Diarrhea deaths are falling but ORS use still stagnant

This was originally published on Global Health TV on October 28, 2015.

I’m grateful to Chelsea Clinton for her admission that she is “obsessed with diarrhea,” and her total lack of embarrassment in bringing it up repeatedly. In an interview with Fast Company, it was the first thing she wanted to talk about.

I’m grateful to her because she is, as far, as I know, the only well-known public figure to champion the prevention and treatment of diarrhea, the world’s second biggest killer of children under five years old, even though we have cheap and effective ways of dealing with it.

“It’s completely unacceptable that more than 750,000 children die every year because of severe dehydration due to diarrhea,” said Clinton last year. “I just think that’s unconscionable.”

We need more champions of the diarrhea issue.

Four years ago, I wrote a blog bemoaning the fact that oral rehydration therapy (ORT) seemed to be on life support, even though The Lancet once called it “the most important medical advance of the 20^th century.” ORT and its practical application, oral rehydration solution (ORS), have long been found to be both effective and cost-effective in treating the dehydration caused by diarrhea.

The rise and fall of a global health success story, and how the G8 can bring it back

This article was also published in The Huffington Post on May 23, 2011.

Lancet once called it “potentially the most important medical advance of the 20th century.” But in the 21^st century, oral rehydration therapy (ORT) — a simple, cost-effective treatment given at home using either packets of oral rehydration salts (ORS) or a simple home solution of sugar, salt and water — seems to be on life support. The result is the unnecessary deaths of children under five.

ORT and ORS are indisputable bright spots in global health: Almost a billion episodes of child diarrhea are treated with ORT annually, reducing child deaths from diarrheal disease by more than 50 percent, according to the U.S. Agency for International Development.

Since the 1970s, ORS has saved an estimated 50 million lives, costing less than US $0.30 per sachet, reported the World Health Organization in 2009. Among major causes of child death, it is now tied for second place, at 14%, with pneumonia.

ORT is also highly cost-effective. A 2005 British Medical Journal paper found that ORT was one of the interventions that “would be chosen on purely cost effectiveness grounds for any level of resource availability.” But after the success of ORT, its uptake has slowed and even reversed in some countries.  A 2008 analysis of the change in ORS use in children under 3 between 1992 and 2005 found declines in 23 countries and increases in only 11. Declines in ORT use seemed to occur despite overall improvements in awareness of ORS.