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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 2012, this translated into 1,600 young children dying each day, or more than 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 2012, the total annual number of deaths from diarrhoea among children under 5 decreased by more than 50 per cent – from almost 1.3 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. The ‘gold standard’ for such therapy is the use of ORS. If ORS packets are not available, recommended homemade fluids or increased fluids are advised. Fluid replacement should be accompanied by continued feeding. Zinc, which reduces the severity and duration of a diarrhoea episode, is an additional recommendation. These interventions have proved cost-effective, affordable and relatively straightforward to implement. However, worldwide, only 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 low in sub-Saharan Africa and South Asia (35 per cent and 38 per cent, respectively), the regions with the most deaths from diarrhoea, and lowest in the Middle East and North Africa.

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, 2008–2012

* Excludes China.

Notes: Estimates are based on a subset of 71 countries with available data for 2008–2012, covering 56 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 the optimal treatment for childhood diarrhoea, the data indicate that just over one third 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 – the gold standard in treatment for childhood diarrhoea
Percentage of children under age 5 with diarrhoea who received oral rehydration salts, 2000 and 2012

* Excludes China.

Notes: Estimates are based on a subset of 75 countries with available data for 2000 and 2012, covering 57 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.

Globally, three quarters of all child deaths from diarrhoea occur in just 15 countries (highlighted in the chart below). Yet the use of ORS in these countries remains very low, reaching less than 30 per cent of children with diarrhoea in 2012. This represents only a 10 per cent improvement over the coverage level in 2000.

Countries with the highest levels of child deaths from diarrhoea have the lowest levels of ORS coverage

Notes: The size of each bubble represents the number of deaths caused by diarrhoea among children under age 5 in a given country in 2012. Fourteen of the top 15 countries in terms of under-five deaths from diarrhoea are highlighted. Angola, for which there are no data on ORS, does not appear.

Sources: UNICEF analysis based on IGME 2013, WHO, CHERG* 2013 and UNICEF global databases, 2014, based on MICS, DHS and other nationally representative surveys.

*Drawing on provisional analyses by WHO and CHERG 2013. References: Liu, Li, et al., ‘Global, Regional, and National Causes of Child Mortality: An updated systematic analysis for 2010 with time trends since 2000’,  Lancet, vol. 379, no. 9832, 2012, pp. 2151–2161;   WHO technical paper.

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.

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, 2008–2012

* Excludes China. 

Notes: Estimates are based on a subset of 70 countries with available data on urban and rural settings for 2008–2012, covering 55 per cent and 88 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, 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.

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 more advantaged children, coverage is far from ideal: Less than half of children from the richest quintile 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, 2008–2011

*Excludes China. 

Notes: Estimates are based on a subset of 51 countries with available data by wealth quintiles for 2008–2012, covering 61 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. 

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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