Oral Rehydration Salt Solution Research Articles

Factors Influencing the Use of Oral Rehydration Solution among Mothers of Under Five Children Attending Holy Rosary Specialist Hospital and Maternity Waterside In Onitsha North Lga, Anambra State.

Purpose: This study determined factors influencing the use of oral rehydration solution among mothers with children below five years of age attending Holy Rosary Specialist Hospital and Maternity Waterside in Onitsha North LGA, Anambra State.
 Methodology: A cross-sectional descriptive design was adopted in conducting the study among mothers with children under five years attending Rosary Specialist Hospital and Maternity, Waterside in Onitsha North Local Government Area, Anambra State. A sample size of one hundred and fifty (150) women was selected by convenience sampling techniques. A self-structured questionnaire with a reliability coefficient of 0.98 was used in gathering the necessary data suitable for the study which were analysed with SPSS version 20.0.
 Findings: It was discovered that majority of the women 141(94.6%) have heard of ORS and they have adequate understanding of the solution, the two different types of oral rehydration solutions (that is solution from oral rehydration salt and salt sugar solution) but do not use SSS hence lack adequate knowledge of its preparation. Also, the mothers 116(95.9%) used ORS when their children had diarrhoea while the remaining 5(4.1%) did not use ORS because their children never had diarrhoea. 65(43.6%) of the women have all the materials needed for the preparation of SSS while 70(47.0%) which were the majority did not know the materials required for the preparation of ORS hence they could not indicate if they had the materials or not. From the hypothesis tested, there is a significant relationship between mothers’ level of education (p=0.030), mother’s occupation (p=0.024), number of under five children (p=0.045) and the use of ORS. From the study, it was ascertained that socio-demographic factors like mother’s level of education, occupation and number of under five children affected the use of ORS in the population used. Mother’s level of knowledge of the solution, availability and accessibility of the ORS sachet (environmental factor) and the occurrence of diarrhoea in a child (Child factor) also affect use of ORS.
 Recommendations: Health workers in the health care facilities should intensify their effort in the provision of adequate health education to the mothers (may be to be incorporated into antenatal care health talks) on the preparation of Salt Sugar Solution (SSS) type which is cost effective and readily available. Also the hospital management should ensure that Oral Rehydration salt sachets are available in the hospitals and at an affordable price so as to ensure authenticity of the product used by the women.

KNOWLEDGE AND PRACTICE REGARDING ORAL REHYDRATION SALTS (ORS) SOLUTION USE IN DIARRHEAL DISEASE AMONG MOTHERS OF UNDER-FIVE CHILDREN IN RURAL WEST BENGAL: A HOSPITAL BASED CROSS SECTIONAL STUDY

Childhood diarrhea is one of the major public health problems. Diarrhea is the second most common cause of mortality in under-ve children. Use of Oral rehydration salts (ORS) solution is the most cost-effective intervention to prevent diarrhea related mortality and morbidity. Aims And Objectives: To evaluate the knowledge and practice towards ORS use in diarrheal disease among mothers of under-ve children in rural West Bengal. This hospital based cross sectional study was carried out in pediatrics department of BSMCH, Bankura. Data aboutMethodology: demography, knowledge and practice regarding diarrheal management and ORS use were collected with predesigned semi structured questionnaire from 300 mothers of under-ve children who have suffered at least once from diarrhea in last one month. DemographicResults: ndings indicated 54.3% mothers belonged to age of 18-25 years while illiterate and primary level educated mothers constituted 35% and 28% of study sample, respectively. Though 87% mothers heard about ORS but only 68.7% mothers considered ORS as remedy of diarrhea. Knowledge about preparation (42%), initiation (43%), amount (39%), timing of use (35.3%) and storage of ORS (22%) were unsatisfactory. Furthermore, majority had no clue regarding Zinc (9.6%) and Rota virus vaccination (13.3). Age and education of the mother had statistically signicant (P< 0.05) association with knowledge and practice. In our study, mothers had lacuna in their knowledge about proper use of ORS.Conclusion: Successful treatment of diarrhea depends on mother's knowledge and practices. Health Education should be aimed at rectifying those inadequacies to reduce further mortality and morbidity

