Strategies to Reduce the Devastating Costs of Early Childhood Diarrhea and Its Potential Long-Term Impact: Imperatives that We Can No Longer Afford to Ignore

We have long known that adequate water and sanitation help control child mortality and morbidity associated with diarrheal diseases. In western Europe and North America fears of preventable diseases such as cholera in the late 1800s drove the implementation of such measures. In tropical areas of the developing world on the other hand such fears drove the development and distribution of oral rehydration therapy in the late 1900s. Despite the huge life-saving impact of oral rehydration therapy however the morbidity associated with diarrheal diseases in developing tropical areas continues largely unabated and with burgeoning growth among impoverished populations it is greater than ever. In this issue of Clinical Infectious Diseases Sobel et al. combine an extensive evaluation of risk factors and protective factors noted in studies of pathogens in persons of an age group (age 12–59 months) that is often underrepresented in studies of diarrheal illness. This study complements a report by Blake et al. of children aged < 12 months in a similar environment in Sao Paulo Brazil. Few other studies have analyzed risk factors and protective factors according to different age groups for specific pathogens. Sobel et al. describe independent risk factors for diarrhea predominantly in toddlers such as presence of another household member with diarrhea and consumption of homemade juice. They also examine protective factors including the boiling of baby bottles and nipples child care at home and piped sewage. Hand washing by caretakers after helping children defecate protected against Shigella infection and preparing rice beans or soup in the morning and serving them to children after noon without adequate storage and further heating were associated with enterotoxigenic Escherichia coli infection. (excerpt)