Preventing Diarrhea in Children: What's Next?

Tier 2 Activities

Diarrheal disease kills an estimated 1.8 million people each year, the majority of whom are under five years of age. Infected but surviving children face the complications of malnutrition and anemia which lead to physical stunting and slow cognitive development. Infected children attend school less and exhibit diminished school performance. These challenges reduce their opportunities to develop into productive, self-sufficient adults.

What should be done first to improve child health?

If the goal is to get children healthy quickly – and keep them healthy, then Tier 1 activities are the most important. As interventions, they are the quickest acting, the easiest for beneficiaries to understand and adopt, and the least expensive for the beneficiary (no cost/low cost).

The following interventions are Tier 2 activities. These interventions take longer to implement, are sometimes more difficult for beneficiaries to understand and adopt, and they can be more expensive or time consuming for the beneficiary than Tier 1 activities.

Tier 2 Family Of Activities For Reducing Diarrhea In Small Children

	Community-Led Total Sanitation focuses on igniting a change in sanitation behavior through a process of social awakening. It concentrates on the whole community rather than on the individual to analyze their sanitation conditions and work collectively to stop open defecation.
	Point-of-use Ceramic Water Filters. A range of randomized studies indicate that ceramic filters reduce diarrhea in treatment groups by 40% to 50% over control groups that aren’t using the filters. This is competitive with other interventions such as sanitation programs and hand washing.
	Culturally Appropriate Latrines. Latrines when implemented correctly. can reduce diarrheal disease by 36%. They must be engineered to not become a source of contamination, and sensitively designed so that community members will use them.
	Installing Concrete Floors for Children's Health. Studies show that covering dirt floors with concrete leads to a 78% reduction in parasitic infestations, 49% reduction in diarrhea, 81% reduction in anemia and a 36 to 96 percent improvement in cognitive development in children.
	Community Water Infrastructure studies are not promising and find little evidence to substantial health impacts. These expensive facilities may provide contaminated water and may fall into disrepair due to poor maintenance. However several key activities have shown effectiveness in improving water quality.
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