By Everard L. Napier, M.R.C.S., L.R.C.P. (Lond.). In charge Kala-azar research, Calcutta School of Tropical Medicine. Second edition. 185 pages of text with 15 charts in the text, 18 plates, and an appendix of references to literature, author index and subject index. Oxford University Press. London, Bombay, Calcutta, Madras, 1927
A field survey of child health was carried out in the rural district (gombolola) of Kayonza in Kigezi, West Uganda. The total population of young children was examined (258 infants, 585 1- to 3-year-olds). Results showed very little evidence of protein-calorie malnutrition (including kwashiorkor); the edema index in 1- to 3-year-olds was only 0.3%. While minor degrees were frequent, severe anemia was found in only 3% in the preschool age group. Malaria was uncommon, as judged by a spleen rate of 0.5% and a parasite rate of 1.6%; stool examinations showed Ascaris in 59.5% and hookworm in only 1.9%. Skin disease due to “environmental” factors was common. Indirect evidence, including admissions to Kabale Hospital, medicinal scar patterns in children examined and records in the death register, shows that severe respiratory infection is the top cause of morbidity and mortality.
The relative absence of protein-calorie malnutrition is probably due to a variety of factors including the excellent transitional diet (prolonged breast feeding, millet, beans) and to the lack of land pressure. A much worse situation would be expected in the overcrowded parts of Kigezi, especially around Kabale.