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Childhood diarrhoea research needs a radical change of direction to reduce the death rate from a "stagnant" 1.8 million per year, say experts.

An international survey found that experts are far more concerned about why effective treatments are not getting to those who need them than they are about research into new products — yet the subject attracts only three per cent of diarrhoea research funding.

The research, published yesterday (10 March) in PLoS Medicine, sought to determine — and guide researchers and funders about — which research avenues should be urgently pursued to meet the millennium development goal (MDG) to reduce childhood mortality by two-thirds between 1990 and 2015.

Diarrhoea is responsible for nearly two million child deaths annually — 18 per cent of worldwide childhood mortality.

Olivier Fontaine, lead author of the research and a medical officer at the WHO's Department of Child and Adolescent Health and Development, asked experts from a range of fields to suggest research questions related to childhood diarrhoea and how to reduce deaths by 2015. These were then assessed and ranked using criteria such as their affordability.

Top priorities were found to be health systems research into how to deliver cheap and effective treatments such as oral rehydration solution and zinc tablets, and health messages such as the role of exclusive breastfeeding in preventing diarrhoea.

"The problem is the interventions are not applied for various reasons," says Mohammed A. Salam, director of the clinical sciences division at the International Centre for Diarrhoeal Diseases Research in Bangladesh, who was involved in the study.

"If they were applied then we could definitely achieve the MDG, therefore we need to understand why we have interventions but the implementation is not carried out. And that has to do mostly with health systems."

But 97 per cent of research funds go instead to the development of new diarrhoea products, says Fontaine. He claims researchers are attracted to product development because they can gain patents and visibility from it.

Health systems research is difficult to do, Fontaine says, because it requires interdisciplinary collaboration, working in the field and adapting to the local environment. "It's certainly more difficult than a clinical trial in a hospital or lab studies. We call it 'low return, low risk' research and people prefer 'high return, high risk' research.

"In the 1980s there were five million kids dying of diarrhoea, now it's 1.8 million — so it's a significant reduction in mortality. But we have been at 1.8 million for the last five years because we are not able to reach the extra group of people with no access to treatment," he says.

Link to full paper in PLoS Medicine