Knowledge and use of oral rehydration therapy for childhood diarrhoea in Tumpat District

A community based study was conducted on the understanding and knowledge of childhood diarrhoea and use of oral rehydration therapy (ORT), in four selected villages in Tumpat District, Kelantan. The calculated annual incidence of diarrhoeal disease in children aged 0 to four years in all study villages was 1.38 episodes for each child. The main care-givers of children aged 0 to four years were interviewed and asked to demonstrate how to mix a standard ORS (oral rehydration solution) sachet if they had previously used ORT. Forty percent of care-givers had heard of the locally available ORT and 30% had actually used ORT. Of those who had heard of or used ORT, 10% had good knowledge of what it was and what it was used for, 51% had some knowledge and 39% had either no knowledge or inaccurate knowledge. Of care-givers who had previously used ORT only 20.5% demonstrated the correct volume of water to add to one sachet of ORT, but 82% would discard an unused solution within 24 hours. Significantly more literate women had used ORT than those not literate (p = 0.002). Mothers, particularly those literate, are the primary target group for ORT intervention strategies. Components of health education should include advice on what ORS is, what it is used for, and how to correctly mix a standard sachet.     

Management of acute childhood diarrhoea with oral rehydration therapy at Kenyatta National Hospital, Nairobi, Kenya

A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute diarrhea was conducted between 1982-1983 to determine the benefits of oral rehydration therapy (ORT) in treatment of diarrheal illness. At admission, specimens of stool, blood and urine were collected and examine for bacterial, parasitic, and viral agents (including malaria), serum electrolytes, urea, white cell counts and hematocrit. Children were started on oral rehydration solution (ORS) unless severly dehydrated, in which case intravenous therapy was initiated. 84% of the children were successfully treated with ORS alone regardless of etiological agent found; 15% required IV therapy initially, then were placed on ORS. Average hospital stay was 56.2 hours. Cost of treatment by ORT is less than 20% the cost of IV therapy. When investigators surveyed other health institutions, they found that ORT was used alone in less than 10% of all children seen with diarrhea. A side benefit of ORT is the utilization of mothers in preparation and administration of solution, reducing the demand on hospital staff. Since 20% of all pediatric admissions at Kenyatta are due to acute diarrheal disease, use of ORT would reduce costs tremendously. Initiation of ORT at home may prevent development of dehydration altogether.     

Oral rehydration therapy

This paper discusses the use of oral rehydration therapy (ORT) in the clinical management of diarrhea with no dehydration, diarrhea with some dehydration, and diarrhea with severe dehydration. The 1st step in ORT is to weigh the patient and assess the degree of dehydration. It should be recognized that a child who has had 4 loose stools in the past 24 hours and is thirsty has some degree of dehydration, and ORT should start as soon as possible. If the child has no signs of dehydration, the mother should be given 3 instructions for treating diarrhea at home: 1) give the child more fluids more often; 2) continue to breastfeed; and 3) return the child to the clinic if he develops signs of dehydration, if the diarrhea gets worse, or if he is not better after 2 days. If a child has 2 or more of the signs of some dehydration (4-10 loose stools/day, more than a little vomiting, thirstiness, and less urine than usual), he should be rehydrated with oral rehydration solution (ORS). If available, the World Health Organization ORS packets should be used. After the child has been given 10-20 ml/kg of ORS each hour for 4 hours, the hydration should be reassessed. ORS should be given for each loose stool. If the child has 2 or more of the signs of severe dehydration (more than 10 loose stools/day, much vomiting, inability to drink fluids, and no urine for 6 hours), intravenous rehydration is necessary. A major problem with use of ORS is the time involved to explain the process to parents. Parents must understand that ORS does not treat the diarrhea per se; rather, it replaces fluids and salts lost by the child and prevents dehydration. If parents do not understand this, they may become discouraged if the diarrhea continues and stop ORT. ORT is as effective in treating adults with diarrhea as it is in children. In addition, ORT is just as good as intravenous rehydration, except in cases where the dehydration is severe.     

Role of oral rehydration therapy in controlling epidemic of cholera and watery diarrhoea

Oral rehydration therapy (ORT) is basically oral administration of liquid containing various electrolytes in specific proportions to prevent and treat dehydration. This treatment facilitates safe and optimal absorption of water and essential electrolytes such as sodium chloride, sodium bicarbonate and potassium chloride in dehydrated patients. Successful ORT was experienced in cholera patients in Kolkata and Dhaka which was followed by the development of oral rehydration salt (ORS). This procedure can be safely implemented at home. ORT reduced mortality rate both in cholera and non-cholera watery diarrhoea. The various health authorities must support preparedness before pre-positioning of adequate stocks of ORS packets for emergency situations. Health workers should have been the knowledge to prepare ORS solutions.     

Oral rehydration therapy with particular reference to super ORS

An improved solution of glucose and three salts (ORS) is an elegant and deceptively simple treatment technology to prevent or treat dehydration from diarrhoea. There are many types of formulation tested earlier. First generation improved ORS trials, cereal-based ORS formulations, rice-based ORS trials, glucose-ORS with reduced osmolarity are summarised in the article to have a look of every pros and cons of oral rehydration therapy (ORT). Since the adoption of ORT, estimates of deaths due to diarrhoea in children below 5 years of age have fallen dramatically from 4.6 million in 1980 to 1.8 million in the year 2000.     

Acute diarrhoeal diseases--an approach to management

Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatmentof diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.     

小儿口服补液盐(ORS)的临床应用及配制方法

目的 :腹泻的主要危害是引起患儿的脱水、电解质紊乱而死亡。 2 0多年来WHO和UNICEF一直主张并推广临床采取口服补液盐 (oralrehydrationsalts简称ORS)进行口服补液盐疗法 (oralrehydrationtherapy简称ORT)来防治腹泻引起的脱水。方法 :通过我科 2 0 0 1年至 2 0 0 3年门诊日志 14 6例小儿腹泻 (轻型 4 4例 ,中型 10 2例 )接受ORT的使用后 ,均在短时间内恢复健康。结果 :临床上进一步扩大ORT的使用后 ,有效地减少了腹泻死亡的危险性 ,对改善儿童健康状况起到了重要作用。     

Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala,Cameroon

Introduction

The use of oral rehydration solutions in our context remains limited. This study was conducted to analyze the rate of this use in Douala, Cameroon and thereby determine the factors associated with it.

Method

A cross-sectional survey was administered to parents of children aged five years and younger during a six-month study period. The studied variables focused on the socio-demographic data of the population, data on diarrhoea and its severity, data on oral rehydration salts (ORS), and data related to other interventions for diarrhoea. The chi-square test was used to qualify associations between variables, with the significance level being set at 5%.

Results

Overall, 672 people agreed to participate in the study. Among them, 418 (62.2%) correctly defined diarrhoea. When their children develop diarrhoea, the majority of the parents (348, 51.8%) reported seeking hospital assistance before any intervention, while 225 parents (33.5%) preferred the use of ORS first. Four hundred seventy-five parents (70.7%) had heard of ORS and among them 313 (65.9%) had actually given ORS to their children as treatment during these children''s most recent episodes of diarrhoea. Of the parents who had given their children ORS, 217 (69.3%) knew how to prepare it, and 122 (39.0%) knew how to administer it. One hundred thirty-five parents (20.1%) had administered metronidazole to treat their children''s diarrhoea. The age of the children, the parents'' level of education, and the number of children in the household significantly influenced the use or non-use of ORS (respectively, p < 0.001, p = 0.003 and p < 0.0001). Rehydration was correctly identified by 234 parents (34.8%) as the purpose of administering ORS.

Conclusion

The knowledge and the use of ORS in diarrhoea by the study sample was insufficient. The role of ORS was poorly known. Awareness campaigns can be carried out in order to improve the use of this effective intervention for diarrhoea.     

Comparative study of rice-based oral rehydration salt solution versus glucose-based oral rehydration salt solution (WHO) in children with acute dehydrating diarrhoea.

One hundred children with acute dehydrating diarrhoea were studied. They were divided into two groups: Group A (n = 50) were given rice-based oral rehydration salt (ORS) solution and group B (n = 50) were given glucose-based ORS solution (WHO). There was no significant decrease in mean stool output and percentage weight gain with rice-based ORS. Both the groups were comparable for volume of ORS solution consumed, time taken for initial rehydration, mean stool output and for correcting biochemical abnormalities.     

Evolution in the recommendations for oral rehydration therapy according to World Health Organisation guidelines: where to go from here?

