PREAMBLE: One of our most visited blogs is entitled “Drawing attention to a global pandemic – diarrhoeal disease” (October 15, 2009). This addresses one of the more neglected issues on the international and global public health agenda, especially when compared with AIDS, Tuberculosis and Malaria and Vaccine Preventable Diseases (all of which are also important priorities). Compared to these, diarrhoeal disease strangely receives much less attention by many donor health agencies and their information outlets. Perhaps this is because some of the solutions so capital-intensive that some donors prefer to look the other way. Or perhaps it is because the problem is perceived to be “local” and does not significantly threaten developed countries with importation: onward transmission is not likely to occur in nations with advanced water and sanitation infrastructures. Yet diarrhoeal disease is one of the most severe burdens for many low income countries, vying with acute respiratory infections as the leading cause of child mortality, and simultaneously causing serious morbidity across the age spectrum.
In this issue of PacificSci Global Perspectives, we are therefore pleased to give visibility to real progress in addressing the long-standing lack of portable drinking water in many developing countries. Our source is a new report from WHO and UNICEF entitled Progress on Drinking Water and Sanitation 2012 Update. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), reports every two years on access to drinking water and sanitation worldwide and on progress towards related targets under Millennium Development Goal 7 (environmental sustainability). This 2012 report is based on data gathered from household surveys and censuses, including both recent and older data sets that have come to the attention of the JMP. The estimates presented here describe the situation as of end-2010 and supersede those of the JMP update published in March 2010.
Despite real progress however, challenges remain for some regions, particularly sub-Saharan Africa, especially in rural settings where the burden of poor water supply falls most heavily on girls and women. Equivalent progress also is not being made with regard to sanitation. At the other end of the spectrum (the world’s rich nations) we also need to take note of the recognition by the UN General Assembly, in 2010, of “water and sanitation as a human right" provides additional political impetus towards the ultimate goal of providing everyone with access to these vital services. Unfortunately, there were a number of abstentions, including Canada (Harper government). See: GA/10967 http://www.un.org/News/Press/docs/2010/ga10967.doc.htm This abstention is curious, to say the least, given that Canada’s indigenous people suffer disproportionately from poor water and sanitation.
PROGRESS ON DRINKING WATER AND SANITATION: 2010 UPDATE
Published jointly by UNICEF and World Health Organization 2012, the full report is available online as a PDF file [66p.]. The full reference and URL are supplied at foot of this page.
The report brings welcome news:
the Millennium Development Goals (MDG) drinking water target, which calls for halving the proportion of the population without sustainable access to safe drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule.
However, the report also shows why the job is far from finished. Many still lack safe drinking water, and the world is unlikely to meet the MDG sanitation target. Continued efforts are needed to reduce urban-rural disparities and inequities associated with poverty; to dramatically increase coverage in countries in sub-Saharan Africa and Oceania; to promote global monitoring of drinking water quality; to bring sanitation ‘on track’; and to look… towards universal coverage.
Since 1990, more than 2 billion people have gained access to improved drinking water sources. This achievement is a testament to the commitment of Government leaders, public and private sector entities, communities and individuals who saw the target not as a dream, but as a vital step towards improving health and well-being. Of course, much work remains to be done. There are still 780 million people without access to an improved drinking water source. And even though 1.8 billion people have gained access to improved sanitation since 1990, the world remains off track for the sanitation target. It is essential to accelerate progress in the remaining time before the MDG deadline (2015).
As we approach the 2015 target date for the MDGs, WHO and UNICEF are addressing current monitoring challenges and those that lie ahead. The safety and reliability of drinking water supplies and the sustainability of both water supply sources and sanitation facilities are not addressed by the current set of indicators used to track progress. Accordingly, this report details work under way to refine both indicators and methods of monitoring, as part of the 2010-2015 JMP strategy. It also discusses the beginnings of a process to develop new water, sanitation and hygiene goals, targets and indicators beyond 2015, in alignment with the human right to water and sanitation and the mandate of the UN Special Rapporteur on the Human Right to Water and Sanitation.
