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‘Diarrhoea: Why children are still dying and what can be done’

UNICEF/WHO joint report on preventing and treating the second leading killer of children

© UNICEF/NYHQ2003-0458/Noorani
Outside the Adja-Ouere community health centre in Benin, where the infant mortality rate for children under five remains one of the world’s highest, a woman gives a toddler a spoonful of oral rehydration salts to treat diarrhoeal dehydration.

NEW YORK, USA, 14 October 2009 – A new report released by UNICEF and the World Health Organization today lays out a seven-point plan to reduce the incidence of diarrhoea worldwide.

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Diarrhoea is the second leading killer of children. Nearly one in five children under the age of five dies as a result of dehydration, weakened immunity or malnutrition associated with diarrhoea.

But it is a preventable and easily treatable disease.

“It is a tragedy that diarrhoea, which is little more than an inconvenience in the developed world, kills an estimated 1.5 million children each year,” said UNICEF Executive Director Ann M. Veneman.

“We know where children are dying of diarrhoea,” said WHO Director-General Dr. Margaret Chan. “We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action."

Promising treatments

While mortality from diarrhoea among children under five has declined over the past two decades, overall incidence has remained steady at 2.5 billion cases per year. South Asia and Africa continue to shoulder the heaviest burden.

© UNICEF/NYHQ2003-0458/Noorani
A 14-year-old girl suffering from dehydration rests on her mother's lap in a paediatric hospital in Baghdad, Iraq.

In the new report – entitled ‘Diarrhoea: Why children are still dying and what can be done’ – UNICEF and WHO recommend a regimen of oral rehydration salts (ORS) and zinc to treat diarrhoea. These two interventions, combined with continued breastfeeding and fluid intake, can greatly reduce mortality.

Oral rehydration therapy has long been the gold standard of diarrhoea treatment and “one of the major medical advances of the 20th century,” said UNICEF Senior Health Specialist Mark Young.

“We now have an improved version of ORS called ‘low-osmolarity ORS’, which over the last couple of years has replaced the standard ORS and is now being rolled out and is saving more lives,” he noted.

Emphasis on prevention

“Were looking not just at diarrhoeal mortality, but also at the toll that morbidity takes,” said UNICEF Chief of Water, Sanitation and Hygiene Clarissa Brocklehurst. She stressed that frequent bouts of diarrhoea, even if not deadly, have a profound impact on a child’s immune system, nutritional status and cognitive development.

That’s why five of the seven recommendations in the report focus on prevention, rather than treatment. These suggested measures include:

  • Early and exclusive breastfeeding, and vitamin A supplementation
  • Rotavirus and measles vaccinations
  • Handwashing with soap
  • Improved water supply
  • Community-based sanitation.
© UNICEF/NYHQ2004-0518/Horner
A young child suffering from acute diarrhoea receives an intravenous drip in the paediatric ward of the Yonsan County Hospital in the Democratic People's Republic of Korea. UNICEF is providing the hospital with equipment, medicine and technical support.

Rotovirus vaccine

The new rotovirus vaccine has the potential to reduce up to 40 per cent of the hospital admissions that currently result from diarrhoea. But while it is affordable by the standards of developed nations, there is an obvious cost to supplying it to the millions of children at risk in the developing world.

Still, the report calls upon national governments to incorporate the vaccine into national immunization plans.

“It’s really up to us to support countries to incorporate the rotovirus vaccine and also the donors to ensure that countries that need it have funding,” said Dr. Young.

Need to expand access

Thirty years ago, a concentrated push by the international community was tremendously successful in reducing diarrhoeal deaths by scaling up the use of oral rehydration therapy. However, access to therapeutic treatments has remained stagnant since 2000.

“It’s a disappointment to many of us that diarrhoea has slipped so much, given that it is such a huge factor in child survival. And it’s a bit of a mystery as to why that has happened,” said Ms. Brocklehurst.

“Of course, other diseases have come in and caught the spotlight,” she added. “What it means is that the spending on the ways to reduce diarrhoeal disease is completely disproportionate to its impact.”




UNICEF correspondent Elizabeth Kiem reviews the new joint UNICEF/WHO report on preventing and treating diarrhoea.
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