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68-450: The conference called for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order . The sentiment of the declaration was partly inspired by the barefoot doctor system in China, which revolutionized

136-500: A child regains his or her full appetite, the WHO recommends combining 25 grams skimmed milk powder, 20 grams vegetable oil, 60 grams sugar, and 60 grams rice powder or other cereal into 1,000 milliliters water and boiling gently for five minutes. Give 130 mL per kilogram of body weight during per 24 hours. A child who cannot or will not eat this minimum amount should be given the diet by nasogastric tube divided into six equal feedings. Later on,

204-411: A dropper or a syringe. Infants under two may be given a teaspoon of ORS fluid every one to two minutes. Older children and adults should take frequent sips from a cup, with a recommended intake of 200–400 mL of solution after every loose movement. The WHO recommends giving children under two a quarter- to a half-cup of fluid following each loose bowel movement and older children a half- to a full cup. If

272-776: A grant from the National Institute of Allergy and Infectious Diseases. He observed that children voluntarily drank as much of the solution as needed to restore hydration, and that rehydration and early re-feeding would protect their nutrition. This led to increased use of ORT for children with diarrhea, especially in developing countries. In 1980, the Bangladeshi nonprofit BRAC created a door-to-door and person-to-person sales force to teach ORT for use by mothers at home. A task force of fourteen women, one cook, and one male supervisor traveled from village to village. After visiting with women in several villages, they hit upon

340-712: A metric to measure the success of independence movements and completing the decolonization process. In 1974, the United Nations General Assembly adopted the "Declaration for the Establishment of a New International Economic Order" along with its accompanying program of action and formalized this sentiment among nation states. A few months later the UN General Assembly adopted the "Charter of Economic Rights and Duties of States". Since then, there have been many meetings to realize

408-578: A more equitable international system was motivated also by increasing inequality in the share of global national income between developed and underdeveloped countries, which more than doubled between 1938 and 1966. From its beginnings in 1964, the United Nations Conference on Trade and Development (UNCTAD), along with the associated Group of 77 and the Non-Aligned Movement , was the central forum for discussions of

476-610: A restrictive approach to health. Therefore, such approach to primary care does not contribute toward integral care (globality) and does not address social determinants as a fundamental aspect of illness and thus essential to health care planning. The World Health Organization, UNICEF and the Government of Kazakhstan co-hosted the Global Conference on Primary Health Care in Astana on 25–26 October 2018. The conference marked

544-447: A severely dehydrated child may be lethargic. If the child drinks poorly, a nasogastric tube should be used. The IV route should not be used for rehydration except in cases of shock and then only with care, infusing slowly to avoid flooding the circulation and overloading the heart. Feeding should usually resume within 2–3 hours after starting rehydration and should continue every 2–3 hours, day and night. For an initial cereal diet before

612-613: Is a set of proposals advocated by developing countries to end economic colonialism and dependency through a new interdependent economy. The main NIEO document recognized that the current international economic order "was established at a time when most of the developing countries did not even exist as independent states and which perpetuates inequality." In the spirit of "trade not aid," the NIEO called for changes in trade, industrialization, agricultural production, finance, and transfer of technology. The United Nations General Assembly adopted

680-473: Is a type of fluid replacement used to prevent and treat dehydration , especially due to diarrhea . It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium . Oral rehydration therapy can also be given by a nasogastric tube . Therapy can include the use of zinc supplements to reduce the duration of diarrhea in infants and children under the age of 5. Use of oral rehydration therapy has been estimated to decrease

748-496: Is also reduced. The reduced osmolarity oral rehydration solution has lower concentrations of glucose and sodium chloride than the original solution, but the concentrations of potassium and citrate are unchanged. The reduced osmolarity solution has been criticized by some for not providing enough sodium for adults with cholera. Clinical trials have, however, shown reduced osmolarity solution to be effective for adults and children with cholera. They seem to be safe but some caution

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816-489: Is best treated with ORT. Persons taking ORT should eat within six hours and return to their full diet within 24–48 hours. Oral rehydration therapy may also be used as a treatment for the symptoms of dehydration and rehydration in burns in resource-limited settings. ORT may lower the mortality rate of diarrhea by as much as 93%. Case studies in four developing countries also have demonstrated an association between increased use of ORS and reduction in mortality. ORT using

884-751: Is not a contraindication to receiving oral rehydration therapy. In persons who are vomiting, drinking oral rehydration solution at a slow and continuous pace will help resolve vomiting. WHO and UNICEF have jointly developed official guidelines for the manufacture of oral rehydration solution and the oral rehydration salts used to make it (both often abbreviated ORS ). They also describe other acceptable solutions, depending on material availability. Commercial preparations are available as prepared fluids and as packets of powder ready to mix with water. A basic oral rehydration therapy solution can also be prepared when packets of oral rehydration salts are not available. The molar ratio of sugar to salt should be 1:1 and

952-399: Is not absorbed. This is why oral rehydration salts include both sodium and glucose. For each cycle of the transport, hundreds of water molecules move into the epithelial cell to maintain osmotic equilibrium. The resultant absorption of sodium and water can achieve rehydration even while diarrhea continues. In the early 1980s, "oral rehydration therapy" meant only the preparation prescribed by

1020-532: Is often impossible to reliably distinguish between moderate and severe dehydration. A severely malnourished child who has signs of severe dehydration but who does not have a history of watery diarrhea should be treated for septic shock . The original ORS (90 mmol sodium/L) and the current standard reduced-osmolarity ORS (75 mmol sodium/L) both contain too much sodium and too little potassium for severely malnourished children with dehydration due to diarrhea. ReSoMal ( Re hydration So lution for Mal nutrition)

1088-544: Is on the World Health Organization's List of Essential Medicines . Globally, as of 2015 , oral rehydration therapy is used by 41% of children with diarrhea. This use has played an important role in reducing the number of deaths in children under the age of five . ORT is less invasive than the other strategies for fluid replacement, specifically intravenous (IV) fluid replacement. Mild to moderate dehydration in children seen in an emergency department

1156-732: Is potentially unsafe; rehydration takes precedence. When oral rehydration salts packets and suitable teaspoons for measuring sugar and salt are not available, the WHO has recommended that homemade gruels, soups, etc., may be considered to help maintain hydration. A Lancet review in 2013 emphasized the need for more research on appropriate home made fluids to prevent dehydration. Sports drinks are not optimal oral rehydration solutions, but they can be used if optimal choices are not available. They should not be withheld for lack of better options; again, rehydration takes precedence. But they are not replacements for oral rehydration solutions in nonemergency situations. In 2003, WHO and UNICEF recommended that

1224-417: Is recommended for such children. It contains less sodium (45 mmol/L) and more potassium (40 mmol/L) than reduced osmolarity ORS. It can be obtained in packets produced by UNICEF or other manufacturers. An exception is if the severely malnourished child also has severe diarrhea (in which case ReSoMal may not provide enough sodium), in which case standard reduced-osmolarity ORS (75 mmol sodium/L)

1292-432: Is recommended. Malnourished children should be rehydrated slowly. The WHO recommends 10 milliliters of ReSoMal per kilogram body weight for each of the first two hours (for example, a 9-kilogram child should be given 90 mL of ReSoMal over the course of the first hour, and another 90 mL for the second hour) and then continuing at this same rate or slower based on the child's thirst and ongoing stool losses, keeping in mind that

1360-430: Is suspected give an antibiotic to which V. cholera e are susceptible. This reduces the volume loss due to diarrhea by 50% and shortens the duration of diarrhea to about 48 hours. Fluid from the body enters the intestinal lumen during digestion . This fluid is isosmotic with the blood and contains a high quantity, about 142 mEq/L, of sodium . A healthy individual secretes 2000–3000 milligrams of sodium per day into

1428-476: Is via intestinal epithelial cells ( enterocytes ). Sodium passes into these cells by co-transport with glucose, via the SGLT1 protein. From the intestinal epithelial cells, sodium is pumped by active transport via the sodium-potassium pump through the basolateral cell membrane into the extracellular space . The sodium–potassium ATPase pump at the basolateral cell membrane moves three sodium ions into

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1496-490: Is warranted according to the Cochrane review . ORT is based on evidence that water continues to be absorbed from the gastrointestinal tract even while fluid is lost through diarrhea or vomiting. The World Health Organization specify indications, preparations and procedures for ORT. WHO/UNICEF guidelines suggest ORT should begin at the first sign of diarrhea in order to prevent dehydration. Babies may be given ORS with

1564-490: The "Right to Development" in 1986. From the 1980s onward, the Washington Consensus and economic globalization on terms often described as neoliberal became dominant. The economic reach of multinational corporations, rather than being circumscribed, would be expanded significantly. Trade in commodities would shift away from state-dominated cartels towards increasingly financialized markets. The formation of

1632-657: The Caribbean Community , reducing developed-country tariffs and other obstacles to free trade, expanding generalized trade preferences, and designing other agreements to reduce trade barriers . These proposals to restructure the international economic system also sought to reform the Bretton Woods system , which had benefited the leading states that had created it – especially the United States . This set of proposals proclaimed that facilitating

1700-530: The North–South Summit in Cancun in 1981, where, according to historian Michael Franczak, "Reagan promised the attending heads of state that private investment and free markets were the surest path to development, prosperity, and, yes, democracy." Within the context of the worldwide debt crisis in the 1980s, it was very difficult to realize the NIEO. Unrealized NIEO proposals contributed to the formulation of

1768-450: The World Health Organization (WHO) and UNICEF . In 1988, the definition was changed to include recommended home-made solutions, because the official preparation was not always available. The definition was also amended in 1988, to include continued feeding as associated therapy. In 1991, the definition became "an increase in administered hydrational fluids "; in 1993, "an increase in administered fluids and continued feeding". Dehydration

1836-585: The World Trade Organization and the proliferation of free trade agreements would compel the reduction of barriers to trade, generally on strictly reciprocal terms. Parts of the NIEO were realized, such as the non-legal, non-binding Restrictive Business Practice Code adopted in 1980 and the Common Fund for Commodities , which came in force in 1989. In addition, in World Trade Organization , Matsushita et al. state, "The realization of

1904-436: The osmolarity of oral rehydration solution be reduced from 311 to 245 mOsm/L. These guidelines were also updated in 2006. This recommendation was based on multiple clinical trials showing that the reduced osmolarity solution reduces stool volume in children with diarrhea by about twenty-five percent and the need for IV therapy by about thirty percent when compared to standard oral rehydration solution. The incidence of vomiting

1972-525: The "Declaration for the Establishment of a New International Economic Order" and its accompanying program of action on 1 May 1974. The idea of a new international economic order emerged from the experiences of decolonization after the Second World War. Newly decolonized countries gained political sovereignty but "felt that their de jure political colonization ended only to be replaced by a de facto economic colonization." This mission to achieve

2040-773: The "gold standard" for the treatment of moderate and severe dehydration. In 1953, Hemendra Nath Chatterjee published in The Lancet the results of using ORT to treat people with mild cholera. He gave the solution orally and rectally, along with Coleus extract, antihistamines, and antiemetics, without controls. The formula of the fluid replacement solution was 4 g of sodium chloride , 25 g of glucose , and 1000 mL of water . He did not publish any balance data, and his exclusion of patients with severe dehydration did not lead to any confirming study; his report remained anecdotal. Robert Allan Phillips tried to make an effective ORT solution based on his discovery that, in

2108-548: The 40th anniversary of the Alma-Ata Declaration, and united world leaders to affirm that strong primary health care is essential to achieve universal health coverage. The conference resulted in the adoption of the Astana Declaration on Primary Health Care that reaffirmed and extended the Alma-Ata Declaration. New International Economic Order The New International Economic Order ( NIEO )

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2176-406: The Alma-Ata Declaration, these aspects were very specific and concise, making global health as successful and attainable as possible. Nonetheless, there were still many supporters who preferred the comprehensive PHC introduced at Alma-Ata over Selective PHC, criticizing the latter as a misrepresentation of some core principles of the original declaration. The main critics are toward selective care as

2244-513: The NIEO for using central planning and monopolistic power to extort transfers of income and wealth from the developed countries. In his view, commanding prices for raw materials above their natural level usually reduces consumption and thus causes unemployment among producers, and price regulation typically gives the extra income to those in control of who is allowed to produce, e.g., to governments or land-owners. Newly elected President Ronald Reagan took these calls for market-led foreign policy to

2312-765: The NIEO visible in the policy arena. In the 21st century, the idea of an NIEO has been endorsed by the Group of Friends in Defense of the Charter of the United Nations . In addition, to mark the 50 year anniversary of the original NIEO proposals in 2024, Progressive International convened a global 2-year process to update the original NIEO. The renewed NIEO proposals were published in September 2024. Oral rehydration Oral rehydration therapy ( ORT )

2380-590: The NIEO. Key themes of the NIEO included both sovereign equality and the right of self-determination , especially when it comes to sovereignty over natural resources. Another key theme was the need for a new commodity order through international commodity agreements and a common fund for commodity price stabilization. Restructuring international trade was also central as a means to improve developing countries' terms of trade , such as by diversifying developing economies through industrialization, integrating developing countries economies into regional free trade blocs like

2448-445: The NIEO. In 2018, the United Nations General Assembly adopted the resolution "Towards a New International Economic Order", which reaffirmed "the need to continue working towards a new international economic order based on the principles of equity, sovereign equality, interdependence, common interest, cooperation and solidarity among all States." The main principles of the original NIEO are: The main reforms required by

2516-656: The New International Economic Order was an impetus for developing country support for the Tokyo Round of trade negotiations. Critics of the WTO continue to state that little of substance for developing countries came out of either the Tokyo or Uruguay Rounds . The adoption of the 1974 Declaration and the much more recent 2018 resolution "Towards a New International Economic Order" keeps the ideas of

2584-407: The WHO recommends supplemental zinc (10 to 20 mg daily) for ten to fourteen days, to reduce the severity and duration of the illness and make recurrent illness in the following two to three months less likely. Preparations are available as a zinc sulfate solution for adults, a modified solution for children and in tablet form. After severe dehydration is corrected and appetite returns, feeding

2652-490: The aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of the declaration. The declaration has 10 points and is non-binding on member states. The first section of the declaration reaffirms the WHO definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". The definition seeks to include social and economic sectors within

2720-405: The attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. The declaration urged governments, international organizations and the whole world community to take this up as a main social target in the spirit of social justice . This section defined primary health care and urged signatories to incorporate

2788-479: The basolateral membrane. Both SGLT1 and SGLT2 are known as symporters , since both sodium and glucose are transported in the same direction across the membrane. The co-transport of glucose into epithelial cells via the SGLT1 protein requires sodium. Two sodium ions and one molecule of glucose (or galactose ) are transported together across the cell membrane via the SGLT1 protein. Without glucose, intestinal sodium

Declaration of Alma-Ata - Misplaced Pages Continue

2856-460: The body. ORT should be discontinued and fluids replaced intravenously when vomiting is protracted despite proper administration of ORT; or signs of dehydration worsen despite giving ORT; or the person is unable to drink due to a decreased level of consciousness; or there is evidence of intestinal blockage or ileus . ORT might also be contraindicated in people who are in hemodynamic shock due to impaired airway protective reflexes. Short-term vomiting

2924-716: The child should be given cereal made with a greater amount of skimmed milk product and vegetable oil and slightly less sugar. As appetite fully returns, the child should be eating 200 mL per kilogram of body weight per day. Zinc, potassium, vitamin A, and other vitamins and minerals should be added to both recommended cereal products, or to the oral rehydration solution itself. Children who are breastfed should continue breastfeeding. The WHO recommends that all severely malnourished children admitted to hospital should receive broad-spectrum antibiotics (for example, gentamicin and ampicillin ). In addition, hospitalized children should be checked daily for other specific infections. If cholera

2992-547: The components of primary health care. The next two sections called on all governments to incorporate primary health care approach in their health systems and urged international cooperation in better use of the world's resources. The Alma-Ata Declaration generated numerous criticisms and reactions worldwide. Many argued that the slogan "Health for All by 2000" was not possible and that the declaration did not have clear targets. In his article "The Origins of Primary Health Care and Selective Primary Health Care", Marcos Cueto claims that

3060-620: The concept of primary health care in their health systems . Primary health care has since been adopted by many member nations. More recently, Margaret Chan , the Director-General of the WHO has reaffirmed the primary health care approach as the most efficient and cost-effective way to organize a health system. She also pointed out that international evidence overwhelmingly demonstrates that health systems oriented toward primary health care produce better outcomes, at lower costs, and with higher user satisfaction. The seventh section lists

