The effect of oral rehydration solution and recommended home fluids on
diarrhoea mortality Melinda K. Munos, Christa L Fischer Walker and Robert E Black Background Most diarrhoeal deaths can be prevented through the prevention
and treatment of dehydration. Oral rehydration solution (ORS) and
recommended home fluids (RHFs) have been recommended since 1970s and 1980s
to prevent and treat diarrhoeal dehydration. We sought to estimate the
effects of these interventions on diarrhoea mortality in children aged <5
Diarrhoeal diseases are very common among young children and
are a leading child killer in developing countries. About 1.2 million children die from
dehydration due to diarrhoeal diseases, 80% of them in the first two years of life.
Oral Rehydration Therapy (ORT), a simple, cost-effective treatment given at home using
either packets of Oral Rehydration Salts (ORS) costing about 10 cents each or a
simple home solution of sugar, salt and water can prevent about 90% of child deaths from
diarrhoeal dehydration. UNICEF and its partners have helped more than 45 countries to
achieve treating 80% of child diarrhoea cases with ORT.
ORT now helps save more than 1 million children's lives each year, indicating substantial
progress towards the goal of halving the child death rate from diarrhoeal
diseases during this decade.
This simple method can break the back of the world's leading killer of children.
The first breakthrough is the discovery of Oral Rehydration Therapy (ORT). It's importance
is that it can stop the dehydration caused by the draining of the child's body as a
result of diarrhoeal infection which now kills an estimated 1.2 million young
children a year and is by far the biggest single cause of death among the developing
Previously it could only be treated by qualified nurses or doctors using expensive
intravenous feeding in an often inaccessible hospital. With the discovery of ORT, it can
be treated by a mother giving her child the right mix of sugar, salt and water in her own
The need for ORT is clear. The technology is known. The means of
dissemination are available. The receptiveness of parents has been
demonstrated. The cost is small.
Again what is required is the global will to make this breakthrough available
to the millions of children who so desperately require if..
What is diarrhoea and what is ORT?
Diarrhoea is the passage of watery stools. This means body fluids and
salts can be quickly lost from the body. The child becomes dry (dehydrated) and this is
very dangerous and may kill the child.
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
Diarrhoea can be prevented through exclusive breastfeeding, 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.
Oral Rehydration Therapy (ORT) is the process of replacing essential
body fluids and salts that a child loses in critical quantities during
attacks of diarrhoea. The treatment consists of common salt and sugar mixed
in one liter of clean drinking water given to the child by mouth.
By replacing lost body fluids, ORT prevents dehydration and nurses the child
back to health..
How is ORT administered?
A very suitable and effective simple solution for rehydrating a child can be
made by using salt, sugar and water. Molasses and other forms of raw sugar can
be used instead of white sugar, and these contain more potassium than white
sugar. Other solutions: Breast milk, gruels (diluted mixtures of cooked cereals
and water), carrot soup, rice water - congee, fresh fruit juice, weak tea, green
coconut water or water from the cleanest possible source brought to the boil and
You can also use a pre-packed
formula called Oral Rehydration Salts (ORS) available in a sachet to make
a liter of solution.
Reduced osmolarity ORS
Trisodium citrate, dihydrate
Four Simple Steps
Download Instruction Guides in English and Creole
Thanks to Charles R. Staubs, D.O. and Jean Michelet
Wash hands with soap and water before preparing
Put clean water to the mark from top of the
bottle. This is equal to one liter. Put the water in a clean pot.
Empty the contents of 1 packet of Oral
Rehydration Salts (ORS) into the water while keeping it stirred.
Give the sick child as much of the solution as it
needs, in small amounts frequently.
Give child alternately other fluids - such as
breast milk and juices.
Continue to give solids if child is four months
If the child still needs ORS after 24 hours, make
a fresh solution.
ORS does not stop diarrhoea. It prevents
the body from drying up. The diarrhoea will stop by itself.
If child vomits, wait ten minutes and give it ORS
again. Usually vomiting will stop.
If diarrhoea increases and /or vomiting persists,
take child over to a health clinic.
What do experts say about ORT?
"The discovery of oral rehydration
therapy is as important as the discovery of penicillin." Professor Mamdouh Gabr - Cairo University, Faulty of Medicine
"We believe that, ultimately,
widespread adoption of ORT in developing countries will break the vicious cycle of
diarrhoea, malnutrition, and death - especially for the principal victims : very young
children." Dr. W B Greennough, Director, International Centre of Diarrhoeal Disease
"ORT can rightly be called the
medical miracle of this century .... For peoples in Asia, Africa and Latin American, ORT
holds the promise of healthier childhoods and more productive adult lives." Shamsul Hag. Minister for Health and Population Control, Government of Bangladesh.
"Today the high success rate and low
cost of ORT makes it the preferred treatment for mildly or moderately dehydrated children.
According to current American Academy of Pediatrics practice guidelines, ORT is as
effective as IV therapy for treatment of mild to moderate dehydration." Mayo Clinic
"A significant development in recent
years has been the demonstration that dehydration from diarrhoea of any etiology can be
treated using a simple glucose-electrolyte solution given by mouth." Nelson Textbook of Pediatrics - 12th Edition 1983
"Nearly 90% of mortality from
diarrhoea is due to fluid loss. Accurate and timely replacement of that loss is
lifesaving." Dr. Norbert Hirschlorn - Nutrition Reviews Volume 40, page 87, 1982
ColaLife is working to help multi-nationals leverage their distribution
muscle to save children's lives in developing countries. ColaLife wants to
work with multinational corporations, such as Coca-Cola to help them use
their distribution channels (which are amazing in developing countries) to
distribute 'social products' such as oral rehydration salts to the people
that need them desperately.
ColaLife is working to get Coca-Cola to open up its distribution channels in
developing countries to carry 'social products' such as oral rehydration
salts, zinc supplements, SODIS water disinfection bags, or whatever else is
required in a particular locality to save lives, particularly children's
You can buy a Coca-Cola virtually anywhere in developing countries but in
these same places 1 in 5 children die before their 5th birthday from simple
preventable cause like dehydration from diarrhoea.
caused by diarrhoea is the biggest single killer of children in the modern world and
diarrhoea itself is one of the major causes of nutritional loss and poor growth.
Now, dehydration can be prevented and nutritional losses minimized by a revolutionary new
technique called Oral Rehydration therapy (ORT). To prevent dehydration, oral rehydration
salts can be made at home from ordinary household ingredients.
To prevent - or treat - dehydration, sachets of the salts made up to precise WHO/UNICEF
formula now cost only a few cents each. But the problem is how to make them available to
millions of parents through out the world.
The sachets, says UNICEF, should be household items available form every
corner shop like soap, batteries, razor-blades or Coca-Cola.
The State of the World's Children 1985 (UNICEF).
Below are some key documents on ORS/ORT. Please also browse our list of helpful websites for more resources.