object!ve here is to reach a plausible estimate of dehydration mortality in Egypt, which in turn will set the upper ceiling of maximum possible impact of the program.

It is unfortunate that detailed base line epidemiological studies are not available for Egypt. Most of the available evidence comes from a few small area studies. A study"<sup>1</sup> of diarrheal morbidity (but not mortality) conducted around 1983 in several Egyptian communities suggests a high toll of such morbidity. On average, young children were found to have diarrhea for 11 percent of the time (varying from 13 percent in the under ones to about seven percent in the 2 to 3 year olds), and nearly two-thirds of this diarrhea was watery. The 1980 Menoufia controlled field trial<sup>7</sup> conducted careful retrospective medical interviews, discussions and consultations to determine the most probable primary cause of reported deaths. The data showed that diarrheal deaths constituted some 48% and 55 % of infant and childhood deaths respectively. The scanty information available does not support the notion that diarrheal deaths are overstated in the civil registers.

Information on deaths due to dehydration are even more difficult to come by and little. is known for Egypt. Black (1984)'5 states that acute diarrheal deaths usually constitute 50-60 percent of all diarrheal deaths. If this figure applies to Egypt, a potential impact of ORS is 16 around 50% of diarrhea associated deaths and 25% of infant deaths. The few studies **17** that have examined closely the contribution of acute watery diarrhea, the type most likely to respond to ORS, to overall mortality come up with much lower estimates. These studies are based on the Matlab field project in Bangladesh. They estimate that acute watery diarrhea deaths accounted for 11% of all deaths in 1 to 11 months old"<sup>6</sup> and only _5..5%_ of all infant deaths<sup>17</sup> .

The few and quite different estimates available for the share in mortality of dehydration deaths caused by episodes of acute watery diarrhea, and the fact that the role of ORS in preventing death from dysenteric or chronic diarrhea is limited, suggest the need for greater caution in estimating the potential of ORS.

Another point of concern is the role of ORS in influencing the health status of those cured from dehydration. Mosley and Becker"<sup>8</sup> point out that children not dying from dehydration are more frail and more predisposed to further infection with increased risk of dying. This attenuates the mortality-reducing potential of curative interventions. Others maintain that ORS may reduce the severity and duration of subsequent sickness episodes through its role in limiting the nutritional damage during an acute watery diarrhea episode. No scientific evidence is available to support either claim.

# 2- Implementation

When examining the evidence presented in Table 2, there is a need to pay attention to the reliability and validity of the reported information. Some of the data may not be of high quality. Also, it is well known that the methodology adopted to obtain the specific pieces of data can have important implications for the validity of results. Further, Menoufia, in particular, had 9