I) What is the problem?

Every year, about 1.5 - 2.5 million child deaths worldwide are attributed to diarrheal diseases, and the overall incidence rate of diarrhea among children has changed little in the last 30 years. Despite the significant contribution of diarrhea to under-five mortality and the new, more effective protocol for oral rehydration therapy (ORT) that has been prescribed, individual countries are still giving insufficient focus to improving diarrhea case management. Lack of attention to diarrheal diseases is likely related to the replacement of earlier diarrheal disease control programs with Integrated Management of Childhood Illnesses (IMCI) strategies, which have not been fully implemented in many areas. And, even when fully implemented, IMCI does not always address the full range of activities that were once included in Control of Diarrhea Disease (CDD) programs.

II) What are the evidence-based interventions?

Both case management and prevention interventions are required to reduce the burden of diarrheal disease. Recent reductions in mortality from diarrheal diseases among children are primarily the result of the improved availability and use of ORT to prevent and treat dehydration due to acute watery diarrhea. Since 2004, WHO and UNICEF have recommended a new low-osmolarity oral rehydration solution (ORS) and zinc supplementation as part of ORT. Advocacy efforts are needed to reposition ORT/ORS and introduce zinc at the global, regional, country and district levels, as well as in pre-service medical, nursing and paramedical schools.

However, management of diarrhea is not enough to significantly improve child health. MCHIP will also work to combine diarrheal management with preventative interventions such as optimal breastfeeding, appropriate complementary feeding, and water/sanitation/hygiene interventions, including hand-washing.