How is diarrhoea prevented?

Many well-known child survival interventions are critical to reducing child deaths due to diarrhoea. These work in two ways: by either directly reducing a child’s exposure to diarrhoea-causing pathogens (through the provision of proper immunization and safe drinking water, for example) or by reducing a child’s susceptibility to severe diarrhoea and dehydration (through improved nutrition and overall health care).

Rotavirus is estimated to cause about 40 per cent of all hospital admissions due to diarrhoea among children under five worldwide. WHO has recently recommended the introduction of rotavirus vaccination on a global scale, and this needs to become a top international priority, especially for Africa and Asia, which are the regions with the greatest rotavirus burdens.

Measles is an acute viral infection that is often self-limiting. But some children, particularly those who are undernourished or have compromised immune systems, may experience serious side effects, including diarrhoea. Diarrhoea is one of the most common causes of death associated with measles worldwide.

How is diarrhoea treated?

The latest recommendations for treating childhood diarrhoea in the developing world are set out in a UNICEF and WHO joint statement issued in 2004.

Oral rehydration therapy:

Since the 1970s, ORT has been the cornerstone of treatment programmes to prevent life-threatening dehydration associated with diarrhoea. Fluid replacement should begin at home and be administered by the caregiver at the start of the diarrhoea episode. A solution made from oral rehydration salts (ORS) is the ‘gold standard’ of oral ORT, and a new formula has been developed (known as low-osmolarity ORS) that improves overall outcomes when compared to the original version. UNICEF and WHO recommend that all children with diarrhoea have access to this new ORS formula; making it widely available to children in need will require innovative delivery strategies.

When ORS packets are not available, other fluids will also work to prevent dehydration among children with diarrhoea, although they are not as effective in treating children who have become dehydrated. Such fluids (which many countries have designated as ‘recommended home-made fluids’) can be prepared using readily available and low-cost ingredients. Examples of rehydrating fluids include water with sugar and salt, cereal-based drinks made from a thin gruel of rice, maize, potato or other readily available low-cost grain or root crop that families have at home. Breastmilk is also excellent for fluid replacement and should be given to infants with diarrhoea simultaneously with other oral rehydration solutions. If ORS or other appropriate fluids are not available, increased amounts of almost any fluid can also help to prevent dehydration.

Continued feeding of the child during the diarrhoea episode further supports the absorption of fluids to prevent dehydration. Children receiving food during a diarrhoea episode are also more likely to maintain their nutritional status and their ability to fight infection.

Zinc supplements: A recent and important development in diarrhoea treatment is the addition of zinc to the regimen. A 10- to 14-day treatment course with zinc tablets effectively reduces both the duration and severity of diarrhoea episodes as well as the need for advanced medical care. Children receiving zinc often have better appetites and are more active during the diarrhoea episode; its use has also been associated with increased ORS uptake. The provision of zinc tablets by health workers may also reduce the demand from caregivers for other less effective drugs, such as antibiotics and antidiarrhoeal medications, which should not be routinely administered.