OTHER HIGHLIGHTS
Huge disparities exist. While coverage of improved water supply sources is 90 per cent or more in Latin America and the Caribbean, Northern Africa and large parts of Asia, it is only 61 per cent in sub-Saharan Africa. Coverage in the developing world overall stands at 86 per cent, but it is only 63 per cent in countries designated as ‘least developed’. Similar disparities are found within countries – between the rich and poor and between those living in rural and urban areas.
Complete information about drinking water safety is not available for global monitoring. Systematically testing the microbial and chemical quality of water at the national level in all countries is prohibitively expensive and logistically complicated; therefore, a proxy indicator for water quality was agreed upon for MDG monitoring. This proxy measures the proportion of the population using ‘improved’ drinking water sources, defined as those that, by the nature of their construction, are protected from outside contamination, particularly faecal matter. However, some of these sources may not be adequately maintained and therefore may not actually provide ‘safe’ drinking water. As a result, it is likely that the number of people using safe water supplies has been over-estimated.
More than 780 million people remain unserved. Although the MDG drinking water target has been met, it only calls for halving the proportion of people without safe drinking water. More than one tenth of the global population still relied on unimproved drinking water sources in 2010. The last two decades have seen impressive increases in the use of both piped connections to a dwelling, plot or yard and other improved sources, such as protected dug wells, boreholes, rainwater collection and standpipes.
Wide variations are found in the rate at which regions have improved coverage. In general, regions in which coverage was already high have made more modest gains, rising by only a few percentage points over 20 years. Of note are the impressive gains in Eastern Asia, which added 23 percentage points, and the small decline in coverage in the Caucasus and Central Asia and in Oceania. The results show that the majority of countries lagging behind on the drinking water target are in sub-Saharan Africa. In fact, only 19 out of 50 countries in that region are on track to meet the target by 2015.
Regarding the number of people who have gained access to an improved drinking water source since 1990, the progress of India and China not only dominates their respective regions, but represents nearly half of the global progress towards the drinking water target. If only the developing world is considered, China and India represent more than half of the people who have gained access.
For the first time, data on the use of unimproved sources have been disaggregated into two categories: surface water and other unimproved sources. The latter includes unprotected dug wells, unprotected springs and water delivered by cart or tanker. Surface water includes water collected directly from rivers, lakes, ponds, irrigation channels and other surface sources. The use of surface water stands at a surprisingly high 3 per cent of the global population, or 187 million people. Most of these people – 94 per cent – are rural inhabitants, and they are concentrated in sub-Saharan Africa. In fact, 19 per cent of rural dwellers in sub-Saharan Africa and 39 per cent of rural residents in Oceania rely on surface water for drinking and cooking.
Source: UNICEF & WHO. Progress on Drinking Water and Sanitation: 2010 Update. Released 2012. http://www.who.int/water_sanitation_health/publications/2012/jmp2012.pdf Accessed March 16, 2012.
Showing posts with label diarrhoeal disease. Show all posts
Showing posts with label diarrhoeal disease. Show all posts
Friday, 16 March 2012
Thursday, 15 October 2009
DRAWING ATTENTION TO A GLOBAL PANDEMIC - Diarrhoeal Disease
PREAMBLE: Diarrhoea remains the second leading cause of death among children under five globally, surpassed only by pneumonia, the most common cause. Nearly one in five child deaths – about 1.5 million each year – is due to diarrhoea. It kills more young children than AIDS, malaria and measles combined.
PacificSci wishes to draw attention to a recently released joint report from UNICEF and WHO that addresses this perennial global pandemic. Diarrhoeal disease, no longer a scourge in developed countries, attracts comparatively little attention from the international donor community, when compared with conditions such as HIV/AIDS, TB and malaria. And today, the media spotlight has shifted to H1N1 influenza, with little sense of proportionality in terms of continuing real disease burdens globally.
Acknowledgement: The material used in this edition of Global Perspectives is drawn almost verbatim from the Executive Summary of the joint UNICEF/WHO report, as referenced below.
