Malnutrition and the common communicable diseases of childhood in rural Guatemala.

THE world of infectious diseases and malnutrition centers strongly in the developing countries. Physicians of North America and western Europe appreciate that differences in disease behavior exist but tend to view that fact abstractly; or influenced by personal experience, as a concern at least remote and even inconsequential. Death rates are higher in the developing regions, and infections predominate among leading causes of death. Nutritional surveys show startling differences in intake of calories, protein and of other principal nutrients. What is grossly unappreciated is the result when the two conditions exist together, when malnutrition and infectious disease prevail in high degree in the same general region. The grandfathers of present-day practitioners would have understood the situation, for three generations ago conditions in the now industrialized countries of the world were much the same as they are today in less privileged areas. An improved environmental sanitation, better medical care, and an expanded economy have contributed to the change. The interaction of nutrition and infection is far less evident, even insignificant from a community standpoint, and yet in many parts of the world it continues to be of major importance. The combined effect when the two conditions are present in the same individual is more than additive. A synergism exists, with consequences more serious than predictable from either disease occurring alone. Infections precipitate acute nutritional disease in children already malnourished. Infections themselves are rendered more severe by a resistance lessened by malnutrition.1 The person most affected is the child less than five years old. In most developing countries children are breastfed well into the second year of life and often during the third year. Weaned from the breast-and of necessity subsisting on a predominantly starchy, adult type of diet-young children proceed in large proportion to varying degrees of malnutrition with an accompanying inhibition of growth and development. Breast milk alone fails to provide sufficient calories and protein beyond six months, and supplements are commonly