Recognizing the importance of these new advances, the 31st World Health Assembly called for a concerted attack on diarrheal diseases as part of the global commitment to primary healthcare and health for all by the year 2000.
Shortly afterward, the WHO program against diarrheal diseases was launched, with the immediate objective of reducing infant mortality and the longer-term objective of reducing morbidity caused by diarrheal diseases and their associated harmful effects, especially malnutrition in infants and young children.
To achieve these objectives, the following strategies or procedures are being promoted:
· To reduce mortality: the treatment of acute diarrhea as early as possible in the course of the disease, using oral rehydration therapy, accompanied by the education of mothers on appropriate feeding of children during diarrhea and convalescence.
· To reduce morbidity: promoting 1) mother and child care practices that are important for preventing diarrhea, especially not interrupting breastfeeding; the preparation of safe weaning foods using locally available food products; good household and personal hygiene; and sufficient nutritional support for pregnant and lactating mothers; and 2) improved environmental hygiene practices, especially the proper use and maintenance of drinking-water and sanitation services designed to meet the needs and practices of the local population.
· To reduce mortality and morbidity: the detection and control of epidemics, especially cholera, through the establishment or strengthening of national epidemiological surveillance systems and the introduction of measures to interrupt transmission.
Because diarrheal diseases are one of the leading causes of mortality among children of all ages in most developing countries, the implementation of national diarrheal disease control programs, and especially the widespread use of oral rehydration therapy, is expected to have impressive short- and medium-term effects on children’s health throughout the world.
National Programs for the Control of Diarrheal Diseases
Since December 1983, countries in the Region of the Americas have developed national action plans against diarrheal diseases, that is, plans containing objectives, goals, timetables and budgets, within the context of their current primary healthcare systems. Six other countries have partially developed action plans.
Of the 29 countries involved in diarrheal disease control, 13 are currently implementing programs against these diseases in accordance with comprehensive action plans, while another 16 are carrying out control activities on a special basis. During 1982, technical assistance in national diarrheal disease control programming was provided to five countries, and in 1983 to five others.
Experience shows that each country implements its diarrheal disease control program in a unique way, adapted to its own realities. In general, oral rehydration therapy is the first strategy emphasized. As part of its promotional activities, PAHO provides specialist consultants to carry out clinical demonstrations of the technique at the request of countries.
These demonstrations generally take place in a carefully controlled clinical environment, often in a large university hospital, and are attended by senior clinicians and high-level ministerial personnel. The results are invariably impressive.
To maintain interest and provide opportunities for gaining further experience with the technique, PAHO often donates small quantities of oral rehydration salts and provides grants to support ongoing clinical trials of oral therapy.
Afterward, some countries begin operational field trials. In others, a planning committee is immediately established, which then formulates the national diarrheal disease control program.
The major elements of the program include the formulation of standards, goals and objectives; personnel training activities; the preparation of promotional and health-education materials; and the improvement of monitoring and surveillance systems.
In some countries, new procedures for administering oral rehydration therapy are being tested. In Haiti, where poor infrastructure and scarce resources limit the coverage of primary healthcare services, packets of oral rehydration salts are being commercially distributed through thousands of small shop owners.
In Ecuador, coverage is being extended to remote areas through teachers involved in a national adult literacy campaign. In Nicaragua, more than 300 oral rehydration therapy units have been established in rural areas.
This therapy has had initial success, achieving broad coverage and reducing diarrhea case-fatality rates to less than 0.10% throughout the country. National public health authorities are now adding other primary healthcare services to these units, such as immunization, nutritional surveillance and breastfeeding promotion.
