[Infant morbimortality due to acute diarrhea in a metropolitan area of northeastern Brazil, 1986-1989]. / Morbimortalidade infantil por diarréia aguda em área metropolitana da região Nordeste do Brasil, 1986-1989.

Six cross-sectional studies involving children under five years of age in three places on S. Luiz island, i.e., Vila Palmeira, Anjo da Guarda and S. José de Ribamar, were performed. A standardized questionnaire on the presence of diarrhoea in the previous 2 weeks was answered by the mothers or by those responsible for the children. Two population based studies (in May 1986 and May 1989) and four sample based surveys (in November of 1986, 1987 and 1988 and in May 1989) were carried out. The prevalence of diarrhoea was highest in May, 1986 and November, 1987. The highest prevalence occurred in S. José de Ribamar. The distribution of cases according to age showed a higher prevalence among children of 6-11 months and between 1 and 2 years of age. The prevalence of diarrhoea was highest among the families: that excreted directly into the sea or a latreen; that used water from uncovered wells; that threw their garbage into the sea; and whose bread-winners were unemployed. Diarrhoea was the principal cause of death in both surveys. Infant mortality, in May 1986, was 44.0 per thousand in children under 1 year of age and 12.8 in children under 5 years old; in May 1989 it was 7.9 per thousand and 4.9 per thousand respectively. The decrease in child morbidity and mortality due to diarrhoea between 1986 and 1989 was statistically significant.

[Oral rehydration therapy for acute diarrhea in a region of northeastern Brazil, 1986-1989]. / Terapia de reidratação oral para diarréia aguda em região do nordeste do Brasil, 1986-1989.

Some aspects of the use of oral rehydration therapy (ORT) in the treatment of acute infant diarrhoea in children under five years of age in three different areas of S. Luís Island, Maranhão, Brazil were analysed. This paper is based on data from a transversal study carried out by "Projeto de Controle da Doença Diarréica Infantil no Maranhão" in the districts of Vila Palmeira and Anjo da Guarda in the municipality of S. Luís and in two other districts in S. José de Ribamar county, involving 13,867 children under five years of age, in 1986 and 1989. Chi-square analysis and Fisher's exact test were used for significance testing. The study revealed a high prevalence of diarrhoeal diseases and a low usage of ORT in the areas analysed, with a significant decrease in the former from 1986 to 1989, and a great variance from one area to another, especially in 1986. The use of ORT was closely related to the age of the children, the educational level, of their mothers, and who it was who prescribed the treatment and medicines. There was no significant association with family income or the working relationships of the head of family at his/her job. There was a lack of knowledge of anthropological aspects of the use of ORT. Some intervention activities are proposed increase the dissemination of ORT, such as a health educational policy directed mainly to low income communities a review of programs on management of infant diarrhoea directed at health workers and a training program for the health community agents to improve their job in the communities.

Rotavirus associated diarrhoea during infancy in the city of S. Luís (MA), Brazil: a two-year longitudinal study.

A total of 479 diarrhoeic children and 337 children without diarrhoea (controls) less than 5 years old were investigated in a two-year study in the city of S. Luís (MA), with the purpose to determine the incidence, the age distribution and the seasonality of rotaviruses, as well as to establish the severity of the disease in this region between the North and the Northeast of Brazil. rotavirus incidence was highest in children of the 1st. year of life, showing an average of 25% per year among the diarrhoeic patients attending the two main hospitals and three health units at the periphery of the city. It was shown that rotaviruses are significant enteropathogens in children less than 18 months old. Frequency of rotaviruses dropped in diarrhoeic patients 18 to 23 months old to only 4%, the same percentage observed in children of the control group. A typical seasonal distribution of rotaviruses was not seen during the two years of study. There was a peak in the incidence of rotaviruses in 1986, during the rainy season, and two peaks in 1987, one in the rainy season and one in the dry season. It was also shown that severity of diarrhoea in rotavirus positive cases was higher than in the negative cases. Rotavirus diarrhoeic patients had more loose stools per day, and higher frequencies of vomiting and fever, resulting more often (> 2 times) in moderate or severe dehydration. Finally, it is concluded that the introduction of immunoprophylaxis may reduce significantly the high mortality rates in early childhood observed in S. Luís.