Worldwide impact of oral rehydration therapy
Banwell, J.G.
Clinical Therapeutics 12 Suppl A 29-36; Discussion: 36-37
1990
ISSN/ISBN: 0149-2918 PMID: 2187610 Document Number: 373190
The impact of oral rehydration therapy (ORT) on the estimated 5 million deaths of children yearly from acute dehydrating diarrhea is discussed in terms of worldwide adoption of ORT as primary therapy; establishment of national ORT programs; new scientific knowledge of intestinal absorption of ORT solutions; and implications of ORT for the next decade. ORT now encompasses 99% of the developing world, although it is implemented unevenly, as low as 12% in Africa. 75% of ORT formula is now produced locally. By 1988 60% of the world had ORT available, and 25% of affected children received ORT. More community health workers need training in ORT, since knowledge by mothers is key to treating children. Research is needed on the effect of ORT on aspiration pneumonia, the incidence of inadequate rehydration and death after ORT. Causes of death in children with diarrhea, and organisms associated with diarrhea resistant to ORT treatment. Current research focuses on maximal flow of nutrients and solvent drag across the intercellular tight junctions of the intestinal epithelium. Short chain fatty acids, butyrate, propionate and acetate, are also being studied as adjuncts to the carbohydrates and amino acids used in ORT solutions. In the future, ORT will be used with interventions such as breastfeeding, better weaning foods, sanitation, management of persistent diarrhea caused by specific organisms, targeted therapy and immunization.