19. Diarrheal Diseases

Abstract

Diarrheal disease primarily affects those living in poverty, especially children under the age of five. The frequency and severity of diarrheal disease?which may occur as acute watery, persistent, or bloody diarrhea?are exacerbated by poor housing conditions; lack of access to sufficient clean water and sanitary disposal of fecal waste; and inadequate feeding practices, handwashing, and care seeking. Disease recovery is hampered when patients with diarrhea do not receive oral rehydration therapy (ORT), do not receive appropriately modified diets to offset nutritional losses, and do not have access to adequate, affordable medical care.

Diarrheal diseases remain a leading cause of preventable deaths among young children living in poverty, although improved case management and nutrition have contributed to a significant decline in diarrheal mortality. Preventive strategies include promotion of exclusive breastfeeding of infant children; improved feeding practices to prevent or treat malnutrition; rotavirus, cholera, and measles immunizations; improved water and sanitation facilities; and promotion of personal and domestic hygiene. Recent case management advances include reformulated ORT and zinc supplementation.

Some of these proven interventions involve trade–offs. For example, while ORT and water and sanitation interventions are more effective than either breastfeeding promotion or vaccinations in reducing morbidity and mortality, they also are less cost–effective. In addition to proven case management and prevention strategies, public–private partnerships for vaccine development, improved ORT practices, and low–technology solutions to enhance water quality at the point of use offer promising avenues for combating diarrheal diseases in the short term. However, the development of new medications to effectively manage bloody diarrhea, a particularly virulent form of the disease, remains a distant hope.