This week, the Lancet released two articles in its “Online First” section, both concerned with the second leading global cause of infant death: diarrhoea. A staggering one in every five child deaths—around 1•5 million a year —is due to diarrhoea, which kills more children than AIDS, malaria, and measles combined. I have previously blogged about the Zimbabwean cholera crisis and the tragedy of the long-established, but poorly translated treatments for diarrhoea. The first article draws attention to a new UNICEF report: “Diarrhoea: why children are still dying and what can be done”, and suggests a seven-point plan for diarrhoea control:

Prevention

1. Rotavirus and measles vaccinations
2. Promotion of early and exclusive breastfeeding and vitamin A supplementation
3. Promotion of handwashing with soap
4. Improve water quantity and quality, including treatment and safe storage of household water
5. Promotion of community-wide sanitation

Treatment

1. Fluid replacement to prevent dehydration
2. Zinc supplements
   The authors find that only 39% of children with diarrhoea in developing countries are receiving these simple, cheap interventions.

The other, more hopeful Lancet article concerns a trial of a new cholera vaccine in more than 65 000 individuals, including children older than 1 year, living in an urban slum in India. Clusters of households were either allocated two doses of the vaccine or the placebo. At 2 years, the vaccine did not have any more side effects than the placebo and was 67% effective in protecting against cholera in the entire population. The vaccine was 49% protective against cholera in children aged 1—5 years, although its effectiveness dropped if the vaccine was not given in two doses. This vaccine is both effective and affordable, giving it great potential for mass immunisation programmes in cholera-endemic areas.

The recent cholera outbreak is the worst in Zimbabwe's history, infecting 66,000 people with over 3,300 deaths [1, 2]. Last week, a Red Cross worker wrote a diary from Zimbabwe for the BBC [1]. Despite technological advances it revealed the desperate circumstances under which people are providing and receiving health care in parts of the world, even when the evidence for cause and cure is beyond doubt.