Mexico reduces childhood deaths from diarrhoeal disease
In Mexico, determined efforts by the government to
promote the use of oral rehydration therapy, immunize children against
measles, and improve access to safe water and sanitation have succeeded
in reducing childhood deaths from diarrhoeal diseases by 60% in less
than a decade. Other key factors include an increase in education
levels among women, investment of adequate resources, and the widespread
use of case management guidelines.
In developing countries, diarrhoeal diseases are a major
cause of death among children under five -- accounting for about 1.5
million deaths every year. Children die because their bodies are weakened
through rapid loss of fluids and undernourished through lack of food.
And parents often fail to recognize the danger signals before it is
too late. Yet most of these child deaths could be prevented. Up to
90% of diarrhoeal deaths can be prevented through the use of low-cost
oral rehydration therapy (ORT) and continued feeding.
Before the introduction of ORT in 1979, and its gradual
take-up by developing countries, diarrhoeal diseases were the number
one childhood killer -- accounting for 4.6 million deaths a year among
children under five. Since then, diarrhoeal deaths have been reduced
by over two-thirds. Other interventions which have also helped in
preventing diarrhoeal deaths are improved access to safe water and
sanitation, promotion of exclusive breastfeeding, immunization against
measles (a risk factor for diarrhoeal disease), better nutrition (including
administration of vitamin A), and improvements in the education of
women. In Mexico, the widespread promotion of ORT for home case management
-- coupled with efforts to improve access to safe water and sanitation
-- has had a major impact in reducing the number of diarrhoeal deaths
among children under five. Since the introduction of ORT in Mexico
in 1984, mortality rates have fallen by 60% in less than a decade --
from over 212 deaths per 100 000 children in 1984 to under 63 by
What is remarkable about this achievement is that the
most significant declines in death rates occurred during the early
1990s -- at a time when a cholera epidemic was sweeping through the
Americas -- adding to the overall burden of disease and threatening
to reverse hard won gains.
In response, mass media campaigns were launched throughout
Mexico to promote the use of ORT. Supplies of oral rehydration salts
skyrocketed from 7.6 million packets a year to almost 80 million packets
a year. As a result, ORT use increased from zero in the early 1980s
to over 80% of cases by 1993, surpassing the mid-decade target set
by the 1990 World Summit for Children of 80% ORT use by 1995. In addition,
the government intensified efforts to immunize children against measles
and stepped up efforts to improve sanitation and provide safe water.
The proportion of mothers reporting correct home-based
case management increased rapidly and ORT was also widely available
in health facilities. As a result, the proportion of under-fives deaths
due to diarrhoeal diseases fell from over 26% in 1983 to 11% in 1993.
Other factors widely believed to have contributed to
Mexico's success in reducing diarrhoeal deaths are the increase in
education levels among women, strong political commitment, adequate
resources, and the existence of a solid base of trained health professionals
in the diarrhoeal control programme with extensive experience of the
case management strategy. The Mexican Government is now building on
the success of the ORT treatment to make use of the broader IMCI strategy
to further reduce deaths among children under five.