Das Jai K, Salam Rehana A, Bhutta Zulfiqar A
aDivision of Woman and Child Health, Aga Khan University, Karachi, Pakistan bProgram for Global Pediatric Research, Hospital for Sick Children, Toronto, Ontario, Canada.
Curr Opin Infect Dis. 2014 Oct;27(5):451-8. doi: 10.1097/QCO.0000000000000096.
Diarrhea is a leading cause of morbidity and mortality among children under 5 years in low-income and middle-income countries. Over the past 2 decades under-five mortality has decreased substantially, but reductions have been uneven and unsatisfactory in resource-poor regions.
There are known interventions which can prevent diarrhea or manage children who suffer from it. Interventions with proven effectiveness at the prevention level include water, sanitation, and hygiene interventions, breastfeeding, complementary feeding, vitamin A and zinc supplementation, and vaccines for diarrhea (rotavirus and cholera). Oral rehydration solution, zinc treatment, continued feeding, and antibiotic treatment for certain strains of diarrhea (cholera, Shigella, and cryptosporidiosis) are effective strategies for treatment of diarrhea. The recent Lancet series using the 'Lives Saved' tool suggested that if these identified interventions were scaled up to a global coverage to at least 80%, and immunizations to at least 90%; almost all deaths due to diarrhea could be averted.
The current childhood mortality burden highlights the need of a focused global diarrhea action plan. The findings suggest that with proper packaging of interventions and delivery platforms, the burden of childhood diarrhea can be reduced to a greater extent. All that is required is greater attention and steps toward right direction.
腹泻是低收入和中等收入国家5岁以下儿童发病和死亡的主要原因。在过去20年中，5岁以下儿童死亡率大幅下降，但在资源匮乏地区，下降情况不均衡且不尽人意。
已知有一些干预措施可以预防腹泻或治疗腹泻患儿。在预防层面已证实有效的干预措施包括水、环境卫生和个人卫生干预措施、母乳喂养、辅食添加、维生素A和锌补充剂以及腹泻疫苗（轮状病毒疫苗和霍乱疫苗）。口服补液盐、锌治疗、继续喂养以及针对某些腹泻菌株（霍乱、志贺氏菌和隐孢子虫病）的抗生素治疗是治疗腹泻的有效策略。近期《柳叶刀》系列文章使用“挽救生命”工具表明，如果将这些已确定的干预措施扩大到全球至少80%的覆盖率，免疫接种率至少达到90%；几乎所有腹泻导致的死亡都可以避免。
当前儿童死亡负担凸显了制定一项重点突出的全球腹泻行动计划的必要性。研究结果表明，通过合理整合干预措施和提供平台，可以在更大程度上减轻儿童腹泻负担。所需要的只是更多关注并朝着正确方向采取措施。
