Introduction

Abstract

The important role of nutritional deficiency as a contributor to childhood mortality particularly from infectious disease, as a conditioning factor in the complex mosaic of many diseases, and as a hurdle to socioeconomic advancement, is widely recognized. Improvements in nutrition, together with better hygiene and immunization, can take most of the credit for decreasing death rate from infectious disease and for the longer expectation of life in industrialized countries. This change in the mortality pattern came before the development of antibiotics and modern medical techniques. In developing countries, gross life-threatening malnutrition in the shape of marasmus and kwashiorkor continues to be rampant. These dramatic syndromes represent the clinical end points of nutritional pathology, and form the tip of the massive iceberg of undernutrition. More than 100 million preschool infants and children suffer from moderate-severe malnutrition in the world. And for one case of kwashiorkor or marasmus, there are at least 100 with mild to moderate deficiencies of one or more nutrients. Recent studies in the Americas have revealed a surprisingly high incidence of nutritional problems. The Pan American Health Organization survey of mortality patterns carried out in Central and South America showed malnutrition and infections to be the most serious health problems in children, as primary or more often as secondary factors in deaths (Puffer and Serrano, 1973).