Evolution of the World Health Organization’s programmatic actions to control diarrheal diseases

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Abstract

The Program for the Control of Diarrheal Diseases (CDD) of the World Health Organization (WHO) was created in 1978, the year the Health for All Strategy was launched at the Alma Ata International Conference on Primary Health Care. CDD quickly became one of the pillars of this strategy, with its primary goal of reducing diarrhea-associated mortality among infants and young children in developing countries. WHO expanded the previous cholera-focused unit into one that addressed all diarrheal diseases, and uniquely combined support to research and to national CDD Programs. We describe the history of the Program, summarize the results of the research it supported, and illustrate the outcome of the Program’s control efforts at country and global levels. We then relate the subsequent evolution of the Program to an approach that was more technically broad and programmatically narrow and describe how this affected diarrheal diseases-related activities globally and in countries.

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Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial.

Saifuddin Ahmed, Sandra Black, J Vaughan … (2002)

To evaluate the effect on morbidity and mortality of providing daily zinc for 14 days to children with diarrhoea. Cluster randomised comparison. Matlab field site of International Center for Diarrhoeal Disease Research, Bangladesh. 8070 children aged 3-59 months contributed 11 881 child years of observation during a two year period. Children with diarrhoea in the intervention clusters were treated with zinc (20 mg per day for 14 days); all children with diarrhoea were treated with oral rehydration therapy. Duration of episode of diarrhoea, incidence of diarrhoea and acute lower respiratory infections, admission to hospital for diarrhoea or acute lower respiratory infections, and child mortality. About 40% (399/1007) of diarrhoeal episodes were treated with zinc in the first four months of the trial; the rate rose to 67% (350/526) in month 5 and to >80% (364/434) in month 7 and was sustained at that level. Children from the intervention cluster received zinc for about seven days on average during each episode of diarrhoea. They had a shorter duration (hazard ratio 0.76, 95% confidence interval 0.65 to 0.90) and lower incidence of diarrhoea (rate ratio 0.85, 0.76 to 0.96) than children in the comparison group. Incidence of acute lower respiratory infection was reduced in the intervention group but not in the comparison group. Admission to hospital of children with diarrhoea was lower in the intervention group than in the comparison group (0.76, 0.59 to 0.98). Admission for acute lower respiratory infection was lower in the intervention group, but this was not statistically significant (0.81, 0.53 to 1.23). The rate of non-injury deaths in the intervention clusters was considerably lower (0.49, 0.25 to 0.94). The lower rates of child morbidity and mortality with zinc treatment represent substantial benefits from a simple and inexpensive intervention that can be incorporated in existing efforts to control diarrhoeal disease.

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Systematic Review of the Effectiveness of Mass Media Interventions for Child Survival in Low- and Middle-Income Countries

Danielle Naugle, Robert C Hornik (2014)

Through a systematic review of the literature, this article summarizes and evaluates evidence for the effectiveness of mass media interventions for child survival. To be included, studies had to describe a mass media intervention; address a child survival health topic; present quantitative data from a low- or middle-income country; use an evaluation design that compared outcomes using pre- and postintervention data, treatment versus comparison groups, or postintervention data across levels of exposure; and report a behavioral or health outcome. The 111 campaign evaluations that met the inclusion criteria included 15 diarrheal disease, 8 immunization, 2 malaria, 14 nutrition, 1 preventing mother-to-child transmission of HIV, 4 respiratory disease, and 67 reproductive health interventions. These evaluations were then sorted into weak (n = 33), moderate (n = 32), and stronger evaluations (n = 46) on the basis of the sampling method, the evaluation design, and efforts to address threats to inference of mass media effects. The moderate and stronger evaluations provide evidence that mass media-centric campaigns can positively impact a wide range of child survival health behaviors.

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The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions.

J Vaughan, Jennifer Bryce, Sandra Black … (2004)

The Multi-Country Evaluation of the Integrated Management of Childhood Illness (IMCI) includes studies of the effectiveness, cost, and impact of the IMCI strategy in Bangladesh, Brazil, Peru, Tanzania, and Uganda. Seven questions were addressed when the evaluation was designed: who would be in charge, through what mechanisms IMCI could affect child health, whether the focus would be efficacy or effectiveness, what indicators would be measured, what types of inference would be made, how costs would be incorporated, and what elements would constitute the plan of analysis. We describe how these questions were answered, the challenges encountered in implementing the evaluation, and the 5 study designs. The methodological insights gained can improve future evaluations of public health programs.

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Journal

Journal ID (nlm-ta): J Glob Health

Journal ID (iso-abbrev): J Glob Health

Journal ID (publisher-id): JGH

Title: Journal of Global Health

Publisher: Edinburgh University Global Health Society

ISSN (Print): 2047-2978

ISSN (Electronic): 2047-2986

Publication date (Print, pub): December 2019

Publication date (Electronic, pub): 22 October 2019

Volume: 9

Issue: 2

Electronic Location Identifier: 020802

Affiliations

[1 ]World Health Organization, Geneva, Switzerland (retired)

[2 ]UNICEF, Geneva, Switzerland (retired)

[3 ]Duke Global Health Institute, Duke University, Durham, North Carolina, USA

Author notes

Correspondence to: Cathy Wolfheim (retired staff from the World Health Organization and UNICEF) Chemin des Grangettes 10 1224 Chêne-Bougeries Geneva Switzerland  wolfheimc@ 123456bluewin.ch

Article

Publisher ID: jogh-09-020802

DOI: 10.7189/jogh.09.020802

PMC ID: 6816052

SO-VID: 5955f4bf-f06b-418f-aa64-c8a20dabe538

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Evolution of the World Health Organization’s programmatic actions to control diarrheal diseases

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Most cited references 30

Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial.

Systematic Review of the Effectiveness of Mass Media Interventions for Child Survival in Low- and Middle-Income Countries

The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions.

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