Oral Rehydration Therapy
 
Every parent knows that diarrhea is one of the commonest ailments of childhood.
It affects hundreds of millions of children around the world an average of three
times a year. And especially in areas where water and sanitation are poor, it can
be a problem for adults also.
 
But children are most vulnerable to the problems caused by diarrhea, especially
children who are poorly nourished and in poor health to start with. UNICEF and
the World Health Organization estimate that more than three million children in
developing countries die each year from serious bouts of diarrhea--the most
important single cause of death and malnutrition among young children.
 
DEHYDRATION--A LIFE-THREATENING CONDITION
 
Most of the children who die from diarrhea die because their bodies have become
dehydrated. That is, they have lost more fluid than they have taken in. As body
fluids are lost, essential salts, minerals, and other nutrients are also lost and the
body is no longer able to function properly. Severe dehydration may cause rapid
weak pulse; fever; fast, deep breathing; or convulsions. Untreated, it is fatal.
 
The diarrhea that causes the dehydration can and should be treated before the
problem becomes so serious. The idea is to give the child (or adult) as much fluid
as possible and to restore the balance of salts and other nutrients. The treatment
is called oral rehydration therapy (ORT). It works almost as fast as an intravenous
(IV) feeding and is safer, simpler, and cheaper. Any mother can treat her
child at home for just a few cents, versus the high cost of an IV or other
medications. WHO estimates that use of ORT saved over 200,000 lives in 1984.
 
Use of ORT is so effective that as of January 1988 some 90 countries around the
world had national programs to promote its use and it is becoming the treatment
of choice in many hospitals in industrialized countries. Many organizations have
programs to teach medical workers as well as parents about the treatment and to
train them in its use.
 
TREATING OR PREVENTING DEHYDRATION
 
A mixture--called rehydration salts--of salt, sugar, sodium, potassium (and perhaps
other nutrients), and water is fed to the child frequently throughout the day and
night. The salt-sugar mix is usually available in packets or tablets to be mixed
with clean water. in some places, the bottled mixture may also be available. If the
salt-sugar mixture is not available, you can make your own rehydration drink at
home (see box).

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Mix up the drink at the first signs of diarrhea. Give the person sips of the drink
every few minutes, day and night, that they are awake--even if they don't feel
like drinking it and even if they vomit. An adult should drink three or more
liters a day and a small child should have at least one liter a day or one glass
for each watery stool.
 
Diarrhea is often caused by malnutrition, but if it goes on long enough the
diarrhea itself contributes to the malnutrition. Be sure that the person who has
diarrhea eats good, easily digestible food along with the rehydration drink. This is
especially important for children, but anyone who is thin and weak should get
plenty of protein and energy foods all the time that they have diarrhea. If they
are too sick to eat much, they should take broth, porridge, rice water, and/or
cooked and mashed beans or fruit, in addition to the rehydration drink. Babies
should continue to be fed breast milk. As soon as they can, the sick persons
should begin eating well again.
 
(It should be noted that doctors often have different ideas about how to treat
people with diarrhea, especially regarding the types and quantities of food the
sick person should eat. Many doctors feel that people with diarrhea should not
eat anything but thin soups or cereals. Other doctors say that the sick person
should be allowed to eat almost any good healthful food they feel like eating. You
should be prepared to follow the advice of your doctor or health worker.)
 
Unless the diarrhea is caused by some other disease, such as amoebic dysentery,
the person should respond quickly to the treatment. If the diarrhea gets worse, or
if there are other disease symptoms such as fever, and the person seems to be
dehydrating, get help from a doctor or health worker immediately. Remember that
children are affected more quickly than adults, and dehydration is very dangerous
for babies.
 
Look for these signs of dehydration:
 
o  dry, tearless, sunken eyes
 
o  sudden weight loss
 
o  dry skin, mouth, and tongue
 
o  sudden weight loss
 
o  sunken "soft spot" on a baby's head
 
o  little or no urine, and what there is is dark yellow
 
Dehydration also causes the skin to lose its elasticity. a pinch of skin does not
fall back to normal, but stays up in a lump. Dehydration may also cause rapid,
deep breathing; a fast but weak pulse; fever; and/or convulsions.
 
Source:
 
Werner, David. Where There Is No Doctor. Palo Alto, California: Hesperian
Foundation, 1980. First published in Spanish as Donde No Hay Doctor. Now
available in English, Spanish, French, Portuguese, and Swahili. Available through
VITA in English, Spanish, and French.
 
The Project for Appropriate Technology for Health, Seattle, Washington USA.
 
Grant, James F. State of the World's Children 1988. New York: Oxford University
Press, for UNICEF (United Nations Children's Fund), 1988.