A good read: The roots of inaction: Understanding and overcoming the obstacles to greater investment in scaling-up effective diarrhea treatment
The roots of inaction: Understanding and overcoming the obstacles to greater investment in scaling-up effective diarrhea treatment
Posted: August 20, 2012
worthy of reprinting: Here is the beginning of a great article by Francisca Oluyole in the Daily Triumph
Impact of sanitation on survival
By Francisca Oluyole
UNICEF reports recently indicated that diarrhea prevalence rate in Nigeria is 18.8 per cent.
The rate, according to the report, is “one of the worst in sub-Saharan Africa”.
For many experts, the situation is “just not good enough” for a leading producer of crude oil, especially as children remain the worst victims of such a preventable disease.
Associated mostly with vomiting, purging and dehydration, diarrhea has been identified by the Nigerian health authorities as the second largest direct cause of child morbidity and mortality in Nigeria.
According to statistics from UNICEF, diarrhea accounts for more than 16 per cent of child deaths. That is a total of 150,000 deaths amongst children under five, annually.
Experts trace the disease to a lack of access to basic sanitation facilities and poor hygiene practices.
They say it is closely connected with malnourishment, as undernourished children usually have a compromised immune system and are also at a higher risk of developing pneumonia.
Recent reports from the World Health Organisation (WHO) have confirmed that Nigerian children will continue to be victims of diarrhea as the country is said to be one of the seven high-population countries with
total sanitation coverage of less than 50 per cent.
In effect, less than half of the population has access to improved sanitation and the access is as low as 10 per cent in some states with the situation worse in the rural areas.
The situation, according to the reports, has worsened in the last two decades, with environmental sanitation problems resulting in an escalating negative impact on public and environmental health.
Experts say poor environmental sanitation in Nigeria is characterised by the presence of heaps of refuse in cities, indiscriminate disposal of solid and other wastes, blocked drains, overgrown weeds, among others.
The state of food sanitation in homes, markets and abattoirs is equally appalling and unwholesome as food meant for human consumption is exposed to dust, flies, bacteria and other micro-organisms, they say.
The experts say that such probably accounts for the increasing cases of food-borne diseases such as cholera, food poisoning and typhoid fever.
According to Mr Jones Abari, an Abuja-based community health expert, the lack of safe and private toilets and hand-washing facilities in schools has ensured a quicker development of sanitation-related diseases on children. ….
to read full article by Francisca Oluyole in Daily Triumph go to http://www.triumphnewspapers.com/impact1522010.html R/AUWAL 1 1431 A.H. published MONDAY FEBRUARY 15 2010.
While this is being covered everywhere , I thought it is worth mentioning. It seems important that in this report WHO is stressing Zink tablets in conjunction the oral rehydration solution (ORS) The tables and charts provide excellent statistic for fundraisers and agencies wanting to bring help and awareness. For those in the field there are important points to note but ones in the field may ask “tell us something we don’t know”
Recognition of the reality that “WASH/WATSAN” address seems to be following the same slow path of Global Warming (and other critical realities) , taking its time to come to be mainstream and get the energy it deserves. Hopefully the material presented within shall be an effective red flag to wave to get recognition and resources.
the publication Diarrhoea: why children are still dying and what can be done is available in pdf format for viewing
from the press release:
Past success and present needs
Campaigns targeting childhood diarrhoea in the 1970s and 1980s achieved success by scaling up the use of oral rehydration solution (ORS) to prevent dehydration and by educating caregivers. In spite of the promising results of these campaigns, in recent years the international community has shifted its focus to other global emergencies. There is now an urgent need to focus once more on preventing and treating diarrhoea.
Treatment with ORS and zinc tablets
WHO and UNICEF recommend treating diarrhoea with low-osmolarity ORS and zinc tablets, which decrease the severity and duration of the attack. These treatments are simple, inexpensive and life-saving.
Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths from this neglected killer.
from the publication:
For a number of years, there was one zinc product that met quality standards for international procurement by UNICEF. Zinc is now procured by UNICEF, governments and
other agencies and is manufactured locally in a handful of countries. However, meeting policy and regulatory requirements for importing a new product continues to present challenges for zinc introduction in many countries. Moreover, changing child health treatment recommendations nationally can also be difficult.
Compounding the problem is the fact that initial start-up funds for these new treatments can be significant, and beyond the scope of regular health budgets. In addition, many countries are hesitant to buy zinc because they have little experience with it as part of diarrhoea management programmes: They are unsure of the demand and are reluctant to devote funds to one-time start-up activities, such as developing training materials. ….
The challenges of scaling up zinc and increasing usage rates of ORS are steep, but not prohibitive. A renewed call to action is needed to ensure that increasing coverage
of diarrhoea treatment interventions becomes an international
pulications Sources: Global Zinc Task Force, 2009; UNICEF Supply Division, 2009.
a new drug for use in Pediatric Rehydration
the question is with all drug how long must the clock tick before it becomes available in the most neediest of places, at a price point that makes it affordable to be subsidized by agencies. Perhaps we should have a site that is a virtual wall of timers each labeled with a drug count the years before the neediest op people are able to benefit.
