Lifesaving oral rehydration solution and zinc are now readily available in villages in Cambodia. Photo: PATH/Heng Chivoan.
Old and new tools offer hope for saving hundreds of thousands of kids a year
>No child should die of anything as commonplace as diarrhea—not when so many cases can be prevented or treated with simple measures. Yet globally, diarrhea is the second leading cause of childhood death after pneumonia. Children who survive the potentially deadly dehydration caused by severe diarrhea can still suffer long-term health problems and developmental delays.
Most children who die from diarrheal disease live in the developing world, where they face a double threat. First, a lack of improved sanitation, safe drinking water, and adequate nutrition puts them at high risk. Then when disease strikes, they don’t have ready access to lifesaving treatment.
The right toolkit
We are working toward a world where no parent has to bury a child because of diarrhea. We have committed to a comprehensive framework to protect, prevent, and treat children suffering from diarrhea and, where possible, to address pneumonia at the same time.
Our comprehensive approach to addressing diarrhea emphasizes the use of proven methods, the scale-up of new techniques, and the development of innovative tools to fill deadly gaps. Our team is developing a complete toolkit to stop the many causes and symptoms of diarrheal disease. We are:
- Advancing the development and introduction of vaccines against several of the major causes of diarrheal disease.
- Making water and sanitation safe through water filters and other devices.
- Developing technologies to quickly diagnose the cause of diarrhea.
- Improving current treatments while developing new drugs to treat severe diarrhea.
- Strengthening the health systems that treat children, educating families on how to save children’s lives, and advocating for needed policy changes.
Prevention made possible
Municipal councilor Florence Weke-sa is helping families in her community prevent death from diarrhea. Read her story. Photo: Robin Biellik.
While dozens of pathogens can cause diarrhea, rotavirus is the most deadly. It kills hundreds of thousands of children each year and causes the hospitalization of millions more. It cannot be treated with antibiotics or other drugs, and nearly every child in the world is at risk. Vaccination is the best hope.
PATH has been at the forefront of this effort since 2006, when we helped Nicaragua introduce a new rotavirus vaccine. It was the first time in history that a vaccine was introduced in a developing country in the same year that it was approved in the industrialized world. Today, the diarrhea wards of Nicaragua’s hospitals are almost empty, and we’ve provided support to a number of other countries introducing rotavirus vaccine.
We’re now working on two fronts: making existing rotavirus vaccines more available while speeding up the development of new and more affordable rotavirus vaccines, including those being developed by India and other emerging economies. We have also teamed up on vaccines that could prevent the leading bacterial causes of diarrheal disease: Shigella and enterotoxigenic Escherichia coli (ETEC). These new vaccines have the potential to significantly decrease the incidence of diarrheal disease in developing countries.
Safe water for life
To help prevent diarrhea as well as pneumonia, we develop and improve technologies that make water safe to drink and improve hygiene. To understand what consumers want and need in a household water filter, we spent hundreds of hours asking questions and observing behavior in families’ homes in Asia and Africa. Based on our research, we created design guidelines that product manufacturers can use to build filters that are effective, easy to use, and appealing to target consumers. We also collaborated with a private company, Cascade Designs, Inc., to develop a portable device that uses salt, water, and a 12-volt car battery to create a chlorine solution that kills bacteria and viruses in water.
Finding smart ways to get clean water technologies into communities and homes is as important as developing the technologies. Through our Safe Water project, we explored using commercial-market forces to distribute water treatment products and sanitary latrines to low-income households. We tested strategies, products, and approaches and reached hundreds of thousands of people in India, Southeast Asia, and East Africa with safe water solutions. We’re now using the most successful approaches—along with a suite of healthy household durable products—to extend the reach of sanitation and hygiene solutions.
Faster diagnosis, better treatment
With about 2 billion cases of diarrheal disease every year, the world has an urgent need for tools that diagnose the different pathogens that cause diarrhea and for safe, effective, and affordable treatments. We’re using our expertise to meet these needs.
For example, we’re working with partners to improve the current formulation of oral rehydration solution (ORS) so that it promotes fluid and electrolyte absorption. Though ORS is a simple, inexpensive, and highly effective means to prevent deadly dehydration, less than half of children with diarrheal disease receive it. This is partly because it does not treat the diarrhea itself, so its effect is not easily seen by caregivers. By reducing diarrheal fluid loss, we hope that a new formulation will motivate caregivers to see an improved ORS as crucial treatment for their child’s diarrhea. We also advocate for policy changes that improve the availability of ORS and zinc—which reduces the severity and duration of diarrhea—in communities.
We are evaluating new treatment opportunities for diarrheal disease and establishing partnerships to move promising drug candidates forward. Our investigational new drug for infectious diarrhea, iOWH032, has the potential to treat diarrheal processes directly by reducing loss of water from the gastrointestinal tract, thereby reducing dehydration. Antidiarrheal drugs have the potential to complement the use of ORS and other proven therapies.
Encouraging winning strategies
Finally, PATH is working to get these tools and other innovative approaches into health facilities and homes. Through advocacy, we ensure that national health plans prioritize and fund child health interventions. Our DefeatDD website provides tools for advocates, key documents for program officers, and links to information on lifesaving interventions.
We also work with countries in sub-Saharan Africa and Southeast Asia to find and implement the strategies that are right for them.
- In Cambodia, we worked with the government to integrate diarrhea and pneumonia control, specifically targeting rural communities where child deaths due to these two illnesses are the highest in the country. In addition, we helped make it easier for parents to access lifesaving treatment. Village health volunteers like Yeksim Chea can now distribute ORS and zinc to parents so they don’t have to travel to the nearest clinic, saving them precious time.
- In Kenya, we helped the government develop a new, integrated policy for diarrhea management. We trained thousands of health workers like Jane Wamalwa and supported the establishment and expansion of oral rehydration therapy corners, where mothers with dangerously dehydrated children can access lifesaving treatment while receiving education on nutrition, hygiene, and home care.