|Diarrhoea case management in low- and middle-income countries — an unfinished agenda|
||Birger Carl Forsberg, Max G Petzold, Göran Tomson & Peter Allebeck
||Bulletin of the World Health Organization, 2007;85: p42-48
More than one region
||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.