202 PAHO BULLETIN l vol. 14, no. 2, 1980
Additional resolutions dealt with control of
foot-and-mouth disease, rabies, and tick-
borne diseases. The Meeting endorsed the res-
olutions of the VII Regular Meeting of the
South American Commission for the Control
of Foot-and-Mouth Disease and insisted on
the advisability of having all technical and fi-
nancial assistance rendered according to the
regional concept established by the countries
of the Americas for the control of the disease
(Resolution VI). Concerning rabies, the Meet-
ing asked that PAHO give priority attention
to programs dealing with both urban and bo-
vine paralytic rabies; it also recommended
that the Pan American Zoonoses Center as-
sign priority to the rabies problem and ex-
pand its direct cooperation with those coun-
tries having rabies problems in the areas of di-
agnosis, production of biologicals, epidemiol-
ogy, and control systems. Those countries
with rabies problems were urged to imple-
ment national rabies control programs (Reso-
lution VIII). As for tick control, the Meeting
recommended that the Inter-American Insti-
tute for Agricultural Sciences contribute to a
program already in progress in Costa Rica for
research on control of ticks and tick-borne
diseases affecting livestock in Central Ameri-
ca, Mexico, Panama, and other subtropical
and tropical countries.
DIARRHEAL DISEASE CONTROL IN THE CARIBBEAN
Representatives of 15 Caribbean countries
and territories ’ met in Kingston, Jamaica,
on lo- 13 March 1980 to discuss recent break-
throughs in diarrhea1 disease control and
establishment of national diarrhea1 disease
control programs. The meeting, entitled
Caribbean Seminar-Workshop on Diarrhea1
Disease Control, featured presentations by a
number of experts in the field and workshop
sessions designed to develop recommenda-
tions about national programs. The event
was supported by a 1979 PAHO Directing
Council resolution encouraging Member
Countries to establish national diarrhea1 dis-
ease control programs within the context of
their primary health care systems.
Dr. Dilip Mahalanabis, a World Health
Organization consultant, outlined some of
SAnguilla, Antigua, Bahamas, Barbados, Belize, Ber- muda, British Virgin Islands, Grenada, Guyana, Jamai- ca, St. Kitts. St. Lucia, Montserrat, Trinidad and Tobar go, Turks and Caicos Islands.
the basic epidemiologic facts about diarrhea1
diseases, including the following:
l In 1975, an estimated 500 million diarrhea,
cases occurred among African, Asian, and Latin, American children less than 5 years old, resulting in 5 million deaths.4
l A large multi-country study conducted in the
early 1970s5 found that 30 to 50 per cent of the Latin American children surveyed were dying before age 5, that 58 per cent of these deaths were associated with infectious diseases, and that diar- rhea (often associated with malnutrition) was the leading cause of death.
l Cholera poses an important potential threat.
Since 1961 eighty countries have reported cholera; eight new countries did so in 1978 alone, Many countries with high diarrhea morbidity, poor water supply systems, and unsanitary conditions now harbor endemic cholera.
l Over a third of the children’s hospital beds in
many developing countries are usually filled by
4’Rohde, J.E., et al. Therapy begins at home: manage- ment of acute diarrhea in the developing world. Proc lnt Gong of Ped (New Delhi, 1977): 809-819, 1977.
l ABSTRACTS AND REPORTS 203
diarrhea patients receiving expensive intravenous therapy and antibiotics.
l Oral rehydration therapy has now made it
possible to undertake a common program for
reducing deaths from acute diarrhea and diarrhea-
associated malnutrition. It also provides a good tool for promoting practices that will help prevent diarrhea long before many drqeloping countries
can attain necessary long-tevm improvement of
their socioeconomic condi+kms.
l Recognition of the roles some bacteria (espe-
cially enterotoxigenic E. CA) and newly discovered viruses (particularly rotaviruses) play in diarrhea
now permits identification of the causative agents
in about two-thirds of the diarrhea patients admit- ted to treatment centers. This contrasts vividly with the situation only a decade ago, when 80 per cent of the cases were undiagnosed and were classified
as “acute undifferentiated diarrheas.”
The Hon. Seymour Mullings, Minister of
Health and Social Security of Jamaica, made
a presentation reviewing the situation in his
country. Among other things, he noted that
breast-feeding is “perhaps the most important
single factor in preventing diarrhea1 disease,”
and that with this in mind the Ministry of
Health of Jamaica had launched a massive
breast-feeding education program in 1977.
An evaluation of the program, which ended
in August 1978, has just been completed.
Mr. Mullings also described a PAHO-assist-
ed clinical study on the use of oral rehydration
salts provided by UNICEF. This work, carried
out at the Bustamante Hospital for Children,
reduced the number of patients receiving
intravenous therapy dramatically. Most re-
cently, the Ministry of Health and Social
Security has been working with the Pediatrics
Department of the University of the West
Indies to get the oral rehydration technique
extended beyond hospitals to health centers in the field.
