Oral Rehydration Therapy

The Four Simple Technologies

Growth Monitoring

This technique involves the use of simple, cheap growth charts that would enable mothers to monitor their children's weight on a regular basis. The weight trend is the most important and practical indicator of the normal healthy growth or state of malnutrition of infants and young children. This information is of particular value in breaking the vicious cycle of malnutrition and infection.

Once the mother recognizes that her child is becoming malnourished, she would then seek the advice of health workers as to whether the child needs supplementary foods, more frequent feeding, or medical help. In this manner, it would be possible to prevent up to half of all the cases of malnutrition which underly the death of several million children a year, as well as the poor growth of many millions more occurring in the developing world.

India, Indonesia, Thailand, Colombia, and Jamaica are some of the more than 80 countries where this technique is now going into use.

Oral Rehydration Therapy (ORT)

Oral rehydration therapy is a simple, cheap, effective, and acceptable treatment that can be prepared and administered by parents at home to counteract dehydration which is the most common cause of death among children with acute diarrhoeal disease. The treatment consists of a solution of sugar and salt given orally to replace both the water and electrolytes lost in diarrhoeal stools.

Diarrhoeal disease is very common in the developing world, where one out of every 20 children born are destined to die from diarrhoeal dehydration before reaching the age of five. Indeed, it is the major single cause of death among children, and accounts for the death of about five million children a year. In addition, repeated diarrhoeal episodes could impair the nutritional status of affected children who become increasingly susceptible to other acute infections.

In contrast to ORT, conventional treatment by intravenous infusions of glucose and salts. is an expensive procedure that should be limited to the minority of severe cases of dehydration not amenable to ORT which does not require the skills and facilities available only in well staffed and equipped clinics and hospitals. Thus ORT offers the potential for home-based treatment by mothers throughout the developing world.

Of the numerous countries where ORT programmes have been initiated, the list includes Bangladesh, India, Indonesia, Nepal, Pakistan, Philippines, Haiti, Thailand, Brazil, Costa Rica, El Salvador, Mexico, Nicaragua, Peru, Guatemala, Honduras, Colombia, Venezuela, Jordan, Turkey, Morocco, Syria, Nigeria, Egypt, Sudan, and Tunisia. Recent studies in some of these countries with support from UNICEF, WHO, or other organizations, have indicated that ORT can decrease the number of deaths from diarrhoea by as much as 50 to 60% over a one-year period.

At the International Conference on Oral Rehydration Therapy (ICORT), sponsored by USAID and held in Washington, D.C., in June 1983, almost complete agreement was reached about the efficacy of ORT, and the need to intensify efforts to make it internationally available.

Promotion of Breast-Feeding

Recent studies have shown that breast milk, besides being nutritious and hygienic, provides immunity transferred from mothers to breast-fed infants, and thus helps to protect them from malnutrition and infection, including diarrhoeal infections. In contrast, bottle-fed babies are more likely to be malnourished, to contract infections, and to die in the first year of life. Despite the convincing evidence supporting these facts, there are alarming indications that breast-feeding is declining in many parts of the developing world. Breast-feeding should, therefore, be promoted along with growth monitoring and ORT.

Expanded Immunization

Immunization against the six communicable diseases of childhood (poliomyelitis, diphtheria, measles, whooping cough, tuberculosis, and tetanus) is quite a simple intervention. It presents a great challenge to the developing world where every one of the 100 million children born each year needs to be vaccinated through carefully planned immunization campaigns.

The World Health Organization, in collaboration with UNICEF as the supplier of vaccines and cold chain equipment, launched its Expanded Programme on Immunization (EPI) in 1977 with the aim of assisting all nations to immunize all children against the six immunizable diseases by 1990. WHO reviewed the EPI in May 1982, and urged its member states to take action to achieve a more rapid improvement of immunization coverage.