Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.

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Selective primary health care. An interim strategy for disease control in developing countries.

Selective primary health care: an interim strategy for disease control in developing countries.

Moderate and severe malnutrition are endemic in much of the developing world and in association with pockets of deprivation in the developed world. The cost in terms of individual and social development is high. The principles of effective management are clearly documented. A low cost, community based treatment programme for moderately and severely malnourished children under 3 years of age was established at a health centre in rural Jamaica. Children were followed up monthly and defaulters were rigorously recalled. Management consisted of carefully delivered dietary advice, antibiotics, anthelminthics, and vitamin supplements. All children improved and the response of 36 children, who were treated in the first year, showed an accelerated weight gain, with catch-up growth and the maintenance of length gain. There was a significant increase in the weight for age, at 1.9% per month over six months, which exceeds the rate reported with food supplementation programmes and nutrition rehabilitation centres.

https://adc.bmj.com/content/archdischild/71/4/297.full.pdf

Community based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica.

Growth, a positive change in the size of a growing individual, is a dynamic measure of health, the best available indicator of nutrition status, and the only real measure of nutrition adequacy [1]. Deviations from the expected, or predictable, course of growing are not visible at the earliest stage, and such invisibility is a major barrier to preventing and curing health problems. Growth monitoring has gained popularity in the last two to three decades and has been practiced in over 80 countries [2], with perhaps the earliest report from clinic-based activities in Nigeria [3]. The most widely promoted method of growth monitoring is weighing and charting growth, since weight gain is believed to be the most sensitive indicator of growth and is universally applicable [4]. This method is favoured by UNICEF. Among other techniques, measuring arm circumference is claimed to be the easiest and cheapest alternative to weighing [5] and has been recommended for use at the home and village levels whenever regular and frequent weighing is not possible [6]. While most published papers have concentrated mainly on technical details, more important issues such as the objectives, feasibility, and usefulness of growth monitoring and its relevance and effectiveness in promoting child nutrition and health have not been dealt with adequately. Only a few evaluations to examine its functional utility and effectiveness have been made. At the twelfth session of the Subcommittee on Nutrition (SCN), in April 1986 in Tokyo, the Advisory Group on Nutrition (AGN) of the SCN was requested to make a statement with regard to growth-monitoring techniques and uses. In its statement of February 1987, the AGN recommended that the SCN investigate the literature to identify background papers on the usefulness of growth monitoring, its utility, and conditions of feasibility in relation to different purposes for which it is used. On the basis of such documents more specific recommendations could then be given to the SCN. The present brief review was prepared as one response to this recommendation . An international workshop was held in Indonesia in 1984 to promote the exchange of experiences in implementing growth monitoring as a primary health care activity [4]. Gopalan and Chatterjee [6] have critically reviewed global experiences in the use of growth charts, examining the operational problems by referring to published and unpublished reports, consultations, and correspondence. More recently Gopalan again questioned the feasibility of growth monitoring in developing countries [7] and discussed some basic related issues [8]. The state of the art of routine growth-monitoring activities was examined by Griffiths [9], who also discussed the unification of growth monitoring and nutrition education [10, 11]. The application of operations-research approaches, methods, and techniques to address the main obstacles in the implementation of ongoing growth-monitoring activities was described by Teller [12]. After an informal consultation at UNICEF headquarters in New York in March 1985, a meeting on growth monitoring was held at the UNICEF regional office for South Central Asia in New Delhi in May 1986. Yee and Zerfas [13] reviewed selected projects to search for evidence showing the uses and effectiveness of growth monitoring in certain existing nutrition projects. Whether or not growth-monitoring programmes can reduce diarrhoea morbidity, mortality, or severity was the subject of a review by Ashworth and Feachem [14]. Bhan and Ghosh [15] and Ghosh [16], reviewing four UNICEF-sponsored case studies, summarized features of successful growth-monitoring programmes to identify factors contributing to their effectiveness. Hendrata and Rhode [17] looked for commonly encountered pitfalls. Recently an information packet has been prepared, with articles and summaries on growth monitoring published within the previous five years [18].

https://journals.sagepub.com/doi/pdf/10.1177/156482658801000414

Growth Monitoring: A Brief Literature Review of Current Knowledge:

In order to promote better mental development in three-year-old children from poor Jamaican families, a home-visiting project was carried out with the aim of helping mothers to interact with and stimulate their children. Homes were visited once a week, and the use of toys and books was demonstrated to the mothers. The play equipment was then left with the family and exchanged at the following visit. After a maximum of 29 visits, the children had made significant gains (average 13 IQ points) compared with children in a previously matched control group. The mothers' knowledge of child-rearing had also improved. Similar intervention programmes may be useful on a larger scale, and need not be expensive if full use is made of the mothers' help.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.1975.tb03527.x

OwenD. Minott

Papers

A young-child nutrition programme in rural jamaica