[Mortality from acute diarrheal diseases in children under 5: Cuba 1959-1987]

The evolution of mortality from acute diarrheal disease in Cuba in children under 5 between 1959-87 was analyzed. Data for the years before 1962 were taken from a graduate thesis in vital statistics while annual reports of the National Bureau of Statistics based on death certificates were the source for later years. There were 1960 deaths due to acute diarrhea in children under 1 year in 1959 corresponding to a mortality rate of 10.3/1000 live births and 29.5% of total mortality in this age group. In 1987 there were 107 deaths and a rate of .6/1000 live births. 4.5% of the total mortality in children under 1 was due to diarrhea. Deaths from acute diarrhea among children under 1 thus declined by 94.2% during the period. Among children 1-4 there were 698 deaths due to diarrhea in 1959 yielding a mortality rate of 9.2/10000. In 1987 there were 11 deaths corresponding to a rate of .2/10000. Acute diarrhea accounted for 34% of all deaths in children aged 1-4 in 1959 and 2.2% in 1987. Mortality from acute diarrhea declined by 97.8% for children 1-4. Deaths from acute diarrhea represented 30.6% of all deaths in children under 5 in 1959 and 4.1% in 1987. The improved nutritional status of preschool children since 1959 is probably the single most important factor explaining the decreased role of diarrhea in child mortality. However substantial improvements in health and educational services hygiene and sanitary services and living conditions in general surely played a significant role. Cuba launched a program to control gastroenteritis in 1963 which was responsible for the 1st mortality declines. In 1970 the gastroenteritis program was incorporated into a program to reduce infant mortality from all causes by 50% during the 1970s. Oral rehydration therapy has been used in Cuba since 1983 to combat dehydration due to diarrhea. Several other steps are underway to reduce mortality and morbidity from acute diarrhea including promotion of breast feeding reduction of the proportion of low birth weight infants and development of vaccines against enteric viruses and bacteria.