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2016 Nov; New York, New York, UNICEF, 2016 Nov. 77 p.Pneumonia and diarrhoea are responsible for the unnecessary loss of 1.4 million children each year. This report highlights current pneumonia and diarrhoea related mortality, and illustrates the startling divide between the children being reached and the considerable number of those left behind. By developing key protective, preventative and treatment interventions, collectively we are now equipped with the knowledge and the tools required to preventing child deaths due to these leading childhood killers. The report also provides recommendations to further accelerate progress in effective interventions and bridge the greatest gaps in equity.
MMWR. Morbidity and Mortality Weekly Report. 2011 Dec 2; 60:1611-4.Rotavirus disease is the leading cause of childhood morbidity and mortality related to diarrhea in Latin America and the Caribbean (LAC), where an estimated 8,000 deaths related to rotavirus diarrhea occur annually among children aged <5 years. After two safe and effective rotavirus vaccines became available, the World Health Organization (WHO) in 2007 recommended inclusion of rotavirus vaccine in the immunization programs of Europe and the Americas, and in 2009 expanded the recommendation to all infants aged <32 weeks worldwide. This report describes progress in the introduction of rotavirus vaccine in LAC, where it was first introduced in 2006 in Brazil, El Salvador, Mexico, Nicaragua, Panama, and Venezuela; by January 2011, it was included in the national immunization schedules of 14 countries in LAC. Estimated national rotavirus vaccine coverage (2 doses of the monovalent vaccine or 3 doses of the pentavalent vaccine) among children aged <1 year in 2010 ranged from 49% to 98% (median: 89%) in the 11 LAC countries with vaccine introduction before 2010. Of the 14 countries that had introduced rotavirus vaccine into their national immunization programs, 13 participate in a hospital-based rotavirus surveillance network. Data from some countries in this network and from other monitoring efforts in LAC countries have shown declines in hospitalizations and deaths related to severe diarrhea after rotavirus vaccine introduction. The rapid introduction of rotavirus vaccine in LAC demonstrates the benefits of the early commitment of national decision makers to introduce these vaccines in low-income and middle-income countries at the same time as in high-income countries.
New York, New York, UNICEF, 2009.  p.This report sets out a 7-point strategy for comprehensive diarrhoea control that includes a treatment package to reduce child deaths, and a prevention package to reduce the number of diarrhoea cases for years to come. The report looks at treatment options such as low-osmolarity ORS and zinc tablets, as well as prevention measures such as the promotion of breastfeeding, vitamin A supplementation, immunization against rotavirus -- a leading cause of diarrhoea -- and proven methods of improving water, sanitation and hygiene practices. Diarrhoea's status as the second leading killer of children under five is an alarming reminder of the exceptional vulnerability of children in developing countries. Saving the lives of millions of children at risk of death from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures. (Excerpt)
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):273-9.Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
Geneva, Switzerland, WHO, 2004. 7 p. (WHO/FCH/CAH/04.7; UNICEF/PD/Diarrhoea/01)Though the mortality rate for children under five suffering from acute diarrhoea has fallen from 4.5 million deaths annually in 1979 to 1.6 million deaths in 2002, acute diarrhoea continues to exact a high toll on children in developing countries. 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. (excerpt)
JAMA. 1993 Feb 17; 269(7):846, 850.From February 1991 through July 1992, 67,000 Bhutanese of Nepalese ethnic origin entered southeastern Nepal because of ethnic persecution in Bhutan, and were established in 6 refugee camps. In July 1992, the Office of the UN High Commissioner for Refugees, the Save the Children Fund, and CDC established a surveillance system to monitor morbidity and mortality of these refugees. Mortality surveillance was established for diarrhea, acute respiratory infections (ARI), measles, malaria, injuries, maternal deaths, and other/unknown. Data were collected from March through July 1992 by a single designated health worker at each camp by interviewing the families. From March 25 through June 30, daily mortality rates for children under 5 years, of age (<5MR) averaged over each week were 2.3-8.8 deaths/10,000 persons/day, a rate 2-8 times greater than in Nepal. Daily crude mortality rates (CMRs) for the entire camp population were 1.5 deaths/10,000/day. Based on verbal autopsies of 89 deaths during July 3-19, 49 (55%) deaths were caused by ARI and 25 (28%) by diarrhea. The ARI-specific <5MR (1.6 deaths/10,000/day) was more than 5 times greater than the ARI-specific mortality rate for persons aged =or> 5 years (0.3 deaths/10,000/day). From March 1 through April 30, 549 cases of measles were recorded at camp health centers. Following this outbreak, <5MRs increased to 4.4-8.8 deaths/10,000/day during April 1-May 16. Nearly 12% of patients with diarrhea during July 3-19 had bloody diarrhea. Shigella flexneri types 1, 2, and 3 were cultured from 5 of 13 (38%) patients. All isolates were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole but sensitive to nalidixic acid. From June 15 through July 19, in one camp 38 (3.4%) of 1129 refugees with suspected malaria had blood smears slide-positive for Plasmodium falciparum and 37 (3.3%) had blood smears positive for P. vivax.
