Nearly one in every five child deaths— around 1.5 million a year—is due to diarrhoea, which kills more children than AIDS, malaria, and measles combined. A new report released by UNICEF and WHO (Diarrhoea: why children are still dying and what can be done) provides a seven-point plan for comprehensive diarrhoea control. The plan, and the momentum behind it, are discussed in a Comment published Online First and in an upcoming edition of the Lancet. The Comment is written by Dr Tessa Wardlaw, UNICEF, New York, USA, and Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO, Switzerland, and colleagues.
Today, only 39% of children with diarrhoea in developing countries receive the recommended treatment, and limited trend data suggest little progress since 2000. Zinc supplements are largely unavailable in most developing countries, and low-osmolarity oral rehydration salts have been slow to roll out, even 5 years after UNICEF and WHO recommended their use in programmes.
On the prevention side, progress has been made in many areas, notably vitamin A supplementation, measles immunisation, access to safe drinking water, and exclusive breastfeeding. But in other areas much work remains. Rotavirus vaccine is not available in most developing countries, and improving drinking water, sanitation, and breast-feeding rates remain key issues.
The authors say: "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 is made up of two treatment and five prevention strategies. For treatment, children need fluid replacement to prevent dehydration, and zinc supplements. Oral rehydration therapy is the cornerstone of fluid replacement, and the gold 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: i) Rotavirus and measles vaccinations; ii) Promotion of early and exclusive breastfeeding and vitamin A supplementation; iii) Promotion of handwashing with soap; iv) Improvement of water quantity and quality, including treatment and safe storage of household water; and v) Promotion of community-wide sanitation.
The authors conclude: "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."
For Dr Tessa Wardlaw and other UNICEF authors, please contact Christopher de Bono, Head of Communications, UNICEF. T) +1 (212) 303 7984 E) cdebono@unicef.org
For Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO, Switzerland, please contact Olivia Lawe-Davies, Communications. T) +41 22 791 1209 /+41 794 755 545 E) lawedavieso@who.int
For full Comment, see: http://press.thelancet.com/unicefwhodr.pdf
Please note: there will be a telephone press briefing to discuss this report tomorrow, Weds 14 October at 1530H UK time.
The panel will be: WHO: Ann M. Veneman, UNICEF Executive Director Elizabeth Mason, WHO Director, Child and Adolescent Health and Development
Technical advisers
- Mickey Chopra, UNICEF Chief of Health
- Tessa Wardlaw, UNICEF Chief of Statistics
- Olivier Fontaine, WHO Medical Officer, specialist in childhood diarrhoea
- Carsten Mantel, WHO Group Leader, New and Underutilized Vaccines Implementation
DATE & TIME: Wednesday, 14 October 2009
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For more information on press briefing, please contact:
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In Geneva: WHO: Olivia Lawe-Davies T: +41 22 791 1209 M: +41 79 475 5545 lawedavieso@who.int
Journal
The Lancet