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Capacity building in public health nutrition

Published online by Cambridge University Press:  21 January 2015

Catherine Geissler
Catherine Geissler*
Affiliation:
Department of Nutrition and Dietetics, King's College, London, UK
*
Corresponding author: Professor Catherine Geissler, email catherine.geissler@kcl.ac.uk
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Abstract

The aim of the present paper is to review capacity building in public health nutrition (PHN), the need for which has been stressed for many years by a range of academics, national and international organisations. Although great strides have been made worldwide in the science of nutrition, there remain many problems of undernutrition and increasingly of obesity and related chronic diseases. The main emphasis in capacity building has been on the nutrition and health workforce, but the causes of these health problems are multifactorial and require collaboration across sectors in their solution. This means that PHN capacity building has to go beyond basic nutrition and beyond the immediate health workforce to policy makers in other sectors. The present paper provides examples of capacity building activities by various organisations, including universities, industry and international agencies. Examples of web-based courses are given including an introduction to the e-Nutrition Academy. The scope is international but with a special focus on Africa. In conclusion, there remains a great need for capacity building in PHN but the advent of the internet has revolutionised the possibilities.

Keywords

NutritionPublic healthCapacity developmentInternationalAfrica

Information

Type
Conference on ‘Food and nutrition security in Africa: new challenges and opportunities for sustainability’
Information
Proceedings of the Nutrition Society , Volume 74 , Issue 4 , November 2015 , pp. 430 - 436
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Copyright
Copyright © The Author 2015 

Towards improved public health nutrition

Despite advances in knowledge of nutrition and interventions there is still a high prevalence of malnutrition, mainly in developing countries, and an increasing prevalence of obesity and non-communicable diseases in both developed and developing countries. This has to be related to inadequate implementation or ineffective nutrition policies.

Effective and sustainable public health nutrition (PHN) policy depends on many factors. One essential is well-funded scientific research on the effects of foods and drinks and their components on health, the identification and measurement of types of malnutrition, including obesity, in individuals and populations, determination of the underlying causes of poor nutrition and the effectiveness of different interventions to prevent or remedy nutrition problems. The results need to be disseminated to the international scientific community through peer reviewed publications and discussion in scientific meetings.

Research findings on specific topics should be synthesised through systematic reviews and reviewed by expert panels to provide up to date evidence-based information. This can be used for nutrition training and education of nutrition and other health professionals and translated into lay language for dissemination to the general public and to policy makers. Registration of qualified nutrition professionals is desirable to ensure the relevance of advice provided. Formulation and publication of standards are required for nutrition education for different levels of professionals and schools, for meals in schools and other institutions, for food suppliers in the form of food standards, e.g. WHO/FAO Codex Alimentarius( 1 ), and for the general public through nutrition labelling of foods and drinks.

Policy makers must be made aware of the social and economic costs of poor nutrition, of the underlying causes of poor nutrition, and of relevant interventions. Governments should be able to coordinate the sectors involved in the underlying causes, leading to the provision of an adequate food supply which should be regulated to ensure its safety and nutritional quality.

Role of government

National governments are responsible for the health of the nation and therefore for policies for good nutrition, although non-governmental organisations and charities also play a part. In most countries, nutrition is within the health sector but the causes of nutritional problems are multifactorial, including employment, wages, education, availability and price of food and water, housing and facilities for sport and exercise. Good nutrition therefore involves other sectors such as agriculture, commerce, transport, housing and education. But these are often not incorporated into nutrition policy.

Governments have to deal with a huge range of issues and policies, even within health, and nutrition is often not high on government priorities. The strength of the economy is always a high priority and if the food industry forms a significant part of the economy, governments are reluctant to impose policies detrimental to the profitability of companies. Hence the main emphasis is on voluntary regulation.

Policy emphasis

In developed countries in relation to obesity and non-communicable diseases

Undernutrition is already largely removed by adequate incomes, food supply, housing, sanitation, health services and welfare provision. The main policy emphasis in industrialised countries is on personal responsibility, so that education on nutrition and activity and public information are the mainstays. In the UK, the government prefers voluntary compliance of industry with recommendations rather than legislation. This is a source of conflict with many public health nutritionists who urge a more forceful policy. In some cases, the voluntary compliance approach has been successful such as the reduction of salt in processed foods( Reference Feng, Pombo-Rodrigues and MacGregor 2 ). In other cases, the voluntary compliance policy is ineffective( Reference Ronit and Jensen 3 ).

