[Nutritional deficiencies affecting children of the Third World. The example of Ethiopia (author's transl)]. / Mangelkrankheiten bei Kindern der Dritten Welt--Beispiel Athiopien.

For the large non-privileged population groups in developing countries and diet shows many deficiencies, often with major disturbances of health as a consequence. This is particularly true for the children. The monotony and the bulkiness of the traditional diet, the often sparse number of meals as well as periodic deteriorations of the food situation ("hungry season") all contributes to make the nutritional situation precarious. The vicious circle between PEM and infections contribute in a major way to the high mortality rate among preschool children in developing countries. In this paper a review is given of different nutritional deficiency diseases affecting children in the Third World. The practical illustrations derive mainly from Ethiopia. During the period between 1962-1975 there has been lively cooperation in the field of nutritional research between Ethiopia and Sweden.

Breast milk composition in Ethiopian and Swedish mothers. I. Vitamin A and beta-carotene.

The vitamin A and beta-carotene contents of breast milk were determined at different stages of lactation in three population groups: nonprivileged Ethiopian, privileged Ethiopian, and Swedish mothers. In addition, a fractionation of vitamin A giving the proportion of retinol was performed. The concentrations of retinol-binding protein (RBP) and (in part of the material) beta-carotene and prealbumin in plasma were also measured. The mean concentrations of vitamin A and beta-carotene in the milk from the Swedish mothers (period 0.5 to 6.5 months) were in the range of 40.0 to 53.1 and 16.3 to 20.8 mug/100 ml, respectively. For the privileged Ethiopian mothers (period 0.5 to 3.5 months) the corresponding ranges were 36.2 to 36.4 and 26.2 to 28.1 mug/100 ml and for the nonprivileged Ethiopian mothers (period 0.5 to 6.5 months) 28.1 to 33.1 and 23.9 to 25.6 mug/100 ml. Only the nonprivileged Ethiopian mothers were examined during a later stage of lactation (6.5 to 11.5 and 11.5 to 23.5 months). The concentrations of vitamin A and beta-carotene in their milk showed a downward trend. The proportion of retinyl ester (percentage of total vitamin A content) was significantly higher in the milk of Swedish mothers than in privileged and nonprivileged Ethiopian mothers. In the Swedish mothers retinol constituted 3.5% of the total vitamin A content of the milk; in Ethiopian mothers it was 15 to 30%. Determination of RBP in plasma showed normal values for Swedish mothers and lowered values for Ethiopian mothers--particularly the nonprivileged, in whom 14 of 81 values were below 20 mug/ml. RBP was demonstrated in colostrum, but only in a low concentration (in the order of 5 mug/ml).

Two-century perspective of some major nutritional deficiency diseases in childhood.

In this review, dealing with historical aspects and the present day situation in developing countries, three major nutritional deficiencies among children are discussed, namely rickets, iron deficiency anaemia and protein energy malnutrition (PEM).

Evolution of breast feeding in Europe.

PIP: During the first few decades of the 20th century infants in Europe were breastfed for 6 months or more; only during the 30s and 40s did breast feeding begin to decrease especially in those countries, as in Northern Europe, where child mortality had experienced a fast decline. Information on the frequency and duration of breastfeeding in Europe is scant; one must also differentiate between whole breastfeeding and breast feeding supplemented by bottle feeding. A study conducted in England in 1947--48 on 1142 infants showed that 58.85%, 33.3% and 22.2% were wholly breastfed at 1, 3, and 6 months, and that breast feeding was more common in professional families than in families of manual workers. A similar study conducted in 1968 indicated that only 33% of mothers continued to breastfeed beyond the first 4 weeks. In Poland breast feeding remained extremely popular until about 1930 when at least 90% of mothers breastfed for at least 1 month, after that frequency of breast feeding decreased to 79% in 1950, to 78% in 1960, and to 52% in 1964; figures for breast feeding at 3 and at 6 months are much lower. The situation in Hungary appears to be much the same. Breastfeeding practices started to decline in Sweden around 1940, and accelerated during the 1960s. Factors which provoked a change in breastfeeding practices include changes in the social structure of the family, for example from the extended family to the nuclear family, changes in delivery conditions, improved knowledge about formula feeding, the impact of breast feeding techniques even by health personnel, changed attitudes about physical attributes such as breasts, and the high percentage of working mothers. Physicians should encourage mothers to wholly breastfeed for 2-3 months, and then switch to mixed breast and formula feeding. In underdeveloped countries mothers in conditions of extreme poverty and lack of hygiene should wholly breastfeed for at least 6 months. Should breast feeding be abandoned at all we would see a decrease in the chance of survival of young children, despite improvement in living conditions.^ieng