Archive - May 2012

Diarrhea is a scourge that has affected humanity throughout history.  Battles have been lost by armies because of epidemics of diarrhea.  Until recently there were no treatments available for diarrhea except intravenous fluids to correct dehydration. In the past 3 decades, oral rehydration solutions (ORS) have been available.  ORS has been distributed around the world in dry powder form in packets that cost a few cents. In the past 3 decades, ORS is credited with saving over 60 million lives! However,  800,000 children continue to die unnecessarily from  diarrhea and dehydration each year.

Why should so many children die of diarrhea when we have such a simple solution to the problem?  Unfortunately, the majority of diarrheal deaths occur in the poorest countries in Africa and Asia. The global coverage of ORS has been stagnant at about 30% for the past decade. In the poorest regions of the world, the ORS coverage is as low as 15%.  

There are various reasons for the poor ORS coverage. In 1978, the Control of Diarrheal Diseases (CDD) Program was announced by the World Health Organization (WHO).  By the early 1980’s, most developing countries had their own National Control of Diarrheal Diseases (NCDD) programs.  The NCDD Programs had their own dedicated funding, staff and monitoring system. In the 1990’s, NCDD programs were merged into Integrated Management Neonatal and Childhood Illness (IMNCI) Programs. With this merger, diarrheal disease programs lost their focus.  The IMNCI programs did not have dedicated funding or staff or a monitoring and evaluation system. The program still does not have a seat at the table for resources.

I have had the joy of watching children in remote parts of Africa and Asia recover from severe dehydration within a couple of hours with use of oral rehydration therapy when they were at death’s door. I have also watched the tragedy of children dying from dehydration because they did not have access to ORS. I distinctly remember arriving at a remote village in Nigeria where I went as a WHO consultant in 1988 to conduct a training program on ORS. A teenage mother ran into the clinic with her baby of about 8 months age, screaming for help because her child had bad diarrhea. I examined the child with my stethoscope and my heart sank – the baby had just died from dehydration. I could not believe that I actually had ORS packets in my pocket to train the local workers.  If only we could have made a packet of ORS available at the child’s home the child would have lived.  The mother stared at me and said in her language, “You are a big doctor from America. Please help my baby.” From that day, I determined to do whatever I can to avert such tragedy.

We have come a long way in the last 30 years. In 1980 when I began my work on diarrhea there were almost 5 million deaths a year. Today, there are less than a million deaths. This is a remarkable achievement. However, there are still far too many unnecessary deaths.  If we can all work together and mobilize the necessary political and financial resources there should be no need for any child to die from diarrhea. In the words of Pandit Jawaharlal Nehru, the first Prime Minister of India who on the occasion of the celebration of India’s independence in the 1950’s said, “We have done a lot in the past few years but there is still a lot more to do.”

-- Dr. Mathu Santosham is a global expert on prevention and control of diarrheal diseases. At Johns Hopkins Bloomberg School of Public Health, Dr. Santosham serves as  the Director of the Center for American Indian Health, and Professor of International Health and Pediatrics . He has served as consultant to various international organizations and countries on issues related to child survival.

For more information:

-- Photos: Restoring ORT corners in Kenya

-- Video: Sometimes saving a life is as simple as combining sugar, water, and salt.

Photo credit: PATH/Hope Randall

Do you know that feeling when someone tells you good news but you have to keep it a secret? We might be bursting to share our excitement, but we have to stay quiet.

This happened to me last week when I was at a scientific session on diarrheal disease and heard that the number of child deaths continues to decrease. I am really excited, that today, with the publication of the data in The Lancet, we can spread the good news.

Child mortality fell from 9.6 to 7.6 million deaths per year over the last decade, according to the updated analysis of annual trends in causes of child mortality from years 2000-2010 by the Child Health Epidemiology Reference Group (CHERG) of the World Health Organization and UNICEF.

The collective efforts of the global health community to save children’s lives are working. The decline in child mortality is proof positive that when we invest in prevention and treatment, we see the results in lives saved.

The overall trend also masks some challenges. Diarrheal disease and pneumonia continue to be the two diseases that are the leading killers of children. While the absolute numbers of deaths from diarrhea and pneumonia declined, the proportion of the mortality pneumonia causes remains about the same and the share from diarrhea fell only slightly. And, we have made little headway in reducing the overall burden of illness from diarrheal disease; the incidence of diarrhea has fallen very little. Finally the averages don’t do justice to the stark disparities. In the highest-burden countries, the death and disease toll is far worse than the averages show.

The mortality decline is cause for celebration – and a reminder to double down on our investments.

How do we double down? The other big topic at the meeting last week is the work underway on national strategies in the 10 highest burden countries and on a Global Action Plan for Diarrhea (D-GAP).

The national strategies focus on the increasing access to the lifesaving treatments for childhood illness. These strategies focus on increasing supply and improving access to zinc, ORS, and the key treatments for pneumonia and malaria. By funding these governments’ scale-up plans, donor countries can make a down payment to jump start progress.

For the D-GAP, WHO and UNICEF will be spearheading a series of consultations in countries and regions to agree on the full range of solutions: water, sanitation, and hygiene; vaccines; feeding and nutrition; and treatment. The result will be a new global norm that can guide country strategies and inform donor investments. Look for the launch of the D-GAP in March of next year.

Both the national strategies and the D-GAP will define concrete ways to further drive down the rates of sickness and death from diarrhea. Because after we pause to savor the impressive progress and the decisive return on our investments, it is time to redouble our efforts.

Eileen Quinn is director of communications for PATH's Vaccine Development Program and fearless leader of defeatDD's Poo Crew.

For more information:

- Diarrhoea Dialogues explores the opportunities in select countries for doubling down on diarrhea control.