|Community-Based Longitudinal Nutrition and Health Studies : Classical Examples from Guatemala, Haiti and Mexico (International Nutrition Foundation for Developing Countries - INFDC, 1995, 184 pages)|
|2. The Santa María Cauqué study: Health and survival of Mayan Indians under deprivation, Guatemala|
Prior to the Cauqué, study, most knowledge of interactions between infection and malnutrition was obtained through clinical and cross-sectional field observations. The background of poverty and deprivation affecting children throughout the world had been mostly ignored or taken for granted, resulting in equivocal interpretation of the origin and nature of the infection-malnutrition complex and its biological and environmental determinants.
The Cauqué, study pioneered long-term observation of rural children in their natural ecosystem. The detailed clinical, dietary, microbiological, anthropometric, and epidemiological observations, unique at that time, are still a subject of discussion, because our studies have not been replicated. Different approaches, however, have confirmed or widened the main observations of the Canqué study. Meantime, paradigms derived from the study have probably influenced changes in policy and management regarding rural health in less developed countries.
In the last 30 years, there has been an emphasis on "primary health care" and "health for all by the year 2000," "growth, oral rehydration, breastfeeding, and immunization" (GOBI), "expanded program of immunization" (EPI), and "improved delivery of medical care." The effort has been more on control and prevention of infection than on improving the diet. Also, more emphasis has been given to holistic strategies to combat poor health than to independent food supplementation and fortification programs. The Cauqué, study taught lessons about the positive and negative determinants of health and survival of contemporary less developed populations (Mate and Behar 1975. Some of these lessons were the following.
a. The village population enjoyed a relatively high quality of life, despite the prevailing poverty and underdevelopment. Families were well structured, with strong bonds and low levels of domestic violence. No abandonment or abuse of wives or children was known to the clinic staff during the study.
b. Women had a remarkably low incidence of birth complications. Effective mother-infant interaction contributed to successful breastfeeding and child rearing.
c. Treatment of the umbilical cord stump prevented tetanus neonatorum. There were very few cases of neonatal sepsis, diarrhea, impetigo, and other neonatal infections.
d. Small babies were kept warm at all times by mothers who slept with them from birth through lactation. In the cool climate such a practice was crucial, counteracting hypothermia in very small infants. Since children were exposed to sunlight, neonatal jaundice was corrected. Survival was absolute for infants able to suck the nipple within the first day of life.
e. Exclusive breast-feeding for five to seven months correlated with adequate nutrition, growth, and protection against infection. Prolonged breast-feeding with supplements for two to three years offered an important source of nutrition supplementation and protection against infection.
a. The high incidence of LBW infants in Cauqué, had a negative effect on village development. More than 70% of the infant deaths were of LBW babies. The priority, then, was to reduce the incidence of LBW infants instead of training more personnel to care for them.
b. Protracted weaning in the village represented a constant risk of enteric infection. Weaning foods had low biological value and were a source of enteric infection.
c. Infections with pathogens of the mucosae and skin were very common during weaning.
d. Stunting was associated with low birth weight, infections, and deficient diets.
e. Deficient health services contributed to the low survival rates.
f. Lack of family planning is resulting in strong demographic pressure in the face of limited land and few opportunities for diversified work.
g. Poor socioeconomic conditions were predominant determinants of biological and environmental deficiencies of the indigenous population and its ecosystem.
h. The most pressing problem is the rapid rise in population density, resulting from greater survival mediated by better public health, and the collateral restricted land, food shortage, inflation, and political unrest. The background of intervention, amply discussed in the early 1970s (Mate, 1 978a), remains valid today.