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Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
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.
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.
Development: Seeds of Change. 1984; 2:66-7.UN International Children's Emergency Fund (UNICEF) experience over the last 20 years suggests that successful development for poor people is not possible without substantial grassroots involvement. This is the experience both in the developing and in industrialized countries. In the 1960s it became increasingly clear to UNICEF that if programs were to succeed with the small and landless farmers and the urban slum dwellers, there was no possibility of finding enough money to meet needs of these people through governmental channels. It was equally clear that in most places the existing patterns of development andeconomic growth would not reach these people until the year 2000 or thereabots. It was this that led UNICEF to adopt its basic services approach in the late 1960s and early 1970s, which implied that the cost of the most needed basic health services, education, and water had to be reduced to manageable limits. At this stage UNICEF began to articulate the imperative of using paraprofessionals, the need for much greater use of technology that was appropriate to rural and slum areas, and the importance of involving the people in this effort. Looking at those low income countries which have managed to achieve longer life expectancy and higher literacy rates, they are all societies which have practiced much more people's participation in economic and social activities than most other countries. These 3 very different societies -- China, South Korea, and Sri Lanka -- all have had a rather unique degree of people's participation in the development process. Grassroots participation in development is a very important element in developing and in industrial countries. 1 example concerns the whole question of proper nutrition practices, the promotion of breastfeeding, and the problem of the infant formula code. It was the people's groups which picked up the research results in the 1960s, which showed that breastfeeding was a better and more nutritious way of feeding children. The 2nd example pertains to the US government recommendation of significant cuts in UNDP and UNICEF, and the refusal of Congress to give in to those cuts. In regard to the developing countries, over the last year it has increasingly become the consensus of international experts that a childrens' health revolutioon is possible. The conclusion was based upon the fact that there were 2 new sets of developments coming together that created this new opportunity: some new technological advances in the development of rural rehydration therapy; and the capacity to communicate with poor people. With the whole emphasis on the basic human needs of the last 10 years, and on primary health care in the last 5 years, literally millions of health auxiliaries and community workers have been trained, a group of people who, if a country can mobilize them, can provide a new form of access.
[Unpublished] . Presented at the Western Hemisphere Conference of Parliamentarians, 4 December 1982, Brasilia. 11 p.In this address to Western hemisphere parlimentarians, the Executive Director of the United Nations Children's Fund (UNICEF) urged conference participants from Latin American countries to serve as advocates for the children in their countries by 1) promoting national policies to reduce infant and child mortality through the implementation of oral rehydration therapy and nutrition surveillance programs; 2) encouraging their respective countries to implement and maintain the International Code on Marketing of Breastmilk Substitues; and 3) lending their support to UNICEF's newly proposed programs to help abandoned children. UNICEF's mission is to help the millions of children trapped by proverty. In line with this goal, UNICEF urges the Latin American countries to focus attention on 1) the 20 million Latin American children, aged 0-4 years, living in poverty and at high risk of death, malnutrition, and serious mental and physical disability; and 2) on the 30 million Latin American street children who have either no ties or only weak family ties. In reference to the 1st group of children, UNICEF urges countries which have not already done so to implement low cost oral rehydration therapy and nutritional surveillance programs and to adopt policies which will reverse the trend toward bottlefeeding. These activities cost little and involve little or no political risk, however, they can siginificantly reduce infant and child death rates. Reductions in the death rate will not, as some fear, increases the population growth problem; indeed, the opposite is true. Historically it has been demonstrated that in countries with an overall death rate of 14-15/1000 population, for each subsequent decline in the death rate there is a larger decline in the birth rate. For example, in Brazil between 1960-80 a 5 point decline in the death rate was accompanied by a 13 point decline in the birthrate. In reference to the 30 million street children, UNICEF is currently developing special programs aimed at providing care and training for these children. Institutionalizing street children is costly and does not provide the home-like environment these children require. Innovative programs, such as group homes, children's cooperative villages, and other community based approaches are less costly and provide the type of support these children need to become productive and adjusted members of society. UNICEF is undertaking a cost benefit analysis of these alternative strategies. UNICEF expects to present a proposal at the 1983 session of the Executive Board to develop a major regional program in Latin America to assist street children and to prevent child abandonment. The program will require siginificant financial support and government support if it is to achieve its goals.