Section 2: Introduction 

Importance for MCH in Low Resource Settings

In Uganda, the second leading cause of death in children under five years is diarrhea.  With limited health centres accessible to rural populations, many Ugandans seek care for their sick children from drug vendors (Löfgren et al., 2012).

According to the United Nations Children Fund (UNICEF) and the World Health Organization (WHO), diarrhea is defined as "having loose or watery stools at least three times per day, or more frequently than normal for an individual” (UNICEF 2009; WHO 2013).  Diarrheal disease is a major cause of morbidity and mortality worldwide.  Each year, approximately 2.2 million people die from diarrhea; most are children in developing countries (Boschi-Pinto, 2008).  It is the second leading cause of death in children under 5 years, accounting for approximately 15% (~1.36 million) of the 6.9 million deaths worldwide (Walker, 2012; UNICEF/WHO, 2012). , killing around 760,000 children each year (WHO 2013). In developing countries, children experience an average of three rounds of diarrhea a year (Boschi-Pinto, 2009). There are several factors that contribute to high mortality and morbidity from childhood diarrhea including poverty, socioeconomic status, maternal education, overcrowding, and access to clean water and sanitation (Boschi-Pinto, 2009).

 Fig. 1: Global Distribution of Deaths Due to Diarrheal Disease Among Children Under 5 in the year 2004; each dot represents 1,000 deaths (Boschi-Pinto, 2008). 

Unlike other endemic diseases, diarrhea can be prevented and treated with simple behavioral and sanitary practices, as well as water treatment interventions, that are readily accessible and useable by most individuals. This requires strong leadership, effective public health interventions, and program management.

Chapter Summary

For the remainder of the chapter, diarrheal disease is discussed to give a better picture of its role in the developing world, particularly in children.  In Section 3, Epidemiology and Etiology, diarrheal disease is looked at in terms of the extent and scope of the problem, particulalry in low-resource settings and the most affected populations.  Transmission, associated morbidity and mortality, the signs and symptoms of diarrheal disease, and the health, economic and social impacts are all discussed.  Section 4, Program Management, presents several interventions and treatments as well as what is needed to make them successsful and problems frequently encountered.  This is folllowed by ideas for monitoring and evalution in terms of the common indicators used.  In Section 5, New Developments, Innnovation, and Technology, emerging technologies and strategies for addressing the health problem are touched upon.  Finally, in Section 6, Controversies, a discussion of controversial issues related to diarrheal disease is presented.