Prevention of diarrhoea in young children in developing countries.

An updated review of nonvaccine interventions for the prevention of childhood diarrhoea in developing countries is presented. The importance of various key preventive strategies (breast-feeding, water supply and sanitation improvements) is confirmed and certain aspects of others (promotion of personal and domestic hygiene, weaning education/food hygiene) are refined. Evidence is also presented to suggest that, subject to cost-effectiveness examination, two other strategies-vitamin A supplementation and the prevention of low birth weight-should be promoted to the first category of interventions, as classified by Feachem, i.e. those which are considered to have high effectiveness and strong feasibility.

PIP: A review of recent evaluations of non-vaccine interventions for the prevention of childhood diarrhea in developing countries both confirmed the importance of standard strategies (e.g., breast feeding, water supply and sanitation improvements) and suggested refinements in approaches to personal and domestic hygiene, weaning education, and food hygiene. Despite the risk of vertical transmission of human immunodeficiency virus in infected areas, the health risks of not breast feeding far outweigh the potential number of lives saved by abandoning this practice. Weaning education programs can produce a 2-12% reduction in diarrhea mortality. Also important is the promotion of food handling, preparation, and storage practices that reduce the risk of fecal contamination. Improvements in water quantity may have a greater impact on diarrhea than improvements in quality alone through their effect on personal and domestic hygiene. Two relatively new strategies, vitamin A supplementation and prevention of low birth weight, should be promoted. Vitamin A intake is significantly associated with both all-cause and diarrhea-specific child mortality; the feasibility of large-scale supplementation programs awaits investigation of their cost-effectiveness, however. The choice of specific diarrheal control strategies depends on local factors such as diarrhea etiologies, the existing infrastructure, and government priorities. In all countries, effective implementation of preventive strategies requires the involvement of a range of sectors (e.g., health, agriculture, water supply, and sanitation).

Institutional maternal mortality in Mali.

OBJECTIVES: To measure the institutional maternal mortality ratio (MMR) in Mali and suggest ways to reduce it. METHODS: Routinely recorded data from 24 health institutions in three regions were reviewed for 1988 to 1992. RESULTS: The overall MMR in the institutions was 201 maternal deaths per 100,000 live births. Hemorrhage, toxemia and infections accounted for 80% of the 360 recorded maternal deaths, almost all of which were preventable. The main reasons why these conditions result in death lie in poor quality and maldistribution of health services, lack of transport and late use of allopathic services. CONCLUSIONS: Maternal mortality is still a major public health problem in Mali, even among the small proportion of women who reach health facilities. Substantial new initiatives are urgently needed to reduce this major cause of preventable adult female mortality.