Use Of Oral Rehydration Salts Research Articles

Establishment and validation of a multivariate predictive model for the efficacy of oral rehydration salts in children with postural tachycardia syndrome

The therapeutic effectiveness of the empirical and unselected use of oral rehydration salts (ORS) on postural tachycardia syndrome (POTS) is not satisfactory in children. Therefore, looking for suitable predictors of the therapeutic effects of ORS before treatment is extremely necessary to implement individualised treatment for paediatric patients with POTS. A retrospective case-control analysis of 130 patients (aged 5-18 years) who suffered from POTS with a 3-month treatment of ORS was conducted. A nomogram model was developed in the training set (n=87) to predict the therapeutic response to ORS. Univariate analysis and logistic regression were applied to select the most useful predictors. ROC curves were applied to evaluate the discriminative performance of the nomogram model. The nomogram was then evaluated by calibration curves and the Hosmer-Lemeshow (H-L) test. The results were further validated using 1000 bootstrap resamples. External validation was performed in an independent validation set (n=43). Among the ten variables with significant differences between the responders and non-responders in univariate analysis, five variables were found to be independently associated factors for ORS therapeutic efficacy among POTS children in the further logistic regression, including mean corpuscular haemoglobin concentration (MCHC), mean corpuscular volume (MCV), mean arterial pressure (MAP) at the first minute of the upright position, urine specific gravity (SG), and P-wave voltage peaking ratio (PWP). The nomogram model was established in the training set (AUC 0.926 [95% CI: 0.865-0.988], yielding a sensitivity of 87.8% and a specificity of 86.8%). The calibration curves showed good agreement between the prediction of the nomogram and actual observation in both the training and validation sets. The nomogram also effectively predicted the external validation set (sensitivity 82.1%, specificity 73.3%, and accuracy 79.1%). We established a feasible and high-precision nomogram model to predict the efficacy of ORS, which would help implement individualised treatment for children with POTS. This study was supported by National High-Level Hospital Clinical Research Funding (Multi-centre Clinical Research Project of Peking University First Hospital) (2022CR59).

Design thinking to improve rational use of oral rehydration salts: lessons from an innovative co-packaged diarrhoea treatment kit

IntroductionWe explored whether greater consideration of product design, informed by end users’ opinions, led to improved utilisation (ie, rational use) of oral rehydration salts (ORS) in home settings. We tested...

Assessment of Determinants of Paediatric Diarrhoea Case Management Adherence in Pakistan

Worldwide, diarrhoea in children under five years of age is the second leading cause of death. Despite having high morbidity and mortality, diarrhoeal diseases can be averted by simple and cost-effective interventions. The Integrated Management of Childhood Illness (IMCI) has proposed the use of Oral Rehydration Salt (ORS) and zinc together with adequate food and fluid intake for the management of acute non-dysenteric watery diarrhoea in children. In the past, few studies examined the determinants of adherence to diarrhoea case management. Therefore, this study measured the determinants of therapeutic and dietary adherence to diarrhoea case management using the third and fourth wave of Pakistan Demographics and Health Surveys (PDHS) datasets. Data from 4068 children between 0 to 59.9 months with positive history of diarrhoea were included, while data on children with dysentery, severe dehydration, and co-morbid condition was excluded. This study reported therapeutic adherence in less than 10% of children in Pakistan, while dietary adherence was reported in 39.2% of children (37.7% in 2012-2013 and 40.7% in 2017-2018). A significant improvement in therapeutic (0.8% in 2012-2013 and 8.1% in 2017-2018) and dietary adherence (37.7% in 2012-2013 and 40.7% in 2017-2018) was reported in the 2017-2018 survey compared to the 2012-2013 survey. In general, children over the age of one year (compared to children <1 year) and of the richer/richest socioeconomic class (compared to poorest/poorer socioeconomic class) showed higher therapeutic and dietary adherence. Therapeutic and dietary adherence among diarrhoeal children can be improved by increasing the awareness and accessibility of ORS, zinc, and essential foods.

