Nutrition in the Caribbean

Abstract

1. In many parts of the Caribbean there is a high mortality between 6 months and 2 years due to malnutrition and gastro-enteritis. These two conditions are so closely inter-connected that they can conveniently be regarded as a single syndrome, for which the term ‘weanling diarrhoea’ has recently been suggested. The clinical picture revealed by visits to children's wards was in line with the vital statistics.2. The prevalence of malnutrition and gastro-enteritis in infants and young children is the result of child-feeding practices characteristic of the area. The duration of breast-feeding is shorter than in Africa and Asia. After 3 months or so breast-feeding, if it does not cease altogether, becomes partial, and in general there is a steady change in the direction of less breast milk. In some territories weaning at an even earlier stage in infancy seems to result in the common occurrence of malnutrition in infants under 6 months of age.3. The foods given to supplement or replace breast milk include processed cow's milk, starch roots and fruits and cereals. Imported processed milk supplies good quality protein otherwise lacking in the child's diet, but the use of expensive proprietory infant milk foods, out of line with family purchasing power and given in over-diluted form, is among the causes of malnutrition. The use in infant and child feeding of dried skim milk-much the cheapest kind of milk in terms of nutritive value-is increasing and this trend should be encouraged.4. Most of the malnutrition is of the ‘marasmic’ type. Classical kwashiorkor, now comparatively rare, was seen more often 5–10 years ago.5. It is suggested that the conventional practice of grouping deaths in the periods 0 to 1 and 1 to 4 has, in the Caribbean and other developing areas, retarded recognition of the importance of malnutrition and gastro-enteritis as the principal cause of death during and after the weaning period. The analysis of mortality statistics according to shorter age intervals is desirable.6. Further studies and action are recommended concerned with the following: the continuing analysis of mortality and morbidity statistics to elicit relationships with malnutrition; child feeding practices in the different territories; the social and economic background of individual victims of malnutrition and of the feeding errors responsible for their condition; improvement in the treatment of malnourished children; the scope and efficiency of maternal and child health services; the distribution of dried skim milk and its extension.7. The establishment of a Caribbean Nutrition Centre will contribute to the prevention of malnutrition and help in solving long-term problems of food supply and nutrition in the area.

The Work of Wallace Aykroyd: International Nutritionist and Author

“…Death rates between the ages of 6 and 24 mo were, in some islands, 20 times the corresponding rate in the U.S. (24). The most common cause of death was a combination of malnutrition and gastroenteritis resulting from very early weaning and the purchase of proprietary infant foods, which were excellent in themselves but given to children overdiluted because of their expense.…”

A History of Breast-Feeding Practices in the English-Speaking Caribbean in the Twentieth Century

“…Bush teas and starch gruels (usually cornmeal, degerminated maize starch) are said to be used throughout infancy (22). Jelliffe's general conclusions about the trends in breast-feeding in the Caribbean are pased upon the studies in Jamaica and Trinidad cited above, plus reference to the work of Aykroyd (18), which, in an interesting circularity, relies heavily on this same work by Jelliffe et al…”

“…These studies show lower incidences of kwashiorkor relative to marasmus in children under 24 months, and higher incidences of malnutrition at younger ages. Aykroyd (18) (19). The authors suggest that this change "may be associated with a change in infant feeding" specifically, earlier weaning and use of infant formula milk.…”

“…Aykroyd (18) reports on a study tour to Jamaica, Puerto Rico, St. Thomas, Surinam, British Guiana, Grenada, Barbados, St. Lucia, Dominica, Antigua, St. Kitts, and Trinidad taken during the winter of 1963-64. In his travels he examined charts of children under treatment for malnutrition, and he reported impressionistic data about changing breast-feeding practices.…”

“…The mother usually needs to continue partial breast-feeding as long as possible in the hope of avoiding pregnancy. [18] Aykroyd also concluded that at that time limited breast-feeding was changing in the direction of even less breast milk being given to the infant, and formula milks were replacing condensed milk (18). However, he acknowledges the superficial nature of the data on feeding and refers to the work of Jelliffe et al in Trinidad (20), and Jelliffe in Jamaica (21,22).…”