The role of curative first-line health services in enhancing screening and rehabilitation of mild-to-moderate malnutrition: results of a pilot project in Bolivia.

Mild-to-moderate malnutrition constitutes an important part of the burden of disease for young children in developing countries (1). In association, and even synergy, with infectious diseases, estimates of the contributing risk on the burden of disease and mortality of all forms of underweight vary between 49% for diarrhoeal diseases and 45% for lower respiratory infections or malaria (2). Due to its higher prevalence, its early detection and effective treatment (secondary prevention) has the potential of significantly contributing to child survival. Up to the early nineties, growth monitoring followed by nutrition education__also called growth monitoring and promotion__was considered the most effective strategy for primary and secondary prevention of malnutrition. Still, evaluations under routine conditions (3), trials estimating effectiveness (4), and reviews on performance (5) could not confirm this hypothesis.