THE EFFECT OF A NATIONAL CONTROL OF DIARRHEAL DISEASES PROGRAM ON MORTALITY - THE CASE OF EGYPT

The National Control of Diarrheal Diseases Project (NCDDP) of Egypt be gan in 1981, became fully operational nation-wide by 1984, and conclud ed in 1991. The project was designed as a campaign to lower mortality from diarrheal disease in children under five by at least 25% within f ive years. The principal strategy employed was to improve case-managem ent of diarrhea through rehydration and better feeding: through assure d production and distribution of oral rehydration salts, education of families through mass media and health workers through training progra ms, and creation of rehydration corners throughout the established pri mary health care and hospital network. A detailed plan for evaluation and research was designed at the start of the project. By its own term s, the NCDDP appears to have succeeded in improving case management; b y several local and national mortality surveys, overall infant and chi ldhood mortality fell by at least one-third with the majority proporti on in diarrheal deaths. The declines coincided with the peak of NCDDP activities and results in improved case-management. The detailed analy ses of this monograph seek to demonstrate that: (a) the mortality decl ine and the diarrheal mortality decline in particular were actual even ts; (b) that case-management improved with plausible sufficiency to ac count for most of the diarrheal mortality reduction; and (c) that chan ges in other proximate determinants to lowered mortality, such as host resistance or diarrheal incidence, do not plausibly account for the m agnitude of the reductions seen. Data are also presented on general so cio-economic changes in the decade of the Project. We conclude that im provements in primary care delivery and the use of mass media would ha ve been facilitating factors to NCDDP efforts, while the overall deter ioration of economic status would have tended to reduce the benefits. The monograph details the strengths and weaknesses of the available da ta, and also makes recommendations for sustained efforts in the contro l of diarrheal diseases.