The evolution of diarrhoeal diseases and malnutrition in Costa Rica: The role of interventions

Abstract

Costa Rica has an infant mortality rate of 17.7%, one of the lowest for developing countries. While it is noted that it is difficult to demonstrate the contributions of specific interventions in accounting for the drastic decline in diarreal disease and infant mortality in the last 2 decades, a graphical comparison of the 2 trends reveals a remarkable correspondence. Field studies also reveal a strong association between fetal growth and infant survival, even in hygienically poor environments. This paper traces the decline of infant mortality from the 1930's to the present and discusses the combination of actions and conditions that have resulted in the improved health status of the population. Democracy, political stability, and priority support for education, health, and agriculture led to the establishment and maintenance of such interventions as providing rural communities with potable water supplies and adequate sewer systems, in addition to health education. Also discussed are the effect of infections on nutritional status and the environmental factors influencing the rates of diarrheal disease and death; e.g., income and communications infrastructures, maternal environment and birth spacing, a rural community health program, oral rehydration therapy, the promotion of breastfeeding, and food supplementation programs. The case of Costa Rica provides a successful example of the holistic approach to improving people's health and securing national development.