In developing countries mainly in relation to undernutrition

Policies are hindered not only by lack of resources, both financial and skills, but also by the double burden of disease and often by the multiplicity of non-governmental organisations and aid agencies, each with separate agendas. This is now increasingly recognised by aid agencies, so that there is some prospect of better coordination e.g. through the Scaling Up Nutrition Movement( 4 ) (see section on limitations later).

Pressure groups

Pressure groups play an important role in fostering policy change at the government and international agency levels. These groups include organisation such as Action Contre La Faim – Action Against Hunger( 5 ), Action on Sugar( 6 ), Baby Milk Action( 7 ), The British Heart Foundation( 8 ), Consensus Action on Salt and Health( 9 ), Consumers International( 10 ), The Food Commission( 11 ), International Baby Food Action Network( 12 ), Oxfam( 13 ), SUSTAIN( 14 ), West Africa Health Organisation( 15 ), World Action on Salt and Health( 16 ), World Cancer Research Fund( 17 ) and World Obesity Federation( 18 ).

Growth of nutrition evidence

The nutrition evidence base is constantly growing, as research develops in relation to the effects of nutrients and foods on health and at what life stages. Also there is an increasing evidence of ‘what works’ i.e. policies and programmes that are effective in combatting malnutrition. The 1970s was a critical period in international food and nutrition policy. There was very little evidence available then on the effectiveness of nutrition interventions, as these were often carried out without evaluation of impact. But the widespread food crises of the early 1970s and a subsequent World Food Conference in 1974( 19 ) engendered a great deal of interest and many publications on PHN, mainly in developing countries. Over the same time the concept was developed that nutrition is an important factor in national development rather than just an outcome( Reference Berg 20 ). This led to the emergence of multisectoral National Nutrition Planning, an approach that was promoted by FAO and United States Agency for International Development in several countries( Reference Berg, Scrimshaw and Call 21 – Reference Payne 24 ).

National Nutrition Planning recommended a systematic approach starting with analysis of the types, extent and causes of malnutrition, coordination of the sectors involved in the underlying causes of malnutrition, selection of the most effective intervention for the specific nutrition problem, evaluation of its effects, and continuing with reiteration of the process. But it soon became apparent that the evidence of effectiveness was not available and so choices of interventions had to be made on intelligent guess work. The need for such a fall-back was a spur to more evaluations of programmes and policies. This later led to the reviews of effective programmes, including Malnutrition: what can be done( Reference Berg 25 ) What works( Reference Allen and Gillespie 26 ) and subsequently the influential Lancet series on Mother and Child Malnutrition focusing on the critical first 1000 d( 27 ). The focus was mainly on developing countries and most of the evaluations were of single issue interventions such as breast feeding and micronutrient supplements.

Limitations in the selection of effective interventions

Review of effective interventions is limited by the difficulties of evaluation, in particular the difficulty of obtaining a control group against which to measure the effects of the intervention. Some are relatively easy to evaluate if the intervention is limited and can be well controlled with a comparative placebo or equivalent population without the intervention. An example is vitamin and mineral supplementation. Others such as agricultural or economic interventions in the form of subsidies or taxation are much less easy to control and  to properly evaluate. This produces emphasis on interventions that remedy nutrient deficiencies, but does not deal with the underlying causes of malnutrition and is therefore less sustainable. A criticism made of this emphasis is that, it plays into the hands of the pharmaceutical industry that supplies the vitamins and minerals and the food industry that supplies special complementary food formulations such as ready to use therapeutic foods and medicalises problems that are fundamentally economic and political.

Interventions that address underlying causes of nutrition problems including poverty due to lack of employment and low wages, low value of agricultural and other products, environmental pollution, lack of education, trade inequalities, etc. are termed nutrition-sensitive interventions or indirect nutrition interventions. These interventions are likely to be more effective and sustainable in the long run but are more difficult to prove scientifically.

In the meantime therefore interventions that have been proven to be effective remain the simpler direct nutrition interventions and the conclusions of these reviews have been propagated by several bodies such as the Copenhagen Consensus and the Scaling Up Nutrition movement. The 2008 Lancet series has had a significant impact on international nutrition policy. It stimulated an increase in political commitment in many countries and organisations to reduce undernutrition. Many agency strategies were revised to focus on the first 1000 d (pregnancy and the first 2 years) and this focus was adopted in the Scaling Up Nutrition movement.

