Oral rehydration of children with diarrhoea in Nigeria: a 12-year review of impact on morbidity and mortality from diarrhoeal diseases and diarrhoeal treatment practices.

Diarrhoea diseases continue to be one of the most important causes of morbidity and mortality in the developing world, particularly among young children. Recognizing the importance of the diarrhoeal problem, the World Health Organization has established a global programme for the control of Diarrhoeal Diseases (CDD). The widespread use of ORT is an important part of this programme. In Nigeria, a nationwide execution of the CDD began in 1986. In view of the huge population of Nigeria, an evaluation of the efficacy of the CDD programme at reducing morbidity and mortality from diarrhoeal diseases has national and global importance. Analysis of the available data shows that there has been clear reduction in reported morbidity from dysentery since 1982, with a sharp decline in 1988, and that the incidence of cholera, typhoid, and paratyphoid are all on the increase since 1982. An analysis of community-based CDD survey data revealed minimal, but insignificant impact on diarrhoeal diseases incidence and diarrhoeal treatment practices in Nigeria from 1986 to 1989. Using the technique of decision analysis, the total annual number of acute diarrhoeal episodes for children under 5 years old in Nigeria was estimated to be 83.2 million and this may have been responsible for at least 314,200 deaths in this age group in 1989 alone, despite the implementation of the CDD programme. CDD interventions, by their very nature, are problematic to evaluate. In fact, evaluation may be one of the most challenging and frustrating aspects of the whole programme. Thus far, CDD in Nigeria is short of its goals.