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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.
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.