World Bank Document

nutrition, and changes in individual example, rose nearly threefold sleeping sickness-now exist inhealth habits. These diseases have between 1972 and 1976; other most of the affected areas. Theydeclined least in developing coun- diseases have also spread, though can be operated effectively withouttries and contribute most to not so sharply. people changing their behaviormortality in those countries today. These reversals have happened (though this is less true of schisto-There has been considerable partly because authorities became somiasis, since people as well asconcern that developing countries, overconfident and allowed control snails play a role in its transmission).particularly in the high mortality programs to run down. In addition, Pesticides can often be used moreareas of Sub-Saharan Africa and control became much more expen- efficiently.South Asia, have not maintained sive in the early 1970s. Pesticide There is also room for betterthe momentum of the 1950s in prices escalated and disease carriers coverage by immunization proreducingdisease. This is largely developed a tolerance for common, grams, even in areas not otherwisebecause countries have moved inexpensive pesticides (especially provided with government healthbeyond the "technological" phase DDT). Economic development has services. Sierra Leone, for example,of improving health: the closer sometimes made matters worse: employs recruitment teams; theythey come to developed-country small-scale irrigated agriculture enlist the help of local leaders inlevels, the harder it is to progress has expanded agricultural produc- gathering together everyone whoat the same rate. It also reflects tion-but also the habitat of snails needs to be immunized immethefact that some communicable that carry schistosomiasis. diately before the vaccinatorsdiseases have increased. The Programs to control endemic arrive in the village.number of cases of malaria, forOral rehydrationdiseases-especially malaria and Apart from these efforts, majorprogress in family health behaviorand in the provision of healthservices is needed. Simple treatmentoral rehydration mixture consisting of: can frequently be effective: forA simple innovation has revolutionized table salt (sodium chloride), 3.5 grams; example, the lives of children withthe treatment of a major killer in devel- bicarbonate of soda, 2.5 grams; potassium acute diarrhea can often be savedoping countries. Diarrhea normally stops chloride, 1.5 grams; and glucose, 20 grams.on its own accord after three to five days, These ingredients are usually mixed and by feeding them a solution ofbut it occasionally causes a severe loss packaged beforehand; the health worker water, salt and sugar (see box).of body fluid; the resulting dehydration (or a child's mother) simply dissolves Education, especially of mothers,is often fatal, particularly to young chil- the mixture in one liter of water. Pre- is important. Studies in 29 develdren.Replacing that fluid can prevent packaged mixes range in cost from $0.07 oping countries have shown thatmost deaths. to $0.10, and one to three packets might infant and child mortality wereFor more than a century, fluid has been be needed while the diarrhea lasts.intravenously "dripped" into sufferers- There now is considerable interest in consistently lower the bettera method with obvious drawbacks in the possibility that mothers could mix a educated the mothers; each extracountries where there are few medical dose from the two ingredients that are year of schooling on average meantfacilities. In the past 12 years it has available in most homes-sugar and table nine per 1,000 fewer infant andgradually been established that an oral salt. But the recipe lacks potassium and child deaths. Cross-country studiesdose has just the same effect. Even dur- bicarbonate (both of which are losting diarrhea, the intestine continues to during diarrhea), and using too much salt (see box on page 38) confirm thatabsorb glucose-and glucose will carry could be dangerous for the child. literacy has a strong, favorablewater and essential salts with it. Home-mixing and the standard WHO effect on life expectancy. And asOral rehydration had its most impres- formula are not, of course, mutually discussed below (see pages 66 andsive initial success in 1971, in camps for exclusive. One report (based on a field 67) family planning services canrefugees from the Bangladesh war. More experiment in Narangwal, India) recomthan3,700 patients were treated in two mended home-mixing for relatively mild contribute directly to better healthmonths under extraordinarily difficult cases of diarrhea, with a variant of the of mothers and children.circumstances, with a case fatality rate WHO formula used only for more Improved water supplies andof 3.6 percent instead of the 30 percent severe ones. This experiment placed waste disposal are important inbefore the treatment began. Oral rehydra- principal responsibility for treatment in the long run in reducing disease.tion has since been used to prevent or the hands of auxiliary nurse-midwivestreat dehydration due both to cholera (who live in the villages) and the mothers But they must be accompanied byand to other diarrheas in many countries of affected children. While the incidence better hygienic practices if theyof Asia, Africa and Latin America. Prop- of diarrhea changed little after the new are to be fully effective. Whereerly delivered, it could save millions of treatment was introduced, the case funds are short, water supplylives a year. fatality rate declined by almost half- networks in urban areas usuallyThe WHO currently recommends an from 2.7 per 1,000 to 1.5 per 1,000. deserve priority over sewers, which56