E-drug: Re: Oral rehydration salts (ORS) - formulation (cont'd)
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Dear E-druggers,
Thank you for the contribution of Olivier Fontaine. The last word has not
yet been said yet about all the advantages of cereal based fluids over ORS
or a sugar-salt solution in the home setting and even in the article quoted
from Bangladesh the availability of sugar in the homes was only 30%. This is
certainly my experience after working for 17 years in a poor rural
community in Zambia.
Of course it is important to emphasize that the main role of cereal based
fluids is in prevention of dehydration during diarrhoea. There are
advantages in a health unit of using a standardized formula such as ORS or,
for the severely malnourished children, RESOMAL or some equivalent formula
for the treatment of dehydration once it is apparent.
The research on the benefits of rice-based rehydration fluid over ORS is
still producing new evidence and both animal and human experiments show
advantages especially in the repair of the cells in the intestinal lining.
Compliance is better when the reduction in stool volume is so significant
in favour of the cereal based fluids. Even Norbert Hirshborn the
rediscoverer in 1966 together with others in Dhaka of the value of oral
rehydration therapy with glucose/salt solutions in cholera patients in
Bangladesh is now advocating cereal-based fluids over standard ORS because
of its benefits.
The article by Almroth and Latham, Lancet, 1995, 345: 709-711 shows how
frequently there are traditional good treatments using cereal fluids that
have already been in use in many communities. These can easily be
strengthened and in fact almost all cultures have examples of "grand-mother
solutions" that are appropriate. If, as has sometimes been done, the
campaign for ORS or sugar/salt solutions in the home setting is too
aggressive, these cereal based fluids can fall into disuse. More recent
research in Guatemala shows that some communities where this has happened
don't give any appropriate treatment for the prevention of dehydration when
they have run out of ORS or sugar/salt. This is a recipe for disaster and
there are many tragic examples of what this leads to. It will also obviate
the countless tragedies where mother make long, expensive and dangerous
journeys to a health unit with a child with diarrhoea because they don't
have ORS or sugar/salt at home and the child dies on the journey.
Gunnar Holmgren,
Consultant in International Health Care, Section for International Maternal
and Child Health, Uppsala University, Sweden
Gunnar.Holmgren@ich.uu.se
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