THE REPORT:
In 2006, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) issued a report highlighting the most common cause of death among children (Pneumonia: The Forgotten Killer of Children). The purpose was to raise the profile of that neglected disease. This new report is written with the same intent – to focus attention on the prevention and management of diarrhoeal diseases as central to improving child survival. Together, pneumonia and diarrhoea are responsible for an estimated 40 per cent of all child deaths around the world each year.
There are lessons to be learned from past experience. An international commitment to tackle childhood diarrhoea in the 1970s and 1980s resulted in a major reduction in child deaths. This came about largely through the scaling up of oral rehydration therapy, coupled with programmes to educate caregivers on its appropriate use. But these efforts lost momentum as the world turned its attention to other global emergencies. Today, only 39 per cent of children with diarrhoea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000.
This report examines the latest available information on the burden and distribution of childhood diarrhoea. It also analyses how well countries are doing in making available key interventions proven to reduce its toll. Most importantly, it lays out a new strategy for diarrhoea control, one that is based on interventions drawn from different sectors that have demonstrated potential to save children’s lives. It sets out a 7-point plan that includes a treatment package to reduce childhood diarrhoea deaths, as well as a prevention package to make a lasting reduction in the diarrhoea burden in the medium to long term.
New aspects of this approach include vaccinations for rotavirus, which is estimated to cause about 40 per cent of hospital admissions due to diarrhea among children under five worldwide.3 In terms of community-wide sanitation, new approaches to increase demand to stop open defecation have proven more effective than previous strategies. It has been estimated that 88 per cent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.
Actions needed to take interventions to scale
In many countries, progress has been made in the delivery or promotion of several of these interventions, particularly vitamin A supplementation and exclusive breastfeeding. However, a substantial reduction in the diarrhoea burden will require greater emphasis on the following actions:
■ Ensure wide availability of low-osmolarity ORS and zinc, which could have a profound impact on child deaths from diarrhoea if scaled up immediately. Possible strategies to increase their uptake and availability could include the development of smaller ORS packets and flavoured formulas, as well as delivering zinc and low-osmolarity ORS together in diarrhoea treatment kits.
■ Include rotavirus vaccine in national immunization programmes worldwide, which was recently recommended by the World Health Organization.
A 7-point plan for comprehensive diarrhoea control is outlined immediately below: two (#1 and #2) elements are contained with a treatment package”, while five (#3 to #7) are contained within a prevention package.
Treatment Package
The treatment package focuses on two main elements, as outlined in a 2004 joint statement from UNICEF and WHO: 1) fluid replacement to prevent dehydration and 2) zinc treatment. Oral rehydration therapy – which has been heralded as one of the most important medical advances of the 20th century – is the cornerstone of fluid replacement.
New aspects of this approach include low-osmolarity oral rehydration salts (ORS), which are more effective at replacing fluids than the original ORS formulation, and zinc treatment, which decreases diarrhea severity and duration. Important additional components of the package are continued feeding, including breastfeeding, during diarrhoea episodes and the use of appropriate fluids available in the home if ORS are not available, along with increased fluids in general.
Prevention Package
The prevention package highlights five main elements that require a concerted approach in their implementation. The package includes: 3) rotavirus and measles vaccinations, 4) promotion of early and exclusive breastfeeding and vitamin A supplementation, 5) promotion of handwashing with soap, 6) improved water supply quantity and quality, including treatment and safe storage of household water, and 7) community-wide sanitation promotion.
Key strategic elements include:■ Develop and implement behaviour change interventions, such as face-to-face counselling, to encourage exclusive breastfeeding.
■ Ensure sustained high levels of vitamin A supplementation, such as by combining its delivery, where effective, with other high-impact health and nutrition interventions.
■ Apply results of existing consumer research on how to motivate people to wash their hands with soap to increase this beneficial and cost-effective health practice. Handwashing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent.
■ Adopt household water treatment and safe storage systems, such as chlorination and
filtration, in both development and emergency situations to support reductions in the number of diarrhoea cases.