The Copenhagen Consensus 2012( 28 ) is a consensus achieved by a panel of economic experts, mainly Nobel Laureates, who set priorities based on the cost-effectiveness of solutions to world challenges, including hunger and malnutrition. In 2012, they ranked the most highly cost-effective interventions for the reduction of chronic undernutrition in pre-schoolers. These supported the type of interventions proven to work, including the provision of micronutrients and complementary foods, treatment for worms and diarrhoea and behaviour change.

The characteristics of the Scaling Up Nutrition movement are listed briefly here( 4 , Reference Schuftan and Greiner 29 ). It started in 2010 as a partnership between developing countries, academics, civil societies, the private sector, development agencies (e.g. FAO, UNICEF, World Food Programme, WHO, United Nations Standing Committee on Nutrition, Renewed Efforts Against Child Hunger and Under-nutrition) and the World Bank. It is based in countries that have volunteered to sign up to a commitment to reduce malnutrition in the first 1000 d of life using multisectoral, scaled up cost-effective interventions, supported by scaled up domestic and external assistance to nutrition. By July 2014, fifty-three countries had signed up.

Effectiveness of nutrition-sensitive interventions

Work on the evaluation of the effectiveness of nutrition-sensitive interventions is beginning to accumulate, for example, through the International Food Policy Research Institute and the Institute of Development Studies( Reference Gillespie 30 – Reference MacDonald, Haddad and Gross 33 ) and the follow-up Lancet series on maternal and child malnutrition in 2013( 34 – Reference Ruel and Alderman 37 ). The evidence of effectiveness of nutrition-sensitive interventions is less strong, largely because of poor quality evaluations( Reference Ruel and Alderman 37 ). But there is evidence of what works from countries that have made recent strides in nutrition e.g. Brazil, China and Thailand( Reference Bhutta, Das and Rizvi 35 ). This work will be encouraged by improved research on nutrition sensitive actions and recent US funding providing more than four times the amount for nutrition-sensitive actions that address the underlying causes of malnutrition than nutrition-specific interventions that address the more immediate causes by providing food, nutrients and medical care.

Reviews of interventions for non-communicable diseases

There are few comprehensive reviews of interventions for non-communicable diseases but recently there have been a number of reports assessing the effectiveness and cost-effectiveness of various types of interventions. These include a WHO report on interventions on diet and physical activity: what works( Reference Anderson, Parker and Steyn 38 ), policy and actions to tackle obesity in England( Reference Jebb, Aveyard and Hawkes 39 ), drug and lifestyle interventions in pre-diabetes( Reference Bertram, Lim and Barendregt 40 ), to reduce dietary salt intake( Reference Cobiac, Vos and Veerman 41 ), to promote fruit and vegetable consumption( Reference Cobiac, Vos and Veerman 42 ), to compare weight watchers and the lighten up to a healthy lifestyle( Reference Cobiac, Vos and Veerman 43 ), to assess diet and exercise to reduce overweight and obesity( Reference Forster, Veerman and Barenregt 44 ) and to determine the effect of ‘traffic light’ nutrition labelling and junk food tax( Reference Sacks, Veerman and Moodie 45 ).

Nutrition capacity building

Over 20 years ago Alan Berg, Chief Nutritionist at the World Bank criticised the nutrition world for focusing only on the science of nutrition and called for increased emphasis on training for its application( Reference Berg 46 ). Much of the nutrition capacity building available including online is targeted to nutritionists and other health professionals and is mainly limited to basic nutrition, the relationship between food, nutrition and health. There are some describing techniques (e.g.( Reference Iyengar and Parr 47 , 48 )) but much less about the practical aspects of policy making and interventions. Nutrition capacity building needs to be much wider. Now there are many efforts in capacity building that go beyond the traditional education and information( Reference Gillespie 30 ).

Many different levels of capacity are needed to be able to devise and conduct effective policies and interventions to improve nutrition. It could be limited to nutrition and health professionals and to basic concepts. But for improvements in PHN, nutritionists need training in developing appropriate programmes and policies and in influencing the public, other health professionals and policy makers. Much has been written on this need (e.g.( Reference Landman, Buttriss and Margetts 49 – Reference Shrimpton, Hughes and Recine 69 )) and in relation to Africa in particular (e.g.( Reference Wade 70 – Reference Sodjinou, Fanon and Deart 80 )).