3128-697: The declaration was condemned as being unrealistic, idealistic, and too broad. As a result of these criticisms, the Rockefeller Foundation sponsored the Health and Population Development Conference held in Italy at the Bellagio Conference Center in 1979 (a year after Alma-Ata). The purpose of this conference was to specify the goals of PHC and to achieve more effective strategies. As a result, Selective Primary Health Care (PHC)

3196-808: The diarrhea losses reduced the need for IV fluid therapy by eighty percent. [46] In 1971, fighting during the Bangladesh Liberation War displaced millions and an epidemic of cholera ensued among the refugees. When IV fluid ran out in the refugee camps , Dilip Mahalanabis , a physician working with the Johns Hopkins International Center for Medical Research and Training in Calcutta, issued instructions to prepare an oral rehydration solution and to distribute it to family members and caregivers. Over 3,000 people with cholera received ORT in this way. The mortality rate

3264-415: The extracellular space, while pulling into the enterocyte two potassium ions. This creates a "downhill" sodium gradient within the cell. SGLT proteins use energy from this downhill sodium gradient to transport glucose across the apical membrane of the cell against the glucose gradient. The co-transporters are examples of secondary active transport . The GLUT uniporters then transport glucose across

3332-409: The health of the people. Participation of people as a group or individually in planning and implementing their health care was declared as a human right and duty. This section emphasized on the role of the state in providing adequate health and social measures. This section enunciated the call for " Health For All " which became a campaign of the WHO in the coming years. It defined Health for All as

3400-591: The idea of encouraging the women in the village to make their own oral rehydration fluid. They used available household equipment, starting with a "half a seer" (half a quart) of water and adding a fistful of sugar and a three-finger pinch of salt. Later on, the approach was broadcast over television and radio, and a market for oral rehydration salts packets developed. Three decades later, national surveys have found that almost 90% of children with severe diarrhea in Bangladesh are given oral rehydration fluids at home or in

3468-680: The illness resolves. Such children should be encouraged to resume normal feeding as soon as possible. Once diarrhea is corrected, the WHO recommends giving the child an extra meal each day for two weeks, and longer if the child is malnourished. Dehydration may be overestimated in wasted children and underestimated in edematous children. Care of these children must also include careful management of their malnutrition and treatment of other infections. Useful signs of dehydration include an eagerness to drink, lethargy, cool and moist extremities, weak or absent radial pulse (wrist), and reduced or absent urine flow. In children with severe malnutrition, it

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3536-526: The illness. This supported the notion that oral rehydration might be possible even during severe diarrhea due to cholera. In 1967–1968, Norbert Hirschhorn and Nathaniel F. Pierce showed that people with severe cholera can absorb glucose, salt, and water and that this can occur in sufficient amounts to maintain hydration. In 1968, David R. Nalin and Richard A. Cash , helped by Rafiqul Islam and Majid Molla, reported that giving adults with cholera an oral glucose-electrolyte solution in volumes equal to those of

3604-479: The intestinal lumen. Nearly all of this is reabsorbed so that sodium levels in the body remain constant . In a diarrheal illness, sodium-rich intestinal secretions are lost before they can be reabsorbed. This can lead to life-threatening dehydration or electrolyte imbalances within hours when fluid loss is severe. The objective of therapy is the replenishment of sodium and water losses by ORT or intravenous infusion. Sodium absorption occurs in two stages. The first

3672-482: The original NIEO are: Renewed NIEO proposals - generated to mark the 50th anniversary of the original proposals - include additional principles such as the need to address a "rapidly changing climate". The United States government rejected the NIEO almost immediately. Neoconservatives and libertarians criticized the NIEO and became influential in US foreign policy circles. For example, economist Harry Johnson criticized

3740-557: The original ORS formula has no effect on the duration of the diarrheic episode or the volume of fluid loss, although reduced osmolarity solutions have been shown to reduce stool volume. The degree of dehydration should be assessed before initiating ORT. ORT is suitable for people who are not dehydrated and those who show signs and symptoms of mild to moderate dehydration. People who have severe dehydration should seek professional medical help immediately and receive intravenous rehydration as soon as possible to rapidly replenish fluid volume in

3808-423: The person speeds the recovery of normal intestinal function, minimizes weight loss and supports continued growth in children. Small frequent meals are best tolerated (offering the child food every three to four hours). Mothers should continue to breastfeed . A child with watery diarrhea typically regains their appetite as soon as dehydration is corrected, whereas a child with bloody diarrhea often eats poorly until

