Celebrating 25 Years of Oral Rehydration Therapy

Brochure: BASICS Project

"A quarter-century after it was introduced to the world, oral rehydration therapy (ORT) is now saving over 1 million young lives a year."

The State of the World's Children 1994, UNICEF Twenty five years ago, U. S. funded research culminated in the successful studies which launched ORT as we know it today. Since then, the U.S. Agency for International Development (USAID) has been a leading partner in the global effort to meet the challenge of Child Survival.As one of the "twin engines" of USAID's Child Survival program, ORT brings together scientific research and cost-effective public health approaches to make a profound difference in the lives of children and their families and communities.

ORT: 25 Years of Saving Lives

Late 1950s-early 1960s
Basic scientific research uncovers the interactive mechanism of salt and sugar in the intestine. Clinicians raise possibility that this physiologic principle could be applied to fluid loss in cholera.
1968-69
Researchers from U.S. government-funded institutes in Dhaka (CRL) and Calcutta (ICMRT) publish reports of successful oral rehydration solution (ORS) use for adult cholera patients in clinical trials.


1968-71
First large scale ORT clinical trial at field hospital, Matlab, Bangladesh

Effective use of ORT demonstrated in children with cholera, and adults and children with non-cholera diarrheas.


1970
First demonstration that addition of an amino acid (glycine) to glucose can enhance fluid absorption and decrease stool loss in cholera.


1971
First mass use of ORT in crowded refugee camps during epidemic cholera outbreaks yields significantly lower mortality than in other camps using only limited supplies of intravenous fluids.

ORT studies in the White Mountain Apache Nation, the first on United States soil, show ORT can be used for infants as young as one month, and that feeding early in the course of diarrhea treatment is not harmful. Evidence that feeding plus fluids enhances nutritional outcome is solidified in field trials in the Philippines, Turkey, and Iran in the mid-70s.

Cholera hits west coast of Africa and spreads throughout the continent after decades-long absence.


1975
UNICEF and WHO agree to single formula rehydration solution regardless of patient age or cause of diarrhea; UNICEF begins procurement and distribution of standard ORS packets.


1977
Studies at CRL and in Costa Rica provide definitive proof that rotavirus, a common agent of childhood diarrhea and severe dehydration, can be effectively treated with ORT.


1978
The British scientific journal The Lancet calls the "discovery that sodium transport and glucose transport are coupled in the small intestine so that glucose accelerates absorption of solute and water ... potentially the most important medical advance this century." - August 5, 1978

International resolution of the World Health Assembly calls for systematic attack on diarrheal diseases and leads to multidonor effort, including WHO, USAID, UNICEF, and UNDP; World Health Organization Diarrheal Disease Control Programme (WHO/CDD) is created.


1979
CRL is reorganized as a multidonor center - the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) with USAID as the largest donor. Researchers work to improve ORS formulation for better nutritional outcome of rehydration.


1980
Controlled study in Egypt is first to demonstrate a reduction in mortality when ORT is used at the clinic and community levels.


1982
ICDDR,B and ICMRT successfully treat patients with cereal-based ORS.


1980-85
USAID funds pilot ORT programs. In Egypt, strong national political and financial commitment combine for a substantial impact on childhood diarrhea mortality. Results in Honduras and The Gambia attest to the potential of mass media and communication to increase home ORT use. However, the difficulty sustaining gains demonstrates the need for long-term commitments.

USAID commits major resources for diarrheal disease control (CDD) through a series of technical support and research projects. USAID's total CDD funding for 1985-93 is $332 million.


1983
USAID funds first International Conference on Oral Rehydration Therapy (ICORT I) in cooperation with ICDDR,B, UNICEF, and WHO. Developing world population access to ORS packets reaches 24%. USAID is supporting ORT activities in 19 countries.


1984
ORT is used for approximately 12% of diarrhea cases worldwide.


1985
ICORT II; An estimated 500,000 diarrhea deaths to children have been averted by the appropriate use of ORT between ICORT I and ICORT II.


1988
ICORT III; With ORT now used for an estimated 32% of all childhood diarrhea cases, one million diarrhea deaths are averted per year.


1989
Pakistan study of pediatric cholera patients suggests feeding plus glucose ORS may significantly reduce stool output and duration of diarrhea.


1990
At the World Summit for Children, the international community sets targets for the year 2000 that include increasing the use of ORT plus continued feeding to 80% of diarrhea episodes, and reducing childhood diarrhea deaths by half.


1990-91
Cholera appears in Latin America after an absence of over 100 years. Past investments bear fruit in Latin America where CDD technologies and programs already in place, including the use of ORT, help keep cholera deaths to a minimum. Cholera epidemics reappear in Africa and Asia.


1991
Thirty-seven USAID-assisted countries exceed USAID's target of 45% ORT use.


1992
WHO estimates global access to ORS at 73%. Four out of five ORS packets are now produced in the country where used. ORT is used for approximately 38% of all diarrhea cases.


1993
The emergence of a new strain of cholera, V.Cholerae 0139, which also infects people normally immune to cholera, greatly increases potential case numbers; this development underlines the need for continuing efforts to strengthen training, surveillance and other elements of CDD programs.

USAID supports CDD activities in over 53 countries.


1994
International efforts have reduced the toll of child deaths due to dehydration from four million each year to less than three million. Applied research, increasingly effective programs, and greater involvement of private sector and community organizations promise to extend the life-saving therapy to greater numbers of children.