Stop the Cycle

Diarrheal Disease Solutions

Breastfeeding & Nutrition

Breastfeeding and good nutrition help ensure that every child can properly develop. Between them, these two critical solutions help protect children from and reduce their exposure to diarrheal disease.

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Breastfeeding provides all the essential nutrition infants need for growth and development.

“What if governments had a proven, cost-effective way to save babies’ lives, reduce rates of malnutrition, support children’s health, increase educational attainment and grow productivity? They do: it’s called breastfeeding. And it’s one of the best investments nations can make in the lives and futures of their youngest members—and in the long-term strength of their societies.”

– Anthony Lake, Executive Director, UNICEF
found on UNICEF


  • Problem: exposure to diarrhea-causing pathogens, missing breast milk’s anti-infective protections

    Infants are at greatest risk of diarrheal disease when they are given foods other than breast milk. This is because they are more likely to be exposed to food- and water-borne pathogens and lose the protection of breast milk’s anti-infective properties.

    Still, breastfeeding rates are less than 50% globallyMany women face obstacles breastfeeding due to a lack of knowledge about its benefits and a lack of sufficient support from key family members and communities. Instead, they turn to breast milk substitutes, which can be heavily marketed in areas where these advertisements are unregulated. Substitutes carry risks in areas where water may be unsafe and in areas prone to high levels of infectious disease and the potential for improper food preparation and storage practices. For women who are unable to breastfeed, it’s important that healthy solutions—made with safe water—are available.

    Additionally, some mothers don’t produce enough milk or have trouble accessing breast milk. Both issues are critical to ensure a child receives good nutrition.

  • Solution: exclusive and continued breastfeeding

    Exclusive breastfeeding has many health benefits for infants, including the prevention and treatment of infections like diarrhea. It provides immediate immune protection to the infant from the mother, stimulates the development of an infant’s immune system, and contains many health- and growth-enhancing properties like enzymes, proteins, and hormones, all of which are unique to breast milk. Breastfeeding also benefits mothers by reducing the risk of breast and ovarian cancer, among other health benefits. Key feeding practices recommended by the World Health Organization (WHO) for infants and young children include:

    • Initiating breastfeeding within the first hour of life
    • Exclusive breastfeeding for the first six months
    • Timely and adequate complementary feeding
    • Continued breastfeeding for two years, and
    • Good nutrition and restorative feeding for toddlers over age two

    Breastfeeding prevents diarrheal disease in two ways:

    • It eliminates the risk of a child consuming contaminated food and water at a point in his/her life when his/her digestive system is not fully developed.
    • Breast milk contains secretory antibodies and other immune factors that protect against gastrointestinal pathogens. Breast milk has also demonstrated anti-inflammatory and immunomodulatory effects.

    For an infant or toddler, continued breastfeeding during and following an episode of diarrhea significantly reduces the risk of dehydration and prevents weight loss and malnutrition. Breastfeeding may also help speed recovery and reduce the severity and duration of an episode.

    After six months, when breast milk needs to be complemented with other foods, caregivers should be educated about safe and hygienic food preparation and feeding. Infants and toddlers are particularly vulnerable to malnutrition between six months and two years due to inadequate feeding practices during and after illness.

    Successful breastfeeding is a collective, community effort. Mothers need support from families, communities, and their governments.

    What are safe alternatives? Donor milk and special cups.
    When a mother is unable to breastfeed her child, human milk banks are critical. In 2008, WHO called for member nations to promote the use of donor breast milk from human milk banks for vulnerable babies. To date, there has been progress in human milk banks opening around the world, with the first human milk bank in Asia opening in India in 2016, followed by Vietnam in 2017.

    Several million babies born each year in Africa and South Asia cannot breastfeed due to prematurity or craniofacial anomalies like cleft lip or palate; however, new inventions like the NIFTY Cup help these babies get the nutrients they need. The cup creates a reservoir and flow channel that allows an infant to lap breastmilk, instead of it being poured down their throats using a traditional cup.

  • Impact: helps prevent and treat infections, saves lives

    Breastfeeding could save an estimated 800,000 infants each year by preventing death and stunting from malnutrition. It protects the immune system and promotes physical and cognitive growth and development, in part by preventing infections like pneumonia and diarrhea.

