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Nutrition Research. 2003; 23(9):1165-1176.This study investigated the nutritional status and eating habits of Mongolian children in relation to dental health. Growth and oral health of 151 Ulaanbaatarian children under age five were examined, and their parents were interviewed on child’s health and eating habits. Every tenth child had a low weight for age and the mean energy intake of the weaned children was 89%-96% of the recommendation by WHO. Frequent eating exposed the teeth of children to many acid attacks. Every third child over age three had serious developmental defects in their teeth, which might be associated with deficient intakes of energy and calcium, highly variable vitamin D supplementation and gastrointestinal infections. All of the examined 4 to 5-year old children had caries and the average number of decayed teeth was 6.5. Severe caries was related to the abundant use of sugar, whereas proper dental health was related to use of hard cheese. (author's)
American Journal of Clinical Nutrition. 2003 Aug; 78(2):291-295.Background: Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided, but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding durations in recipient infants. Objective: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding. Design: We conducted an observational cohort study nested within a large randomized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo (with continued mixed breastfeeding through = 6 mo) with 621 infants who were exclusively breastfed for = 6 mo. Regression to the mean, within-cluster correlation, and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses. Results: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent. Conclusions: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life. (author's)
Journal of the American Water Resources Association. 2000 Aug; 36(4):799-809.Drinking of arsenic-contaminated tubewell water has become a serious health threat in Bangladesh. Arsenic contaminated tubewells are believed to be responsible for poisoning nearly two-thirds of this country's population. If proper actions are not taken immediately, many people in Bangladesh will die from arsenic poisoning in just a few years. Causes and consequences of arsenic poisoning, the extent of area affected by it, and local knowledge and beliefs about the arsenic problem - including solutions and international responses to the problem - are analyzed. Although no one knows precisely how the arsenic is released into the ground water, several contradictory theories exist to account for its release. Initial symptoms of the poisoning consist of a dryness and throat constriction, difficulty in swallowing, and acute epigastric pain. Long-term exposure leads to skin, lung, or bladder cancer. Both government and nongovernmental organizations (NGOs) in Bangladesh, foreign governments, and international agencies are now involved in mitigating the effects of the arsenic poisoning, as well as developing cost-effective remedial measures that are affordable by the rural people. (author's)
[Unpublished] 1986. 6 p. (WHO/CDD/CMT/86.1)This article presents an overview of current therapeutic practice as recommended by the World Health Organization (WHO) Diarrheal Disease Control Program. The recommendations apply solely to acute diarrheal disease in infants and children. Therapy for such cases is primarily concerned with the prevention or correction of dehydration, the maintenance of nutrition, and the treatment of dysentery. The various approaches to treatment considered are: 1) oral rehydration, which is highly effective for combating dehydration and its serious consequences, but does not diminish the amount or duration of diarrhea; 2) antimotility drugs, none of which are recommended for use in infants and children because the benefits are modest and they may cause serious side effects, such as nausea and vomiting; 3) antisecretory drugs, only a few of which have been properly studied in clinical trials, virtually all of which have important side effects, a low therapeutic index, and/or only modest efficacy. Consequently, none can at present be recommended for the treatment of acute infectious diarrhea in infants and children. 4) aciduric bacteria, on which conclusive evidence is still lacking; 5) adsorbents: kaolin and charcoal have been proposed as antidiarrheal agents in view of their ability to bind and inactivate bacterial toxins, but the results of clinical studies have been disappointing. 6) improved Oral Rehydration Salts (ORS): this may turn out to be the most effective and safest antidiarrheal drug. 7) antibiotics and antiparasitic drugs for a few infectious diarrheas (e.g., cholera). Antibiotics can significantly diminish the severity and duration of diarrhea and shorten the duration of excretion of the pathogen. No antibiotic or chemotherapeutic agent has proven value fort the routine treatment of acute diarrhea; their use is inappropriate and possibly dangerous. It is concluded that oral that oral rehydration is the only cost-effective method of treating diarrhea among infants and children.The Inter-African Committee's (IAC) work against harmful traditional practices is mainly directed against female circumcision. Progress towards this aim is achieved mostly through the efforts of th non governmental organizations (NGO) Working Group on Traditional Practices Affecting the Health of Women and Children and the IAC. In 1984 the NGO Working Group organized a seminar in Dakar on such harmful traditional practices in Africa. The IAC was created to follow up the implementation of the recommendations of the Dakar seminar. The IAC has endeavored to strengthen local activities by creating national committees in Benin, Djibouti, Egypt, Ethiopia, Gambia, Ghana, Kenya, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Somalia, Sudan and Togo. IAC activities in each country are briefly described In addition, the IAC has created an anatomical model, flannelgraphs, and slides to provide adequate educational material for the training of medical staff in teaching hospitals and to make village women aware of the harmful effects of female circumcision. The IAC held 2 African workshops at the Nairobi UN Decade for Women Conference. The African participants recognized the need for international solidarity to fight female circumcision and showed a far more definite and positive difference in their attitude towards the harmful practice than was demonstrated at the Copenhagen Conference/ Forum of 1980. At the United Nations level, female circumcision is receiving serious consideration. A special Working Group has been set up to examine the phenomenon. Finally, this article includes a statement by a sheikh from the Al Azhar University in Cairo about Islam's attitude to female circumcision.
