More proven interventions are available to prevent and treat diarrhea than any other major child kil

1
More proven interventions are available to
prevent and treat diarrhea than any other major
child killer
Jones G Bryce J. et al., Lancet CS series 2003
2
The Effectiveness of ORS

• Oral rehydration treatment reverses dehydration
  in more than 90 of patients
• Since 1971, saved the lives of over 40 million
  children
• When ICDDR,B began experiments with oral
  rehydration in the 1960s, fatalities among
  diarrhea patients dropped from 50 to zero.

3
Zinc for the Treatment ofDiarrhea Research
Findings

• 25 reduction in duration of acute diarrhea
• 29 reduction in duration of persistent
  diarrhea
• 40 reduction in treatment failure or death in
  persistent diarrhea
• WHO-issued recommendations about the use of zinc
  in treating diarrhea

Zinc Investigators Collaborative Group. Am J
Clin Nutr 2000
4
Breastfeeding

• Non-breastfed infants aged 0-5 months have 7-fold
  increased risk of death from diarrhea
• 13 of the under-5 deaths could be prevented if
  infants were exclusively breastfed for 6 months.
• 6 of under-5 deaths could be prevented with
  adequate and safe complementary feeding.

WHO, Key strategies for promotion of
breastfeeding
5
Rotavirus vaccines

• GSK Rotarix - monovalent, human, live,
  attenuated, oral rotavirus vaccine
• Lyophilized vaccine reconstituted with CaCO3
  buffer
• human G1P8 strain cross-protective of multiple
  strains
• high efficacy and safety
• 2-dose schedule, given with DPT1,2
• WHO prequalification Jan 2007

• Merck RotaTeq - pentavalent, human-bovine
  reassortant, live, attenuated, oral, rotavirus
  vaccine
• Liquid vaccine, 5 human-bovine reassortant
  strains
• G serotypes - human G1, G2, G3 and G4 bovine G6
  cross-protective of multiple strains
• high efficacy and safety
• 3-dose schedule, given with DPT1,2,3
• WHO prequalification Oct 2008

6
Diarrhea Still a Top Killer
Source Bryce J. et al., Lancet 2005
7
Incidence of Diarrheal Disease Remains High
Incidences for Diarrheal Episodes per Child per
Year from Three Reviews of Prospective Studies in
Developing Areas, 1955-2000
Gerald T. Keusch,et al, "Diarrheal Diseases."
2006. Disease Control Priorities in Developing
Countries (2nd Edition),ed. 371-388. New York
Oxford University Press. DOI 10.1596/978-0-821-36
179-5/Chpt-19.
8
Decline in ORS use
Source UNICEF. State of the Worlds Children
9
Uptake of ORS 1992-2005
In 23 countries - 14 in Africa - use of ORS has
declined
Ram et al, Bulletin of the WHO, March 08
10
Perceptions Research Donors, Policymakers,
Advocates Academics Indicate Diarrheal Disease
Ranks Low Among Global Health Priorities
Perceptions Research Respondents Say Diarrhea
Currently Ranks Low Among Global Health Priorities

• Whenever policymakers talk about global health
  problems they leave out the big three of the
  neglected problems diarrheal disease,
  pneumonia, and malnutrition
• -Academic
• Policymakers think of specific diseases, and I
  dont think diarrheal disease comes in the top
  ten
• -Advocate

N 33
PATH, FSG Social Impact Advisors. Diarrheal
disease advocacy Findings from a scan of the
global funding and policy landscape.
11
Interviewees Offer Reasons Why Awareness of
Diarrheal Disease May be Low
Diarrhea has dropped out of the public health
agenda it has become totally invisible. This
is not only a problem with lay people, but public
health specialists, too. People have forgotten
about diarrheal disease
Lack of advocacy around diarrheal disease in the
last decade
We are really lacking a champion for diarrheal
disease. You need two people a celebrity...
and someone from the scientific community to
bring credibility There is no high profile
person we need a Bono. But who wants to be
associated with diarrhea? You cant make
diarrhea sexy
Diarrheal disease does not have a well-known
spokesperson from either the scientific or
celebrity community
PATH, FSG Social Impact Advisors. Diarrheal
disease advocacy Findings from a scan of the
global funding and policy landscape.
12
Diarrheal Disease Has Failed to Capture the
Attention of Donors Policymakers
13
The Potential of Integration

• No single solution is adequate
• Successful at the policy level
• One intervention like rotavirus vaccines can
  mobilize adoption of others
• Allows flexibility to design a package
  appropriate for a countrys needs
• Programmatic level?
• Combining interventions may offer
  efficiencies/cost savings
• Opportunity to strengthen health systems

14
Jim Grants Vision
The world community has now set itself the
challenge to reach the goal of 80 ORT use by the
end of 1995. I am convinced that the goal can
be reached -Celebrating 25 years of ORT
conference, 1994
15
Increasing Access to Data
When Asked What Motivates Donors and
Policymakers, Interviewees Agreed On Actionable
Solutions and Hard Data
Key Factors Motivating Health Funders and
Policymakers to Take on a Particular Issue or
Disease
PATH, FSG Social Impact Advisors. Diarrheal
disease advocacy Findings from a scan of the
global funding and policy landscape.
16
Increasing Access to Interventions
Percent Respondents Selecting Each Intervention
as Integral to an Integrated DD Approach
Perceptions Research Increasing access to
proven interventions is believed to be the most
effective way to accelerate progress toward MDG 4
N 30
PATH, FSG Social Impact Advisors. Diarrheal
disease advocacy Findings from a scan of the
global funding and policy landscape.
17
What Will It Take to Put Diarrheal Disease Back
on the Public Health Stage?
18
Action Agenda

• Pursue a research agenda around individual and
  integrated interventions for the prevention and
  treatment of diarrheal disease
• Communicate the evidence and data to
  policy-makers
• Support integration of packages of interventions
  to prevent and treat diarrheal disease
• Speak out to raise awareness of diarrheal disease