Regional workshop to discuss diarrheal disease solutions for Asia

Vietnamese Ministry of Health, National Pediatric Hospital and PATH bring regional health leaders together Nov. 10-11, 2010 to discuss diarrheal disease solutions for Asia

Each year, diarrheal disease claims the lives of 1.3 million children under five worldwide and hospitalizes millions more. The vast majority of these deaths occur in developing countries of Asia and Africa, but fortunately, interventions exist that can greatly reduce deaths and save lives. To bring attention to the solutions available today for defeating diarrhea, the Vietnam Ministry of Health, the National Pediatric Hospital of Vietnam, and PATH are hosting a two-day regional workshop where they will present the evidence and lessons learned from initiatives currently underway.

Vietnam's Ministry of Health recently unveiled new national "Guidelines for Management of Diarrheal Disease in Children," reinforcing the government's commitment to saving children's lives by preventing diarrhea-related illness. The guidelines add new interventions like zinc and low-osmolarity oral rehydration solution (ORS) to proven interventions including proper nutrition, hygiene, and continued breastfeeding, which have helped Vietnam reduce the number of diarrhea-related deaths among children under five during the past two decades.

"We hope that this conference empowers provincial health leaders to apply the new guidelines in their communities," said Dr. Luong Ngoc Khue, general director of the Vietnam Medical Health Services Administration. "We have the knowledge and tools to significantly reduce the health and economic burdens that diarrheal disease creates in Vietnam, and we want to encourage best practices across Asia."

The greatest burden of diarrheal disease in Vietnam falls on the rural poor, where access to clean water and simple, lifesaving treatments like ORS can be limited. The country had seen major gains through the provision of ORS, but in the past couple of years, officials noted that diarrheal morbidity and mortality had stagnated. The new clinical guidelines bring an opportunity to re-invigorate their commitment to this resilient-yet conquerable-killer.

The Mekong Regional Workshop on Diarrheal Disease Control will bring together policymakers and physicians from around the region to discuss strategies and next steps toward overcoming diarrheal disease. In addition to Vietnam's health leaders, officials from Cambodia and Laos also will discuss national strategies to prevent and treat childhood diarrhea. Other topics to be addressed include:

• Discussions about rotavirus vaccine, cholera vaccine, and other enteric vaccines;
• Scaling up the use of zinc treatment;
• Point of use water treatment;
• Water/sanitation/hygiene issues;
• Exclusive breastfeeding; and
• Nutrition

"Stopping diarrheal disease illness and death is possible," said Dr. Le Thanh Hai, Vietnam National Hospital of Pediatrics, vice director and head of the emergency department. "Vietnam is making tremendous progress to control diarrhea-related child deaths and we hope that success in our country can encourage others in the region to increase uptake of simple, affordable, and effective solutions. This workshop is a wonderful opportunity to share what we are learning with the wider health community in Asia."

Rotavirus vaccines will be one major point of discussion at the event. Rotavirus is the leading cause of severe diarrheal disease in Vietnam and worldwide, but vaccines now exist that can greatly reduce its burden. In August, the Lancet published the first-ever clinical trial data on rotavirus vaccines in impoverished settings of Asia. Regionally representative results from Bangladesh and Vietnam showed the vaccines prevented nearly half of severe rotavirus disease. In Vietnam specifically, vaccines reduced severe rotavirus diarrhea by 72.3 percent during the first year of life, when children are at greatest risk. The Vietnamese National Institute of Hygiene and Epidemiology was a primary partner in the study, which contributed to the growing global evidence demonstrating the safety, efficacy, and lifesaving impact of rotavirus vaccines. They are not yet available in the public sector of Vietnam, but with the new data, demand in the region is growing.

"Rotavirus vaccines will be an important part of diarrhea control programs, as their availability increases," said Evan Simpson, program officer at PATH. "In the interim, we have been piloting efforts in Bihn Dinh province to implement the new clinical guidelines, and our collaboration with the Government of Vietnam and the National Pediatric Hospital is revealing the potential of a comprehensive set of interventions to prevent and combat severe diarrhea."

There is a growing consensus among medical and public health practitioners that effectively reducing the diarrheal disease burden will be a major step toward reaching the global Millennium Development Goals. But all available interventions must be accessible to those who need them. This requires a coordinated and integrated approach, supportive policies, and increased awareness among health care workers, communities, and caregivers.