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March 14, 1977


JAMA. 1977;237(11):1078. doi:10.1001/jama.1977.03270380022007

To the Editor.—  Dr Bomgaars' lucid and concise report (236:2513, 1976) does indeed warrant editorial comment. However, important issues are raised besides those addressed by Dr Aring (236:2535, 1976).A concern of mounting importance to Nepal and other similar countries described in many other publications1-5 is the impact of selective, mid 20th century technology on the few remaining totally nonindustrialized nations. Dr Bomgaars' article indicates that a major cause of infant and child mortality has been identified in Nepal, and a simple, culturally acceptable, and inexpensive means of correcting it exists. What must be dealt with in the next breath is the impact of this treatment on the social fabric of the country as life expectancy is prolonged and the population grows. Unless simultaneous attention is given to such widely diverse issues as food production and distribution, housing, fuel, land ownership and inheritance practices, immunization programs, water treatment and sewage