Who? – who needs capacity building?

The target participants could be: the general public; nutritionists; other health workers e.g. doctors, nurses, midwives, pharmacists, etc.; related sector workers in for example, agriculture, education, social services, commerce; and policy makers, at local or national level.

What? – what information is needed?

Depending on the target audience this could include: basic nutrition i.e. the relationship between food, nutrients and health; the many causes of poor nutrition; assessment of nutritional status; effective policies and interventions; evaluation.

How? – what techniques can be learned?

Nutrition research techniques, including data search, topic selection, nutritional assessment, laboratory and field methods, analysis of data, reporting findings, presentation at scientific meetings, and publication in scientific and other journals; the use of tools such as food composition data and types of equipment; methods and content of advocacy to decision makers; nutrition education/information techniques for public, professionals; the design and conduct of interventions including their evaluation.

Where? – where can this capacity building be obtained?

Traditionally, capacity development has been carried out in universities and colleges for professionals, in schools for children, and through newspapers, magazines, radio and television for the general public. More recently it has been made available by distance learning using mail, computers and CDs, and most recently by the revolutionary advent of the internet: e-learning. The advent of electronic technology has transformed the global scene and the possibilities for capacity building.

Examples of e-learning materials

Many examples of e-learning materials in nutrition exist already. These are provided by: universities e.g. University of Southampton( 81 ), London School of Hygiene and Tropical Medicine( 82 ); nutrition societies e.g. British Association for Parenteral and Enteral Nutrition( 83 ); food companies e.g. Nestle Nutrition Institute( 84 ), Unilever Food Solutions( 85 ); other companies e.g. Fitness Industry Training( 86 ), High Speed Training( 87 ),  non-governmental organisations e.g. eTALC( 88 ); government bodies e.g. FANTA( 89 ), NICE( 90 ); international agencies e.g. UNICEF( 91 ), FAO( 92 ), WHO( 93 , 94 ); web archives e.g. The Nutrition and Food Web Archive( 95 ).

Massive open online courses

Universities face a new competitor in the form of massive open online courses (MOOC)( 96 ), which have the advantages of low start-up costs, economies of scale, lower price for students, wider access, flexibility. The first MOOC started in Canada in 2008 as an online computing course and in 2012 three large MOOC providers were launched: edX( 97 ), Coursera( 98 ) and Udacity( 99 ), run by or associated with Harvard, MIT and Stanford Universities. These three sources by June 2014 have provided courses to over 12 million students of which about  one-third are Americans, but about half from developing countries: USA 138 000; Europe 72 000; India 60 000; other Asia 60 000; Africa 33 000 and Latin America 32 000. There is an on-line list of MOOC courses( 100 ). On this list are several nutrition courses. But online learning has its pitfalls, with a lower percentage of students passing the courses, high drop-out rates, the possibility of cheating in exams, and lack of interaction with other students. Students need more personalised support.

Properties of existing e-learning materials

Some material is completely free and available for use; for others it is required to register and in many cases pay a fee. Some provide complete courses which run at specific times and have a maximum number of participants. Most are on-line but others provide the e-learning on CD Rom. Those that charge are obviously limited to people who can afford the fees. Some are provided free or at low cost through external funding. Not all are specifically relevant to nutrition capacity building in Africa.

e-Learning for Africa

Dr Luis Gomes Sambo, the WHO Regional Director for Africa (2010–2015), has urged African countries to embrace e-learning and has listed major e-health projects in the region e.g. Telemedicine Network for Francophone African Countries( 101 ), organised by Geneva University Hospitals; Access to Research Initiative( 102 ), supported by WHO and major publishers; ePortuguese Project( 103 ), a WHO platform; and Pan African eNetwork Project( 104 ), provided by Indian Universities, but none of these focuses on nutrition.

It was on this premise that the eNutrition Academy( 105 ) is being developed specifically for Africa initially by a consortium of the Nutrition Society, the American Society for Nutrition, the African Nutrition Society, the Federation of African Nutrition Societies and the International Union of Nutrition Societies. The eNutrition Academy was launched at the 6th African Nutritional Epidemiology Congress Meeting in Accra, Ghana in July 2014. The concept was received with much enthusiasm and with many offers of training materials and collaboration. We hope that this will be accompanied by funding support from organisations that are keenly aware of the need for improved PHN in Africa.

