3 Nutritional Challenges in Special Conditions and Diseases Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 168–172 DOI: 10.1159/000367878

3.6 Reducing the Burden of Acute and Prolonged Childhood Diarrhea Jai K. Das  Zulfiqar A. Bhutta

Diarrhea · Nutrition · Children

Key Messages • Diarrhea remains one of the leading causes of mortality among children under 5 years of age • Risk factors for diarrhea include those related to poverty, undernutrition, poor hygiene, and underprivileged household conditions making children more at risk of developing infectious diarrhea • Recent evidence suggests that if a range of existing interventions are scaled up, diarrhea burden can be significantly reduced © 2015 S. Karger AG, Basel

Introduction

In 2011, 6.9 million children under 5 years of age died; 4.4 million (58%) of these deaths were attributable to infectious diseases, of which pneumonia and diarrhea were the leading ones [1]. The incidence of diarrhea has decreased from 3.4 episodes per child-year in 1990 to 2.9 episodes per child-year in 2010; however, it still remains one of the most common reasons for hospital admission, with an estimated 1,731 million episodes of childhood diarrhea reported in 2011 [2]. There

are three clinical types of diarrhea: (1) acute watery diarrhea that lasts several hours or days and includes cholera; (2) acute bloody diarrhea, also called dysentery, and (3) persistent diarrhea that lasts 14 days or longer. Risk factors for diarrhea include those related to poverty, undernutrition, poor hygiene, and underprivileged household conditions making children more at risk of developing infectious diarrhea. Lack of breastfeeding is a single independent risk factor for diarrhea, and it is estimated that not breastfeeding is associated with a 165% increase in diarrhea incidence among 0- to 5-month-olds, a 47% increase in diarrhearelated mortality among 6- to 11-month-olds, and a 157% increase among 12- to 23-montholds. Overall, lack of breastfeeding is found to be associated with a 566% increase in all-cause mortality among children aged 6–11 months and a 223% increase in mortality among those aged 12– 23 months [3]. Despite these figures, the rates of exclusive breastfeeding (EBF) remain unacceptably low worldwide, especially in low- and middle-income countries. In this chapter, we will discuss the preventive and therapeutic strategies and nutrition interventions pertaining to acute and persistent diarrhea among children along with the delivery strategies to increase access to these interventions. Downloaded by: UCONN Storrs 137.99.31.134 - 5/22/2015 3:33:13 AM

Key Words

Recent evidence suggests that if a range of existing interventions are scaled up, diarrhea burden can be significantly reduced. These include EBF up to 6 months of age, the promotion of complementary feeding, rotavirus vaccinations, use of oral rehydration solution (ORS) and zinc in diarrhea, improved case management, antibiotics for dysentery, as well as water, sanitation and hygiene (WASH) strategies. Table  1 summarizes the effects of the preventive and therapeutic interventions for diarrhea. Among the diarrhea prevention interventions, breastfeeding promotion interventions in developing countries can significantly increase EBF rates by 43% at day 1, 30% at

3.6 Reducing the burden of acute and prolonged childhood diarrhea.

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