• Fischer WalkerChrista LCLJohns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA. cfischer@jhsph.edu, Ingrid K Friberg, Nancy Binkin, Mark Young, Neff Walker, Olivier Fontaine, Eva Weissman, Akanksha Gupta, and Robert E Black.
• Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA. cfischer@jhsph.edu
• PLoS Med. 2011 Mar 1; 8 (3): e1000428e1000428.

BackgroundDiarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated.Methods And FindingsWe use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions.ConclusionUsing currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015.

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