Tuesday, October 20, 2009

Simple solutions that save children’s lives

A previous posting discussed the death toll among children due to malaria. As staggering as those figures are, they are far smaller than the number struck down by a far more common affliction: Diarrhea.

Of the 9 million children under age 5 that died worldwide in 2008, 40% died from two conditions: pneumonia and diarrhea. Nearly 20 percent of all deaths in children under age 5, a total of 1.5 million each year, are caused by diarrhea. (The death rate in children under age 5 is often used as an indicator of overall population health.)

Rosemary Caron, Ph.D. , M.P.H., associate professor in the graduate public health program at the University of New Hampshire, reminds her students that behind anonymous population health statistics are individual people, every data point has a face. As the parent of two young children, I can’t imagine the pain of losing a single child. What makes death due to diarrhea all the more tragic is how basic the prevention and treatment strategies are. In a new report, UNICEF and the WHO outline seven steps necessary to combat diarrheal deaths in children:

Prevention steps:

• Rotavirus and measles vaccinations

• Promotion of early and exclusive breastfeeding and vitamin A supplementation

• Promotion of hand-washing with soap

• Improve water quantity and quality, including treatment and safe storage of household water

• Promotion of community-wide sanitation

Treatment steps:

• Fluid replacement to prevent dehydration

• Zinc supplements

Progress in these areas remains slow. Rotavirus causes 40% of hospital admissions from childhood diarrhea, but the vaccine is not available in most developing countries. Nearly 1 billion people lack access to safe drinking water, and twice that many lack access to safe sanitation facilities. 129 million children under age 5 are underweight (a leading indicator of future health problems, and susceptibility to disease), and only 37% of infants in developing nations are exclusively breastfed for the first 6 months of life.

In some cases the problem is rooted in the lack of effective development strategies, but in others there are cultural and commercial forces in action. Breastfeeding, which may seem like a natural and obvious choice among mothers the world over, is actively being discouraged by the robust resources of the infant-formula industry.

Among this glum news are glimmers of opportunity. Quality improvement of healthcare systems has conclusively shown that even small changes can lead to large improvements in health outcomes, and the same is true for public health interventions aimed at populations. Often what is needed is the innovative approach of a new-comer to the field, paired with professional knowledge of ground-level realities. When you look at the prevention and treatment list above, what solutions come to your mind? Give it some thought, and let us know. It could save a life.

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