Diarrhoea is still one of the leading causes of death in children under five, killing several hundred thousand children a year according to WHO estimates, almost all of them in low-income countries. Two cheap treatments prevent most of those deaths: oral rehydration salts (ORS) and zinc.
The 2004 joint statement
In May 2004 the World Health Organization and UNICEF issued a joint statement on the clinical management of acute diarrhoea. It changed two things. First, it introduced a new low-osmolarity ORS formula with less glucose and salt than the earlier one, which shortens the illness and reduces the need for intravenous fluids. Second, it added zinc supplementation for ten to fourteen days to every treatment: 10 mg a day for infants under six months and 20 mg a day for older children. The statement was based on trials from Bangladesh, India and elsewhere showing that zinc shortens the episode by around a quarter and lowers the risk of another episode in the following months.
Why zinc works
Zinc is needed for the repair of the intestinal lining and for immune function. Children in regions where diets are dominated by cereals with little animal food are frequently zinc-deficient, and a diarrhoeal episode drains the body’s stores further. Supplementation during and after the episode breaks that cycle. Dispersible 20 mg zinc tablets that dissolve in a spoon of water or breast milk are now on the WHO Essential Medicines List.
Coverage today
Adoption has been slow. UNICEF data suggest that fewer than half of children with diarrhoea in the poorest countries receive ORS and only a fraction receive zinc, partly because caregivers stop treatment once the stools improve and partly because private pharmacies still sell antibiotics and antidiarrhoeals instead. Co-packaged ORS and zinc kits, promoted since the 2010s, have improved adherence where they are available. The WHO treatment guidance was updated again with the 2023 recommendations on the management of diarrhoea in children, which keep zinc and ORS at the centre.
This site is an independent reference on micronutrients. It is not connected to the former MOST micronutrient programme and does not hold its documents. For clinical guidance consult the current WHO recommendations.
