In the Freetown area of Sierra Leone, the proportion of children under five years of age dying from diarrhoea-associated conditions has decreased since the 1970s from 4% to 3%. This reduction relates to children between 12 months and 5 years; deaths associated with diarrhoeal disease in infancy do not appear to have decreased significantly. Currently, 2% of children die in infancy and a further 1% before their fifth birthday from diarrhoeal diseases. Thirty-one percent of short-term growth-faltering in children under five years of age is attributed to diarrhoeal disease. Reasons for improvement in mortality may include the implementation of a National Diarrhoeal Diseases Control Programme and improved case management; some 55% of cases of acute diarrhoea in Freetown now receive oral rehydration therapy. Morbidity and mortality are influenced by the seasons. This is likely to be related to the fact that the nutritional status of children shows a significant deterioration in the early rainy season. At this time incidence of severe diarrhoea warranting hospital admission and diarrhoea mortality rates in hospital and at a Rehydration Center increased significantly. On the other hand, the presentation of dehydrating diarrhoea is greatest in the driest months of the year. Progress in the rural areas of Sierra Leone may not have been so evident although 60% of the population now have access to primary health units within 4 miles and efforts to increase host resistance have included the measles immunization programme which currently protects 60% of under-fives nation-wide. Efforts to reduce the transmission of pathogens have meant increasing access to safe water to 22% and to improved sanitation to 35% in rural areas of Sierra Leone. The sustainable prevention and control of diarrhoeal diseases in developing countries depends also upon increasing levels of adult literacy especially of women.

In this paper we provide an empirically-based way to address the general question of the broad-scale spatial relationship between poverty occurrence and areas of interest to those seeking conservation of large wild areas. We address the question of the spatial relationship between poor people and areas less impacted by human activity by asking three questions about the global spatial relationship between poor people and ecological intactness and how it varies by major biome and geographical region. We use infant mortality rate as a proxy for poverty and the Human Footprint as a proxy for ecological intactness, comparing global terrestrial maps of both. The analysis shows that the vast majority of the world's poor people live in extremely urban and very transformed (peri-transformed) areas. Only a small percentage of the world's most poor are found in areas that are somewhat or extremely wild: about 0.25% of the world's population. This fact has implications for the calls being made for conservation organizations to undertake poverty alleviation, suggesting that at a global scale those groups with interest in conserving wild areas would be able to contribute little to globally significant poverty alleviation efforts. However, these conservation groups are well positioned to develop new partnerships for delivery of benefits to some of the least accessible poor people in the wildest places of the world.