29th July is observed every year as National ORS Day to highlight the importance of ORAL REHYDRATION SALTS (ORS) as a cost-effective method of health intervention.
ORS – THE AMRUT IN DEHYDRATION is the theme of ORS week observation 2019 endorsed by INDIAN Academy of Pediatrics. Acute diarrheal diseases are one of the leading causes of mortality in infants and young children in many developing countries.
According to WHO, Diarrheal disease is the second leading cause of death in children under five years old. It is estimated that each child in India suffers an average of 1.6 episodes of diarrhea per year for the first five years. Estimated 1,58,000 children die each year in India due to diarrhea. 9.1% of deaths in the age group of 0-6 years contributed by acute diarrhea.
Diarrhea which is frequently caused by poor sanitation and hygiene can lead to fluid loss from the body and cause severe dehydration and death. It particularly affects infants, children and old people.
Dehydration from diarrhea can be prevented by giving extra fluids at home or it can be treated simply and effectively by giving adequate glucose – electrolyte solution called ‘ ORAL REHYDRATION SALTS’ solution ( ORS)
GLOBAL AND NATIONAL DIARRHEA TREATMENT POLICY
Prevent and treat dehydration with ORS or ( IVF in severe dehydration). Continue feeding or increase breastfeeding during and increase fluid and feeding after the diarrheal episode. Abstain from giving antidiarrheal or other drugs. Use antibiotics only when appropriate i.e. bloody diarrhea, systemic infection, cholera, and severe malnutrition. Give Zinc in recommended doses as soon as diarrhea starts.
The World Health Organization launched “ORAL REHYDRATION THERAPY” (ORT) with home available fluids and ORS in 1978. The treatment has reduced mortality due to diarrhea from 5 million to 1.3 million deaths annually. Because of its remarkable success, ORS is widely acknowledged as the ‘most important medical advance of the century’
WHO, ORS is safe and effective and can alone successfully rehydrate 95% -97% patients with diarrhea. Reduces hospital case fatality rates by 40 – 50 %
WHEN SHOULD ORS BE USED
Parents must begin to use ORS when a child has three or more loose stools in a day. A child under the age of 2 years needs at least ¼ to ½ of 20 ml cup of ORS drink after each purge. Children above 2 years and older kids require ½ to one whole 250 ml cup of ORS drink after each watery stool. If the child is above 6 months of age 20mg of Zinc per day for 10- 14 days and if the child is below 6 months of age 10mg per day should be given. Zinc helps children recover faster from diarrhea by replenishing depleted nutrients. Zinc also has been proven to prevent further episodes of diarrhea ORS Jodi ( ORS and Zinc ) has proven to be successful in the prevention and management of acute diarrhea and dehydration
HOW TO PREPARE ORS
- Wash your hands with soap and water before preparing ORS solution
- Read the packet label for direction.
- Take a clean container and put the contents of ORS packet in it
- Add the appropriate amount of clean water. If the water added is inadequate or more it could make diarrhea worse.
- Do not add ORS to milk, soup, fruit juice or soft drinks. Do not add sugar.
- Stir it well and feed the child using a clean spoon from a clean cup in sips. Give a sip of ORS, wait for 30 -60 seconds, then give the next sip. Don’t give the sips too fast or ORS in a feeding bottle as it can worsen loose stools due to gastrocolic reflux.
WHO/UNICEF/ Govt. of India recommends low osmolality ORS containing 75mg/l of sodium and 75 mmol/l of glucose (osmolality 245 mos mol/l) should be used as a universal single solution for treating and preventing diarrhea in children. Low osmolality ORS is also safe and effective for children with cholera.
Low osmolarity ORS is safe and effective for all ages. In severely malnourished child low osmolarity ORS with potassium supplements given
COMPOSITION OF STANDARD AND LOW OSMOLALITY ORS SOLUTION
|CONSTITUENT||WHO ORS||HYPO OSMOLAR ORS|
|Nacl||3.5 gm||2.6 gm|
|Kcl||1.5 gm||1.5 gm|
|Glucose||20 gm||13.5 gm|
|Na||90 meq/l||75 meq/l|
|k||20 meq/l||20 meq/l|
|Cl||80 meq/l||65 meq/l|
|Citrate||10 meq/l||10 meq/l|
|Glucose||111 meq/l||75 meq/l|
|Osmolarity||311 meq/l||245 meq/l|
WHAT DO OUR PRESCRIPTION SAYS?
Recent surveys of 30 districts in India
ORS - 47%
Zinc - 1.3%
Antibiotics – 5.6 %
Injections – 23 %
Antidiarrheal – 18.2 %
*Management practices for childhood diarrhea in India survey of 10 districts ORS use rates are dismally low in some regions
>50% - Goa, Himachal, Meghalaya, Tripura, Manipur
>40% - West Bengal, J&K, Mizoram, Chattisgarh
>20% - Bihar, Orissa, Uttaranchal, Punjab, Southern states
<20% - Rajasthan, U.P, Assam, Jharkhand, Nagaland
*Recent NFHS- 3 data
ORS The Amrut in Dehydration should be endorsed by all health workers so that dehydration can be prevented in diarrhea and vomiting. ORS therapy has significantly brought down diarrhoeal mortalities. It is a simple, cost-effective therapy and least scientific skill required for administration. It is also regarded as the most important advances of the last century.
Dr. Sunu John(1988 batch), DCH DNB
Cons. Pediatrician & HOD
Vice President, IAP Kottayam