INTERVENCIONES DE EFICACIA PROBADA EN LA PREVENCIÓN DE LA DIARREA AGUDA

Armando E. De Gracia Nieto

Enviado octubre 18, 2024

Publicado 2026-04-06

Artículos de Investigación

Vol. 17 Núm. 2 (2004): Revista Médica Científica

INTERVENCIONES DE EFICACIA PROBADA EN LA PREVENCIÓN DE LA DIARREA AGUDA

Armando E. De Gracia Nieto⁺⁻

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Publicado: 2026-04-06

Derechos de autor 2024 Revista médico científica

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.

Resumen

La diarrea es una de las principales causas de morbilidad y mortalidad en los países en vías de desarrollo. Se ha visto que la mortalidad por diarrea ha caído substancialmente a pesar del crecimiento de la población mundial y la inclusión de China en el análisis actual, pero la morbilidad ha seguido alta durante las pasadas cuatro décadas. Los programas de control de la diarrea , en países en vías de desarrollo, se basan en el manejo exitoso de los casos, principalmente con la terapia de rehidratación oral (TRO) y la promoción de la alimentación adecuada durante y después de un episodio de diarrea. Se necesitan medidas que sirvan para reducir signilicativamente la incidencia de la diarrea. La prevención de la diarrea, cuando se lleva apropiadamente, puede ser tan importante como el manejo de los casos, y puede ser la única manera de evitar la muerte en lugares en donde el tratamiento no está disponible. No hemos encontrado en nuestro país estudios de intervención para la prevención de la diarrea aguda en niños. En esta revisión, resaltaremos la importancia de las principales lormas de intervención que han mostrado ser lactibles para prevenir la diarrea en niños.

