Systematic review of strategies to increase use of oral rehydration solution at the household level

Lindsey M Lenters,Zulfiqar A Bhutta,Jai K Das

doi:10.1186/1471-2458-13-s3-s28

Abstract

BackgroundDiarrhea is one of the major causes of death in children under five years of age, disproportionately affecting children in low- and middle-income countries. Treatment of diarrhea with oral rehydration solution addresses dehydration and reduces diarrhea related deaths. The World Health Organization Programme for the Control of Diarrhoeal Disease began in 1978 and while global ORS access rates have improved substantially over the past forty years, rates of ORS use have stagnated. Investigation is required to understand which interventions are effective in promoting the use of ORS, and where there are gaps in the literature.MethodsWe conducted a systematic search of peer-reviewed and grey literature and included interventions to promote the use of ORS for the treatment of acute diarrhea in children under 6 years. We used a standardized grading format based on the Child Health Epidemiology Research Group guidelines and performed meta-analysis for all categories with more than one data point.ResultsWe identified 19 studies for abstraction. For co-promotion of zinc and ORS, mothers in the intervention group were 1.82 (95% CI 1.17, 2.85) times more likely to use ORS to treat their child’s diarrhea episode than mothers in the comparison group. Meta-analysis of ORS social marketing and mass media strategies indicates that mothers exposed to messages were 2.05 (95% CI, 0.78, 5.42) times more likely to use ORS to treat their child’s diarrhea episode than unexposed mothers. However, this is not statistically significant. Both meta-analysis had significant heterogeneity and were graded as moderate/low and low quality, respectively.ConclusionsWe found few studies of interventions to promote the use of ORS; many categories of interventions had only one study. While there are some promising results, this analysis reinforces the need for further investigation into approaches to increasing ORS use.

Highlights

Diarrhea is one of the major causes of death in children under five years of age, disproportionately affecting children in low- and middle-income countries
The cause of death is almost always due to fluid loss and dehydration [2]. This can be addressed through fluid therapy in the form of oral rehydration solution - a simple, cost-effective treatment that was proven to be effective during a cholera epidemic in Bangladesh in the 1970s [3]
After excluding studies graded as very low quality [11,12,13], we were able to conduct meta-analyses on two categories of oral rehydration solution (ORS) strategies: co-promotion of zinc and ORS as well as social marketing and mass media

Summary

Introduction

Diarrhea is one of the major causes of death in children under five years of age, disproportionately affecting children in low- and middle-income countries. Treatment of diarrhea with oral rehydration solution addresses dehydration and reduces diarrhea related deaths. Diarrhea is one of the major causes of death in children under five years of age, leading to an estimated 1.071 million annual deaths and disproportionately affecting children in low- and middle-income countries [1]. The cause of death is almost always due to fluid loss and dehydration [2] This can be addressed through fluid therapy in the form of oral rehydration solution - a simple, cost-effective treatment that was proven to be effective during a cholera epidemic in Bangladesh in the 1970s [3]. Activities in diarrheal disease control programs vary widely from country to country and have included social marketing and mass media campaigns, the involvement of political figures and religious leaders, educational campaigns in schools, training of partly skilled health care workers, changes to medical school curricula, distribution schemes, as well as the establishment of outpatient oral rehydration centers [2]

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