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  • Title: Falling diarrhoea mortality in Northeastern Brazil: did ORT play a role?
    Author: Victora CG, Olinto MT, Barros FC, Nobre LC.
    Journal: Health Policy Plan; 1996 Jun; 11(2):132-41. PubMed ID: 10158455.
    Abstract:
    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. Proportionate infant mortality in the northeast of Brazil fell from 32% in 1980 to 17% in 1989, with infant deaths attributed to diarrhea falling from 41% to 25%; these declines comprise an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. No such decline was observed in any of the other major causes of death or admissions. The authors explored the impact of oral rehydration therapy (ORT) upon this recent decline in diarrhea mortality in the region. 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. Socioeconomic conditions worsened during the 1980s, but the levels of water supply, vaccine coverage, breastfeeding duration, and nutritional status increased. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhea mortality, or approximately one third of the actual decline. An ecological analysis found ORT use rates to be inversely correlated with infant diarrhea mortality. These findings suggest that the introduction and use of ORT in northeastern Brazil had an important impact upon diarrhea mortality.
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