Knowledge, Attitudes and Practices of Mothers with Children Under Five Years towards Diarrheal Diseases in Displaced People Camp

A cross sectional-community based study was conducted in Al-Salaam displaced people Camp to assess knowledge, attitudes and practices of mothers with under five years children towards diarrheal diseases, the study aimed to study knowledge, attitudes and practices of mothers with under five years children towards diarrheal diseases. 380 mothers with fewer than five children were selected using a systematic random sampling technique. The data collected through structured questionnaire designed to cover all research objectives and observations. The statistical Package for Social Science (SPSS) was used to analyze the data; the results were presented in figures. The study clarified that mothers have low knowledge regarding the possible causes of diarrheal diseasess. Large number of mothers (70.5%) believe that tooth loss is a major cause of diarrhea in children under five years old, regarding practices during diarrheal infections, 50.8% of mothers increased numbers of meals to their children. Very small numbers of mothers (28.2%) prepared oral rehydration salts solution correctly, most mothers believe in seeking health services when home management was failed, sanitation was very weak, the majority (78%) of residences were using shared toilets. The study recommended that the local health authorities should increase knowledge of mothers about diarrheal diseases and its management through health education sessions, provision of clean water and sanitation services.

Determinants of oral rehydration salt utilization among under-five children with diarrhea in Ethiopia: A multilevel mixed-effect analysis.

Background:Oral rehydration salt therapy is a critical intervention to reduce mortality and morbidity of children with diarrheal diseases. However, it remains underused in low- and middle-income countries. In Ethiopia, only less than half of children with diarrheal diseases were treated with oral rehydration salt solution. Therefore, the objective of this study was to identify the determinants of oral rehydration salt utilization among children with diarrhea in Ethiopia.Method:A secondary data analysis was done using the 2016 Ethiopian Demographic and Health Survey. A weighted sample of 1227 children who had diarrhea in the last 2 weeks with their index mothers during the 5 years survey was included in the study. A multilevel mixed logistic regression model was fitted to identify factors associated with oral rehydration salt utilization. Finally, statistical significance was declared at p-value < 0.05.Result:The overall prevalence of oral rehydration salt utilization for children with diarrhea was 29.5%. In this study, age of mother ⩾35 (adjusted odds ratio = 1.66, 95% confidence interval = 1.05, 2.64), mothers with formal education (adjusted odds ratio = 1.52, 95% confidence interval = 1.09, 2.11), media exposure (adjusted odds ratio = 1.72, 95% confidence interval = 1.25, 2.38), living in Metropolitan regions (Addis Ababa and Dire Dawa (adjusted odds ratio = 1.76, 95% confidence interval = 1.14, 2.69)), and small peripheral regions (Afar, Gambela, Somalia, Benishangul-Gumuz (adjusted odds ratio = 1.69, 95% confidence interval = 1.22, 2.34)) were associated with higher odd of oral rehydration salt utilization for children with diarrhea.Conclusion:The study concludes that the age of mothers, educational status of the mother, media exposure, and regions of mothers were determinants of oral rehydration salt utilization for children with diarrhea. Therefore, media advertising regarding diarrhea management should be scaled up to increase oral rehydration salt utilization for children with diarrhea. Special attention to socio-cultural constraints or beliefs regarding diarrhea management should be given to mothers from large to center (Tigray, Amhara, Oromia, Southern Nations Nationalities, and People’s Region, and Harari) regions.

Characteristics of Prehospital Heat Illness Cases During the Annual Heat Wave Period in Telangana, India.

Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem. This retrospective observational study reviewed patients presenting to Telangana's prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients' characteristics and prehospital intervention. There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned. This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.

Foodborne Pathogenic Vibrios: Antimicrobial Resistance.

