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.
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.
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.
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.
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.
