E-drug: Oral rehydration salts (ORS) - formulation (cont'd)
-------------------------------------------------------------------------
In response to the queries on ORS, I have a few references that might
be useful. Unfortunately, I do not have these references in electronic
format.
1. Mahalanabis D, Merson MH, Barua D. Oral rehydration therapy:
Recent advances. World Health Forum 1981; 2:245-249. This
article explains the rational for the actual WHO ORS
formulation.
2. Programme for the Control of Diarrhoeal Diseases. The selection
of fluids and food for home therapy to prevent dehydration from
diarrhoea. WHO/CDD/93.44. This document describes WHO
policies with regard to home-made fluids for the prevention of
dehydration due to diarrhoea.
3. UNICEF-WHO. Oral rehydration Salts (ORS) - A joint
UNICEF/WHO update. July 1996. This document presents the
current WHO and UNICEF policies with regard to the
composition of ORS (bicarbonate versus citrate), the
concentrations of the different components (emphasizing the
importance of a range of concentrations rather than a single
concentration), the limited advantages offered by rice-based
ORS, and the use of flavored/sweetened ORS.
In relation to Holmgren's comments on this forum, I would like to
mention the meta-analyses by S. Gore, N. Pierce and myself, which
have been published in the British Medical Journal, The Lancet and
more recently the Cochrane Library and showing no real advantage of
rice-based ORS versus standard WHO ORS for the management of
acute diarrhoea in children.
Concerning the use of rice water or rice-based home made ORS,
please find below the abstract of a very interesting article by
Chowdhury (from BRAC Bangladesh), that showed that home-made
rice-based solutions are a poor alternative to other home-made fluids.
Bull World Health Organ 1991;69(2):229-34. Related Articles, Books,
LinkOut:
Oral rehydration therapy: a community trial comparing the
acceptability of homemade sucrose and cereal-based solutions.
Chowdhury AM, Karim F, Rohde JE, Ahmed J, Abed FH.
Research and Evaluation Division, Bangladesh Rural
Advancement Committee (BRAC), Dhaka.
Abstract:
Sugar-based oral rehydration therapy (ORT) for diarrhoea is
promoted in many countries of the world. One programme in
Bangladesh has instructed more than 13 million mothers in the
preparation of a sugar-salt solution in the home; despite very
high rates of correct mixing and knowledge, subsequent
application was found in only some 20% of all diarrhoea
episodes. Since rice is far more available in rural homes (95%)
than any type of sugar (30%) and rice gruel is a widely
accepted food during illness, a field trial was conducted in three
areas (total population, 68,345) to compare the acceptability
and use of rice-based ORT with that of sugar-based ORT.
Although the mothers unanimously agreed that the rice-based
solutions "stopped" the diarrhoea more quickly, they used the
sugar-based solutions twice as often (in 40% of severe watery
episodes) as the rice-based solutions (in 18%), because the
rice-ORT was much more time-consuming and difficult to
prepare. The observed reduced utilization of home-made
rice-ORT makes it a poor substitute for sugar-ORT at the
community level in rural Bangladesh.
I hope you'll find these few comments useful.
Amities,
Olivier Fontaine
WHO/CAD
Geneva, Switzerland
e-mail: fontaineo@who.ch
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.