In developing countries, diarrhoeal diseases are a major cause of death among children under five – accounting for about 1.5 million deaths every year

In Mexico, determined efforts by the government to promote the use of oral rehydration therapy, immunize children against measles, and improve access to safe water and sanitation have succeeded in reducing childhood deaths from diarrhoeal diseases by 60% in less than a decade. Other key factors include an increase in education levels among women, investment of adequate resources, and the widespread use of case management guidelines.

In developing countries, diarrhoeal diseases are a major cause of death among children under five – accounting for about 1.5 million deaths every year. Children die because their bodies are weakened through rapid loss of fluids and undernourished through lack of food. And parents often fail to recognize the danger signals before it is too late. Yet most of these child deaths could be prevented. Up to 90% of diarrhoeal deaths can be prevented through the use of low-cost oral rehydration therapy (ORT) and continued feeding.

Before the introduction of ORT in 1979, and its gradual take-up by developing countries, diarrhoeal diseases were the number one childhood killer – accounting for 4.6 million deaths a year among children under five. Since then, diarrhoeal deaths have been reduced by over two-thirds. Other interventions which have also helped in preventing diarrhoeal deaths are improved access to safe water and sanitation, promotion of exclusive breastfeeding, immunization against measles (a risk factor for diarrhoeal disease), better nutrition (including administration of vitamin A), and improvements in the education of women. In Mexico, the widespread promotion of ORT for home case management – coupled with efforts to improve access to safe water and sanitation – has had a major impact in reducing the number of diarrhoeal deaths among children under five. Since the introduction of ORT in Mexico in 1984, mortality rates have fallen by 60% in less than a decade – from over 212 deaths per 100 000 children in 1984 to under 63 by 1993.

What is remarkable about this achievement is that the most significant declines in death rates occurred during the early 1990s – at a time when a cholera epidemic was sweeping through the Americas – adding to the overall burden of disease and threatening to reverse hard won gains.

In response, mass media campaigns were launched throughout Mexico to promote the use of ORT. Supplies of oral rehydration salts skyrocketed from 7.6 million packets a year to almost 80 million packets a year. As a result, ORT use increased from zero in the early 1980s to over 80% of cases by 1993, surpassing the mid-decade target set by the 1990 World Summit for Children of 80% ORT use by 1995. In addition, the government intensified efforts to immunize children against measles and stepped up efforts to improve sanitation and provide safe water.

The proportion of mothers reporting correct home-based case management increased rapidly and ORT was also widely available in health facilities. As a result, the proportion of under-fives deaths due to diarrhoeal diseases fell from over 26% in 1983 to 11% in 1993.

Other factors widely believed to have contributed to Mexico’s success in reducing diarrhoeal deaths are the increase in education levels among women, strong political commitment, adequate resources, and the existence of a solid base of trained health professionals in the diarrhoeal control programme with extensive experience of the case management strategy. The Mexican Government is now building on the success of the ORT treatment to make use of the broader IMCI strategy to further reduce deaths among children under five.