Environmental and Educational Interventions against Diarrhea in Guatemala

Abstract

Diarrheal diseases play an important role in the incidence of malnutrition. Diarrhea and malabsorption in association with malnutrition are best documented and most devastating in young children.^1,2 Data presented and discussed in a workshop sponsored 10 years ago by the U.S. National Academy of Sciences³ supported the concept that improved nutrition would result from the prevention of enteric infection and enteric diseases because (a) infections decrease food intake and increase metabolic losses, (b) diarrhea produces malabsorption of nutrients, and (c) chronic, subclinical enteric disease is associated with impaired tests of intestinal function, such as the absorption of D-xylose and vitamin B₁₂, and with morphologic abnormalities of the intestinal mucosa. It is believed that these abnormalities are related to alterations in microbial colonization of the gut or to chronic or recurrent intestinal infections. Lindenbaum and co-workers^4,5 showed that the structural and functional gastrointestinal changes observed in an indigenous population and visitors living in developing countries where sanitation is poor and there is a high incidence of diarrheal diseases can revert to normal after the individuals live for several months or years in a more sanitary environment.