Progress in the prevention and control of diarrhoeal diseases since Independence.

Acute diarrhoeal diseases constitute one of the major health problems among young children in India. It was estimated in 1978 that 1.5 million children under the age of 5 years die due to diarrhoea every year, which declined to 0.6-0.7 million in the estimate revised in 1992. A similar declining trend has also been noted in hospitalized cases in Calcutta (present Kolkata) during 1980-95 as well as from other parts of India. Even today, cholera epidemics occur regularly in India. The cholera epidemic caused by a novel strain of Vibrio cholerae, designated as V. cholerae 0139 Bengal in 1992 and multidrug-resistant shigellosis in eastern India in 1984 are matters of grave concern. The launching of the National Diarrhoeal Diseases Control Programme (CDD) in 1978, based on a three-tier approach, is of great importance. The rate of use of oral rehydration salt (ORS) solution and oral rehydration therapy (ORT) remain suboptimal in India. In spite of the launching of the 'Ganga Action Plan' and the 'National River Action Plan', India faces a major problem of diarrhoeal diseases. Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta and poor personal hygiene help to perpetuate and spread diarrhoeal diseases in India. Since diarrhoeal diseases are caused by 20-25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible. However, as the majority of childhood diarrhoeas are caused by V. cholerae, Shigellae dysenteriae type 1, rotavirus and enterotoxigenic Escherichia coli (E. coli) which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrhoeal diseases in India, a formidable task in a country with a population of over 1 billion.