Determining critical gaps in implementation of WHO and UNICEF's 7-point plan in diarrhoea control and prevention strategy: A cross sectional study in District Swabi, Pakistan.

To determine the critical gaps in knowledge and practices of mothers/caregivers in the management of diarrhoea in children at home. The descriptive cross-sectional study was conducted from September 2019 to August 2020 at primary health centres across Swabi district of the Khyber Pakhtunkhwa province of Pakistan, and comprised mothers/caregivers presenting with children aged <5 years suffering from diarrhoea. Barriers to childhood diarrhoea prevention and control were identified in accordance with the 7-point plan adopted by the federal government in 2009. Data was analysed using SPSS 23. There were 287 mothers with a mean age of 26.8±5.39 years (range: 17-42 years). The mean age of the children was 24.85±12.72 months (range: 2-55 months). Among the mothers, 145 (51.5%) had received no schooling, 83(29%) had primary level schooling, 56(19.5%) secondary level and 3(1%) had received higher-level education. Only 63(22%) were aware of the use of oral rehydration salts and 32(11%) knew about the need of using zinc in diarrhoea. Safe water was available in 14(5%) households. Hand hygiene awareness was low, as 169(59%) mothers were washing hands with soap. Household access to toilet facility was 247(86%). Preventive health services were good with overall breastfeeding practices 204(71%) and children vaccination 244(85%.). Majority of mothers were found to be well aware of breastfeeding practices and the children had adequate vaccination coverage. There was a wide gap in direct awareness and practices of mothers about sanitation and hygiene and also home-based management of diarrhoeal diseases in children.

ROTAVIRUS AND GASTROENTERITIS: CLINICAL AND EPIDEMIOLOGICAL TRAITS

There is a strong association between rotavirus and gastroenteritis. The gastroenteritis by rotavirus is one of the most important cause of child internation at hospital. The rotavirus belongs to the Reoviridae family, genus Rotavirus and it have been classified into seven groups (A to G), where the A group is the major cause of diarrhea in children, and the B group in adults. The symptoms of the rotavirus gastroenteritis are high fever, vomiting, and severe diarrhea, leading to dehydration. Subclinical and assymptomatic rotavirus infections are very common among adults. The detection of rotavirus is done by various methods. The treatment is the use of Oral Rehydration Salts, the control is made through epidemiological vigilance and the immunization is done by the use of vaccines (as RRV-TV, in the US market, and 89-12, still being tested).Was realized this bibliographic research using the international databanks SCIELO, BIREME, PUBMED and HIGHWIRE. The diarrhea caused by this virus is the most common severe infection in children younger than 5 years and it leads to approximately 440.000 deaths per year. By this way, efforts to discovery of vaccines more effective should be stimulated and the health workers must be prepared to detect these viruses to alert the epidemiological vigilance. Key words: rotavirus; gastroenteritis; diarrhea; children diarrhea; viruses.

The Co-Utilization of Oral Rehydration Solution and Zinc for Treating Diarrhea and Its Associated Factors Among Under-Five Children in Ethiopia: Further Analysis of EDHS 2016.

IntroductionDiarrhea causes a loss of body water and salt, which can lead to dehydration and death. The use of oral rehydration salts and zinc together is regarded as an effective treatment for diarrhea in resource-poor settings like Ethiopia. However, studies that examine the co-utilization of oral rehydration solution and zinc in the treatment of diarrhea are limited Ethiopia.ObjectiveTo assess the prevalence and associated factors of oral rehydration solution and zinc co-utilization to treat diarrhea in children under the age of five in Ethiopia, EDHS 2016.MethodsSecondary data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used to investigate the prevalence and factors associated with the co-utilization of ORS and zinc to treat diarrhea in under-five children. A multilevel binary logistic regression model was fitted to identify factors associated with the co-utilization of ORS and zinc. Adjusted odds ratios (AOR) with 95% CI were calculated and used as a measure of associations, and variables having a p-value of less than 0.05 were declared as statistically significant.ResultsThe national prevalence of ORS and zinc co-utilization was 16.65% (14.66%, 18.84%). Maternal educational status (AOR = 1.45; 95% CI; (1.01, 2.09)), household size (AOR = 1.53; 95% CI; 1.09, 2.16) and distance to health facilities at the community level (AOR = 1.60, 95% CI = 1.02, 2.58) were variables significantly associated with the co-use of ORS and zinc.ConclusionThe co-utilization of ORS and zinc for the management of diarrhea was low in Ethiopia. Education, household size, and distance to health facilities at the community level were significantly associated with the co-utilization of ORS and zinc in Ethiopia.

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&lt; 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

Awareness of quantity of ORS and Zinc among mothers of under five children with diarrhoea at a tertiary care Centre Lahore.

To assess mothers' knowledge about the quantity of oral rehydration salt and zinc in the management of diarrhoea. The cross-sectional study was conducted from May to August 2019 at The Children's Hospital, Lahore, Pakistan, and comprised mothers accompanying children aged <5 years admitted with diarrhoea complaints. Data was collected regarding demographics and mothers' awareness of signs of dehydration in diarrhoea, familiarity with the term oral rehydration salt, its correct preparation and administration and zinc supplementation. Data was analysed using SPSS 20. Of the 334 mothers interviewed, 154(46%) were able to identify the signs of dehydration. Maternal awareness regarding use of oral rehydration salt and zinc in diarrhoea were significantly associated with maternal education and socioeconomic status (p<0.05). There is a need to generate awareness among mothers about the use of oral rehydration salt and zinc in diarrhoea.

Knowledge, attitudes, and practices of mothers on the use of oral rehydration salts in children with diarrhoea: a cross‐sectional survey in Malaysia

AbstractBackgroundThe present study aimed to assess maternal knowledge, attitudes, and practices regarding the use of oral rehydration salts (ORS) in the treatment of childhood diarrhoea in Malaysia.MethodsA cross‐sectional study was conducted between 20 November and 20 December 2018. Mothers in different public places across Kuala Lumpur and Selangor were approached to complete a questionnaire. A non‐probability sampling method was used to collect data.ResultsA total of 400 mothers participated in the study. All mothers had received a formal education, with 80.2% having a tertiary education. 79.0% of participants managed to correctly define childhood diarrhoea, whereas 24.5% and 61.0% correctly identified all diarrhoea symptoms and the preventive approaches, respectively. However, only 49.0% knew that only treated or boiled water can be used to prepare ORS, while 78.8% were aware of the appropriate indication of ORS. The majority of respondents practice good hygiene when managing a child with diarrhoea.ConclusionAlthough mothers are equipped with reasonable knowledge regarding diarrhoea and ORS, certain issues identified in the study are disconcerting, namely the use of untreated water for ORS solution preparation, the inappropriate storage of ORS solution, and a lack of understanding regarding the urgency of ORS use. Hence, education interventions could prove useful in overcoming these false perceptions.

Mothers’ perception and management preference of acute diarrheal disease

Globally, diarrheal disease is one of the leading causes of morbidity and mortality among under-five years of children. Every day, approximately 2195 children die due to diarrheal diseases, which accounts for 1 in 9 child deaths worldwide. Many interventions that attempt to reduce childhood diarrhea are often fail because they are programed without understanding the problem in the target community and are culturally unsuitable. Therefore, this study aimed to assess perception and management preference of acute diarrheal disease among mothers who attend under five clinics. An institution based descriptive cross sectional study was conducted from May 1-May 30/2019. A total of 276 respondents were included in the study and consecutive sampling technique was used to identify the study participants. The results show that 47% of respondents perceive childhood diarrhea is caused by teething, 47.8% of the respondents perceive that diarrhea cannot be transmitted from one child to other. Majority of care givers prefer to give home remedies to their child, and also a substantial proportion of mothers and caregivers were not adequately knowledgeable on the use of oral rehydration salt which resulted in many of them using traditional medicine. There is need for increased health education focused on increasing caregivers‟ knowledge about the cause of diarrhea and enhancing adoption of appropriate prevention practices of diarrhea among children under five years.

