Reducing deaths from diarrhoea through oral rehydration therapy

In 1980, diarrhoea was the leading cause of child mortality, accounting for 4,6 million deaths annually. Efforts to control diarrhoea over the past de cade have been based on multiple, potentially powerful interventions implem ented more or less simultaneously. Oral rehydration therapy (ORT) was intro duced in 1979 and rapidly became the cornerstone of programmes for the cont rol of diarrhoeal diseases. We report on the strategy for controlling diarr hoea through case management, with special reference to ORT, and on the rel ationship between its implementation and reduced mortality. Population-based data on the coverage and quality of facility-based use of ORT are scarce, despite its potentia I importance in reducing mortality, es pecial ly for severe cases. ORT use rates du ring the 1980s are available f or only a few countries. An improvement in the availability of data occurre d in the mid-1990s. The study of time trends is hampered by the use of seve ral different definitions of ORT. Nevertheless, the data show positive tren ds in diarrhoea management in most parts of the world. ORT is now given to the majority of children with diarrhoea. The annual number of deaths attrib utable to diarrhoea among children aged under 5 years fell from the estimat ed 4.6 million in 1980 to about 1.5 million today. Case studies in Brazil, Egypt, Mexico, and the Philippines confirm increase s in the use of ORT which are concomitant with marked falls in mortality. I n some countries, possible alternative explanations for the observed declin e in mortality have been fairly confidently ruled out. Experience with ORT can provide useful guidance for child survival programm es. With adequate political will and financial support, cost-effective inte rventions other than that of immunization can be successfully delivered by national programmes. Furthermore, there are important lessons for evaluator s. The population-based data needed to establish trends in health service d elivery, outcomes and impact are not available in respect of diarrhoea, as is true for malaria, pneumonia and other major childhood conditions. Standa rd indicators and measurement methods should be established. Efforts to cha nge existing global indicators should be firmly resisted. Support should be given for the continuing evaluation and documentation activities needed to guide future public health policies and programmes.