Vi. Effect of Health and Nutrition Interventions on Infant and Child Mortality in Rural Guatemala·

annual per capita income, large proportions of populations residing in rural areas, unequal distribution of land ownership and sizes of plots, semi-subsistence agricultural practices, high levels of illiteracy, limited public sanitation, water supply deficient in quantity, quality and availability, poor personal hygienic practices and, in sorne cases, language and cultural barriers within the population. Variations exist within the sub-region, however. Panama and Costa Rica have experienced substantial improvement in socio-economic indicators in the last 20 years; the other countries show only moderate evidence of socio-economic progress. The success of Costa Rica and Panama could be attributed to the model of development they adopted. Since the beginning of the last century, the Governments of both countries have emphasized educational programmes ta reduce illiteracy rates. In the first half of the present century, social reforms took place, which included the creation of a social security system, the development of housing and the initiation of an income tax and other forms of income redistribution. Moreover, since the late 1960s Costa Rica has been implementing nation-wide programmes designed to deliver services to the people. Among these, the rural health care programmes and the collective food supplementation programmes appear as the mainforces responsible for the decline in morbidity, malnutrition and mortality rates. In turn, Panama has been promoting the implementation of rural development projects in those communities exhibiting higher malnutrition, mortality and poverty rates. As shown in table 136, the rate of population growth for the six countries of Central America varied from 2.3 to 3.5 per cent during the 1975-1980 period. Table 136 also presents estimates of life expectancy at birth in 1950, 1960 and 1970 for the six countries. The difference between the lowest and the highest mortality conditions is 16 years of life expectancy in 1950 (between Costa Rica and Honduras) and 18 years in 1970 (again between Costa Rica and Honduras). In ail countries life expectancy increased between 10 and 12 years during the 20-year period, with the exception of Panama, which registered a gain of nearly 15 years. Three of the countries Costa Rica, Guatemala and Honduras experienced a more rapid drop in mortaIity during the 1960-1970 period than during the previous decade. In the other countries the pace of mortality decline slowed down. However, these countries exhibited extremely high rates of mortality decline during the earlier decade; rates that would have been very difficult to sustain (United Nations, 1981). Table 137 shows estimates of the probability of dying during the first two years of life (denoted q(2» around