Control of diarrheal diseases.

The tremendous advances made in the control of diarrheal diseases in the past few years indicate what more can be achieved. Even though the lives of an estimated three quarters of a million children are being saved each year, over three million children are still dying from readily preventable diarrheal disease. The challenge is to build on the successes thus far, to learn from experience, to promote changes in health habits that will prevent diarrhea, and to make all of these activities sustainable. From this analysis, we have three specific recommendations for CDD programs in the next decade. 1. ORT programs should move strongly toward promoting home treatment, building on local traditions of giving food-based preparations, with ORS available from health workers and health facilities for those who need it. Local assessment of people's beliefs and practices in caring for diarrhea should lead to simple methods of adapting ORT preparations that are culturally acceptable. Most of these traditional preparations have adequate amounts of the proteins and starches that are now being shown to produce better clinical results than the glucose in the standard ORS formula. Usually, the main change needed is more precision in the quantity of sodium added. Education of parents can then focus simply on how to make these adapted preparations, on starting rehydration early, and on replacing fluid volume as it is lost. The use of ORS packets in health facilities should continue, but the main indicator of progress in CDD should be ORT use including home solutions. Every packet of ORS should have printed on it the locally recommended formula for home ORT. 2. Nutritional support is just as important as rehydration. Diarrhea precipitates and accelerates the progression of malnutrition, which lowers resistance and increases the duration of diarrhea. Nutritional support through continued breast feeding and improved weaning practices using high density, easily digestible, local foods is especially important during and after episodes of diarrhea. 3. For long-term prevention, breaking the transmission cycles of the many common pathogens that cause diarrhea will be necessary. The most immediate preventive impact can be achieved by promoting hand washing with soap. Priority should also continue to be given to improving water supply, sanitation, and excreta control, especially of childrens' stools. Even with the great progress of recent years, the Child Survival and Development Revolution has just begun.