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Washington, D.C., National Academy Press, 1981. 22 p. (Contract AID/ta-C-1428)2 essential direct interventions in management of acute diarrheal diseases, oral rehydration and continued feeding, are summarized. Recent estimates of the global problem are that more than 500 million episodes of diarrhea occur yearly in infants and children under 5 years of age in Asia, Africa, and Latin America. 5 million deaths from diarrhea have been reported each year. Dehydration is the major cause of the immediate morbidity and mortality of children with diarrhea. Oral rehydration techniques may assist and reverse progression to severe dehydration and thereby are highly efficient in managing diarrheal disease. Formula selection, preparation of ingredients, distribution of oral rehydration solution, economic considerations, and cost-effectiveness of therapy programs are the primary concerns for those using oral rehydration. Formula selection should take into account the quantity of sodium, potassium, bicarbonate, and glucose in the formula. Preparations should be made so they can be done in the household rather than in national agencies. Centralized national packaging is recommended to standardize the salt/sugar mix. Measuring spoons and containers are also important in the packaging. Distribution should be accomplished by government or private agencies. The home preparation is the most economical. The effectiveness of the program is an important consideration. It is recommended that 2 different formulas be introduced into the community: a simpler lower sodium formula for home preparation and the more complex World Health Organization solution for supervised use in the health center. Continuation of feeding is important during and after diarrheal illness. Anorexia, nausea, vomiting, and abdominal cramps, may accompany acute infection. Cow milk may help produce symptomatic fermentative diarrhea, however breastfeeding should be continued. Fruits, vegetables, and sources of protein should also be fed to patients with diarrhea. Deleterious effects may occur if a patient fails to continue eating. A community system of surveillance and education should be developed to control diarrheal disease.
[Control of diarrheal diseases in Mexico and Latin America] El control de las enfermedades diarreicas en Mexico y Latinoamerica.
BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO. 1989 May; 46(5):360-7.Gastrointestinal infections are the most frequent causes of illness and death in children under 5 in most Latin America countries and in other developing countries. The simple and effective techniques now available to prevent death from diarrhea offer promise therefore of lowering overall pediatric mortality rates. Oral rehydration therapy is the single most effective treatment for control of diarrheal disease in children because most diarrhea deaths are directly related to dehydration. The discovery during the 1960s that intestinal absorption of glucose, sodium, and salt by the small intestine continued during diarrheal episodes gave scientific support to oral rehydration therapy. The World Health Organization estimates that up to 67% of diarrheal deaths can be prevented with oral rehydration therapy. Oral rehydration therapy can help prevent harmful treatments such as fasting and requires no laboratory controls. By the late 1980s, diarrheal control programs were in effect in over 90 countries, including all of Latin America except Chile. 20% of children with diarrhea receive modern treatment, thus avoiding an estimated 600,000 deaths annually. The World Health Organization formula for oral rehydration has been proven effective and safe for treatment of dehydration caused by diarrhea at any patient age. Early experience with oral rehydration therapy in Mexico and elsewhere demonstrated that it resulted in shorter episodes of diarrhea with fewer effects on nutritional status. The reduced need for hospitalization is another significant benefit or oral rehydration therapy. An estimated 60% of the population of Latin America has access or oral rehydration therapy. In late 1985 the rate of use was estimated at 20% for Latin America as whole but only 9% in Mexico. Research in Mexico indicated that the product name and packaging of oral rehydration packets were unattractive and intimidating to mothers. The new packaging has pictures of a healthy baby and the tree of life, a statement of indications for use (avoid dehydration due to diarrhea), and logos of institutions in Mexico's health sector. The package also provides simple instructions for preparation and use. In 1986-87 greater emphasis was placed on clinical training in use of oral rehydration therapy, communication, and increasing access. Selected personnel from each of the 32 Mexican states and territories received training in oral rehydration therapy in a hospital in Mexico City and returned to act as multipliers in their home states. Over 1700 health professionals were trained in 6 priority states. In 1986, efforts were initiated to promote use of oral rehydration therapy directly in the home. A 2nd survey showed that by 1987 the rate of use of oral rehydration therapy in Mexico had increased from 9 to 24%, but that some harmful practices persisted.