GLOBAL: Overlooked cures for diarrhoea

Photo: Lourenço Silva/PlusNews

Child is treated for dehydration due to diarrhoea outbreak in São Tomé and Príncipe (file photo)

DAKAR, 15 October 2009 (IRIN) - Diarrhoea claim more under-five children than AIDS, malaria and measles combined, yet remains a neglected disease, according to World Health Organization diarrhoea specialist Olivier Fontaine. “We made huge progress in the 1980s, but donor investment decreased in the 1990s as attention was diverted to AIDS, tuberculosis and malaria.”

Diarrhoea received less than 5 percent of total disease research and treatment funding in 2007, a fraction of the funding put toward other diseases that claimed far fewer lives.

The most severe forms of diarrhoea – which can lead to dehydration – kill an estimated 1.5 million under-five children every year. Most children recover from milder forms – more than four billion children get diarrhoea every year. “There is no reason for these deaths,” said WHO’s Fontaine. “There are 20th-century revolutionary medical miracles that should have wiped out [diarrhoea] by now.”

Zinc

But treatments like oral rehydration therapy (ORT), salty liquids, reach less than 40 percent of children who need them in Asia and Africa, according to UN Children’s Fund (UNICEF).

Why the deaths?
	Zinc costs less than 2 US cents per tablet, 15 cents for full  treatment
	39 percent of children with diarrhoea in developing countries get proper treatment
	Diarrhoea gets less than 5 percent of international research and treatment funds
	1,400 children die from rotavirus infections every day, common cause of diarrhoea
	Home solution of salt, sugar, water can save 90 percent of child deaths from diarrhoea dehydration
Source: UNICEF, George Institute for International Health, WHO

In recent years zinc tablets have been proven to boost ORT’s efficacy. “Zinc is the most ubiquitous mineral in the body,” said Fontaine. “It is responsible for activating more than 300 enzymes. Every level of metabolism needs it and the immune system is dependent on it.”

Recommended five years ago by World Health Organization to accompany ORT, the zinc tablet – costing less than 2 US cents – has been studied in diarrhoea treatments since 2007 in countries from Bangladesh to Brazil, said Fontaine. In Mali, US-based Johns Hopkins School of Public Health is carrying out a three-year study on zinc scheduled to finish in June 2010.

But despite a donor push to get zinc into at-risk communities – UNICEF purchased almost 160 million zinc tablets in 2008 – the agency has said need outstrips supply and that both zinc and ORT have been slow to roll out in some of the worst-affected areas.

Director of nutrition services at Mali’s Health Ministry, Racky Ba Samaké, told IRIN that while zinc is used to treat diarrhoea in Mali, it is not yet distributed widely as a supplement because of cost.

But WHO’s Fontaine told IRIN zinc can be a money-saver, and has helped cut the cost of treating diarrhoea by one-fourth in India. “In Mali we have parents who actually complain to us that their children have too much of an appetite. Zinc boosts appetites and [helps avoid] unnecessary drugs and long hospital stays.”

In a recent report on diarrhoea, UNICEF outlined a seven-point plan to treat and prevent childhood diarrhoea that includes the rotavirus vaccine - which can help prevent one of the most common viral causes of diarrhoea; exclusive breastfeeding and Vitamin A to boost children’s immune systems; hygiene through hand-washing, safe water and a clean environment; and oral rehydration therapy and zinc to nurse children to health.

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