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Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003; 81(3):197-204. Epub 2003 May 16.
Santosham M, Daum RS, Dillman L, Rodriguez JL, Luque S, Russell R, et al. Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama. N Engl J Med. 1982; 306(18):1070-6.
Readings on diarrhoea: student manual. Geneva: World Health Organization; 1992.
Huttly SRA, Morris SS, Pisani V. Prevention of diarrhea in young children in developing countries. Bull World Health Organ. 1997; 75(2):163-74.
Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ. 2000; 78(10):1246-55.
Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Pediatrics. 1996; 97:424-35.
Ruel MT, Rivera JA, Santizo MC, Lonnerdal B, Brown KH. Impact of zinc supplementation on morbidity from diarrhea and respiratory infections among rural Guatemalan children. Pediatrics. 1997; 99(6):808-13.
Grotto I, Mimouni M, Gdalevich M, Mimouni D. Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: a meta-analysis. J Pediatr. 2003 Mar; 142(3):297-304.
Cheung YB, Jalil F, Yip PS, Karlberg JP. Association between size at birth, pediatric diarrhoeal incidence, and postnatal growth. Acta Paediatr Jpn. 2001; 90(11):1309-15.
Cremonini F, Di Caro S, Nista EC, Bartolozzi F, Capelli G, Gasbarrini G, Gasbarrini A. Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2002; 16(8):1461-
Soares-Weiser K, Goldberg E, Tamimi G, Pitan OC, Leibovici L. Rotavirus vaccine for preventing diarrhoea. Cochrane Database Syst Rev. 2004;(1):CD002848.
Morrow AL, Guerrero ML, Shults J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomized controlled trial. Lancet. 1999; 353:1226-31.
International Institute for Population Sciences (IIPS) and ORC Macro. National Family Health Survey (NFHS-2), 1998-99. Mumbai: IIPS, 2000.
Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomized controlled trial. Lancet. 2000; 356:1643-7.
Mahmood DA, Feachem RG, Huttly SRA. Infant feeding and risk of severe diarrhea in Basrah city, Iraq: A case-control study. Bull World Health Organ. 1989; 67(6):701-6.
Martines JC. The interrelationships between feeding mode, malnutrition and diarrhoeal morbidity in early infancy among the urban poor in southern Brazil. PhD thesis, University of London, 1988.
Lulseged S. Predictors of moderate to severe dehydration in acute diarrhoeal disease: a case-control study. Ethiop Med J. 1992; 30(2):69-78.
Ahmed F, Clemens JD, Rao MR, Sack DA, Khan MR, Haque E. Community-based evaluation of the effect of breastfeeding on the risk of microbiologically confirmed or clinically presumptive shigellosis in Bangladeshi children. Pediatrics. Sep 1992; 90:406-11.
GlassRI,StollBJ.Theprotectiveeffect01humanmilkagainst diarrhea: a review 01 studies lrom Bangladesh. Acta Paediatr Scand Supp11989;351:131-6.
Clemens JO, Sack DA, Harris JR, Khan MR, Chakraborty J, Chowdhury S, et al. Breast leeding and the risk 01severe cholera in rural Bangladeshian children.Am J Epidemiol1990; 131(3):400 11.
Ruiz-Palacios GM, Calva JJ, Pickering LK, Lopez-Vidal Y, Volkow P, Pezzarossi H, et al. Protection of breast-fed infants against Campylobacter diarrhea by antibodies in human milk. J Pediatr. 1990; 116(5):707-13.
Rowe SY, Rocourt JR, Shiferaw B, Kassenborg HD, Segler SD, Marcus R, et al. Breast-feeding decreases the risk of sporadic salmonellosis among infants in FoodNet sites. Clin Infect Dis. 2004; 38 Suppl 3:S262-70.
Long KZ, Wood JW, Vasquez Gariby E, Weiss KM, Mathewson JJ, de la Cabada FJ, et al. Proportional hazards analysis of diarrhea due to enterotoxigenic Escherichia coli and breast feeding in a cohort of urban Mexican children. Am J Epidemiol. 1994; 139(2):193-205.
Baqui AH, Black RE, Sack RB, Yunus MD, Siddique AK, Chowdhury HR. Epidemiological and clinical characteristics of acute and persistent diarrhoea in rural Bangladeshi children. Acta Paediatr Suppl. 1992; 381:15-21.
Del Fante P, Jenniskens F, Lush L, Morona O, Moeller B, Lanata CF, et al. HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding. J Trop Med Hyg. 1993; 96(4):203-11.
Here are the citations ordered by number:
Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trials (PROBIT): a randomised trial in the Republic of Belarus. JAMA. 2001; 285(4):413-20.
Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet. 2000; 356:1643-7.
Grummer-Strawn LM, Rice SP, Dugas K, Clark LD, Benton-Davis S. An evaluation of breastfeeding promotion through peer counselling in Mississippi WIC clinics. Matern Child Health J. 1997; 1:35-42.
Valdes V, Pugin E, Schooley J, Catalan S, Aravena R. Clinical support can make the difference in exclusive breastfeeding success among working women. J Trop Pediatr. 2000; 46:149-54.
Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: A cluster randomised controlled trial. Lancet. 2003; 361(9367):1418-23.
Schorling PA, McAuliffe JF, de Souza MA, Guerrant RL. Malnutrition is associated with increased diarrhoea incidence and duration among children in an urban Brazilian slum. Int J Epidemiol. 1990; 19(3):728-35.
Baqui AH, Sack RB, Black RE, Chowdhury HR, Yunus M, Siddique AK. Cell mediated immune deficiency and malnutrition are independent risk factors for persistent diarrhea in Bangladeshi children. Am J Clin Nutr. 1993; 58(4):543-8.
Yoon PW, Black RE, Moulton LH, Becker S. The effect of malnutrition on the risk of diarrheal and respiratory mortality in children <2 years of age in Cebu, Philippines. Am J Clin Nutr. 1997; 65(4):1070-7.
Sachdev HP, Kumar S, Singh KK, Satyanarayana L, Puri RK. Risk factors for fatal diarrhea in hospitalized children in India. J Pediatr Gastroenterol Nutr. 1991; 12(1):76-81.
Fauveau V, Henry FJ, Briend A, Yunus M, Chakraborty J. Persistent diarrhea as a cause of childhood mortality in rural Bangladesh. Acta Paediatr Suppl. 1992; 381:12-4.
Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ. 2000; 78(10):1207-21.
De Onis M, Frongillo EA, Blossner M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 2000; 78(10):1222-33.
Henry FJ, Patwary Y, Huttly SR, Aziz KM. Bacterial contamination of weaning foods and drinking water in rural Bangladesh. Epidemiol Infect. 1990; 104(1):79-85.
Motarjemi Y, Kaferstein F, Moy G, Quevedo F. Contaminated weaning food: a major risk factor for diarrhea and associated malnutrition. Bull World Health Organ. 1993; 71(1):79-92.
Mensah PP, Tomkins AM, Drasar BS, Harrison TJ. Fermentation of cereals for reduction of bacterial contamination of weaning foods in Ghana. Lancet. 1990; 336(8708):140-3.
Monte CMG. Improving weaning food hygiene practices in a slum area of Fortaleza, north-east Brazil: a new approach. PhD thesis, University of London, 1993.
Water, Sanitation and Hygiene Links to Health. Facts and figures. Updated March 2004. World Health Organization.
World Bank. World development report: development and the environment. New York, Oxford University Press, 1992:112.
Informe Final del Taller sobre Evaluación e Implementación de las Iniciativas sobre Recursos Hídricos y Áreas Costeras en la Región Ciudad de Panamá, 20-22 de octubre de 1997. Anexo 4.4. Privatización de los Servicios de Agua Potable y Alcantarillado en Panamá. Gestión Integrada de Recursos Hídricos en Mesoamérica. Unidad de Desarrollo Sostenible y Medio Ambiente, Secretaría General de la Organización de los Estados Americanos. Washington, D.C., 1998.
Esrey SA, Habicht JP, Roberts L, Shiff C. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ. 1991; 69(5):609-21.
Huttly SRA. The impact of inadequate sanitary conditions on health in developing countries. World Health Stat Q. 1990; 43(3):118-26.
Varley RC, Tarvid J, Chao DN. A reassessment of the cost-effectiveness of water and sanitation interventions in programmes for controlling childhood diarrhoea. Bull World Health Organ. 1998; 76(6):617-31.
Nanan O, White F, Azam I, Aisar H, Hozhabri S. Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan. Bull World Health Organ. 2003; 81(3):160-5. Epub 2003 May 16.
Clasen TF, Brown J, Collin S, Suntura O, Cairncross S. Reducing diarrhea through the use of household-based ceramic water filters: a randomized, controlled trial in rural Bolivia. Am J Trop Med Hyg. 2004; 70(6):651-7.
Curtis V, Kanki B, Cousens S, Diallo I, Kpozehouen A, Sangare M, et al. Evidence of behaviour change following a hygiene promotion programme in Burkina Faso. Bull World Health Organ. 2001; 79(6):518-27.
Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA. 2004; 291(21):2547-54.
Khan MV. Interruption of shigellosis by handwashing. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1982; 76:164-8.
Mertens TE, Jaffar S, Fernando MA, Cousens SN, Feachem RG. Excreta disposal behaviour and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka. Int J Epidemiol. 1992; 21(6):1157-64.
Cutts FT, Henderson RH, Clements CJ, et al. Principles of measles control. Bull World Health Organ. 1991; 69:1-7.
Kapoor SK, Reddaiah VP. Effectiveness of measles immunization on diarrhea and malnutrition-related mortality in 1-4 year olds. Indian J Pediatr. 1991; 58(6):821-3.

