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  • Title: Evolution of paradigms of child health in developing countries.
    Author: Mohs E.
    Journal: Pediatr Infect Dis; 1985; 4(5):532-7. PubMed ID: 4047963.
    Abstract:
    In 1982 Costa Rica had an infant mortality of 18 per 1000 live births and a life expectancy at birth of 76 years for women and 72 years for men. In the evolution of infant health in Costa Rica two paradigms were identified. One developed in the decades before 1970 and the other during the 1970s. The necessity of conceptualizing a third new paradigm compatible with health needs of the present and the immediate future is recognized. The first or "malnutrition paradigm" was orthodox in its derivation; it identified the lack of food as the underlying base for the major health problems and placed its emphasis on institutional medicine. The paradigm was influenced by foreign schools of nutrition and pediatrics and led to the development of an infrastructure for the delivery of medical services and the programs for food distribution. The "infectious disease paradigm" recognized infectious diseases as the main determinants of morbidity, mortality and malnutrition in childhood. The strategies derived from such a revolutionary paradigm aimed at the control and eradication of infectious diseases, and they resulted in a rapid improvement of child nutrition and health. However, the infectious disease paradigm does not seem to reduce infant mortality below the present level.(ABSTRACT TRUNCATED AT 250 WORDS) Costa Rica had an infant mortality rate of 18/1000 live births and a life expectancy at birth of 76 years for women and 72 years for men in 1982. 2 paradigms were identified in the evolution of infant health in Costa Rica. The first, the "malnutrition paradigm", emerged in the decades before 1970. It was orthodox in its derivation and identified the lack of food as the underlying base for the major health problems. The paradign emphasized institutional medicine, and was influenced by foreign schools of nutrition and pediatrics and led to the development of an infrastructure for the delivery of medical services and the programs for food distribution. The 2nd paradigm, "the infectious disease paradigm," developed during the 1970s. It recognized infectious diseases as the main determinants of morbidity, mortality, and malnutrition in childhood. The strategies derived from such a revolutionary paradigm aimed at the control and eradication of infectious diseases, and they resulted in rapid improvement of child nutrition and health. Yet, the infectious disease paradigm does not seem to reduce infant mortality below the present level. Thus the "holistic health paradigm" is proposed in which the control and prevention of infectious diseases are maintained but priority is given to the prevention of perinatal problems, noninfectious diseases, and various disabilities. This paradigm copes with lifestyles, individual responsibility, and coordination of public and private health and medical care. The paradigm concentrates on emerging health problems that previously were not apparent or were masked by the prevalence of malnutrition and infectious diseases. The dramatic results observed in Costa Rica and in a few other tropical countries demonstrate that health can be improved without undergoing urbanization and industrialization. The malnutrition paradigm should be discarded. The infectious disease paradigm should guide public health action in underdeveloped countries to ensure a reduction in malnutrition and infant mortality. The holistic health paradigm emerges as the option for countries like Costa Rica in which a further improvement of present health status no longer depends on control of infectious diseases alone.
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