Geneva, Switzerland, WHO, 1986. 130 p. (WHO/CDD/86.16)This 5th report of the Diarrheal Diseases Control Program (CDD) describes the activities undertaken by the program during 1984-1985. Primary objectives of the program are to reduce diarrhea associated mortality, malnutrition, and treatment costs. In so doing the program advocates the use of oral rehydration therapy (ORT) solutions in the treatment of diarrhea and dehydration, and promotes proper feeding during and after diarrheal illness. 3 major strategy areas are: improved nutrition (such as breastfeeding for the 1st 2 years of life), use of safe water, and good personal and domestic hygiene. Program activities involve planning, training (supervisory, management and technical), increasing the availability of ORT (including household solutions, and production and supply of ORS), promoting health education and communication, and the control of cholera in Africa. Summaries of program activities in different regions are included, and collaborations with other WHO programs and other agencies are described. The program supports biomedical research through its global and regional scientific working groups, which includes 62 new projects for 1984 and 67 new projects for 1985. Scientific Working Groups focus on bacterial enteric infections, viral diarrheas, drug development, and clinical management ofdiarrhea.
Geneva, Switzerland, WHO, 1985. 29 p. (WHO/CDD/85.12)This paper reports the activities and proposed program budget for 1986-1987 reviewed by the Technical Advisory Group (TAG) at its 6 meeting. The Group also examined 2 reports on the use of oral rehydration therapy (ORT) and the incorporation of cost-effective control interventions other than case management in national CDD programs, and reviewed revised guidelines for the management of the research component of the global Program. With respect to the health services component, the following conclusions and reccomendations were made: the program should maintain a comprehensive approach to diarrheal disease control, while continuing to give major emphasis to and expanding further the case management strategy; continued efforts to promote plan preparation in all developing countries should be maintained; progress is to be regularly monitored; latent plans should be implemented; efforts to improve the global use rate of ORT should be effected; routine antidiarrheal remedies are to be discouraged; training curricula of health personnel must be promoted and improved; preparation of guidelines to facilitate mobilization of developmental support is urged. In the research component, the Group approved the proposed changes in the research management structure, particularly the termination of the Scientific Working Groups and Steering Committees; it endorsed the overall approach of the Program in diarrheal research development; it stressed the need for and suggested ways of achieving a flexible, rapid response to operational research; it welcomed the increase of biomedical projects; it emphasized the need for urgent research to determine which diarrhea cases required ORS treatment. Numerous other recommendations were made.
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.
