2. OVERVIEW

GLOBAL SUMMARY
AFRICA
ASIA
LATIN AMERICA AND THE CARIBBEAN

During the 1980's, developing countries have suffered a series of economic shocks. These have included: rapid rises in the price of oil, high interest rates, and significant unfavourable shifts in terms of trade. Natural and man-made disasters such as drought and desertification have compounded the problems. In responding to these crises many countries borrowed heavily in an attempt to finance economic expansion and balance of payments' deficits, but soaring interest rates combined with a slowdown in global demand left them heavily indebted. This has meant that for many developing countries a major portion of their export earnings must be used to pay the interest on their external debts. With this worsening of the general economic climate, as experienced by most developing countries, the trend to improvement in health and nutrition noted in the seventies, has slowed or even been reversed during recent periods of exceptional stress. But it is apparent from the case studies reported here that, where conditions do improve - even temporarily - nutritional status is seen to respond positively.

In the section immediately below we review economic growth, external debt, food availability, prices and nutrition, in a global¹ context. This will be followed by three regional summaries which will concentrate on differences within these regions in terms of external debt, prices and nutrition. It will be seen that the extent to which individual countries have been able to adjust their economies in order to address their problems has varied considerably, not only between different regions but also within a given region.

¹ By 'global' we intend that inter-regional differences will be the focus of the discussion. The regional summaries provide within-region, i.e. by country, comparisons.

GLOBAL SUMMARY

Economic Growth

Prior to the oil crisis of the early seventies the global economy was expanding at a respectable 5% per annum. Subsequently, the average rate of growth has been a more modest 3% per annum. Not surprisingly, the global figure disguises marked regional differences in performance. The developed economies have continued to grow during the first half of the eighties at annual rates ranging from 1.5% to 3.3%. The economies of the developing world also show a comparable rate of growth in the aggregate, however, within this group the regional disparities are pronounced (see Table 1)². While East and South Asia managed annual average rates in excess of 7% and 5%, respectively, between 1980-'85, Latin America and the Caribbean (LAC) averaged only 0.2% per annum during the same period. Sub-Saharan Africa (excluding South Africa), however, actually recorded a negative rate of growth of -0.5% per annum. When population increases are taken into account, the per capita decline in Sub-Saharan Africa, and to a lesser extent in LAC, is very evident.

² Regional groupings for different indicators correspond to those used by the source agency, e.g. debt: the World Bank, Food Production: FAO, etc.

(Source: World Bank, Annual Report 1988. Figures for '86 & '87 are estimates.)

The external debt (measured as debt outstanding and disbursed - DOD) for all countries combined rose nearly 80% between 1980 and 1985, from US$353.9 billion (1980) to US$631.9 billion (1985). In terms of the debt service ratio (i.e. the total debt service as a proportion of the export of goods and services) this represented a significant rise on average from 12.7% in 1980 to 18.9% in 1985. The growth in both debt and debt service ratio are shown on a regional basis in figs. 1 & 2. In figure 1 it will be seen that Latin America and the Caribbean not only maintain a substantially higher debt in absolute terms, but that it is increasing at a much faster absolute rate than the other regions. However, figure 2 indicates that while the LAC debt ratio at 26% in 1985 is higher than that of Africa, East Asia and South Asia, the latter, particularly Africa and South Asia, are beginning to rise more rapidly.

Figure 1 - Change in Debt Outstanding and Disbursed by Region

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Figure 2 - Change in Debt Service Ratio by Region

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

The relative levels of food production and per capita dietary energy supply are graphed in figures 3 and 4. The data has been dis-aggregated by the following regions: Sub-Saharan Africa, Middle America, South America, South Asia and South East Asia. Between 1980 and 1985 the food production index for Sub-Saharan Africa fell overall, with the sharpest decline between '82 and '84 - the drought period. Middle and South America show a slight fall and a slight rise, respectively, by 1985. By contrast, the Asian regions experienced a growth of between 8%-11% relative to 1979/'81. The availability of dietary energy on a per capita basis follows a similar pattern to the food production index for the various regions. What is of special interest is the difference in the levels of available energy. South Asia and Sub-Saharan Africa show levels of availability well below the remaining three regions.

