The epidemiologic importance of dysentery in communities.

This paper explores the epidemiologic importance of dysentery with use of several community studies that demonstrate its prevalence and incidence as well as its association with pathogens, nutritional status, persistent diarrhea, and death. Results of these studies showed that while watery diarrhea was most prevalent in children aged 6-11 months, the prevalence of dysentery peaked between 18 and 23 months of age. Severely stunted children were found to have significantly prolonged episodes of dysentery. Shigella and persistent diarrhea were more frequent in children with dysentery than in those with nonbloody diarrhea. A striking feature was that watery diarrhea, dysentery, persistent diarrhea, and malnutrition each account for less than 5% of all deaths among children aged less than 5 years. However, persistent diarrhea in association with malnutrition causes 13% of deaths in children aged 0-4 years and 27% of deaths in those aged 1-4 years. These data suggest that a more balanced strategy for diarrheal control is required simply because most diarrheal deaths occur among malnourished children with prolonged diarrhea, which is mainly due to dysentery. Results of the studies also suggest that methods to control dysentery in the community should focus on improved hygiene and antimicrobial treatment with use of appropriate algorithms. Recognition of the synergism between dysentery and persistent diarrhea accompanied by malnutrition is crucial in formulating effective programs for control of diarrhea.