By Dr Vivek Rege, PediatricianAlso Read – From Digestion to Strong Immunity, Did You Know Fermented Food Can Also Be Healthy? | Know about Different Fermented Food Items And Health Benefits
Diarrhea is one of the most common ailments in children. But what most of us fail to realise is that it is also one of the leading causes of mortality and morbidity in children less than 5-years-old. According to the World Health Organisation (WHO), dehydration is the most severe threat caused by diarrhea. Poor living conditions, low nutrition and impure water are the leading causes of dehydration induced by diarrhea in India. The tragedy here is that it is completely preventable with simple measures like administrating Oral Rehydrating Solution (ORS). Also Read – Hepatitis Types, Treatment, Symptoms Explained by Dr. Harshavardhan Rao B
ORS to the rescue
Dehydration is one of the common and most severe effects of diarrhea. It is caused due to the loss of water and electrolytes through stool, urine, vomit, and sweat. ORS works by negating the effects of dehydration by rehydrating the body. It should be given to children at the very first sign of diarrhea. While it may not treat diarrhea, consuming ORS during early signs of diarrhea rehydrates the body, bringing down the need for hospitalisation and intravenous fluid treatment. What makes it particularly effective is the ease with which it can be used. It is widely available in the market and can easily be prepared and administered by a non-medical person, such as the child’s parents or relatives at home. Also Read – All You Need To Know About Covid-19 And People Suffering From Hepatitis : World Hepatitis Day 2021
It is important to note here that to be effective one must always consume a correctly formulated ORS solution. WHO and UNICEF recommends ORS solution containing 75 mEq/l of sodium with a low osmolarity of 245 mOsm/l. The Indian Academy of Pediatrics, WHO, and UNICEF also endorse the use of zinc supplementation for 14 days along with ORS. This effective combination stimulates water and electrolyte absorption from the gut in spite of fluids rushing through the digestive tract. It prevents or reverses dehydration and reinstitutes lost electrolytes. This has contributed significantly to the dramatic reduction in mortality rates caused from diarrhea.4
Then and now
Interestingly, the birth of the ORS solution as we know it today occurred in the Indian subcontinent. While there had been similar attempts at rehydration of suffering patients earlier, these were either largely ineffective or undocumented. In the late 1960s, acute diarrhea was the main cause of death for over five million children each year. Plain water wouldn’t suffice as the liquid passed through the body before being absorbed. Archaic rehydration methods included an intravenous drip to replenish lost nutrients. However, this method proved to be too harsh and invasive for a child. In India, doctors had already realised the futility of IV drips to treat diarrhea.
Finally, it was during the late 1950s-60s that researchers in Dhaka and Kolkata came up with the early rehydrating formulations. These were finally tested during the influx of refugees from Bangladesh during the early 1970s. Thereafter in 1978 WHO officially launched the diarrheal disease control program to encourage the use of ORS as a therapy worldwide. From the beginning, WHO worked with UNICEF, focusing on the treatment of children under 5 years of age. It simplified the diagnostic process and recommended the use of ORS, while limiting the use of antibiotics.
In 2002, the WHO and UNICEF improved on the ORS formula with reduced levels of sodium and glucose, as a result of which the total osmolarity is far less than the previous formula. The revised guidelines came after studies indicated that the slightly “hyperosmolar” ORS solution may cause increased stool output. The revised formula, hence, tweaked the osmolarity.
In spite of easy access, mortality rates in India still remain relatively high, with 102,813 children below 5 years of age reported to have died from diarrhea in 2016, a mortality rate of 4.1 per 1,000 live births.
In India, ORS is available for purchase in a powder form in sachets as well as ready tetra pack solutions. However, one must be careful when buying ORS. Some brands in the market today have misleading names or packaging, claiming to be ORS such as ORSL and QRS. These solutions often do not follow the WHO guidelines and could have inconsistency with regards to their product formulation. They could either be similar to energy drinks which are high on sugar or have incorrect osmolarity that could do more harm if consumed during diarrhea or dehydration. A regulatory body to ensure strict adherence is the need of the hour. Till then, look out for WHO approved ORS solution before purchase. Remember that precaution is better than cure. Ideally, every family should have packets of WHO-approved ORS stored in their home ready to be consumed as soon as there is a need.
(Disclaimer: Dr Vivek Rege is a pediatrician. This is a guest column.)