Diarrheal Diseases Control Program: Global Activities, 1983

In its Interim Program Report for 1983,*** the World Health Organization (WHO) Diarrheal Diseases Control (CDD) Program gives a brief overview of its activities and progress to date. Some of the major developments described in the report are summarized below: HEALTH SERVICES COMPONENT

National program planning and implementation: Eighteen countries formulated plans of operation for national CDD programs in 1983, bringing the total to 72. Of these, 52 (72%) now have operational CDD programs, 14 having been implemented in 1983 (Figure 1).

Training: The CDD Program Managers Training Course was held five times in 1983 and attended by 170 participants from 49 countries. In addition, the first nine Supervisory Skills Training Courses were held and attended by 410 participants from 14 countries. Modules from this course were used in two combined Diarrheal Diseases Control/Expanded Program on Immunization courses and at workshops for United Nations Children's Emergency Fund (UNICEF) field staff. Further technical training courses were held in clinical management, laboratory diagnosis, epidemiology, and environmental health. The number of regional and national CDD training centers increased to 37 with the addition of units in five institutes in the Regions of the Americas and the Eastern Mediterranean.

Production of Oral Rehydration Salts (ORS): Technical collaboration in ORS production was undertaken by WHO and UNICEF with 12 countries in 1983, while UNICEF supplied 29 million packets to 78 countries. Thirty-eight developing countries now produce ORS. The Program also continued its research and development activities to develop a more stable and improved ORS formulation.

Health education and promotion: Thirty countries in four Regions developed promotional and educational materials in 1983, bringing the total to 43 since 1980.

Evaluation: The Program field-tested and refined its management information system to enable it to monitor progress toward the achievement of its global targets. In addition, it conducted a questionnaire survey to determine the impact of oral rehydration therapy (ORT) in hospitals, which revealed significant decreases in diarrhea admission rates in seven of eight hospitals, decreases in overall diarrhea case-fatality rates in five of eight hospitals, and decreases in inpatient diarrhea case-fatality rates in four of 13 hospitals. An additional 29 diarrhea morbidity and mortality surveys were conducted in 15 countries in 1983, and the methodology of these surveys was revised to increase its accuracy. The Program reviewed six national CDD programs, bringing the total number to 10; of these, seven utilized the Program's comprehensive review methodology. RESEARCH COMPONENT

Support of research projects: The Program continued to provide support to biomedical and operational research through its global and regional Scientific Working Groups (SWGs) and their Steering Committees. These groups awarded support to 71 new projects in 1983, bringing the total number of projects supported by the Program to 231. These projects were undertaken in 68 countries by investigators from 71 countries, and 59% were in developing countries. In the area of biomedical research, support was provided to 51 of 116 projects submitted; so far, 147 projects have been undertaken in 43 countries in all WHO Regions, and 46% were in developing countries. In addition, five research training grants were awarded to enable investigators to receive appropriate training for specific projects. Regarding operational research, four Regional Offices convened regional SWGs or Steering Committees in 1983. Support was awarded by five Regions to 20 of 71 projects submitted, bringing the total number of projects funded to 84. These projects have been undertaken in 45 countries in all WHO Regions.

Research areas: The broad biomedical research areas receiving support from the three global SWGs continued to be: (1) development of more stable and more effective ORS and homemade solutions and appropriate feeding regimens during diarrhea; (2) etiology and epidemiology of acute diarrhea; (3) development and evaluation of improved diagnostic tests (in particular, to detect rotavirus and enterotoxigenic Escherichia coli); (4) development and testing of new vaccines (e.g., against typhoid fever, rotavirus diarrhea, and cholera); and (5) development and testing of new and existing antidiarrheal drugs. The majority of operational research projects were concerned with etiology/epidemiology and case management of acute diarrhea, especially the delivery of ORT in local settings. Research was also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials.

Research training and strengthening: Research training activities included three courses for research workers; an interregional Workshop on Clinical Trials, attended by investigators from six institutes conducting clinical trials with WHO support, a regional Workshop on Electron Microscopy and Immunoelectron Microscopy attended by investigators undertaking research in viral diarrheas, and a course on Laboratory Aspects of Diarrheal Diseases. In addition, the SWG on Drug Development and Management of Acute Diarrhea awarded institution strengthening grants to three institutes to permit them to improve their facilities and capabilities for conducting clinical trials.

During the 1982-1983 biennium, $13.7 million was received by the Program from 19 contributors. The estimated obligations of the Program for the 1984-1985 biennium amount to $19.7 million. Reported in Weekly Epidemiological Record 1984;59:245-7. *The full report (document WHO/CDD/84.10) is obtainable in English or French from: The Director, Diarrhoeal Diseases Control Programme, WHO, 1211 Geneva 27, Switzerland. **A summary of the program report for 1981-1982 appeared in Weekly Epidemiological Record No. 21, 1983, pp. 157-8.

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