Foodborne illness caused by pathogenic Vibrios is generally associated with the consumption of raw or undercooked seafood. Fish and other seafood can be contaminated with Vibrio species, natural inhabitants of the marine, estuarine, and freshwater environment. Pathogenic Vibrios of major public health concerns are Vibrio cholerae, Vibrio parahaemolyticus, and Vibrio vulnificus. Common symptoms of foodborne Vibrio infection include watery diarrhea, stomach cramping, nausea, vomiting, fever, and chills. Administration of oral or intravenous rehydration salts solution is the mainstay for the management of cholera, and antibiotics are also used to shorten the duration of diarrhea and to limit further transmission of the disease. Currently, doxycycline, azithromycin, or ciprofloxacin are commonly used for V. cholerae, and doxycycline or quinolone are administered for V. parahaemolyticus, whereas doxycycline and a third-generation cephalosporin are recommended for V. vulnificus as initial treatment regimen. The emergence of antimicrobial resistance (AMR) in Vibrios is increasingly common across the globe and a decrease in the effectiveness of commonly available antibiotics poses a global threat to public health. Recent progress in comparative genomic studies suggests that the genomes of the drug-resistant Vibrios harbor mobile genetic elements like plasmids, integrating conjugative elements, superintegron, transposable elements, and insertion sequences, which are the major carriers of genetic determinants encoding antimicrobial resistance. These mobile genetic elements are highly dynamic and could potentially propagate to other bacteria through horizontal gene transfer (HGT). To combat the serious threat of rising AMR, it is crucial to develop strategies for robust surveillance, use of new/novel pharmaceuticals, and prevention of antibiotic misuse.

Low Osmolarity Oral Rehydration Salt Solution (LORS) in Management of Dehydration in Children

JustificationThe IAP last published the guidelines “Comprehensive Management of Diarrhea” in 2006 and a review in 2016. The WHO in 2002 and the Government of India in 2004 recommended low osmolarity rehydration solution (LORS) as the universal rehydration solution for all ages and all forms of dehydration. However, the use of LORS in India continues to be unacceptably low at 51%, although awareness about ORS has increased from a mere 14% in 2005 to 69% in 2015. Availability of different compositions of ORS and brands in market added to the confusion.ProcessThe Indian Academy of Pediatrics constituted a panel of experts from the fields of pediatrics, pediatric gastroenterology and nutrition to update on management of dehydration in children with particular reference to LORS and issue a current practice guideline. The committee met twice at CIAP HQ to review all published literature on the aspect. Brief presentations were made, followed by discussions. The draft paper was circulated by email. All relevant inputs and suggestions were incorporated to arrive at a consensus on this practice guideline.ObjectivesTo summarize latest literature on ORT and empower pediatricians, particularly those practicing in rural areas, on management of dehydration by augmenting LORS use.RecommendationsIt was stressed that advantages of LORS far out-weigh its limitations. Increased use of LORS can only be achieved by promoting better awareness among public and health-care providers across all systems of medicine. LORS can also be useful in managing dehydration in non-diarrheal illness. More research is required to modify ORS further to make it safe and effective in neonates, severe acute malnutrition, renal failure, cardiac and other co-morbidities. There is an urgent need to discourage production and marketing all forms of ORS not in conformity with WHO approved LORS, under a slogan “One India, one ORS”.

Clinical and laboratory predictors of 30-day mortality in severe acute malnourished children with severe pneumonia.

To determine the predictors of mortality within 30days of hospital admission in a diarrhoeal disease hospital in Bangladesh. Cohort study of hospitalised children aged 0-59months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30days of hospital admission. We enrolled 191 children. Mortality within 30days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR=5.80, 95% CI: 1.34-25.19), LAZ <-4 (aOR=6.51, 95% CI: 1.49-28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0×109 /L) (aOR=1.06, 95% CI: 1.01-1.11). Using sex, Z-score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross-validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30-day mortality. The results of our data suggest that female sex, severe malnutrition (<-4 LAZ) and higher PMNL percentage were prone to be associated with 30-day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.

How do glucose-based oral rehydration salt solutions with osmolarity ≤ 270 mOsm/L compare with ≥ 310 mOsm/L solutions for treating adolescents and adults with cholera?

