Under-five Mortality Rate - U5MR
|Under-five mortality rate - (per 1,000 live
|Least Developed Countries
Infant Mortality Rate - IMR
|Infant mortality rate - (per 1,000
|Least Developed Countries
Use of Oral Rehydration Salts
to Control Diarrhoeal Diseases
Oral Rehydration Salts (ORS), a mixture of water, salts
and glucose in specific proportions, was developed in 1968 by researchers in Calcutta and
Dhaka as a treatment for cholera. The solution, as simple as a home remedy, was
found to be--and remains--the best way to rehydrate a child
suffering from diarrhoea.
It became the cornerstone of Oral Rehydration Therapy
(ORT), which emphasizes giving a child plenty of fluids--ORS and/or other appropriate
household fluids--along with continued feeding during the illness and increased feeding
for at least a week after.
Diarrhoea is the greatest single cause of child
deaths after pneumonia, responsible for 22.8 per cent of the deaths of children less than
five years old in developing countries in 1993, versus 26.9 per cent due to acute
It is estimated that the use of
ORT saves the lives of more than one million children yearly.
Percentage of Total Diarrhoea Cases Treated
|East Asia and the Pacific
|Middle East and North Africa
|Eastern and Southern Africa
|Americas and Caribbean
|West and Central Africa
For the 25th anniversary of ORT,
24 countries around the world held UNICEF-supported ORT/Child Health Weeks in 1993, to
educate families, mobilize media and NGOs and persuade professional associations to
promote the therapy. As a result, ORS use worldwide rose by 6 percentage points that year.
ORS Supply in Developing Countries, 1979-1992
|1979 - 80
|1981 - 82
|1983 - 84
|1985 - 86
|1987 - 88
|1989 - 90
|1991 - 92
It is estimated that 410 million packets
were produced in 1991 and 390 in 1992. The amount of this total production that was
supplied by UNICEF was 67 million packets in 1991, rising to 82 million packets in 1992.
UNICEF-supplied ORS accounted for three-quarters of the
ORS available in Africa in 1992. At the other extreme, UNICEF supplied only 1 per
cent of that available in South Asia.
From the beginning, UNICEF has encouraged the local
production of ORS. It is estimated that by 1992, two-thirds of the ORS supply was produced
locally, and that only 11.5 per cent of this, or 45 million packets, was prepared
according to the WHO/UNICEF recommended formula. Production was taking place in 60
developing countries as of the end of 1993.
Challenges: By The Year 2000
Achievement and maintenance of 80 per cent
ORT use and a halving of child deaths caused by diarrhoea.
In 1994, 57 per cent of diarrhoea cases worldwide were
treated with ORT, versus 17 per cent in 1986. Although this level of ORT use is
credited with saving one million child deaths per year, more than three million children
below age five continue to die annually from diarrhoeal dehydration.
Sustaining support for ORT use
The ORT use rate tends to drop off without social
mobilization efforts that continue until behavioural change is achieved and ORT becomes a
family habit. For instance, Egypt launched a campaign in 1988 and within two years, 96 per
cent of mothers had heard of ORT and the home usage rate was more than 50 per cent.
When lack of funding put an end to social mobilization,
ORT usage dropped to 34 per cent. The same happened in the Gambia, where a two-year
campaign boosted usage to 64 per cent, which fell to 11 per cent a year later. Not only
nations, but entire regions can thus lose ground.
Eastern and Southern Africa's 60 per cent 1994 use rate
actually represented a drop from the previous year's 64 per cent, and West and Central
Africa's 36 per cent in 1994 represented a drop from 38 per cent in 1993. In the Americas
and the Caribbean, the 1994 rate of 58 per cent was down from 65 per cent the previous
Overcoming obstacles to ORT/ORS posed by
Because it is so simple, many doctors and other health
providers are not convinced that ORT is a state-of-the-art treatment and fail to prescribe
it. Especially in the industrialized world--about 500 children in the US die of diarrhoeal
dehydration each year--hospitalization for intravenous therapy, which costs an average
US$2,300 versus the minimal costs of a packet of ORS, is the standard procedure.
Insurance companies do not reimburse for ORT, which is
also a very time-consuming therapy in the hospital, since the child must be held and fed
liquids for several hours.
Overcoming obstacles to ORT/ORS posed by drug
The World Health Organization has determined that
several types of drugs widely used in the industrialized world to treat diarrhoea are
ineffective or even dangerous. These include adsorbents and antimotility drugs, both of
which can stop the diarrhoea, sometimes at the risk of intestinal obstruction, but still
leave a child with the risk of dehydration. Even in developing countries, manufacturers
may have no financial incentive to produce such a simple product for commercial sale.
Overcoming obstacles to ORT/ORS by the
Parents must not only be aware of the existence of ORT,
but must also be taught how to use it. Because ORT stops dehydration, not the diarrhoea
that causes it, many parents believe that drugs are preferable. Information and
communication campaigns are necessary to dispel such misunderstandings as well as
mistaken, outmoded beliefs, such as that children should not be given food or water while
suffering from diarrhoea.
This can be pursued by multi-sectoral efforts to achieve
and maintain high levels of immunization, improve access to clean water and safe
sanitation, support breastfeeding and promote hygiene education.