Reducing the Burden of Acute and Prolonged Childhood Diarrhea 171
3
children with acute diarrhea, lactose-free liquid
feeds can reduce the duration and the risk of
treatment failure compared to lactose-containing
liquid feeds, with only limited evidence assessing
either of these two approaches in persistent diar-
rhea. Home-available lactose-free diets impact
weight gain in children with acute diarrhea com-
pared to those fed with a commercial diet. For
children in low- and middle-income countries,
where diarrhea and malnutrition co-exist, it is
suggested to use locally available age-appropriate
foods in the majority of acute diarrhea cases, but
the evidence remains limited for the dietary man-
agement of children with persistent diarrhea [13].
Probiotics are becoming increasingly popular
treatments for diarrhea in some countries and
have been shown to reduce diarrhea duration and
stool frequency on the second day of treatment
with no effect on the risk of diarrhea hospitaliza-
tions. However, evidence is still needed to under-
stand the effect of probiotics as adjunct therapy
for diarrhea among children in developing coun-
tries [14].
Intervention Delivery Strategies
No new innovations are required, just improving
the coverage of the above-mentioned existing
proven interventions could help achieve the goal
of reducing diarrhea burden. Most of the inter-
ventions exist within present health systems, al-
though their coverage and availability to poor and
marginalized populations vary greatly. Improv-
ing the coverage of these key, effective, and af-
fordable interventions requires alternate strate-
gies or platforms to accelerate their uptake and
scale-up. Given the shortage of human resources
in some of the poorest areas of the world, one
such strategy is reaching out through community
health workers, which offers an opportunity to
reach the population with only minimal health
care access [15]. Recent evidence suggests that
community-delivered interventions for diarrhea
prevention and management can improve care-
seeking behaviors and the use of ORS, and they
are also associated with a decline in the unneces-
sary use of antibiotics for diarrhea [16]. Such de-
livery platforms also offer a unique opportunity
for integrating services at the point of service de-
livery and enabling an implementation strategy in
poor and difficult-to-reach populations. Finan-
cial incentives are also being widely used to allevi-
ate poverty, reduce barriers to health care access,
promote care seeking, and improve health. Fi-
nancial incentives in the form of vouchers and
conditional and unconditional cash transfers
could promote increased coverage of several im-
portant child health interventions, with the most
pronounced effects achieved by the mechanisms
that directly removed user fees for access to health
services [17].Way ForwardImplementing these interventions and utilizing
the delivery platforms could be made possible by
engaging policy makers and civil society when as-
sessing the overall progress in coverage at the
country level. Political will and partnerships are
imperative to implement evidence-based inter-
ventions at scale. With an increasing number of
countries deploying community health worker
programs to reach the unreached, real opportuni-
ties exist to scale up community advocacy and ed-
ucation programs and early case detection and
management strategies. Bangladesh provides an
example of how targeting the poorest for key diar-
rhea interventions could result in far more lives
saved. Nearly 6 times more lives could be saved in
the poorest households when compared to the
richest by scaling up key diarrhea interventions to
near universal levels [18]. Similar attention needs
to be paid to countries contributing considerably
to the diarrhea burden, including India, Nigeria,
Pakistan, the Democratic Republic of the Congo,
and China.Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 168–172
DOI: 10.1159/000367878