Community-based interventions for diarrhoeal diseases and acute respiratory infections in Nepal.
OBJECTIVE
Acute diarrhoeal diseases and acute respiratory infections (ARIs) are the most common causes of child mortality worldwide. Safe, effective and inexpensive solutions are available for prevention and control, but they do not reach needy communities.


METHODS
Interventions based on research were designed to train and engage community health volunteers (CHVs) to implement a community-based control programme in Nepal. With the advent of the Integrated Management of Childhood Illnesses (IMCI) strategy, this programme subsequently emerged as a community-based IMCI but retained its mainstream activities. We reviewed and analysed policy decisions and programme development, implementation and expansion.


METHODS
Severe resource constraints and difficult terrain limit access to health-care facilities in many parts of Nepal.


RESULTS
In districts with interventions, more cases of acute diarrhoea and of ARIs (including pneumonia) were reported. The proportion of diarrhoea cases with dehydration and the proportion of ARI cases with pneumonia were significantly lower in districts with interventions. Case fatality rates due to acute diarrhoea and the proportion of severe pneumonia among ARI cases across the country showed a significant trend towards a decrease from 2004 to 2007. Nepal has succeeded in training many CHVs and is on course to meet the Millennium Development Goal for child mortality.


CONCLUSIONS
The burden of acute diarrhoea and ARIs can be reduced by training and engaging CHVs to implement community-based case management and prevention strategies. Monitoring, supervision and logistical support are essential. Policy decisions based on evidence from national research contributed to the success of the programme.
Ghimire
Madhu
M
Department of Communicable Diseases, World Health Organization Regional Office for South-East Asia, Mahatma Gandhi Marg (Ring Road), New Delhi, 110002, India. madhu_ghimire@hotmail.com
Pradhan
Yasho Vardhan
YV
Maskey
Mahesh Kumar
MK
D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D019058:Community Networks / Q000458:organization & administration*; D003967:Diarrhea / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006297:Health Services Accessibility; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*