Modern sanitation has largely eliminated outbreaks of severe, dehydrating diarrhea in the industrialized world, but such diseases remain common in Asia. With support from many donors, including the U.S. Agency for International Development, UNICEF, the World Health Organization and other donors, the Afghanistan Ministry of Public Health is better prepared to respond to diarrheal illness when it appears in Kabul ["Expert Warns of Cholera Epidemic in Afghanistan," news story, June 15].

The ministry's Sentinel Surveillance System, put in place to detect increased incidents of disease before outbreaks emerge, provided early warning to our epidemiologic emergency preparation and response team, which mobilized quickly to chlorinate the Kabul water supply and more than 9,000 wells in the city. Upgraded laboratories now can analyze samples from the field, and during the past 21 months, 1,143 doctors and nurses have received refresher training that includes the identification and treatment of acute diarrheal disease. An educational program that uses mass media, posters and leaflets has focused on detection and prevention of diarrhea, personal hygiene and safe water.

Mortality rates from severe diarrheal illnesses can reach 20 percent, but the ministry's pharmaceutical management team has provided IV fluids, oral rehydration salts and antibiotics to hospitals and treatment centers throughout Kabul, keeping deaths to less than 1 percent of those affected.

As a result of all these efforts, the effects of diarrheal disease in Kabul and throughout Afghanistan will be much less acute this year than in previous years.


Minister of Public Health