Diarrhoea treatment fails to reach the poorest children

Acute dehydration caused by diarrhoea is one of the most common causes of death amongst children in low and middle-income countries. A new study from the Swedish medical university Karolinska Institutet now shows that almost half a billion cases of child diarrhoea a year could be treated if they all received treatment equal to the best standards in their home countries.

"It's unacceptable that so many children risk death when we know that there's simple - and cheap - fluid replacement treatment available," says Dr Birger Forsberg, one of the researchers behind the study.

The study was based on the results of 93 different household surveys in 55 low and middle-income countries between 1990 and 2005. The researchers made particularly close study of data on the incidence and treatment of diarrhoea in children up to the age of five, and socioeconomic differences. One of their findings was that the treatment of diarrhoea with fluid replacement - oral rehydration - was 30 per cent more common in the wealthiest 20 per cent of households than it was in the poorest. If all households had had the same standards as this top 20th percentile, an additional 481 million disease episodes could have been treated in the countries concerned.

Not unsurprisingly, differences in standard of living between the households in the 55 countries also affect children's health. Amongst the poorest 20 per cent of households studied, diarrhoea diseases were 1.5 times more common than amongst the wealthiest. If all households had had the same standard as the wealthier ones, the number of diarrhoea cases would have been almost 23 per cent lower. This, say the researchers, is equivalent to an annual 511 million cases of diarrhoea in children. Forsberg et al.

It is estimated that some 1.8 million children die from diarrhoea diseases every year, mainly through the loss of fluids and the resulting dehydration. But diarrhoea also contributes heavily to malnourishment in children and an impaired quality of life for families with children who regularly suffer the disease. Fluid replacement for children costs less then 1 Euro per treatment.

"In the long run, the very poorest children are going to have to gain access to clean water and better sanitation," says Dr Forsberg." But much can be done in the short term through the greater distribution and use of oral rehydration solutions."

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