indent:.5in;line-height:150%'>Sanitation promotion is another component of the systemic approach to reducing diarrheal illnesses. Especially in urban settings in poor countries, sanitation services are neglected since resources for any infrastructure are stretched thin . Barriers to the provision of sanitation services include the reluctance of governing bodies to legitimize illegal occupation of land by providing social services, lack of experience, and lack of funding . Yet the effectiveness of sanitation-focused interventions, including hand-washing and latrine promotion, has been shown; recent studies have found they reduce diarrheal incidence between 32% and 43% .
Hand washing has been shown to reduce diarrhea incidence by an average of 33%, but interventions must address the complexity of behavior change and the resources that are needed . Plain hand soap must be provided, and washing hands after defecating or handling children's feces and before handling food entails an average of 32 hand washes per day, using a total of 20 liters of water per day . Thus, these interventions must go hand-in-hand with projects to provide clean water. But, as with any systemic change, the details must be tailored to the needs and abilities of the target communities.
VIII. The Role of International Organizations
One of UNICEF’s major foci is on water, environment, and sanitation. They work with governments and other organizations to implement effective water sanitation interventions, with local organizations to ensure that households have clean water supplies, and with schools to make students healthier and allow girls to access education instead of fetch water for their families . UNICEF is also present in emergency situations to bring clean water supplies to affected populations .
The World Health Organization is a division of the United Nations, governed by 192 member states through the World Health Assembly. The mission of WHO is “is the attainment by all peoples of the highest possible level of health. Health is defined in WHO's Constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity .” There are several programs through WHO that focus on reducing diarrheal diseases around the world. The International Network to Promote Household Water Treatment and Safe Storage (HWTS) works to improve access to safe drinking water and provide interventions to people without safe drinking water . The publication International Travel and Health offers guidance for travelers in avoiding various diseases, including diarrheal ones . The WHO Global Taskforce on Cholera Control provides technical support for cholera control and prevention in several countries, trains health professionals in prevention, preparedness, and response to diarrheal disease outbreaks, and disseminates information on cholera and other enteric diseases to health professionals and the general public . The Initiative for Vaccine Research (IVR) has vaccine programs for rotavirus, cholera, and Shigella .
VI. What You Can Do
This chapter serves as an introduction to the complexities of one of the most common causes of mortality for children around the world. More information can be found through any of the sources used for this chapter, or through the following links:
Disease Control Priorities Project http://www.dcp2.org/pubs/DCP/19
American College of Physicians http://www.acpmedicine.com/sample/ch0403s.htm
Rx for Survival
There are countless ways that you can personally get involved in the efforts to end the preventable deaths and illnesses caused by diarrheal diseases around the world. For information on how to volunteer:
Institute for OneWorld Health http://www.oneworldhealth.org/how/volunteer.php
Save the Children http://www.savethechildren.org/involved/
Water Partners International http://www.water.org/involved/index.htm
Peace Corps http://www.peacecorps.gov/index.cfm?shell=Learn.whatvol.healthhiv.water
For more information on advocacy efforts:
Save the Children http://www.savethechildren.org/advocacy/
Sanitation Connection http://www.sanicon.net/titles/topicintro.php3?topicId=1
Global Health Council http://www.globalhealth.org/view_top.php3?id=228
For information on making donations:
Institute for OneWorld Health http://www.oneworldhealth.org/how/donate.php
Save the Children https://secure.ga4.org/01/support_now?stationpub=i_hpddh1_adv1
Water Partners International http://www.water.org/donate/
For information on employment in the field:
Institute for OneWorld Health http://www.oneworldhealth.org/how/listing.php
Save the Children http://www.savethechildren.org/careers/
Most importantly, stay safe and implement prevention measures for yourself and your household. More information can be found here:
1. Bryce, Jennifer. WHO estimates of the causes of death in children; Lancet, 2005, vol. 365, issue 9465, p 1147.
2. Kosek, Margaret. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000; Bulletin of the World Health Organization, 2003, vol. 81, issue 3, p 197.
4. http://www.who.int/healthinfo/bodgbd2002revised/en/index.html. Estimates by WHO region, mortality.
29. Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bulletin of the World Health Organization 2000;78:1246–55.
39. http://www.healthunit.on.ca/factsheets/dp.cfm?action=Fact_Sheets_Details& ContentID=466
42. Newburg DS, Ruiz-Palacios GM, Morrow AL. Human milk glycans protect infants against enteric pathogens. Annu Rev Nutr. 2005;25:37-58.
43. Hanson LA, Korotkova M, Haversen L, Mattsby-Baltzer I, Hahn-Zoric M, Silfverdal SA, Strandvik B, Telemo E. Breast-feeding, a complex support system for the offspring. Pediatr Int. 2002 Aug;44(4):347-52.
45. WHO. 2001. "The Optimal Duration of Exclusive Breastfeeding: Results of a WHO Systematic Review." http://www.who.int/inf-pr-2001/en/note2001-07.html
47. WHO. 2003. HIV and Infant
Feeding—Framework for Priority Action .
48. Prüss, Annette. Estimating the Burden of Disease from Water, Sanitation, Hygiene at a Global Level; Environmental Health Perspectives, 2002, vol. 110, issue 5, p 537.
50. Chiller TM, Mendoza CE,
51. Rainey RC, Harding AK.
Acceptability of solar disinfection of drinking water treatment in
52. Rose A, Roy S, Abraham V,
Holmgren G, George K, Balraj V, Abraham S, Muliyil J, Joseph A, Kang G. Solar
disinfection of water for diarrhoeal prevention in southern
53. Lule JR, Mermin J, Ekwaru JP,
Malamba S, Downing R, Ransom R, Nakanjako D, Wafula W, Hughes P, Bunnell R,
Kaharuza F, Coutinho A, Kigozi A, Quick R.
Effect of home-based water chlorination and safe storage on diarrhea
among persons with human immunodeficiency virus in
54. Clasen T, Garcia Parra G,
Boisson S, Collin S. Household-based ceramic water filters for the prevention
of diarrhea: a randomized, controlled trial of a pilot program in
55. Khosla R, Bhanot A, Karishma S. Sanitation: a call on resources for promoting urban child health. Indian Pediatr. 2005 Dec;42(12):1199-206.