Academic journal article Journal of Health Population and Nutrition

Effect of HIV/AIDS and Malaria on the Context for Introduction of Zinc Treatment and Low-Osmolarity ORS for Childhood Diarrhoea

Academic journal article Journal of Health Population and Nutrition

Effect of HIV/AIDS and Malaria on the Context for Introduction of Zinc Treatment and Low-Osmolarity ORS for Childhood Diarrhoea

Article excerpt

ABSTRACT

Diarrhoea was estimated to account for 18% of the estimated 10.6 million deaths of children aged less than five years annually in 2003. Two--Africa and South-East Asia--of the six regions of the World Health Organization accounted for approximately 40% and 31% of these deaths respectively, or almost three-quarters of the global annual deaths of children aged less than five years attributable to diarrhoea. Much of the effort to roll out low-osmolarity oral rehydration solution (ORS) and supplementation of zinc for the management of diarrhoea accordingly is being devoted to sub-Saharan Africa and to South and South-East Asia. A number of significant differences exist in diarrhoea-treatment behaviours and challenges of the public-health systems between Africa and Asia. The differences in rates of ORS use are the most common indicator of treatment of diarrhoea and vary dramatically by and within region and may significantly influence the roll-out strategy for zinc and low-osmolarity ORS. The prevalence of HIV/AIDS and the endemicity of malaria also differ greatly between regions; both the diseases consume the attention and financial commitment of publi.c-health programmes in regions where rates are high. This paper examined how these differences could affect the context for the introduction of zinc and low-osmolarity ORS at various levels, including the process of policy dialogue with local decision-makers, questions to be addressed in formative research, implementation approaches, and strategies for behaviour-change communication and training of health workers.

Key words: Acquired immunodeficiency syndrome; Child health; Diarrhoea; HIV; Infant health; Malaria; Oral rehydration therapy; Osmolar concentration; Review literature; Zinc

INTRODUCTION

Over a quarter-century has passed since the introduction of oral rehydration therapy (ORT) for diarrhoea in 1978 (1). ORT, including both prepackaged oral rehydration salts (ORS) and local recipes for home-fluids, remains the cornerstone of management of diarrhoea. ORT enables caregivers to manage dehydration in the home, decreases the need for intravenous fluids, and decreases rates of hospitalization and mortality. In 1980, diarrhoea was estimated to account annually for 4.6 million deaths of children aged less than five years (under-five children) (2), while recent estimates for 2003 attribute 18% or 1.9 million of 10.6 million annual deaths to diarrhoea, representing 3% of neonatal mortality and 17% of mortality in children aged 1-59 month(s) (3). Two--Africa and South-East Asia--of the six regions of the World Health Organization (WHO) account for approximately 40% and 31% deaths due to diarrhoea among children respectively, or almost three-quarters of the global annual deaths of children aged less than five years (under-five deaths) attributable to diarrhoea (3). This decrease in mortality is a great public-health success story, yet there has been limited or no decrease in rates of incidence of diarrhoea and morbidity (4). Improved case management is an important strategy to decrease the remaining 1.9 million childhood deaths attributable to diarrhoeal illness.

In May 2004, the WHO and United Nations Children's Fund (UNICEF) issued new recommendations for the management of all episodes of childhood diarrhoea, including new low-osmolarity oral rehydration salts (ORS) and supplementation of zinc for 10-14 days (5). When properly deployed, these two advances in treatment will decrease morbidity and enable further reductions in mortality due to diarrhoea. Low-osmolarity ORS continues to prevent and treat dehydration and also decreases stool volume by 25-30%, decreases the prevalence of vomiting by 30%, and decreases the need for unscheduled intravenous therapy by 30% (6-8). Supplementation of zinc for 10-14 days decreases the duration and severity of the diarrhoea episode and decreases morbidity from diarrhoea and pneumonia in the 2-3 months following treatment (9,10). …

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