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[Unpublished] 1986. 6 p. (WHO/CDD/CMT/86.1)This article presents an overview of current therapeutic practice as recommended by the World Health Organization (WHO) Diarrheal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, 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.
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.
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.