Global Rehydration Therapy

Global Diarrhoeal Diseases Control Programmes

Over 150 nations signed the Alma Ata Declaration on Primary Health Care which emerged from the first International Conference on Primary Health Care held at Alma Ata in the Soviet Union in 1978. This marked the beginning of a new era for the promotion of health based on community participation and the use of para-professionals and appropriate technologies.

Motivated by the significant recent developments in the treatment and control of diarrhoeal diseases, and as part of its commitment to its global strategy for health for all by the year 2000, based on Primary Health Care (PHC), WHO launched a global Diarrhoeal Diseases Control (CDD) Programme in 1978 with the close collaboration of UNICEF, UNDP, and the World Bank. The programme budget for the biennium 1983-1984 is US $20.2 million.

The short-term objective of the WHO global CDD programme involving a concerted attack on diarrhoeal diseases is to endeavour to reduce childhood mortality due to diarrhoeal dehydration and malnutrition through the widespread implementation of ORT and improved feeding practices. An important long-term objective is to substantially reduce childhood morbidity caused by diarrhoeal diseases and their associated ill effects, especially malnutrition, in infants and young children. This objective is to be attained through promotion of improved mother and child care practices, the provision of safe water supply and sanitation facilities, and epidemiological surveillance for the detection and control of epidemics, especially those due to cholera.

The World Health Organization's CDD programme of activities falls into three main categories: first, planning and developing national CDD programmes in developing countries as an integral part of national PHC programmes, with emphasis on ORT; second, providing technical training programmes for national programme managers and field supervisory staff; and third, supporting both field and laboratory research in the development of new methods and approaches for the prevention and treatment of diarrhoeal diseases. Whereas WHO focuses more on the aspects of management, training, and research, UNICEF concentrates on production and supply of oral rehydration salts (ORS).

In the absence of any constraints and setbacks, WHO expects to achieve the following in the developing countries by 1989: (a) development of 80 national CDD programmes; (b) over 30% of all childhood diarrhoea cases will be receiving adequate ORT; and (c) at least 1.5 million childhood deaths due to diarrhoea will be prevented annually. By December 1982, national CDD programmes were already in operation in 38 developing countries.

The WHO global CDD programme is also closely linked with the International Drinking Water Supply and Sanitation Decade, 1981-1990 (IDWSSD). The predominant concern of this international programme is the reduction of such communicable diseases as diarrhoeal infections, polio, typhoid, and amoebiasis, all of which are associated with the widespread lack of safe drinking water and sanitary disposal facilities and practices. The incidence of diarrhoeal diseases transmitted through contaminated food is often indirectly related to inappropriate faecal waste disposal or lack of personal hygiene.

The IDWSSD programme aims at fostering national and international action so that by 1989 the WHO member states will have implemented national programmes for the provision of purer drinking water and better sanitation facilities and practices. This is intended to meet the global target of assuring safe drinking water and adequate excreta disposal for all by 1990. The approach to the decade which WHO has adopted is that water supply and sanitation development must be complementary, and that national decade plans and programmes must be closely integrated with all aspects of PHC programmes. This would require major changes in national policy and management.

Through the initiative and support of UNDP, the Dhaka Cholera Control Laboratory in Bangladesh was transformed in 1978 into the International Centre for Diarrhoeal Diseases Research. Its programme of activities includes conducting research and field trials of new tools and treatment methods. It also serves as an international training ground for health personnel from developing countries.