (2 cups watel' tablespoons milk powder) 1 bunch, about 1 lb. and salt.

• &

1. 2.

Prepare milk and put in a pot to heat. Prepare rourou - clean under the tap. pot and leave lid on.

3. \-/hen mill{ is boiling' take the leaves and put into

Boil for 5 minutes, then turn the leaves over. Boil for another 5 minutes then serve. Watch carefully to see that pot aces not boil over.

Taro leaves in milk is a very good body-building food for all the family. This is a particularly good dish for little children and sick people. other Idnds of green leaves may be cooked in the same ;my.

•

Note:

Dried milk mixtures burn very easily J e.l.ways stir the pot well. Do not put on v--ery hot fire or primus.

WPR/WI!RI26 Annex

•

page 84 (g) Mashed banana or cooked

root vegetables and dried

milk

Thoroughly mash a very ripe banana or sof'ttaro, etc., with 1 tablepoon milk powder. (h) Vegetables in 'White sauce made from flour or grated cassava 1 ~ cups vegetable -water

3 Level tablespoons skim milk powder 2 level. tablespoons flQUr or 2 tablespoons grated raw cassava 1 2" teaspoon saLt 1 cup chopped vegetables, e.g. carrot, pTh."lpldn, s.reet potato, green leaves Method 1.

Prepare vegetables and boil till soft. COOking water.

Save

Combine flour and sldm milk powder and mix to a smooth paste with a little cold water. 1 ~ cups vegetable water _ mix till no hlIIlpS. Stir over heat and boil 5 minutes. Then mix with cooked vegetables.

•

3. Graduel1.y stir in

l!OOS

(a)

Sof't- boiled e!)8.

PLace an egg on tap of a pot of bOiling root vegetables. Remove after four minutes. Al.ternatively, place egg in pot of coLd -water and take out when water boils. Mash the 1-2 teaspoons of yolk with sof't taro, yam or slreet potato. ( b) Steamed

egg

custar,2:

1 egg 1. tablespoon sieved or mashed cooked vegetable 1 -; cup milk

Pinch of saLt Method Mix aLtogether and beat -well. Put in enamel. bowl and place over a pot of boiling water. Cook at Low heat till egg is firm.

WPR/NtJ!R/26 Annex 6 page 85

3. COCONUT (a) Green coconut Sc..:r81'C the flesh out of a green rru.t and mash up very finely. Mix with 1/2 cup cocorru.t water beaten with 2- 3 level teaspoons milk powder. The milk can be replaced with 2-3 teaspoons of finely mashed fish flesh. Give abOut 3-4 montbs. {b} Germinating coconut Take out the coconut embryo (vera of Fiji) • Cook till soft in coconut water or io/ater, when cool sprinkle with 2-3 level teaspoons of milk povrder. Mash up till very soft. Note: The young coconut and little protein. Milk increase tbe protein. use cooked and finely sprouting coJItain very povrder is added to If m1l1~ is not s,","ailable masbed fish flesh •

•

SOOPS

The fol1.o"ling are su:tte.ble for infants 4-6 months (or older). (a) Dried peas/beans ~ cup dried peas or beans (dhal) 2 cups water ~ onion (can be left out) 2 teaspoons oil or fat

•

Method 1. Wash tre dried peas or beans vith cold water and leave to soak several hours - if possible for one day or night. Add water and boil until the dried peas or beans are cooked. Rub through a sieve, or mash well.

3. "1ben cooked strain (save the water for soup). 4. Chop onion, and fry till brown in fat. .lidd some of the water to mw;:e a soup. Just before serving add the soft peas or beans with a little salt. Serve with rice or cooked root vegetables. A good lunch or tea dish for young children. Dried peas and beans take a long time to cook. The cooking time can be reduced if :peas are soaked in water for half to one day before boiling.

Note:

wPR/NfFP../ 26 Annex 6 "page 86

Fish

4 ozs. fish or about one smal.1. fish (3 tablesv:ons when chopped up)

1 ~ tables-poons coconut cream I 12" cups 'later ~ teas-poon salt

(can be lett out)

Hethod 1. 2. Clean fish. Remove flesh from bones.

Cut finely w.i.th knife. Cool::. in water until tender.

3. 4.

Strain fish w.i.th fish. ,·rater; if no strainer beat till the miXture is thielc and smooth. Add 12 tables-poons of coconut crear~ if available, and a little salt. 1

(c)

Pt;lanut

6 tables-poons peanuts 1 teaspoon salt

3 cups '-later Method L

Reruove shells and then grind nuts by "pounding with a stone, or "put through a mincer. Boil ground peanuts in water for ten minutes ~ add salt. Strain.

3. ( d)

l<!eat or 11ver 11ver or meat l"'-cups ,.rater teas-poon salt 4 cup cho-pped vegetables '" 1 cup

Method 1.

Cut up meat very finely. Add salt and water; let stand five mim;.tes. Add vegetables and siLmter fifteen minutes. Do not boiL

WPR/NrJI!R/26 Annex 6 page 87 (e) Shellfish

6 large shellfish, or 12 small ones 1 pint water onion (for older children only) teaspoon salt 2- 3 tablespoons grated cassava or sweet :potato to thicl:en. (This can be left out).

t t

Method 1. 2. Prepare in the usual way and then cook till soft. Chop up till like minced using a heavy chopping knife, e.g. cane knife. Put baclt in water and add very finely chopped onions and boil a few minutes.

The soup may be thickened with grated cassava or sweet potato •

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 1968

Source World Health Organization