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[1] Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003; 81(3):197-204. Epub 2003 May 16.

[2] Santosham M, Daum RS, Dillman L, Rodriguez JL, Luque S, Russell R, et al. Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama. N Engl J Med. 1982; 306(18):1070-6.

[3] Readings on diarrhoea: student manual. Geneva: World Health Organization; 1992.

[4] Huttly SRA, Morris SS, Pisani V. Prevention of diarrhea in young children in developing countries. Bull World Health Organ. 1997; 75(2):163-74.

[5] Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ. 2000; 78(10):1246-55.

[6] Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Pediatrics. 1996; 97:424-35.

[7] Ruel MT, Rivera JA, Santizo MC, Lonnerdal B, Brown KH. Impact of zinc supplementation on morbidity from diarrhea and respiratory infections among rural Guatemalan children. Pediatrics. 1997; 99(6):808-13.

[8] Grotto I, Mimouni M, Gdalevich M, Mimouni D. Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: a meta-analysis. J Pediatr. 2003 Mar; 142(3):297-304.

[9] Cheung YB, Jalil F, Yip PS, Karlberg JP. Association between size at birth, pediatric diarrhoeal incidence, and postnatal growth. Acta Paediatr Jpn. 2001; 90(11):1309-15.

[10] Cremonini F, Di Caro S, Nista EC, Bartolozzi F, Capelli G, Gasbarrini G, Gasbarrini A. Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2002; 16(8):1461-

[11] Soares-Weiser K, Goldberg E, Tamimi G, Pitan OC, Leibovici L. Rotavirus vaccine for preventing diarrhoea. Cochrane Database Syst Rev. 2004;(1):CD002848.

