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UNICEF STATISTICS
Current Status + Progress
Diarrhoea remains a leading killer of young children, despite the availability of a simple treatment solution

Diarrhoea is a leading killer of children, accounting for 9 per cent of all deaths among children under age 5 worldwide. In 2013, this translated into 1,600 young children dying each day, or about 580,000 children a year. Most deaths from diarrhoea occur among children less than 2 years of age living in South Asia and sub-Saharan Africa.

Despite this heavy toll, progress is being made. From 2000 to 2013, the total annual number of deaths from diarrhoea among children under 5 decreased by more than 50 per cent – from over 1.2 million to fewer than 0.6 million. Many more children could be saved through the widespread use of a simple solution of oral rehydration salts (ORS) and zinc supplementation.

COVERAGE OF RECOMMENDED TREATMENT

Since 2004, UNICEF and the World Health Organization (WHO) have recommended treating childhood diarrhoea by replacing fluids through oral rehydration therapy. Along with continued feeding, oral rehydration salts (ORS) and zinc supplements are the recommended methods for treating diarrhoea and these could be saving the lives of hundreds of thousands of children each year if they were available to all. These interventions have proved cost-effective, affordable and relatively straightforward to implement. However, worldwide, just about 40 per cent of children under age 5 with diarrhoea receive the recommended treatment of oral rehydration therapy and continued feeding. Coverage of this treatment package is lowest in sub-Saharan Africa and South Asia (36 per cent and 38 per cent, respectively), the regions with the most deaths from diarrhoea.

Only 4 in 10 children with diarrhoea are given the recommended treatment of oral rehydration therapy and continued feeding
Proportion of children under age 5 with diarrhoea receiving oral rehydration therapy (ORS or recommended homemade fluids or increased fluids) and continued feeding, 2009–2013

* Excludes China.
Notes: Estimates are based on a subset of 86 countries with available data for 2009–2013, covering 60 per cent of the global population under 5 (excluding China, for which comparable data are not available) and at least 50 per cent of the under-five population in each region. Data coverage was insufficient to calculate the regional averages for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS) and Latin America and the Caribbean.
Source: UNICEF global databases, 2014, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative surveys.

Although a simple solution made from ORS is an effective treatment for childhood diarrhoea, the data indicate that just over one third (35 per cent) of children ill with diarrhoea receive it. Moreover, little progress has been made since 2000.

Little progress has been made since 2000 in expanding the use of ORS for treatment of childhood diarrhoea
Percentage of children under age 5 with diarrhoea who received oral rehydration salts, 2000 and 2013

* Excludes China.
Notes: Estimates are based on a subset of 79 countries with available data for 2000 and 2013, covering 67 per cent of the global population under 5 (excluding China, for which comparable data are unavailable) and at least 50 per cent of the under-five population in each region. Data coverage was insufficient to calculate the regional averages for CEE/CIS and Latin America and the Caribbean.
Source: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative surveys.

Countries with the highest levels of child deaths from diarrhoea have the lowest levels of ORS treatment. ORS is safe and inexpensive, yet in high-burden regions such as sub-Saharan Africa and South Asia only 1 in 3 children with diarrhoea is treated with it.

Countries with the highest levels of child deaths from diarrhoea have the lowest levels of ORS coverage
Percentage of under-five deaths caused by diarrhoea, and percentage of children under age 5 with diarrhoea receiving ORS

• The size of each bubble represents the number of deaths caused by diarrhoea annually among children under 5 in the given country or area in 2013. • The horizontal axis shows the percentage of children with diarrhoea receiving oral rehydration salts. • The vertical axis shows the percentage of under-five deaths caused by diarrhoea in the given country.
Source: UNICEF global databases, 2014, based on DHS, MICS, and other national household surveys, 2009-2013. Causes of death from WHO and the Child Health Epidemiology Reference Group (CHERG) provisional estimates 2014 (http://www.who.int/healthinfo/statistics/ChildCOD_method.pdf)

DISPARITIES IN COVERAGE

Across all regions, ORS coverage is inadequate. However, children in urban areas are still more likely to receive this recommended treatment than children in rural areas. Even among children living in cities and towns, coverage is far from optimal: Only about 4 in 10 urban children with diarrhoea receive ORS. In rural areas, just about 3 in 10 children with diarrhea receive this-life saving treatment.

Diarrhoea treatment with ORS is low overall and lagging in rural areas
Percentage of children under age 5 with diarrhoea who received ORS, by urban or rural residence, 2009–2013

* Excludes China.
Notes: Estimates are based on a subset of 74 countries with available data on urban and rural settings for 2009–2013, covering 58 per cent and 82 per cent of the global population under 5 in urban and rural areas respectively (excluding China, for which comparable data are unavailable) and at least 50 per cent of the under-five population in each region. Data coverage was insufficient to calculate the regional averages for CEE/CIS.
Source: UNICEF global databases 2014, based on MICS, DHS and other nationally representative surveys.

In the poorest countries, children from the poorest 20 per cent of the population – those often at greatest risk of diarrhoea – are much less likely to receive ORS for the treatment of diarrhoea than children from the richest quintile. However, even among the richest quintile, less than half of children suffering from diarrhoea are treated with ORS.

The richest children are more likely than the poorest children to receive ORS for diarrhoea
Percentage of children under age 5 with diarrhoea receiving ORS (ORS packet or pre-packaged ORS fluids), by household wealth quintile, 2009–2013

*Excludes China.
Notes: Estimates are based on a subset of 61 countries with available data by wealth quintiles for 2009–2013, covering 65 per cent of the global population under 5 (excluding China, for which comparable data are unavailable) and at least 50 per cent of the under-five population in each region. Data coverage was insufficient to calculate the regional averages for CEE/CIS, Latin America and the Caribbean, and the Middle East and North Africa.
Source: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative surveys.

REFERENCES

PLOS Medicine Collection, Measuring Coverage in Maternal, Newborn, and Child Health, vol. 10, no. 5, May 2013.

UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.

UNICEF, Pneumonia and Diarrhoea: Tackling the deadliest diseases for the world’s poorest children, UNICEF, New York, 2012.

UNICEF and WHO, Diarrhoea: Why children are still dying and what can be done, UNICEF, New York, 2009.    

WHO and UNICEF, Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD), WHO, Geneva, 2013.

WHO and UNICEF, WHO/UNICEF Joint Statement: Clinical management of acute diarrhoea, WHO, Geneva, 2004. 

Access The Data
Diarrhoeal Disease
Diarrhoea treatment: Children under age five with diarrhoea receiving oral rehydration salts (ORS packets or pre-packaged ORS fluids), disaggregated by gender, place of residence and wealth quintiles Download Data
Diarrhoea treatment: Children under age five with diarrhoea receiving oral rehydration treatment (ORS or RHF or increased fluids) with continued feeding, by gender, place of residence and wealth quintiles Download Data
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Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children

This report makes a remarkable and compelling argument for tackling two of the leading killers of children under age 5: pneumonia and diarrhoea.

 

Notes on the Data

Definition of main indicators

Diarrhoea treatment with ORS: Percentage of children under age 5 who had diarrhoea in the two weeks preceding the survey and who received oral rehydration salts (ORS packets or pre-packaged ORS fluids).

Diarrhoea treatment with oral rehydration therapy and continued feeding – Percentage of children under age 5 who had diarrhoea in the two weeks preceding the survey and who received oral rehydration therapy (oral rehydration salts, recommended home-made fluids or increased fluids) and continued feeding