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INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1990; 20(4):691-715.PAHO followed nutrition programs of Brazil, which have been supported almost exclusively from internal sources, since 1983 to provide technical assistance and to learn what may be applied to other countries. The PAHO program effectiveness evaluation study compared 2 ways of running nutrition programs which presumed that malnutrition was mainly caused by poverty--a subsidy of basic foods and direct distribution--between 1974-1986. 2 programs subsidized at least 4 basic foodstuffs with 1 program restricting the amount of food to identified families while the other allowed any family coming to stores in low income areas that participated in the program to take subsidized food. 2 other programs either gave free traditional commercial foods or specially formulated supplements to identified clients. The status of most well nourished or malnourished participants did not change despite intervals as long as 48 months. Moreover the nutritional status of a considerable percentage of participants deteriorated. Nevertheless moderate or severe malnourished children who started in a program tended to recover substantially, especially children >1 year old. Further the longer a client participated in a program the more likely the nutritional status would improve, yet frequent participation did not affect status. Thus the programs were more likely to cure than prevent malnutrition. Besides participants tended to not grow much, but weight status did improve. Those programs that also provided medical care and health education were more effective than those that just provided subsidies. This finding highlights how malnutrition is not just a problem of low income and low food consumption, but also a problem of poor health. The programs did not transfer benefits efficiently. In addition, the costs of securing the food, its poor quality, and insufficient volume discouraged beneficiary participation.