NUTRITION IN THE CARIBBEAN

1. In many parts of the Caribbean there is a high mortality between 6 months and 2 years due to malnutrition and gastro-enteritis. These two conditions are so closely inter-connected that they can conveniently be regarded as a single syndrome, for which the term ‘weanling diarrhoea’ has recently been suggested. The clinical picture revealed by visits to children's wards was in line with the vital statistics.

2. The prevalence of malnutrition and gastro-enteritis in infants and young children is the result of child-feeding practices characteristic of the area. The duration of breast-feeding is shorter than in Africa and Asia. After 3 months or so breast-feeding, if it does not cease altogether, becomes partial, and in general there is a steady change in the direction of less breast milk. In some territories weaning at an even earlier stage in infancy seems to result in the common occurrence of malnutrition in infants under 6 months of age.

3. The foods given to supplement or replace breast milk include processed cow's milk, starch roots and fruits and cereals. Imported processed milk supplies good quality protein otherwise lacking in the child's diet, but the use of expensive proprietory infant milk foods, out of line with family purchasing power and given in over-diluted form, is among the causes of malnutrition. The use in infant and child feeding of dried skim milk-much the cheapest kind of milk in terms of nutritive value-is increasing and this trend should be encouraged.

4. Most of the malnutrition is of the ‘marasmic’ type. Classical kwashiorkor, now comparatively rare, was seen more often 5–10 years ago.

5. It is suggested that the conventional practice of grouping deaths in the periods 0 to 1 and 1 to 4 has, in the Caribbean and other developing areas, retarded recognition of the importance of malnutrition and gastro-enteritis as the principal cause of death during and after the weaning period. The analysis of mortality statistics according to shorter age intervals is desirable.

6. Further studies and action are recommended concerned with the following: the continuing analysis of mortality and morbidity statistics to elicit relationships with malnutrition; child feeding practices in the different territories; the social and economic background of individual victims of malnutrition and of the feeding errors responsible for their condition; improvement in the treatment of malnourished children; the scope and efficiency of maternal and child health services; the distribution of dried skim milk and its extension.

7. The establishment of a Caribbean Nutrition Centre will contribute to the prevention of malnutrition and help in solving long-term problems of food supply and nutrition in the area.