Global Burden of Diarrhea and Epidemiological Trends

Diarrheal illnesses in young children are among the leading causes of morbidity and mortality in developing countries. Diarrhea is an important cause of morbidity in developed countries as well. In developing countries, children younger than 5 years old suffer 3-10 episodes of diarrhea per year, whereas in developed countries young children have on average 1 or 2 diarrheal episodes per year. The advent of oral rehydration therapy (ORT) and its use in the past three decades have dramatically reduced the case fatality rate for diarrhea. However, globally the estimated 3 billion annual episodes of diarrhea account for approximately 2 million deaths in children younger than 5 years old. The majority of diarrhea-related mortality occurs in developing countries and the highest rates of diarrhea occur among infants with malnutrition. The case fatality rate is highest among children 6 months to 1 year old. The primary reason is that for most children this is the period when the immune system is not yet fully matured and the maternal antibodies are reduced. In addition, they may receive contaminated foods to complement breast-feeding, and they begin to crawl, potentially to areas where they may have direct contact with human or animal feces.

Although dehydration is the most direct effect of diarrhea, there are many adverse and potentially fatal nutritional consequences when proper nutritional management is not followed. This article provides an overview of the epidemiology of diarrheal diseases, including the interaction of diarrhea and malnutrition, and discusses the treatment of diarrhea, including fluid therapy and dietary management to minimize the nutritional cost of diarrhea.

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