Who Chronicle. 1984; 38(5):212-6.This article highlights the conclusions and recommendations of the 5th meeting of the Technical Advisory Group of the World Health Organization (WHO) Diarrheal Diseases Control (CDD) Program held in March 1984. On the basis of clinical trials supported by the CDD Program, WHO has endorsed use of oral rehydration salts (ORS) containing trisodium citrate dihydrate in place of sodium bicarbonate. Although the bicarbonate formulation remains highly effective and may continue to be used, the citrate formula results in less stool output and is more stable under tropical climatic conditions. At its meeting, the Technical Advisory Group expressed satisfaction with progress in the health services and research components of the program's activities. By 1983, 72 countries or areas had formulated plans of operation for national CDD programs and 52 had actually implemented programs. Training courses directed at program managers, first-line supervisors, and middle-level health workers are held on a regular basis. 38 developing countries are now producing ORS. Another area of activity has involved development of a management information system to monitor progress toward the target of increased access to and use of oral rehydration therapy for diarrhea in children under 1 year of age. Data from 40 countries indicate that access to ORS was 6-10% in 1982 and usage was 1-4%. There have been reviews of 10 national CDD programs, 7 of which utilized a joint national-external team to collect and analyze information on the management and impact of the CDD program. During 1983, 71 new research projects were funded by the CDD program, bringing the total number of projects supported to 231 (59% in developing countries). Biomedical research has focused on development of more stable and effective ORS; the etiology and epidemiology of acute diarrhea: and development and evaluation of new diagnostic tests, vaccines, and antidiarrheal drugs. In 1982-83, the CDD program received US$1.4 million from WHO and about US$11 million from voluntary contributors. The 1984-85 budget has been set at US$19.7 million.
[Geneva, Switzerland], WHO, . 2 p. (WHO/CDD/SER/84.7)In 1982-1983 the Who Diarrhoeal Diseases Control (CDD) Programme supported laboratory studies to identify a more stable ORS composition, particularly for use in tropical countries, where ORS has to be packed and stored under climatic conditions of high humidity and temperature. The results of these studies demostrate that ORS containing 2.9 grams of trisodium citrate dihydrate in place of 2.5 grams of sodium bicarbonate was the best of the formulations evaluated. 7 clinical trials were undertaken in which the efficacy of ORS-citrate and ORS-bicarbonate was compared. All but 1 of these trials had a double-blind study design. 4 of these studies were undertaken in children below 2 years of age with moderate to severe noncholera diarrhea. The ORS-citrate was received by 128 children and found to be uniformly as effective as ORS-bicarbonate in correcting acidosis. In 3 of the 4 studies from which preliminary data are available, there was a trend towards a reduction (8-14%) of diarrheal stool output in children receiving the ORS-citrate. Countries should have no hesitation in continuning to use ORS-bicarbonate, which is highly effective. However, because of its better stability and apparently greater efficacy, WHO and UNICEF now recommend that countries use and produce ORS-citrate where feasible.
The role of food safety in health and development. Report of a Joint FAO-WHO Expert Committee on Food Safety.
World Health Organization Technical Report Series. 1984; (705):1-79.This document presents the recommendations of a Joint Food and Agriculture Organization (FAO)-World Health Organization (WHO) Expert Committe on Food Safety. Illness due to contaminated food is perhaps the most widespread health problem in the world and a major cause of reduced economic productivity. The safety of food is affected by food systems, sociocultural factors, food chain technology, ecologic factors, nturitional aspects, and epidemiology. It was the assumption of the Committee that, if food safety is given sufficient priority within national planning, countries can prevent and control foodborne disease, especially pathogen-induced diarrheal syndromes, and interrupt the vicious cycle of diarrhea-malnutrition-disease. Attainment of this objective requires a national commitment and the collaboration of all ministries and agencies concerned with health, agriculture, finance, planning, and commerce as well as the food industry, the biamedical and agricultural scientific community, and the consuming public. Prevention and control interventions should aim to avoid or minimize contamination, to destroy or denature the contaminant, and to prevent the further spread or multiplication of the contaminant. The Committee outlined a series of recommendations for achieving a worldwide reduction in the morbidity and mortality caused by foodborne hazards. Food safety should be considered an integral part of the primary health care delivery system. Food safety should also be regarded as an integral part of the total food system. National food control infrastructures should be strengthened, and regional, national, multinational, and international surveillance of foodborne diseases should be carried out. Each country should aim to develop at least 1 laboratory capable of identifying the etiologic agents of diarrhea and other foodborne diseases. Health workers should be trained to play a role in identifying and monitoring critical control points in food production and preparation. Health education, within the context of the cultural and social values of the community, should inform the public about food safety hazards and preventive measures. Finally, the hazard analysis critical control point approach to prevention is recommended.