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
Geneva, Switzerland, WHO,  27 p.This is the 1st interim report issued by the Diarrhoeal Diseases Control (CDD) Programme, summarizing progress in its main areas of activity during the previous calendar year. Most of the information is presented in the form of tables, graphs and lists. Other important developments are mentioned briefly in each section. The information is presented according to major program areas; health services; research; and program management. Within the health services component, national program planning, training, the production of Oral Rehydration Salts (ORS), health education and promotion are areas of priority activity. Progress in the rate of development of national programs, participants in the various levelsof training programs, and the countries producing their own ORS packets and developing promotional and educational materials are presented. An evaluation of the health services component, based on a questionnaire survey to determine the impact of Oral Rehydration Therapy (ORT), indicates significant decreases in diarrheal admission rates and in overall diarrheal case-fatality rates. Data collected from a total of 45 morbidity and and mortality surveys are shown. Biomedical and operational research projects supported by the program are given. Thhe research areas in which there was the greatest % increase in the number of projects funded were parasite-related diarrheas, drug development and management of diarrheal disease. Research is also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials. The program's organizational structure is briefly described and its financial status summarized. The report ends with a list of new publications and documents concerning health services, research and management of diarrheal diseases.
POPLINE. 2001 Mar-Apr; 23:3.Nearly 1 in 3 children born in Sierra Leone's diamond-rich Kenema district died last year before turning 1 year old, according to a recently released report. Issued by Sierra Leone's Health and Sanitation Ministry and the International Rescue Committee (IRC), the report came on the heels of a mortality survey in the West Central African country. The UN International Children's Emergency Fund (UNICEF) previously reported that Sierra Leone's infant mortality level of 157 newborn deaths per 1000 births is the world's highest. The new study, however, demonstrates that the rate in Kenema is almost twice that level. Robin Nandy of IRC called the findings “a public health catastrophe”. Additionally, the survey revealed an overall death rate for Kenema that was 3 times the normal level for sub-Saharan Africa--44 deaths a year per 1000 people. UNICEF estimated in 1999 that the overall mortality rate in Sierra Leone was much lower--24 deaths per 1000 people--though even that number is considered among the world's highest mortality rates. Most of the deaths were attributed to common illnesses that are easily treatable, with ailments involving fever proving to be the most fatal. Malaria was the leading cause of death, followed by diarrheal disease and respiratory infections. Nandy called the findings worse than anticipated since Kenema was fairly peaceful last year, compared to considerable fighting the year before. She said that IRC assumes death rates are even higher in areas where conflict continues. With a fertility rate of 6.3 children per woman, Sierra Leone is on course to double its population of 5.2 million in only 26 years and triple its human numbers in 50 years. (full text)
JOURNAL OF TROPICAL PEDIATRICS. 1998 Jun; 44(3):126-7.UNICEF's Child Survival initiative (which disseminated low-cost technologies, such as oral rehydration, immunization, breast feeding, and improvement in weaning practices to reduce child mortality) has led to improvements in survival rates. Improvement in child health lead to improvements in the nutritional status of children since severe infection causes nutritional deterioration. Thus, there is increasing awareness that persistent diarrhea is also a nutritional disease. The promotion of breast feeding has been one of the most cost-effective ways of improving nutrition, and it is important to prevent childhood malnutrition by all available means. Case fatality rates from severe malnutrition remain unchanged, indicating that case management requires reevaluation. It is now known, for example, that clinical recovery during nutritional rehabilitation may precede immunological recovery. The implication that even mild/moderate forms of malnutrition increases the risk of mortality suggests that, while control of some childhood illnesses makes an impact on overall health and nutrition, a resistant core of child mortality is caused by underlying undernutrition. Therefore, interventions are needed to improve the nutrition of children, especially during the weaning period. Child mortality determinants can be classified in three tiers: the proximate tier includes immediate biomedical conditions; the intermediate tier includes factors such as child care that expose children to disease; and the bottom tier is the broader socioeconomic setting that affects distribution of the basic necessities of life.