Conclusions

There remains a great need for capacity building in PHN not only for the nutrition and health workforce but also for policy makers and workers in other sectors, as the causes of nutritional problems are multifactorial and require collaboration across sectors in their solution. In view of limited human and material capacities in many countries and specifically in Africa, the advent of the internet has revolutionised the possibilities.

Acknowledgements

I am grateful to the African Nutrition Society for their invitation to ANEC IV in Accra, Ghana, and for covering associated travel and accommodation expenses.

Financial Support

None.

Conflicts of Interest

None.

Authorship

Catherine Geissler is solely responsible for the formulation and writing of this paper.

References

1. Codex Alimentarius. www.codexalimentarius.org (accessed June 2014).Google Scholar
2. Feng, JH, Pombo-Rodrigues, S & MacGregor, GA (2014) Salt reduction in England from 2003–2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open 4, e004549.Google Scholar
3. Ronit, K & Jensen, JD (2014) Obesity and industry self-regulation of food and beverage marketing: a literature review. Eur J Clin Nutr 68, 753–759.CrossRefGoogle ScholarPubMed
4. Scaling Up Nutrition movement. http://scalingupnutrition.org (accessed June 2014).Google Scholar
5. Action contre la Faim/ Action against Hunger. www.actionagainsthunger.org (accessed June 2014)Google Scholar
6. Action on Sugar. www.actiononsugar.org (accessed June 2014).Google Scholar
7. Baby Milk Action. www.babymilkaction.org Google Scholar
8. British Heart Foundation. www.bhf.org.uk (accessed June 2014).Google Scholar
9. Consensus Action on Salt & Health. www.actiononsalt.org.uk (accessed June 2014).Google Scholar
10. Consumers International. www.consumersinternational.org Google Scholar
11. Food Commission. www.foodcomm.org.uk (accessed June 2014).Google Scholar
12. International Baby Food Action Network. www.ibfan.org (accessed June 2014).Google Scholar
13. Oxfam. www.oxfam.org (accessed June 2014).Google Scholar
14. SUSTAIN – Alliance for Better Food and Farming. www.sustainweb.org (accessed June 2014).Google Scholar
15. West African Health Organisation. www.wahooas.org (accessed June 2014).Google Scholar
16. World Action on Salt and Health. www.worldactiononsalt.com (accessed June 2014).Google Scholar
17. World Cancer Research Fund. www.wcrf.org (accessed June 2014).Google Scholar
18. World Obesity Federation. www.worldobesity.org (accessed June 2014).Google Scholar
19. Food and Agriculture Organisation (1974) World Food Conference. www.fao.org/docrep/meeting/007/F5340E/F5340E03.htm (accessed June 2014).Google Scholar
20. Berg, A (1973) The Nutrition Factor – its Role in National Development. Washington, DC: The Brookings Institute.Google Scholar
21. Berg, A, Scrimshaw, NS & Call, DL (1971) Nutrition, National Development and Planning. Cambridge, Mass: MIT Press.Google Scholar
22. Joy, JL (1973) Food and nutrition planning. J Agric Econ 26, 165–197.Google Scholar
23. Joy, JL & Payne, PR (1975) Food and Nutrition Planning FAO, Nutrition Consultants Reports Series No. 35, Rome: Food and Agriculture Organisation (ESN: CRS/75/351).Google Scholar
24. Payne, PR (1976) Nutrition planning and food policy. Food Policy February, 107–111.Google Scholar
25. Berg, A (1987) Malnutrition: What Can be Done? Lessons from World Bank Experience. Baltimore, Md: Johns Hopkins University Press.Google Scholar
26. Allen, L & Gillespie, S (2001) What works? A review of the Efficacy and Effectiveness of Nutrition Interventions. UN SCN Nutrition Policy Paper # 19 and Asian Development Bank Nutrition & Development Series #5. www.unscn.org/layout/modules/resources/files/Policy_paper_No_19.pdf (accessed June 2014).Google Scholar
27. The Lancet (2008) Maternal and Child Nutrition 371, 243–621.Google Scholar
