Magnitude and impact of diarrhoeal disease
Guerrant, Richard L.
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Diarrhoea seems to be a minor problem in humans and other mammals living in small, isolated tribes or groups. Under such conditions there is limited, if any, introduction of pathogenic agents and, if agents are introduced, there may not be sufficient critical mass to guarantee transmission and the production of an endemic state of a given agent of diarrhoea. Furthermore, small groups of individuals tend to handle water and faeces more carefully, with fewer opportunities for spread of the aetiological agents of diarrhoea. When humans cluster in crowded cities and villages without having attained the desirable level of environmental sanitation and personal hygiene, microbial pathogens rapidly become endemic, and diarrhoea is then a leading cause of morbidity, malnutrition and mortality.
Artículo científico -- Universidad de Costa Rica. Instituto de Investigaciones en Salud. 1988