Editing Diarrhea (section)

==Prevention==

===Sanitation===
{{Further|WASH#Health aspects}}
Numerous studies have shown that improvements in drinking water and sanitation ([[WASH]]) lead to decreased risks of diarrhoea.<ref name=":0">{{cite journal | vauthors = Wolf J, Prüss-Ustün A, Cumming O, Bartram J, Bonjour S, Cairncross S, Clasen T, Colford JM, Curtis V, De France J, Fewtrell L, Freeman MC, Gordon B, Hunter PR, Jeandron A, Johnston RB, Mäusezahl D, Mathers C, Neira M, Higgins JP | title = Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression | journal = Tropical Medicine & International Health | volume = 19 | issue = 8 | pages = 928–42 | date = August 2014 | pmid = 24811732 | doi = 10.1111/tmi.12331 | s2cid = 22903164 | url = https://ueaeprints.uea.ac.uk/51912/1/Wolf_2014_Assessing_impact_of_drinking_water.pdf | doi-access = free | access-date = 17 December 2019 | archive-date = 13 April 2020 | archive-url = https://web.archive.org/web/20200413184758/https://ueaeprints.uea.ac.uk/id/eprint/51912/1/Wolf_2014_Assessing_impact_of_drinking_water.pdf | url-status = live }}</ref> Such improvements might include for example use of water filters, provision of high-quality [[drinking water|piped water]] and [[sanitary sewer|sewer]] connections.<ref name=":0" />

In institutions, communities, and households, interventions that promote [[hand washing]] with soap lead to significant reductions in the incidence of diarrhea.<ref name=":1">{{cite journal | vauthors = Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA | title = Hand-washing promotion for preventing diarrhoea | journal = The Cochrane Database of Systematic Reviews | volume = 12 | pages = CD004265 | date = January 2021 | issue = 1 | pmid = 33539552 | pmc = 8094449 | doi = 10.1002/14651858.CD004265.pub4 }}</ref> The same applies to preventing [[open defecation]] at a community-wide level and providing access to [[improved sanitation]].<ref name="UN2015">{{cite web|title=Call to action on sanitation|url=http://sanitationdrive2015.org/wp-content/uploads/2013/03/DSG_Sanitation_Fast-Facts_final.pdf|website=United Nations|access-date=15 August 2014|url-status=usurped|archive-url=https://web.archive.org/web/20140819084624/http://sanitationdrive2015.org/wp-content/uploads/2013/03/DSG_Sanitation_Fast-Facts_final.pdf|archive-date=19 August 2014}}</ref><ref>{{cite journal | vauthors = Spears D, Ghosh A, Cumming O | title = Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts | journal = PLOS ONE | volume = 8 | issue = 9 | pages = e73784 | year = 2013 | pmid = 24066070 | pmc = 3774764 | doi = 10.1371/journal.pone.0073784 | doi-access = free | bibcode = 2013PLoSO...873784S }}</ref> This includes use of [[toilet]]s and implementation of the entire [[sanitation]] chain connected to the toilets (collection, transport, disposal or reuse of [[human waste|human excreta]]).

There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease.<ref>{{cite journal | vauthors = Majorin F, Torondel B, Ka Seen Chan G, Clasen T | title = Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD011055 | date = September 2019 | issue = 9 | pmid = 31549742 | pmc = 6757260 | doi = 10.1002/14651858.CD011055.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref><ref>{{cite journal | vauthors = Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung IC, Jenkins MW, Scott B, Sugden S, Cairncross S | title = Interventions to improve disposal of human excreta for preventing diarrhoea | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD007180 | date = June 2010 | volume = 2010 | pmid = 20556776 | pmc = 6532559 | doi = 10.1002/14651858.CD007180.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref>

