Control of diarrheal diseases

C. E. Taylor, William Greenough

Research output: Contribution to journalArticle

Abstract

Globally 4.5 million small children died because of infections in 1982. Diarrheal diseases, respiratory infections, and malnutrition are predisposing factors to infections. Diarrhea can be watery and dysenteric causing loss of body water. Oral rehydration therapy (ORT) prevented 700,000 deaths in 1986 period. Improved case management can prevent deaths: nutrition both during and after an episode of diarrhea, appropriate use of medications, antimicrobial agents in cholera, and factors that protect against enteric infections (gastric acid). Antibiotic use during an epidemic of verotoxin-producing strain of E. coli increased that risk of death. 330 million packets of oral rehydration salt (ORS) were produced around the work in 1987. Continuation of breast feeding and nutrient rich, food-based oral rehydration therapy (ORT) is vital. ORT benefit illnesses caused by Shigella, Salmonella, or campylobacter. Hand washing with soap and water reduces the incidence of dysentery. Chemotherapy can control chronic diarrhea, while malnutrition prolongs diarrhea. Among antidiarrhea drugs berberine and bismuth subsalicylate are effective. Typhoid vaccine TY 21a, a killed oral cholera vaccine with rotavirus, protects against Shigellae. Social mobilization efforts relying on mass media include the Child Survival and Development Revolution (CSDR) of UNICEF, Expanded Program for Immunization (EPI), and Control of Diarrheal Diseases (CDD). Promotion of breast feeding reduced 8-20% of diarrhea-related morbidity and 24-27% of mortality up to 6 months of age. Improved weaning practices by education cut mortality by 2-12% for under fives. A rotavirus immunization program could slash the 6% incidence of diarrhea and 20% of deaths in children under 5. Cholera immunization with efficacy of 70% could eliminate the .4% of diarrhea episodes and 8% of diarrhea deaths caused by cholera. Measles immunization coverage of 60% would reduce diarrhea morbidity by 1.8% and mortality by 13% in children under 5. Improved water supply and sanitation lowered morbidity by 22%, hand washing with soap and water cut diarrhea by 14-48%, secondary Shigella Cases by 35%, and all diarrhea episodes by 37%. Sustainability suffers from inadequate planning. The integration of CDD with primary health care is shown by the example of Thailand where the rural health network was expanded. The World Health Organization has developed a framework for local problem solving. Advances have been made in the past few years, but 3 million children are still dying from preventable diarrheal disease.

Original languageEnglish (US)
Pages (from-to)221-244
Number of pages24
JournalAnnual Review of Public Health
Volume10
StatePublished - 1989

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Diarrhea
Fluid Therapy
Shigella
Cholera
Hand Disinfection
Soaps
Immunization Programs
Rotavirus
Breast Feeding
Morbidity
Malnutrition
Mortality
Immunization
Infection
Cholera Vaccines
Typhoid-Paratyphoid Vaccines
Shiga Toxins
Berberine
Food
Rural Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Control of diarrheal diseases. / Taylor, C. E.; Greenough, William.

In: Annual Review of Public Health, Vol. 10, 1989, p. 221-244.

Research output: Contribution to journalArticle

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