Prevention and control of enterohaemorrhagic Escherichia coli (EHEC) infections: memorandum from a WHO meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1998; 76(3):245-55.This memorandum was developed at a World Health Organization Consultation on Prevention and Control of Escherichia coli (EHEC) Infections, held in Geneva, Switzerland, April 28 to May 1, 1997. Since EHEC O157:H7 was recognized as a human pathogen in 1982, it has been a steadily increasing cause of food-borne illness worldwide. In view of the magnitude and severity of recent outbreaks of food-borne diseases caused by EHEC O157:H7, there is an urgent need for public health and environmental health agencies, farmers, animal producers, food processors and caterers, and researchers to collaborate to reduce or eliminate the health impact of this hazard. The memorandum presents a global overview of EHEC infections, then addresses surveillance of EHEC infections, outbreak identification, and control measures. Recommended prevention and control measures include: use of potable water in food production, presentation of clean animals at slaughter, improved hygiene throughout the slaughter process, appropriate use of food processing measures, thorough cooking of food, and education of food handlers and others on the principles and application of food hygiene.
Epidemiology of an outbreak of cholera in Senegal (West Africa) in 1985: modes of transmission and mortality.
[Unpublished] . 24,  p.A cholera outbreak in villages under demographic surveillance by a team of ORSTOM researchers in the center part of Senegal during the first three months of 1985 is described. Health authorities started a vaccination campaign and disinfection of the wells. The ORSTOM team helped to treat cholera cases and a house-to-house survey of the area was started immediately. All cases of cholera-like diarrhea and vomiting that occurred during January-March 1985 in the villages were recorded on special forms. Most cases (63%) and most deaths occurred in January. The epidemic reached a peak during the fourth week of January, then plunged. Interventions started at the end of the third week with a mass vaccination campaign, chlorinization of wells, treatment of cases with oral rehydration therapy (ORT) and tetracycline (4 x 500 mg per day for 2 days), and chemoprophylaxis of cholera patient contacts with sulfadoxine. The pattern of the disease transmission was clearly identified from retrospective interviews in 4% of all cases. Among the 102 identified cases, 56% showed evidence of primary contamination at a funeral ceremony and 44% were secondary cases within the household caused by person-to-person cholera transmission. 70% of adults were contaminated at a burial ceremony and 82% of children inside the compound. 31% of all cholera patients were below 15 years of age (more than 44% of the total population), while 28% of all cholera cases were among the population aged over 50 (14% of the population). During these 3 months, 235 cases of cholera with 44 deaths were recorded. The overall attack rate was 1.9/100 population, and the global lethality rate was 18.7%. However, below age 50 the case-fatality rate was 10%, and after age 50 it rose to 40%. 24.7% of males vs. 14.5% of females were at risk of dying. The drop from a peak of 43% lethality to less than 10% a week later was most probably attributable to ORT and tetracycline treatment.
METHODS AND FINDINGS IN EXPERIMENTAL AND CLINICAL PHARMACOLOGY. 1992 May; 14(4):289-95.UNICEF promotes the use of a very effective, inexpensive treatment of dehydration in developing countries: oral rehydration therapy (ORT), which is oral administration of a solution with equimolar concentrations of sodium and glucose (osmolality of about 300 mosmol). The solution is isotonic with respect to total body water when it reaches the small intestine. It expands the extracellular fluid without changing serum osmolality, thus, brain edema does not occur. Further, metabolic degradation of glucose eventually releases free water. On the other hand, intravenous rehydration with saline solution can be lethal, causing excess free water to expand shrunken cells and, thereby, causing brain swelling, rupture of blood vessels and hemorrhage. Yet, physicians and other health workers in developed countries have been quite sow to accept ORT. Leading conditions of dehydration include insensible loss of water and heat through evaporation from the respiratory tract and skin (common in dry air, hot environment, and fever), sensible loss of water and heat through perspiration (common in hot, humid environment and with warm and absorbent clothing), and irritation of the intestinal mucosa by allergies, infections, toxins, and intolerance to some nutrients, resulting in diarrhea. Diarrhea is indeed the main cause of dehydration. Other causes of dehydration are: failure of the hypothalamus to secrete antidiuretic hormone (ADH), kidney unresponsiveness to ADH, diabetes mellitus, protein-rich nutrition, catabolic states, and brush-border lactase after weaning. Physiological changes in dehydration consist of rigidity of the connective tissue (vascular system and lungs) and intracellular fluid loss to the extracellular spaces, resulting in dry mucous membranes, shrunken muscle cells in the lips and the tongue, soft eyes, and adverse effects to the central nervous system. Children become dehydrated more readily than adults, but they tolerate it better.