“No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period and at so little cost” — UNICEF 1987

The end of the 1990s marked the epidemiological transition from infectious diseases to non-communicable diseases, with heart disease and cancer taking over as the leading causes of death from diarrhea and pneumonia. This transition was observed due to the introduction of oral rehydration therapy (ORT) between 1970 and 1990 which led to a significant decrease in the number of deaths from diarrhea. Overall, diarrheal deaths decreased from 4.6 million annually to less than 1.5 million as a result of WHO and UNICEFs efforts to increase ORT utilization and caregiver education. 

However, despite the decline, diarrhea remains the second leading cause of death for children under the age of five, resulting in approximately 1,300 deaths per day and 0.5 million deaths annually, with 80% of these deaths occurring in Africa and South Asia alone.

ORT is suggested as the first-line treatment for acute diarrheal diseases in low and middle-income countries by UNICEF and WHO as these countries often struggle with poor hygiene and sanitation problems. On the other hand, despite being the country that pioneered the ORT formulation, only 51% of children receive ORT for diarrhea in India. Another tragic irony is that ORT is the only Indian contribution to the WHO Essential Medicines List.  ORT is underused in India primarily due to a trust deficit in low-cost treatments rather than a lack of funds.

A ratio much smaller in comparison to 78% in Bangladesh and many African nations like Mozambique, Kenya, and Namibia. Intriguingly, the proportion of children under five who die from diarrhea per 1,000 live births in each nation is reflected in the use of ORTs:9.3 in India versus 6.9 in Bangladesh. Additionally, only 13% of children under the age of five in India receive the ORT-zinc combination recommended by WHO and UNICEF. 

However, in the past decade, with increased access, ORT utilization has increased slightly (from 34 percent in 2000 to 43 percent in 2015) despite the poor state of global progress in third-world nations. On the other hand, the "Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea" aims to achieve universal access to basic drinking water, adequate sanitation, and hand washing in healthcare facilities and homes by 2030. This plan aims to reduce the incidence of severe diarrhea by 75%, ensure appropriate management, and reduce diarrhoeal mortality to less than 1 per 1000 live births by 2025.

Source: Journal of Global Health Economics and Policy. 2022 Apr 8;2:2022007. DOI: https://doi.org/10.52872/001c.33895