A more detailed report on the Bustamante
Hospital study was presented by Dr. Deanna
Ashley, Acting Senior Medical Officer for
Maternal and Child Health of the Jamaican
Ministry of Health. Dr. Ashley noted that the
study had sought to determine the possible
beneficial effects of administering oral re-
hydration therapy at the Hospital’s Casualty
Department and instructing the mothers of
infants with acute gastroenteritis about how
to provide such therapy at home.
The results of the study indicate that it is
possible to successfully treat mild to moderate
cases of gastroenteritis on an outpatient basis
with oral rehydration therapy and that after
receiving simple instructions, mothers can
safely continue the therapy at home. This
procedure, besides reducing the average
length of time spent in the Casualty Depart- ment from over 6 hours to 2.3 hours, pro- duced other marked benefits.
In January 1979, before the study began,
307 of 559 (55 per cent) of the gastroenteritis
patients seen in the Casualty Department
were admitted to the Hospital or were given
intravenous therapy. But in April, when the
project was in full swing, the number receiv-
ing intravenous therapy or admission shrank
to 22 of 552 (4 per cent) patients. Overall, the
study showed a sharp reduction in the staff
time and hospital costs involved.
In addition to these two descriptions of cur-
rent work in Jamaica, a number of other ac-
counts were presented. These dealt with the
following subjects: nutrition and diarrhea1
disease-by Dinesh Sinha; the WHO Global
Diarrhea1 Disease Control Program-by Dilip
Mahalanabis; UNICEF assistance to national
diarrhea1 disease control programs-by Kofi
Joppa; planning national diarrhea1 control
programs-by Robert E. Black; therapeutic
principles of rehydration therapy- by Angela
M. Ramlal (see p. 204); food hygiene in hospi-
tal formula rooms-by M. Torres-Angel, L.
Butcher, and G. Ferdinand; a programming
model for diarrhea1 disease control in the Car-
ibbean-by Michael J. McQuestion; the Car-
ibbean Epidemiology Center’s work on the
surveillance of diarrhea1 diseases-by Peter
Diggory; and laboratory identification of di-
arrheal disease agents at the University Hospi-
tal of the West Indies-by Dorothy King.
After these presentations, the participants
204 PAHO BULLETIN l vol. 14, no. 2, 1980
ous matters relating to national diarrhea1 dis-
ease control programs. The specific areas cov-
ered were (1) strategies for health care deliv-
ery; (2) promotional, educational, and orga-
nizational strategies at the community level;
(3) planning, management, monitoring, and
evaluation; (4) training needs; and (5) surveil-
lance.
The formal conclusions of the meeting
were:
1) Interested Member Countries and terri-
tories should make firm, clear commitments
to developing national diarrhea1 disease con-
trol (CDD) programs.
2) This commitment should entail the for-
mation of an interdisciplinary national (CDD)
committee, the designation of an appropriate
national program manager, and the develop-
ment of a national CDD program document.
3) National CDD programs should be inte-
grated with existing national primary health
care delivery systems on a country-specific ba-
sis.
4) Norms, training materials, and promo-
tional materials for national CDD program
activities should be based on WHO-recom-
mended guidelines and should be adapted to
local needs and customs.
5) Member Countries and territories are
encouraged to support local or area-lev-
el production or procurement of the WHO-
recommended oral rehydration salts (ORS).
6) PAHO, UNICEF, the Caribbean Epide-
miology Center, and the Caribbean Food and
Nutrition Institute are prepared to offer tech-
nical assistance to interested Member Coun-
tries and territories in all aspects of national
CDD program development.
7) In light of the Strategy and Plan of Ac-
tion to Corn bat Gastroenteritis and Malnutri- tion (SPA CGEM), 6 the participating Member
Countries and territories urged that the an-
nual Conference of Ministers Responsible for
Health in the Caribbean consider the develop-
ment of national CDD programs as an agenda
item at their next meeting.
6A document produced by a working 8~oup meeting on St. Vincent in January 1974 that has heretofore pro- vided the basis for policy on control of infant diarrhea1 diseases in the Caribbean.
Administration of Oral Rehydration Therapy 7 by Angela M. Randal’
A major breakthrough in our understanding and management of diarrhea1 disease
has come with the recognition that there appears to be a factor in the brush border
membrane of the small intestine that facilitates absorption of sodium, provided the so-
dium is coupled to glucose. This mechanism remains functional during diarrhea1 epi-
sodes of varied etiology and is applied clinically to the management of diarrhea by
lkbstracted from a paper entitled “Pathophysiology, Therapeutic Principles, and Local Clinical Re- search in Diarrhea1 Disease,” presented at the Caribbean Seminar-Workshop on Diarrhea1 Disease Control (Kingston, Jamaica, March 1980).
