- www.thelancet.com Vol 382 July 27, 2013 307 foot (Ethiopia and Rwanda) or bicycle (Malawi) to collect supplies. In many parts of Africa, supplies are much worse. In Bangladesh, the large scale production of ORS—developed over the past two decades—has many unique features, including the establishment by large non-governmental organisations of substantial pharmaceutical manu facturing capacity. Bangladesh now produces 97% of key commodities locally—a situation not possible to replicate in most countries in the medium term. Since the 1980s in Bangladesh and Zimbabwe, and now in Niger, CHWs or volunteers promote household use of sugar-salt solution or similar (lobon and gur) as a fi rst step before referral for ORS. The failure to recommend home fluids in The Lancet Series undermines these eff orts. We could only find one review of recommended home fluids which concluded that there is insufficient evidence to recommend their use. Little research has been done providing insuffi cient and low quality evidence. Yet recommended home fluids are being used and are still recommended (albeit half-heartedly) in the latest WHO/UNICEF Global Action Plan for Pneumonia and Diarrhoea. Do we not have an ethical obligation to also train CHWs to promote recommended home fl uids (including sugar-salt solution or cereal-based fl uids) in the common situation where ORS is unavailable? We urgently need more research on home fluids. Furthermore, we need clear strategies, commitments, and fi nancial investments in community mobilisation and intersectoral actions for prevention of diarrhoea through improved water quality and availability, improved sanitation, and handwashing with soap.