Changes in the anthropometric status of rural African under-fives during a decade of primary health care.

Protein energy malnutrition (PEM) is a major cause of hospital admissions and death in most impoverished Third World countries. In the Gelukspan Health Ward, in rural Western Transvaal, a primary health care (PHC) programme, based on the GOBI-FFF strategy, commenced in 1980. Community health surveys on African under-five children were regularly undertaken. In 1990, to assess improvements achieved, anthropometric and other data were obtained on a representative series of 926 children. Harvard standards were used prior to 1984, and American NCHS reference standards thereafter. Low weight-for-age fell from 28 to 19%, low height for age from 33 to 17%, and low weight-for-height from 5 to 1%. The percentage with low arm circumference was unaffected, 3 and 4%, respectively. The improvements described are believed to be due in part to the PHC programme. Greater definition of the causes and extent of improvements are needed to optimize the State's present desire to intensify PHC, especially in rural areas.