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  1. 1

    Diarrhoea: Why children are still dying and what can be done.

    Johansson EW; Wardlaw T; Binkin N; Brocklehurst C; Dooley T

    New York, New York, UNICEF, 2009. [65] 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)
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  2. 2

    'The silent emergencies:' 1987 State of World's Children - UNICEF report.

    UN Chronicle. 1987 May; 24:[5] p..

    While the media focus on Africa from 1984 to 1986 brought extraordinary assistance to that crisis-ridden continent, it may have tended to obscure everyday emergencies wrought by disease and malnutrition elsewhere in the world. Recent events in Africa have alerted United Nations agencies once again that ways must be found to sensitize politicians as well as the press to what the United Nations Children's Fund (UNICEF) Executive Director James P. Grant has called the "silent emergencies'--the less dramatic continuum of death and human suffering imposed by poverty and ignorance. In the UNICEF State of the World's Children Report for 1987, Mr. Grant notes that over the past two years, more children died in India and Pakistan than in most nations of Africa combined. "In 1986, more children died in Bangladesh than in Ethiopia, more in Mexico than in the Sudan, more in Indonesia than in all eight drought stricken countries of the Sahel', he says. (excerpt)
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  3. 3

    WHO / UNICEF joint statement: Clinical management of acute diarrhoea.

    World Health Organization [WHO]; UNICEF

    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)
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  4. 4

    Diarrhoeal and acute respiratory disease: the current situation.

    World Health Organization [WHO]. Office of Information

    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.
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  5. 5

    Interim programme report, 1983.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, [1984] 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.
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  6. 6

    Statistics on children in UNICEF assisted countries.


    New York, New York, UNICEF, 1992 Jun. [360] p.

    This compendium provides statistical profiles for 136 UNICEF countries on the status of children. Statistics pertain to basic population, infant and child mortality, and gross national product data; child survival and development; nutrition; health; education; demography; and economics. Official government sources are used whenever possible. The nine major sources include the UN Statistical Office, UNICEF, the UN Population Division, the Organization for Economic Cooperation and Development, the World Health Organization, the Food and Agriculture Organization of the UN, the World Bank, Demographic and Health Surveys, and UNESCO. Statistics rely on internationally standardized estimates, and whenever standardized estimates were unavailable, UNICEF field office data were used. Some statistics may be more reliable than others. Countries are divided into four groups for under-five mortality: very high (140 deaths per 1000 live births); high (71-140/1000); middle (21-70/1000); and low (20/1000 and under). The median value is the preferred figure, but the mean is used if the range in data is not extensive. Data are footnoted by definitions, sources, explanations of signs, and individual notation where figures are different from the general definition being used. Comprehensive and representative data are used where possible. Data should not be used to delineate small differences. Countries with very high child mortality include Afghanistan, Angola, Bangladesh, Benin, Bhutan, Bolivia, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Comoros, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Guinea, Guinea-Bissau, India, Laos, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Nepal, Niger, Nigeria, Pakistan, Rwanda, Senegal, Sierra Leone, Somalia, Sudan, Swaziland, Tanzania, Togo, Uganda, and Yemen.
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  7. 7

    Diarrheal diseases.

    Vesikari T; Torun B

    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.
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  8. 8
    Peer Reviewed

    Management of acute diarrhea in children: lessons learned.

    Richards L; Claeson M; Pierce NF


    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.
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  9. 9

    Beyond pediatrics: the health and survival of disadvantaged children. E.H. Christopherson Lectureship on International Child Health.

    Werner D

    PEDIATRICS. 1993 Apr; 91(4):703-5.

    The limited success of UNICEF's massive Child Survival campaign reflects a failure to move beyond the practice of medicine and address issues such as social equity, demilitarization, and accountability. Oral rehydration and immunization--the "twin engines" of the child survival effort--are crucial health measures. Their effectiveness has been compromised, however, by 2 factors: 2)a top-down, vertical model of planning and implementation, in which no input has been sought from the disadvantaged families who are the target population, and 2) a narrow, technological approach to medical problems whose root causes are largely social and political. The promotion of oral rehydration, for example, tends to obscure the web of physical, cultural, economic and political causes underlying the malnutrition that produces diarrhea mortality. Expenditures by poor families on harmful products exported from developed countries (e.g., infant formula, useless medications for diarrhea, and cigarettes) contribute to this undernutrition, yet the profit needs of multinational corporations are supported over the human needs of poor Third World families. Also devastating have been unnecessarily high military expenditures, promoted by arms merchants and developed country governments. Numerous studies have shown that home- mix rehydration drinks are as effective as commercial packets, more quickly and easily available, and likely to enhance mothers' confidence in their ability to confront health problems. Despite this evidence, peasant families are encouraged by health officials to purchase rehydration packets--another example of a prioritization of the needs of the commercial sector. US pediatricians are urged to follow the example of Dr. Benjamin Spock and his opposition to militarism, the arms race, environmental destruction, and social injustice.
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  10. 10

    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.

