A steep decline of death in a shigellosis epidemic in Bangladesh by a community--participated intervention.

The outcome of an intervention of a shigellosis epidemic during April-July 1985 at Dimla, northern Bangladesh is reported. People of the epidemic-affected community operated a makeshift hospital to provide early indoor treatment for 1,708 patients of blood dysentery, based on empirically selected antibiotic(s), oral rehydration of the patients and giving them high-protein diets. They raised funds and received technical and logistic assistance from the physicians and officials of the local government health centre and of the International Centre for Diarrhoeal Disease Research, Bangladesh. In comparison with the number of deaths recorded before intervention, there was a 187-fold reduction of case-fatality ratio from 11.2 to 0.06% (p less than 0.0001). Probable causes for this precipitious decline of mortality are discussed. It is concluded that such a community action in the intervention of a rural shigellosis epidemic in a developing country may avert death almost totally.