Abstract

PIP: A comprehensive program review of Indonesia's Control of Diarrheal Diseases (CDD) program conducted in 1983 indicated that considerable success has been achieved in this area. Oral rehydration solution (ORS) is widely available, there has been community involvement, a strong managerial structure has developed, baseline data on diarrhea morbidity and mortality are being collected, and staff have received adequate training. At the same time, there have been some problems: inadequate use of ORS, a lack of coordination among CDD programs, insufficient surveillance, budgetary problems, and a lack of laboratory support. During the last 10 years, diarrhea mortality in Indonesia has been reduced by 50-70%, to about 20,000 (20% of child mortality). The Government has established the goal of reducing mortality from diarrhea to less than 1% of child deaths by the year 2000. A major strategy for achieving this goal is integrating family planning, nutrition, maternal-child health, immunization, and CDD programs. Another strategy involves improving research in this area. Areas for further research include: epidemiologic studies, rehydration treatment, antidiarrheal agents, social aspects, immunity and vaccine development, and laboratory examination. The cause of diarrheal diseases is not only enteric infection, it is indirectly caused by acute respiratory infection, malnutrition, measles and other systemic infection as well as the health knowledge and education of the mother. Priority is to be given to 7 areas of research: 1) the use of home-prepared rehydration fluids, 2) feeding practices during acute diarrhea that can prevent chronic diarrhea and malnutrition, 3) the determinants of progression to chronic diarrhea, 4) the impact of simple health information on hygienic and feeding practices on mortality, 5) the potential of using traditional birth attendants in ORS campaigns, 6) traditional attitudes and practices, and 7) the effectiveness of traditional medicines in diarrhea treatment.