====Hand washing====
Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30–48%.<ref>{{cite journal | vauthors = Curtis V, Cairncross S | title = Effect of washing hands with soap on diarrhoea risk in the community: a systematic review | journal = The Lancet. Infectious Diseases | volume = 3 | issue = 5 | pages = 275–81 | date = May 2003 | pmid = 12726975 | doi = 10.1016/S1473-3099(03)00606-6 }}</ref><ref>{{cite journal | vauthors = Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt WP | title = Water, sanitation and hygiene for the prevention of diarrhoea | journal = International Journal of Epidemiology | volume = 39 | issue = Suppl 1 | pages = i193-205 | date = April 2010 | pmid = 20348121 | pmc = 2845874 | doi = 10.1093/ije/dyq035 }}</ref><ref name=":1" /> Hand washing in developing countries, however, is compromised by poverty as acknowledged by the [[Centers for Disease Control and Prevention|CDC]]: "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.<ref>{{cite web|title=Diarrheal Diseases in Less Developed Countries|url=https://www.cdc.gov/healthywater/hygiene/ldc/diarrheal_diseases.html|work=CDC|access-date=28 October 2013|url-status=live|archive-url=https://web.archive.org/web/20131104042634/http://www.cdc.gov/healthywater/hygiene/ldc/diarrheal_diseases.html|archive-date=4 November 2013}}</ref>

====Water====
Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean [[water supply]] and [[improved sanitation]] have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene.<ref name="Brown 629–34"/><ref>{{cite journal | vauthors = Black RE, Morris SS, Bryce J | s2cid = 14509705 | title = Where and why are 10 million children dying every year? | journal = Lancet | volume = 361 | issue = 9376 | pages = 2226–34 | date = June 2003 | pmid = 12842379 | doi = 10.1016/S0140-6736(03)13779-8 }}</ref> Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease.<ref>{{cite journal | vauthors = Esrey SA, Feachem RG, Hughes JM | title = Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities | journal = Bulletin of the World Health Organization | volume = 63 | issue = 4 | pages = 757–72 | year = 1985 | pmid = 3878742 | pmc = 2536385 }}</ref>

Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens.<ref>{{cite journal | vauthors = Arnold BF, Colford JM | title = Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis | journal = The American Journal of Tropical Medicine and Hygiene | volume = 76 | issue = 2 | pages = 354–64 | date = February 2007 | pmid = 17297049 | doi = 10.4269/ajtmh.2007.76.354 | doi-access = free }}</ref>

===Vaccination===
Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2–3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6–10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease.<ref>{{cite journal | vauthors = de Zoysa I, Feachem RG | title = Interventions for the control of diarrhoeal diseases among young children: rotavirus and cholera immunization | journal = Bulletin of the World Health Organization | volume = 63 | issue = 3 | pages = 569–83 | year = 1985 | pmid = 3876173 | pmc = 2536413 }}</ref> Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society.<ref>{{cite journal | vauthors = Rheingans RD, Antil L, Dreibelbis R, Podewils LJ, Bresee JS, Parashar UD | title = Economic costs of rotavirus gastroenteritis and cost-effectiveness of vaccination in developing countries | journal = The Journal of Infectious Diseases | volume = 200 | pages = S16-27 | date = November 2009 | issue = Suppl 1 | pmid = 19817595 | doi = 10.1086/605026 | doi-access = free | url = http://libres.uncg.edu/ir/asu/f/Rheingans_Richard_2009_Economic_Costs_of_Rotavirus_orig.pdf | access-date = 27 February 2024 | archive-date = 27 February 2024 | archive-url = https://web.archive.org/web/20240227043727/http://libres.uncg.edu/ir/asu/f/Rheingans_Richard_2009_Economic_Costs_of_Rotavirus_orig.pdf | url-status = live }}</ref><ref>{{cite book|title=Oral cholera vaccines in mass immunization campaigns |year=2010 |publisher=WHO |isbn=978-92-4-150043-2 |pages=6–8 |url= http://whqlibdoc.who.int/publications/2010/9789241500432_eng.pdf |url-status=live |archive-url= https://web.archive.org/web/20140903045312/http://whqlibdoc.who.int/publications/2010/9789241500432_eng.pdf |archive-date=3 September 2014 }}</ref>

[[Rotavirus vaccine]] decreases the rates of diarrhea in a population.<ref name=WHO2010a/><ref>{{cite journal | vauthors = Soares-Weiser K, Goldberg E, Tamimi G, Pitan OC, Leibovici L | title = Rotavirus vaccine for preventing diarrhoea | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002848 | date = 2004-01-26 | volume = 2004 | pmid = 14973994 | pmc = 6532746 | doi = 10.1002/14651858.CD002848.pub2  | collaboration = Cochrane Infectious Diseases Group }}</ref> New vaccines against rotavirus, ''Shigella'', [[Enterotoxigenic Escherichia coli|Enterotoxigenic Escherichia coli (ETEC)]], and cholera are under development, as well as other causes of infectious diarrhea.{{medcn|date=January 2015}}

