Oral rehydration salts and zinc: Co-packaging offers simple solution to save children from diarrhoea
UNICEF works to ensure reliable supply of these life-saving products for emergencies and programmes around the world.
Oral rehydration salts (ORS) are considered one of the most significant medical innovations of the twentieth century. They are a cheap and effective treatment to diarrhoea, which is a leading cause of deaths of children under five.
From 2000 to 2019, the total annual number of deaths from diarrhoea among children under 5 decreased by 61 per cent. This decline can be linked to the expanded use of ORS for diarrhoea treatment.
ORS are a mixture of salt and sugar that is dissolved in clean water to treat dehydration caused either by severe diarrhoea, heat stroke or any other illnesses that result in loss of fluid. One of its main advantages is that it can be easily prepared and given to children who lost water and salts by community health workers and caregivers at home.
The impact of ORS on the efforts to save children from diarrhoea is even more remarkable when the product is used in combination with zinc. Approximately 70 to 90 per cent of deaths caused by acute watery diarrhoea can be prevented by oral rehydration salt, while zinc is estimated to decrease diarrhoea mortality by 11.5 per cent.
Zinc is a vital micronutrient that becomes drained during diarrhoea. When given as a supplement, it reduces the duration and severity of the illness and can also reduce the risk of recurrences in the short term.
“It is tragic that, every year, about 484,000 young children still die of diarrhoea when there is such a cheap and effective treatment."
A treatment course of ORS co-packed with Zinc can cost as little as US$ 0.57. “Co-packaging ORS and zinc together is a game changer. It is unexpensive, and co-packaging greatly increases the chance that children receive both supplements together and will close the massive gap in uptake of zinc we see across countries,” says UNICEF Health Specialist Anne Detjen. “It is tragic that, every year, about 484,000 young children still die of diarrhoea when there is such a cheap and effective treatment,” she adds.
Saving children’s lives
Childhood diarrhoea can be caused by several diseases and conditions, mainly brought about by pathogens found in contaminated drinking water. It usually passes in three or four days, but because so much liquid and salts are lost through stools and vomiting, it can become life-threatening if not treated.
In addition to adequate and timely treatment, appropriate fluids, breastfeeding, continued feeding and selective use of antibiotics are also critical in saving children from diarrhoea.
Over the past decade, UNICEF has procured and delivered more than 700 million sachets of oral rehydration salts (ORS). Previously, UNICEF’s procurement of ORS was mainly in response to emergencies but, in recent years, the demand has increased to respond to country programme needs.
WHO’s Essential Medicines List
UNICEF started procuring ORS in 1975 after agreeing with WHO on promoting a single formula of oral rehydration salt in standard sachets. In the same year, UNICEF purchased its first supply of ORS on what seemed like an ambitious scale at the time - 1,088,000 packets from Australia. In 2006, UNICEF started procuring zinc tablets in addition to ORS after the supplement was added to WHO’s Essential Medicines List for treatment of diarrhoea in 2005.
To promote the combined use of the products, UNICEF collaborated with manufacturers to develop a co-packaged ORS and zinc product based on WHO’s guidelines and that is easier for caregivers to administer. UNICEF added the product to its Supply Catalogue in 2014 and since then more than twenty countries have introduced this product for public sector distribution.
To allow for faster delivery times, UNICEF has expanded and diversified its supplier base to include local manufacturers in low-income countries in diversified geographical locations. With rising cholera outbreaks globally and the persistent challenge of diarrhoeal diseases in low-resource settings, ensuring reliable supplies of ORS and zinc is an effective strategy to reduce mortality.
UNICEF assists governments in increasing the use of ORS and zinc by sourcing and promoting quality co-packaged ORS and zinc in countries that require quality-assured, secure and stable programme supply. In 2021, UNICEF distributed over 93 million zinc tablets and more than 30 million oral rehydration salt sachets worldwide and works to expand access to the co-packaged products.
Recently UNICEF launched a new tender for medicines for diarrhoea treatment (RFP-DAN 2022-503459) via the United Nations Global Marketplace, open until January 2023, to ensure reliable supply of ORS and zinc products for emergencies and programmes. The tender also promotes new user-friendly co-packaged ORS and zinc products and encourages more local producers to participate, which could increase competition and reduce prices.
“Having quality sources of the co-packaged ORS and zinc ensures that children receive the correct and effective treatment for diarrhoea from health workers and when taking the medicine at home”, said Cynthia Kamtengeni, Contracts Manager, Medicines and Nutrition Centre of UNICEF Supply Division.