Home treatment for infections
Give sick children appropriate home treatment for infections.
Three practices are summarised here:
oral rehydration therapy for acute diarrhoea;
community case management of malaria;
management of pneumonia in community settings.
Only the first practice is carried out by household themselves, while the other two practices are carried out through community health providers.
Oral rehydration therapy for acute diarrhoea
ORT remains one of the most effective treatment interventions available both at health facility and the community.
ORT was initially defined as the administration of oral rehydration salts (ORS) and/or recommended home fluids—which became known as the pre-1993 definition. The importance of continued feeding was also recognised. The emphasis then shifted to the administration of increased fluids—“ORT (increased fluids)”— with continued feeding as appropriate management of diarrhoea. More recently, the focus of ORT has been on the administration of ORS (oral rehydration salts) or recommended home-made fluids or increased fluids, and continued feeding.
A review published in The Lancet estimated that ORT could have saved 15% of under-five deaths occurring in the 42 countries where 90% of worldwide under-five deaths occurred (Lancet 2003; 362:65-71).
WHO recommends a reduced osmolarity ORS formulation (245 mOsm/l), with lower glucose (75 mmol/L) and sodium (75 mEq/L) concentrations than the standard ORS used in the past (311 mOsm/L).
This new ORS formulation is capable of reducing stool output, incidence of vomiting and unscheduled intravenous fluids.
ORT has been promoted on a large scale and successfully in many countries in the past, especially through national Diarrhoeal Disease Control Programmes and their partners, showing that it is a feasible and cost-effective intervention with substantial impact on mortality.
Within the context of ORT, ORS promotion requires not only encouraging its use, but also teaching its correct preparation and proper use, and ensuring a regular and adequate supply.
WHO/UNICEF joint statement on clinical management of acute diarrhoea
Implementing the new recommendations on the clinical management of diarrhoea
Diarrhoea: Why children are still dying and what can be done
The Lancet Child survival series
Community case management of malaria.
Community case management of malaria with antimalarials in children under five years of age is a promising strategy to prevent progress to severe malaria and death in areas with limited access to health facility-based child care services.
Prompt availability of medicines—preferably pre-packed—and rapid diagnostic tests (RDTs), appropriate training, health education, supervision and community involvement are some important elements of the interventions.
Community case management of malaria and childhood illnesses
Management of pneumonia in community settings
Effective treatment for pneumonia in young children should be available promptly since the start of illness, bringing it as close as possible to the community.
Community-based interventions in which adequately trained and supervised community health workers have provided case management have had a significant impact on both overall and pneumonia specific under-five mortality, with a reduction estimated at 20% and 24%, respectively (Family and community practices that promote child survival, growth and development – A review of the evidence). A meta-analysis of seven community-based trials of case management of pneumonia presented in a WHO report on “Evidence base for the community management of pneumonia”(2002) showed a 26% reduction of child mortality and a 37% reduction in mortality from pneumonia.
A supporting environment, including enabling policies, government commitment, acceptance by the academia, strong links with the health system and a functioning referral system, is needed to deliver and sustain the intervention in the community effectively, in addition to quality training, medicines and supervision.
Large-scale community-based interventions by community health providers are feasible and sustainable.
Related links:
WHO/UNICEF joint statement on management of pneumonia in community settings
Evidence base for the community management of pneumonia