28. Copenhagen Consensus (2012) http://www.copenhagenconsensus.com/copenhagen-consensus-iii/outcome (accessed June 2014).Google Scholar
29. Schuftan, C & Greiner, T (2013) The Scaling up Nutrition (SUN) initiative. 02c. Right to Food and Nutrition Watch, 22–23.Google Scholar
30. Gillespie, S (2001) Strengthening capacity to improve nutrition. Discussion paper no 106 Food Consumption and Nutrition Division Washington, DC: International Food Policy Research Institute.Google Scholar
31. Gillespie, S (2013) Nutrition policy and practice – unpacking the politics. Chap 7. In Global Food Policy Report 2013, pp. 75–85 [Marble, A and Fritschel, H editors]. Washington, DC: International Food Policy Research Institute.Google Scholar
32. Pinstrup-Anderson, P (2013) Nutrition-sensitive food systems – from rhetoric to action. Comment in Lancet 382, 375–376.Google Scholar
33. MacDonald, B, Haddad, L, Gross, R et al. (2002) Nutrition: making the case. In Nutrition: a Foundation for Development, Geneva: ACC/SCN.Google Scholar
34. The Lancet (2013) Maternal and Child Nutrition 382 371–569Google Scholar
35. Bhutta, ZA, Das, JK, Rizvi, A et al. (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382, 452–477.Google Scholar
36. Gillespie, S, Haddad, L, Mannar, V et al. (2013) The politics of reducing malnutrition: building commitment and accelerating progress. Lancet 382, 552–569.Google Scholar
37. Ruel, M, Alderman, H & the Maternal and Child Study Group (2013) Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition. Lancet 382, 536–551.Google Scholar
38. Anderson, J, Parker, W, Steyn, NP et al. (2009) Interventions on Diet and Physical Activity: What Works. Geneva: WHO. www.who.int/dietphysicalactivity/whatworks/en Google Scholar
39. Jebb, SA, Aveyard, PN & Hawkes, C (2013) The evolution of policy and actions to tackle obesity in England. Obes Rev 14 Suppl. 2, 42–59.Google Scholar
40. Bertram, MY, Lim, SS, Barendregt, JJ et al. (2010) Assessing the cost-effectiveness of drugs and lifestyle intervention following opportunistic screening for pre-diabetes in primary care. Diabetologia 53, 875–881.Google Scholar
41. Cobiac, LJ, Vos, T & Veerman, JL (2010) Cost-effectiveness of interventions to reduce dietary salt intake. Heart 9, 1920–1925.Google Scholar
42. Cobiac, LJ, Vos, T & Veerman, JL (2010) Cost-effectiveness of interventions to promote fruit and vegetable consumption. PLoS ONE 5, e14148.Google Scholar
43. Cobiac, LJ, Vos, T & Veerman, JL (2010) Cost-effectiveness of weight watchers and the lighten up to a healthy lifestyle program. Aust N Z J Public Health 34, 240–247.Google Scholar
44. Forster, M, Veerman, JL, Barenregt, JJ et al. (2011) Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity. Int J Obes 35, 1071–1078.Google Scholar
45. Sacks, G, Veerman, JL, Moodie, M et al. (2011) ‘Traffic-light’ nutrition labelling and ‘junk-food’ tax – a modelled comparison of cost-effectiveness for obesity prevention. Int J Obes 35, 1001–1009.Google Scholar
46. Berg, A (1992) Sliding toward nutrition malpractice: time to reconsider and redeploy. Am J Clin Nutr 57, 3–7.Google Scholar
47. Iyengar, GV & Parr, RM (2005) International Atomic Energy Agency's Contribution to advances in nutritional and environmental metrology. Accred Qual Assurance 10, 393–402.Google Scholar
48. International Atomic Energy Agency (2014) www.iaea.org/newscenter/focus/human-health / Google Scholar
49. Landman, J, Buttriss, J & Margetts, B (1998) Curriculum design for professional development in public health nutrition in Britain. Public Health Nutr 1, 60–74.Google Scholar
50. Heaver, R (2002) Improving Nutrition: Issues in Management and Capacity Development. Washington: HNP The World Bank.Google Scholar
51. Hughes, R (2003) A conceptual framework for intelligence-based public health nutrition workforce development. Public Health Nutr 6, 599–605.Google Scholar
52. Hughes, R (2003) Public health nutrition workforce composition, core functions, competencies and capacity: perspectives of advanced level practitioners in Australia. Public Health Nutr 6, 607–613.Google Scholar