Figure 3 - Change in Food Production by Region

(Source: figures provided by FAO and reported in the Supplement to the First Report on the World Nutrition Situation, ACC/SCN, 1987)

Figure 4 - Change in Dietary Energy Supply by Region

(Source: figures provided by FAO and reported in the Supplement to the First Report on the World Nutrition Situation, ACC/SCN, 1987)

The regional differences in relation to the general rise in prices and especially in the relative price of food, are best illustrated by reference to specific country examples (see figure 5). For Sub-Saharan Africa there would appear to be three distinct situations with respect to the rise in the general consumer price index. There may be exemplified by reference to Ghana, Madagascar and Ethiopia. Between 1980 and 1987, the consumer price index (CPI) rose by over 1500 points in Ghana, with accelerated growth during the crisis of 1983. Over the same period, the rise in CPI in Madagascar and Ethiopia was 300 points and 30 points, respectively. The latter two show relatively modest inflation rates by comparison with Ghana. In looking at the relative price of food (Food Price Index/Consumer Price Index - FPI/CPI) we note that in both Ethiopia and Madagascar there has been essential parity between food prices and the general price rise. In Ghana food prices began to rise during the drought years of 1982/'83, but fell sharply - relative to CPI - in 1984 and stayed low until mid-'87.

In Asia general prices typically rose by around 100 to 200 points (see Philippines and Bangladesh, figure 5) For the Philippines, the relative price of food rose at approximately the same rate as did general consumer prices. In Bangladesh food prices dropped by around 10% between 1981 and 1983, but then increased by around 20% between 1983 and 1987.

Latin America differs critically from Africa and Asia in that several countries experienced hyper-inflation during the early eighties (see figure 5). Bolivia is a case in point; the CPI increased exponentially and had reached 7 digits by 1986. It is of interest to note that during the same period, the relative price of food rose by at most 20% and then fell back so that by 1986 the figure was closer to 10%. By comparison with Bolivia, Venezuela experienced a modest increase in the general consumer price index, but food prices - in relation to consumer prices - also rose by around 20%, although at a fairly steady rate.

Nutrition

The data show some important changes in the last five years¹. In Africa, for example, Ghana shows significant recovery from the 1983/4 crisis; nutrition in Botswana has probably improved despite drought; in countries such as Burkina Faso and Togo, nutrition improved again after suffering in the 1983/4 drought. Others continue with marked deterioration, such as Lesotho and Madagascar. Moreover, those noted with recent improvement are probably returning to pre-crisis levels, and the underlying trend looks more likely to be static than improving.

¹ See the respective country reports for details; also, regional trends are provided in the "First Report on the World Nutrition Situation" - these have not been reproduced here.

Many countries in South America faced economic stress in the '80's, and the evidence, although fragmentary still, indicates effects on nutrition. In some cases, long-term improvement is apparent. In Colombia, for instance, prevalences of children underweight (and stunted) declined between 1965 and 1986, particularly in rural areas. In Bolivia and Venezuela, as other examples, economic troubles in 1983 and 1985 (respectively) were associated with temporary increases in child malnutrition prevalences.

The countries in Asia for which recent data were available, show differing trends, probably related to their economic and political situations. Where development policies and public services could be sustained in the '80's, such as in Indonesia and Thailand, there is evidence for gradual improvement in nutrition. However, for example, in the Philippines, the available data point to no improvement or possibly increasing child malnutrition prevalences. In Bangladesh there is some indication that improvements in the late 70's may not have continued. Particularly in urban areas, China has had sustained increases in child growth from 1950 to the early '80's.

One way of bringing together the results is to look at different perspectives in time, from decade-long through to monthly.

The long-term, decade-by-decade, trend in child nutrition seems to be of gradual improvement, if undisturbed by crisis (political, economic or drought). In Africa, where per capita incomes and food availability have declined in the last 20 years, nonetheless a slight improvement was detected in the 1970's; but this was reversed in the 1980's. Elsewhere, increasing income, education, food availability, and health services have improved welfare, except where interrupted by such factors as economic recession.

Taking a shorter perspective, of within-decade changes, the disrupting effects of crises can be seen in country after country. A severe crisis affects levels of living and nutrition for several years. In Ghana malnutrition levels were elevated from 1982 through 1985; in Nicaragua they remain high and are may well be rising; in the Philippines, the crisis of 1984/85 was reflected in increased underweight prevalence, reversing previous trends. One can see retrospectively in some cases that crises pass and malnutrition falls - Ghana again illustrates this. But the implication is clear that more rapid and more effective measures are warranted during such crises to protect health and lives: to prevent the peaks of malnutrition, no doubt associated with increased mortality, occurring.

Year-to-year, malnutrition rates are seen to respond to drought, food shortages, price inflation, and the like. The response appears to be quite rapid - possibly with a lag of a few months in relation to prices (which has implications for timely warning) - and the effects of food shortage may linger (e.g. see data from Togo).

Seasonal patterns of malnutrition are clearly seen in most of the African data, and elsewhere when the information is available, such as in Chile and Thailand. Seasonal variations in women's weight are clearly shown in the data from the Gambia. Policies aimed at preventing malnutrition should perhaps give some emphasis to reducing the peaks of seasonal malnutrition, even in times of adequate rainfall.

Figure 5 - Change in the Consumer Price Index and in the relative price of food for selected countries in Africa, Asia and Latin America

AFRICA

External Debt

Trends in debt outstanding and disbursed (DOD) and in the debt ratio for 11 selected Sub-Saharan countries are shown in figures 6 &7. With respect to DOD, the countries have been divided into two graphs in accordance with the scale of their external debt. In the first group -those below US$1 billion - the trend is ever positive over the period, with the exception of Togo which also has the highest debt for this set of countries (see figure 6a). The latter's DOD actually decreased between 1980 and 1984, but has been rising in 1985 and 1986. The second group of countries have DOD in excess of US$1 billion, and in the case of the Sudan the figure is close to US$6.5 billion in 1985 (figure 6b). Sudan's debt is seen to be not only the largest but appears to be rising at a faster rate than the 4 other countries in this grouping. While Botswana's total DOD is by no means unusual in relation to those graphed, it is the highest when expressed on a per capita basis (see Table 2). The Sudan has the second largest per capita DOD of these selected countries, while Rwanda and Ethiopia have the lowest. In terms of their Debt Ratio, the rankings differ once more. (To avoid too much overlap, the debt ratios have also been divided between two graphs.) Botswana, Lesotho and Rwanda, have the lowest ratio of total debt service to exported goods and services (Debt Ratio, see figure 7a) at around 5% in 1985; Madagascar and Togo have the largest, with the latter's debt ratio at just under 30% by 1985 (figure 7b). Ethiopia, Ghana and the Sudan had their debt service ratio rise to just over 10% by 1985.

Table 2 - Debt Outstanding and Disbursed on a per capita basis for 1986

(Source: World Development Report 1988, World Bank)

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Figure 6 b - Trends in debt outstanding and disbursed for selected African countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Ghana experienced a rate of inflation which far exceeded that of any other country in the selection for Sub-Saharan Africa in the report. By mid 1987 the CPI was 1648 relative to the base figure of 100 for 1980 (see figure 5 above). The exponential growth of inflation began in 1983, as a result of the country's economic and natural crises. The relative price of food may be seen to have peaked at this time and then to decline later in the year and continue downwards until late 1985. A number of other countries experienced high levels of inflation, for example, Madagascar, Sudan and Tanzania. CPI's quadrupled and more for these countries relative to 1980. Finally, countries such as Botswana, Ethiopia, and Niger, all had comparatively modest price rises, i.e. not actually doubling during the period being considered.

Figure 7 a - Trends in the debt ratio for selected African countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Figure 7 b - Trends in the debt ratio for selected African countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

The trends in child underweight prevalences, for the nine countries for which these are available on a monthly basis, are summarized in figure 8. Descriptive text is given with each case-study.

Three patterns of trend may be discerned. First, the underlying trend may be static or possibly showing a slight increase in prevalence. Second, - for the majority - the underlying trend is also probably static, but recent events have produced a significant peak in prevalence. Third, there may be clear evidence of increasing prevalence.

In Rwanda, prevalences appear to have changed little from 1982-1986. This is broadly in line with the food availability data. However, in 1987 food production was sharply down; it might be expected that food availability suffered and that malnutrition significantly increased.

Benin, Ghana and Togo show some similarity in pattern. In all three countries, prevalences appeared to peak in 1983, gradually falling to underlying levels by 1986. Drought clearly contributed, and in Ghana the economic crisis had a major impact. For all three countries, there are indications of another increase in malnutrition in late 1987. In Burkina Faso also, the overall data indicate somewhat increased malnutrition in 1983-85. Especially in the north, where rainfall was particularly erratic, already high prevalences may be continuing to rise. Niger (based on data for the capital, Niamey) may be showing long-term deterioration in nutrition, similar to Burkina Faso. Botswana's drought relief programme is well-known, and no doubt contributed to containing malnutrition from 1983-87. The outlook depends heavily on future rainfall.

Lesotho and Madagascar give examples of particular concern, with malnutrition rising from 1984/5 onwards. Economic conditions have been particularly severe in Madagascar. In cases such as these, it seems clear that further action is needed to prevent a continuing deterioration in nutrition.

More fragmentary nutritional data from a further seven countries are included in the case-studies.

The nutrition situation in Ethiopia is known to be very serious. Trends in mean weight-for-length for Ethiopia's Wollo province are shown in the case study. It will be seen that, in this province, a marked deterioration (with some seasonal recovery being evident) occurred between 1982 and 1984. In Sudan, the position in 1987/8 also appears of grave concern, with production down in '87 and food shortages reported. Chad, Mali and Mauritania are likely to be similar in nutritional conditions to Burkina Faso and Niger. Tanzanian data are of particular interest, as they are considered to demonstrate the positive effects in one region of an intensive programme aimed at improving nutrition.

Figure 8 - Trends in the percentage prevalence of underweight (< 80% Wt/Age) pre-school children in selected African countries

ASIA

External Debt

The region overall experienced a steady economic growth during the 1980's, although individual country exceptions - especially India - are notable. Of immediate impact in the graph of trends in debt outstanding and disbursed (DOD, see figure 9) is the scale and rate of growth of DOD for Indonesia. While the total debt for Indonesia far exceeds that for the other 5 countries, on a per capita basis it is the Philippines which has the highest figure (see Table 3) with Indonesia coming only fourth in this ranking. For all of these countries we see that the debt ratio (figure 10) has been growing steadily from, typically, between 5%-10% in 1980 to 13%-20% in 1985. The exception to this trend is China, which maintained its debt ratio below 1.5%.

Table 3 - Debt Outstanding and Disbursed on a per capita basis for 1986

(Source: World Development Report 1988, World Bank)

Based on the evidence from the selected countries, consumer prices have risen comparatively moderately during the period from 1980 to 1987 (see figure 5 above). Generally the rate of increase has been steady, although in the Philippines there was a marked rise in the rate toward the end of 1983 which continued until late 1984 - corresponding to the crisis during and after the change of government. For the examples shown the rise in the price of food relative to the general consumer price rise appears to have been low, i.e. below 10% (figure 5 also). In the Philippines food prices generally rose less quickly than consumer prices. [In fact in Thailand (see the country report) the rate of increase in the relative price of food has been falling; this is also the situation in Indonesia (cf. country report), although the trend shows signs of reversing since 1986.] Bangladesh, subsequent to 1983, experienced a faster rate of increase in food prices over general prices.

Figure 9 - Trends in Debt Outstanding and Disbursed for selected Asian countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Figure 10 - Trends in the Debt Ratio for selected Asian countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

To establish a systematic pattern of nutritional status development for the Asian region is problematic, given the differences in time scales for which data are available in the selected countries. This is further compounded by a lack of consistency across countries in relation to the measure used¹. Each country will be reviewed briefly, followed by a summary overview (see figure 11).

¹ This point is especially pertinent when looking at country differences in the accompanying figure. Differences in the measure used and the choice of cut-point preclude cross-country comparisons.

From the available evidence, the prevalence of wasting has declined significantly over the ten year period between 1975 and 1985, particularly after 1981/'82. The results are from four rural surveys conducted since 1975. The measure is prevalence of wasting (<80% reference Wt/Ht) in pre-school children. The reliability of the '75 and '81 results - and the very high rates of wasting reported - must be considered in the context of their small sample sizes. The results from the '82 and '85 studies suggest a slight deterioration over this more recent period.

China:

A pronounced increase in mean weight is evident for both sexes and all age groups over the three decades. Much of the gain occurred by the late seventies with comparatively little change in the eighties. One exception, to be seen in both males and females, is for the 13 year old's. This group continued to gain in mean weight up to 1985. Broadly speaking, similar patterns may be see in mean height gain for the same age groups, and in mean weight gain for the preschool children (as reported in the country profile).