Guidelines on the use of oral rehydration salts (ORS) have been revised over the years based on evidence from research studies and clinical experience. This paper charts the evolution in oral rehydration therapy (ORT) in the context of World Health Organisation (WHO) recommendations. Diarrhoeal disease case management, with ORT as its cornerstone, has had tremendous success in terms of implementation and outcome. To further decrease global diarrhoeal morbidity and mortality, there should be increased efforts to accelerate the introduction of safe, effective, and affordable against diarrhoeal pathogens such as cholera and rotavirus.     

Future challenges in communication for promoting ORT--an overview

Oral rehydration therapy (ORT) is a cheap and simple intervention aimed to prevent mortality and morbidity associated with dehydration due to diarrhoea. ORT promotion strategies through programme communication, social mobilisation and social marketing, and advocacy efforts have yielded substantial improvement in the scenario. However, it has also taught us lessons and suggested changes in communication strategies to make the promotion efforts more effective in future.     

儿童急性腹泻辅助治疗的研究进展

急性腹泻的主要病原体包括细菌、病毒、寄生虫等,它是发展中国家导致儿童死亡的第二原因,占5岁以下儿童死亡率18％.2004年估计有150万儿童死于腹泻,2岁以内儿童腹泻死亡占80％.急性腹泻的治疗目标是防止脱水和营养丢失,并减少腹泻的持续时间和严重程度.世界卫生组织建议使用口服与补液结合的治疗方法.世界胃肠病组织治疗指南认为使用消旋卡多曲可以减少粪便排泄量.推荐的治疗方案是提供口服补液和继续喂养.口服补液有效地减轻脱水,微量营养和益生菌辅助治疗以及止泻剂的应用具有临床治疗效果.本文主要介绍儿童急性腹泻的病原学、流行病学以及辅助治疗的研究进展,为改善及治疗儿童急性腹泻提供参考依据.     

Study on efficacy of WHO-ORS in malnourished children with acute dehydrating diarrhoea

Twenty-five well nourished children (group A) and 25 malnourished children (group B) of acute diarrhoea with some dehydration were taken up for the study. Both the groups were given World Health Organisation-oral rehydration solution (WHO-ORS) as per WHO guidelines. In both the groups, isonatraemic dehydration was the commonest (group A 64%, group B 56%). Hypokalaemia was noted in 32% cases in group A and 60% cases in group B. Oral rehydration therapy (ORT) was successful in 92% cases in well nourished group A cases and in 80% in group B cases. The mean time in hours required for hydration (group A 8.1+/-1.6; group B 9.1+/-1.4; p<0.05) and hospital stay in days (group A 1.6+/-0.9; group B 3.2+/-3.3; p<0.05) were longer in group B.     

口服补液治疗小儿急性腹泻的临床观察

目的：比较口服补液盐与米汁在小儿急性腹泻的临床疗效。方法：60名急性腹泻患儿随机分为2组．在两组均予抗病毒及思密达治疗的同时，A组加服口服补液盐（ORS），B组予米汁。结果：24h后A组93．3％的患儿纠正了脱水，B组为73．3％；72h后疗效比较B组大便次数减少优于A组，差异均有统计学意义。结论：ORS对小儿急性腹泻轻、中度脱水的治疗优于传统的米汁，而米汁较ORS更能有效的减少大便次数。     

消旋卡多曲治疗婴幼儿中重型急性水样腹泻

目的探讨消旋卡多曲治疗婴幼儿中、重型急性水样腹泻的疗效和安全性。方法选择符合条件的3～36个月的中、重型急性水样腹泻患儿共78例,按随机编号分别给予消旋卡多曲和安慰剂,医生和家长均不知何种治疗方案。记录治疗期间患儿腹泻次数、ORS摄入量、静脉补液量、脱水纠正时间。治疗72h时判定疗效。结果共有73例患儿完成本实验,破盲分析,治疗组大便次数、摄入ORS量、静脉补液量、脱水纠正时间均明显低于对照组(P<0.01)。治疗组总有效率88.9%,显著高于对照组的64.9%(P<0.05)。结论消旋卡多曲治疗婴幼儿中、重型急性水样腹泻能明显减少患儿大便次数,降低ORS和静脉补液量,迅速纠正脱水,且未发现与药物有关的不良反应,安全性高。     