[Children in poor countries also have a right to good health care. A new health care program will reduce child mortality] Aven barn v fattiga lander har ratt till god vard. Nytt omvardnadsprogram skall minska barnadodligheten.
LAKARTIDNINGEN. 1997 Oct 8; 94(41):3637-41.This article discusses the integrated management of childhood illness (IMCI) approach, developed by WHO and UNICEF based on international experience, which allows the care and treatment of sick children in countries with limited resources. It is estimated that every year 12 million children die in low-income countries before age 5. 70% of these deaths are related to common diseases: respiratory infections, diarrhea, measles, malaria, and malnutrition. The guidelines were developed for local health workers. Two flowcharts were designed for presenting the guidelines: one for children aged 1 week to 2 months and one for children aged 2 months to 5 years. For infants, the treatment of bacterial infections, diarrhea and feeding, and low weight are paramount. Fever and breathing difficulty may be the expression of severe general infection. The care of children aged 2 months to 5 years should consider four general warning symptoms: cramps, loss of consciousness, inability to drink or suckle, and constant vomiting. The presence of one of these symptoms indicates serious illness and the need for immediate care. Coughing and breathing difficulties are signs of severe pneumonia or serious respiratory illness, which requires transfer to a hospital after administering a dose of antibiotics. The use of trimethoprim-cotrimoxazole is recommended for treatment of pneumonia, while trimethoprim-sulfamethoxazole is indicated for malaria. The diagnosis, classification, and treatment of diarrhea is performed according to earlier WHO guidelines. General erythema and either coughing, a cold, or red eyes are the signs of measles.
In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 135-46.In the early 1980s approximately 4.6 million children under 5 years old died from diarrheal diseases each year in developing countries, and the annual number of diarrheal episodes in this age group was above 1 billion. Rotavirus is the single most important causal agent of acute and profuse watery diarrhea characterized by vomiting and fever. The typical age for rotavirus diarrhea is between 6 and 11 months of age. Enterotoxigenic Escherichia coli (ETEC) are found in 10-50% of cases of acute diarrhea in developing countries. Enteropathogenic E. coli (EPEC) also cause diarrhea in developing countries, but only in the first months of life. Shigellosis commonly refers to dysentery, the clinical picture of which includes fever, abdominal cramps, and bloody diarrhea with frequent, small and mucoid stools. Both S. flexneri and S. dysenteriae 1 are important causes of dysentery in developing countries. Shigellosis is one of the few diarrheal infections in which antibiotics are indicated. The clinical symptoms of Salmonella sp. include fever, abdominal pains, headache, and cough, and clinical signs include coated tongue, splenomegaly, rales in lungs, and relative bradycardia. Typhoid fever is endemic in large parts of the world with an estimated death toll of 500,000-600,000 per year. An estimated 120,000 deaths are caused annually by Vibrio cholerae. Today most cases of cholera are manageable with oral rehydration therapy (ORT). In addition, antimicrobials are routinely given. Case management of acute diarrhea includes treatment of dehydration by oral rehydration solution (ORS). The physiological principles of ORT were established in the 1960s. The World Health Organization formula for ORT is suitable for the management of all types of dehydration. Antimicrobials should be discouraged in uncomplicated acute diarrhea. Several causes of persistent diarrhea have been proposed including: infection with enteroadherent E. coli, enteropathogenic E. coli and Cryptosporidium; and intolerance to foods.