[12] Morrow AL, Guerrero ML, Shults J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomized controlled trial. Lancet. 1999; 353:1226-31.

[13] International Institute for Population Sciences (IIPS) and ORC Macro. National Family Health Survey (NFHS-2), 1998-99. Mumbai: IIPS, 2000.

[14] Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomized controlled trial. Lancet. 2000; 356:1643-7.

[15] Mahmood DA, Feachem RG, Huttly SRA. Infant feeding and risk of severe diarrhea in Basrah city, Iraq: A case-control study. Bull World Health Organ. 1989; 67(6):701-6.

[16] Martines JC. The interrelationships between feeding mode, malnutrition and diarrhoeal morbidity in early infancy among the urban poor in southern Brazil. PhD thesis, University of London, 1988.

[17] Lulseged S. Predictors of moderate to severe dehydration in acute diarrhoeal disease: a case-control study. Ethiop Med J. 1992; 30(2):69-78.

[18] Ahmed F, Clemens JD, Rao MR, Sack DA, Khan MR, Haque E. Community-based evaluation of the effect of breastfeeding on the risk of microbiologically confirmed or clinically presumptive shigellosis in Bangladeshi children. Pediatrics. Sep 1992; 90:406-11.

[19] GlassRI,StollBJ.Theprotectiveeffect01humanmilkagainst diarrhea: a review 01 studies lrom Bangladesh. Acta Paediatr Scand Supp11989;351:131-6.

[20] Clemens JO, Sack DA, Harris JR, Khan MR, Chakraborty J, Chowdhury S, et al. Breast leeding and the risk 01severe cholera in rural Bangladeshian children.Am J Epidemiol1990; 131(3):400 11.

[21] Ruiz-Palacios GM, Calva JJ, Pickering LK, Lopez-Vidal Y, Volkow P, Pezzarossi H, et al. Protection of breast-fed infants against Campylobacter diarrhea by antibodies in human milk. J Pediatr. 1990; 116(5):707-13.

[22] Rowe SY, Rocourt JR, Shiferaw B, Kassenborg HD, Segler SD, Marcus R, et al. Breast-feeding decreases the risk of sporadic salmonellosis among infants in FoodNet sites. Clin Infect Dis. 2004; 38 Suppl 3:S262-70.

[23] Long KZ, Wood JW, Vasquez Gariby E, Weiss KM, Mathewson JJ, de la Cabada FJ, et al. Proportional hazards analysis of diarrhea due to enterotoxigenic Escherichia coli and breast feeding in a cohort of urban Mexican children. Am J Epidemiol. 1994; 139(2):193-205.

[24] Baqui AH, Black RE, Sack RB, Yunus MD, Siddique AK, Chowdhury HR. Epidemiological and clinical characteristics of acute and persistent diarrhoea in rural Bangladeshi children. Acta Paediatr Suppl. 1992; 381:15-21.

[25] Del Fante P, Jenniskens F, Lush L, Morona O, Moeller B, Lanata CF, et al. HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding. J Trop Med Hyg. 1993; 96(4):203-11.

[26] Here are the citations ordered by number:

[27] Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trials (PROBIT): a randomised trial in the Republic of Belarus. JAMA. 2001; 285(4):413-20.

[28] Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet. 2000; 356:1643-7.

[29] Grummer-Strawn LM, Rice SP, Dugas K, Clark LD, Benton-Davis S. An evaluation of breastfeeding promotion through peer counselling in Mississippi WIC clinics. Matern Child Health J. 1997; 1:35-42.

[30] Valdes V, Pugin E, Schooley J, Catalan S, Aravena R. Clinical support can make the difference in exclusive breastfeeding success among working women. J Trop Pediatr. 2000; 46:149-54.

[31] Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: A cluster randomised controlled trial. Lancet. 2003; 361(9367):1418-23.

[32] Schorling PA, McAuliffe JF, de Souza MA, Guerrant RL. Malnutrition is associated with increased diarrhoea incidence and duration among children in an urban Brazilian slum. Int J Epidemiol. 1990; 19(3):728-35.

[33] Baqui AH, Sack RB, Black RE, Chowdhury HR, Yunus M, Siddique AK. Cell mediated immune deficiency and malnutrition are independent risk factors for persistent diarrhea in Bangladeshi children. Am J Clin Nutr. 1993; 58(4):543-8.