■ Implement approaches that increase demand to stop community-wide open defecation. As with handwashing, the new approach employs behavioural triggers, such as pride, shame and disgust, to motivate action, and leads to greater ownership and sustainability of programmes.
The report states: “We know what works to immediately reduce deaths from childhood diarrhoea. We also know what actions will make a lasting contribution to reducing the toll of diarrhoeal diseases for years to come. But strengthened efforts on both fronts must begin right away.”
The following actions are needed to take the 7-point plan to scale:
■ Mobilize and allocate resources for diarrhea control.
■ Reinstate diarrhoea prevention and treatment as a cornerstone of community-based primary health care.
■ Ensure that low-osmolarity ORS and zinc are adopted as policy in all countries.
■ Reach every child with effective interventions.
■ Accelerate the provision of basic water and sanitation services.
■ Use innovative strategies to increase the adoption of proven measures against diarrhoea.
■ Change behaviours through community involvement, education and health-promotion activities.
■ Make health systems work to control diarrhoea.
■ Monitor progress at all levels, and make the results count.
■ Make the prevention and treatment of diarrhea everybody’s business.
The Executive Summary to the report concludes with the statement that "There is no better time than now. Political momentum is building to address the leading causes of child deaths, including pneumonia and diarrhoea, to achieve measurable gains in child survival. The year 2008 marked the 30th anniversary of the Alma- Ata Declaration, with reinvigorated calls to focus on primary health care. Lessening the burden of childhood diarrhoea fits squarely with this emphasis, and is essential for achieving Millennium Development Goal 4: reduce child mortality, whose target date is now only six years away."
SOURCE: Executive Summary. Diarrhoea :Why children are still dying and what can be done. The United Nations Children’s Fund (UNICEF)/World Health Organization (WHO), 2009. http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf
PacificSci wishes to draw attention to a recently released joint report from UNICEF and WHO that addresses this perennial global pandemic. Diarrhoeal disease, no longer a scourge in developed countries, attracts comparatively little attention from the international donor community, when compared with conditions such as HIV/AIDS, TB and malaria. And today, the media spotlight has shifted to H1N1 influenza, with little sense of proportionality in terms of continuing real disease burdens globally.
Acknowledgement: The material used in this edition of Global Perspectives is drawn almost verbatim from the Executive Summary of the joint UNICEF/WHO report, as referenced below.
THE REPORT:
In 2006, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) issued a report highlighting the most common cause of death among children (Pneumonia: The Forgotten Killer of Children). The purpose was to raise the profile of that neglected disease. This new report is written with the same intent – to focus attention on the prevention and management of diarrhoeal diseases as central to improving child survival. Together, pneumonia and diarrhoea are responsible for an estimated 40 per cent of all child deaths around the world each year.
There are lessons to be learned from past experience. An international commitment to tackle childhood diarrhoea in the 1970s and 1980s resulted in a major reduction in child deaths. This came about largely through the scaling up of oral rehydration therapy, coupled with programmes to educate caregivers on its appropriate use. But these efforts lost momentum as the world turned its attention to other global emergencies. Today, only 39 per cent of children with diarrhoea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000.
This report examines the latest available information on the burden and distribution of childhood diarrhoea. It also analyses how well countries are doing in making available key interventions proven to reduce its toll. Most importantly, it lays out a new strategy for diarrhoea control, one that is based on interventions drawn from different sectors that have demonstrated potential to save children’s lives. It sets out a 7-point plan that includes a treatment package to reduce childhood diarrhoea deaths, as well as a prevention package to make a lasting reduction in the diarrhoea burden in the medium to long term.
New aspects of this approach include vaccinations for rotavirus, which is estimated to cause about 40 per cent of hospital admissions due to diarrhea among children under five worldwide.3 In terms of community-wide sanitation, new approaches to increase demand to stop open defecation have proven more effective than previous strategies. It has been estimated that 88 per cent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.
Actions needed to take interventions to scale
In many countries, progress has been made in the delivery or promotion of several of these interventions, particularly vitamin A supplementation and exclusive breastfeeding. However, a substantial reduction in the diarrhoea burden will require greater emphasis on the following actions:
■ Ensure wide availability of low-osmolarity ORS and zinc, which could have a profound impact on child deaths from diarrhoea if scaled up immediately. Possible strategies to increase their uptake and availability could include the development of smaller ORS packets and flavoured formulas, as well as delivering zinc and low-osmolarity ORS together in diarrhoea treatment kits.
■ Include rotavirus vaccine in national immunization programmes worldwide, which was recently recommended by the World Health Organization.
A 7-point plan for comprehensive diarrhoea control is outlined immediately below: two (#1 and #2) elements are contained with a treatment package”, while five (#3 to #7) are contained within a prevention package.
Treatment Package
The treatment package focuses on two main elements, as outlined in a 2004 joint statement from UNICEF and WHO: 1) fluid replacement to prevent dehydration and 2) zinc treatment. Oral rehydration therapy – which has been heralded as one of the most important medical advances of the 20th century – is the cornerstone of fluid replacement.
New aspects of this approach include low-osmolarity oral rehydration salts (ORS), which are more effective at replacing fluids than the original ORS formulation, and zinc treatment, which decreases diarrhea severity and duration. Important additional components of the package are continued feeding, including breastfeeding, during diarrhoea episodes and the use of appropriate fluids available in the home if ORS are not available, along with increased fluids in general.
Prevention Package
The prevention package highlights five main elements that require a concerted approach in their implementation. The package includes: 3) rotavirus and measles vaccinations, 4) promotion of early and exclusive breastfeeding and vitamin A supplementation, 5) promotion of handwashing with soap, 6) improved water supply quantity and quality, including treatment and safe storage of household water, and 7) community-wide sanitation promotion.
Key strategic elements include:■ Develop and implement behaviour change interventions, such as face-to-face counselling, to encourage exclusive breastfeeding.
■ Ensure sustained high levels of vitamin A supplementation, such as by combining its delivery, where effective, with other high-impact health and nutrition interventions.
■ Apply results of existing consumer research on how to motivate people to wash their hands with soap to increase this beneficial and cost-effective health practice. Handwashing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent.
■ Adopt household water treatment and safe storage systems, such as chlorination and
filtration, in both development and emergency situations to support reductions in the number of diarrhoea cases.
■ Implement approaches that increase demand to stop community-wide open defecation. As with handwashing, the new approach employs behavioural triggers, such as pride, shame and disgust, to motivate action, and leads to greater ownership and sustainability of programmes.
The report states: “We know what works to immediately reduce deaths from childhood diarrhoea. We also know what actions will make a lasting contribution to reducing the toll of diarrhoeal diseases for years to come. But strengthened efforts on both fronts must begin right away.”
The following actions are needed to take the 7-point plan to scale:
■ Mobilize and allocate resources for diarrhea control.
■ Reinstate diarrhoea prevention and treatment as a cornerstone of community-based primary health care.
■ Ensure that low-osmolarity ORS and zinc are adopted as policy in all countries.
■ Reach every child with effective interventions.
■ Accelerate the provision of basic water and sanitation services.
■ Use innovative strategies to increase the adoption of proven measures against diarrhoea.
■ Change behaviours through community involvement, education and health-promotion activities.
■ Make health systems work to control diarrhoea.
■ Monitor progress at all levels, and make the results count.
■ Make the prevention and treatment of diarrhea everybody’s business.
The Executive Summary to the report concludes with the statement that "There is no better time than now. Political momentum is building to address the leading causes of child deaths, including pneumonia and diarrhoea, to achieve measurable gains in child survival. The year 2008 marked the 30th anniversary of the Alma- Ata Declaration, with reinvigorated calls to focus on primary health care. Lessening the burden of childhood diarrhoea fits squarely with this emphasis, and is essential for achieving Millennium Development Goal 4: reduce child mortality, whose target date is now only six years away."
SOURCE: Executive Summary. Diarrhoea :Why children are still dying and what can be done. The United Nations Children’s Fund (UNICEF)/World Health Organization (WHO), 2009. http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf
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