Which research will help to reduce deaths from childhood diarrhea?

March 10, 2009,

An international team of health researchers, writing in this week's PLoS Medicine, says that the number one research priority for reducing childhood deaths from diarrhoea is to find ways to improve the acceptability and effectiveness of oral rehydration solution (ORS).

But unfortunately, says the team, donor agencies have shown little interest in funding this type of research.

claims almost 2 million lives each year and is responsible for about 1 in 5 worldwide. The World Health Organization (WHO) recommends a new reduced osmolarity ORS for treating dehydrating diarrhoeal disease.

The 15 researchers, led by Olivier Fontaine at the WHO's Department of Child and Adolescent Health and Development, set out to define which research questions should be prioritized to improve the chances of cutting childhood by 2015. They used a methodology designed by the Child Health and Research Initiative (www.chnri.org) — in which all possible research options are initially listed and are then given scores.

The top 10% of research investments prioritized by the researchers included:

• What is the acceptability and effectiveness of the new reduced osmolarity ORS in the clinic as well as in the community?
• What is the effectiveness of zinc supplementation (a proven treatment against diarrhoea) on the outcome and incidence of diarrhoea in the community?
• What are the barriers against appropriate use of ORS?
• Designing locally adapted training programs to orient health workers on a treatment strategy called 'Integrated Management of Childhood Illness' (www.who.int/child_adolescent_health/topics/prevention_care/child/imci/en/index.html>)
• Identifying cost-effective, sustainable methods for community-based promotion and support for early initiation and continuation of breastfeeding during the first 6 months of life and prolonged breastfeeding.

"The main message of the process," say Fontaine and colleagues, "is that the research priorities to reduce global mortality from childhood diarrhoea within the present context are dominated by health systems, policy research, and epidemiological questions."

"These questions are mainly targeted at better understanding the barriers towards implementation, effectiveness, and optimisation of use of available interventions and programmes such as oral rehydration solution, zinc supplementation, exclusive breastfeeding, and Integrated Management of Childhood Illness."

The authors caution, however, that "very few donors agencies recognise the importance of these domains of health research and are willing to readily invest in those options."

More information: Fontaine O, Kosek M, Bhatnagar S, Boschi-Pinto C, Chan KY, et al. (2009) Setting research priorities to reduce global mortality from childhood diarrhoea by 2015. PLoS Med 6(3): e1000041. doi:10.1371/journal.pmed.1000041, medicine.plosjournals.org/perl … journal.pmed.1000041

Source: Public Library of Science

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