Control of Diarrheal Disease

Diarrheal diseases are one of the major causes of infant and child deaths in the developing world. Annually, an estimated 2 million diarrhea-related deaths occur in developing countries.

Since the 1960s, USAID has been instrumental in developing, introducing, and expanding the use of oral rehydration salts (ORS) and oral rehydration therapy (ORT, which combines ORS with breastfeeding in infants and with fluids and supplemental feeding in older children) to combat diarrhea-related dehydration. In the 1990s, home management of child diarrhea improved dramatically. In 33 countries containing almost half the world’s under-five population, use of ORS or recommended home fluids increased from about one-third of cases in 1990 to 85 percent of cases by mid-decade.

USAID’s strategy for control of diarrheal disease (CDD) focuses on:

• Training health workers
• Promoting breastfeeding
• Applying social marketing and modern communication techniques
• Expanding community approaches for delivering ORT through community agents and activities

CDD interventions are usually nested in larger integrated child health and primary health care programs. USAID efforts have helped develop and strengthen CDD programs that prevent diarrheal illness and deliver ORT to children who need it. USAID is seeking further reductions in diarrhea-related illness and death by extending ORT coverage to unreached populations and by continuing to promote adequate care and timely care-seeking at the community level. Breastfeeding, improved water supplies and sanitation, and continued feeding of children with diarrhea are other integral components of USAID’s strategy to reduce diarrheal diseases and their effects.

USAID also supports zinc supplementation to decrease the duration and severity of diarrheal disease in children under age 5. Studies have demonstrated that an inexpensive 7- to 10-day course of 20-mg zinc supplements can reduce diarrhea severity by 40 percent and its duration by 20 percent. It can also reduce the likelihood of future occurrences. Zinc is a part of USAID-supported food fortification initiatives.

Costs and Savings

ORT, which treats diarrhea as effectively as intravenous treatment, can save children’s lives in countries where intravenous treatment is not available. Furthermore, its cost (8 cents for one ORS packet) is less than one-tenth the cost of intravenous fluids. An estimated 1 billion dollars per year could be saved worldwide by treating diarrhea with ORT and eliminating useless, potentially harmful drugs.

USAID's Key Achievements in the Control of Diarrheal Disease

• The World Health Organization (WHO) introduced an improved oral rehydration salts (ORS) formula at the 2002 United Nations General Assembly Special Session on Children. The formula, developed after extensive USAID-supported research, reduces the severity and duration of acute diarrheal illness. WHO estimates the formula could avert 14,000 deaths and save $7.1 million for every 1 million diarrhea episodes.
• Oral rehydration therapy (ORT) is now widely accepted as an effective treatment for diarrheal disease. Globally, 60 to 70 percent of children receive ORT when needed.
• USAID, in collaboration with the World Bank, UNICEF, and other international donors, has joined with multinational and national soap manufacturers in Ghana, India, Nepal, Peru, and Senegal to launch public-private partnerships to promote hand washing with soap. The campaign is modeled after a successful USAID-led public-private initiative in five Central American countries that in the late 1990s produced 50 percent increases in hand washing with soap among mothers and reduced diarrheal diseases in children under age 5.
• After Hurricane Georges devastated the Dominican Republic, USAID worked with the rural water supply authority and nongovernmental organizations to replace infrastructure and improve hygiene behaviors for diarrhea prevention. Hand washing with soap increased from 63 to 75 percent, and the percentage of households storing water appropriately increased from 41 to 92 percent. Access to hygienic latrines also improved substantially. A guide for diarrheal disease prevention was adopted for integrating into the community Integrated Management of Childhood Illness (C-IMCI) training program. USAID also worked with the Pan American Health Organization to integrate the guide into C-IMCI programs in Nicaragua and Peru.