Thailand: attainable targets.

Diarrheal diseases are the leading cause of sickness and death in Thailand. The problem is particularly severe in children under age 5 who account for about 40% of all cases and about 50% of all deaths due to diarrhea. In October 1980 Thailand began a program of national control of diarrheal disease. It had as its target a substantial reduction in mortality from acute diarrheal diseases through oral rehydration therapy (ORT) by way of the primary health care approach and reduced morbidity by promoting better nutritional and maternal and child health practices and safer water supply and sanitation. The governments Pharmaceutical Organization produces 750 milliliter packets of oral rehydration salts (ORS) according to the World Health Organization (WHO) formula specifications. These are purchased by the Department of Communicable Diseases and distributed to all health facilities and to village health volunteers through the provincial health offices. Some villages have their own drug cooperatives run by village committees or by volunteers where people also can buy ORS and other essential drugs. WHO and the UN International Childrens Emergency Fund (UNICEF) are helping to supply training materials in the Thai language for health staff at all levels to familiarize them with clinical and program management. The volunteers themselves receive training as providers of ORS and as disseminators of health information. Since 1983 more and more messages reach the public through the mass media especially television and radio. Most hospitals are able to screen slide sets and video cassettes about ORT and diarrhea prevention while the mothers sit in the waiting rooms. Between 1981-84 the proportion of the population under 5 years of age with access to ORT has risen from 12% to about 60% in areas where the program is fully developed. In areas where the program is fully developed the use rate of ORS in the same group has gone up from 12% to 30%. Throughout Thailand as a whole the use rate in children under 5 suffering from diarrhea is about 18%. The mortality rate from diarrhea in these young children fell from 4.97/100000 in 1981 to 2.35/100000 in 1983 a reduction of 53%. In 1984 the mortality rate increased from the previous year while the morbidity rate decreased. One reason may be that the most non-severe cases can be self-managed by ORT while more severe cases are detected and referred by the village health volunteers and other health workers. This results in a higher number of deaths reported.