Frequent diarrhoea or inadequate diet

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their relative contributions to malnutrition in the tropics

During diarrhoea, weight loss is common and in some children repeated attacks of persistent diarrhoea can lead to malnutrition. Yet the importance at the community level of the diarrhoea related growth faltering is still debated. In the 70’s, several community studies concluded that most of the growth deficit observed in poor rural communities in the tropics could be attributed to repeated attacks of diarrhoeas. The role of diarrhoea as a cause of growth faltering was later challenged by studies from Bangladesh and Zimbabwe showing that weight loss after diarrhoea was transient and had no long term impact on growth for most children. More recently, community studies from Australia and Gambia showed a drastic reduction of diarrhoea prevalence and mortality without effect on growth faltering. These observations also suggest that inadequate diet, and not repeated attacks of diarrhoea, is a major cause of growth faltering in poor communities. Yet, the case for an inadequate diet as a cause of growth faltering would be stronger if nutritional interventions resulted in marked growth improvement. Admittedly, so far, nutritional interventions failed to promote adequate growth in poor communities even in controlled settings. Possible inadequacies of current nutritional interventions will be reviewed to explain their apparent lack of efficacy.

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Last modified: December 10, 2001