Some thoughts on malnutrition, dietary intervention and amelioration of high death rates in young South African Blacks.

In South Africa, mortality rates from nutritional deficiency and infectious diseases among the very young are lower in Whites than in the other ethnic groups, particularly Blacks. Among Black preschool children, 25 - 35% are under the 3rd percentile of weight for age according to Harvard reference standards, and orthodoxly, exhibit protein energy malnutrition. The proportion is even higher among Black scholars until late puberty. Many, particularly overseas, believe that direct or indirect dietary intervention by health authorities could ameliorate these situations to a tremendous extent. In fact only dietary intervention in the very young is likely to significantly improve morbidity and mortality rates. Elsewhere, intervention during school years has usually failed to yield unequivocally beneficial results, and the same applies as regards supplements in pregnancy and lactation and their effects on morbidity and mortality in infants. All these uncertainties underline the need, emphasized by World Health Organization bodies, to carry out definitive controlled elucidatory studies. As regards non-dietary measures relating to medical services, water supply, socio-economic level and health education (particulary nutritional)--while all these are mandatory, elsewhere their beneficial effects have often been slow in forthcoming or have been of uncertain clinical value. There is no universal 'blueprint' for reducing morbidity and mortality rates from malnutrition in developing populations. Preventable adverse health situations in the young in other parts of the world are by no means limited to Third World populations.