Nutrition and infection field study in Guatemalan villages, 1959-1964. 8. An epidemiological appraisal of its wisdom and errors.

摘要: The variety of problems that became evident during a 5 year-prospective field study are reviewed by the investigators. critique focuses on experimental design methodology operational procedures and administrative matters. took place from 1959-1964 in 3 highland villages Guatemala sought to discern interactions malnutrition infectious disease among infants children under years old measure changes our nutritional status resulting supplementary food program results an integrated medical service evaluate impact ecological factors health status. called for 1 village be used as control receive supplemental services combining both curative preventive approach. were selected according criteria enhance internal comparability however certain biases introduced because entire population was not exposed same external e.g epidemic spread through 2 3rd. Alternative designs such random sample general split or switchback feasible financial practical reasons. addition 4th receiving interventions might have enhanced results. Hindsight showed some faulty incomplete given data requirements. There no substitute increased social interaction which inevitably accompanied intervention may contribute growth development. Information attendance at feeding station age attending amount supplement consumed contribution breastmilk regular diet collected. These would interpretation Many objectives could realized particularly due cost selection inappropriate personnel. For example providing water each household too expensive. these diminished avoided had more complete pilot been conducted. Better training workers resulted smoother operation. A manual containing set standard operating including specific discerning presence diseases syllabus collection form so beneficial workers. Supervision personnel also improved. In nonmedical reported morbidity mortality. Classification proved broad careful investigation reliability reports somewhat questionable. suffered extent inadequate periodic review recorded findings. developed common longterm studies: change key this included new director year; allocation project funds analysis. One often unrecognized value studies is extensive collateral information obtained alert