Child malnutrition and deprivation--observations in Guatemala and Costa Rica

Abstract

Traditional populations consisting of small tribal groups living in close contact with nature may be virtually free from endemic malnutrition owing to the relative absence of infectious diseases. Transition toward modern ways of life and population growth, leading to crowding and underdevelopment, favours endemic malnutrition due to the interaction of malnutrition and infection. Although important features of the traditional culture--breast-feeding, protective child rearing--may remain intact, they are not enough, and such populations exhibit high rates of infectious disease, malnutrition and premature death. In modern industrialized societies, malnutrition often appears related to child abuse and neglect. Organic and metabolic forms are observed but social pathology appears to be the main determinant of most malnutrition observed. Prevention and control of malnutrition requires improvement of the environment and interventions applied in a holistic manner. Emphasis should be given to education and maternal technology, and to promotion of mother-infant interactions, breast-feeding, adequate weaning procedures and detection of factors that may lead to child deprivation and abuse. Improvement is feasible for most developing nations if social forces become conscious of the needed changes, but positive elements of traditinal culture should be preserved.

PIP: Traditional populations made up of small tribal groups living in close contact with nature may be virtually free from endemic malnutrition because of the relative absence of infectious diseases. Transition toward modern ways of life and population growth, resulting in crowding and underdevelopment, favors endemic malnutrition because of the interaction of malnutrition and infection. Attention is directed to 2 societies, the Guaymi aborigines who live in Villa Palacios in Costa Rica and who have satisfactory nutrition and the Maya Cakchiquel Indians who live in the Guatemalan highlands and who are experiencing malnutrition. The Guaymi live in dwellings scattered in the forests and jungles bordering Panama. The women deliver the babies at home in the traditional way, and breastfeeding is customary. These circumstances seem to ensure an adequate level of nutrition and health disturbed only by occasional epidemics of infectious diseases following the arrival of visitors or travel outside the village. Weaning was not studied in detail, but the healthy condition and stocky build of mothers would indicate that an infant's supply of human milk is adequate in the 1st year of life. Weaning begins after 6 months with the introduction of poorly prepared traditional foods. The diet is monotonous and, by Western standards and international dietary recommendations, poor in quality and quantity. The prevalence of stunting of infants was doubled in the 2nd year of life, but wastage (deficit in weight for height greater than 20%) was not observed, a situation contrasting with other Indian populations such as the Cakchiquels of Guatemala. Better nutrition and health may result from adequate child rearing practices in an environment relatively free of stress, especially infection, even in the absence of abundant and well balanced diets. The genesis of protein energy malnutrition (PEM) was observed during a study of infants from birth until school age in Santa Maria Cauque, a Maya Cakchiquel Indian village located in the Guatemalan highlands. This traditional village is in slow transition toward modern ways of life and resembles many other crowded and poor communities of Latin America. The dominant features of the village are socioeconomic underdevelopment, preservation of traditional ways of child birth and child rearing, and subsistence on traditional agriculture. Infection, particularly enteric, stands out as a primary determinant of PEM. The origin of PEM in societies in transition is frequently different from that described for traditional communities. Characteristics such as early mother infant attachment and breastfeeding have been disturbed by obstetric practices and artificial feeding, and there is a pronounced increase in social pathology, i.e., stress and anxiety, alcohol and drug consumption, family disruption, and aggression. In societies in transition intervention must recognize the origin and nature of the problem and holistic measures must be adopted.