53. Lansang, MA & Dennis, R (2004) Building capacity in health research in the developing world. Bull World Health Org 82, 764–770.Google Scholar
54. Keller, I (2006) Building capacity. Public Health Nutr 9, 94.Google Scholar
55. Baillie, E, Bjarnholt, C, Gruber, M et al. (2009) A capacity–building conceptual framework for public health nutrition practice. Public Health Nutr 12, 1031–1038.Google Scholar
56. LaLonde, RJ (2009) Building capacity to evaluate health and nutrition programs. J Public Health Manage Pract 15 Suppl., S90–S99.Google Scholar
57. Lawrence, MA, Galal, O, Margetts, BM et al. (2009) Building global alliances for Public Health Nutr training. Nutr Rev 67 Suppl., S66–S68.Google Scholar
58. Pavlovic, M, Pepping, F, Demes, M et al. (2009) Turning dilemma into opportunities: a UNU/SCN capacity development network in public nutrition in Central and Eastern Europe. Public Health Nutr 12, 1046–1051.Google Scholar
59. Jonsdottir, S, Hughes, R, Thorsdottir, I et al. (2010) Consensus on the competencies required for public health nutrition workforce development in Europe – JobNut project. Public Health Nutr 14, 1334–1449.Google Scholar
60. Jonsdottir, S, Thorsdottir, I, Kugelberg, S et al. (2012) Core functions for the public health workforce in Europe: a consensus study. Public Health Nutr 15, 1999–2004.Google Scholar
61. Fox, A & Beyers, J (2011) Planning a graduate programme in public health nutrition for experienced nutrition professionals. Public Health Nutr 14, 1479–1488.Google Scholar
62. Deckelbaum, RJ, Ntambi, JM & Wolgemuth, DJ (2011) Basic science research and education: a priority for training and capacity building in developing countries. Infec Dis Clin North Am 25, 669–676.Google Scholar
63. Gantner, LA & Olson, CM (2012) Evaluation of Public Health professionals’ capacity to implement environmental changes supportive of healthy weight. Eval Progrm Plan 35, 407–416.Google Scholar
64. Pelletier, DL, Menon, P, Ngo, T et al. (2011) The nutrition policy process: the role of strategic capacity in advancing national nutrition agendas. Food Nutr Bull 32 Suppl, S59–S69.Google Scholar
65. Pelletier, D, Haider, R, Hajeebhoy, N et al. (2013) The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction. Matern Child Nutr 9 Suppl. 2, 83–100.Google Scholar
66. Radford, S & Hall, A (2011) Building capacity across the frontline nutrition workforce. Perspect Public Health 131, 19–20.Google Scholar
67. Hughes, R & Margetts, B (2012) The public health nutrition intervention bi-cycle: a model for training and practice improvement. Public Health Nutr 15, 1981–1988.Google Scholar
68. Yngve, A, Tseng, M, Haapala, I et al. (2012) A robust and knowledgeable workforce is essential for public health policy implementation. Public Health Nutr 15, 1979–1980.Google Scholar
69. Shrimpton, R, Hughes, R, Recine, E et al. (2014) Nutrition capacity development: a practice framework. Public Health Nutr 17, 682–688.Google Scholar
70. Wade, S (2003) The importance of high level training for nutrition scientists in Sub Saharan Africa. Forum Nutr 56, 136–138.Google Scholar
71. Brown, K, McLachlan, M, Cardosa, P et al. (2010) Strengthening public health nutrition research and training capacities in West Africa: report of a planning workshop convened in Dakar, Senegal, 26–28 March 2009. Glob Public Health 5 Suppl. 1, S1–S19.Google Scholar
72. Gurinovic, M, Novakpvic, R, Satalic, Z et al. (2010) Capacity development in food composition database management and nutritional research and education in Central and Eastern European, Middle Eastern and North African Countries. Eur J Clin Nut 64 Suppl. 3, S134–S138.Google Scholar
73. Aaron, GJ, Wilson, SE & Brown, KH (2010) Bibliographic analyses of scientific research on selected topics in Public Health Nutrition in West Africa. Review of articles published from 1998–2008. Glob Public Health 5 Suppl. 1, S42–S53.Google Scholar
