The control and prevention of diarrheal diseases at the national level

Abstract

Dr. Rohde told us this morning that diarrhea and poor diet interact in a vicious circle leading to malnutrition and frequently maiming and killing infants and young children. It appears certain that diarrhea has deleterious effects on nutrition and health through reduced food consumption, altered digestion and impaired absorption, and metabolic alterations, all of which eventually interfere with growth and development (Marta, 1983a; Mata, 1985). Invasive diarrhea often results in chronic loss of nutrients and cells (a protein-losing enteropathy), increasing the risk of malnutrition and death, The risk is greater for infants and young preschool children, but persons of other ages may also be affected. Recurrent or chronic diarrhea often causes debilitation, wastage, and stunting An episode of acute diarrhea may precipitate a child into severe protein-energy malnutrition, just as it occurs with other acute infections. In some countries children experience only a few attacks of diarrhea per year (Snyder & Merson, 1982; WHO, 1983), but in others, as many as seven to nine episodes per child per year are observed (Mata, 1983b; Mata, 1985). This formidable force of infection sometimes accounts for 20 percent of the total span during the first three years of life, resulting in toss of time for stimulation and learning. Children with diarrhea may be described as smelly, irritable, fearful, and retarded. Such children may become detached from their families and can be the target for mistreatment and abuse by parents or attendants. Those who have personally experienced severe diarrhea and dysentery can appreciate the misery and effects of such events. Untreated watery diarrhea with dehydration and invasive diarrhea with toxic manifestations often lead to death within hours or days of onset. In less developed countries, diarrhea is one of the main contributors to global mortality, particularly among infants. The correlation between diarrheal disease mortality and infant mortality is striking (regression coefficient = 0.95) since more than 80 percent of all diarrhea deaths occur among infants; a decrease in diarrhea deaths will inevitably be followed by a drastic reduction in infant mortality (Mata, 1981). Therefore, the control and prevention of diarrheal diseases is one of the main priorities in the process of national development. Responsible scientists, politicians, and planners are rightly interested in bringing about the necessary interventions to attain such an aim.