PEDIATRIC INFECTIOUS DISEASE JOURNAL. 1993 Jan; 12(1):5-9.Each year diarrheal disease causes an estimated 3.2 million deaths worldwide in children under 5 years of age. Reported attack rates in developing countries range from 1 to 12 episodes per child per year, with a global average of 3 episodes per child per year. Diarrhea is associated with 1/4 of all deaths in children under 5 years in developing countries. Oral rehydration therapy (ORT) is the cornerstone of global efforts to reduce mortality from acute diarrhea. The World Health Organization (WHO)/UNICEF ORS formula contains glucose and sodium in a molar ratio of 1.2:1. Potassium chloride is added to replace potassium lost in the stool. Trisodium citrate dihydrate (or sodium bicarbonate) corrects metabolic acidosis caused by fecal loss of bicarbonate. The WHO case management strategy for children with diarrhea consists of: prevention of dehydration through early administration of appropriate fluids available in the home; treatment of dehydration with ORS solution; treatment of severe dehydration with an intravenous electrolyte solution; continued feeding during, and increased feeding after the diarrheal episode; and selective use of antibiotics and nonuse of antidiarrheal drugs. The WHO/UNICEF formula is also suitable as a maintenance fluid when given with equal amounts of water, breast milk, or low carbohydrate juice. Despite the unquestioned success of ORT in developing countries, physicians in the United States, the United Kingdom, and other industrialized countries have been slow to adopt ORT. Guidelines for case management call for patient assessment. The physician evaluating a child with diarrhea should inquire about clinical features including its duration and the presence of blood in the stool. Thus, a reliable treatment plan can be made without need of laboratory tests. Most diarrheal episodes are self-limited and do not benefit from antimicrobial therapy. Children with bloody diarrhea should be treated for suspected shigellosis with an oral antibiotic.
CENTRAL AFRICAN JOURNAL OF MEDICINE. 1992 Jul; 38(7):314-5.Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
BERC BULLETIN. 1987 Mar; (15):12-5.UNICEF-supported work (GOBI/FFF) has proposed to early childhood mortality and disease which are free, relevant and available: 1) growth mortality, which can expose malnutrition before it's too late; 2) oral rehydration therapy for diarrhea which is a major killer and is remedied by rehydration salts; 3) breast feeding, which provides immunity, nutrition at low cost, and warmth, and security, and 4) immunization from measles, TB, diphtheria, tetanus, polio, and whooping cough. GOBI/FFF recommends strengthening female education, providing nutritious food, and providing family planning which involves child spacing. Most children in the east African regions are denied the rights outlined in the 1959 UN Declaration of the Rights of the Child, even though governments do provide some level of care. Kenya, with the highest birth rate, has all departments providing some input into the well-being of the child. Several national programs are supported by UNICEF in concert with the Kenya government. The 3 neediest rural districts receive concentrated resources, and the health department has been reorganized to focus on child survival. Integrated community rural development projects are underway. Basic urban services with be provided in Kisumu Municipality in a participatory process with civil servants which will focus on female headed households with lots of children. The emphasis will be on increasing family income. In order to relieve mothers of some of the work burden, technology in food production, and in water and fuel collection will be introduced. Educational materials for young and old people need to be developed. Greater coordination and utilization of resources need to be implemented to insure that all parents are informed of birth spacing, prenatal care, low cost ways of preventing and managing childhood illnesses, how to promote normal physical and mental growth, and birth control.
National Program on the Control of Diarrheal Diseases. Report of the Joint MOH / WHO / UNICEF / USAID Comprehensive Program Review, 28 January to 11 February, 1985.
