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Oral Rehydration Therapy: A Solution for Survival

Twenty-five years ago, researchers appalled by the deaths of millions of babies every year from diarrhoeal dehydration found that the best way to counter the deadly effects of diarrhoea was nothing more than a mixture of glucose, salts and clean water.

It was such an ingenious, inexpensive solution the The Lancet, the leading British medical journal, called oral rehydration therapy (ORT) "potentially the most important medical advance of the century."

The oral rehydration salts (ORS) that go to make up a litre of the solution cost 10 US cents a packet.The secret of ORS is mixing water, salts and sugar in the right amounts, thus making a powerful corrective to the chemical imbalance created by diarrhoea. ORS is excellent for preventing as well as treating dehydration.


 

THE BIRTH OF ORT

There have long been attempts to prevent diarrhoea from taking its deadly toll among the young. Sushutra, an Ayurvedic pioneer in Indian traditional medicine, was on the right track 3,000 years ago when he prescribed a mixture of tepid water, rock salt and molasses for cholera victims, although he had the wrong proportions.
 
With intravenous (I.V.) rehydration, the medical profession thought it had the answer, and I.V. became the dehydration treatment of choice. Strict fasting was also recommended.

Brochure: UNICEF


Then in 1971, a team led by Dr. Dilip Mahalanabis of Calcutta's Johns Hopkins Center for Medical Research accomplished a near miracle among victims of advanced cholera in a camp for refugees from the war in East Pakistan (now Bangladesh).

Only 3.6 per cent of the 3,700 patients treated with ORS died. The Indian team had proved that, taken orally, ORS is transported with great speed through the walls and membranes of the small intestine. The high glucose content of ORS replaced the fluids, salts, electrolytes and potassium flushed out by diarrhoea.
 

OBSTACLES TO ORT USE

It is an erroneous belief that because I.V. treatment costs more, it is better. A study among babies treated for severe diarrhoea at Chicago Children's Memorial Hospital showed that I.V. costs an average of US$2,299.50 per infant, compared to US$272.78 for each baby treated exclusively with ORT.

The study did not show that intravenous rehydration was better. Yet every year, 600 children in the United States, who could have been saved with ORT and correct management, die from diarrhoeal dehydration.

"In spite of our knowledge, an enormous gap still exists - 25 years after its discovery - between the availability of ORS and its actual application."

- UNICEF Executive Director James P. Grant

The US, where 16.5 million children suffer from diarrhoea every year, spends US$1 billion a year on I.V. rehydration for 300,000 children hospitalized for diarrhoeal episodes.

Dr. Julius Goepp of Johns Hopkins University, who is among medical practitioners trying to promote ORT in the US, often quotes physicians as saying: "I like ORT but I don't get reimbursed for giving it. So I use I.V. treatment."

ORT also requires hospitals to change their attitude towards parents. Hospitals prefer I.V. treatment, because ORT entails holding the child and feeding the child fluids for several hours, something mothers may cherish but hospital staff do not. I.V. does not require hands-on attention from busy professionals.

Another obstacle is resistance to change. ORT has received seals of approval from pediatric academies and societies around the world, but many hospitals and physicians are reluctant to prescribe ORT. Although ORT is 'low-cost', it is not 'no-cost' --- and adequate resources are not made available for nationwide programmes.

Also, families need to gain the knowledge and ability to act promptly and correctly.

Every family should be taught that even a child with the worst kind of diarrhoea,   including cholera, can be saved by giving plenty of fluids, continuing feeding and knowing when to seek further help.

 

Diarrhoea: Cause and effect

Diarrhoea is caused by bacteria or viruses. The key factors are unclean water, dirty hands at mealtime and spoilt food. Children who are malnourished suffer much more; in turn, diarrhoea weakens children and makes them more malnourished. There is always some degree of dehydration, and, most often, the draining of too much fluid from the body is the cause of death.

Diarrhoea can be prevented through exclusive breast-feeding, improved weaning practices, measles immunization, use of latrines, washing hands (the baby's as well), keeping water and food clean, washing with soap before touching food and by sanitary disposal of stools.

 

THE CHALLENGE

Only 38% of diarrhoeal dehydration sufferers are treated with ORT. The 1990 World Summit for Children set 27 major health and development goals for children to be achieved by the year 2000, including a 50 % reduction in deaths due to diarrhoea in children under five and a 25% reduction in the diarrhoea incidence rate. A priority is to increase the proportion of patients receiving ORT and continued feeding to 80% by end of 1995.

To achieve these goals:

  • ORT should be made "a family habit" through communication, social mobilization and information;
  • Health providers should prescribe ORS and promote ORT for every case of diarrhoea, advise parents and give correct treatment for all types of diarrhoea;
  • All health facilities -- private and public -- should be strengthened with skilled personnel and adequate drugs;
  • preventive measures should be taken.

