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Child Survival: From Knowledge to Action

This session discusses the trends in diarrhoea mortality among children under five years of age, as well as the major causes and case management strategies. It also highlights recent developments in the management of diarrhoea, including new vaccines, improved oral rehydration solution, and zinc supplements.

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Child Survival: From Knowledge to Action

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  1. Child Survival: From Knowledge to action Venice, 26 to 28 January 2003 Session 2: Diarrhoeal Diseases Dr Hans Troedsson, Director, Department of Child and Adolescent Health and Development (CAH) CAH

  2. Time trends in diarrhoea mortality 1975-2000 Source: Boschi-Pinto C et al. Deaths from diarrhoeal diseases among children under five years of age in the developing world. A review. Submitted for publication CAH

  3. Major causes of death among children under five years of age - World 2002 Source: WHR, 2003 CAH

  4. Age specific incidence for diarrhoea episode perchild per year from 2 reviews of prospective studies in developing areas,1955-2000 number of episodes/person/year Source: Kosek et al. Bulletin of the WHO 2003; 81:197-204 CAH

  5. Case Management of Diarrhoea in the Home • prevent dehydration through early administration of appropriate fluids available in the home, and if available ORS solution; • continue feeding or increased breastfeeding during, and increased feeding after the diarrhoeal episode • know signs of dehydration indicating the need to take a child to a health care provider for treatment with either ORS or intravenous electrolyte solution, and other indications for medical treatment (such as bloody diarrhoea); CAH

  6. Case Management of Diarrhoea inHealth Facilities • Educate mothers to begin appropriate home fluids as soon as the child has diarrhoea; • treat dehydration with ORS solution (or with an intravenous electrolyte solution in case of severe dehydration); • recommend continued feeding or increased breastfeeding during,and increased all feeding after the diarrhoeal episode; • use antibiotics only when appropriate (in case of bloody diarrhoea or shigellosis, and cholera) and discourage use of anti-diarrhoeal drugs; • advise caretakers on the need to increase fluids and continued feeding during future episodes. CAH

  7. Evolution of Oral Rehydration Therapy use rates in three regions from 2001 to 2004 number of episodes/person/year Source: The State of the World Children 2001 and 2004, UNICEF (Statistical Tables- Health) CAH

  8. Recent Developments in theManagement of Diarrhoea • Two new vaccines against rotavirus are being licensed for Phase II trials; • A new improved ORS solution that significantly reduces severity of diarrhoea is now being available through UNICEF; • Zinc supplements given during an episode of diarrhoea andfor14 days after reduces the severity of the episode and the incidence of diarrhoea for the following 4 to 6 months. CAH

  9. Reduced Osmolarity ORS Solution in children with acute non-cholera diarrhoea • stool output reduced by 20%, • vomiting reduced by 30%, and • need for unscheduled IV reduced by 35%. CAH

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