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Last update: Jan 2009

World Fit For Children Goal
Reduce by one half deaths due to pneumonia among children under five

The challenge

Diarrhoeal diseases account for 18 per cent of deaths among children under five years of age worldwide, or an estimated 1.7 million child deaths every year - making them the second most common cause of child deaths globally.


Diarrhea is caused by ingesting certain bacteria, viruses or parasites that may be spread by water, food, utensils, hands, and flies. Most diarrhoea-related deaths in children are due to dehydration - the loss of large quantities of water and electrolytes (sodium, potassium and bicarbonate) from the body in liquid stool.


For more than two decades, oral rehydration therapy (ORT) has been the cornerstone of treatment programmes for childhood diarrhoeal diseases, although recommendations on its use have changed over time. Measures to prevent diarrhoeal episodes include promoting exclusive breastfeeding, raising vitamin A supplementation rates, improving hygiene, increasing the use of improved sources of drinking water and sanitation facilities, promoting zinc intake and immunizing against rotavirus.


Programme recommendations on treating diarrhoeal diseases have changed over time, reflecting a better understanding of what works at home and in the community. In the 1980s, the World Health Organization recommended treating diarrhoeal episodes with a solution of oral rehydration salts (ORS). Subsequent research showed that home-made fluids - particularly those containing sodium and glucose, sucrose or other carbohydrates, like cereal-based solutions - could be just as effective. By the early 1990s, the importance of increasing fluids and continued feeding and more recently, the use of zinc and low-osmolarity ORS in preventing and treatment diarrhoeal episodes, has been emphasized.


These changes in treatment recommendations have subsequently led to shifts in the indicators used for monitoring treatment coverage, and thus there is a relative lack of comparable data from the early- to mid-1990s.


Recommended treatment Indicator used for monitoring treatment
Oral rehydration therapy (ORT) (later 1980s to 1993) Proportion of children under five with diarrhoea receiving oral rehydration salts (ORS) or recommended homemade fluids (RHF)
Home management of diarrhoea (1993 to 2004) Proportion of children under five with diarrhoea receiving increased fluids and continued feeding
ORT or increased fludis with continued feeding (2004 to present) Proportion of children under five with diarrhoea receiving ORT (ORS or RHF) or increased fluids, as well as continued feeding