Celebrating 25 Years of Oral Rehydration Therapy
Brochure: BASICS Project
"A quarter-century after it was
introduced to the world, oral rehydration therapy (ORT) is now saving over 1 million young
lives a year."
The State of the World's Children 1994, UNICEF
Twenty five years ago, U. S.
funded research culminated in the successful studies which launched ORT as we know it
today. Since then, the U.S. Agency for International Development (USAID) has been a
leading partner in the global effort to meet the challenge of Child Survival.
As one of the "twin
engines" of USAID's Child Survival program, ORT brings together scientific research
and cost-effective public health approaches to make a profound difference in the lives of
children and their families and communities.
ORT: 25 Years of Saving Lives
Late 1950s-early 1960s
Basic scientific research uncovers the
interactive mechanism of salt and sugar in the intestine. Clinicians raise
possibility that this physiologic principle could be applied to fluid loss in cholera.
Researchers from U.S. government-funded institutes in Dhaka
(CRL) and Calcutta (ICMRT) publish reports of successful oral rehydration solution (ORS) use for adult
cholera patients in clinical trials.
First large scale ORT clinical trial at field hospital,
Effective use of ORT demonstrated in children with cholera, and adults and children with
First demonstration that addition of an amino acid
(glycine) to glucose can
enhance fluid absorption and decrease stool loss in cholera.
First mass use of ORT in crowded refugee camps during epidemic cholera outbreaks
yields significantly lower mortality than in other camps using only limited supplies of
ORT studies in the White Mountain Apache Nation, the first on United States soil, show ORT
can be used for infants as young as one month, and that feeding early in the course of
diarrhea treatment is not harmful. Evidence that feeding plus fluids enhances
nutritional outcome is solidified in field trials in the Philippines, Turkey, and Iran in
Cholera hits west coast of Africa and spreads throughout the continent after decades-long
UNICEF and WHO agree to single formula rehydration solution regardless of patient
age or cause of diarrhea; UNICEF begins procurement and distribution of standard ORS
Studies at CRL and in Costa Rica provide definitive proof that rotavirus, a
common agent of childhood diarrhea and severe dehydration, can be effectively treated with
The British scientific journal The Lancet calls the "discovery that
sodium transport and glucose transport are coupled in the small intestine so that glucose
accelerates absorption of solute and water ... potentially the most important medical
advance this century." - August 5, 1978
International resolution of the World Health Assembly calls for systematic attack on
diarrheal diseases and leads to multidonor effort, including WHO, USAID, UNICEF, and
World Health Organization Diarrheal Disease Control Programme (WHO/CDD) is created.
CRL is reorganized as a multidonor center - the International Center for
Diarrheal Disease Research, Bangladesh (ICDDR,B) with USAID as the largest donor.
Researchers work to improve ORS formulation for better nutritional outcome of rehydration.
Controlled study in Egypt is first to demonstrate a reduction in mortality when
ORT is used at the clinic and community levels.
ICDDR,B and ICMRT successfully treat patients with cereal-based ORS.
USAID funds pilot ORT programs. In Egypt, strong national political and
financial commitment combine for a substantial impact on childhood diarrhea mortality.
Results in Honduras and The Gambia attest to the potential of mass media and
communication to increase home ORT use. However, the difficulty sustaining gains
demonstrates the need for long-term commitments.
USAID commits major resources for diarrheal disease control (CDD) through a series of
technical support and research projects. USAID's total CDD funding for 1985-93 is
USAID funds first International Conference on Oral Rehydration Therapy
in cooperation with ICDDR,B, UNICEF, and WHO. Developing world population access to
ORS packets reaches 24%. USAID is supporting ORT activities in 19 countries.
ORT is used for approximately 12% of diarrhea cases worldwide.
ICORT II; An estimated 500,000 diarrhea deaths to children have been averted by
the appropriate use of ORT between ICORT I and ICORT II.
ICORT III; With ORT now used for an estimated 32% of all childhood diarrhea
cases, one million diarrhea deaths are averted per year.
Pakistan study of pediatric cholera patients suggests feeding plus glucose ORS
may significantly reduce stool output and duration of diarrhea.
At the World Summit for Children, the international community sets targets for
the year 2000 that include increasing the use of ORT plus continued feeding to 80% of
diarrhea episodes, and reducing childhood diarrhea deaths by half.
Cholera appears in Latin America after an absence of over 100 years. Past
investments bear fruit in Latin America where CDD technologies and programs already in
place, including the use of ORT, help keep cholera deaths to a minimum. Cholera
epidemics reappear in Africa and Asia.
Thirty-seven USAID-assisted countries exceed USAID's target of 45% ORT use.
WHO estimates global access to ORS at 73%. Four out of five ORS packets are
now produced in the country where used. ORT is used for approximately 38% of all
The emergence of a new strain of cholera, V.Cholerae 0139, which also infects
people normally immune to cholera, greatly increases potential case numbers; this
development underlines the need for continuing efforts to strengthen training,
surveillance and other elements of CDD programs.
USAID supports CDD activities in over 53 countries.
International efforts have reduced the toll of child deaths due to dehydration
from four million each year to less than three million. Applied research,
increasingly effective programs, and greater involvement of private sector and community
organizations promise to extend the life-saving therapy to greater numbers of children.