Strategies and causes of reduced infant and young child diarrheal disease mortality in Cuba, 1962-1993.

This article describes the basic strategies employed by Cuba's Diarrheal Disease Control Program (DDCP) to reduce acute diarrheal disease (ADD) mortality among infants and young children from 1962 through 1993, together with the diarrheal disease trends recorded in these years. An initial control effort, the Program to Combat Gastroenteritis, began operating in 1963. Since then, in one form or another, increasingly effective efforts have consistently lessened ADD mortality. Among other things, these efforts have concentrated on providing improved sanitation, effective health education, proper nutrition (including promotion of breast-feeding and food hygiene), and adequate health care (which in recent times has placed increasing emphasis on oral rehydration therapy and primary care). Largely as a result, recorded infant ADD mortality fell from 12.9 deaths per 1,000 live births in 1962 to 0.3 in 1993, while recorded mortality from this cause among children 1-4 years old dropped from 6.4 deaths per 10,000 children in this age group in 1962 to 0.1 in 1993. Besides describing the work performed through 1993, the author also outlines plans for the period through 1999 that are directed at maintaining and perhaps augmenting these gains.