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  1. 1

    Report of the eleventh meeting of the technical advisory group (Geneva, 7-8 March 1990).

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

    [Unpublished] 1990. 12 p. (WHO/CDD/90.33)

    Findings from the 11th meeting of the Technical Advisory Group (TAG) of the Diarrheal Diseases Control Program are reviewed. Progress made in health services during 1988-1989 include training in supervisory skills for an estimated 17% of the staff and in case management for 11% of the staff, endorsal of breast feeding and rational drug use, 61 countries producing oral rehydration salts (ORS), a 60% access rate to ORS and 34% rate of use of oral rehydration therapy, increased communication activities, and improved assessment for diarrheal management. Major research progress includes determining the effectiveness of rice-based ORS, continued feeding, and breast feeding in diarrheal management. Revisions in research management include the utilization of multi- disciplinary research teams and the replacement of Scientific Working Groups (SWG) with experts to review research priorities, determine study methods, review proposals, and confer with investigators on research design. Research priorities are vaccine development and childhood diarrhea which involves case management research by employing clinical trials, epidemiology and disease prevention, and determining cost effectiveness and optimal delivery of intervention methods. 1995 goals are increased production of ORS, improved supervisory skills training, and improved case management of oral rehydration therapy. During 1988- 1989, the program had access to US$ 20.9 million. US$ 4.7 million carried over at the end of 1989 into 1990. The 1990-1991 overall budget was reduced by 26% because increased contributions were not acquired. Recommendations for the health services component of the program include program implementation which utilizes effective diarrheal assessment tools, focuses on lowering childhood mortality due to diarrhea in 24 countries, and correcting the misuse of antibiotics and antidiarrheal drugs; training for the medical profession in diarrheal management, improved training materials and additional training units; increased accessibility to ORS; improved communication which involves promoting diarrheal treatment in the educational system; and preventing diarrhea by encouraging breast feeding. Recommendations for research includes revised research management guidelines and close collaboration between TAG and investigators.
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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

    Interim programme report, 1983.

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

    Geneva, Switzerland, WHO, [1984] 27 p.

    This is the 1st interim report issued by the Diarrhoeal Diseases Control (CDD) Programme, summarizing progress in its main areas of activity during the previous calendar year. Most of the information is presented in the form of tables, graphs and lists. Other important developments are mentioned briefly in each section. The information is presented according to major program areas; health services; research; and program management. Within the health services component, national program planning, training, the production of Oral Rehydration Salts (ORS), health education and promotion are areas of priority activity. Progress in the rate of development of national programs, participants in the various levelsof training programs, and the countries producing their own ORS packets and developing promotional and educational materials are presented. An evaluation of the health services component, based on a questionnaire survey to determine the impact of Oral Rehydration Therapy (ORT), indicates significant decreases in diarrheal admission rates and in overall diarrheal case-fatality rates. Data collected from a total of 45 morbidity and and mortality surveys are shown. Biomedical and operational research projects supported by the program are given. Thhe research areas in which there was the greatest % increase in the number of projects funded were parasite-related diarrheas, drug development and management of diarrheal disease. Research is also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials. The program's organizational structure is briefly described and its financial status summarized. The report ends with a list of new publications and documents concerning health services, research and management of diarrheal diseases.
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  4. 4

    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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  5. 5

    The WHO Diarrhoeal Diseases Control Program: the practical application of oral rehydration therapy.

    Merson MH

    [Unpublished] 1983. Presented at the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C. 11 p.

    3 aspects of oral rehydration therapy (ORT) have to be considered in evaluating its potential importance as a priority primary health care intervention. First, studies have proven that ORT is safe and effective. Second, the World Health Organization (WHO) and UNICEF have established a recommended approach to ORT delivery. This includes early therapy in the home with appropriate household solutions, use of OR salts (ORS) for treatment of dehydration at health centers and hospitals and by village health workers, and the provision of backup support with intravenous therapy at larger health centers and hospitals. A universal rehydration solution has been adopted as well, consisting of sodium chloride 3.5 gm, sodium bicarbonate 2.5 gm, potassium chloride 1.5 gm, dissolved in 1 liter of water; this solution is also appropriate for maintenance although its sodium concentration may be too high for use in infants. Studies have shown that dehydrated infants receiving a solution lacking potassium had prolonged hypokalemia compared with those receiving ORS solution. It is now known from experience in many countries that ORT using ORS solution can be readily implemented in health facilities and has also been shown to lead to a signicant decline in the use of intravenous fluids and case-fatality rates in hospitals and health centers. In Calcutta the efficacy of a solution made from cooked rice powder was compared in dehydrated infants with the standard ORS solution and one to which glycine was added. Both the rice-based ORS and that containing glycine resulted in a 40% decrease in stool output compared with the standard ORS solution; thus it might be possible to achieve a good result by using a rehydration solution that enhances fluid absorption in the intestine. Almost all typical home remedies for diarrhea lack the needed potassium chloride and sodium bicarbonate and are therefore not ideal but can be used in situations where ORS is not available. The 3rd aspect of ORT is its relationship to other factors in clinical management, namely the replacement of calories lost during the diarrhea episode. A recent WHO study estimated that in 1980 there were up to 1 billion diarrheal illnesses resulting in 4.6 million deaths in Africa, Asia, and Latin America, and that the highest incidence and mortality rates were in the 1st 2 years of life. The WHO diarrheal disease control program has 2 components, health services and research. In the health services area, the maternal and child health and environmental health strategies promote exclusive breastfeeding for the 1st 4-6 months of life, and continued breastfeeding up to at least 2 years of age, and the addition of locally available semisolid foods from age 4-6 months, as well as the use of clean water and hygienic food practices. Health education and information materials are also being produced.
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