[34] Yoon PW, Black RE, Moulton LH, Becker S. The effect of malnutrition on the risk of diarrheal and respiratory mortality in children <2 years of age in Cebu, Philippines. Am J Clin Nutr. 1997; 65(4):1070-7.

[35] Sachdev HP, Kumar S, Singh KK, Satyanarayana L, Puri RK. Risk factors for fatal diarrhea in hospitalized children in India. J Pediatr Gastroenterol Nutr. 1991; 12(1):76-81.

[36] Fauveau V, Henry FJ, Briend A, Yunus M, Chakraborty J. Persistent diarrhea as a cause of childhood mortality in rural Bangladesh. Acta Paediatr Suppl. 1992; 381:12-4.

[37] Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ. 2000; 78(10):1207-21.

[38] De Onis M, Frongillo EA, Blossner M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 2000; 78(10):1222-33.

[39] Henry FJ, Patwary Y, Huttly SR, Aziz KM. Bacterial contamination of weaning foods and drinking water in rural Bangladesh. Epidemiol Infect. 1990; 104(1):79-85.

[40] Motarjemi Y, Kaferstein F, Moy G, Quevedo F. Contaminated weaning food: a major risk factor for diarrhea and associated malnutrition. Bull World Health Organ. 1993; 71(1):79-92.

[41] Mensah PP, Tomkins AM, Drasar BS, Harrison TJ. Fermentation of cereals for reduction of bacterial contamination of weaning foods in Ghana. Lancet. 1990; 336(8708):140-3.

[42] Monte CMG. Improving weaning food hygiene practices in a slum area of Fortaleza, north-east Brazil: a new approach. PhD thesis, University of London, 1993.

[43] Water, Sanitation and Hygiene Links to Health. Facts and figures. Updated March 2004. World Health Organization.

[44] World Bank. World development report: development and the environment. New York, Oxford University Press, 1992:112.

[45] Informe Final del Taller sobre Evaluación e Implementación de las Iniciativas sobre Recursos Hídricos y Áreas Costeras en la Región Ciudad de Panamá, 20-22 de octubre de 1997. Anexo 4.4. Privatización de los Servicios de Agua Potable y Alcantarillado en Panamá. Gestión Integrada de Recursos Hídricos en Mesoamérica. Unidad de Desarrollo Sostenible y Medio Ambiente, Secretaría General de la Organización de los Estados Americanos. Washington, D.C., 1998.

[46] Esrey SA, Habicht JP, Roberts L, Shiff C. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ. 1991; 69(5):609-21.

[47] Huttly SRA. The impact of inadequate sanitary conditions on health in developing countries. World Health Stat Q. 1990; 43(3):118-26.

[48] Varley RC, Tarvid J, Chao DN. A reassessment of the cost-effectiveness of water and sanitation interventions in programmes for controlling childhood diarrhoea. Bull World Health Organ. 1998; 76(6):617-31.

[49] Nanan O, White F, Azam I, Aisar H, Hozhabri S. Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan. Bull World Health Organ. 2003; 81(3):160-5. Epub 2003 May 16.

[50] Clasen TF, Brown J, Collin S, Suntura O, Cairncross S. Reducing diarrhea through the use of household-based ceramic water filters: a randomized, controlled trial in rural Bolivia. Am J Trop Med Hyg. 2004; 70(6):651-7.

[51] Curtis V, Kanki B, Cousens S, Diallo I, Kpozehouen A, Sangare M, et al. Evidence of behaviour change following a hygiene promotion programme in Burkina Faso. Bull World Health Organ. 2001; 79(6):518-27.

[52] Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA. 2004; 291(21):2547-54.

[53] Khan MV. Interruption of shigellosis by handwashing. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1982; 76:164-8.

[54] Mertens TE, Jaffar S, Fernando MA, Cousens SN, Feachem RG. Excreta disposal behaviour and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka. Int J Epidemiol. 1992; 21(6):1157-64.

[55] Cutts FT, Henderson RH, Clements CJ, et al. Principles of measles control. Bull World Health Organ. 1991; 69:1-7.

[56] Kapoor SK, Reddaiah VP. Effectiveness of measles immunization on diarrhea and malnutrition-related mortality in 1-4 year olds. Indian J Pediatr. 1991; 58(6):821-3.

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