    Philippines. Ministry of Health; World Health Organization [WHO]; UNICEF; United States. Agency for International Development [USAID]

    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.
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  11. 11
    Peer Reviewed

    Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene.

    Sarkar K; Sircar BK; Roy S; Deb BC; Biswas AB; Biswas R

    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%.
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  12. 12
    Peer Reviewed

    Child mortality levels and survival patterns from southern Sudan.

    Roth EA; Kurup KB

    JOURNAL OF BIOSOCIAL SCIENCE. 1990 Jul; 22(3):365-72.

    Data from a 1985 survey in 2 urban centers in Sudan, Juba and Wau, were analyzed to assess childhood mortality levels and the effect of UNICEF's health care program. A sample of 5120 mothers (Juba, 3061 and Wau, 2059) with 21,509 children were collected from the towns. Logistic regression analysis was used to delineate determinants of child survival. The child mortality measures denote continued high infant and child mortality levels for Southern Sudan. 3 components of the UNICEF program were significantly associated with child survival: oral rehydration therapy, maternal education and immunization. The study concludes that maternal education is the most important determinant of child survival, affecting both the cure and prevention of child ill- health. (Author's modified).
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  13. 13

    Improving child survival and nutrition. The Joint WHO/UNICEF Nutrition Support Programme in Iringa, Tanzania.

    Chorlton R; Moneti F

    Dar es Salaam, Tanzania, UNICEF, 1989. [6], 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.
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  14. 14

    The state of the world's children 1988.

    Grant JP

    Oxford, England, Oxford University Press, 1988. [9], 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.
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  15. 15

    Thailand: attainable targets.

    Ramaboot S

    World Health. 1986 Apr; 23.

    Diarrheal diseases are the leading cause of sickness and death in Thailand. The problem is particularly severe in children under age 5 who account for about 40% of all cases and about 50% of all deaths due to diarrhea. In October 1980, Thailand began a program of national control of diarrheal disease. It had as its target a substantial reduction in mortality from acute diarrheal diseases through oral rehydration therapy (ORT) by way of the primary health care approach and reduced morbidity by promoting better nutritional and maternal and child health practices and safer water supply and sanitation. The government's Pharmaceutical Organization produces 750 milliliter packets of oral rehydration salts (ORS) according to the World Health Organization (WHO) formula specifications. These are purchased by the Department of Communicable Diseases and distributed to all health facilities and to village health volunteers through the provincial health offices. Some villages have their own drug cooperatives run by village committees or by volunteers, where people also can buy ORS and other essential drugs. WHO and the UN International Children's Emergency Fund (UNICEF) are helping to supply training materials in the Thai language for health staff at all levels to familiarize them with clinical and program management. The volunteers themselves receive training as providers of ORS and as disseminators of health information. Since 1983, more and more messages reach the public through the mass media, especially television and radio. Most hospitals are able to screen slide sets and video cassettes about ORT and diarrhea prevention while the mothers sit in the waiting rooms. Between 1981-84, the proportion of the population under 5 years of age with access to ORT has risen from 12% to about 60% in areas where the program is fully developed. In areas where the program is fully developed, the use rate of ORS in the same group has gone up from 12% to 30%. Throughout Thailand as a whole, the use rate in children under 5 suffering from diarrhea is about 18%. The mortality rate from diarrhea in these young children fell from 4.97/100,000 in 1981 to 2.35/100,000 in 1983, a reduction of 53%. In 1984, the mortality rate increased from the previous year while the morbidity rate decreased. One reason may be that the most non-severe cases can be self-managed by ORT, while more severe cases are detected and referred by the village health volunteers and other health workers. This results in a higher number of deaths reported.
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  16. 16

    The ORT opportunity: putting children at the forefront of accelerated primary health care.

