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Diarrhoea case management in low- and middle-income countries--an unfinished agenda
Birger Carl Forsberg1, Max G Petzold, Göran Tomson
1Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Insights
Diarrhoea management in children saw modest improvements in oral rehydration therapy and fluid intake between 1986-2003, but millions still lack adequate treatment, highlighting an urgent child survival issue.
Area of Science:
- Global Health
- Pediatrics
- Public Health
Background:
- Diarrhoea remains a leading cause of child mortality in low- and middle-income countries.
- Effective case management strategies, including oral rehydration therapy (ORT) and appropriate fluid/food intake, are crucial for reducing childhood deaths.
- Significant global efforts were made to promote improved diarrhoea management from 1986 to 2003.
Purpose of the Study:
- To evaluate the trends in diarrhoea management among children in low- and middle-income countries between 1986 and 2003.
- To assess improvements in the use of oral rehydration therapy (ORT), increased fluid intake, and continued food intake during childhood diarrhoea episodes.
- To identify the extent to which children received adequate treatment for diarrhoea during this period.
Main Methods:
- Analysis of household data from 107 Demographic and Health Surveys (DHS) across 40 low- and middle-income countries.
- Assessment of trends in key diarrhoea management indicators: rehydration, fluid quantity, and food intake.
- Statistical analysis of overall trends for each indicator from 1986 to 2003.
Main Results:
- Modest annual progress observed in oral rehydration therapy (ORT) use (0.39%) and increased fluid intake (1.02%).
- Despite improvements, ORT and increased fluid intake use rates remained low in 2003, far from desired full coverage.
- Millions of children annually did not receive ORT (307 million) or increased fluids (356 million), with 227 million receiving neither by the early 21st century.
Conclusions:
- Many children in low- and middle-income countries still do not receive adequate treatment for diarrhoea, underscoring an unfinished agenda in child survival.
- There is an urgent need to improve the effectiveness of diarrhoea control strategies by critically reviewing established approaches.
- Scaling up interventions to reach caregivers and improve case management is essential to reduce childhood deaths from diarrhoea.
Objective:
To ascertain whether diarrhoea management improved during 1986-2003, a period when significant efforts were made to promote effective case management in children.
Methods:
We analysed household data from 107 Demographic and Health Surveys in 40 low- and middle-income countries from 1986 to 2003 and assessed trends in indicators of rehydration, fluid quantity and food intake in children with diarrhoea. A statistical analysis was made of the overall trend for each indicator.
Findings:
Modest progress was made with regard to the use of oral rehydration therapy (ORT) (0.39% per year) and increased fluid intake (1.02% per year), and use rates remained low in 2003, when compared with desired full coverage. Although use rates improved in the majority of countries, no progress was made in several countries. We estimate that, annually, 307 million children in low- and middle-income countries did not receive ORT, 356 million did not get increased amounts of fluids, and at the beginning of the 21st century, 227 million children got neither ORT nor increased amounts of fluids.
Conclusion:
The finding that many children in low- and middle-income countries do not receive proper treatment for diarrhoea points to the urgency in addressing this unfinished agenda in child survival. The effectiveness of diarrhoea control needs to be improved after critical review of established approaches and activities to reach caregivers of children at risk of dying from diarrhoeal diseases. Significant efforts must be made to scale up activities to improve case management and reduce childhood deaths from diarrhoea.
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