Falling diarrhoea mortality in Northeastern Brazil: did ORT play a role?
The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41% to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r=-0.61; p=0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality.
Victora
C G
CG
Department of Social Medicine, Universidade Federal de Pelotas, Brazil.
Olinto
M T
MT
Barros
F C
FC
Nobre
L C
LC
D001938:Brazil / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005440:Fluid Therapy / Q000592:standards*; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D016014:Linear Models; D010343:Patient Admission / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors