--- Learning Objectives: --- 1. Describe how the public health community’s attention to diarrheal disease has decreased, despite the fact that diarrhea is the second leading cause of under-five death 2. Identify what is being done and what can be done more in terms of treatment and prevention 3. Discuss what new technology can be used and what the current experiences are. --- Background: --- Diarrhea is the second leading cause of death in children less than five years of age, causing 1.3 million deaths annually. More than 80 percent of these deaths occur in sub-Sahara Africa and South Asia and nearly three quarters of these deaths occur in 15 countries topped by India, Nigeria and Democratic Republic of Congo, Afghanistan and Ethiopia. A disease of under development, poor nutrition and unsanitary environmental conditions, UNICEF and WHO estimate 2.5 billion cases of diarrhea occurring annually. ORS, the mainstay of diarrhea treatment and hailed as the greatest medical invention of the XXth century, reaches too few children with diarrhea, particularly those in the poorest households. Access to ORS is as low at 33 percent in developing countries and 29 percent in sub-Sahara Africa. Zinc has been shown to reduce the severity and duration of diarrhea, and to prevent future bouts of both diarrhea and pneumonia. However, programs have faced the challenge of the initial lack of commodities in countries and continued inappropriate practices by health workers who widely prescribe antibiotics and anti-motility agents. --- Current strategies and new opportunities: --- In 2009, UNICEF and WHO laid out a seven-point plan for comprehensive diarrheal disease control. Despite the significant contribution to under-five mortality, individual countries are still giving insufficient focus to improving diarrhea case management. Effective preventive strategies include water and sanitation and hygiene, notably hand washing with soap or ash, and Vitamin A supplementation and exclusive breastfeeding for the first six months of life. All of which except for Vitamin A supplementation have limited coverage. At the beginning of the XXIst century, new technologies are increasingly available. Countries in the Americas and Europe are using rotavirus vaccine with significant success in reducing deaths and hospitalizations due to rotavirus. Global partners, governments, and the GAVI Alliance are supporting the introduction of rotavirus vaccine to a possible 40 developing countries in the coming years. This is a high visibility initiative that can be capitalized on to raise the profile of diarrheal disease prevention and treatment more broadly. A global Communication Framework for New Vaccines and Child Survival has been developed to link vaccination against diarrhea and pneumonia with other prevention, protection and control measures. ORS and Zinc are not widely available. The use of simple technology such as mobile phone can allow community health workers to transmit their stock information to the health center and allow community level data, previously unavailable, to be visible to decision makers at all levels of the system. --- Conclusion: --- There is a clear call for global advocacy for a renewed effort in diarrhea control which remains a public health and social challenge. Reducing diarrheal deaths will accelerate attainment of MDG 4. Now is the time for a broad coalition of public health practitioners, private sector investors, engineers, habitat planners and politicians to rise to the challenge to defeat diarrheal disease. --- Overview of the panel: --- This preformed panel will provide a general overview on current situation as well as solutions and approaches that have been applied and have worked in different settings. Presentations will include experiences from Nigeria, Ethiopia and Malawi.