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 13 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The World Health Organization's (WHO's) Control of Diarrheal Diseases Program (CDD) is seeking ways to prevent diarrhea and has identified breastfeeding as an important factor. CDD has developed activities in both its research and services components. In the research component, results from recent studies, some of which received support from the program, have shown the strong protective effect of breastfeeding against diarrheal morbidity and mortality. Exclusively breastfed infants are at lower risk of experiencing diarrhea than infants who are partially breastfed, and those who are partially breastfed are at lower risk than those who are not breastfed. Breastfeeding, which also may reduce the severity of the diarrheal illness, has a powerful effect on the risk of diarrhea-associated death. CDD's priorities for research support in the area of infant feeding were reviewed at an April 1988 meeting. Further research that the program feels is needed falls into 2 broad categories: trials of hospital and community-based interventions that aim to promote exclusive breastfeeding in the 1st 4-6 months of life; and evaluation of approaches for implementing tested breastfeeding promotion interventions in the context of national diarrheal disease control programs. CDD's services component has as its basic responsibility collaboration with countries in developing national control programs. It applies the results of research and involves activities in planning, oral rehydration solution (ORS) supply, training, communication, monitoring, and evaluation. It is in the area of training that specific recommendations on breastfeeding have been made. These recommendations are outlined. The training courses are being used to train approximately 5000 supervisory and management staff a year. The program plans to monitor the effectiveness of the training and develop future activities based on that information.
In: Mortality and health issues in Asia and the Pacific: report of a seminar held at Beijing in collaboration with the Institute of Population Research, People's University of China from 22 to 27 October 1986. New York, New York, United Nations, 1987. 107-32. (Asian Population Studies Series No. 78.; ST/ESCAP/485.)Around 1980, half of the population of the Economic and Social Commission for Asia and the Pacific (ESCAP) region was already living in countries where the average life expectancy at birth is 65 years. Impressive as this progress is, its interpretation as a proof for improvement of the health status of the populations has not remained unchallenged. Repeatedly, it has been argued that as a consequence of the import of sophisticated modern medical technology, as well as large-scale foreign aid inspired and financed public health programs, the reduction of mortality has outpaced improvements in health. Similar reservations against the use of mortality data as evidence for trends and differentials in health status have been put forward in the more developed countries of the ESCAP region, particularly vocally in Japan. The debate is not academic but concerns crucial policy issues. In many countries of the ESCAP region, the health care delivery system is neither sufficiently organized nor staffed, in numbers and qualifications, to cope with the problems raised by a rapidly increasing population, particularly in certain high risk groups such as pregnant women, infants, and children. This challenge is compounded by the fact that very often traditional health problems exist side by side with newly emerging hazards. The dominant conclusion of an analysis of all the available information is that in contrast to the significant advances in the control of mortality, the morbidity situation has either stagnated or, at any rate, failed to match the gains in longevity. Impressive advances in some areas and countries exist side by side with grave setbacks in others. On the whole, the diversity of national health conditions has increased, with some countries approaching a "modern" epidemiological scenario, others lagging behind, and another group tackling old and new disease problems concurrently. Likewise, within countries, similar differences exist or gradually emerge between urban and rural populations. Malnutrition, in synergistic action with diarrhoeal diseases and acute respiratory infections, as well as malaria, are the main challenge in the ESCAP region, particularly for the countries of Middle South Asia. Successful agricultural policies have laid the foundation for overcoming the age-old threat of mal- and undernutrition. As regards malaria, the current situation hardly justifies optimism. In the developed countries of the region, the common causes of illness are cardiovascular diseases, cancer, and accidents.
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.
