Diarrhoea is a leading killer of children, accounting for approximately 8 per cent of all deaths among children under age 5 worldwide in 2016. This translates to over 1,200 young children dying each day, or about 450,000 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 2016, the total annual number of deaths from diarrhoea among children under 5 decreased by more than 50 per cent. 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.
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.
Treatment interventions – when timely and appropriate can cure children from diarrhoea and ensure survival
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 the Middle East and North Africa, South Asia and sub-Saharan Africa (34 per cent, 37 per cent and 39 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.
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 over 4 in 10 (44 per cent) of children ill with diarrhoea are treated with ORS, which represents only a marginal increase from 2000.
Despite the global recommendation to include zinc supplementation for diarrhoea, global coverage of this intervention is extremely low with only 11 per cent of children with diarrhoea 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.
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: 48 per cent of urban children with diarrhoea receive ORS. In rural areas, 42 per cent of children with diarrhea receive this life saving treatment.
Globally, children from the poorest 20 per cent of households in their respective countries – 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 (34 per cent vs. 45 per cent). However, even among the richest quintile, less than half of children suffering from diarrhoea are treated with ORS.
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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.
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PLOS Medicine Collection, Measuring Coverage in Maternal, Newborn, and Child Health, vol. 10, no. 5, May 2013
For most children around the world, pneumonia and diarrhoea are easily prevented and managed illnesses with simple and effective interventions that are rarely life threatening. However, not all children are so fortunate. This report describes the face of current pneumonia and diarrhoea-related mortality and illustrates the startling divide between those being reached and the abundant number of children left behind, which threatens sustainable development for the world’s poorest nations.
Many children’s lives can be saved with correct management of childhood diarrhea. Too many children are not receiving adequate care for diarrhea in high-burden sub-Saharan African countries, even among those seen in health facilities. Redoubling efforts to increase careseeking and improve quality of care for childhood diarrhea in both health facilities and at community level is an urgent priority.
This report makes a remarkable and compelling argument for tackling two of the leading killers of children under age 5: pneumonia and diarrhoea.
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.