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Diarrhoeal disease control: reviews of potential interventions.


 Diarrheal diseases are a major cause of illness and death in young children in most developing countries, with recent estimates attributing nearly 5 million deaths/year to children under 5 in developing countries excluding China. Because diarrheal disease mortality can be effectively reduced at reasonable cost by oral rehydration and possibly other measures, it is a priority target for primary health care programs in many countries. Other interventions are needed in addition to oral rehydration to lessen the impact of probable operational constraints on oral rehydration programs, to reduce mortality from chronic or dysenteric diarrheas in which oral rehydration is of limited use, and to reduce diarrhea morbidity rates. The Diarrhoeal Diseases Control (CDD) Programme of the World Health Organization (WHO) advocates a 4-part strategy for diarrhea control consisting of improved case management, improved maternal and child health care, improved use and maintenance of drinking water and sanitation facilities and improved food hygiene, and detection and control of epidemics. The CDD program has undertaken a systematic review of the effectiveness, feasibility, and cost of available antidiarrheal interventions and has developed a classification of interventions to guide the review process. Each intervention will be reviewed using a standard format and assigned to 1 of 3 categories: 1) those shown to be effective, feasible, and affordable, for which the CDD program will develop guidelines for implementation within primary health care programs and promote any additional operational research needed; 2) those believed on theoretical grounds to be effective but in which insufficient field experience has been gained will receive further field testing; and 3) those shown to be too costly, ineffective, or unfeasible will not be recommended by the CDD. The classification of possible interventions has 4 categories: 1) case management, including oral rehydration therapy at home or at a medical facility, promoting appropriate feeding during diarrheal episodes, and chemotherapy at home or in a medical facility; 2) increasing host resistence to infection through various programs of maternal nutrition, child nutrition, immunization, or chemoprophylaxis; 3) reducing transmission of the pathogenic agents through control of water supply and excreta disposal, personal and domestic hygiene, food hygiene, control of zoonotic reservoirs, or fly control; and 4) controlling or preventing diarrhea epidemics.
