Health

Diarrhoea

Acute diarrhoea still a major cause of child death

Diarrhoeal diseases account for nearly 1.3 million deaths a year among children under-five years of age, making them the second most common cause of child deaths worldwide. Over half of the deaths occur in just five countries: India, Nigeria, Afghanistan, Pakistan and Ethiopia.

Oral rehydration salts (ORS) and oral rehydration therapy (ORT), adopted by UNICEF and WHO in the late 1970s, have been successful in helping manage diarrhoea among children. It is estimated that in the 1990s, more than 1 million deaths related to diarrhoea may have been prevented each year, largely attributable to the promotion and use of these therapies. Today, however, there are indications that in some countries knowledge and use of appropriate home therapies to successfully manage diarrhoea, including ORT, may be declining.

Source: Progress for Children, 2007

Measures to prevent childhood diarrhoeal episodes include promoting exclusive breastfeeding, raising vitamin A supplementation rates, improving hygiene, increasing the source of improved sources of drinking water and sanitation facilities, promoting zinc intake and immunization against rotavirus.

Improved Diarrhoea Management to Reduce Child Deaths

Two recent advances in managing diarrhoeal disease – newly formulated oral rehydration salts (ORS) containing lower concentrations of glucose and salt, and zinc supplementation as part of the treatment and rotavirus vaccines  – can drastically reduce the number of child deaths. These new methods, used in addition to prevention and treatment with appropriate fluids, breastfeeding, continued feeding and selective use of antibiotics will reduce the duration and severity of diarrhoeal episodes and lower their incidence. Families and communities are key to achieving the goals set for managing the disease by making the new recommendations routine practice in the home, the community and in health facilities.

The revised recommendations, formulated by UNICEF and WHO in collaboration with the United States Agency for International Development (USAID) and experts worldwide, take into account new research findings while building on past recommendations. Success in reducing diarrhoea depends on acceptance of the scientific basis and benefits of these therapies by governments and the medical community. It also depends on reinforcing family knowledge of prevention and treatment of diarrhoea, and providing information and support to underserved families.

The revised recommendations emphasize family and community understanding of preventing, recognizing and appropriately managing diarrhoea. When they become routine practice, caretakers will act quickly at the first sign of diarrhoea, rather than waiting before treating the child.

Mothers and other caretakers should

  • Improve hygiene through hand washing with soap, increase use of improved sources of drinking water and sanitation facilities.
  • Prevent dehydration through the early administration of increased amounts of appropriate fluids available in the home, and ORS solution, if on hand
  • Provide children with 20 mg per day of zinc supplementation for 10-14 days as part of the diarrhoea treatment
  • Promote exclusive breastfeeding and increase breastfeeding and all feeding during and after the episode of acute diarrhoea
  • Recognize the signs of dehydration and take the child to a health care provider for ORS or intravenous electrolyte solution, as well as familiarize themselves with other symptoms requiring medical treatment (e.g. bloody diarrhoea)

Health care workers should

  • Counsel mothers to begin administering suitable available home fluids immediately upon onset diarrhoea in a child.
  • Treat dehydration with ORS solution (or with an intravenous electrolyte solution in cases of severe dehydration) and provide children with 20 mg per day of zinc supplementation for 10-14 days as part of the treatment
  • Emphasize continued feeding or increased breastfeeding during, and increased feeding after the diarrhoeal episode.
  • Use antibiotics only when appropriate, i.e. in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrhoeal drugs.
  • Advise mothers of the need to increase fluids and continue feeding during episodes of acute diarrhoea.
  • Promote hygiene, sanitation and water
  • Promote and ensure adequate vitamin A supplementation


UNICEF, WHO and other partners support these actions by

  • Advocating, facilitating and investing resources to ensure country adoption and implementation of these revised recommendations
  • Working with governments and the private sector, including non-governmental organizations and businesses, to rapidly disseminate and implement these recommendations.
  • Ensuring adequate supplies of  new ORS and zinc supplements
  • Helping with communication efforts aimed at enhancing prevention and management of diarrhoea, including promoting routine use of new ORS and zinc supplements.
  • Working with countries to build local capacities to introduce and scale up the use of zinc supplementation as part of diarrhoea management.
  • Working with governments to introduce Rotavirus vaccines as per GIVS recommendations.

 


 

 

 

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References

WHO/UNICEF. Clinical management of acute diarrhoea. New York:World Health Organization/United Nations Children’s Fund, 2004

Black, RE et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet. 2010. Vol. 375, Issue 9730, pp. 1969-1987.

Fischer Walker, CL and Black, RE. Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size. BMC Public Health. 2011. 11(Suppl 3):S16

WHO, Rotavirus surveillance worldwide – 2009. Wkly Epidemiol Rec,  86  (2011), pp. 173–176

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