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  1. 1

    Report of the sixth meeting of the Technical Advisory Group (New Delhi, 11-15 March 1985).

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

    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.
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  2. 2

    Fourth programme report, 1983-1984.

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

    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.
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  3. 3

    Breastfeeding as an intervention within diarrhea diseases control programs: WHO/CDD activities.

    Hogan R; Martines J

    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.
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  4. 4

    The epidemiological situation in the ESCAP Region: facts, fallacies and implications.

    Hansluwka H

    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.
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  5. 5

    Status summary: WHO key research activities in ORT.

    Mahalanabis D

    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.
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  6. 6

    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.

    Amatayakul K; Stoeckel JE; Baron BF

    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.
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  7. 7

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

    Cash RA

    Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
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  8. 8

    An assessment of the scientific achievements of the International Centre for Diarrhoeal Disease Research, Bangladesh and their relevance to AID health sector priorities.

    Buck A; Elliott V; Guerrant R; Levine M

    [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)
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  9. 9


    Heckler MM

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

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