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
Health care workers should
UNICEF, WHO and other partners support these actions by
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