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 [55]. 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 [55]. 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% [55].

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 [46]. 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 [46]. 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

UNICEF

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 [30]. UNICEF is also present in emergency situations to bring clean water supplies to affected populations [30].

WHO

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 [56].” 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 [57]. The publication International Travel and Health offers guidance for travelers in avoiding various diseases, including diarrheal ones [56]. 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 [58]. The Initiative for Vaccine Research (IVR) has vaccine programs for rotavirus, cholera, and Shigella [59].

 

VI. What You Can Do

Learn More

            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

                           http://www.pbs.org/wgbh/rxforsurvival/series/diseases/diarrheal_diseases.html

Get Involved

            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/

International Center for Diarrheal Disease Research, Bangladesh

                                                http://202.136.7.26/activity/?typeOfActivity=Contribute

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/

International Center for Diarrheal Disease Research, Bangladesh

                                                                                     http://202.136.7.26/job/job.jsp

Most importantly, stay safe and implement prevention measures for yourself and your household. More information can be found here:

CDC                                        http://www.bt.cdc.gov/disasters/hurricanes/katrina/diarrheal.asp

 

References

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.

3. Murray, Christopher J.L Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study; Lancet, 1997, vol. 349, issue 9063, p 1436.

4. http://www.who.int/healthinfo/bodgbd2002revised/en/index.html. Estimates by WHO region, mortality.

5. http://www.cdc.gov/ncidod/dvrd/revb/gastro/rotavirus.htm

6. http://www.cfsan.fda.gov/~mow/chap33.html

7. http://www.rotavirusvaccine.org/rotavirus-facts.htm#_edn2

8. http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm

9. http://www.rotavirusvaccine.org/documents/TenFactsAboutRotavirus_051404.pdf

10. http://www.rotavirusvaccine.org/vaccine-facts.htm#_ednref9

11. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm

12. http://people.ku.edu/~jbrown/ecoli.html
13. http://www.wrongdiagnosis.com/artic/escherichia_coli_o157_h7_dbmd.htm

14. http://www.azdhs.gov/phs/edc/edrp/es/salmonellosisf.htm

15. http://www.about-salmonella.com/page3.htm

16. http://www.who.int/topics/cholera/surveillance/en/index.html

17. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_g.htm

18. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_g.htm

19. http://www.dpd.cdc.gov/dpdx/HTML/Giardiasis.htm

20. http://www.cdc.gov/ncidod/dpd/parasites/giardiasis/factsht_giardia.htm

21. http://www.dpd.cdc.gov/dpdx/HTML/Cryptosporidiosis.htm

22. http://www.cdfound.to.it/html/enta3.htm

23. http://medicine.ucsf.edu/housestaff/Chiefs_cover_sheets/amebiasis.pdf

24. http://www.dpd.cdc.gov/dpdx/HTML/Amebiasis.htm

25. http://kidshealth.org/parent/infections/parasitic/amebiasis.html

26. http://www.rehydrate.org/ors/ort_how_it_works.htm

27. http://www.brown.edu/Courses/Bio_160/Projects2004/rotavirus/Treatment.htm

28. http://www.unicef.org/sowc96/joral.htm

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.

30. http://www.unicef.org/wes/index_action.html

31. http://www.rehydrate.org/solutions/homemade.htm#recipes

32. http://www.eurekalert.org/pub_releases/2004-04/bc-fsc040804.php

33. http://www.rotavirusvaccine.org/rotavirus-facts.htm

34. http://www.case.edu/med/epidbio/mphp439/

35. http://www.brown.edu/Courses/Bio_160/Projects2004/rotavirus/Rotashield.htm

36. http://www.fda.gov/cber/approvltr/rotamer020306L.htm

37. http://www.brown.edu/Courses/Bio_160/Projects2004/rotavirus/OtherVaccines.htm

38. http://www.merck.com/product/usa/pi_circulars/r/rotateq/rotateq_ppi.pdf

39. http://www.healthunit.on.ca/factsheets/dp.cfm?action=Fact_Sheets_Details& ContentID=466

40. http://www.bchealthguide.org/healthfiles/hfile41k.stm

41. http://www.who.int/vaccine_research/documents/en/Status_Table.pdf

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.

44. Morrow AL, Rangel JM. Human milk protection against infectious diarrhea: implications for prevention and clinical care. Semin Pediatr Infect Dis. 2004 Oct;15(4):221-8.

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

46. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.2542

47. WHO. 2003. HIV and Infant Feeding—Framework for Priority Action . Geneva: WHO.

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.

49. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.2557

50. Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, Luby SP. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bull World Health Organ. 2006 Jan;84(1):28-35.

51. Rainey RC, Harding AK. Acceptability of solar disinfection of drinking water treatment in Kathmandu Valley, Nepal. Int J Environ Health Res. 2005 Oct;15(5):361-72.

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 India. Arch Dis Child. 2006 Feb;91(2):139-41.

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 Uganda. Am J Trop Med Hyg. 2005 Nov;73(5):926-33.

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 Colombia. Am J Trop Med Hyg. 2005 Oct;73(4):790-5.

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.

56. http://www.who.int/about/en/

57. http://www.who.int/household_water/network/objectives/en/index.html

58. http://www.who.int/cholera/en/index.html

59. http://www.who.int/topics/diarrhoea/en/