Evolution of paradigms of child health in developing countries.

In 1982 Costa Rica had an infant mortality of 18 per 1000 live births and a life expectancy at birth of 76 years for women and 72 years for men. In the evolution of infant health in Costa Rica two paradigms were identified. One developed in the decades before 1970 and the other during the 1970s. The necessity of conceptualizing a third new paradigm compatible with health needs of the present and the immediate future is recognized. The first or "malnutrition paradigm" was orthodox in its derivation; it identified the lack of food as the underlying base for the major health problems and placed its emphasis on institutional medicine. The paradigm was influenced by foreign schools of nutrition and pediatrics and led to the development of an infrastructure for the delivery of medical services and the programs for food distribution. The "infectious disease paradigm" recognized infectious diseases as the main determinants of morbidity, mortality and malnutrition in childhood. The strategies derived from such a revolutionary paradigm aimed at the control and eradication of infectious diseases, and they resulted in a rapid improvement of child nutrition and health. However, the infectious disease paradigm does not seem to reduce infant mortality below the present level.(ABSTRACT TRUNCATED AT 250 WORDS)