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A clinical trial was conducted to assess the efficacy of a rice-based gruel as a rehydration solution, identified in a previous study to be widely used by mothers during diarrhoeal episodes in their children. Seventy children under five years of age, admitted to a paediatric hospital with clinical dehydration secondary to acute diarrhoea, were randomly assigned to receive rice-based gruel (n = 37) or oral rehydration salts (ORS) (n = 33). The hydration status was measured on admission and hourly until discharge, for a maximum of 8 hours, after which treatment was considered to have failed in children who had not been rehydrated Successful rehydration was achieved in 92% of the patients receiving rice-based gruel and 91% of those receiving ORS. Over 50% of all patients were rehydrated 4 to 5 hours after treatment was initiated; at these times the faecal output was statistically significantly lower in patients receiving rice-based gruel than in those receiving ORS. More patients were discharged from the study with hypernatraemia in the group receiving ORS than in the group receiving rice-based gruel, whereas the number of patients with hyponatraemia on discharge was similar in both groups. Faecal sodium concentrations were similar on admission in both groups but were statistically significantly lower at discharge in the group receiving rice-based gruel. We concluded that rice-based gruel could be safely used as an oral rehydration solution at the community level.

The nutritional deficiencies of the greatest importance today are five in number: energy, protein, iron, vitamin A and iodine. Deficiency of energy and protein leads in children to stunted growth and in cases of severe deficiency to clinical marasmus, kwashiorkor and millions of deaths a year. Anaemia, common in women and children, is caused above all by iron deficiency. Vitamin A deficiency causes blindness at the rate of about a million cases a year, and most of these end in death. Iodine deficiency results in goitre and six million cretins in the world today.

The relationship between nutrition socioeconomic development and fertility is logically examined a model describing the interaction between the variables is presented and policy implications flowing from this model are discussed. From a biological standpoint improvements in health and nutrition would be expected to have a positive affect on reproductive capacity; however improved standards of living are negatively related to fertility. Therefore behavioral factors and not biological factors must account for the observed negative relationship. The behavior of poor people is rational and oriented toward maintaining an equilibrium between resource allocation and production. They retain this balance by adhering to principles developed over time and found to be effective under existing environmental conditions. For example the allocation of food resources is based on the time-tested principle that those family members most involved in production should receive the largest share of the food supply in times of scarity. Given the conditions under which these individuals live this allocation decision makes sense. Similarly the number of children in a family is considered to be more important than the quality of life for these children. Having many children even if these children suffer from malnutrition and lack an education contributes more toward the productive capacity of the family than having 1 or 2 healthy educated children under existing economic conditions. To expect parents living in these situations to allocate resources for the improvement of the nutritional status of infants is to expect them to act irrationally. Changing the environment in which these individuals live is the only way to induce them to change. If new conditions create a need for healthy educated children parents will alter the way they allocate resources. For example if new jobs requiring intellectual skills and improved agricultural technology requiring capital investment are made available the existing allocation system will be thrown out of balance; parents will respond by reallocating resources so as to take advantage of the new opportunities and reestablish the balance between resources and production by applying new principles more in tune with the environmental changes. This model based on the assumption that the peasant farmer is rational has policy implications which differ radically from the policy implications flowing from the backward peasant model.

Comparisons of population prevalences of disease or of inadequate nutriture, across locations or over time (as in monitoring to detect a change in prevalence) are important activities in epidemiology and public health. The data collected are often counts based on a dichotomy of a continuous indicator variable, and performance of the test procedure depends on the cut-off point used. This cut-off may be chosen to optimize performance, on the assumption that the indicator has a mixed normal distribution with unknown mixing proportion corresponding to the unknown prevalence of disease. Results of James (1978, Biometrics 34, 265-275) are applied and extended to the context of monitoring. Charts are presented to facilitate determination of the optimal cut-off, and examples are given for several indicators of nutritional status.