International Notes Diarrheal Diseases Control Program: Global Activities, 1981-1982

From May 1981 to December 1982, Diarrheal Diseases Control (CDD) Programs continued to emphasize the organization of well-planned national CDD programs and the support of goal-oriented health services and biomedical research.

Some abstractions from the recently issued Third Program Report, 1981-1982,* follow. HEALTH SERVICES COMPONENT

Country programming and implementation: An additional 31 countries developed plans of operation for national CDD programs, bringing the total to 55. In 38 (69%) of these countries, CDD programs are already in operation.

Training: A further 467 persons from 100 countries received training in national program managers' training courses, 14 of which were held during this period. An additional training course was developed for first-line supervisors of national staffs. In the technical training area, courses on oral rehydration therapy (ORT) were held in 45 countries; six courses were held on laboratory diagnosis of enteric pathogens, and two, on epidemiological aspects of diarrheal diseases. Many of the above activities took place at regional and national training centers, which have so far been established in 27 countries.

Production of Oral Rehydration Solution (ORS): An estimated 41 million packets of ORS were supplied by the United Nations International Children's Emergency Fund (UNICEF) in 1981 and 1982 in 87 countries. UNICEF and/or the World Health Organization (WHO) initiated collaboration with 21 countries in local ORS production, and by December 1982, production was under way in 30 developing countries. Steps were also taken to increase the stability of ORS to prolong their shelf-life and reduce the packaging costs.

Communications support: Activities were initiated in this area, including the issue of a catalogue containing examples of health education materials produced by different countries, and support to 13 countries in the development of such materials.

Evaluation: A management information system to measure progress in achieving objectives and to provide information for program management at global, regional, and national levels was introduced in 1982, and information was received from 65 countries. Morbidity and mortality surveys to provide baseline data for planning national programs were carried out in 11 countries, and comprehensive program reviews, in four countries. A number of countries have accumulated data documenting that the use of ORT in hospitals leads to a significant decrease in intravenous fluid usage and case-fatality rates. In collaboration with the Environmental Health Division, "Minimum Evaluation Procedures" were developed for use in assessing the functioning and use of water supplies and sanitation facilities. RESEARCH COMPONENT

Activities of the Scientific Working Groups (SWGs): The three global SWGs on Bacterial Enteric Infections, Viral Diarrhea, and Drug Development Management of Acute Diarrheas each met in 1982 to review a topic of current interest. Regional SWGs were established at the regional offices for Africa and Europe, thus completing the plans to establish such groups in all six WHO regions; all regional groups met at least once during the period under review and established a work plan and a list of priority research areas.

Support of research projects: As of December 31, 1982, the program had awarded support to 158 research projects in 59 countries, 64% of which are being carried out in developing countries. Ninety-six biomedical research projects in 37 countries were awarded support by the global SWGs; 44 (46%) of these are under way in developing countries, and six are co-supported with one of the regional SWGs. At the same time, 62 health services research projects in 42 countries were awarded support by the regional SWGs; of these projects, 92% are under way in developing countries. In April 1982, the program convened a meeting to coordinate the research activities of the regional SWGs. Coordination among all regions and between regional and global levels was further assured through a computer-based research management information system.

Research areas: Because most of the supported projects are still in their first to second year, it is possible only to provide an overview of the main areas where research is currently being supported: 1) ORT and feeding during diarrhea, 2) community and family attitudes and practices regarding diarrheal diseases, 3) etiology and epidemiology of acute diarrhea, 4) development and evaluation of improved diagnostic procedures, 5) development and testing of vaccines, and 6) development and testing of new and existing antidiarrheal drugs. A full list of projects funded in 1981-1982 is provided in the Third Program Report, as well as a summary of the results of some completed projects.

Collaboration with the pharmaceutical industry: Active collaboration has been established to date with eight pharmaceutical companies in the development of diagnostic tests, vaccines, and drugs. In addition, 14 companies sent representatives as observers to the second meeting of the SWG on Drug Development and Management of Acute Diarrheas.

Collaborating centers: Two new centers were established--a Collaborating Center for Environmental and Epidemiological Aspects of Diarrheal Diseases at the Ross Institute for Tropical Hygiene, London, United Kingdom, and a Collaborating Center for Training and Research on Oral Rehydration Therapy at the National Children's Hospital, San Jose, Costa Rica. GENERAL

Information services: The program further expanded its activities concerned with information dissemination and collaborated with a number of other organizations with an interest in promoting diarrheal disease control.

The resources available to the program for 1980-1981 and 1982 amounted to approximately 135 million, contributed by 17 countries and agencies.

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