Acute diarrhoea is still a major cause of child death
Diarrhoeal diseases account for roughly 530,000 deaths a year, 9% of total deaths 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. Despite this heavy toll, progress is being made. From 2000 to 2015, the total annual number of deaths from diarrhoea among children under 5 decreased by more than 50 per cent – from over 1.2 million to half a million.
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. Zinc, in addition to ORS, has shown significant improvement in shortening a child’s current episode of diarrhoea, and helping prevent against subsequent episodes.
Measures to prevent childhood diarrhoeal episodes, follow the traid of prevent, protect and treat, laid out by WHO and UNICEF’s Global Action Plan for Pneumonia and Diarrhoea (GAPPD), include promoting exclusive breastfeeding, raising vitamin A supplementation rates, improving hygiene, increasing availability of improved sources of drinking water and sanitation facilities, promoting zinc intake and immunization against rotavirus.
Source: UNICEF APR Report 2015, p.42
Improved Diarrhoea Management to Reduce Child Deaths
Three recent advances in managing diarrhoeal disease – newly formulated Oral Rehydration Salts (ORS) containing lower concentrations of glucose and salt, 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.
In 2005, ORS was typically available in countries as an OTC product but zinc was not despite being safe to use without supervision of a trained health provider. As a result, zinc could not be sold in pharmacies or at retail outlets without a prescription and could not be advertised directly to caregivers. In order to ensure widespread availability of zinc, particularly at the community level, partners worked closely with national regulatory authorities and other stakeholders to pursue the favorable policy change. By 2015, OTC status was secured in nine of the 10 focal countries supported by the Diarrhea & Pneumonia Working Group.
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 diarrhea
Recognize the signs of dehydration and take the child to a health care provider for ORS or intravenous electrolyte solutions and familiarize themselves with other symptoms requiring medical treatment (e.g. bloody diarrhoea)
Picture of ORS sachets and Zinc dispersible tablets
Adaptable communication materials for ORS and Zinc have been developed for countries to utilize and are available at http://www.zinc-ors.org/ . These materials are developed to supplement the iCCM/IMCI training manuals and job aids to help providers council caregivers.
Health care workers should:
- Counsel parents 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
- Ensure that the child has received the Rota virus vaccine, where available
UNICEF, WHO and other partners support these actions by:
- Leading the Global Diarrhea and Pneumonia Working Group, supporting high mortality countries in their efforts to reduce deaths from diarrhea.
- 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.
- Progress Over a Decade of Zinc and ORS Scale-Up: Best Practices and Lessons Learned
- Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD)
- Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children
- Pneumonia & Diarrhea Progress Report