Progress in the use of ORS and zinc for the treatment of childhood diarrhea

W orldwide deaths from childhood diarrhea have declined in recent decades, but still total a half million per year [1].A major contributor to this decline has been the use of oral rehydration solution (ORS) to both treat and prevent dehydration from diarrhea [2].In fact, it was 50 years ago in 1968 that the scientific basis of glucose facilitated sodium absorption that led to ORS was first published [3,4].Ten years later in 1978, the World Health Organization launched the global diarrheal control program with ORS at its heart [5], and ORS was hailed as "potentially the most important medical advance" of the 20th century [6].After rapid scale-up of ORS use from 1980 with support from the World Health Organization (WHO) and other international agencies, ORS is now used for treatment in about a third of diarrhea episodes [7,8].A second advance in diarrhea treatment was the demonstration that oral zinc would shorten the duration and severity of diarrhea [9,10].The use of zinc for treatment of all childhood diarrhea was recommended by WHO and UNICEF in 2004 [11]; however, in spite of nearly all low-income and lower-middle income countries including zinc in their national diarrhea treatment guidelines, use in these countries has been low [7,8,12].The opportunity for greater reduction in childhood diarrhea mortality if greater coverage of ORS and zinc for diarrhea treatment could be achieved has led to several calls for action [7,8,13].