74. Pepping, F (2010) The current capacity for training in public health nutrition in West Africa. Glob Public Health 5 Suppl. 1, S20–S24.Google Scholar
75. Jima, D, Mitike, G, Hailemariam, Z et al. (2011) The Ethiopian Field Epidemiology and Laboratory Training Program: strengthening public health systems and building human resource capacity. Pan Afr Med J 10 Suppl. 1, 5.Google Scholar
76. Mousseau, F (2011) Achieving Regional Integration – the Key to Success for the Fight Against Hunger in West Africa. Zero Hunger: Phase 3. Oakland, CA: ACF International Network & Oakland Institute.Google Scholar
77. Ali, J, Hyder, AA & Kass, NE (2012) Research ethics capacity development in Africa: exploring a model for individual success. Dev World Bioeth 12, 55–62.Google Scholar
78. Schὅnfeldt, HC & Hall, N (2013) Capacity building on food composition in Africa. Food Chem 140, 513–519.Google Scholar
79. Van Royen, K, Lachat, c, Holdsworth, M et al. (2013) How can the operating environment for nutrition research be improved in Sub Saharan Africa? The views of African researchers. PLoS ONE 8, e66355.Google Scholar
80. Sodjinou, R, Fanon, N, Deart, L et al. (2014) Region-wide assessment of the capacity for human nutrition training in West Africa: current situation, challenges and way forward. Glob Health Action 7, 23247.Google Scholar
81. University of Southampton. www.som.soton.ac.uk/learn/test/nutrition (accessed June 2014).Google Scholar
82. London School of Hygiene and Tropical Medicine. www.lshtm.ac.uk Google Scholar
83. British Association for Parenteral and Enteral Nutrition. www.bapen/elearning (accessed June 2014).Google Scholar
84. Nestle Nutrition Institute. www.nestlenutrition-institute.org/education/e-learning (accessed June 2014).Google Scholar
85. Unilever Food Solutions UK. www.unileverfoodsolutions.co.uk/our-services...nutrition/elearning (accessed June 2014).Google Scholar
86. Fitness Industry Training. www.fitnessindustrytraining.org.uk (accessed June 2014).Google Scholar
87. High Speed Training. www.highspeedtraining.co.uk (accessed June 2014).Google Scholar
88. Teaching Aids at Low Cost. www.talcuk.org (accessed June 2014).Google Scholar
89. Food And Nutrition Technical Assistance. www.fantaproject.org/tools/e-learning-introduction-nutrition (accessed June 2014).Google Scholar
90. National Institute for Health and Care Excellence. www.nice.org.uk/usingguidance/education/educational_tools.jsp (accessed June 2014).Google Scholar
91. UNICEF Global Nutrition Cluster. www.unicef.org/nutritioncluster/index_68478.html (accessed June 2014).Google Scholar
92. FAO-ENACT. www.fao.org/ag/humannutrition/nutrtitioneducation/69725/en (accessed June 2014).Google Scholar
93. WHO/AFRO – ICATT. www.icatt-training.org (accessed June 2014).Google Scholar
94. WHO Health Academy Project. www.who.int/healthacademy/courses/en (accessed June 2014).Google Scholar
95. The Nutrition and Food Web Archive Website Directory. www.nafwa.org/lma/directory/Free_e-courses/Nutrition/Nutrition.php (accessed June 2014).Google Scholar
96. The Economist (2014) Briefing. The future of Universities – the digital degree. June 28th p. 21–24.Google Scholar
97. edX. www.edX.org (accessed June 2014).Google Scholar
98. Coursera. www.coursera.org (accessed June 2014).Google Scholar
99. Udacity. www.udacity.com (accessed June 2014).Google Scholar
100. MOOC-List. www.mooc-list.com (accessed June 2014).Google Scholar
101. Reseau en Afrique Francophone pour la Telemedicine. www.raft.unige.ch Google Scholar
102. HINARI. www.who.int/hinari/en (accessed June 2014).Google Scholar
103. ePortuguese Project. www.who.int/eportuguese/en (accessed June 2014).Google Scholar
104. Pan African eNetwork Project. www.panafricanenetwork.com (accessed June 2014).Google Scholar
105. eNutrition Academy. www.enutritionacademy.org (accessed June 2014).Google Scholar