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DIARRHEA IS THE SECOND LEADING CAUSE OF CHILDHOOD MORTALITY
Each year, 1.8 million people die from diarrhea-related illness caused by poor sanitation, contaminated water, and lack of access to effective treatments.1 Of the more than 4 billion cases reported, children are the most vulnerable. Diarrhea is the second leading cause of death for children under the age of five, killing 1.5 million annually; more than malaria, AIDS, and measles combined.1 Frequent episodes of diarrhea in early childhood contribute to morbidity, malnutrition, stunting and learning challenges that undermine development and carry long-term consequences for educational attainment and income.
The Current Form of Therapy
The current standard of care for treating diarrhea in children focuses on mitigating the effects of dehydration, through oral rehydration therapy (ORT), continued feeding (including breastfeeding), and, more recently, zinc supplementation. Early gains from these efforts were remarkable. Over a 20-year period, from 1979 to 1999, annual mortality in children under-five declined from 4.6 million to 1.5 million.3 Yet, since 1999 progress has slowed and in some countries even reversed. Despite the genuine therapeutic benefits of oral rehydration salts (ORS), the main component of ORT, coverage and demand in the developing world remains low. Currently only 39% of children with diarrhea are receiving ORS with less than 1% receiving zinc.4
“Mothers will NOT accept [ORS]—it does not stop diarrhea, children do not like to drink it, and the mother has walked 10 km to receive something else.” 2
– Quotation from Referral Hospital doctor in Cambodia
Knowledge vs. Implementation
While most caregivers are familiar with ORS, there is little use of such products. In a recent survey of more than 2000 caregivers and 500 providers in Kenya and India, most responded that the primary goal when their child is sick is to stop the diarrhea. 5 ORS and zinc are effective interventions to reduce the health impacts of diarrhea-induced dehydration, but do little to quicken resolution of the diarrhea itself.
As a result, parents are more likely to seek out suboptimal treatments that are perceived to quicken the recovery for their children, leading to the widespread misuse of antibiotics, which are only recommended in fewer than 5% of cases.6
- UNICEF/WHO (2009) Diarrhoea: Why children are still dying and what can be done.
- USAID (2007) Social Marketing of Zinc to Improve Diarrhea Treatment Practices: Findings and Lessons Learned from Cambodia. USAID POUZN Initiative Brief
- Pierce N. F. (2001) How Much Has ORT Reduced Child Mortality? Journal of Health, Population and Nutrition: 19(1)
- UNICEF (2012) Pneumonia and Diarrhoea: Tackling the deadliest diseases for the worldâ€™s poorest children.
- Zwisler, G. et al. (2013) Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya. Journal of Global Health: Vol. 3 (1), June
- Yoon, S. S. et al. (1997) Efficiency of EPI cluster sampling for assessing diarrhoea and dysentery prevalence. Bulletin of the World Health Organization, 75(5)
- Water and Sanitation Program (2011) The Economic Impacts of Inadequate Sanitation in India.
- The Economic Times, India (2013) Budget 2013: Health sector gets a meager rise in allocation. 28 February