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Panel 10

ORS: The medical advance of the century

During the 1980s, UNICEF launched the 'child survival and development revolution', concentrating its efforts on four potent methods of saving children's lives -- growth monitoring, breastfeeding, immunization, and the use of oral rehydration salts (ORS) -- the best way of combating the dehydration caused by diarrhoea.

The British medical journal The Lancet has described ORS as "potentially the most important medical advance of this century."

In the late 1970s, acute diarrhoea was killing around 5 million children each year. The obvious response to dehydration -- giving the child water to drink -- did not work because the liquid rushed through the digestive tract too quickly to be absorbed by the body tissues. The only answer seemed to be to bypass the digestive system altogether and rehydrate the body using an intravenous drip. This is an invasive and traumatic procedure for a child. And because it must be administered by someone with medical training, it is completely impractical for most episodes of childhood diarrhoea, which take place out of range of any kind of medical attention.

Photo: A Cambodian mother feeds a solution of oral rehydration salts to her dehydrated child. ©

In 1968, researchers in Bangladesh and India discovered that adding glucose to water and salt in the right proportions enabled the liquid to be absorbed through the intestinal wall. So anyone suffering from diarrhoea could replace the lost fluids and salts simply by drinking this solution.

One of the first large-scale field applications of oral rehydration salts took place in 1971 during the Bangladesh war of independence when outbreaks of cholera swept through refugee camps. Of the 3,700 victims treated with ORS, over 96 per cent survived.

Home-made versions of ORS are not difficult to make and can help prevent diarrhoeal dehydration. The Bangladesh Rural Advancement Committee (BRAC), for example, has shown mothers in Bangladesh how to mix water, salt and molasses to prevent dehydration when a child falls ill with diarrhoea. Families can also use the rice water from the cooking pot to prevent dehydration. ORS, however, is best to treat dehydration when it occurs, as well as to prevent it.

ORS sachets are now being produced, with UNICEF support, in 60 developing countries. Total production is around 500 million sachets a year -- costing around 10 cents (US) each.

Around half of all diarrhoea cases in the world's poorest countries are now treated with oral rehydration therapy (ORT), which means that ORS as well as recommended home fluids are given. This is a vast improvement over the 1 per cent level of usage at the beginning of the 1980s. But there is still an urgent need to make ORT more accessible.

One of the problems is that the medical establishment is still reluctant to accept ORS. In the United States, for example, it costs almost 10 times as much to treat dehydration with an intravenous drip in a hospital as it does to administer ORS, yet the intravenous method prevails. Drug companies, too, stand to gain more by selling antidiarrhoeal drugs, most of which are useless and some of which are dangerous.

Around 8,000 children still die each day from diarrhoeal dehydration, a toll the world can and must reduce with ORT.

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