Officially reported death rates from acute diarrheal disease for children in the first year of life show Guatemala to occupy a middle position among countries of the Americas. For the age group 1 to 4 years, the rates exceed those of any other. Distribution of deaths by months and years suggest recurring outbreaks of acute diarrhea, closely spaced, of varying size, of relatively long duration, and of an epidemiologic pattern consistent with spread by contact infection. The recorded causes of deaths should be interpreted as actually due to a synergism between infection and malnutrition.
Field studies of a Guatemalan highland child population aged less than 6 years established an annual case incidence of acute diarrheal disease that ranged from 135 per 100 pre-school children during a beginning epidemic to 41 per 100 during a more or less endemic period at the end of an outbreak. Repeated attacks in the same child in the course of a year occurred in both situations, but more frequently as general incidence increased. Attack rates were greatest at ages 6 through 17 months and continued at excessive levels during the second and third years of life. Frequency of attack and severity of illness coincided with the ages at which kwashiorkor is commonest.