Manila, Philippines, Ministry of Health, 1985. v, 36 p.In early 1985, representatives of the Philippines Ministry of Health, WHO, UNICEF, and USAID visited health facilities (barangay health stations to hospitals) and used data from 9106 households (11,131 children under 5 years old) in the provinces of La Union, Bohol, and Bukidnon in the Philippines, to evaluate implementation and effect of the National Program on the Control of Diarrheal Diseases (CDD). 10.8% of the children had had diarrhea within the last 2 weeks. Mean diarrhea episode/child/year stood at 2.8. Mean infant mortality was 62.3/1000 live births (35.8 in La Union to 94 in Bukidnon). Diarrhea-related mortality for all children studied ranged from 3 in La Union to 18.3 in Bukidnon (mean = 8.6). Between 1978 and 1982, the diarrhea-related mortality rate for all of the Philippines fell from 2.1 to 1, presumably due to the CDD Program. Diarrhea was the leading cause of death in Bukidnon (21.3%), but in La Union and Bohol, it was the 5th leading cause of death (6.6% and 10.3%, respectively). 33% of children with diarrhea received oral rehydration solution (ORS), 12% did not receive any treatment, and 72% received herbs, antibiotics, or antidiarrheals. Many of the children receiving ORS also received other treatments. 86% of mothers were familiar with ORS and 73% of them had used it. 92% would use it again. 84% would buy it from stores, if sold. Government health facilities tended to use ORS and to prescribe it for diarrhea cases. Most facilities had successfully promoted breast feeding. The supply of ORS packets in most facilities was good. Almost all health personnel had received ORT training. Some recommendations included promotion of non-ORT strategies (e.g., hand-washing and food safety), conducting research (e.g., to identify suitable fluids and foods for home-based oral rehydration therapy, and regular monitoring and evaluation of the CDD Program.
Baltimore, Maryland, Johns Hopkins University, School of Hygiene and Public Health, Dept. of Population Dynamics, 1992. v, 60 p.During most of the 1980s, Iraq was at war with Iran. Despite the war, Iraq, with the help of UNICEF, was able to improve health services that impact on child health so that child survival also improved. They were able to do so because, in 1983, UNICEF, social organizations, the community, and the health sector joined forces to improve the health of the nation's children. They set up a district based primary health care system which saved the lives of 1000s of children annually. Their efforts concentrated on immunization, oral rehydration, unsafe birth practices, and increasing mothers' knowledge of childbearing and child health practices. Some achievements in child survival in Iraq during was included a sharp rise in neonatal tetanus immunizations from 8-72.5% (1985-1989) and a fall in neonatal tetanus deaths between 1983-1989 from 0.7-<.1, a rise in full immunization coverage from 13-85.5% and a fall in all vaccine preventable deaths (e.g., 58 pertussis deaths in 1980 to 0 deaths beginning in 1986), and a rise is use of oral rehydration therapy from 9-76% and a subsequent fall in diarrhea related deaths from 600-<100 (1980-1988). This monograph examined the factors responsible for the evolution of development trends, behavioral patterns, and program management style in Iraq. These factors centered around geopolitical and economic forces. Chapter 3 explains how child survival became a national priority and what strategies were undertaken to achieve child survival goals. Program implementation and the basis of program sustainability are laid out in chapters 4-5. Program achievements are presented in chapter 6. The last chapter discusses lessons learned and assesses child survival in wartime and continuing obstacles. This monograph points out that achieving child survival under adverse circumstances is possible when political will and commitment stands behind child survival efforts.
INDIAN JOURNAL OF PUBLIC HEALTH. 1990 Jan-Mar; 34(1):48-52.The WHO Global Diarrhoeal Disease Control (CDD) Programme has been implemented in at least 110 member countries. It encourages oral rehydration therapy (ORT) as the chief means to reduce child mortality caused by diarrhea. Despite relatively high ORT access rates ORT (20%->70% in Africa and South East Asia respectively, 1989), oral rehydration solution (ORS) use is inadequate (12.1-26.7% Africa and Eastern Mediterranean respectively, 1988) as well as ORT use (19.2-39.8% Africa and Eastern Mediterranean respectively, 1988). These poor results could be a factor of diminished knowledge and inadequate numbers of trained staff. Yet 58 countries now produce ORS and worldwide production increased from 100-350 million 1 between 1983-1987. In India, however, at least 75% of ORS brands do not meet WHO standards. Further 0.5-1 million <5 year olds succumb annually due to diarrhea (25% of all deaths among <5 year olds). In addition, about 500 million episodes of diarrhea occur each year. ORT is required in 50-100 million of these episodes and hospitalization is needed for 5 million. The Indian CDD program has reduced child mortality from diarrhea by 50% between 1981-1990. It operates under a 3 tier strategy including home management with ORS, and hospital management with ORS and/or IV fluids. This strategy faces several obstacles. For example, mothers in some villages do not know the village health guides who teach mothers how to make ORS. Besides few are motivated at the village level to teach this to mothers. According to government studies, ORT use varies in India from 36-96.3%, but according to operational research by the National Institute of Cholera and Enteric Diseases, ORT use in the best health facilitate is only 11-12%.