BOSTON – October 5, 2009— Baxter International Inc. (NYSE: BAX) today announced the commercial launch of HYLENEX recombinant (hyaluronidase human injection) for use in pediatric rehydration at the 2009 American College of Emergency Physicians (ACEP) scientific assembly (Boston). HYLENEX, an enzyme, allows fluids to be administered under the skin (subcutaneously) rather than through a vein. This allows for rapid treatment initiation and delivery of intravenous (IV)-like fluid rates, which can help lead to successful rehydration of children in a less invasive manner. Additionally, data from Baxter’s Increased Flow Utilizing Subcutaneously-Enabled (INFUSE) PEDS 1 study are debuting today in the preeminent pediatric journal, Pediatrics. The study was designed to assess the efficacy, safety and clinical utility of HYLENEX recombinant-facilitated subcutaneous rehydration in mild to moderately dehydrated children ages two months to 10 years. This approach was found to be effective, easy to use and well-tolerated. 1 Baxter licensed HYLENEX, the first and only recombinant human hyaluronidase, from Halozyme Therapeutics, Inc. (Nasdaq: HALO)…..
Yale School of Medicine gets $1.8 million from Bill & Melinda Gates Foundation for oral rehydration solution ( ORS) study
New Haven, Conn. — http://media-newswire.com/release_1100879.html
To improve treatment of acute diarrhea, the Bill & Melinda Gates Foundation recently gave a two-year, $1.8 million grant to the Yale School of Medicine to design clinical trials to test the effectiveness of a major modification of oral rehydration solution ( ORS ) in the treatment of acute diarrhea in children in developing countries.
After working together on various aspects of this project for more than 15 years, a team of scientists — Dr. Henry J. Binder, professor of medicine and of cellular and molecular physiology at Yale, and his two collaborators Dr. B.S. Ramakrishna, professor of gastroenterology at Christian Medical College, Vellore, India, and Professor Graeme P. Young, head of the Flinders Centre for Cancer Prevention and Control, Flinders University, Adelaide, Australia — have proposed a modified ORS, based on the addition of a starch that reduces fluid loss.
“The development of ORS to treat diarrhea more than three decades ago has been considered one of the most important milestones in therapeutics during the last century,” says Binder. But although oral rehydration therapy has been responsible for a substantial reduction in infant mortality in the developing world, Binder says, “It is not used as much as it should be for many reasons, including the failure of mothers and caregivers to appreciate its effectiveness. Although ORS corrects dehydration, it does not reduce diarrhea.”
Since diarrhea can be caused by bacterial, viral and parasitic infections, an improvement in current therapies will have far-reaching impact, say the scientists. The primary objectives of this two-year planning grant are to establish a network of sites to collaborate in a series of clinical trials in developing countries, and to identify the most effective starch to be used in these trials.
Resistant starch – 0verview
Amylase – overview
- Amylase-Resistant Starch plus Oral Rehydration Solution for Cholera NEJM
- A Randomized Controlled Trial of Glucose versus Amylase Resistant Starch Hypo-Osmolar Oral Rehydration Solution for Adult Acute Dehydrating Diarrhea PLOS
there is a good new story in Time this past August (’09) Here is an excerpt
Can One Pill Tame the Illness No One Wants to Talk About?
By Vivienne Walt / Sogola Monday, Aug. 17, 2009
It is hard to grasp the impact diarrhea has on people’s lives across Africa and Asia. The disease kills more children than either malaria or AIDS, stunts growth, and forces millions — adults and children alike — to spend weeks at a time off work or school, which hits both a country’s economy and its citizens’ chances of a better future. In countless villages like Sogola, where people have long drawn water from unreliable wells, diarrhea kills so many that there is a general sense of resignation, as if watching children die is simply one of life’s inevitable tragedies. One morning I ask Djene-Sira Diakité how many children she has. “God gave me 10 children, and took five of them back,” she says with a shrug.
But now a quiet revolution is under way. Over the past few years, a handful of aid organizations and governments — including the Bill and Melinda Gates Foundation and the U.S. Agency for International Development — have begun distributing zinc supplements to villagers in Bangladesh, India, Mali and Pakistan. Several other groups are working with governments in Africa to introduce zinc, which comes both in tablet form and as a syrup. In Mali, Save the Children U.S. used $680,000 from a 2007 charity concert of American Idol to distribute zinc tablets to a handful of villages in the south of the country. (Read TIME’s Persons of the Year cover story on Bill and Melinda Gates.)
So far, the small programs have drawn little attention. But their impact has been dramatic. Zinc pills appear to halt diarrhea in its tracks. “Before, we were terrified when children’s stomachs began running, because we knew some of them would die,” says Sata Djialla in the Malian village of Morola. “Now our children are not dying of diarrhea.”
…A second medical breakthrough should also help. At least one-third of all diarrhea deaths among young children are caused by the rotavirus, which infects the cells lining the small intestine and causes gastroenteritis. In June, the WHO approved the first rotavirus vaccine for global use. The vaccine, which in trials in Latin America, Europe and the U.S. cut rotavirus infections by 85%, could someday be part of routine vaccination programs for children, along with those for polio, measles and other diseases whose death rates have plummeted in recent years.
for full story : http://www.time.com/time/magazine/article/0,9171,1914655-1,00.html