Poor health conditions were evident in the high rate of infant mortality and a short life expectancy. In the mid-1960s, a national health survey was conducted. In 1991 that survey was still considered the major comprehensive published source of information on the national public health situation. A number of diseases and chronic infections were prevalent. Goiter, a disease directly associated with iodine deficiency, was endemic in certain villages in the hills and mountains. In most of the villages surveyed, more than half of the population had goiter, and in these same villages the incidence of deafness and mental retardation was much higher than in other villages. Leprosy also was a serious problem. Foreign assistance, specifically through Christian missions, was responsible for setting up leprosy treatment centers in different parts of the country. Tuberculosis has been a chronic problem and was more common in urban areas. During the 1970s, the Tuberculosis Control Project was established to provide immunizations to all children younger than fifteen, and it is likely that this project has reduced tuberculosis. Other chronic, widespread problems were intestinal parasites, diarrhea, and gastrointestinal disorders. Some polio and typhoid infections were common but not severe. Malnutrition was a chronic problem, especially in rural areas. More than 50 percent of the children surveyed were reported to have stunted growth. "Wasting," defined as a condition in which a child has very low weight for his or her height, was also evident. These conditions were particularly bad in the Hill and Mountain regions, both of which suffered from food shortages. The country's public health program, however, has essentially eliminated smallpox and has been able to control malaria, which used to be endemic to the Tarai Region and other lowlands. Data as of September 1991
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