  • Global guidance: breastfeeding

    WHO and UNICEF recommend exclusive breastfeeding—where the infant only receives breast milk without additional food or drink—for the first six months of life. This is followed by continued breastfeeding with appropriate complementary foods for up to two years or beyond. Learn more.

    The World Health Assembly hopes to achieve at least a 50 percent rate of exclusive breastfeeding during the first six months of life by 2025. (The 2012 baseline is 37 percent.) By investing US$570 million a year for the next 10 years, governments, donors, and partners can help increase the rate of exclusive breastfeeding. Learn more.

    The Global Breastfeeding Collective (GBC) developed a scorecard to track progress on seven policy actions and on the state of breastfeeding practices within countries. Learn more.

    The Maternal and Child Survival Program (MCSP) compiled a list of barriers to exclusive breastfeeding as well as a summary of global guidelines and country actions. Learn more.

    By the GBC’s estimates, every dollar invested in increasing breastfeeding generates US$35 in future returns across low- and middle-income countries, resulting in healthier families with higher productivity.

World Breastfeeding Week

AUGUST 1 to 7

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Good health begins with good nutrition. Proper infant and young child nutrition fortifies the immune system against infectious diseases, including diarrhea, and promotes healthy growth and development.

“The link between malnutrition and cognitive development is powerful and far-reaching. Its effects span not only the lifespan of the individual affected but also cross generations… Malnourished children often become malnourished parents and the vicious cycle is repeated…”

– Dr. Cyril Engmann, Director of Maternal, Newborn and Child Health and Nutrition, PATH
in a DefeatDD Blog


  • Problem: poor nutrition/inability to absorb nutrients

    Diarrheal disease and malnutrition are inextricably linked. It’s not just a lack of food that causes poor nutrition outcomes. When a child experiences persistent diarrhea infections, he/she is less likely to be able to absorb the necessary nutrients needed to survive and develop. Five or more cases of diarrhea before the age of two can lead to stunting—the effects of which are largely irreversible.

    Diarrhea is a leading cause of malnutrition in children under five years, and children who are malnourished are more susceptible to it. Diarrhea and malnutrition feed off each other in a relentless loop—keeping children sick and vulnerable to infection.


    Fortunately, global rates of stunting have declined along with deaths from diarrheal disease: childhood stunting dropped globally from 165.8 million in 2012 to 149 million in 2018, representing a 10% relative decrease. Still, nearly one quarter of the world’s children remain affected, and significant disparities exist at the subnational level, according to the 2020 Global Nutrition Report.

    Long-term gut damage caused by repeated enteric infections is called environmental enteric dysfunction (EED). It prevents nutrient absorption and immune system function, even when children eat healthy foods.

    Poor–quality diets contribute to and exacerbate this cycle. Children without adequate nutrients in their diets suffer even more when the minimal nutrients aren’t able to be absorbed due to diarrhea. Those whose diets consist of maize (such as nsima or ugali) or rice—foods with little nutritional content—aren’t necessarily hungry, but suffer greater consequences from diarrhea because the few vitamins, minerals, and nutrients they have become quickly depleted.

    Stunting limits potential

    • India has the highest number of children suffering from stunting in the world—48 million, or two in every five.
    • Nigeria and Pakistan rank second and third with 10.3 and 9.8 million children suffering from stunting, respectively.
    • Timor-Leste has the highest percentage of children who are stunted, at about half.

    Pathogens from unsafe drinking water, poor sanitation, and lack of hygiene cause changes to the gut structure that prevent nutrient absorption. When this happens during a child’s first years of life, the long-term impact can be devastating. Mounting evidence links diarrhea-associated malnutrition and its adverse consequences with impaired physical and cognitive development. This can perpetuate the cycle of poverty by curtailing a child’s educational achievements and limiting future employment opportunities.

    Stunting highlights disparities within and among countries

    Stunting in children less than five years old highlights many systemic inequalities, both within countries and among them. Understanding the scope and nature of these disparities is important in directing funding and policy change that can make the greatest impact.

    Wealth is the greatest disparity factor in stunting among children. Whether a child suffers from stunting is related to whether he or she grows up in a rich or poor household. And progress in decreasing this wealth gap is uneven. The inequality between the poorest and richest households in stunting is decreasing in 47 countries, but still increasing in 33.

