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 to over 1,400 young children dying each day, or about 526,000 children a year, despite the availability of simple effective treatment.

 

 

 

 

Diarrhoea kills too many children
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: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) estimates 2015

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.

SIMPLE SOLUTIONS CAN SAVE CHILDREN’S LIVES

The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) sets forth an integrated framework of key interventions proven to effectively protect children’s health, prevent disease and appropriately treat children who do fall ill with diarrhoea and pneumonia.

Protect, Prevent and Treat Framework
Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD)

Source: Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD)

Protective interventions provide the foundations for keeping children healthy and free of disease

  • Exclusive breastfeeding: For the first 6 months of life, exclusive breastfeeding (without additional foods or liquids, including water) protects infants from disease and guarantees them a food source that is safe, clean, accessible and perfectly tailored to their needs. Nearly half of all diarrhoea episodes and one-third of all respiratory infections could be prevented with increased breastfeeding in low and middle-income countries.
  • Adequate complementary feeding and continued breastfeeding: Good nutrition supports strong immune systems and provides protection from disease. From 6 months to 2 years of age, adequate complementary feeding – providing children with adequate quantities of safe, nutritious and age appropriate foods alongside continued breastfeeding – can reduce child deaths, including those due to pneumonia and diarrhoea.
  • Vitamin A supplementation: High-dose vitamin A supplementation helps maintain strong immune systems and can reduce all-cause mortality by 24 per cent and cases of diarrhea by 15 per cent. Children between the ages of 6-59 months should be protected with 2 high-dose supplements of vitamin A every year in countries with high under-five mortality or where vitamin A deficiency is a public health problem.

Preventative interventions help stop disease transmission and prevent children from becoming ill

  • Immunization: The rotavirus vaccine provides protection against one of the most common causes of childhood diarrhoea-related death.
  • Safe drinking water, sanitation and hygiene: Almost 60 per cent of deaths due to diarrhoea worldwide are attributable to unsafe drinking water and poor hygiene and sanitation. Hand washing with soap alone can cut the risk of diarrhoea by at least 40 per cent and significantly lower the risk of respiratory infections. Clean home environments and good hygiene are important for preventing the spread of both pneumonia and diarrhoea, and safe drinking water and proper disposal of human waste, including child faeces, are vital to stopping the spread of diarrhoeal disease among children and adults.
Improved sanitation facilities translates into fewer childhood diarrhoea-related deaths
Relationship between population with improved sanitation facilities and under-5 deaths due to diarrhoea

Source: UNICEF analysis based on WHO and Maternal and Child Epidemiology Estimation Group (MCEE) estimates 2015 and UNICEF global databases 2016

About the chart

  • 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 2015.
  • The horizontal axis shows the percentage of population using improved facilities.
  • The vertical axis shows the percentage of under-five deaths caused by diarrhoea in the given country.

Treatment interventions – when timely and appropriate can cure children from diarrhoea and ensure survival

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.

Source:  WHO/UNICEF Joint Statement: Clinical management of acute diarrhoea, 2004

Availability and accessibility of these treatments 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). Sub-Saharan Africa and South Asia are also the regions with the most deaths from diarrhoea. Over the observed period, progress of this important intervention has been very slow.

Coverage of oral rehydration treatment and continued feeding for diarrhoea is low across regions, particularly in the ones with highest mortality
Percentage of children under five with diarrhoea receiving oral rehydration therapy (oral rehydration salts recommended home fluid or increased fluids) and continued feeding during illness, by UNICEF region

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

Note: Estimate for 2000 includes data for the 1998-2009 period, with 2000 as the median year and estimate for year 2015 includes data for the 2010-2015 period, with 2012 as the median year. Note: Global estimates are based on a subset of 74 countries, covering 60% of population under 5 in 2015. Regional estimates represent data from countries covering at least 50% of regional under-five population. There were not enough data to calculate a regional estimate for Latin America and the Caribbean regions.

*Excludes India, **Excludes China, ^Excludes China and India.

Zinc is an important component of diarrhoea treatment recommendation, however data were not enough to calculate global and regional averages.

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
Trends in the percentage of children under 5 with diarrhoea receiving oral rehydration salt solution, UNICEF regions, 2000 and 2015

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

Note: Estimate for 2000 includes data for the 1998-2009 period, with 2000 as the median year and estimate for year 2015 includes data for the 2010-2015 period, with 2012 as the median year. Global estimates are based on a subset of 84 countries, covering 65 per cent of population under 5 in 2015. Regional estimates represent data from countries covering at least 50 per cent of the regional under-five population. There were not enough data to calculate a regional estimate for Latin America and the Caribbean regions.

*Excludes India, **Excludes China, ^Excludes China and India. Note: Zinc is an important component of diarrhoea treatment recommendation, however data were not enough to calculate global and regional averages.

Despite the global recommendation to include zinc supplementation for diarrhoea, global coverage of this intervention is extremely low with 4% of children receiving it. There are a few exceptions to this rule in South Asia – namely Bangladesh and Nepal – but overall, much more needs to be done to ensure that all children are receiving both ORS and zinc as part of treatment for diarrhoea

Too few children with diarrhoea receive zinc supplementation in all regions
Percentage of children with diarrhoea receiving zinc for diarrhoea treatment, by region, latest available value between 2010 and 2015. Regional estimates indicated on region names

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

*Excludes India, **Excludes China, ^Excludes India and China

Disparities in diarrhoea treatment 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 5 with diarrhoea receiving oral rehydration salt solution, by residence, UNICEF regions,
2000 and 2015

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

Note: Global estimates are based ona subset of 70 countries, covering 50% of population under 5 in urban and 79% in rural areas, 2015. Regional estimates represent data from countries covering at least 50%of regional under-five population.

*Excludes India, **Excludes China, ^Excludes China and India.

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 5 with diarrhoea receiving ORS, wealth quintiles, UNICEF regions, 2010-2015

Source: UNICEF global databases2016 based on MICS, DHS and othernationally representative sources

Note: Global estimates are based on a subset of 96 countries, covering 72% of population under five in 2015. Regional estimates represent data from countries covering at least 50% of regional under five population.

*Excludes India, ** Excludes China, ^Excludes China and India

REFERENCES

UNICEF, One is too many: Ending child deaths from pneumonia and diarrhea, UNICEF, New York, 2016.

UNICEF, Committing to Child Survival: A promise renewed – Progress report 2015, UNICEF, New York, 2015.

United Nations Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2015, UNICEF, New York, 2015.WHO and UNICEF, 

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.

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

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

 

Access The Data
Diarrhoeal Disease
Diarrhoea_careseeking (2016)Download Data
Diarrhoea_treatment with ORT + cont feeding (2016)Download Data
Diarrhoea_treatment with ORS (2016)Download Data
Diarrhoea_treatment with ORS and zinc (2016)Download Data
Diarrhoea_treatment with zinc (2016)Download Data
Diarrhoea as a cause of death (2015)Download Data
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.