Usage of oral rehydration solutions (ORS): a critical assessment of utilization rates

Abstract

Policymakers and program managers rely on the oral rehydration solution (ORS) use rate as an indicator of program performance. The ORS use rate has several limitations e.g. it disregards other program objectives. Other diarrheal disease control program objectives may include reducing the source of infection promotion of effective home-based treatment and training of health workers in appropriate diarrhea case management. WHO and the Demographic and Health Surveys (DHS) try to standardize the methodology for estimating ORS use rates but they have not looked at them as cross-country indicators. Error sources lie in the terms used for diarrhea the reference period and the sequence of questions referring to treatment. In Bangladesh the people recognize different types of diarrhea and treat each type differently. In 1 instance health workers informed mothers to prepare and give a homemade sugar salt solution. Later they learned that mothers did not use ORS very much because they only used ORS for the type of diarrhea the health workers described. There has been considerable variation of ORS use rates in Bangladesh perhaps because of the differences in meanings of the words used for diarrhea. The DHS uses a 2-week reference period yet a Bangladesh survey finds underreporting of diarrheal episodes which occur early in the week of the survey. Other surveys do not use a specific reference period and mothers tend to remember only serious diarrheal episodes. A direct question about ORS use in surveys is too leading as indicated by higher ORS use rates when interviewers prompt respondents. ORS use rates do not give a true picture of a program and can even be counterproductive. No consensus exists as to what is high ORS use rate and what is low ORS use rate. Managers should not use ORS use rates as the only program indicator.