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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)
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.
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.
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.
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.
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.
An assessment of the scientific achievements of the International Centre for Diarrhoeal Disease Research, Bangladesh and their relevance to AID health sector priorities.
[Unpublished] 1983. ii, 32 p.This docunment reports the findings of a United States Agency for International Development (USAID) assessment of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) which examined the scientific work of the Center in realtion to USAID's health sector priorities. USAID's Bureau of Science and Technoloby/Health has been providing core support to ICDDR,B but this grant terminated during fiscal year 1983. The multi-disciplinary assessment team was charged with making recommendations about the continuation of these funds and about any ways in which the ICDDR,B program might be modified to more closely respond to USAID's concerns. ICDDR,B's scientific reseachis of excellent quality and of great significance to the acquisition and spread of new knowledge about diarrheal diseases. There is every reason to believe that the work of scientists at ICDDR,B, which has in the past revolutionized thinking about these diseases, will continue to contribute to the search for ways to address this critical public health probelm. USAID should, therefore, continue to provide generous core support to ICDDR,B. The nature and diversity of the global diarrheal disease problem, and the ecologically determined differences in the requirements of implementation of control programs, make it impossible for ICDDR,B to carry the burden of scientific investigation alone. While the Center should continue to play a focal role, USAID is encouraged to identify and support institutions in other developing countries which could undertake scientific and operational research of diarrheal diseases. ICDDR,B could assist this globall effort by providing guidance and specialized technical consultation and training as new research programs are being developed elsewhere. The program of ICDDR,B is generally balanced and appropriate. However, the assessment team was concerned about the lack of expertise in epidemiology and immunology. (author's modified)
Geneva, Switzerland, World Health Organization [WHO], (1982). 14 p.For those countries with high infant mortality rates e.g. 220 deaths per 1000 born, at least 25% are due to diarrheal diseases. The usual cause of death in acute diarrhea is dehydration. The known causes of acute diarrhea are many and often involve an interaction among several factors. The World Health Organization (WHO) in an effort to reduce infant mortality and increase primary health care 9PHC) cites conditions which predispose the individual to acute diarrhea. Included are interactions of certain bacteria, viruses, and parasites with improper treatment, malnutrition, inadequate infant feeding, poor hygiene, lack of safe drinking water, lack of adequate sanitation, and lack of effective epidemic controls. Effective treatment involves oral rehydration salts (ORS) therapy, continued feeding or intravenous therapy, and vaccines and drugs. WHO urges health education to ensure proper and more widespread treatment. To help prevent acute diarrhea, breastfeeding is suggested along with proper domestic hygiene and adequate food. To offset the spread of the disease, careful epidemiological surveillance should be maintained and when an epidemic is detected, treatment should be immediate and intensified. New prevention and control methods are emerging through research in health service and biomedical science. Research is focused on providing different treatment approaches and improved means of delivery, increasing the understanding of the etiology of acute diarrhea, and determining the best methods for community health education. Specific work includes the development of better methods for pathogen diagnosis, a better understanding of virulence factors and associated immune responses, possible vaccines, and intervention of disease transmission. Scientists are looking closely at both bacterial and viral diarrhea with similar objectives. The final hope of these scientists is to provide significant advance in drug development and clinical management.