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[Infant and child morbidity and mortality due to diarrheal disease in central Africa].


 Diarrheal diseases in Central African countries have often been identified as the 2nd leading cause of death after measles and the 2nd leading cause of morbidity after malaria. These diseases are responsible for death rates in children under 5 that range from 58/1000 in urban centers to 150 in rural areas, and they impose heavy costs on the health services for both pediatric beds and intravenous rehydration. Diarrhea contributes to malnutrition and to high fertility rates among parents who believe they must have many children to insure survival of a few. To study patterns of diarrheal disease in the region, 10 sites with different characteristics were selected for survey. 9 surveys of locations with widely varying climatic, ecologic, demographic, and socioeconomic conditions have been completed, 3 in Cameroon, 1 in the Central African Republic, 2 in Congo, 1 in Gabon, and 2 in Chad. All but 1 of the surveys were conducted between October 1983 and March 1985. The methodology was based on the cluster sampling recommended by the World Health Organization, which has the advantages of relative speed, moderate cost, and low personnel requirements. The clusters were either a village in rural areas or a section of an urban area. Interviewers obtained information about the number of children under 5 in the household, the number who had diarrhea in the previous 15 days and the treatment given, the number dying in the 12 months preceding the survey and the cause of death, whether diarrhea was a factor, and the age of the child at the time of death. A total of 63,107 children under 5 belonging to 33,051 households were surveyed. 12,732 episodes of diarrhea in the preceding 15 days were reported. It was estimated that each child in the region had an average of 4.8 episodes of diarrhea per year. The rate of diarrheal morbidity varied significantly by climatic zone. A follow-up survey of diarrheal morbidity figures from sentinel health centers is underway to determine the significance of climatic and seasonal variations. Only 7.1% of the reported diarrheal episodes were treated by oral rehydration therapy. 50.7% received some other form of medical treatment, 27.4% received traditional treatment, and 14.7% were not treated. Oral rehydration was not used at all in 2 survey locations and use exceeded 13% in only 3 locations. Diarrhea was a factor in 53% of reported deaths in infants and small children. Deaths due to diarrhea without any associated cause were in 2nd place following measles. Mortality rates due to diarrhea varied from under 65/1000 in survey sites with tropical or equatorial climates to 119.31 and 263.9.1000 in sites with Sahelian climates. Rural diarrheal mortality rates were higher than urban rates except in N'djamena, Chad.