UNICEF, the World Health Organization, the Rockefeller Foundation, the United States Agency for International Development, Junior Chamber International, The Hunger Project and the US Centers for Disease Control and Prevention have mobilized behind these goals and placed them at the top of their agendas. The Boy Scouts have pledged their participation. The coalition of there forces promises a good beginning. But they cannot do it alone.

 

WHAT IS AT STAKE

Oral rehydration therapy(ORT) saves the lives of more than a million children a year , but much remains to be done to make it accepted universally as the standard treatment and prevention of choice for all types of diarrhoea.

This year, 3 million babies will die of dehydration caused by diarrhoea -- that is 57,000 a week, 8,000 a day, six every minute. A sustained effort to make ORT the standard in every corner of the world can thus potentially save some 19 million children before the end of the decade -- 7.4 million in Africa and the Middle East, 10 million in Asia and 1.6 million in the Americas.

What decision makers can do:

  • Disseminate information on the problem, and the solution, to ensure sustained political commitment and adequate resource allocation;
  • Support the creation of a social movement to make ORT a family habit;
  • Create an alliance of governmental and non-governmental bodies to teach correct ORT procedures to families;
  • Ensure that families are taught the importance of the three Fs -- fluids, feeding and further help -- when children are having diarrhoeal attacks;
  • Ensure that there is one ORS dispensing depot within walking distance for every 1,000 families;
  • Increase the output of ORS packets from 500 million to 1 billion globally;
  • Speak out in favour of ORT;
  • Ask education ministers to mobilize teachers to talk about ORT in the classroom.

 

What communicators can do:

  • point out that one of this century's most important medical breakthroughs has been largely underreported and underappreciated;
  • report that most diarrhoea medications are useless or harmful, that only in a small number of cases are antibiotics or antimoebics the correct treatment, and that, other than ORS, medicine should be used only if prescribed by a doctor or nurse;
  • broadcast television reports on the worldwide ORS programme to save more lives than did penicillin;
  • assign reporters to investigate the obstacles to ORT use in their countries;
  • use the media to promote ORT as the best scientific option for the prevention and treatment of diarrhoeal dehydration.

 

How to influence the medical profession:

  • distribute leaflets reiterating that I.V. treatment is eight times as expensive as ORT;
  • promote the fact recognized by modern doctors that ORT is the most scientific and cost-effective option;
  • rally around other voices from the medical profession that endorse and reaffirm ORT.

There are doctors, nurses and pharmacists who fail to advise parents about ORT. THIS IS NOT RIGHT. All doctors, nurses and pharmacists must recommend ORS for every case of diarrhoea. When they fail to do so, it is because they have not kept up with the research about ORT or are wary of new treatments that were not taught when they were in medical school. In some countries, medical school started teaching about ORT only a few years ago.

A firm proponent of ORT, Dr. David Bratt, a pediatrician at the General Hospital in Port of Spain (Trinidad and Tobago), says: "The major problem today is the attitude of most of the general practitioners. Invariably, these doctors over prescribe antibiotics, antidiarrhoeals, anti-emetics and antispasmodics for diarrhoea. Invariably, no information on rehydration is given."

 

BRINGING ORT HOME TO THE WORLD

PERU
In 1991, more than a quarter of m million Peruvians came down with acute diarrhoea during a cholera epidemic that swept across the nation. Less than 1 per cent died because 3 million packets of ORS were distributed and administered by a group of community workers with knowledge of ORT who trained others on the spot.

MEXICO
President Carlos Salinas de Gortari has launched a national programme to make ORT a family habit and to implement several measures to control diarrhoeal diseases. Already 86 per cent of mothers know how to prepare and administer ORT correctly. Through their 'white flag' project, thousands of mothers and fathers are taught life skills, including ORT. When everyone in a community is educated, a white flag is hoisted.

EGYPT
The Government fully supports the programme, and four out of five mothers use ORT at home. ORT is used in more than half of all cases of infants and young children suffering from diarrhoea. The National Control of Diarrhoeal Disease Project, chaired by the Minister of Health and aided by distinguished public health academics, is one of the most successful in the world, credited with saving at least 1 million children's lives.

BANGLADESH
Bangladesh is now geared up to implement a nationwide programme. A tremendous change is promised by a powerful partnership between NGOs --- Boy Scouts, Girl Guides, The Hunger Project, Junior Chamber International and the Bangladesh Rural Advancement Committee (BRAC)-- - combined with measures to strengthen health facilities.

SOUTH ASIA
All countries have started programmes to bring ORT to individual homes, and to administer it through health facilities.

LATIN AMERICA
Almost all countries have drawn up plans for promotion of ORT and control of diarrhoeal diseases. A second phase will bring basic sanitary improvements and clean water all municipalities.

AFRICA
Most countries are in various stages of bringing ORT into every home. Plans are under way for nationwide programmes.

February 1994


 

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updated: 02 August, 2013
 

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