Authors: Gerald Keusch, Christa Fischer Walker, Demissie Habte, Jai Das, Susan Horton
The chapter explores the still-limited evidence on subclinical infections due to known microbial causes of diarrhea and impacts on intestinal physiology, nutrient absorption, and nutritional status as plausible mechanisms underlying growth stunting and developmental delays. The potential interventions for clinical and subclinical intestinal infections do not necessarily prove identical, although they undoubtedly overlap. Accordingly, epidemiology, transmission, and mechanisms of disease, as well as social and cultural factors instrumental in determining outcomes, require consideration. Diarrheal diseases remain good indicators of the stage of development of communities in low- and middle-income countries (LMICs) because of the impact of proximal and distal determinants of diarrheal morbidity and mortality, including the availability of (1) safe drinking water; (2) sanitation; (3) level of education, particularly of mothers; (4) income; (5) food security; (6) nutrition; and (7) access to health care, both preventive and therapeutic. Continued progress depends on recognition that intersectoral interventions remain integral to reducing or eliminating diarrheal diseases.