How do glucose-based oral rehydration salt solutions with osmolarity ≤ 270 mOsm/L compare with ≥ 310 mOsm/L solutions for treating adolescents and adults with cholera?

Pathogen-specific risk of seizure in children with moderate-to-severe diarrhoea: Case control study with follow-up.

To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings. This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset. The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR=5.34, 95% CI=2.37-12.04) particularly S. flexneri (OR=3.34, 95% CI=1.48-7.57), S. flexneri 6 (OR=23.24, 95% CI=2.79-193.85), S. sonnei (OR=6.90, 95% CI=2.34-19.85); norovirus (OR=6.77, 95% CI=1.69-27.11), fever (OR=16.75, 95% CI=1.81-154.70) and loss of consciousness (OR=35.25, 95% CI=1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P=0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P<0.001) and WAZ (P<0.05), whereas deterioration in HAZ (P<0.001) in both cases and controls. Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.

Comparison of acute pressor effects of plain water, oral rehydration solution, and fruit juice ingestion in healthy young adults

Background and Objectives: Ingestion of plain water is associated with an acute rise in blood pressure, probably due to elicitation of a sympathetic reflex in patients with autonomic dysfunction. Whether the pressor response is similar in healthy individuals is disputed. Other types of fluid could have different effects. Comparison of the pressor effects of plain water ingestion with other types of fluids has been reported scantily. &#x0D; Material and methods: In a cross-over experimental study, young medical students ingested 500 mL of plain water (PW), 500 mL of oral rehydration salt solution (ORS), or 400 mL of commercial fruit juice (FJ) on separate days, with at least two days’ gap. Their heart rate (HR) and blood pressure (BP: systolic, SBP and diastolic, DBP) were recorded before, immediately after (0 min), and at 2, 5, 20, and 40 min after fluid ingestion and compared with baseline values. &#x0D; Results: Sixty nine apparently healthy medical students (40 males and 29 females, age range 18-24 years) participated in the study. Compared to baseline, SBP and DBP were significantly higher at 0, 2, and 5 min measurements with ORS and FJ; then lowered at 20 and 40 min. With the PW, BP changes were not significant at any time of measurement. In all experimental set ups, HR increased significantly at 0, 2, and 5 min and lowered to near baseline levels then after. &#x0D; Conclusion: Ingestion of ORS and FJ, but not PW, is associated with acute pressor effects in healthy young adults. This finding could have implications on the choice of fluid for prophylaxis in hypotensive conditions such as blood donation, postural hypotension, and autonomic dysfunction.

Impact of oral resuscitation on circulating and splenic leukocytes after burns.

Hemodynamic aberrations after severe burns are treated with aggressive intravenous (IV) fluid resuscitation however, oral resuscitation has been proposed in resource poor scenarios. Previously we have shown that animals receiving oral fluid following burns were able to recover kidney function. However, immune function such as circulating and splenic immune cell populations after oral or intravenous fluid administration was not examined. Herein, we perform a follow up analysis of splenic tissue and plasma from the previous animal study to examine the splenic response following these resuscitation strategies after burn injury. Eighteen anesthetized Yorkshire swine receiving 40%TBSA contact burns were randomized to receive either: (1) no fluids (Fluid Restricted; negative control), (2) 70 mL/kg/d Oral Rehydration Salt solution (Oral), or (3) 2 mL/kg/%TBSA/d of lactated Ringer's solution IV. Blood was drawn for blood cell analysis, and CT scans were performed before and 48 h post-burn, at which point spleens were harvested for histological, Western blot, and RT-PCR analyses. Splenic artery diameter decreased by -0.97 ± 0.14 mm in fluid-restricted animals, while IV led to an increase of 0.68 ± 0.30 mm. No significant differences were detected in white and red pulp. IV fluids reduced the population of splenic monocytes (CD163; P = 0.001) and neutrophils (MPO protein; P = 0.13), as well as cytokines IL-8 (P = 0.003), IFN-γ (P = 0.11) and TNFα (P = 0.05). Additionally, withholding IV fluids consistently decreased the expression of FoxP3, CCR6, and IL17β in spleen, suggesting a shift in T-cell phenotype with IV resuscitation. The route of fluid administration has a minor influence on the changes in circulating and splenic leukocytes post-burn in the acute phase. Further research is needed to help guide resuscitation approaches using immunologic markers of splenic function following burns.

