New formula for oral rehydration salts will save millions of lives
8 May 2002 - Number of deaths and severity of illness will be reduced
The new formula Oral Rehydration Salts (ORS), released by the World Health Organization (WHO) today, will save millions of lives and reduce the severity of illness of those suffering from acute diarrhea. ORS is a sodium and glucose solution that is widely used to treat children with acute diarrhea, a serious killer of children under five worldwide. The new formula ORS will reduce the severity of diarrhea and vomiting, the number of hospitalizations, the need for costly intravenous (IV) fluid treatment and the length of illness.
The use of ORS is responsible for saving the lives of millions of children worldwide. This inexpensive and readily available intervention reduces death and suffering from dehydration caused by diarrhea. Since WHO adopted ORS in 1978 as its primary tool to fight diarrhea, the mortality rate for children suffering from acute diarrhea has fallen from 5 million to 1.3 million deaths annually.
The new improved formula is the result of extensive research sponsored by WHO’s Department of Child and Adolescent Health and Development and supported by the U.S Agency for International Development (USAID). The latest study was conducted in five developing countries among children from one month to two years old with acute diarrhea and dehydration.
The study’s findings suggest that using the low-sodium, low-glucose ORS formulation reduces the need for intravenous fluids by 33 percent. The effect of this reduction could result in fewer children requiring hospitalization, fewer secondary infections, a diminished need to handle blood with its potentially dangerous consequences, and lower health care costs.
"Oral Rehydration Therapy is one of the great public health success stories of our time," according to Dr Gro Harlem Brundtland, Director-General of WHO. "Reducing childhood deaths from diarrhea by half in ten years is a notable success but, despite this progress, diarrhea remains a major cause of death. This week at the UN General Assembly Special Session on Children governments will endorse a new goal to reduce deaths from diarrhea by a further 50 percent by 2010."
Oral Rehydration Therapy was first researched in the 1940s but it was twenty years later before the idea was developed by research institutions in Bangladesh and India for the management of severe cholera. Then conventional wisdom said only health professionals could mix and administer the solution and that its use was limited to hospitals. The use of ORS during the 1971 war between India and Pakistan provided convincing evidence that ORS could be given by non-medical personnel, volunteers and family members.
The war provoked a public health emergency in the unsanitary, overcrowded and primitive border camps set up to house those fleeing the violence. The camps quickly became breeding grounds for diseases, especially cholera. With cholera spreading rapidly and death rates rising, the head of a medical centre in one of the camps instructed his staff to distribute ORS that was stored in steel drums around the camp. The distribution, like the solution, was simple but effective. The ORS solution administered by family members and others dramatically reduced the death rates from diarrhea.
In the refugee camps where ORS was being used the death rate was only 3 percent compared to between 20 and 30 percent in those camps using only intravenous fluid therapy. But, still the medical community held out - sceptical that such a devastating problem could have such a simple solution.
The dramatic improvement in home management of diarrhea through ORS use took place between 1990 and 1995, saving about 1 million children annually. In 1990, oral rehydration salts were used in approximately one-third of diarrhea cases, and by mid-decade the average was 85 per cent among 33 reporting countries that account for almost half of the world's under-five population.
"To reach the 2010 goal we need to expand the use of ORS dramatically. To do this the role of parents, volunteer care givers and health workers is going to be vital. Having access to packets of oral rehydration salts when you need them is also very important to scaling-up. Ideally, all families should have packets of ORS in the home ready to be mixed as soon as it is needed. Using ORS packets should become routine at the first signs of diarrhea to avoid the risk of parents waiting too long before rehydrating the child. If we can achieve this, the 2010 goals should be well within our reach," says Dr Tomris Turmen, Executive Director, Family and Community Health at WHO .
Use of the new formula ORS will begin later this year in India.