Each year, acute diarrhea is responsible for the deaths of more than 1.5 million children under the age of five. However, many of these deaths can be avoided with proper management of diarrhea, including prevention and treatment of dehydration..

In May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) revised the recommendations for management of diarrheal disease in children under age five.

The new recommendations include—

• Use of low osmolarity oral rehydration salts (ORS) and home-available fluids
• Breastfeeding
• Continued feeding
• Selective use of antibiotics

In addition, the new WHO and UNICEF recommendations now include 20 mg zinc treatment for 10 to 14 days (10 mg per day for infants under the age of six months). These recommendations are based on the scientific evidence that zinc salts given during, and just after, an episode of acute diarrhea reduces the duration and severity of the episode and lowers the incidence of diarrhea in the following two to three months.

RPM Plus contributes to this global movement to improve the management of diarrhea by providing technical assistance in developing and implementing global guidelines.

RPM Plus played a major role in the writing and review of the WHO guidelines Implementing the New Recommendations on the Clinical Management of Diarrhoea: Guidelines for Policy Makers and Programme Managers, published in 2006. This document is directed toward policy makers and program managers. It includes information needed to introduce and scale up the diarrhea management and incorporates the new ORS formulation and zinc treatment.

RPM Plus also works at the country level by collaborating with international and local partners to support the national introduction of the WHO/UNICEF recommendations, including zinc treatment. As part of this process, RPM Plus has provided technical assistance by conducting country assessments using standard tools and indicators to analyze the feasibility and processes needed to introduce or scale up adoption of the recommendations.

As an example of RPM Plus's country level efforts, RPM Plus collaborated with partners in Madagascar to assess the needs for zinc introduction. RPM Plus continues to work in partnership with the BASICS project in Madagascar to provide technical assistance on the pharmaceutical aspects of zinc introduction, including policy issues.