Selective primary health care: strategies for control of disease in the developing world. XXIII. Control of infection to reduce the prevalence of infantile and childhood malnutrition.

Malnutrition is due to many complex and interacting factors, both biologic and social. This may be why so little has been accomplished in the global efforts to reduce its prevalence and impact. The greatest burden of malnutrition falls on the youngest members of society, and in these infants and children it is closely associated with infectious diseases. Because of multiple effects on host nutrition and metabolism, infections result in nutritional deterioration that must be corrected during convalescence. When this is precluded by limitations in the adequacy and availability of food, and infections are frequent, progressive deterioration in nutritional status occurs, with high morbidity and mortality rates. Measures that reduce the prevalence and nutritional consequences of infection are the most feasible and cost-effective interventions to improve nutritional status of young children at the present time. These measures include immunization, oral rehydration programs for diarrheal disease, promotion of breast feeding, continued feeding during infection, development of adequate weaning foods from mixtures of available local commodities, specific nutrient fortification, growth monitoring, improved environmental sanitation and water supplies, and education. The first seven measures can be introduced immediately in all societies and are basic elements of effective primary health care. The last two, which promise the greatest return in benefits, are the most costly and most difficult to implement. Malnutrition and infection are inseparable and the measures to deal with the former must effect a reduction in the latter if they are to succeed.