Indonesia:

Prevalence of underweight (<70% reference Wt/Age) in the pre-school Urban children has shown a substantial improvement by 1986 over the 1978 figure. However, at the national and rural levels this improvement is not evident. Urban prevalences are also noticeably lower than those in rural areas.

Philippines:

Overall, there is little evidence of any real improvement over the last decade. The prevalence of underweight (<75% reference Wt/Age) in pre-school children shows a marked decline from 1978 to 1982. This trend was reversed by 1984. The figure for 1985 indicates a possible further deterioration, with marginal improvements following in 1986 and '87. Regional prevalences (reported in the country report) also indicate pronounced inter-regional differences.

Sri Lanka:

The available evidence would indicate a substantial improvement between 1980 and 1986 for Urban (other than Colombo Metro) and Rural districts. The improvement for the Estate group is slight. Data from two survey periods are available: 1980/'82 and 1986, and relate to the prevalence of growth retardation (<-2 Std. Dev. reference Ht/Age) for somewhat different age groups.

Thailand:

The prevalence of first degree malnutrition (Gomez classification) in pre-school children has dropped steadily from 28.5% in 1983 to 20.9% in 1987. Second degree and third degree malnutrition combined were 6.7% in 1982 down to 2.5% in 1987. During the same period the prevalence for under 5's in Bangkok has gone from 14.7% to 8.6% (1st. degree malnutrition) for 1982 and 1987, respectively. Urban-rural and inter-provincial differences are marked (cf. country report).

Of these 6 countries, four permit a comparison between the seventies and the eighties (Bangladesh, China, Indonesia, and the Philippines). Some degree of improvement is evident during this period for these countries, although for Bangladesh and the Philippines the more recent trend may be negative and for Indonesia the improvement appears to be in the Urban district only. Sri Lanka and Thailand show improvements during the course of the eighties.

Figure 11 - Trends in anthropometric indicators for selected Asian countries

BANGLADESH

% PREVALENCE - Prevalence of wasting (< 80% Wt/Ht) in children aged 0-59m('76& '82). 3-71 m ('83) and 6-71 m ('86); Rural.

% PREVALENCE - Prevalence of stunting (< 90% Ht/Age) in children aged 0-59 m ('76 & '82). 3-71 m ('83) and 6-71 m ('86); Rural.

CHINA

MEAN WEIGHT (Kg) - Change in mean weight for males aged 7-13 years in Beijing (Urban) since the 1950's.

MEAN WEIGHT (KG) - Change in mean weight for females aged 7-13 years in Beijing (Urban) since the 1950's.

INDONESIA

% PREVALENCE - Prevalence of underweight (<70% Wt/Age) in children aged under 5 years: 1978 & 1986. By Urban/Rural area.

PHILIPPINES

% PREVALENCE - Prevalence of underweight (<75% Wt/Age) in children aged under 6 years. 1978 & '82 (Survey), 1984-87 (National Weighing Programme).

SRI LANKA

% PREVALENCE - Prevalence of stunting (<-2 S.D. Ht/Age) in children aged: 0-60m (1980). 3-36m (1986). By area.

% PREVALENCE - Prevalence of wasting (<-2 S.D. Wt/Ht) in children aged: 0-60m (1980). 3-36m (1986). By area.

THAILAND

% PREVALENCE - Prevalence of underweight (Wt/Age. Thai Standards) in children aged under 5 years. Gomez Grade I National Weighing Programme.

LATIN AMERICA AND THE CARIBBEAN

Practically all countries in Latin America and the Caribbean experienced a severe economic depression from 1981 to 1984. By 1986-'87 several of them seemed to be stabilizing their economy, and some even improving their situation comparatively (Bolivia, Colombia, Costa Rica, and Uruguay). In addition to the depression caused by the world-wide situation, many of the countries in the region suffered severe natural disasters, political upheavals and civil disturbances. As a result, there has been a general pattern of increased food prices beyond increases in salaries, and there has been a consequent decrease in purchasing power as compared with the previous decade. There is evidence, in some countries, that the gap between food availability and food requirements is increasing, at least in certain population groups.

