According to the World Health Organization (WHO), an estimated 2.5 billion cases of diarrhea occur among children under 5 years of age each year, and estimates suggest that the overall incidence has become stable over the past two decades. More than half of the cases occur in Africa and South-East Asia, where bouts of diarrhea are likely to result in death or other severe outcomes. The incidence varies with the season and the child’s age: incidence varies in the first two years and declines thereafter. Diarrhea is the second leading cause of death among children under five. Nearly one in five child deaths (about 1.5 billion each year) is due to diarrhea.

Mortality from diarrhea has declined over the past two decades from an estimated 5 million deaths among children under 5 to 1.5 million deaths in 2004, which parallels downward trends in overall under-five mortality during this period. Despite these declines, diarrhea remains the second most common cause of death among children under 5 globally, following closely behind pneumonia, the leading killer of young children, and before malaria.

Why should diarrhea, an easily preventable and treatable disease still be causing an estimated 2.5 billion under five deaths every year? Reducing these deaths depends not only on preventive measures and the rotavirus vaccine, but largely on delivering life saving treatment of low osmolarity oral rehydration salts (ORS) and zinc tablets to all children with diarrhea. Today, only 39% of children with diarrhea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000. In this paper, we highlight the potential benefits from current available evidence, of low osmolarity ORS and zinc in the treatment of diarrhea in children, to incite health professionals to adopt and implement WHO recommendations which have proven their worth.

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