Does a home-prepared ORS have to be made of sugar, salt and water?

Sugar is in many places very expensive, or even unobtainable. The "red booklet" "THE MANAGEMENT OF DIARRHOEA AND USE OF ORAL REHYDRATION THERAPY - A Joint WHO/UNICEF Statement" makes clear on page 11 that there are two basic types of Home- prepared solutions: (a) Those containing starch rather sugar - throughout the world all people have a basic starchy foodstuff that is a staple part of their diet - it may be rice, root tubers, e.g. yams, potatoes, etc, or grains e.g. wheat, etc. Those starchy foods are nearly always boiled in water to cool them and in the process the cooling water, especially near the end of cooking, becomes a rich starchy solution, already boiled and cooled. With the addition of a little salt (so that it tastes no more salty than tears) such liquids are an excellent home-prepared solution to give to children for the prevention of dehydration. Unfortunately, they may be less effective for children less then 3 months old. Only in areas of famine would such solutions not be readily available in the home at no significant extra cost. With starches you cannot really give an excess - whereas with sugar as excess in solution (over 3%) will cause a worsening of diarrhoea due to osmotic effects. More operational research needs to be done in specific regions and countries to identify and popularize the use of these starch based home- prepared solutions and uncover and unforeseen problems e.g. fermenting of the solution after a few hours storage - or that the liquid is normally fed to animals and may be culturally unacceptable to give to children. In such cases some simple modification to the procedure may be devised to overcome these problems. (b) Sugar and salt solutions have been widely promulgated for years simply because they are analogous to ORS. They have certain disadvantages, for instance: It involves measuring quite accurately two different weights (or measures) of solids - hence a very real possibility of muddling the two up, with disastrous consequences = and measuring the volume of water accurately. It is thus more difficult to mix properly than ORS, where you only need to measure the water. It requires more tuition time and a more competent parent to do it correctly. It is more expensive - often much more expensive and so may be used too sparingly and therefore be of no use. In spite of this, there are examples where it has been widely used with great success, e.g. lobon-gur in Bangladesh. The applicability of either method depends very much on local or national circumstances and policies and should be decided accordingly - there is never a universal "right" method.