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

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Diarrhoea is a leading killer of children, accounting for 9 per cent of all deaths among children under age 5 worldwide in 2015. This translates into over 1,400 young children dying each day, or about 530,000 children a year, despite the availability of simple effective treatment. 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 2015, 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 half a million. Many more children could be saved through basic interventions to improve drinking water, sanitation and hygiene (WASH) for diarrhoea prevention, and the widespread use of a simple solution of oral rehydration salts (ORS) and zinc supplementation during episodes of diarrhoea.

COVERAGE OF RECOMMENDED TREATMENT

Since 2004, UNICEF and the World Health Organization (WHO) have recommended treating childhood diarrhoea by replacing lost fluids through oral rehydration therapy. Along with continued feeding, oral rehydration salts (ORS) and zinc supplements are the recommended methods for treating diarrhea. Availability, accessibility of these drugs to all children, especially those in poor, rural and marginalized populations, could save the lives of hundreds of thousands additional children each year. These interventions have proved cost-effective, affordable and relatively straightforward to implement. However, worldwide, just over 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 (38 per cent and 47 per cent, respectively), the regions with the most deaths from diarrhoea. Over the observed period, progress of this important intervention has been very slow.

Coverage of the recommended treatment package is low across regions, particularly in the ones with highest mortality
Percentage of under 5 children received diarrhoea treatment: ORT (oral rehydrations salts ORS or recommended homemade fluids RHF or increased fluids) with continued feeding, 2000–2015

Source: UNICEF global databases 2016 based on DHS, MICS and other nationally representative sources.

Notes:Global estimates are based on a subset of 74 countries, covering 60 per cent of under-five population (excluding China and India for which data were not available).  Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was not sufficient to calculate regional estimates for CEE/CIS, Latin America and the Caribbean and Middle East and Northern Africa regions.


When it comes to specific use of ORS for diarrhea management, little progress has been made in coverage of this effective intervention. Available data indicate that just 4 in 10 (40 per cent) of children ill with diarrhoea are treated with ORS, an increase of just 6 percentage points since 2000. Most critical is the low coverage levels observed in regions where the burden of diarrhea deaths in children under age 5 is highest.

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 2015

* Excludes India

** Excludes China

^ Excludes India and China

Source: UNICEF global databases 2016 based on DHS, MICS and other nationally representative sources.

Notes: Global estimates are based on a subset of 84 countries, covering 65 per cent of under-five population (excluding China and India for which data were not available).  Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was not sufficient to calculate regional estimates for CEE/CIS and Latin America and the Caribbean regions.


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 more likely to receive this recommended treatment than children in rural areas. Even among children living in cities and towns where health services are in general more available, coverage is far from optimal: 45 per cent of urban children with diarrhoea receive ORS. In rural areas, 39 per cent of 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, 2010–2015

* Excludes India

*** Excludes China

^ Excludes China, India and high income countries

Notes: Estimates are based on a subset of 77 countries with available data for urban and rural residence for 2010–2015, covering 56% per cent of the urban and 82% of the rural population under 5 (excluding China and India, 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, 2015, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (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, 2015 (2010–2015)

* Excludes India

** Excludes China

^ Excludes India, China and high-income countries

Notes: Estimates are based on a subset of 63 countries, covering 60 per cent of population under 5 in richest and poorest areas (excluding China and India, 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, 2015, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (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_ORS (February 2016)Download Data
Diarrhoea all indicators (February 2016)Download Data
CoD Diarrhoea (December 2015)Download Data
Diarrhoea ORT+CF (February 2016)Download Data
Recent Resources
Publication 2012-PD_35

Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children

Jun 1, 2012

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

Download full report (PDF)
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.