A field worker's guide to a nutritional status survey

Field methods for the assessment of health and disease in pre-agricultural societies

The few surviving pre-agricultural societies preserve the best available indication of human adaptation during more than 99% of the species' history. The field methods described allow collection of data that may explain why hunters and gatherers are physically small in the face of apparent plenty, what causes their death and how they control population growth. Observations of daily life, especially family, food and work, provide the context within which biological data can be interpreted. Computer-compatible event-recording systems make possible the collection and encoding of quantitative behavioural observations. A careful census permits characterization of fertility and mortality. Physical assessment, by medical history, physical examination and anthropometry, establishes the patterns of growth and development in the population and the prevalence of clinically recognizable diseases and nutritional disorders. If blood, urine or faeces can be collected, lightweight portable field-proven equipment and techniques are available for the collection, analysis and preservation of specimens for biochemical, nutritional, haematological and genetic determinations.

Energetic factors and seasonal changes in ovarian function in women from rural Poland

Female mammals can optimize their fitness by temporal suppression of reproductive function in response to unfavorable environmental conditions. Since reproduction is energetically demanding for a human female, ovarian function is expected to be sensitive to factors influencing energy availability and metabolism. Dieting and exercise in women from industrial countries, and low-calorie diet and workload in women from developing countries, are often associated with ovarian suppression. This study shows that in Polish rural women seasonal changes in workload correlate with seasonal changes in indices of ovarian function (progesterone measured in saliva samples collected daily for six menstrual cycles for each subject). Mean levels of energy expenditure of the most work demanding weeks of the summer exceeded mean levels of energy expenditure during winter by 37%. Energy intake in this population was sufficient throughout the year. During the summer, when physical work was most intense, low values of progesterone levels were observed (178.2 pmol/L in July and 182.2 pmol/L in August), indicating ovarian suppression. Mean progesterone levels rose to 234.6 pmol/L in October when levels of energy expenditure were lower due to cessation of harvest-related activities. As indicated by several causal models tested through path analysis, energy expenditure was the only variable responsible for suppressed progesterone levels during the summer. Variables describing the nutritional status and energy balance did not correlate significantly with progesterone levels; neither body weight nor body fat or seasonal changes of these variables seem to influence ovarian function in this population. Thus work-related energy expenditure does not need to lead to negative energy balance in order to cause suppression of reproductive function in women.

Cultural change, growth and feeding of children in an isolated rural region of Yemen

This paper reports a study on the growth and feeding patterns of children from an isolated region of North Yemen. Marasmus was extremely common and was associated with poor infant feeding practices--particularly the widespread use of bottled milk--and frequent infections. Despite the appearance of a homogeneous traditional society, there were significant differences in the growth of children from adjacent areas. Children from a small township serving as the administrative centre of the region grew more poorly and had a higher mortality than those from the immediate rural hinterland. While poorer living conditions and more frequent infections may explain much of the worse growth and higher mortality of the township children, it is likely less adequate patterns of feeding, particularly greater use of artificial milk, also contribute significantly to the observed difference in growth. Despite the remote rural setting of the study, feeding patterns and growth may be influenced by a number of social factors associated with 'urbanisation'.

High levels of childhood rickets in rural North Yemen

Despite a warm sunny climate, rickets is extremely common in children living in an isolated mountainous area of North Yemen. In a small township the overall prevalence amongst children under five years attending for vaccination was 27%. The condition was most common at the end of the first year and had disappeared by the fifth year. Marasmus was commonly associated with rickets. Children from the rural villages outside the township had significantly lower rates of rickets. Several factors may contribute to the very high rates of rickets in rural Yemen. However, lack of exposure to sunlight as a consequence of particular cultural practices is likely to be the most important. The major social and behavioural factors which restrict the young child access to sunlight are outlined, and possible remedies discussed.

Stimulating action to improve nutrition (how to make community nutritional assessment lead to changes)

Public health action does not automatically follow the presentation to appropriate authorities of the results of community surveys, including those to assess the prevalence and cause of malnutrition. To stimulate action, results have to be presented in various levels of sophistication for different audiences. Such results need to be given with suggestions for potential solutions within local financial and ecological constraints and with realistic recognition of political issues and priorities.

Patterns of growth and malnutrition among preschoolers in Belize

An anthropometric survey of 750 preschoolers was conducted 1979 in Belize to assess nutritional status in two districts, one coastal and the other inland. Mothers were interviewed concerning reproductive history, child's health and dietary history, and associated factors. Analysis included the recognition of low arm circumference, weight-for-age, stature-for-age, and weight-for-stature. Survey results indicate that about 25% of the children, birth to 5 years old, show evidence of stunting, while 2.5% show evidence of wasting. Comparisons of rates of malnutrition by ethnic group reveal the Maya and Garifuna (Black Carib) children are significantly more commonly malnourished than others. Applying a discriminant function to groups of children designated as "poor" and "better-than-average" growth classes reveals several factors which may be contributory to the etiology of preschool malnutrition in Belize. the frequency of diarrhea and age at introduction to sold foods, are significantly related to growth retardation among preschoolers. Analysis of 24-hour-diet recalls corroborates the patterning of malnutrition among the ethnic groups.

The nutritional status of poor children in London

Concern for the growth and development of poor inner-city children prompted an investigation of the relationship of growth to diet, health and sociological background. Between 1973 and 1976, 1000 households in poor areas of London were screened for at-risk children between the ages of one and 12 years. Two hundred and thirty-one children from 112 families qualified for the survey. Of the white children, 21 per cent fell below the 10th percentile for height. The mean energy intake of the shortest children was 72 per cent of the RDI. Half the families spent 4.80 pounds or less per person per week on food, and 33 per cent of the children fell below the 10th percentile for height. A remedial feeding programme may be of benefit to these and similar children.