Child survival and development toward Health for All: roles and strategies for Asia-Pacific universities.
ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH. 1989; 3(2):118-28.The child survival and development movement in relation to universities in the Asia-Pacific region were the subject of recent discussions of medical practitioners and academics. There are 14 million deaths of children that could be avoided if they could benefit from immunizations, pure water, sanitation, nutrition, and oral rehydration therapy. Also there is a large loss of physical and mental ability. Many international agencies have helped improved children's health and survival, and life expectancy has risen 40% in the last 40 years. In countries such as China, India, Pakistan, Thailand, and Indonesia there has been an exceptional achievement in child survival and development. In many developing countries health services have been patterned after western medical systems that promote treatment rather than prevention. Universities' role in relation to these problems has been the conducting of research, providing instruction, education, and training. The areas of success are in vaccine development and mass communications research. New roles can be taken in technical assistance and introduction of technology in planning and evaluation. There are also possibilities in the pooling of information and resources to help in child survival and development. In long range strategies and roles, universities can use conventional methods. In midrange areas the universities can use new modes and share and interact with governments and international organizations. In the short term they can use the less conventional methods and follow the leadership of the international organizations. In short term, universities can provide help in planning of national campaigns, provide resources, and participate in evaluations of campaigns. In the mid-range they can be involved in joint initiatives in operations research, specialized training, and clinical trials. In the long range universities are best suited to conventional research, training, laboratory science and technology development.
Improving child survival and nutrition. The Joint WHO/UNICEF Nutrition Support Programme in Iringa, Tanzania.
Dar es Salaam, Tanzania, UNICEF, 1989. , 20 p.The June-October 1988 evaluation of the Joint WHO/UNICEF Nutrition Support Programme (JNSP) in the Iringa Region of Tanzania demonstrated substantial improvement in the nutritional status of infants and children and a decrease in child deaths since 1984. Prevalence rates of underweight children were 38% in the 2nd quarter of 1988 as compared with 56% in 1984. In addition, prevalence rates of severely underweight children in the 2nd quarters of 1988 and 1984 were 1.8% and 6.3% respectively. This was accomplished because of an enhanced awareness of nutrition among all the people in the region and decision makers consciously considered the growth and development of children as an objective in their daily work. Specifically, the JNSP targeted activities that increase and sustain people's ability to address nutrition problems. These activities included increasing accessibility to nutrition information, establishment of the village based nutritional status and death monitoring system done by existing village health committees and village health workers, and integrated training. These activities concentrated on maternal and child health, water and environmental sanitation, household food security, child care and development, income generating actions, research, and management and staff. This approach in Iringa can be adapted and transferred to other areas of Tanzania.
