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Progress in the prevention and control of diarrhoeal diseases since Independence
1National Institute of Cholera and Enteric Diseases, P33, CIT Road, Scheme XM, Beliagata, Kolkata 700010, West Bengal, India.
Insights
Acute diarrhoeal diseases remain a significant health issue for Indian children, despite declining mortality rates. Addressing this requires improved sanitation, safe water, and targeted vaccines against key pathogens like Vibrio cholerae and rotavirus.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Acute diarrhoeal diseases are a major health concern for young children in India, with significant mortality.
- While mortality has declined, cholera epidemics and multidrug-resistant shigellosis remain serious threats.
Purpose of the Study:
- To highlight the persistent challenge of diarrhoeal diseases in India.
- To discuss the importance of control programs and identify key areas for intervention.
Main Methods:
- Review of epidemiological trends and disease outbreaks in India.
- Analysis of factors contributing to the spread of diarrhoeal diseases.
- Evaluation of current control strategies and future prevention possibilities.
Main Results:
- Diarrhoeal disease mortality in children under 5 has decreased but remains substantial.
- Suboptimal use of oral rehydration salt (ORS) solution and oral rehydration therapy (ORT) persists.
- Lack of safe water, poor sanitation, and hygiene perpetuate disease transmission.
Conclusions:
- Vaccination against major diarrheal pathogens like Vibrio cholerae, Shigellae dysenteriae type 1, rotavirus, and enterotoxigenic E. coli is essential for epidemic control.
- Effective control requires strong political will, adequate funding, and improvements in water supply, sanitation, and hygiene.
Abstract:
Acute diarrhoeal diseases constitute one of the major health problems among young children in India. It was estimated in 1978 that 1.5 million children under the age of 5 years die due to diarrhoea every year, which declined to 0.6-0.7 million in the estimate revised in 1992. A similar declining trend has also been noted in hospitalized cases in Calcutta (present Kolkata) during 1980-95 as well as from other parts of India. Even today, cholera epidemics occur regularly in India. The cholera epidemic caused by a novel strain of Vibrio cholerae, designated as V. cholerae 0139 Bengal in 1992 and multidrug-resistant shigellosis in eastern India in 1984 are matters of grave concern. The launching of the National Diarrhoeal Diseases Control Programme (CDD) in 1978, based on a three-tier approach, is of great importance. The rate of use of oral rehydration salt (ORS) solution and oral rehydration therapy (ORT) remain suboptimal in India. In spite of the launching of the 'Ganga Action Plan' and the 'National River Action Plan', India faces a major problem of diarrhoeal diseases. Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta and poor personal hygiene help to perpetuate and spread diarrhoeal diseases in India. Since diarrhoeal diseases are caused by 20-25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible. However, as the majority of childhood diarrhoeas are caused by V. cholerae, Shigellae dysenteriae type 1, rotavirus and enterotoxigenic Escherichia coli (E. coli) which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrhoeal diseases in India, a formidable task in a country with a population of over 1 billion.