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