Introduction

Richard L. Guerrant Division of Geographic Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia

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Along with malnutrition and respiratory tract infections, diarrhea and leishmaniasis constitute the leading causes of hospitalization in the pediatric wards at Hospital Walter Cantidio and Hospital Albert Sabin in Fortaleza, Ceara, Brazil. These leading diagnoses exemplify the major contribution that common infectious diseases and malnutrition make to the high morbidity and mortality rates seen among impoverished populations throughout the tropical, developing world. The data from large regional studies of causes of mortality, such as those of Puffer and Serrano, document the impressive contributions of diarrheal diseases, alone or in combination with malnutrition, as being responsible for 52.4% of the high childhood mortality in regions such as northeastern Brazil (see Table 1 in article by Guerrant and others in this symposium). These data are remarkably similar to those obtained from recent family histories such as those in the rural town of Pacatuba or in the urban favela (shantytown), Goncalves Dias, in Fortaleza, Ceara, in the heart of northeastern Brazil (see Table 2 in article by Guerrant and others in this symposium).

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