A qualitative study on experiences of mothers about control of diarrhoea of their children

Background: Diarrheal disease poses a significant problem to the health, wellbeing and survival of children of less than five-year age group and is the second leading cause of mortality. Most of the deaths are due to dehydration and it can be preventable by proper and timely use of oral rehydration salt solution (ORS). There is lack of awareness among the mothers about the appropriate use of ORS during diarrhea of children. So, authors have tried to find out the experiences of the mothers about the management of diarrhea of their children.Methods: The study is one of qualitative descriptive type involving 27 mothers of children who are suffering from diarrhoea in face to face in depth interviews (IDI).Results: The mothers of children were within the age group of 21 to 34 years of age group. On the basis of qualitative data analysis, the present study shows the data related to childhood diarrhea can be classified under six themes. The themes are : 'Perception of the participant mothers about the diarrhea of their babies', 'Measures taken by the mothers to combat diarrhea at home', 'How Oral rehydration salt solution is applied by the mothers', 'How Oral rehydration salt solution is beneficial', 'How Oral rehydration salt solution is causing undesirable effects on the baby' and 'What additional measures taken to control diarrhea of the baby'.Conclusions: There are several misconceptions and lack of awareness of the mothers about management of diarrhoea. However, it is possible to create awareness among them so that they can take all suitable measures to control diarrhoea.

Temporal changes of abomasal contents and volumes in calves fed milk diluted with oral rehydration salt solution.

Several manufacturers recommend to feed mixture comprising equal amounts of oral rehydration salt (ORS) solution and milk for diarrheic calves after milk withdrawal. Such a feeding method is expected to supply more nutrients and energy compared to feeding only the ORS solution. However, little is known about the effects of feeding milk diluted with ORS solution on calves’ digestive process. This study examined the abomasal contents, volumes, and emptying rates in calves fed whole milk, milk diluted by 50% with ORS solution (50% ORS-milk), and ORS solution. Ultrasonography identified curds in the milk-fed calves, but not in the 50% ORS-milk-fed or the ORS-fed calves. The abomasal fluid of the 50% ORS-milk-fed calves contained not only β-lactoglobulin but also α-casein (CN), β-CN, and κ-CN, which were used for curd formation and undetectable in the milk-fed calves. Abomasal pH was relatively higher in the 50% ORS-milk-fed than that in the milk-fed calves. Abomasal emptying rates were significantly faster in the ORS-fed than in the 50% ORS-milk-fed and the milk-fed calves. These data indicate that the formation of abomasal curd is inhibited in the 50% ORS-milk-fed calves due to the resultant high abomasal pH and low κ-CN concentration. The 50% ORS-milk may not provide rehydration as quickly as the ORS solution. In conclusion, we do not recommend feeding 50% ORS-milk to calves.

Enteral resuscitation with oral rehydration solution to reduce acute kidney injury in burn victims: Evidence from a porcine model.

