Efficacy of oral rehydration therapy in dehydrating diarrhoea of children

Establishment of diarrhoea treatment and training units (DTTUs) in all major health facilities for promotion of appropriate oral rehydration therapy (ORT) is an important strategy for control of diarrhoeal diseases (CDD) in children in this country. Univariate analysis of mortality experiences of a random sample of 225 diarrhoea cases among children treated at DTTU in the department of paediatric medicine, RG Kar Medical College, Kolkata revealed that case fatality rate (CFR) of diarrhoea was much higher among children treated with parenteral fluid therapy with or without drugs (20.6% and 20.9% respectively), compared to those treated with oral rehydration solution (ORS) only (0.75%). Certain child care practices, like immunisation, breastfeeding and use of ORS at home also favourably influenced survival of children suffering from diarrhoea. The CFR of diarrhoea cases did not depend on type of diarrhoea or nutritional status of the child. Thus, promotion of correct practice of ORT merits attention through all possible means.     

Effect on clinical outcome of breast feeding during acute diarrhoea

The effects of oral rehydration fluid alone and of oral rehydration fluid plus breast feeding on the course and outcome of acute diarrhoea were assessed in two groups of 26 children aged under 2 years. Children who continued to be breast fed during treatment with oral rehydration solutions passed significantly fewer diarrhoeal stools. They also passed, on average, a smaller volume of diarrhoeal stools and recovered from diarrhoea sooner after the start of treatment. Their requirement for oral rehydration fluid was significantly reduced. Breast feeding exerts a beneficial effect on the course and outcome of acute diarrhoea by reducing the number and volume of diarrhoeal stools.     

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.     

History of the development of oral rehydration fluids

The development of oral rehydration fluid for the treatment of cholera and other diarrhoeal diseases has been regarded as one of the most important medical advances of the last century. This article summarises information on how this achievement was made possible. The development is traced from the historical empiric use of oral fluids for treating diarrhoea, to physiologic studies in animals that defined how glucose and sodium were coupled in absorption by the small intestine and finally, to the use of this knowledge in developing the simple effective solutions that were adopted by WHO as the mainstay of diarrhoeal therapy worldwide.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Oral rehydration fluids used in the treatment of diarrhoea. Analysis of the osmolalities, and sodium, potassium and sugar contents of commercial and home-made products

Analysis of 91 commercial dietary "clear" fluids, including carbonated beverages, cordials, powdered drinks, jellies, fruit juices, fruit juice drinks, syrups, and soups showed a range of zero to 175 mmol/L of sodium, zero to 52.1 mmol/L of potassium, zero to 839 mmol/L of reducing sugars and an osmolality of 50 to 914 mmol/kg water. Home-made oral rehydration solutions prepared by a group of mothers and medical staff members also showed unacceptably wide variability in their composition. The composition of products specifically indicated for the treatment of diarrhoea was also remarkably diverse, with a range of 24 to 100 mmol/L of sodium, 14.2 to 21.0 mmol/L of potassium, 45 to 326 mmol/L of glucose, and 170 to 460 mmol/kg water osmolality. On the basis of our current knowledge of water and electrolyte absorption, neither the commercial dietary "clear" fluids nor the home-made solutions can be recommended for the treatment of diarrhoea. Of the therapeutic products, only "Unicef Oral Rehydration Salts" has been subjected to clinical trails and found safe and effective. However, the formulation of Diolyte appears appropriate for the treatment of mild diarrhoeal dehydration.     

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.     

Hypernatraemic dehydration after Lucozade.

OBJECTIVE: To emphasise the dangers of inappropriate rehydration fluids in the treatment of gastroenteritis. CLINICAL FEATURES: A two-year-old girl was admitted to hospital in shock and unconscious. She had a 36-hour history of diarrhoeal illness and had received Lucozade. Therapy with this hypertonic fluid resulted in worsening diarrhoea and seizures. On examination she had hypernatraemic dehydration and decorticate posturing. INTERVENTION AND OUTCOME: An intravenous line was inserted, stable plasma protein solution was given, and she was admitted to the intensive care unit. Anticonvulsant and antibiotic therapy were begun. Significant neurological impairment was still evident after 14 days, at which time shw was discharged from hospital. Six months later she had made a good recovery, with no persisting neurological deficit. CONCLUSION: The inappropriate use of hypertonic fluids in gastroenteritis may be associated with significant electrolyte imbalances and neurological sequelae.     

