Challenges | Money Talks | 1990 World Summit for Children
Challenges for the Year
The 1990 World Summit for Children set major health and development goals
for children to be achieved by the year 2000, including
- a 50 per cent reduction in deaths due to diarrhoea in children
under five and
- a 25 per cent reduction in the diarrhoea incidence rate.
A priority is to increase the proportion of patients receiving ORT
and continued feeding to 80 per cent by the end of 1995.
Currently only 38
per cent of diarrhoeal dehydration sufferers are treated with ORT.
What needs to get done
1. Achievement and maintenance of 80 per cent
ORT use and a halving of child deaths caused by diarrhoea. In 1994, 57 per cent of diarrhoea cases worldwide were treated with ORT,
versus 17 per cent in 1986. Although this level of ORT use is credited with saving
one million child deaths per year, more than three million children below age five
continue to die annually from diarrhoeal dehydration.
2. Sustaining support for ORT use The ORT use rate tends to drop off without social mobilization efforts
that continue until behavioural change is achieved and ORT becomes a family habit. For
instance, Egypt launched a campaign in 1988 and within two years, 96 per cent of mothers
had heard of ORT and the home usage rate was more than 50 per cent. When lack of funding put an end to social mobilization, ORT usage
dropped to 34 per cent. The same happened in the Gambia, where a two-year campaign boosted
usage to 64 per cent, which fell to 11 per cent a year later. Not only nations, but entire
regions can thus lose ground. Eastern and Southern Africa's 60 per cent 1994 use rate actually
represented a drop from the previous year's 64 per cent, and West and Central Africa's 36
per cent in 1994 represented a drop from 38 per cent in 1993. In the Americas and the
Caribbean, the 1994 rate of 58 per cent was down from 65 per cent the previous year.
3. Overcoming obstacles to ORT/ORS posed by
medical practitioners Because it is so simple, many doctors and other health providers are not
convinced that ORT is a state-of-the-art treatment and fail to prescribe it. Especially in
the industrialized world--about 500 children in the US die of diarrhoeal dehydration each
year--hospitalization for intravenous therapy, which costs an average US$2,300 versus the
minimal costs of a packet of ORS, is the standard procedure. Insurance companies do not reimburse for ORT, which is also a very
time-consuming therapy in the hospital, since the child must be held and fed liquids for
4. Overcoming obstacles to ORT/ORS posed by
drug companies The World Health Organization has determined that several types of drugs
widely used in the industrialized world to treat diarrhoea are ineffective or even
dangerous. These include adsorbents and antimotility drugs, both of which can stop the
diarrhoea, sometimes at the risk of intestinal obstruction, but still leave a child with
the risk of dehydration. Even in developing countries, manufacturers may have no financial
incentive to produce such a simple product for commercial sale.
- Immodium and other antimolility drugs are not necessarily safe or
effective and they do not stop diarrhoea. Actually, the diarrhoea keeps on, but
they stop the movement of the intestine so that bloating can occur. Because the intestine stops squeezing, and the
diarrhoea continues, that is why children (or anyone) can get dehydrated.
- these drugs do not rehydrate, i.e., do not replace fluids lost, nor
match electrolytes lost.
- Adsorbents also do not stop diarrhoea. Instead they are clay-like
substances with make the loose stool look more normal and formed. Again, these drugs do not replace either fluids lost nor electrolytes and fool
people into thinking all is okay.
Additionally, rice-based oral electrolytes reduce fluid losses (by 20 to 30 %) and
rehydrate by matching fluids lost, as is appropriate.
5. Overcoming obstacles to ORT/ORS by the
general population Parents must not only be aware of the existence of ORT, but must also be
taught how to use it. Because ORT stops dehydration, not the diarrhoea that causes it,
many parents believe that drugs are preferable. Information and communication campaigns
are necessary to dispel such misunderstandings as well as mistaken, outmoded beliefs, such
as that children should not be given food or water while suffering from diarrhoea.
6. Preventing diarrhoea This can be pursued by multisectoral efforts to achieve and maintain
high levels of immunization, improve access to clean water and safe sanitation, support
breastfeeding and promote hygiene education.
How to get it done
- ORT should be made "a family habit" through
communication, social mobilization and information;
- health providers should prescribe ORS and promote ORT for
every case of diarrhoea, advise parents and give correct treatment for all types of
- all health facilities - private and public - should be
strengthened with skilled personnel and adequate drugs;
- preventive measures should be taken.
