FALLING DIARRHEA 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. Proportion ate infant mortality fell from 32% in 1980 to 17% in 1989 and infant d eaths attributed to diarrhoea dropped from 41% to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for childre n aged 1-4 years, Diarrhoea admissions also fell from 57% of infant ho spitalizations 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 t hose regarded as severe by the mother. Other changes included a worsen ing 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 t he 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.