In: Symposium proceedings: Cereal-Based Oral Rehydration Therapy: Theory and Practice, February 17, 1987 at the National Academy of Sciences, Washington, D.C., edited by Charlene B. Dale and Robert S. Northrup. Columbia, Maryland, International Child Health Foundation, [1987?]. 47-9.The WHO Diarrheal Disease Control Program has 2 components to the program, intervention and research. In this article, the WHO-supported research projects are summarized. There are 6 studies ongoing based on a glucose and combination of amino acids and/or dipeptides for oral rehydration solution (ORS). 10 studies are underway of ORS containing maltodextrin in place of glucose. WHO is collaborating with other institutions in studies on cereal-based solutions. WHO is supporting studies on feeding during and following diarrhea with the hope of developing simple guidelines to prepare and provide optimally nutritious diets based on inexpensive, locally available ingredients. WHO is also studying antidiarrheal drugs. The most promising of these are chlorpromazine and cholestyramine. Finally, WHO is supporting research on the microflora in children with persistent diarrhea and effects of treatment with oral antibiotics.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(2):74-81.This article traces the history of the worldwide struggle to control diarrheal diseases. When the 7th pandemic of cholera began in 1961, WHO responded with a greatly expanded program of activities which included cooperation with countries in training and control efforts, and research on treatment and prevention. In 1970, when the cholera pandemic spread to Africa, the emergency assistance program was reactivated, with increasing attention to the provision of appropriate treatment, especially oral rehydration therapy. Another public health problem of importance during the 1970s was the increase in antibiotic resistance of enteric bacteria. The demonstration of the effectiveness of a single formulation of oral rehydration salts (ORS) in the treatment of all diarrheas was instrumental in convincing public health administrators that diarrheal diseases control should become an essential component of primary health care and led to the creation of a global Diarrheal Diseases Control program. The Program, which has the objective of reducing childhood mortality and morbidity due to diarrheal diseases and their associated ill effects, especially malnutrition, consists of 2 main components: a health services and control component and research component. If the targets set by the Program for 1989 can be attained, it is expected that by then at least 1.5 million childhood deaths due to diarrhea will be prevented annually. (Summaries in ENG, FRE)
In: Proceedings. Annual Seminar on the Afghan Refugee Health Programme, December 3 and 4, 1986, Rawalpindi, Pakistan, edited by Claude J. Aguillaume, Altaf-ur-Rahman Khan. Islamabad, Pakistan, [Chief Commissionerate for Afghan Refugees, 1986]. 39-54.Over 50% of the children in Pakistan have poor nutritional status, making the combination of malnutrition and diarrhea lethal. As diarrhea may be defined as a change in the usual stool pattern, both consistency and the number of stools is important. Usually there is an increase in the number of stools which become more loose than normal. As breastfed infants have less frequent stools normally, this should not be diagnosed as diarrhea. Infantile diarrhea is a common illness because of poor infantile and personal hygiene and unsatisfactory feeding practices. Breastfed babies do not get diarrhea unless they are being given supplementary bottle feeding or other foods in an unhygienic manner. Some of the causative factors contributing to increasing infantile diarrhea are breastfeeding failure, bottle feeding, unhygienic supplementary feeding practices, and malnutrition. Etiological agents which have been isolated from the stool samples of children in developing countries include: viruses; E. coli; V. cholera; Shigellae; Salmonellae; Compylobactor Jejuni; Yersinia Enterocolitica; protozoal infections; and parenteral infections. Infantile diarrhea leads to loss of electrolyte and water from the body. There must be adequate replacement of these or it leads to dehydration and malnutrition. A plan for clinical assessment of acute diarrhea is outlined. Early replacement fluid therapy should begin promptly after diarrhea starts. It is the first and the only effective treatment for dehydration caused by diarrhea. It consists of administering either intravenous or orally a solution in water of salts comprising essential electrolyte. The World Health Organization (WHO) complete formula for oral rehydration is regarded by the majority of people as physiologically the most appropriate single formulation for worldwide use. Guidelines for rehydration therapy are outlined. Children with mild diarrhea may not need rehydration therapy, but dehydration must be prevented. Such children should be given extra fluid -- household food solutions -- which they are used to drinking. The dietary management of diarrhea and the role of drugs in infantile diarrhea are reviewed. Diarrhea can be prevented in the community with environmental sanitation, proper excreta disposal, the control of flies, a clean water supply, personal and domestic cleanliness, and measles immunization.
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.