Oxford, England, Oxford University Press, 1988. , 86 p.The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1986 Jan; 35(1):1-2.A paper by Hazlett et al. is of particular importance because it addresses the question of the role of acute respiratory infections (ARI) as a cause of morbidity and especially mortality in 3rd world children. Diarrheal disease and malnutrition are generally thought to be the major killers of these children, and until recently little attention was paid to ARI. Recent data suggest that ARI are more important than realized previously and almost certainly are the leading cause of death in children in developing countries. It is estimated that each year more than 15 million children less than 5 years old die, obviously most in socially and economically deprived countries. Since death usually is due to a combination of social, economic, and medical factors, it is impossible to obtain precise data on the causes of death. It has been estimated that 5 million of the deaths are due to diarrhea, over 3 million due to pneumonia, 2 million to measles, 1.5 million to pertussis, 1 million to tetanus, and the other 2.5 million or less to other causes. Since pertussis is an acute respiratory infection and measles deaths frequently are due to infections of the respiratory tract, it is becoming clear that ARI are associated with more deaths than any other single cause. The significance of this is emphasized when the mortality rates from ARI in developed and underdeveloped nations are compared. Depending on the countries compared, age group, and other factors, increases of 5-10-fold have been reported. These factors raise the question of why respiratory infections are so lethal for 3rd world children. The severity of pneumonia, which is the cause of most ARI deaths, seems to be the big difference. Data are accumulating which show that bacterial infections are associated with the majority of severe infections and "Streptococcus pneumoniae" and "Haemophilus influenzae," infrequent causes of pneumonia in developed world children, are the microorganisms incriminated in a large proportion of cases. The increase in severity of ARI in 3rd world children has been associated, at least in port, with malnutrition, diarrheal diseases, an increased parasite load, and more recently with air pollution. Crowding and other factors associated with poverty doubtless also play a role. How these various factors contribute to increased severity and lethality is not well understood. The increasing recognition of the important role played by ARI as causes of mortality in 3rd world children is encouraging. The UN International Children's Emergency Fund (UNICEF) has joined the World Health Organization in the battle against ARI in developing countries, and the 2 organizations recently issued a joint statement on the subject in which they pledged to collaborate to integrate an ARI component into the primary health care program.
The Population Council's research program on infant and child mortality in Southeast Asia: a case study of the relationship between contamination of infant weaning foods, household food handling practices, morbidity, and growth faltering in a rural Thai population.
Bangkok, Thailand, Population Council, Regional Office for South and East Asia, 1986 Aug. 24 p. (Population Council Regional Research Papers. South and East Asia)This booklet describes the overall plan of the research program on infant and child mortality in Southeast Asia, sponsored by the Population Council, the Ford Foundation, the Australian Development Assistance Bureau, and the Canadian International Development Research Center. The objectives are to gain scientific knowledge about the socioeconomic, behavioral and medical factors in mortality; to increase awareness through networking and publication; and to evaluate the effectiveness of interventions at the household and community levels. It is assumed that a small number of simple techniques will prevent over half of child deaths. Applied social science or operations research will be used primarily, rather than clinical or demographic studies. Statistical sociological correlations between a variety of environmental characteristics and mortality as the dependent variable will point to determinants of mortality. The 5 chief determinants are: maternal factors, environmental contamination, nutrient deficiencies, injury, and personal illness controls. The concerns reflected in the projects funded so far include: to focus on some combination of determinants of child survival; to focus on a specific location; to use multiple approaches to data collection; to produce results that can be applied as interventions. As an example, the study on the relationship of contamination of infant weaning foods to morbidity and infant growth in a rural Thai population is summarized.
The World Health Organization's Expanded Programme on Immunization: a global overview. Le Programme Elargi de Vaccination de L'Organization Mondiale de la Sante: apercu mondial.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):232-52.In recognition that immunization is an essential element of primary health care, the World Health Organization (WHO), with other agencies, is sponsoring the Global Program on Immunization whose goal is to reduce morbidity and mortality from vaccine-preventable diseases by providing immunization for all children of the world by 1990. A global advisory group of experts meets yearly to review the program. This paper summarizes the most salient features of the 1984 meeting. The major event for the Expanded Program on Immunization (EPI) in 1984 was the Bellagio Conference on protecting the world's children. Activities undertaken as a result of this conference are discussed. 1 outcome was the formation of the Task Force for Child Survival whose main objective is to promote the reduction of childhood morbidity and mortality through acceleration of key primary health care activities. Focus is on supporting Colombia, India and Senegal in accelerating the expansion of their immunization programs and strengthening other elements of primary health care, such as diarrheal diseases control, family planning and improved nutrition. The 5-point action program consists of the following components: promoting EPI within the context of primary health care; investing adequate human resources in EPI; ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases; and pursuing research efforts as part of program operations. EPI has continued to collaborate with other programs to help assure that immunization services are provided to support delivery of other services. Integration of EPI in Africa, the Americas, the Eastern Mediterranean Region, Europe, the South-East Asia Region, and the Western Pacific Region is examined.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.