A joint 2009 publication by UNICEF and WHO, Diarrhoea: Why children are still dying and what can be done, revives action-oriented discussion about diarrheal disease — one of the world’s direst threats to babies and infants living in unsanitary, under-resourced environments. The report provides current data on the distribution and burden of the disease and on how the most affected countries are working to reduce the toll of infant diarrhea. The report also includes a strategic seven-point plan for diarrhea control, describing prevention, intervention, and treatment practices that can and should be brought to scale.

Diarrhea is the second leading cause of death for children under five globally — with pneumonia being the first — and kills approximately 1.6 million children under five each year. Eighty percent of these entirely preventable deaths occur in the poorer regions of South Asia and Africa. Although major efforts in delivering treatments and effective prevention campaigns have reduced the global impact of infant diarrheal death, many low-resource communities still face barriers to accessing low-cost, life-saving remedies for their sick children. According to the World Health Organization (WHO), only 39% of children afflicted with diarrhea receive the recommended, inexpensive treatments of fluid replacement, zinc supplementation, and continued feeding.

The diarrhea treatment plan outlined by UNICEF and WHO proposes two main solutions — fluid replacement and zinc supplementation — in addition to continued breastfeeding. The proven, standard treatment for fluid replacement is known as oral rehydration therapy (ORT), a solution of salts and sugars. WHO/UNICEF advocates for a reformulated version of ORT known as ORS, or low-osmolarity oral rehydration salts, which may be more effective overall in reducing the severity of diarrheal disease. Zinc also plays a vital role in decreasing the severity and duration of diarrhea, but how it works is still unclear. TIME calls zinc “the miracle mineral” in a December 2009 article profiling the profound affect that zinc has had on changing health outcomes and community perceptions about managing infant diarrhea.

WHO/UNICEF’s prevention strategy makes up the five remaining points of the seven-point plan, including “[1] rotavirus and measles vaccinations, [2] promotion of early and exclusive breastfeeding and vitamin A supplementation, [3] promotion of hand-washing with soap, [4] improved water supply quantity and quality, including treatment and safe storage of household water, and [5] community-wide sanitation promotion.” Nearly 90% of all diarrheal cases worldwide are attributable to unsanitary water and poor hygiene. Diarrhea is caused by a “wide range of pathogens, including viruses, bacteria, and protozoa.” While infrastructural changes may take a long time — and are much more out of an individual’s control — changes in behaviors and perceptions can go a long way in reducing susceptibility to these pathogens.

The impact of diarrhea is far-reaching and not yet under control. Only with concerted efforts that target both technical and behavioral improvements — water sanitation methods and hand-washing, for example — will the disease burden on developing countries begin to lift. If these improvements are made, communities and parents in the developing world, who were once resigned to the life-threatening illness, may begin to see how diarrheal disease can be managed and easily overcome. Parents can then begin to take control of their children’s health with relatively little cost and little effort.

 
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