Intravenous (IV) resuscitation of burn patients has greatly improved outcomes and become a cornerstone of modern burn care. However, the heavy fluids and vascular access required may not be feasible in austere environments, mass casualty, or delayed transport scenarios. Enteral resuscitation has been proposed for these situations; we sought to examine the effectiveness of this strategy on improving burn-induced kidney injury. Anesthetized Yorkshire swine sustaining 40% TBSA full-thickness contact burns were randomized to three groups (n = 6/group): fluid deprivation, ad libitum water access, or 70 mL/kg/d Oral Rehydration Salt solution (ORS). Urine and blood were collected at baseline (BL), 6, 12, 24, 32, and 48h post-burn, at which point tissue was harvested and CT angiography performed. Although fluid consumption by ad libitum and ORS groups were matched (132±54mL/kg versus 120±24mL/kg, respectively), ORS intake increased urine output compared with water and no water (47.3±9.0 mL/kg versus 16.1±2.5 mL/kg, and 24.5±1.7 mL/kg respectively). Plasma creatinine peaked 6h following burn (1.67±0.07mg/dL) in all animals, but at 48h was comparable to BL in animals receiving water (1.23±0.06mg/dL) and ORS (1.30±0.09mg/dL), but not fluid deprived animals (1.56±0.05mg/dL) (P<0.05). Circulating levels of blood urea nitrogen steadily increased, but also decreased by 48h in animals receiving enteral fluids (P<0.05). Water deprivation reduced renal artery diameter (-1.4±0.17mm), whereas resuscitation with water (-0.44±0.14 mm) or ORS maintained it (-0.63±0.20 mm;P< 0.02). Circulating cytokines IL-1β, IL-6, IFNγ, and GM-CSF were moderately elevated in the fluid-deprived group. Taken together, the data suggest that enteral resuscitation with ORS rescues kidney function following burn injury. Incorporating enteral fluids may improve outcomes in resource-poor environments and possibly reduce IV fluid requirements to prevent co-morbidities associated with over-resuscitation. Studies into different volumes/types of enteral fluids are warranted. While ORS has saved many lives in cholera-associated dehydration, it should be investigated further for use in burn patients.

High doses of Antisecretory Factor stop diarrhea fast without recurrence for six weeks post treatment

BackgroundDiarrheal illnesses in young children cause morbidity and preventable deaths in developing countries. We evaluated two high doses of Salovum® [Antisecretory Factor] to treat diarrhea in young children and followed up for recurrence 6 weeks post treatment. MethodsForty children, 6-24 months old, admitted with acute diarrhea, to the Outpatient Department of Children’s Hospital in Lahore, Pakistan were selected. The patients were randomly allocated to either Group A given 2 sachets, or to Group B, given 4 sachets. Each sachet contained 4gram of Salovum® and was mixed with Oral Rehydration Salt solution. This mixture was administered perorally within the first 30min of treatment. The trained nursing staff observed them for number of stools and consistency over every half hour for a total of 4hours. Follow up for 6 weeks was done daily by telephone, or visits by the mothers. The results demonstrate that Salovum provides a protective effect irrespective of the diarrhea causes. ResultsGroup B, given 4 sachets of Salovum® showed improved fecal consistency in 80% of the children compared to 50% in Group A within 30minutes of treatment, p=0.004. The number of diarrheal stools decreased over this time from seven to one/two over 4hours in the two groups [p=0.234]. None of the children showed a recurrence of diarrhea over the follow up period. ConclusionPeroral high doses of Salovum® rapidly and safely counteract diarrhea in children followed by a diarrhea-free period of 6 weeks.

Dispensing pattern for acute non‐infectious diarrhoea in children at community pharmacies in Thailand

AbstractBackgroundIn cases of non‐infectious diarrhoea in children, the WHO and the Thai Antibiotic Smart Use (ASU) project recommend that no antibiotics should be given and drinking water should be replaced with oral rehydration salt (ORS) solution until the diarrhoea is finished.AimTo survey the dispensing pattern for non‐infectious diarrhoea treatment in children in Thailand.MethodsSimulated clients visited 91 Class I community pharmacies in five districts in Khon Kaen province and asked for advice to treat non‐infectious diarrhoea in a 14‐month‐old child. The patient history questions asked by the dispensers, the medications dispensed and non‐pharmacological advice given were recorded by the simulated clients immediately after leaving the pharmacy.ResultsIn this study, ORS solution was correctly dispensed to the simulated clients in only 7.7% of pharmacies with 68.1% incorrectly dispensing antibiotics. More than half of the dispensers (57.1%) did not give any advice regarding non‐pharmacological treatment.ConclusionThe results of this study indicate the need to implement a program to emphasise the importance of providing ORS and discourage the dispensing of antibiotics in this circumstance.

Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria

Background and Aim: Diarrheal deaths are largely preventable with the use of oral rehydration salt (ORS) solution. The aim of this study was to investigate the preparation and use of ORS for the treatment of childhood diarrhea in Ilesa, Nigeria. Materials and Methods: The characteristics of the present diarrheal illness as well as biodata, social class, use of ORS solution, and the method of preparation were documented in 250 children with diarrhea at the Wesley Guild Hospital, Ilesa, Nigeria. Data were analyzed using the statistical program for the social sciences (SPSS) version 16.0. Results: A total of 151 (60.4%) of the children had been given ORS before the presentation. The ORS was correctly prepared in 38 (25.2%) of them, whereas hypertonic ORS solution was mostly given to the others. A significantly higher proportion (66.7%) of those from high social class had their ORS correctly prepared, compared with 16.1% of those from low social class (P = 0.000). The use of ORS was more prevalent among children with longer duration of diarrhea (P = 0.004). A significantly higher proportion of children who were still breastfeeding were given ORS, compared with those who had stopped breastfeeding (P = 0.007). Conclusion: Teachings on the use and correct preparation of ORS should not be limited to diarrhea treatment units, but should rather be included in the routine health talks given to mothers at antenatal and immunization clinics. The provision of a 1 L measure to be used for measuring water for ORS preparation should be seriously considered to combat the problem of hypertonic ORS preparations.

Harnessing the power of emotional drivers to promote behaviour change.

Harnessing the power of emotional drivers to promote behaviour change.

Multiple behaviour change intervention for diarrhoea control in Lusaka, Zambia: a cluster randomised trial.

Effective prevention and control of diarrhoea requires caregivers to comply with a suite of proven measures, including exclusive breastfeeding, handwashing with soap, correct use of oral rehydration salts, and zinc administration. We aimed to assess the effect of a novel behaviour change intervention using emotional drivers on caregiver practice of these behaviours. We did a cluster randomised controlled trial in Lusaka Province, Zambia. A random sample of 16 health centres (clusters) were selected from a sampling frame of 81 health centres in three of four districts in Lusaka Province using a computerised random number generator. Each cluster was randomly assigned 1:1 to either the intervention-clinic events, community events, and radio messaging-or to a standard care control arm, both for 6 months. Primary outcomes were exclusive breastfeeding (self-report), handwashing with soap (observation), oral rehydration salt solution preparation (demonstration), and zinc use in diarrhoea treatment (self-report). We measured outcome behaviours at baseline before start of intervention and 4-6 weeks post-intervention through repeat cross-sectional surveys with mothers of an infant younger than 6 months and primary caregivers of a child younger than 5 years with recent diarrhoea. We compared outcomes on an intention-to-treat population between intervention and control groups adjusted for baseline behaviour. The study was registered with ClinicalTrials.gov, number NCT02081521. Between Jan 20 and Feb 3, 2014, we recruited 306 mothers of an infant aged 0-5 months (156 intervention, 150 standard care) and 343 primary caregiver of a child aged 0-59 months with recent diarrhoea (176 intervention, 167 standard care) at baseline. Between Oct 20 to Nov 7, 2014, we recruited 401 mothers of an infant 0-5 months (234 intervention, 167 standard care) and 410 primary caregivers of a child 0-59 months with recent diarrhoea (257 intervention, 163 standard care) at endline. Intervention was associated with increased prevalence of self-reported exclusive breastfeeding of infants aged 0-5 months (adjusted difference 10·5%, 95% CI 0·9-19·9). Other primary outcomes were not affected by intervention. Cluster intervention exposure ranged from 11-81%, measured by participant self-report with verification questions. Comparison of control and intervention clusters with coverage greater than 35% provided strong evidence of an intervention effect on oral rehydration salt solution preparation and breastfeeding outcomes. The intervention may have improved exclusive breastfeeding (assessed by self-reporting), but intervention effects were diluted in clusters with low exposure. Complex caregiver practices can improve through interventions built around human motives, but these must be implemented more intensely. Absolute Return for Kids (ARK) and Comic Relief.