[The National Program to Control Diarrheal Diseases: its impact on health and health services].

The frequency and distribution of diarrheal diseases as well as their health impact are determined by numerous factors including the cultural and educational level of mothers nutritional status basic sanitation and access to health services and their quality. Diarrheal control programs should consider all these aspects and involve diverse sectors of society not just health institutions. But the appearance of oral rehydration an effective simple and inexpensive treatment for diarrhea has caused a surge in diarrheal treatment programs within health institutions. By preventing or correcting dehydration oral rehydration allows mortality from diarrhea to be reduced in the short run. Mexicos National Program for Diarrheal Disease Control was founded in 1984 to promote oral rehydration with the formula recommended by the World Health Organization. The program has since grown prompted in part by the arrival of the cholera epidemic in Mexico. The number of oral rehydration packets distributed increased from four million in 1984 to 78 million in 1993. The fear of cholera increased receptivity of the population to information about oral rehydration. Over 150000 health workers were trained in 1993. National surveys of diarrheal management demonstrate that the average annual number of diarrheal episodes per child declined from 3.5 in 1991 to 2.2 in 1993. Diarrheal deaths in children under five declined by more than 50% between 1990 and 1993. The program has converted mortality analysis from a historical exercise into an instrument of epidemiologic monitoring and timely evaluation of health programs. The techniques of monthly analysis of mortality data and verbal autopsies used by the diarrheal control program could also be applied to other health problems.