South-East Asia Regional Conference on Epidemiology

The role of current diarrhoea management in
decreasing child mortality
Yati Soenarto
Millennium Development Goals (MDGs) represents international paradigm of global development
agreed by 189 member states of the United Nations (UN) at the Millennium Summit in September
2000. The purpose is to reduce poverty and its impacts, such as hunger, disease, low education level,
gender gap, and environment problem, by 2015. Each goal has one or several target including indicators
to measure progress. Among the eight goals, the focus of MDG 4 is reducing infant mortality rate.
Its target is to reduce mortality rate of children less than five years of age (U5) by two thirds in 1990-
2015 with following indicators: 1) infant mortality rate per 1,000 live births, 2) child mortality rate
per 1,000 live births, and 3) percentage of children aged between 12-23 months immunized against
measles.
Indonesia has made progress by reducing infant mortality rate from 68 per 1,000 live births in 1991
to 32 per 1,000 live births in 2005. As for U5 children, the mortality rate has decreased from 97 per
1,000 live births in 1991 to 40 per 1,000 live births in 2005. The percentage of children aged 12-23
months received measles immunization was increasing from 57% (1990) to 71.6 % in 2003.
All efforts, such as, promotion of the use of insecticide-treated mosquito net, oral rehydration for
diarrhoea, increased access to vaccine for various infectious diseases, and increased water quality and
sanitation have made significant contribution to this improvement. Despite overall reduction in infant
and child mortality rate, mortality caused by preventable disease remains high and higher compared
to other ASEAN countries: 4.6 times more than Malaysia, 1.8 times more than Thailand, and 1.3 times
more than Philippines.
Pneumonia and diarrhoea are still the main cause of under five children mortality worldwide.
In Indonesia, the number of deaths caused by diarrhoea has exceeded the number caused by
pneumonia.
Current Diarrhoea Management
WHO and UNICEF have recommended policies for health professionals on treatment of diarrhoea,
which are: 1) Counsel mother to begin administering suitable home fluids immediately upon onset
of diarrhoea in a child, 2) Treat dehydration with new low osmolarity ORS (or with intravenous
electrolyte solution in cases of severe dehydration), 3) Emphasize continued feeding or increased
breastfeeding during, and increases feeding after the diarrhoea episode, 4) Use antibiotics only when
appropriate, i.e., in the presence of bloody diarrhoea or shigellosis, and abstain from administering
anti-diarrhoea drugs, 5) Provide children with 20 mg per day of zinc supplementation for 10-14 days
(10 mg per day for infants under six months old), and 6) Advise mothers of the need to increase fluids
and continue feeding during future diarrhoea episodes.