===Nutrition===
Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group.<ref>{{cite journal | vauthors = Black RE | title = Zinc deficiency, infectious disease and mortality in the developing world | journal = The Journal of Nutrition | volume = 133 | issue = 5 Suppl 1 | pages = 1485S–9S | date = May 2003 | pmid = 12730449 | doi = 10.1093/jn/133.5.1485S | doi-access = free }}</ref><ref>{{cite journal | vauthors = Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, Khatun F, Martorell R, Ninh NX, Penny ME, Rosado JL, Roy SK, Ruel M, Sazawal S, Shankar A | title = Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group | journal = The Journal of Pediatrics | volume = 135 | issue = 6 | pages = 689–97 | date = December 1999 | pmid = 10586170 | doi = 10.1016/S0022-3476(99)70086-7 | doi-access = free }}</ref> The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence.<ref>{{cite journal | vauthors = Mayo-Wilson E, Imdad A, Herzer K, Yakoob MY, Bhutta ZA | title = Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis | journal = BMJ | volume = 343 | pages = d5094 | date = August 2011 | pmid = 21868478 | pmc = 3162042 | doi = 10.1136/bmj.d5094 }}</ref> Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.<ref>{{cite journal | vauthors = Chhagan MK, Van den Broeck J, Luabeya KK, Mpontshane N, Bennish ML | title = Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation | journal = Public Health Nutrition | volume = 17 | issue = 9 | pages = 2138–45 | date = September 2014 | pmid = 23930984 | doi = 10.1017/S1368980013002152 | doi-access = free | pmc = 11108711 }}</ref>

====Breastfeeding====
Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive [[Breastfeeding#Duration and exclusivity|exclusive breastfeeding]] during their first 6 months of life are better protected against infection with diarrheal diseases.<ref>{{cite journal | s2cid = 30952224 | title = Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality | journal = Lancet | volume = 355 | issue = 9202 | pages = 451–5 | date = February 2000 | pmid = 10841125 | doi = 10.1016/S0140-6736(00)82011-5 }}</ref> One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants.<ref name=Lawrence2016>{{cite book | vauthors = Lawrence R | title=Breastfeeding : a guide for the medical profession, 8th edition | publisher=Elsevier | location=Philadelphia, PA | year=2016 | isbn=978-0-323-35776-0 | page = 28}}</ref> Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the [[World Health Organization|WHO]],<ref>{{cite web| vauthors = Sguassero Y |title=Optimal duration of exclusive breastfeeding: RHL commentary|url=http://apps.who.int/rhl/pregnancy_childbirth/care_after_childbirth/yscom/en/|publisher=WHO|access-date=14 October 2013|url-status=dead|archive-url=https://web.archive.org/web/20131103115327/http://apps.who.int/rhl/pregnancy_childbirth/care_after_childbirth/yscom/en/|archive-date=3 November 2013}}</ref><ref name="World Health Organization 2017">{{cite web | title=Infant and young child feeding | website=World Health Organization | date=3 October 2017 | url=https://www.who.int/mediacentre/factsheets/fs342/en/ | access-date=5 January 2018 | archive-date=8 February 2015 | archive-url=https://web.archive.org/web/20150208145357/http://www.who.int/mediacentre/factsheets/fs342/en/ | url-status=live }}</ref> with continued breastfeeding until at least two years of age.<ref name="World Health Organization 2017"/>

===Others===
[[Probiotics]] decrease the risk of diarrhea in those taking [[antibiotics]].<ref>{{cite journal | vauthors = Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, Johnsen B, Shekelle PG | title = Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis | journal = JAMA: The Journal of the American Medical Association | volume = 307 | issue = 18 | pages = 1959–69 | date = May 2012 | pmid = 22570464 | doi = 10.1001/jama.2012.3507 | doi-access =  }}</ref> [[Insecticide]] spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year.<ref>{{cite journal | vauthors = Das JK, Hadi YB, Salam RA, Hoda M, Lassi ZS, Bhutta ZA | title = Fly control to prevent diarrhoea in children | journal = The Cochrane Database of Systematic Reviews | volume = 12 | pages = CD011654 | date = December 2018 | issue = 12 | pmid = 30556598 | pmc = 6302900 | doi = 10.1002/14651858.CD011654.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref>