Strategies and causes of reduced infant and young child diarrheal disease mortality in Cuba, 1962-1993.

This article describes the basic strategies employed by Cuba's Diarrheal Disease Control Program (DDCP) to reduce acute diarrheal disease (ADD) mortality among infants and young children from 1962 through 1993, together with the diarrheal disease trends recorded in these years. An initial control effort, the Program to Combat Gastroenteritis, began operating in 1963. Since then, in one form or another, increasingly effective efforts have consistently lessened ADD mortality. Among other things, these efforts have concentrated on providing improved sanitation, effective health education, proper nutrition (including promotion of breast-feeding and food hygiene), and adequate health care (which in recent times has placed increasing emphasis on oral rehydration therapy and primary care). Largely as a result, recorded infant ADD mortality fell from 12.9 deaths per 1,000 live births in 1962 to 0.3 in 1993, while recorded mortality from this cause among children 1-4 years old dropped from 6.4 deaths per 10,000 children in this age group in 1962 to 0.1 in 1993. Besides describing the work performed through 1993, the author also outlines plans for the period through 1999 that are directed at maintaining and perhaps augmenting these gains.

[Persistent diarrhea]. / Diarrea persistente.

PIP: Mortality from diarrheal diseases is most common in areas with high prevalence of caloric malnutrition. The considerable reduction of mortality from diarrhea following introduction of oral rehydration therapy has revealed the seriousness of persistent diarrhea with malnutrition. Persistent diarrhea is internationally defined as a diarrheal episode lasting 14 days or longer, generally accompanied by growth problems and protein calorie malnutrition. Persistent diarrhea is now considered a nutritional disease, generally occurring in low birth weight or malnourished children and itself a significant cause of protein calorie malnutrition. 10% of episodes of acute diarrhea are believed to evolve into persistent diarrhea, which accounts for 35% of deaths from diarrhea. Around 15% of episodes of persistent diarrhea are fatal. Several risk factors have been identified. Most patients are under one year old. Various studies have shown that protein calorie malnutrition retards repair of the damaged intestinal epithelium and prolongs diarrhea. Recent introduction of milk of animal origin is implicated in 30-40% of episodes of persistent diarrhea. Patients at risk have been shown to react abnormally to skin tests of antigens and to have recent histories of acute diarrhea or previous episodes of persistent diarrhea. Inconclusive studies implicate antimotilic drugs such as paregoric elixir and indiscriminate use of antibiotics as risk factors, but increased risk has been proven only with some antiparasitics. Patients with persistent diarrhea are deficient in vitamins A, B12, and folic acid, and in zinc and iron. Children under 6 months of age with persistent diarrhea should be hospitalized. Adequate feeding is the most important aspect of treatment. The objectives of nutritional treatment include temporary reduction of milk of animal origin, assurance of sufficient protein and calorie consumption, avoidance of foods aggravating the diarrhea, and correction of existing malnutrition.^ieng

[Mortality from acute diarrheal diseases in children under 5 years of age. Cuba, 1959-1987]. / Mortalidad por enfermedades diarreicas agudas en menores de 5 años. Cuba, 1959-1987.

Mortality from acute diarrheal diseases in Cuban children under 5 for the period 1959-1987 is analyzed. The data come from the Public Health Ministry's National Bureau of Statistics and other sources. The death rate in children under 5 declined from 28.5 per 10,000 in 1959 to 1.4 in 1987, or 95.1%. In the 1-4 age group it was reduced by 97.8%, and in those under 1 year, by 94.2%. In 1959 the deaths from acute diarrheal diseases represented 30.6% of all deaths in children under 5; 29.5% in those under 1 year, and 34.0 in those between 1 and 4. In contrast, by 1987 the respective figures had fallen to 4.1, 4.5, and 2.2%. The acute diarrheal disease situation in several countries of the Americas is stated for purposes of comparison and, finally, factors that have helped to lower mortality from this cause are analyzed as are other factors which will contribute to lower it in the future.

Infant mortality in Cuba, 1969-1988.

