Diarrhoea and mortality in Menoufia, Egypt

Abstract

From 1982 the Ministry of Health of Egypt implemented the National Control of Diarrhoeal Diseases Project (NCDDP) which attempted to improve case management of childhood diarrhoea by making oral rehydration salts (ORS) widely available and used, to improve feeding patterns during diarrhoea, and other measures. National data indicate a high level of success in achieving the targets. However, impact evaluation is hampered by weak national baseline information available prior to NCDDP on case management of diarrhoea and causes of infant and childhood mortality. A study in Menoufia Governorate in 1979-80 obtained such information. Consequently, in 1988 the area was revisited to examine subsequent changes. Findings showed marked improvement in case management of diarrhoea and rapid mortality decline, with diarrhoeal mortality apparently declining somewhat faster than mortality from other causes.

PIP: The Ministry of Health (MOH) of Egypt has done much for more than a decade to control diarrheal disease (CDD). Oral rehydration salts (ORS) have been distributed since 1978, and the National Control of Diarrheal Diseases Project (NCDDP) was launched in 1982. Full CDD measures in place since 1984 have expanded the use of ORS to treat diarrhea, and have resulted in lower levels of infant and child mortality across the country. Impact evaluation is, however, hampered by weak national baseline data. At the national level, information on the cause of death in the vital register is not considered reliable. Second, there is little data on the case management of diarrhea before the initiation of the NCDDP. These issues were addressed in some sample villages in Dakahlia Governorate, where increases in knowledge and the use of ORS between 1980 and 1986 were associated with a decrease in diarrheal mortality. A potentially comparable situation existed in Menoufia Governorate, where the effect of a program of home distribution of ORS on mortality was evaluated in 12 villages in 1979-80. This paper reports findings from a return visit to the villages in 1988 to compare the current treatment of diarrheal diseases and mortality patterns against conditions at baseline. The authors report marked improvement in the case management of diarrhea and rapid mortality decline, with diarrheal mortality apparently declining somewhat faster than mortality from other causes.