The impact of diarrhoeal disease on childhood deaths in the RSA, 1968-1985.

Diarrhoeal disease remains a major cause of morbidity and mortality in children in the RSA. In 1984, 8,984 deaths from diarrhoea of children under 5 years of age were registered, representing 27.7% of all registered deaths in this age group. Assuming a case/fatality ratio (deaths per 100 episodes of diarrhoea) of 0.6, it is estimated that 1.5 million cases of diarrhoea in children occurred during 1984 in the RSA. Analysis of diarrhoeal disease mortality rates revealed that the group at highest risk is black and coloured children under the age of 1 year. Over the period 1968-1985 there have been steady declines in diarrhoeal disease mortality rates for whites, coloureds and Asians. Uncertainty exists as to the true mortality rate in black children. A marked seasonal cycle is evident in diarrhoeal disease mortality rates for blacks and coloureds with peaks occurring in the period December-March. No seasonal effect on mortality is evident in the white and Asian groups. A nationally co-ordinated diarrhoea control programme is urgently needed in the RSA. This would involve a primary prevention component involving improved water supply, sanitation and sewerage, and a death prevention component emphasising the use of oral rehydration solutions. The seasonality in mortality suggests that the health education component of this programme should be aimed at the period just preceding the summer/autumn epidemic.