Diarrhoeal disease, oral rehydration, and childhood mortality in rural Egypt.

The Egyptian National Control of Diarrhoeal Diseases Project (NCDDP) is reported to have had great success in improving case management of diarrhoea, and in reducing diarrhoea-related mortality among children, while deaths due to other causes have remained unchanged. Recent reports have claimed that with this dramatic decline in diarrhoea mortality, respiratory infection is now the main cause of child death in Egypt. As a result, the degree of commitment to control of diarrhoeal disease activities has been greatly reduced. We present new data from a large prospective study that confirms much of the success of the NCDDP, but which questions the extent of the claimed project impact on mortality. Child mortality has declined greatly over the past decade. However, deaths from other causes have declined almost as much as those from diarrhoea, and most importantly, diarrhoea remains the main cause of death among children. Our discussion demonstrates the need for appropriate methodology in evaluating the mortality impact of an intervention, and to the very great importance of reinvigorating control of diarrhoeal diseases activities in Egypt.