PREVENTION OF DIARRHEA
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Prof. A. Gaffar Billoo, Saira Waqar Ahmed
Department of Pediatrics
Aga Khan University Karachi, Pakistan
Email : firstname.lastname@example.org
Diarrhea is the second among the most common causes of death in children. Death is usually due to loss of fluid and electrolytes. It is an important factor in development of malnutrition. It is one of the principal causes of morbidity and mortality among children in the developing world. About 4 billion episodes of diarrhea / year cause 1.5 million deaths mostly in children <5 yrs.
For children under 5 years of age in developing areas and countries, there is a median of 3.2 episodes of diarrhea/child/year. This mortality study revealed that 4.9 children per 1000 per year in these areas and countries died as a result of diarrheal illness in the first 5 years of life, a decline from the previous estimates of 13.6 and 5.6 per 1000 per year. The decrease was most pronounced in children aged less than 1 year. Despite improving trends in mortality rates, diarrhea continues to account for a median of 15% of all deaths of children aged less than 5 years in these areas and countries, being responsible for 1.5 million deaths per year. (fig.1)
The major cause of concern is that there has not been a concurrent decrease in morbidity rates attributable to diarrhea. As population growth is focused in the poorest areas, the total morbidity component of the disease burden is greater than previously 1
In 1982, on the basis of a review of active surveillance data from studies conducted in the 1950s, 1960s and 1970s, it was estimated that 4.6 million children died annually from diarrhea. In 1992, a review of studies conducted in the 1980s suggested that diarrheal mortality had declined to approximately 3.3 million annually. Both reviews estimated that children in the developing world experienced a median of 3 episodes of diarrhea every year.
Most interventions for diarrheal disease, e.g. increased breastfeeding, better weaning practices, clean water, improved sanitation and higher rates of measles immunization, would be expected to affect mortality as well as morbidity simultaneously. Nutritional status is another factor that may help to explain the de-linking of diarrheal mortality and morbidity rates. The use of oral rehydration therapy is an exception, its increased use over the past two decades probably having been responsible for some of the decrease in case-fatality rates, especially from acute dehydrating diarrhea (2).
In order to achieve further declines in mortality it may be necessary to adopt a more complex approach that would include distinguishing acute watery diarrhea, dysentery and persistent diarrhea, and ensuring appropriate case management for each syndrome. These issues are specifically addressed in the WHO/UNICEF initiative for the improved management of childhood illness (3).
Diarrhea thus still accounts for 1.5 million deaths annually, and each child in the developing world experiences an average of three episode of diarrhea per year. (fig.2)
STEPS FOR PREVENTION OF DIARRHOEA
Proper case management, consisting of oral rehydration therapy and feeding, can reduce the adverse effects of diarrhea, which include dehydration, nutritional damage, and risk of death
A number of interventions have been proposed for preventing diarrhea in young children, most of which involve measures related to infant feeding practices, personal hygiene, cleanliness of food, provision of safe water, safe disposal of faeces, and immunization. An analysis of the effectiveness, feasibility, and cost of each proposed intervention has shown that some are particularly effective and affordable.
Efforts to prevent diarrhea should focus on a few interventions of proven efficacy. The seven practices identified as targets for promotion are:
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