[Control of diarrheal diseases in Mexico and Latin America]

Abstract

Oral rehydration therapy (ORT), has been considered the major advance in the treatment of the diarrheal diseases, and has been the single most important factor in the decrease of mortality and decreased morbidity in childhood diarrheal. ORT, is not limited to the administration of oral rehydration solution; it also includes feeding techniques and community education and participation. In order to promote ORT, national programs have been developed and promoted in educational centers in strategic areas of the Latin America countries, where medical and paramedical staff attend. In México there have been two national surveys to evaluate the ORT program. This policy has allowed for participating countries to reduce the cost of treatment of diarrheal disease.

PIP: Gastrointestinal infections are the most frequent causes of illness and death in children under 5 in most Latin America countries and in other developing countries. The simple and effective techniques now available to prevent death from diarrhea offer promise therefore of lowering overall pediatric mortality rates. Oral rehydration therapy is the single most effective treatment for control of diarrheal disease in children because most diarrhea deaths are directly related to dehydration. The discovery during the 1960s that intestinal absorption of glucose, sodium, and salt by the small intestine continued during diarrheal episodes gave scientific support to oral rehydration therapy. The World Health Organization estimates that up to 67% of diarrheal deaths can be prevented with oral rehydration therapy. Oral rehydration therapy can help prevent harmful treatments such as fasting and requires no laboratory controls. By the late 1980s, diarrheal control programs were in effect in over 90 countries, including all of Latin America except Chile. 20% of children with diarrhea receive modern treatment, thus avoiding an estimated 600,000 deaths annually. The World Health Organization formula for oral rehydration has been proven effective and safe for treatment of dehydration caused by diarrhea at any patient age. Early experience with oral rehydration therapy in Mexico and elsewhere demonstrated that it resulted in shorter episodes of diarrhea with fewer effects on nutritional status. The reduced need for hospitalization is another significant benefit or oral rehydration therapy. An estimated 60% of the population of Latin America has access or oral rehydration therapy. In late 1985 the rate of use was estimated at 20% for Latin America as whole but only 9% in Mexico. Research in Mexico indicated that the product name and packaging of oral rehydration packets were unattractive and intimidating to mothers. The new packaging has pictures of a healthy baby and the tree of life, a statement of indications for use (avoid dehydration due to diarrhea), and logos of institutions in Mexico's health sector. The package also provides simple instructions for preparation and use. In 1986-87 greater emphasis was placed on clinical training in use of oral rehydration therapy, communication, and increasing access. Selected personnel from each of the 32 Mexican states and territories received training in oral rehydration therapy in a hospital in Mexico City and returned to act as multipliers in their home states. Over 1700 health professionals were trained in 6 priority states. In 1986, efforts were initiated to promote use of oral rehydration therapy directly in the home. A 2nd survey showed that by 1987 the rate of use of oral rehydration therapy in Mexico had increased from 9 to 24%, but that some harmful practices persisted.