Progress in the prevention and control of diarrhoeal diseases since Independence

Acute diarrhoeal diseases constitute one of the major health problems among young children in India. It was estimated in 1978 that 1.5 million children under the age of 5 years die due to diarrhoea every year, which declined to 0.6-0.7 million in the estimate revised in 1992. A similar declining trend has also been noted in hospitalized cases in Calcutta (present Kolkata) during 1980-95 as well as from other parts of India. Even today, cholera epidemics occur regularly in India. The cholera epidemic caused by a novel strain of Vibrio cholerae, designated as V. cholerae 0139 Bengal in 1992 and multidrug-resistant shigellosis in eastern India in 1984 are matters of grave concern. The launching of the National Diarrhoeal Diseases Control Programme (CDD) in 1978, based on a three-tier approach, is of great importance. The rate of use of oral rehydration salt (ORS) solution and oral rehydration therapy (ORT) remain suboptimal in India. In spite of the launching of the 'Ganga Action Plan' and the 'National River Action Plan', India faces a major problem of diarrhoeal diseases. Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta and poor personal hygiene help to perpetuate and spread diarrhoeal diseases in India. Since diarrhoeal diseases are caused by 20-25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible. However, as the majority of childhood diarrhoeas are caused by V. cholerae, Shigellae dysenteriae type 1, rotavirus and enterotoxigenic Escherichia coli (E. coli) which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrhoeal diseases in India, a formidable task in a country with a population of over 1 billion.     

消旋卡多曲治疗婴幼儿中重型急性水样腹泻

目的探讨消旋卡多曲治疗婴幼儿中、重型急性水样腹泻的疗效和安全眭。方法选择符合条件的3—36个月的中、重型急性水样腹泻患儿共78例，按随机编号分别给予消旋卡多曲和安慰剂，医生和家长均不知何种治疗方案。记录治疗期间患儿腹泻次数、ORS摄入量、静脉补液量、脱水纠正时间。治疗72h时判定疗效。结果共有73例患儿完成本实验，破盲分析，治疗组大便次数、摄入ORS量、静脉补液量、脱水纠正时间均明显低于对照组（P〈0．01）。治疗组总有效率88．9％，显著高于对照组的64．9％（P〈0．05）。结论消旋卡多曲治疗婴幼儿中、重型急性水样腹泻能明显减少患儿大便次数，降低ORS和静脉补液量，迅速纠正脱水，且未发现与药物有关的不良反应，安全性高。     

Economic barriers to the use of oral rehydration therapy. A case report

Diarrheal dehydration is a highly prevalent condition among young children and is readily prevented and treated with oral rehydration therapy. We report a death due to hypernatremic dehydration caused by rotavirus diarrhea of a 9-month-old infant whose mother attempted to purchase oral glucose-electrolyte solution in a pharmacy but was unable to afford it. While efforts such as the National ORT Project should help to promote the proper at-home treatment of this condition, we conclude that oral rehydration therapy will not be used optimally by the parents of children living in poverty until the economic barriers to its use are removed.     

喜炎平联合思连康治疗小儿轮状病毒腹泻临床观察

目的观察喜炎平联合思连康治疗小儿轮状病毒腹泻的疗效。方法将140例秋季腹泻患儿随机分成治疗组70例和对照组70例。对照组应用思密达及利巴韦林,口服ORS,并卧床休息,合理饮食,有严重脱水者给予静脉补液。治疗组加用喜炎平联合思连康治疗。结果治疗组在止泻时间上明显小于对照组,经统计学处理P0.01,差异有显著性。治疗组在总有效率方面同对照组比较差异有非常显著的意义(P0.01)。结论喜炎平联合思连康治疗小儿轮状病毒腹泻疗效显著,安全性好,值得临床推广应用。     

Honey in the treatment of infantile gastroenteritis

A clinical study was undertaken using honey in oral rehydration solution in infants and children with gastroenteritis. The aim was to evaluate the influence of honey on the duration of acute diarrhoea and its value as a glucose substitute in oral rehydration. The results showed that honey shortens the duration of bacterial diarrhoea, does not prolong the duration of non-bacterial diarrhoea, and may safely be used as a substitute for glucose in an oral rehydration solution containing electrolytes. The correct dilution of honey, as well as the presence of electrolytes in the oral rehydration solution, however, must be maintained.