UNICEF, the World Health Organization, the Rockefeller
Foundation, the United States Agency for International Development, Junior Chamber
International, The Hunger Project and the US Centers for Disease Control and Prevention
have mobilized behind these goals and placed them at the top of their agendas. The Boy
Scouts have pledged their participation. The coalition of these forces promises a good
beginning. But they cannot do it alone.
Here are some activities that could be carried out by individuals,
non-governmental and volunteer organizations to help promote
Oral Rehydration Therapy.
What decision makers can do:
- Disseminate information on the problem, and the solution, to ensure
sustained political commitment and adequate resource allocation;
- Support the creation of a social movement to make ORT a family habit;
- Create an alliance of governmental and non-governmental bodies to teach
correct ORT procedures to families;
- Ensure that families are taught the importance of the three Fs -- fluids,
feeding and further help -- when children are having diarrhoeal attacks;
- Ensure that there is one ORS dispensing depot within walking distance for
every 1,000 families;
- Increase the output of ORS packets from 500 million to 1 billion
- Speak out in favour of ORT;
- Ask education ministers to mobilize teachers to talk about ORT in the
- point out that one of this century's most important medical breakthroughs
has been largely underreported and underappreciated;
- report that most diarrhoea medications are useless or harmful, that only
in a small number of cases are antibiotics or antimoebics the correct treatment, and that,
other than ORS, medicine should be used only if prescribed by a doctor or nurse;
- broadcast television reports on the worldwide ORS programme to save more
lives than did penicillin;
- assign reporters to investigate the obstacles to ORT use in their
- use the media to promote ORT as the best scientific option for the
prevention and treatment of diarrhoeal dehydration.
How to influence the medical profession:
- distribute leaflets reiterating that I.V. treatment is eight times as
expensive as ORT;
- promote the fact recognized by modern doctors that ORT is the most
scientific and cost-effective option;
- rally around other voices from the medical profession that endorse and
There are doctors, nurses and pharmacists who fail to advise parents
about ORT. THIS IS NOT RIGHT. All doctors, nurses and pharmacists must recommend ORS for
every case of diarrhoea. When they fail to do so, it is because they have not kept up with
the research about ORT or are wary of new treatments that were not taught when they were
in medical school. In some countries, medical school started teaching about ORT only a few
What everybody can do:
- Convene meetings of community and government leaders to discuss specific
issues related to children.
- Organize youth forums to discuss dehydration and the Convention on the
Rights of the Child and call for its implementation.
- Persuade sports stars to promote ORT through the mass media, youth and
sports organizations, and stadium management to display messages about the dehydration
- Arrange encounters of leading artists, public personalities, writers and
intellectuals to discuss the situation of children in the country and in the world.
- Organize exhibitions of photographs and art work by professional
photographers and artists including children on child-related subjects.
- Organize peaceful marches to alert the public to such issues as
dehydration, survival and child development.
- Urge radio stations to broadcast talk shows for youth to ask questions
concerning dehydration and problems affecting children in their communities.
- Seek the involvement of parliamentarians in promoting ORT through
round-table discussions, town meeting and meet-the-people sessions.
- Enlist the support of NGOs and civic and religious leaders through
encounters/seminars on the well-being of children and of the importance of ORT, and ask
that all places of worship dedicate services, with appropriate liturgy, music, prayers and
- Encourage airlines to play the ORT promotional video before the in-flight
- Encourage transit authorities to display ORT posters on buses or subway
trains, and leading merchants to display the poster in store windows.
- Encourage school superintendents to include an ORT course.
- Encourage regularly scheduled concerts and other performances to be
dedicated to children, and to include messages about ORT in their printed programmes and
- Ask radio and TV stations, and publications of all kinds, to run public
services announcements and display ads about ORT and the needs of children
- Sell ORT T-shirts, buttons, posters, etc., to promote awareness and raise
funds for local children's service and advocacy efforts.
- Hold an exhibition on the Rights of the Child and invite prominent
community leader, the mass media and school children.
- Organize a road run, big walk or bike tour to raise awareness on
- Raise funds to adopt a project in a developing country benefiting
- Persuade local and national libraries to highlight books on children.
- Organize essay-writing competitions among children and adults.
- Convince newspapers to carry supplements on children's issues;
especially about dehydration.
updated: 23 April, 2014