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Editor's Note: Space limitations prevent us from reprinting more of this 30-page article by Gordon, Chitkara, and Wyon, which was so clearly written and so important in its conceptual contributions. Not only was weanling diarrhea defined and placed in the proper context as a condition of unsurpassed international public health importance, but also the health effects of breast-feeding and the synergistic effects of nutrition and infection were emphasized.The diarrheas and the dysenteries that come with the transition of babies from a breastfed existence to a mixed diet are here presented as an epidemiologic entity, weanling diarrhea. The clinical syndrome, for this is a collection of diseases, some identified as to causative agent and some not, is no longer a major health problem of advanced nations. Many factors have contributed to that result: a favorable economy, improved environmental sanitation, technical gains in human nutrition and control of communicable disease, and the development of modem pediatrics.The contrast today with conditions in 1900 is striking. In that year, the death rate in New York City from dysentery, diarrhea and enteritis of children in the first year of life was 5,603.0 per 100,OOO infants; in the then existing registration area of the United States it was 4,523.2. Preschool children of I to 4 years had a rate of 398.7 per 100,OOO

This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, including child survival service coverage, mortality impact, and the level of resources required to attain these results. As a result of first identifying the entire programme population through visits at least biannually to all homes and then targeting selected high-impact services to those at highest risk of death, the mortality levels of children under five years of age in the established programme areas was one-third to one-half of mortality levels in comparison areas. Card-documented coverage for the complete series of all the standard six childhood immunizations among children 12-23 months of age was 78%, and card-documented coverage for three nutritional monitorings during the previous 12 months among the same group of children was 80%. Coverage rates in comparison areas for similar services was less than 21%. The local annual recurring cost of this approach was US $8.57 for each person (of all ages) in the programme population. This cost includes the provision of primary care services for all age groups as well as targeted child survival services. This cost is well within the affordable range for many, if not most, developing countries. Manpower costs for field staff in Bolivia are relatively high, so in countries with lower salary scales, the overall recurring cost could be substantially less. An Expert Review Panel reviewed the CBIO approach and found it to be worthy of replication, particularly if stronger community involvement and greater reliance on volunteer or minimally paid staff could be attained. The results of this approach are sufficiently promising to merit implementation and evaluation in other sites, including sites beyond Bolivia.