New Report Released By UNICEF And WHO Gives A 7-point Plan To Reduce Child Death Due To Diarrhea

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Main Category: Pediatrics / Children's Health
Also Included In: Public Health;  Immune System / Vaccines;  Water - Air Quality / Agriculture
Article Date: 16 Oct 2009 - 0:00 PST

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A new report released by UNICEF and WHO provides a seven-point plan for comprehensive diarrhea control. The plan and its objectives are discussed in a comment published Online First and in a future edition of The Lancet. The comment is the work of Dr Tessa Wardlaw, UNICEF, New York, USA, and Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO, Switzerland, and colleagues. Presently, nearly one in every five child deaths (around 1.5 million a year) is due to diarrhea. More children die from it than from AIDS, malaria, and measles combined.

In developing countries, only 39 percent of children with diarrhea receive the recommended treatment. Limited trend data suggest little progress since 2000. Zinc supplements are largely out of stock in most developing countries. Five years after UNICEF and WHO recommended the use of low-osmolarity oral rehydration salts in programs, they are still often unavailable.

In many areas, there has been progress on the prevention side. Particularly in vitamin A supplementation, measles immunisation, access to safe drinking water, and exclusive breastfeeding. But still much work remains in other areas. In most developing countries rotavirus vaccine is not available. Important improvement is needed in sanitation, breast-feeding rates and supplying drinking water.

The authors explain: "Vaccination against rotavirus, which causes 40% of hospital admissions from diarrhoea in children under 5 worldwide, has recently been recommended for inclusion in all national immunisation programmes. Accelerating its introduction in Africa and Asia, where the rotavirus burden is greatest, needs to become an international priority."

The 7-point plan includes two treatment and five prevention strategies. For treatment, children need fluid replacement to prevent dehydration, and zinc supplements. Oral rehydration therapy is the basis of fluid replacement. The key standard is low-osmolarity oral rehydration solution. Important additional components include continued feeding, including breastfeeding, and use of appropriate fluids in the home if oral rehydration solution is not available, along with increased fluids in general.

The prevention package consists of:

1- Rotavirus and measles vaccinations
2- Promotion of early and exclusive breastfeeding and vitamin A supplementation
3- Promotion of hand washing with soap
4- Improvement of water quantity and quality, including treatment and safe storage of household water
5- Promotion of community-wide sanitation

The authors write in conclusion: "We know what works to reduce child deaths from diarrhoea and what actions will make a lasting reduction in the burden of diarrhoea. We need to make the prevention and treatment of diarrhoea everybody's business, from families and communities to government leaders to the global community."

"Diarrhoea: why children are still dying and what can be done"
Tessa Wardlaw, Peter Salama, Clarissa Brocklehurst, Mickey Chopra, Elizabeth Mason
DOI: 10.1016/S0140-6736(09)61798-0
The Lancet

Written by Stephanie Brunner (B.A.)
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