Child Survival: From Knowledge to action

Venice, 26 to 28 January 2003

Session 2: Diarrhoeal Diseases

Dr Hans Troedsson, Director, Department of Child and Adolescent Health and Development (CAH) CAH

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Time trends in diarrhoea mortality 1975-2000

Snyder & Merson 1982 Bern et al. 1992 Kosek et al. 2003 Parashar et al. 2003 Boschi-Pinto et al (submitted) WHO/EIP 2001 3 2 1 0 1975 1980 1985 1990

Year

1995 2000

Source: Boschi-Pinto C et al. Deaths from diarrhoeal diseases among children under five years of age in the developing world. A review. Submitted for publication

2005

CAH

Major causes of death among children under five years of age - World 2002

Source: WHR, 2003

CAH

Age specific incidence for diarrhoea episode per child per year from 2 reviews of prospective studies in developing areas,1955-2000 5 number of episodes/person/year 4 3 2 1 0 0-5m 6-11m 1 year 2 years 3 years 4 years

Source: Kosek et al. Bulletin of the WHO 2003; 81:197-204

1980-1990 1990-2000 CAH

Case Management of Diarrhoea in the Home

  

prevent dehydration through early administration of appropriate fluids available in the home, and if available ORS solution; continue feeding or increased breastfeeding during, and increased feeding after the diarrhoeal episode know signs of dehydration indicating the need to take a child to a health care provider for treatment with either ORS or intravenous electrolyte solution, and other indications for medical treatment (such as bloody diarrhoea); CAH

Case Management of Diarrhoea in Health Facilities

    

Educate mothers to begin appropriate home fluids as soon as the child has diarrhoea; treat dehydration with ORS solution (or with an intravenous electrolyte solution in case of severe dehydration); recommend continued feeding or increased breastfeeding during,and increased all feeding after the diarrhoeal episode; use antibiotics only when appropriate (in case of bloody diarrhoea or shigellosis, and cholera) and discourage use of anti-diarrhoeal drugs; advise caretakers on the need to increase fluids and continued feeding during future episodes.

CAH

Evolution of Oral Rehydration Therapy use rates in three regions from 2001 to 2004 80 number of episodes/person/year 70 60 50 40 30 20 10 0 AFRO AMRO ASIA

Source: The State of the World Children 2001 and 2004, UNICEF (Statistical Tables- Health)

2001 2004 CAH

Recent Developments in the Management of Diarrhoea

  

Two new vaccines against rotavirus are being licensed for Phase II trials; A new improved ORS solution that significantly reduces severity of diarrhoea is now being available through UNICEF; Zinc supplements given during an episode of diarrhoea andfor14 days after reduces the severity of the episode and the incidence of diarrhoea for the following 4 to 6 months.

CAH

Reduced Osmolarity ORS Solution in children with acute non-cholera diarrhoea

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stool output reduced by 20%,

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vomiting reduced by 30%, and

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need for unscheduled IV reduced by 35%.

CAH