This great blog post comes to us from Dr. Juan José Amador, Director of Health Systems and Technology in Nicaragua at PATH

During my childhood in Nicaragua, I used to see a shocking sight: Groups of people carrying child-size coffins through the streets toward the cemetery. Families-usually the poorest in my community-mourning the deaths of their youngest members. Almost always, diarrheal disease was the cause.

Back then, these funeral processions were common. Diarrhea was a lethal epidemic, most often striking babies before they reached their first birthdays. We had few resources and little information to stop it.

When I became a doctor, we didn’t think that our country could overcome the disease. Three years ago, however, things began to change.

With PATH’s partnership, Nicaragua began vaccinating newborn babies against rotavirus, the most common cause of severe diarrheal disease, and helping families understand how better hygiene reduces risk. PATH partnered with health workers to introduce new saline solutions and other remedies for keeping young bodies hydrated and healthy.

And it’s working. We’ve cut the number of children who die from diarrhea in half. Hospital diarrhea wards are now empty, thanks to lifesaving rotavirus vaccine and other simple interventions:

Read Wilson’s story here, and check out the slide show here.

My hope for Nicaragua is a generation of healthy children who can learn better, smile bigger, and grow up strong-without the threat of death from diarrhea. Many years ago, we didn’t believe this was possible. But in a few short years, we have changed the history of my country.

The World Health Organization’s expert advisory panel on immunizations announced today that all children should receive a vaccine that can prevent a severe type of diarrhea and vomiting caused by the rotavirus.

Every year, 600,000 children die from severe diarrhea caused by rotavirus around the world.  Although most of these deaths occur in developing countries, rotavirus also afflicts children in the developed world.  In the United States, 55,000 children are hospitalized because of rotavirus infections every year. 

Research to determine whether the rotavirus vaccine is safe and effective in countries with high child mortality has proven successful: cases of severe diarrhea were reduced after administration of the vaccine.  Funded by the GAVI Alliance, and conducted by PATH, WHO, and GlaxoSmithKline, as well as many research institutions in South Africa and Malawi, this research “clears the way for vaccines that will protect children in the developing world from one of the most deadly diseases they face,” said Dr. Tachi Yamada, President of the Global Health Program at the Bill and Melinda Gates Foundation.

As one of the diseases that causes the greatest number of deaths and illness in the developing world but receives little attention and resources, the prevention and treatment of diarrheal diseases is a priority area for the Bill and Melinda Gates Foundation.  Their work involves funding research to determine the causes of diarrheal disease in developing countries, supporting the development of a vaccine, including the rotavirus vaccine, and efforts to develop medicines and other treatments for diarrheal disease.

Delivering the rotavirus vaccine with a package of other essential interventions including improving water and sanitation to children in need in Africa and Asia will be critical for reducing child mortality.

<em>-Lisa Fleisher</em>

Two new reports out this week by WaterAid and PATH remind us what we have shamefully forgotten: diarrhea is the second biggest killer of children worldwide. This is a wake-up call because even those of us in the international development field have pretty much neglected the fact that diarrhea is still fatal in many parts of the world. It kills 1.6 million children each year.

The WaterAid report “Fatal Neglect” reveals that diarrhea prevention and treatment programs are woefully under-funded when compared to programs for HIV/AIDS and malaria. For example, HIV/AIDS receives over $10 billion a year in global health financing, while diarrhea receives well under $2 billion. These funding levels grossly misrepresent the disease burden as both these diseases are responsible for roughly the same death toll. However, the WaterAid report also makes very clear that adequately addressing diarrheal diseases should not come at the expense of funding needed for tackling other diseases.

The PATH report “Solutions to Defeat a Global Killer” highlights that during the 1980s and 1990s incredible progress was made through a variety of interventions in preventing and treating deaths from diarrheal dehydration but the momentum ceased when the issue fell off the radar in the 2000s.

The report states:

Extraordinary improvements were made in access to safe drinking water and sanitation. In total, development efforts during the International Drinking Water Supply and Sanitation Decade (1981 to 1990) and the following decade (1991 to 2000) provided water to more than 2 billion people and sanitation to more than 1.5 billion.

A 2008 research study conducted by PATH to evaluate the global health funding and policy landscape found that diarrheal disease ranked last among a list of other global health issues.

Fortunately, two recent initiatives in Congress give some hope that political attention is shifting back to diarrhea and other sicknesses that inadequate water and sanitation trigger.

New bipartisan legislation called “The Senator Paul Simon Water for the World Act of 2009″–if passed–would be one way to increase the financing to stop fatal diarrhea and to put progress back on track. The Act would commit the U.S. government to extending safe, affordable and sustainable supplies of water and sanitation to 100 million people by 2015.

This Act–building on earlier landmark legislation (The Senator Paul Simon Water for the Poor Act of 2005)–could ratchet up interventions such as building latrines, promoting handwashing with soap, constructing water wells and providing point of use water treatment, all of which reduce fatal diarrhea.

Another bipartisan Act, “The Newborn, Child and Mother Survival Act of 2009” would also have an impact on eradicating fatal diarrhea if it were signed into law. Appropriations for this Act would fund both prevention (water and sanitation programs) and treatment (oral reyhdration therapy and zinc tablets).

Together these two pieces of legislation are an incredible opportunity for the U.S. government to take a leadership role in addressing the imbalance in priority and funding that the WaterAid and PATH reports uncover. A “Call to Action” that PATH organized has been signed so far by 80 groups from the health, corporate, environmental and water and sanitation sectors. They represent the breadth of support that is needed to push these two pieces of legislation through Congress and get them signed into law by President Obama.

-John Sauer, Water Advocates

Diarrheal disease is a leading killer of children under age five worldwide, responsible for the deaths of nearly 1.6 million children annually.

Are you surprised? If so, I understand why. Diarrhea is a hard thing to talk about and most of us aren’t dying from it. At best it is the subject of unfortunate jokes and at worst usually an infrequent symptom of a passing stomach virus. But there are children in the U.S. who still die from it and there are far more avoidable deaths from diarrhea around the world.

In fact, diarrheal disease is commonplace in Africa and Asia, as Nicolas Kristof and student contest winner Paul Bowers note in their recent Facebook and NYT blog posts. But it doesn’t have to be commonplace. The global health community knows what is necessary to prevent and treat diarrheal disease – there just isn’t adequate attention and funding to bring this knowledge and the tools to those who need it most.

Yesterday, PATH along with over 80 supporting organizations announced a call to action to encourage our peers in the health, development, environmental, water/sanitation, and research communities to push for adequate funding of the proven interventions that prevent and treat diarrheal disease.

This call to action comes on the heels of the releases of Diarrheal Disease: Solutions to Defeat a Global Killer from PATH and Fatal Neglect: How Health Systems are Failing to Comprehensively Address Child Mortality from WaterAid America which both highlight the urgent need to refocus attention on diarrheal disease. You can be part of the call to action too. Please take a few minutes to check these reports out at www.path.org and www.wateraidamerica.org.

-Dr. John Wecker, Immunization Solutions Program and Rotavirus Vaccine Program, PATH