An applied nutrition program in an Ethiopian rural community

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Abstract
The results of a longitudinal study of 212 children under 11 years of age (living in a typical rural district in western Ethiopia and subjected for 2 years to the influence of an applied nutrition program) can be summarized as “improvements,” “no change,” and “impairments,” as follows: Improvements Statistically highly significant increase in upper arm muscle circumference-for-age. Marked reduction in clinical signs of PCM. Decrease in pathological chest/head ratios. Very marked decrease in the prevalence of goiter. Improved gums. Decrease in records of history of diarrheal disease. Decrease in the prevalence of various skin and scalp infections. Increase in the serum levels of urea nitrogen and decrease in the amino acid ratio levels, both changes being statistically highly significant. Disappearance of Endamoeba histolytica from the stools. No (or slight) change Slight decrease in weight-for-age during the first 12 months, followed by a slight-moderate increase during the second year. No significant change in height-for-age. Slight and nonsignificant increase in triceps skin fold towards the end of the study. No change during the first 12 months. No significant change in frequency of anemia. No significant change in the erythrocyte sedimentation rate. The same frequency of Ascaris infestations at the last (after 1½ years) as at the first (at base line) stool examinations. Impairments Increase in the frequency of hookworm infestations. Statistically significant increase in gamma globulins in the serum. Considering particularly the change in upper arm circumference and the marked decrease in physical signs of PCM, the conclusion is reached that an appreciable average improvement in the children’s general nutritional status was obtained, and that this improvement at first seemingly was related to the protein supplement fed to the children. It can also be pointed out that the absence of an increase in weight-for-age in spite of a significant increase in muscle mass as measured by arm circumference, plausibly indicates that the process of recovery from mild to moderate PCM is associated with the disappearance of “subclinical edema,” and supports the idea that anthropometric estimations of muscle mass comprise a more sensitive index of protein gain (and loss) than body weight.

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