Tag Archives: diarrhoea

Scale up diarrhoea prevention to save lives

A widespread scale up of existing low-cost and effective tools to prevent and treat diarrhoea could substantially reduce diarrhoeal deaths and could be a major step towards achieving the Millenium Development Goal 4 of reducing child mortality by 2015, according to research published in PLoS Medicine.

Depressingly, in this modern era, diarrhoea—three or more loose bowel movements a day—is still a common cause of death in developing countries and is the 2nd biggest killer of young children (under 5 years) worldwide. Poor hygiene, inadequate sanitation and lack of clean, safe drinking water all contribute to the spread of the harmful viruses, bacteria and parasites that cause diarrhoea. Now, Fischer Walker and colleagues use their Lives Saved Tool (LiST) to estimate the potential lives saved after implementing two different scale-up scenarios for key diarrhoeal prevention (breastfeeding, vitamin A supplements, basic water, sanitation, hygiene, and rotavirus vaccination) and treatment (oral rehydration salts, zinc supplementation, and antibiotics for dysentery) intervention strategies in 68 countries with high childhood mortality.

The researchers put forward two scenarios for the priority countries, which included Bangladesh, China and Haiti, for a 5-year period (between 2010 and 2015)—the “ambitious” (which assumed feasible improvement in all interventions) and the “universal” (which assumed near 100% coverage for all interventions). By 2015, diarrhoeal deaths could be reduced by 78% and 92% in the ambitious and universal scenarios, respectively. With the universal scenario, nearly 5 million deaths could be averted at an additional costs of US$0.80 per capita using some of the key diarrhoea prevention and treatment interventions (such as rotavirus vaccination and oral rehydration salts) and $3.24 per capita when all sanitation and water interventions (such as handwashing, improved sanitation and access to safe, clean water) implemented.

Fischer Walker and co-workers argue that “real progress” could be made in the treatment and management of diarrhoeal diseases if intervention strategies are made an international priority and the global health community works together to eliminate this harmful disease. Furthermore, the research acts as a pertinent reminder that we already have the technologies and interventions needed to prevent and reduce the devastating effects of diarrhoea, we just need to use them in the right scenario.

ResearchBlogging.orgWalker, C., Friberg, I., Binkin, N., Young, M., Walker, N., Fontaine, O., Weissman, E., Gupta, A., & Black, R. (2011). Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis PLoS Medicine, 8 (3) DOI: 10.1371/journal.pmed.1000428


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Diarrhoea is the 2nd biggest childhood killer worldwide

Diarrhoeal disease is a significant global health problem. Every year there are ~4 billion cases, and 2.5 million deaths, from diarrhoea. Most of these cases are in developing countries, and the sad fact is each year 1.5 million children under five die from diarrhoea (that’s more than the childhood deaths caused by AIDS, malaria and measles combined). This makes diarrhoea the 2nd biggest killer of under fives globally. That’s 1.5 million under fives dying from a disease that can be easily, and cheaply treated, and in developed countries it is thought of as nothing more than the squits.

On 14th October, UNICEF and WHO published a new report “Diarrhoea: why children are still dying and what can be done” as part of a strategy to try and boost global efforts to fight childhood diarrhoea. Bacteria (such as Shigella and Vibrio cholerae), parasites (such as Crpytosporidium) and viruses (such as Rotavirus) all cause diarrhoeal disease. They are often spread in contaminated, dirty water via a faecal-oral route of transmission (that’s pathogens in faeces from one person transferred, via contaminated water or food, to the mouth). Also, limited access to medical care and malnutrition can make the burden of the disease worse. So, they’ve come up with a 7-point plan to treat and prevent childhood diarrhoea.

This plan is to:

  1. replace lost fluids to prevent dehydration (using the new improved low-osmolarity oral rehydration solution)
  2. include zinc treatment for diarrhoea (it reduces the severity and duration of diarrhoea, as well as reducing the likelihood of getting it again)
  3. rotavirus and measles vaccination
  4. promote exclusive breastfeeding (breastmilk is nutritious and provides crucial antibodies for infants to survive and develop) and vitamin A supplementation (it reduces childhood mortality and reduces the severity, duration and complications associated with childhood diarrhoea)
  5. promote handwashing with soap (this helps break the faecal-oral transmission route and reduces the incidence of diarrhoea by over 40%)
  6. improve access to clean water; improving the supply and quality as well as promoting safe household water treatment (including chlorination, filtration and solar disinfection) and storage
  7. promote sanitation in communities; especially approaches to change people’s attitudes to reduce open defecation (1.2 billion people practice open defecation worldwide)

This 7-point plan needs to be put in place in areas where it is needed the most; 80% of deaths from childhood diarrhoea occur in Africa and South Asia, with almost three quarters of these deaths in only 15 countries (the top four with the highest deaths from childhood diarrhoea are India, Nigeria, Democratic Republic of Congo and Afghanistan). Hopefully this 7-point plan will inspire governments, charities and non-governmental organisations to reduce childhood deaths from diarrhoea and help meet the Millennium Developmental Goals 4 (to reduce childhood mortality by two-thirds by 2015) and 7 (halve the number of people without access to safe drinking water and sanitation).

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