Childhood Diarrhoea: Failing Conventional Measures, what Next?

Abstract

BackgroundDiarrhoea is one of the leading causes of infant mortality. This article analyzes its contribution towards the realization of millennium development goal number 4 (MDG-4).MethodsA PubMed search using keywords acute infant diarrhea together with prevalence, management, or prevention 23 of the 634 generated articles were reviewed for inclusion.ResultsWHO first expressed concern about diarrhoeal mortality in 1979. Two decades later it reported diarrhoea as the second leading cause of infant mortality worldwide. The annual death toll of 1.5 million is greater than AIDS, malaria and measles combined. Short term repercussions (dehydration, electrolyte imbalance, malnutrition, shock, death) plus long-term diminished fitness index, cognitive function, and school performance have major impact on society. Ever since its 1971 success, Oral Rehydration Therapy has been the cornerstone treatment of diarrhoea. Decreased compliance has been recorded worldwide with Kenya ranking first. Intravenous therapy is useful in preventing complications while anti-diarrhoeals and anti-microbials, are indicated in severe cases. Zinc supplementation has also proven effective, and is recommended along with rehydration. Furthermore, immunization and good hygiene prevent faecal-oral transmissions.ConclusionMDG-4 aims to reduce childhood mortality by 2/3 by 2015. Studies, however, show minimal progress, and the target is likely to be missed. Efforts must therefore be made to review existing strategies and formulate newer ones. Research priorities need to move away from perceived ‘killer diseases’ since far more children die in a day than have ever died from avian influenza for example.

Knowledge and attitude towards oral rehydration therapy among mothers of under-five children of South Rajasthan, India

“…Only less than 40% of children with diarrhoea in developing countries received the recommended treatment and there has been a little progress toward the trend in the last decades. 3,4 Numerous studies about the maternal awareness of proper diet of children with diarrhoea suggested that knowledge of the etiologic factors, symptoms, treatment, and caring methods in diarrheal children among mothers is inadequate. 5,6 Oral rehydration solutions enhance and promote the reabsorption of sodium and water and studies indicate that these solutions greatly reduce vomiting, volume loss from diarrhoea, and the duration of the illness.…”

Assessing the Impact of a Community-Based Health and Nutrition Education on the Management of Diarrhea in an Urban District, Cairo, Egypt

“…Morbidity due to diarrhea has not shown a parallel decline in comparison to mortality trends, and global estimates remain between two and three episodes of diarrhea per under-five year child per year ( WHO, 2013 ). Millennium Development Goal - 4 aimed to reduce childhood mortality by 2/3 by the year 2015, however previous studies ( Alkizim, Matheka, & Murithi, 2011 ; EDHS, 2014 ) have showed minimal progress in this regard. Therefore, efforts must be made to review existing strategies and formulate newer ones.…”

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

“…Despite reductions in global deaths due to diarrhea in under five children to around 400,000 each year, globally (range, 200,000 to 500,000) during 2000-2010, the mortality rate is still high [1] and diarrhea remains the second leading cause of childhood deaths [2]. Malnutrition is associated with both macro-and micronutrient deficiencies [3], and directly or indirectly related to 35% of all deaths among under-five children [4].…”