OBJECTIVES: Acute diarrheal disease (ADD) remains a leading cause of morbidity and mortality in children under 5 worldwide. In Paraguay, the introduction of the rotavirus vaccine in 2010 aimed to reduce the burden of ADD in infants and young children. This study analyzed 31 years of public data on ADD morbidity and mortality in Paraguayan children under 5 and evaluated the impact of rotavirus vaccination. METHODS: Annual ADD incidence, total deaths, and mortality rates from 1993 to 2023 were obtained from public databases. Proportionate mortality due to ADD, cause-specific mortality rates, absolute risk reduction (ARR) and relative risk reduction (RRR), and joinpoint regression were calculated using EPIDAT 4.2 and Joinpoint 5.3.0 software, with data stratified by age group and vaccination period. RESULTS: Between 1993 and 2021, pediatric mortality in Paraguay declined steadily across all age groups. Following the introduction of Rotarix in 2010, infant mortality dropped from 2.36 to 0.19 deaths per 1,000 live births (ARR, 0.83; RRR, 81.4%). Joinpoint analysis showed a decline in under-5 mortality between 2009 and 2012 (annual percentage change=−35.2%, p<0.05), followed by stabilization. ADD incidence increased until 2019 and then declined, while vaccine coverage exceeded 70%. CONCLUSIONS Paraguay has sustained declines in infant and childhood mortality over 3 decades through improvements in healthcare and immunization, with the 2010 introduction of Rotarix reducing the mortality rate by 43 deaths per 100,000 infants under 12 months. These results underscore the impact of vaccination and health system strengthening, while highlighting the need to monitor emerging threats.

Background: While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. Methods: We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes. Results: During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years—mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80–0.82) for 30-day mortality. Conclusion Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.