Nutrition interventions to reduce diarrhoea morbidity and mortality.

Despite improved case management, diarrhoeal diseases still account for an estimated 23 % of all deaths among children aged 0-4 years (World Health Organization (WHO), 1995~). Diarrhoeal diseases are largely confined to developing countries and, given their very limited health budgets (typically < US $5/person per year), it is essential to identify cost-effective strategies for disease prevention. With this in mind, in 1982 the Diarrhoeal Diseases Control Programme of WHO initiated a systematic and comprehensive review of a wide range of potential non-clinical interventions for the reduction of diarrhoeal morbidity a n d or mortality among infants and young children (Feachem et al. 1983). The potential strategies were primarily of two kinds: (a) strategies that increase host resistance to infection and/or death, (b) strategies that reduce transmission of diarrhoeal pathogens. After the reviews were completed, the potential interventions were assigned to one of three categories (Feachem, 1986). In group 1 were strategies for which there was already good evidence that they would be effective, feasible and affordable, and the expectation was that these would be implemented within national primary health care programmes. Assigned to group 2 were strategies of uncertain effectiveness, feasibility or cost, requiring more research. In group 3 were strategies that were ineffective or excessively costly and could be disregarded. Of the eighteen potential interventions examined, seven were primarily nutritional interventions and these were assigned as follows: