Most of the tiny patients confined to the children's ward at the International Centre for Diarrhoeal Disease Research (ICDDR) in Dhaka, Bangladesh, are weak, malnourished and dehydrated. They've suffered attack after attack of diarrhea and, in some cases, are clinging to life. Five-month-old Sohag, who is lying on green plastic sheeting in a bed four times her size, had suffered diarrhea for seven days before she was admitted. Her weight had dropped to 2.75 kg, just over one-third of that expected for her age, and she now seems to be little more than a distended stomach, bulging head and collection of scrawny limbs. According to the chart at the foot of her bed, she may also have pneumonia and sepsis. But at the root of her problem is chronic diarrhea, a daily killer of 5,000 young children in the developing world and the cause of one-third of child deaths in Bangladesh. Her 15-year-old mother, Jharana, had never heard of diarrhea before she was advised to take Sohag to ICDDR's hospital. There, the baby received saline solution through a vein in her arm, and a rice-based solution through a tube in her nose.
Weak as she is, patients like Sohag who make it to a hospital are the lucky ones. Most of them are treated and released within a few days, as her doctor expected Sohag would be. But many children never reach a treatment center and die from dehydration as they lose critical body fluids faster than they can be replaced. Like Jharana, their family members don't know how to prepare a life-saving remedy that can be assembled for just a few pennies: a large pinch of salt and a fistful of sugar dissolved in a jug of clean water, the simplest recipe for oral rehydration solution. "To save the life of a person with diarrhea is probably the cheapest health intervention you can think of," says David Sack, an American doctor who is the ICDDR's executive director.
Cheap; but nothing like as commonly available as it should be. Oral rehydration has saved the lives of more than 40 million children since it was first put to the test during a cholera outbreak among refugees on India's border with Bangladesh in 1971. But decades later, it remains grossly underused. The result, according to the World Health Organization (WHO): 3 million people a year still die from diarrheal complications, including 1.9 million children under 5, or 17% of the estimated 11 million deaths in that age group. These deaths are largely preventable and unnecessary. "We have the tools to really reduce deaths," says Olivier Fontaine, a diarrheal disease expert at the WHO in Geneva, Switzerland. "The cost of this intervention is minimal. Yet we can't get it to every child that needs it."
Why not? Because crowded cities and remote areas of poor countries often don't have adequate health facilities nearby; because many parents of young children never learn how to make oral rehydration solution at home; because sachets of the powdered mix require packaging, storage and distribution to those who need them; because oral rehydration does not initially reduce a child's stool output, leading some parents to conclude that it doesn't work, and give up. Because perhaps above all our sense of global health priorities is uncomfortably skewed. While diarrhea is a major killer in developing countries, in the rich world it is usually no more than an irritant. So developed nations channel health-care funds into areas perceived as presenting greater risks. Antiviral drugs are purchased and vaccines are ordered to guard against the potential threat from avian influenza instead of getting packages of rehydration solution costing just 6˘ a liter to those at risk of dying from diarrhea elsewhere. But far more children die from diarrhea every day than have ever died from avian flu.