    Grant JP

    In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 8-13. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    The worst economic setbacks since the 1930s do not augur well for the 100s and millions of children already trapped in the day-to-day silent emergency resulting from the conjunction of extreme poverty and underdevelopment which contributes so greatly to the death and disability toll which afflict over 40,000 small children per day. In the absence of special measures to accelerate health progress significantly, millions more children and mothers in low income areas are likely to die in the decade ahead. This meeting on promoting oral rehydration therapy is a concrete reminder that the key to the effectiveness in improving children's conditions is a refusal to accept a limitation upon what can be done with the available resources. In September, 1982, UNICEF invited a group of experts drawn from international agencies and nongovernmental groups involved in improving the lives of children to meet and discuss the problem. They recognized that certain elements of the primary health care strategy, including oral rehydration therapy, could greatly contribute to the realization of the health for all goal. They focused on community-based services and primary health care and how to improve health services. The improved techniques and technologies, the increased acceptance of the primary health care approach, and a new capacity of social organization for reaching low-income families could save a high proportion of children's lives. Nutritional surveillance, oral rehydration, breastfeeding and better weaning practices, immunization, family spacing, food supplements, and health education will contribute to the health of millions of mothers and families. Everyone is urged to make a commitment to strive for the health for all goal. The media, private organizations and ministeries of health must all join in the effort.
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  17. 17

    Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.

    Cash RA

    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.
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  18. 18

    The state of the world's children 1984.

    Grant JP

    New York, New York, UNICEF, [1984]. 42 p.

    In the last 12 months, world-wide support has been gathering behind the idea of a revolution which could save the lives of up to 7 million children each year, protect the health and growth of many millions more, and help to slow down world population growth. This document summarizes case studies which illustrate the techniques which make this revolution possible. These techniques are: oral rehydration therapy (ORT); growth monitoring; expanded immunization using newly improved vaccines to prevent the 6 main immunizable diseases which kill an esitmated 5 million children a year and disable 5 million more (measles, whooping cough, neonatal tetanus, polio, diphtheria and tuberculosis); and the promotion of scientific knowledge about the advantages of breastfeeding and about how and when an infant should be given supplementary foods. Results are summarized from Guatemala, Papua New Guinea, Brazil, Egypt, Indonesia, Barbados, the Philippines, Nicaragua and Honduras, Malawi, China, Nepal, Bangladesh, Colombia, and Ethiopia. The impact of economic recession and female education on childrens' health is discussed, and basic statistics for developed and underdeveloped countries are given.
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  19. 19

    WHO global diarrhoeal diseases control programme.

    Merson MH

    [Unpublished] 1979. Paper prepared for World Health Organization Regional Office for South-East Asia Inter-country Consultation to Develop a Regional Programme on Diarrhoeal Disease Services and Research, New Delhi, 18-23 June 1979 (SE ICP RPD 002.104) 6 p.

    Reviews, from the global perspective, the development and direction of the new WHO Programme for the Control of Acute Diarrhoeal Diseases. Examines briefly the magnitude of the problem of diarrheal diseases, the relatively new research findings which have greatly stimulated the effort at control, and the global strategies for control that Member States may employ in technical cooperation with WHO.
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  20. 20

    The state of the world's children.

    Grant JP

    In: Grant JP. The state of the world's children, 1982-83. New York, Oxford Univ. Press, 1982. 3-42.

    40 thousand young children died each day from malnutrition and infection in developing countries during 1982. For each child that died, 6 live on in hunger and ill-health. A continuation of present trends would result in an increase in the nubers to some to 650 million seriously undernourished children by the year 2000. This report indicates that organized communities and trained paraprofessional development workers backed by government services and international assistance can bring basic education, primary health care, cleaner water, and safer sanitation to the majority of poor communities in the developing world. Specifically, oral rehydration therapy, universal child immunization, promotion of breast feeding, and the use of growth charts are touted as low-cost, low-risk people's health actions that do not depend on economic and political changes. 1/3 of the families whose children are malnourished are simply too poor to provide enough food for the children to eat. For these people, the long-term solution to eradicate malnutrition lies in having the land to grow food or the jobs and income with which to buy it. Employment and land reform are therefore areas that must eventually be addressed in the quest for reduced child mortality levels.
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  21. 21


    Heckler MM

    In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.
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