Reflecting on 50 years of ORT

The August 18th issue of the Lancet reflected on 50 years of Oral Rehydration Therapy. Here are some interesting and selected extracts and thanks to The Health Information for All organisation for these…

…’50 years ago, the first study showing that an oral solution of glucose and electrolytes was effective for replacing water and electrolyte losses in cholera was published in The Lancet. The 4·6 million annual deaths from diarrhoea in children younger than 5 years estimated in 1980 has fallen to under 500 000 in 2018, despite a 70% increase in the world’s population. Although several factors contributed to this reduction, as of 2007 it was estimated that oral rehydration therapy (ORT) alone had prevented 54 million diarrhoeal deaths.’

…’In Haiti in 2010 and 2011 thousands of people died, especially early in the [cholera] outbreak, when neither ORT nor intravenous fluids were widely used.’

…COMMENT: The reduction in child mortality is a demonstration of how a very simple and inexpensive treatment can readily save lives. Such treatment does not depend on pharmaceutical preparations of oral rehydration solution such as Dioralyte. It can be provide through appropriate mixing of water, sugar and salt, which is (almost) always locally available. Deaths are so often caused not by lack of availability, but by lack of basic healthcare information. I learned this as a volunteer doctor in the Peruvian Andes back in 1987. One day, a mother carried her sick infant daughter many miles to my health post, but by the time they arrived, the child was dead. As we comforted her, we learned her story. The child had had diarrhoea for 3 days and her mother believed that she should withhold fluids. This is of course the exact opposite of what one should do: increase fluids to avoid dehydration. Tragically this mother’s false belief had unknowingly contributed to the child’s death. Worldwide, more than 2,000 children continue to die every day from diarrhoea, largely because they do not receive adequate fluids. So, while the reduction in deaths from dehydration can be celebrated, there is more to do. The same applies, of course, to the vast majority of avoidable deaths and suffering that are strongly associated with failure to provide appropriate life-saving interventions – interventions that are inexpensive and often locally available, but simply not provided in time.

CITATION: 50 years of oral rehydration therapy: the solution is still simple
David R Nalin & Richard A Cash
Lancet Vol 392, Issue 10147, p536-538, August 18, 2018
DOI:https://doi.org/10.1016/S0140-6736(18)31488-0

Our work with Save the Children in India and in Nigeria urges schools and teachers to ensure that children aged 8-14 learn and then share 12 essential messages linked to the prevention and control of Diarrhoea. Here are the list messages and note that one of these messages includes one about oral rehydration.

  1. Wash your hands properly: use water, a little soap. Rub for 20 seconds, rinse and air-dry.
  2. Wash your hands properly before touching the T-zone on your face (eyes, nose and mouth), as this is where germs enter the body. Avoid touching the T-zone when you can.
  3. Wash your hands at five critical times. a. After urinating or stooling b. After cleaning baby or helping someone who is ill c. After handling animals or garbage. d. Before preparing food e. Before eating or giving food to babies.
  4. Always use a toilet for poo and pee.  This will protect you and others from illness like diarrhoea.
  5. Food that helps you GO plus food that helps you GROW plus food that helps you GLOW is good food that keeps your body strong
  6. Breast milk is the only food and drink a baby needs from birth to 6 months. It has Go, Grow & Glow
  7. Eat enough Vitamin A in colourful fruit and vegetables like carrots and sweet potato. It makes our body strong and helps to fight disease. It improves eyesight and makes skin glow
  8. Millions of parents all over the world take their children to be immunised to make sure they are safe, strong and protected from diseases like measles and rotavirus.
  9. Prevent diarrhoea by breastfeeding babies, good hygiene habits, and immunisation and by making sure food and drinks are safe.
  10. Diarrhoea is dangerous because the loss of water and salts dehydrates and makes the body weak. Replace liquids to stop diarrhoea killing young children from dehydration.
  11. ORS stands for ‘Oral Rehydration Salts’. Find ORS at clinics & shops. Follow directions to mix it correctly with safe water to make the best drink for diarrhoea
  12. Zinc tablets and syrup stop diarrhoea sooner for children older than 6 months. Oral Rehydration Salts and safe drinks MUST be given as well.