NEW ENGLAND JOURNAL OF MEDICINE. 1986 Sep 18; 315(12):768.Cola drinks are often recommended as rehydration solutions for acute diarrhea. Although several other commercial solutions are available, cola drinks are still very popular worldwide. I have analyzed the electrolyte content and osmolality of Coca-Cola in Israel and have taken the opportunity to review all reported data in this regard in the literature. Like data reported from other countries, my results demonstrated that cola drinks are not suitable for use as rehydration solution, since they have a very low electrolyte content and an extremely high osmolality (Table 1). Thus, adequate electrolyte replacement is not possible, and induction of osmotic diarrhea may worsen the situation. For comparison, the content recommended by the WHO is also presented in the table. Contrary to the general impression, cola drinks should not be recommended as rehydration solutions for acute diarrhea in general or for infantile diarrhea in particular. (full text)
Geneva, Switzerland, WHO, EPI, 1984 Oct. 12 p. (Logistics and Cold Chain for Primary Health Care 8; EPI/LOG/84/8)The objective of this module is to enable the user to estimate the 1st requirement for oral rehydration salts (ORS) packets. This could be for a new health center or an existing center providing ORS packets for the 1st time. With each calculation an empty column has been left entitled "Your area." In this space one can change the assumptions given in the module and put in the figures for his/her own area. This module focuses on how to calculate the requirements for oral rehydration salts. The method used is the same as that described in the module "How to Estimate Requirements for the First Time." This module covers 5 steps: estimate the size of the target population; estimate the incidence of diarrheal diseases; estimate the coverage; decide on the standard treatment; and calculate the number of ORS packets for the 1st month's supply. Exercises are included.
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.
People. 1985; 12(1):31.The World Health Organization's (WHO's) improved way to counter the dehydrating effect of diarrhea is a mix of salts and sugars, much the same as oral rehydration salts (ORS) solution already widely used, but is earier and cheaper to package, has a longer shelf life, and will be more effective against the disease itself. In developing countries diarrhea is the biggest killer of children under 5, and most of the deaths are caused by the rapid loss of essential salts and water. Increasing emphasis has been placed on the early prevention of dehydration at home using drinks such as tea and rice water, but the message has not always got through. Many millions of children reach a stage of moderate or severe dehydration when they need treatment with oral rehydration salts. The ORS solution recommended by WHO for over a decade is made up of 20 grams of glucose and 3 salts -- sodium chloride (3.5 g), sodium bicarbonate (2.5 g) and potassium chloride (1.5 g ) -- mixed in 1 liter of water. The children's program UN International Childrens Emergency Fund (UNICEF) supplied some 42 million packets of this ORS worldwide in 1982-83. By the end of 1983, the mixture was being produced in 38 developing countries. Its greatest appeal is that it is simple, inexpensive, and can be used at home. ORS is usable in place of intravenous therapy in 80-90% of clinically dehydrated patients, which has reduced significantly the number of child deaths due to diarrhea in many developing countries. The new improved formula will now make it even more useful. This replaces the sodium bicarbonate of the original formula with trisodium citrate dihydrate, resulting in a more stable product. Clinical trials show that the new formula corrects acidosis at a similar rate to the sodium bicarbonate formula and is considerably more effective in reducing the amount of diarrhea. This is most likely due to the increased intestinal absorption of sodium and water that is facilitated by the citrate. Packets of the new ORS-citrate supplied by UNICEF will look the same as the original bicarbonate. Research continues into other improved ORS formulae.
Dghs Chronicle. 1985 Jan-Mar; 21(1):1, 3.The World Health Organization (WHO) has developed an improved formula for oral rehydration solution (ORS) that is based on trisodium citrate dihydrate rather than sodium bicarbonate. The new preparation will be easier and cheaper to package, have a longer shelf-life, and be more effective against diarrhea. Clinical trials have shown that the new formula corrects acidosis at a similar rate to sodium bicarbonate and is far more effective in reducing the amount of diarrhea, especially in diseases such as cholera. Although the citrate solution costs slightly more than the earlier preparation, packaging costs can be reduced by up to 50% through local production, making the end product cheaper. Local production of ORS-citrate does not require new investment or changes in equipment. WHO is recommending that countries with supplies of ORS-bicarbonate should use up these stocks and then decide whether to switch to the new formula. Research is also being carried out on other improved ORS formulas, e.g. glycine-fortified and rice powder-based ORS.