Selective primary health care: strategies for control of disease in the developing world. XV. Acute diarrhea.

Diarrhea claims the lives of at least five million children per year and is a major contributor to malnutrition in developing countries. A variety of infectious agents cause diarrhea through several pathogenic mechanisms. Bacteria such as Shigella can directly invade the intestinal mucosa, and those similar to Vibrio cholerae or enterotoxigenic Escherichia coli can produce toxins that alter cellular absorption and secretions. Rotavirus appears to cause 30%-40% of diarrhea in toddlers. Diarrhea frequently accompanies parasitic infestation and infections in other parts of the body. Several methods, including improvement of water supplies and sanitation and administration of vaccines and antibiotics, may be useful in preventing mortality and morbidity due to diarrhea. Oral rehydration to replace fluids and electrolytes, accompanied by attention to early feeding and encouragement of breast feeding, is the most effective and economical intervention currently available.