Oral rehydration therapy in the home by village mothers in Burma

Abstract

Acceptability and effectiveness of oral rehydration therapy (ORT) when given by mothers in the home under village conditions was investigated in six (two control and four test) communities at Htauk-kyant near Rangoon, Burma. The control and test village communities had populations of 2085 and 4278 respectively, of which 218 and 623 were children under five. In the test villages, Oral Rehydration Salts (ORS) were made constantly available by providing each household with one packet of ORS, which was replenished whenever a used packet was returned to the field workers during their daily surveillance rounds. In control villages ORS packets were not provided. Daily diarrhoea surveillance was made for one year, including daily weighing of each child with diarrhoea, and across-episode weight changes were calculated. Monthly mass anthropometric measurements (weight and height) were carried out on over 90% of all children in test and control villages. Stool samples were investigated for bacterial aetiological agents. In test villages 327 children developed diarrhoea (52% of all children) with a total of 639 episodes and an incidence of 1·3 episodes per child per year. 314 diarrhoea episodes (49% of all) occurred in 67 children who had three or more episodes each. ORS was readily accepted and administered by mothers in 96% of the diarrhoea episodes. The impact of ORS on mortality and morbidity could not be demonstrated as there was no death, nor necessity for admission to hospital for diarrhoea in either test or control village populations. This could be due to the mild nature of diarrhoea which is supported by the fact that the magnitude of weight changes during diarrhoea was small, to the administration of other fluids and food, and an inadequate population size. During the whole year no significant difference was observed in the growth curves of boys and girls between test and control villages. However, in children under two years who developed three or more episodes in a year, those who took ORS solution during diarrhoea were protected from a loss of body-weight during the month in which diarrhoea occurred compared with those children who did not receive ORS. Those who were given ORS also had better weight gain over a three-month period after diarrhoea episodes.