An important step, but not a leap forward

Papers p 81

Diarrhoea remains one of the leading causes of death in children below 5 years of age in developing countries, resulting in over 4 million deaths a year. Most diarrhoeal deaths are caused by dehydration, which can be treated by replacing fluid loss with oral rehydration solution in over 90% of cases. For over 20 years the World Health Organization and Unicef have recommended an oral rehydration solution containing 90 mmol/l of sodium and 111 mmol/l of glucose. 1 2 This solution is of established efficacy in treating children and adults with diarrhoea regardless of its cause. Despite proved efficacy, the acceptance of oral rehydration solution by patients worldwide and particularly outside facility-based treatment centres has been less than optimal and even poor. As a result, other formulations have been developed and tested, and this week's issue carries a meta-analysis of studies comparing the standard WHO oral rehydration solution with reduced osmolarity solutions (p 81).3

One of the major constraints of the WHO oral rehydration solution is that it does not visibly reduce the severity of diarrhoea (volume of stool and duration of diarrhoea), which is often …