    Social and geographic factors that predispose children to stunting, according to the Global Nutrition Report 2020, include:

    • Wealth: Average stunting rates are estimated to be more than twice as high among children living in the poorest households (43.6%) compared with those in the richest (18.6%).
    • Education: Stunting is higher among children with less educated mothers (39.2%) versus more educated mothers (24.0%).
    • Rural vs. urban: Of 110 countries with available stunting data by location, children living in rural areas (35.6%) have higher stunting rates than those living in urban areas (25.6%).

    While increased availability of treatments such as oral rehydration solution (ORS) has greatly reduced diarrhea deaths, the overall number of enteric infections persists and continues to trap communities in a cycle of poor health, malnutrition, and poverty.

  • Solution: proper nutrition

    The 1,000 days between when a mother’s pregnancy begins and her child’s second birthday is a critical window during which good nutrition is essential for a child’s healthy development. An integrated approach to prevent and treat diarrheal disease, with particular emphasis on the 1,000-day period, is vital to comprehensively address the vicious cycle of diarrhea and malnutrition.

    The mother’s health during the 1,000 days is also imperative to preventing diarrhea in her children. Mothers must ensure they do not get diarrhea and malnutrition themselves in order to avoid passing along these conditions. Malnourished mothers are much more likely to give birth to low birthweight babies who are more susceptible to diarrhea and often less able to breastfeed. These children are, therefore, prone to be malnourished and stunted.

    For children, nutrition-based solutions for diarrhea incorporate optimal infant and young child feeding—exclusive breastfeeding in the first six months, plus continued breastfeeding and nutritious, hygienically prepared, complementary foods throughout the child’s first two years of life. These programs should also account for WASH (water, sanitation, and hygiene) solutions. PATH’s rice fortification project in India found reduced prevalence of diarrheal illness and stunting after implementing fortified rice in a school feeding program alongside lessons about the importance of cleanliness and hygiene.

    When a child has diarrhea, feeding should continue. After the episode, feeding should increase to help counteract weight loss and malnutrition.

    WASH solutions, breastfeeding, proper nutrition, and vaccines are crucial to preventing infections that contribute to chronic diarrheal disease, environmental enteric dysfunction (EED), the malabsorption of nutrients, and compromised immune function in young children, all of which limit children’s potential.

    Integrating WASH through Global Partnerships: Scaling Up Nutrition (SUN) & Sanitation & Water for All (SWA)

    Recognizing the close relationship between WASH conditions and undernutrition, government actors working WASH and nutrition policies and programs have increasingly begun to collaborate. To reinforce and accelerate these efforts, the SUN Movement and SWA Partnership began to work together in 2015 on high-level advocacy, including joint participation at the 2015 Bonn WASH Nutrition Forum, joint seminars at the European Development Days, Stockholm World Water Week in 2016, and the United Nations General Assembly (UNGA) in 2015 and 2016.

    SUN and SWA have now agreed to a joint workplan focused on advocacy for integration; identifying, documenting, and sharing good practices in integrated national policies and programming; and research and learning to enhance and communicate the benefits of more integrated approaches.

  • Global guidance: nutrition

    Sustainable Development Goal (SDG) 2 addresses hunger and calls for progress by 2030.

    Goal 2: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

    2.1: End hunger and ensure access by all people, in particular the poor and people in vulnerable situations (such as infants), to safe, nutritious, and sufficient food all year round.
    Indicator: Prevalence of undernourishment

    2.2: End all forms of malnutrition, including achieving by 2025 the internationally-agreed targets on stunting and wasting in children under five years, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.
    Indicator: Prevalence of stunting (height for age ≤2 standard deviations from the median of WHO Child Growth Standards) among children under five years.

    WHO’s complementary feeding guidelines provide guidance for infants and toddlers six months and older. Learn more.

    SDG 6 addresses WASH and calls for progress by 2030.

    Goal 6: Ensure availability and sustainable management of water and sanitation for all.
    6.1: By 2030, achieve universal and equitable access to safe and affordable drinking water for all.
    6.2: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations. Learn more.

    The World Health Organization tracks country progress against global nutrition targets with the Global Database on the Implementation of Nutrition Action (GINA). Learn more.

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