5岁以下儿童补充维生素A对预防死亡、疾病及失明的系统回顾和荟萃分析

目的研究补充维生素A与6个月至5岁儿童死亡率和发病率的减少是否相关。方法系统回顾和荟萃分析,由2名研究者独立筛选文献,数据经双方提取,不同点通过讨论解决,主要进行死亡、疾病、视力及副作用的荟萃分析。数据来源于Cochrane中心注册的对照研究,包括Cochrane图书馆、Medline、Embase、GlobalHealth、Latin American和Caribbean HealthSciences,metaRegister of Controlled Trials和African Index Medicus。数据检索至2010年4月前已发表或待发表的各种语言的文献。入选标准为对口服合成维生素A的6个月至5岁儿童的随机对照研究,研究儿童患有疾病（包括腹泻、麻疹及HIV）,排除住院以及食物强化或B胡萝卜素儿童。结果包括215633名儿童的43项研究人选。其中17项研究（194483名儿童）显示全因死亡率减少了24％,其比值比为0．76,95％可信区间（95％CI）0．69～0．83。7项研究报道与腹泻相关的死亡率减少了28％,其比值比为0．72（95％C10．57—0．91）。维生素A的补充与腹泻减少的比值比为0．85（95％C10．82—0．87）、与麻疹、视力问题包括夜盲和眼球干燥症减少的比值比分别为0．50（95％C10．37—0．67）、0．32（95％C10．21～0．50）和0．31（95％C10．22—0．45）。3项研究报道在补充维生素A的48小时内呕吐增加的风险为2．75（95％CI1．81～4．19）。结论补充维生素A在一定范围内与儿童的死亡率、发病率及视力问题的大幅减少有关,且这一结论不能由偏倚来解释。在6个月至59个月的儿童中已无需进行补充维生素A的安慰剂对照研究,但是有必要进一步比较不同剂量和不同给药方式（如强化）的区别。就目前得到的数据而言,所有可能缺乏维生素A的儿童均应得到补充,尤其是中低收入的国家。     

Oral hydration therapy for children in Florida.

Eighty-six children in Florida died of complications associated with diarrhea between 1985 and 1990, deaths which constituted an important preventable fraction of infant mortality. The state will support health professionals in reducing the number of hospitalizations and deaths due to diarrheal complications, Governor Lawton Chiles announced in September 1991, and the Florida Department of Health and Rehabilitative Services is being awarded a $100,000 grant from the Centers for Disease Control for a three-year study on the effectiveness and utilization of oral rehydration therapy. During the last 20 years, a worldwide experience has developed indicating that sodium-glucose cotransport is preserved in both secretory diarrhea (cholera) and diarrhea produced by loss of surface area. This experience indicates that almost no one would die (adult or infant) if oral rehydration solutions and someone with knowledge in their use were readily available. This presentation has three objectives: (1) increase physicians' awareness regarding the state's oral rehydration therapy project; (2) provide a ready practical guide for those using oral rehydration therapy; and (3) promote use of the therapy as treatment for infantile dehydration rather than the more expensive intravenous therapy.     

Demography and causes of death among the Huli in the Tari Basin

Monthly demographic surveillance by local reporters was continuous in the Tari Basin from 1971 until 1995 and cause of death was determined primarily by verbal autopsy. In 1982 the de jure population was 26,500, 15% aged less than 5 years. Crude birth rate was 34/1000/annum in 1980-1984; from 1977 to 1983 crude mortality rate was 15/1000/annum and life expectancy at birth 50 years. Infant mortality fell from 160 in the 1920s to 72/1000 livebirths in the 1970s, the greatest decline occurring between 1952 and 1971 when antibiotics became widely available. Respiratory disease (particularly chronic lung disease in adults) accounted for 39% of all deaths, and pneumonia for 50% and 33% of infant and toddler deaths respectively. Very few deaths from pigbel have occurred since the introduction of pigbel vaccine. Initially childhood mortality from diarrhoea declined following introduction of an oral rehydration program but subsequently rose when medical attention was no longer sought and children were inadequately treated at home. The higher mortality in the lower-lying Iumu area was attributed to malaria. Since the opening of the Highlands Highway in 1981, there has been a dramatic increase in short-term movement of both men and women in and out of Tari resulting in increased incidence of sexually transmitted diseases and viral infections such as measles. If restored, the Tari Research Unit could continue to play a key role in assisting the Department of Health in making decisions on appropriate interventions to improve the quality of life of Papua New Guineans.     

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.     

2. Acute infectious diarrhoea and dehydration in children

Gastroenteritis in children is still a common reason for consulting a general practitioner and for hospital admission. Rotavirus is the most common cause of gastroenteritis in children and accounts for half of all hospital admissions for severe acute infectious diarrhoea. Most children with gastroenteritis do not develop dehydration and can be treated at home. Children with mild to moderate dehydration should be treated with low osmolarity oral rehydration solutions, and those with severe dehydration or shock need to be admitted for administration of intravenous fluids. Lactose-free feeds should not be routinely used after acute gastroenteritis, but there is some evidence that a lactose-free diet may reduce the duration of diarrhoea. Antimotility drugs are rarely indicated in children with gastroenteritis, as the potential risks outweigh the benefits. The development of a rotavirus vaccine would provide huge public health benefits and cost savings. Other preventive strategies include educating people about personal and food hygiene and encouraging breastfeeding.