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www.jogh.org • doi: 10.7189/jogh.10.020386 1 December 2020 • Vol. 10 No. 2 • 020386 Children in low-income countries under the age of 5 years have a high mortality risk. If, with good luck, they survived the neonatal life-threatening diseases during the first month, they have a chance of 16% to die from diarrhoea in the next 59 months [1]. The recently in the Lancet Infection Disease published studies of the Global Burden of Disease project demonstrated, that in 2015 in low-middle income countries still more than half a million children died from diarrhoea [2]. Although this was a decrease of 57% from the year 2000, the United Nations Millennium Development Goal of a reduction towards 66% was not yet achieved. If that had been the case, the chance of dying would be reduced to 10%. With the current trend of 6.5%, there is hope this goal will soon be achieved. Unfortunately, this progressive decline will be inconsistent for Sub-Saharan Africa. Due to the large population growth, in 2030 the absolute number of children who die from diarrhoea will be higher than today and a large proportion (72%) of these children will die in the first two years of life [3,4]. In contrast to the decline of deaths, it is remarkable that the number of diarrhoea disease-episodes between 1990 and 2010 barely decreased. This dropped from 1,9 to 1,7 billon, a modest number of 10.5% [5,6]. Why is there such a big difference in decrease between mortality and incidence ?

Decreasing child death from diarrhoea requires more focus on poor hygiene