The available statistical data indicate that Cuban infant mortality fell substantially, by roughly 74.5%, between 1969 and 1988. Especially great gains were made against late neonatal (7-28 days) and postneonatal (28 days-11 months) mortality, though reduction in early neonatal (0-6 days) mortality was also substantial, amounting to about 64.0%. In general the gains were spread fairly evenly among the country's provinces, with infant mortality tending to remain higher in the eastern provinces than in the central and western regions. A key factor contributing to these improvements was a policy decision made in the early 1960s that assigned high priority to the health sector and led to major improvements in health service organization, quality, and coverage. Other associated changes that seem to have made significant contributions to this trend include improvements in living standards, sanitary and epidemiologic conditions, outpatient medical care, hospital care, and health technology.

[Mortality in the Cuban child under 15 years of age]. / Mortalidad en el nino cubano menor de 15 anos

PIP: An analysis of infant and child mortality in Cuba is presented. Mortality is examined separately for the age groups 0-6 days, 7-27 days, 28 days-11 months, 1-4 years, and 5-14 years. A review of data sources and the relevant literature is first provided, and variations in infant mortality by province and major cause of death are described for the years 1970 to 1979. Changes in infant mortality patterns over time are discussed, together with the factors influencing them. Comparisons are also made with infant mortality patterns in other American countries.^ieng

[Infant mortality in Cuba in the 1970-1979 decade]. / Mortalidad infantil en Cuba, en el decenio 1970-79.

PIP: This paper discusses the 50% reduction in infant mortality achieved in Cuba during the decade 1970-1979. After an analysis of the various factors that contributed to such a reduction, it is pointed out that early neonatal mortality during that period declined by 36.2%; late neonatal mortality by 67.2%, and postnatal mortality by 59.3%. By province, the lowest mortality rates were in Matanzas (14.9%), Villa Clara (15.6%), and the city of Havana (16.2%). The highest rates were in Las Tunas (26.1%), Guantanamo (24.1%), and Granma (23.9%) in infants of 1 year of age/1000 live births. With respect to cause of death, diarrheal diseases dropped from 2nd to 6th place, with a reduction of 71.4% in mortality. As a result of decreases in other causes, congenital malformations moved up to 2nd place. Also, acute respiratory diseases were lowered by 43.4%. Furthermore, it is pointed out that 11 consultations/delivery and 6.7 checkups/healthy infant under 1 year of age were attained as an annual average. In the same decade, the birth rate declined from 27.7 to 14.7/1000 inhabitants. (author's)^ieng

Mortalidad infantil en Cuba, en el de cenio 1970-1979. / Infant mortality in Cuba, in the decade 1970-1979

Con anterioridad a 1959 y durante los primeros anos del decenio de 1960, las cifras existentes sobre mortalidad infantil en Cu ba eran poco fidedignas. Sin embargo,debido a sucesivas mejoras en la consecucion de los datos, desde 1968 se han comenzado a conocer en detalle los distintos componentes de la mortalidad infantil y se han precisado las causas de muerte

Mortalidad prescolar en las Américas en el decenio 1970-1979: la situación en Cuba / Prescholar mortality in America during 1970-1979 decennial. Situation in Cuba

Se analiza el comportamiento de la mortalidad prescolar en Cuba durante el decenio 1970-1979. La cifra registrada en 1979 fue de 1,0 por 1 000 habitantes de 1 a 4 años. Se compara la cifra alcanzada en Cuba, con relación a un grupo selecionado por países de América donde se evidencia la baja cifra registrada. Se revisan los trabajos existentes en el país en relación con esta temática. El porcentaje de participación en relación al total de defunciones disminuyó de 2,25 porciento a 1,28 porciento en el período estudiado. Se analizan las 20 primeras causas de muerte y se destaca la reducción en los rubros enteritis y otras enfermedades diarreicas agudas, influenza, neumonías y sepsis. Por último, se hace un resumen de los elementos que han contribuido a disminuir la mortalidad prescolar (AU)