PEDIATRICS Vol. 38 No. 2 August 1966, pp. 321-333
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Background to the Study

ALMOST 60 years have elapsed since Correa in Yucatanacute, México, described a pathological condition called culebrilla which was present mainly in toddlers and was associated with a deficient intake of foodstuffs of animal origin. Since that time reports from South America, India, Africa south of the Sahara, the Balkan Peninsula, China, Southeast Asia, the Philippines and Central America had by 1952 shown the widespread occurrence of the syndrome. The prevalence surveys of Brock and Autret in Africa, Autret and Behar in Central America, and Waterlow and Vergara in Brazil, have made the size of the problem apparent and have fully confirmed previous impressions of high frequency which had been based upon cases admitted to general and to pediatric hospitals. As a consequence, since 1955 protein-calorie malnutrition has come to be recognized as a condition having worldwide importance for the people's health.

Although its incidence and causal background may vary, the syndrome is associated with the same basic characteristics of clinical and biochemical pathology in all countries, and has regional variations of only secondary importance. The literature has grown steadily and many reviews of protein-calorie malnutrition have appeared over the last two decades. Of particular value for providing a detailed picture have been those of Waterlow, West Indies 1948, Meneghello, Chile 1949, Brock and Autret, Africa 1952, Oomen, Indonesia 1953, Gopalan and Ramalingaswami, India 1955, Gomez, et al. Mexico, 1953, Trowell, Devies, and Dean 1954, Behar et al. 1953, Ramos and Cravioto 1953, Waterlow, Cravioto and Stephen 1960, and Viteri, et al. 1964.