This represents a reduction of 9 1% and 3 5%, respectively, for a

This represents a reduction of 9.1% and 3.5%, respectively, for a mean stay of 4 days. The value of HAA in 2000 was adjusted

for inflation, based on the year 2010. Since the 1980s, the overall infant mortality trend and that caused by diarrhea are described as downwards, both in Brazil3, 12 and 13 and worldwide.2 and 6 However, learn more it has been reported that progress in the decease of global mortality has not been accelerated, when compared with three decades ago;7 the same was observed in Brazil in the previous decade.13 In parallel, a slow progress has been observed in the implementation of the new global recommendations for diarrhea control.1 Contaminated water, inadequate sanitation, and poor hygiene still account for 88% of world deaths due to diarrhea.1 This slow progress in the management of diarrheal disease may be a factor contributing to the stabilization of infant mortality, since this disease is the second infectious cause of this indicator worldwide.1 and 2 It is fair to say that the current rates of mortality attributable to this disease in Brazil, albeit low, are still unacceptable. This is a disease transmitted via fecal-oral route; it is self-limited, preventable, of simple management at home with ORS, and does not Bortezomib mouse require technology or relatively high costs for its prevention. In some parts of Brazil, diarrhea is still

a major public health problem.3 The regional heterogeneity in mortality rates from diarrhea described here reflects the socioeconomic and cultural inequality, as well as the difficulty of access to health care and sanitation.The Northeast and Midwest showed higher rates of reduction in these coefficients when compared to the South and Southeast. Although these regions showed higher levels of these indicators in 2000, which could explain the higher rates of reduction, it is possible that this downward

trend is a reflection of national public health strategies, such as the Family Health program, training programs Methocarbamol for professionals on diarrheal disease monitoring, rotavirus vaccine campaigns, breastfeeding encouragement programs, and vitamin A supplementation. These strategies were implemented in important sectors, especially after the 1990s, with promising results on the impact of overall mortality, as well as mortality due to diarrheal disease, in children younger than 5 years.3, 14, 15, 16 and 17 It is possible that the recent investments aimed at reducing inequalities have been an important factor on infant mortality due to diarrhea in some regions;3 however, this assumption should be taken with caution due to the limitation of academic studies on infant mortality in regions such as the North and the Midwest.13 Such prevention strategies were considered models for export;16 however, regarding the treatment of diarrhea, Brazil does not explicitly adopt the recommendation of low-osmolarity ORS (66 countries) and zinc supplementation (46 countries).

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