Prospective Study of Diarrheal Illnesses in Northeastern Brazil: Patterns of Disease, Nutritional Impact, Etiologies, and Risk Factors

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Abstract
Diarrhea is a leading cause of death in tropical countries. One of the highest childhood mortalities is in northeastern Brazil, where little is known about the morbidity, etiology, and risk factors of diarrhea. Prospective village surveillance over 30 months revealed diarrhea attack rates of more than seven episodes per child-year at six to 11 months of age among the children of the poorest families. Other risk factors included early weaning and the lack of toilets. Diarrhea led to weight loss and stunted growth. Enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens, accounting for 21% and 19% of cases, respectively, followed by Shigella species (8.0%), Campylobacterjejuni (7.5%), Giardia species (6.7%), Strongyloides species (5.3%), and enteropathogenic E coli serotypes (4.6%). Most (84%) enterotoxigenic E coli were isolated during the rainy season of October to March (P < 0.03), whereas 71% of rotaviral illnesses occurred during the drier months of June to October (P < 0.03). In the present study, the early occurrence and nutritional impact of diarrhea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns haw been defined for this region in which life-threatening diarrhea is endemic.