Diarrheal diseases, nutritional status and health care: analysis of their interrelationships.

Abstract

The relationship between diarrheal disease, nutritional status, and health care was studied prospectively in Guatemalan Indian children 0-24 months of age. Subjects were drawn from the Patulul Project, a nutrition intervention study conducted by the Institute of Nutrition of Central America and Panama. The total population includes 7000 Indians who live on 12 coffee plantations in Guatemala. Data were collected from October 1977 to September 1978 and analyzed by quarter: October-December (dry season), April-June (rainy season), and January-March and July-September (transitional). Most diarrhea was found to occur during the rainy season, yet visits to a simplified health care clinic set up as part of the Patulul Project steadily declined from October to September. The conditional probability of visiting the clinic was calculated at less than 50% for children with either simple diarrhea or diarrhea with blood and mucus. Although there were no sex differences in the rate of diarrhea, boys with gastrointestinal disorders were more likely to be taken to the clinic than girls. When children were grouped by nutritional status (weight-for-age, length-for-age, weight-for-length), the cumulative incidence of and percent time ill with diarrhea with blood and mucus were consistently higher in malnourished children. The magnitude of the differences between nutritional groups was highest during the rainy season. The effects of diarrhea episodes and visits to the clinic on weight-for-age changes were also examined. Children with initially low weight-for-age (or=75%) and with diarrhea during the trimester gained significantly less weight-for-age during that period than children without diarrhea. In addition, children with diarrhea who visited the health clinic gained more weight-for-age than those with diarrhea who did not receive care. Diarrhea and health service utilization had less of an effect on well-nourished children. These results support the hypothesis that the negative nutritional consequences of diarrhea are more significant among malnourished children and demonstrate the positive effect of a simplified health care program on the nutritional status of children suffering from gastrointestinal disorders.