External Debt

Following a decade of financial liberalism, accompanied by a deterioration in trade and an accelerated growth of the external debt, the Latin America and Caribbean region has been suffering a major crisis. The rise in the debt outstanding and disbursed for 8 LAC countries is shown in figures 12a and 12b. For Bolivia, Costa Rica, Guatemala and Uruguay, the DOD has been steadily rising during the first half of this decade; by 1985 the absolute levels of DOD for these four ranged from US$2 billion to US$3.5 billion. For Chile, Colombia, Peru and Venezuela, the values of DOD were in excess of US$10 billion in 1985. On a per capita basis, Costa Rica and Venezuela have the highest DOD's for this selection with values of just under US$1,400 (see Table 4). Guatemala and Colombia are around one quarter of this figure. Comparing by debt ratio (figs. 13 a & b), it will be seen that Bolivia, Costa Rica, Peru and Uruguay range between 10% and 35% (1985), with Costa Rica the highest. It will be noted that although Peru started the 80's with a comparatively high debt service burden, since 1982 it has been falling and was in 1985 the lowest of the countries shown. Venezuela also shows a downturn in its debt ratio, however the remaining countries show an overall positive trend.

Table 4 - Debt Outstanding and Disbursed on a per capita basis for 1986

(Source: World Development Report 1988, World Bank)

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Figure 12 b - Trends in debt outstanding and disbursed for selected LAC countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Bolivia and Peru experienced hyper-inflation during the early eighties (see fig 5 above). Of the remaining countries, Uruguay's general consumer price index had risen by around 2000 points by 1987, while in Chile and Colombia the CPI quadrupled in the same period. Guatemala and Venezuela experienced more 'normal' rates of inflation. The relative price of food (FPI/CPI) showed little consistency across these countries. For Bolivia and Peru - the two countries with hyper-inflation - food prices rose more rapidly than general prices for the former (after 1982) and more slowly for the latter. Guatemala showed a significant shift in the ratio in 1984 after a gradual decline in food prices vis-a-vis consumer prices.

Figure 13 a - Trends in Debt Ratio for selected LAC countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

Figure 13 b - Trends in Debt Ratio for selected LAC countries

(Source: World Debt Tables 1986-87 Edition, World Bank, 1987)

The table below (table 5) may be used to provide a general overview of changes in nutritional status of young children across the region. Inter-country comparisons may be misleading in that different data collections methods have been used and different population sub-groups sampled. In the majority of cases the prevalence of underweight has decreased during the comparison period, despite the severe economic conditions prevailing. One should keep in mind that in a number of cases the period between observations is quite short (e.g. Chile) and in others the differences are so small (Jamaica, Cuba and Chile) that they may well be due to chance variations. The data represent national averages and within-country variation is known to be substantial. Table 6 shows the prevalence of low birth weight in several countries in the region. Birth weight is not only a predictor of the future development of the individual child and indirectly a reflection of the nutritional status of the mother, but has been called a social indicator which is associated with general socio-economic, environmental and health conditions. As the available data refers to hospital deliveries it is a biased sample in most of the countries.

Table 5 - Changes in the prevalence of underweight in young children between the 1970's and the '80's.

Country	Year	% Underweight	Year	% Underweight	Classification	Source
Bolivia (La Paz)	1985	23.0	1987	20.1	< -2 SD	HC
Colombia	1977	20.6	1986	11.9	< 3rd cent.	NS
Costa Rica	1966	13.7	1982	5.3	< -2 SD	NS
Chile	1984	2.1	1986	2.4	< -2 SD	HC
Cuba	1984	1.4	1987	0.9	<3rd cent. W/H	HC
Guatemala	1980	43.5	1987	33.5	< -2 SD	NS
Guyana	1974	12.8	1986	10.7	Gomez II+III	HC
Jamaica	1978	7.8	1985	8.0	Gomez II+III	NS
Nicaragua	1966	17.1	1982	27.1	< -2 SD	NS
Peru	1984	9.5	1987	13.2	< -2 SD	HC
Uruguay	1980	13.4	1987	9.3	< 80% median	HC
Venezuela	1982	9.8	1986	7.4	<10th cent. W/H	HC

HC = Health Centre NS = National Survey

(Source: Compiled by PAHO)

Country	Year	% Under-2.5 kg.	Year	% Under-2.5 kg.
Chile	1984	6.5	1987	6.9
Costa Rica	1976	8.7	1985	6.7
Cuba	1984	7.9	1987	7.9
El Salvador	1980	8.7	1986	8.6
Uruguay	1981	7.9	1985	7.9

(Source: Compiled by PAHO)