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Implementing the New Recommendations on the Clinical Management of Diarrhoea Guidelines for Policy Makers and Programme Managers TABLE OF CONTENTS i WHO Library Cataloguing-in-Publication Data Implementing the new recommendations on the clinical management of diarrhoea : guidelines for policy makers and programme managers. Produced by the World Health Organization. 1.Fluid therapy. 2.Diarrhea, Infantile - therapy. 3.Diarrhea - therapy. 4.Child. 5.Rehydration solutions. 6.Dehydration - preve
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  i T  ABLE   OF   CONTENTS   Implementing the New Recommendations onthe Clinical Management of Diarrhoea Guidelines for Policy Makers and Programme Managers  I MPLEMENTING   THE N EW R  ECOMMENDATIONS   ON   THE C LINICAL M  ANAGEMENT   OF D IARRHOEA  ii © World Health Organization 2006  All rights reserved. Publications of the World Health Organization can be obtained from WHOPress, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22791 2476; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission toreproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email:permissions@who.int).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerningthe legal status of any country, territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of asimilar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify theinformation contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretationand use of the material lies with the reader. In no event shall the World Health Organization beliable for damages arising from its use.Printed by the WHO Document Production Services, Geneva, Switzerland.WHO Library Cataloguing-in-Publication DataImplementing the new recommendations on the clinical management of diarrhoea : guidelines forpolicy makers and programme managers.Produced by the World Health Organization.1.Fluid therapy. 2.Diarrhea, Infantile - therapy. 3.Diarrhea - therapy. 4.Child. 5.Rehydrationsolutions. 6.Dehydration - prevention and control. 7.Zinc - therapeutic use. 8.Guidelines. I. WorldHealth Organization.ISBN 92 4 159421 7(NLM classification: WS 312)ISBN 978 92 4 159421 9  iii T  ABLE   OF   CONTENTS These guidelines were first discussed in a meeting entitled Planning for implementation of zinc fortreatment of diarrhea held at the Mount Washington Conference Centre, Baltimore, MD, USA, on22-23 June 2004. The meeting was supported by the Johns Hopkins University, Bloomberg School of Public Health, the WHO Department of Child and Adolescent Health and Development, the UnitedStates Agency for International Development Global Health Bureau, and the United Nations Children'sFund (UNICEF). These guidelines were then developed by the Zinc Task Force.Participants in the Zinc Task Force are: Dr S Aboubaker (WHO, Geneva); Dr Z Bhutta (Aga KhanUniversity, Karachi, Pakistan); Professor. R E Black (Bloomberg School of Public Health, Baltimore,USA); Mr A Boni (USAID, Washington DC, USA); Mr N Brandes (USAID, Washington DC, USA);Professor K H Brown (UC Davis, Davis, USA); Dr C Fischer-Walker (Bloomberg School of PublicHealth, Baltimore, USA); Dr O Fontaine (WHO, Geneva); Dr P Harvey (A2Z Project, Washington,USA); Dr D Houleymata (Save the Children, Mali); Mr P S Jakobsen (UNICEF, Copenhagen);Mr D Kraushaar (Bill and Melinda Gates Foundation, Seattle, USA); Dr C A Marzetta (AppliedStrategies Consulting, San Mateo, USA); Dr K Mukelabai (UNICEF, New York); Dr P Paredes (USAID,Washington DC, USA); Dr N Terreri (UNICEF, New York); Mrs E Wainwright (USAID, WashingtonDC, USA); Mrs S Wrobel (Applied Strategies Consulting, San Mateo, USA).Special thanks to Ms. J Briggs (Management Sciences for Health [MSH] RPM Plus Program,Washington DC, USA), Dr E. Lee (MSH RPM Plus, France), and Dr K. Hoffmann (USAID, WashingtonDC, USA) for their important contributions in the development of this document and for reviewingand commenting on various drafts. Also the support of MSH RPM Plus is acknowledged in the editingof the document.  Acknowledgement  I MPLEMENTING   THE N EW R  ECOMMENDATIONS   ON   THE C LINICAL M  ANAGEMENT   OF D IARRHOEA  iv Table of contents 1.Introduction.................................................................................................................12.New recommendations on the clinical management of diarrhoea................................2 2.1What are the new recommendations?...........................................................................22.2The scientific evidence supporting these new recommendations.................................3 3.How to translate these new global recommendations into country-level action..........6 3.1Identifying key stakeholders...........................................................................................63.2Gathering clinical and scientific evidence.....................................................................73.3Endorsing the new recommendations............................................................................73.4Revising/updating policy guidelines...............................................................................8 4.Issues for the implementation of the new recommendations.....................................10 4.1Product issues................................................................................................................104.2Supply management issues...........................................................................................124.3Monitoring and evaluation...........................................................................................22  Annex 1Summary of the evidence...............................................................................24 1.Zinc supplementation and the treatment of acute diarrhoea.....................................242.Zinc supplementation and the treatment of persistent diarrhoea.............................243.Zinc supplementation and the prevention of acute and persistent diarrhoea...........254.Zinc supplementation and the treatment and prevention of bloody diarrhoea........255.Zinc supplementation and cost effectiveness evaluation............................................256.Zinc supplementation and irrational use of antibiotics..............................................26  Annex 2 References......................................................................................................27 1.Diarrhoea treatment policy..........................................................................................272.Scientific rationale for low osmolarity ORS................................................................273.Scientific rationale for zinc supplementation.............................................................274.Programme implementation.........................................................................................305.Training and treatment guidelines...............................................................................316.Advocacy tools (included in CD-ROM)......................................................................31  Annex 3Specifications of zinc products for use in the management of diarrhoea.......32 1.Dosage............................................................................................................................322.Type of zinc salt............................................................................................................323.Type of tablets...............................................................................................................324.Taste-masking................................................................................................................325.Costing...........................................................................................................................326.Packaging.......................................................................................................................327.Shelf life.........................................................................................................................33
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