Achievements

1. Under-five Mortality Rate - U5MR

Under-five mortality rate - (per 1,000 live births)	1960	1993
Developing Countries	216	102
Industrialized Countries	43	10
Least Developed Countries	282	173

2. Infant Mortality Rate - IMR

Infant mortality rate - (per 1,000 live births)	1960	1993
Developing Countries	137	69
Industrialized Countries	36	9
Least Developed Countries	171	111

3. Use of Oral Rehydration Salts to Control Diarrhoeal Diseases

Oral Rehydration Salts (ORS), a mixture of water, salts and glucose in specific proportions, was developed in 1968 by researchers in Calcutta and Dhaka as a treatment for cholera. The solution, as simple as a home remedy, was found to be--and remains--the best way to rehydrate a child suffering from diarrhoea. It became the cornerstone of Oral Rehydration Therapy (ORT), which emphasizes giving a child plenty of fluids--ORS and/or other appropriate household fluids--along with continued feeding during the illness and increased feeding for at least a week after. Diarrhoea is the greatest single cause of child deaths after pneumonia, responsible for 22.8 per cent of the deaths of children less than five years old in developing countries in 1993, versus 26.9 per cent due to acute respiratory infections. It is estimated that the use of ORT saves the lives of more than one million children yearly.

4. Percentage of Total Diarrhoea Cases Treated with ORT

	1986	1994
World	17	57
East Asia and the Pacific	14	79
Middle East and North Africa	28	61
Eastern and Southern Africa	13	60
Americas and Caribbean	43	58
South Asia	29	44
West and Central Africa	19	36

For the 25th anniversary of ORT, 24 countries around the world held UNICEF-supported ORT/Child Health Weeks in 1993, to educate families, mobilize media and NGOs and persuade professional associations to promote the therapy. As a result, ORS use worldwide rose by 6 percentage points that year.

5. ORS Supply in Developing Countries, 1979-1992

Years	Millions of Packets
1979 - 80	51
1981 - 82	101
1983 - 84	325
1985 - 86	645
1987 - 88	660
1989 - 90	760
1991 - 92	800

It is estimated that 410 million packets were produced in 1991 and 390 in 1992. The amount of this total production that was supplied by UNICEF was 67 million packets in 1991, rising to 82 million packets in 1992. UNICEF-supplied ORS accounted for three-quarters of the ORS available in Africa in 1992. At the other extreme, UNICEF supplied only 1 per cent of that available in South Asia. From the beginning, UNICEF has encouraged the local production of ORS. It is estimated that by 1992, two-thirds of the ORS supply was produced locally, and that only 11.5 per cent of this, or 45 million packets, was prepared according to the WHO/UNICEF recommended formula. Production was taking place in 60 developing countries as of the end of 1993.

Challenges: By The Year 2000

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 several hours.
   

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.
   

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 multi-sectoral efforts to achieve and maintain high levels of immunization, improve access to clean water and safe sanitation, support breastfeeding and promote hygiene education.