Are probiotics a feasible intervention for prevention of diarrhoea in the developing world?
N Hajela, GB Nair and NK Ganguly
Gut Pathogens 2010, 2:10doi:10.1186/1757-4749-2-10
With about 1.4 million of the just under 9 million child deaths attributed to diarrhoea in 2008 and 49% of them occurring in five countries namely, India, Nigeria, Democratic Republic of the Congo, Pakistan and China, there is an urgent need for interventions to prevent and control diarrhoeal diseases. Of the various interventions to prevent diarrhoea, probiotics offer potential. The past decade has witnessed the validation of their utility for the prevention, treatment and management of a variety of infective and non infective disorders. The most investigated field continues to remain infectious diarrhoea and compelling evidence comes from randomized placebo controlled trails. While results from these studies are encouraging, most of them reflect the outcomes of the developed world. Developing countries like India continue to struggle with nutritional and health challenges and bear the greatest burden of diarrhoea. A paucity of data from the developing countries limits the definite recommendation of probiotics. In these countries curd, often confused for a probiotic, is practiced as an integral part of the culture. While the nutritional benefits of these products cannot be understated, it is still uncertain whether these products can be classified as a probiotic. The emergence of probiotic foods which are scientifically validated for their efficacy and impart defined health benefits offer an excellent opportunity to improve public health. A recent randomized controlled trial conducted by the National Institute of Cholera and Enteric Diseases in Kolkata, India demonstrated a protective efficacy of 14% in preventing diarrhoea among children who received a probiotic. For the developing world, however, the vision for probiotics would mean a fundamental change in perception and developing a well-planned strategy to allow interventions like probiotics to permeate to impoverished settings, where the assault of micro organisms is on a daily basis. This would mean that probiotics be ingrained into the public health system without being seen as a medicine.
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