3876-432: The person vomits, the caregiver should wait 5–10 minutes and then resume giving ORS. ORS may be given by aid workers or health care workers in refugee camps, health clinics and hospital settings. Mothers should remain with their children and be taught how to give ORS. This will help to prepare them to give ORT at home in the future. Breastfeeding should be continued throughout ORT. As part of oral rehydration therapy,

3944-530: The presence of glucose, sodium, and chloride could be absorbed in patients with cholera; but he failed because his solution was too hypertonic and he used it to try to stop the diarrhea rather than to rehydrate patients. In the early 1960s, Robert K. Crane described the sodium-glucose co-transport mechanism and its role in intestinal glucose absorption. This, along with evidence that the intestinal mucosa appears undamaged in cholera, suggested that intestinal absorption of glucose and sodium might continue during

4012-474: The rate of economic development and market share among developing countries will fight global issues such as hunger and despair more effectively than the current focus on philanthropy and development aid. This advocacy among nations of the Non-Aligned Movement can also be understood as an extension of the decolonization movement that was present in many developing countries during that time. In this perspective, political and economic equity were perceived as

4080-421: The resulting mixture is not shelf stable in high-humidity environments. It works as glucose increases the uptake of sodium and thus water by the intestines , and the potassium chloride and sodium citrate help prevent hypokalemia and acidosis , respectively, which are both common side effects of diarrhea. A number of other formulations are also available including versions that can be made at home. However,

4148-473: The risk of death from diarrhea by up to 93%. Side effects may include vomiting , high blood sodium , or high blood potassium . If vomiting occurs, it is recommended that use be paused for 10 minutes and then gradually restarted. The recommended formulation includes sodium chloride , sodium citrate , potassium chloride , and glucose . Glucose may be replaced by sucrose and sodium citrate may be replaced by sodium bicarbonate , if not available, although

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4216-495: The scope of attaining health and reaffirms health as a human right . The declaration highlighted the inequality of health status between the developed and the developing countries and termed it politically, socially and economically unacceptable. The third section called for economic and social development as a pre-requisite to the attainment of health for all. It also declared positive effects on economic and social development and on world peace through promotion and protection of

4284-412: The solution should not be hyperosmolar . The Rehydration Project states, "Making the mixture a little diluted (with more than 1 litre of clean water) is not harmful." The optimal fluid for preparing oral rehydration solution is clean water. However, if this is not available, the usually available water should be used. Oral rehydration solution should not be withheld simply because the available water

4352-485: The state of primary care in China's rural areas. The declaration urged governments, the WHO, UNICEF , and other international organizations, as well as multilateral and bilateral agencies, non-governmental organizations, funding agencies, all health workers and the world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The conference called on

4420-410: The use of homemade solutions has not been well studied. Oral rehydration therapy was developed in the 1940s using electrolyte solutions with or without glucose on an empirical basis chiefly for mild or convalescent patients, but did not come into common use for rehydration and maintenance therapy until after the discovery that glucose promoted sodium and water absorption during cholera in the 1960s. It

4488-601: Was 3.6% among those given ORT, compared with 30% in those given IV fluid therapy. After Bangladesh won independence, there was a wide campaign to promote the use of saline in the treatment of diarrhea. In 1980, the World Health Organization recognized ORT and began a global program for its dissemination. In the 1970s, Norbert Hirschhorn used oral rehydration therapy on the White River Apache Indian Reservation with

4556-525: Was a major cause of death during the 1829 cholera pandemic in Russia and Western Europe. In 1831, William Brooke O'Shaughnessy noted the changes in blood composition and loss of water and salt in the stool of people with cholera and prescribed intravenous fluid therapy (IV fluids). The prescribing of hypertonic IV therapy decreased the mortality rate of cholera to 40%, from 70%. In the West, IV therapy became

4624-577: Was introduced. As opposed to PHC of the Alma-Ata Declaration, Selective PHC presented the idea of obtaining low-cost solutions to very specific and common causes of death. The targets and effects of Selective PHC were clear, concise, measurable, and easy to observe. This is because Selective PHC had explicit areas of focus that were believed to be the most important. They were known as GOBI (growth monitoring, oral rehydration treatment, breastfeeding, and immunization ), and later GOBI-FFF (adding food supplementation , female literacy, and family planning). Unlike

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