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[17 September 2007] - Diarrhoea is still one of the most common reasons for the high child mortality rates in many low and middle-income countries despite two decades of global efforts to control it. One fifth of all the deaths amongst children under the age of five that are reported every year are caused by serious diarrhoea, according to a study by Dr Birger Forsberg of the Department of Pubic Health Sciences, Karolinska Institute, Sweden. Although diarrhoea-related death amongst children has declined in the past thirty years, it is still thought to be the cause of several million child deaths every year. “Research shows that around 1.5 million children suffering from diarrhoea can be saved every year with the right treatment,” says Dr Forsberg. Back in the 1980s the World Health Organization (WHO) started a special programme to reduce diarrhoea-related child mortality. The organisation estimated that about two thirds of all deaths from diarrhoeal diseases were attributable to violent, watery diarrhoea and acute dehydration. It therefore promoted the greater use of rehydration solutions with sugar and salt additives and increased fluid intake. The recommendations were incorporated in most countries’ national health programmes and active information campaigns were run through the WHO, UNICEF and national authorities. The use of the recommended treatments (rehydration or increased fluid intake) has increased but not as much as desired. "Even now, in the first decade of the 21st century, my thesis documents that more than 200 million children suffering from diarrhoea may still be deprived of this treatment", says Dr Forsberg. “In the 1970s, when rehydration solutions had their medical breakthrough as a treatment for diarrhoea, no one thought that it would be so difficult to spread its use.” In his thesis, Dr Forsberg discusses several possible reasons for the lack of adequate and effective adoption and implementation of diarrhoea management. Perhaps the information has not reached out to all households, or perhaps conflicting messages from health providers confuse users. It is also conceivable that poor and underprivileged families are unable to take care of the sick child, even if they know how to. “Giving rehydration solution to a child with serious diarrhoea is a 24-hour commitment in the most acute phases, something which might have to make way for other priorities in households with scant resources,” says Dr Forsberg. “We also have to realise that childhood diarrhoea in many areas is just as common as a cold amongst children in Sweden. This may not keep caretakers on alert when their children contract diarrhoea.” “It’s obvious to us that much still needs to be done to improve the care of children with diarrhoea and to reduce the number of child deaths from diarrhoeal diseases,” he concludes. The study was prepared for a doctoral thesis presented at the Karolinska Institutet, Sweden this month.