Risk factors for fatal childhood diarrhea: a case-control study from two remote Panamanian islands.

Between September 1979 and March 1980, distinguishing features between fatal and nonfatal cases of diarrhea caused by the same etiologic agents were sought in a case-control investigation of Cuna Indian children living on the San Blas Islands located off Panama's Caribbean coast. The eight fatal cases of diarrhea (four associated with rotavirus, one with Giardia lamblia, and three without identifiable pathogens), which occurred in a cohort of 186 children aged less than five years who were followed for seven months, were matched with 24 contemporaneously occurring nonfatal cases of diarrhea. Weight-for-length measurements falling below the 90th percentile of the reference standard, reliance on traditional rather than equally as available Western medicine, and failure to receive oral rehydration solution were significantly more common among fatal than nonfatal cases. Incorporating traditional medicine men with their long-standing village-wide authority into expanded community health education programs that emphasize the importance of early treatment of diarrhea with oral rehydration solution would probably reduce mortality associated with diarrheal illness in this population.