A retrospective mixed-methods evaluation of a national ORS and zinc scale-up program in Uganda between 2011 and 2016.

BackgroundIn Uganda, diarrhoea was the third leading cause of mortality among children under the age of five in 2010. To address this issue, the Ministry of Health (MOH) formed a national Diarrhoea and Pneumonia Coordination Committee (DPCC) in 2011. One of the objectives of the DPCC for reducing diarrhoea mortality was to increase the use of oral rehydration salts (ORS) and zinc. This study aimed to describe and evaluate efforts by the DPCC to increase ORS and zinc coverage.MethodsWe conducted a retrospective mixed-methods evaluation to describe the activities conducted under the DPCC and evaluate the extent to which the committee’s goal of increasing ORS and zinc use was achieved. We conducted secondary analysis using Uganda’s Demographic and Health Survey from 2011 and 2016, analyzed cross-sectional private medicine outlet surveys from 2014 and 2016, analyzed ORS and zinc distribution data from the Uganda National Medical Stores, and reviewed program documents from DPCC partners.ResultsNationally, the proportion of children under five with diarrhoea treated with ORS and zinc increased from 1% (95% confidence interval (CI) = 1%, 2%) in 2011 to 30% (95% CI = 27%, 32%) in 2016. Among private medicine outlets, the adjusted odds of having any zinc in-stock was 1.5 (95% CI = 1.14, 1.97) times higher in 2016 than in 2014, and the retail price for a complete treatment (2 ORS sachets and 10 zinc tablets) declined by $0.19 (95% CI = -0.31, -0.06), or 14%.ConclusionsUse of combined ORS and zinc for treatment of diarrhoea in children under five significantly increased in Uganda during the program period. The range of activities conducted by the various members of the DPCC likely contributed to the increase in the use of combined ORS and zinc.

The role of price and convenience in use of oral rehydration salts to treat child diarrhea: A cluster randomized trial in Uganda.

BackgroundOver half a million children die each year of diarrheal illness, although nearly all deaths could be prevented with oral rehydration salts (ORS). The literature on ORS documents both impressive health benefits and persistent underuse. At the same time, little is known about why ORS is underused and what can be done to increase use. We hypothesized that price and inconvenience are important barriers to ORS use and tested whether eliminating financial and access constraints increases ORS coverage.Methods and findingsIn July of 2016, we recruited 118 community health workers (CHWs; representing 10,384 households) in Central and Eastern Uganda to participate in the study. Study villages were predominantly peri-urban, and most caretakers had no more than primary school education. In March of 2017, we randomized CHWs to one of four methods of ORS distribution: (1) free delivery of ORS prior to illness (free and convenient); (2) home sales of ORS prior to illness (convenient only); (3) free ORS upon retrieval using voucher (free only); and (4) status quo CHW distribution, where ORS is sold and not delivered (control). CHWs offered zinc supplements in addition to ORS in all treatment arms (free in groups 1 and 3 and for sale in group 2), following international treatment guidelines. We used household surveys to measure ORS (primary outcome) and ORS + zinc use 4 weeks after the interventions began (between April and May 2017). We assessed impact using an intention-to-treat (ITT) framework. During follow-up, we identified 2,363 child cases of diarrhea within 4 weeks of the survey (584 in free and convenient [25.6% of households], 527 in convenient only [26.1% of households], 648 in free only [26.8% of households], and 597 in control [28.5% of households]). The share of cases treated with ORS was 77% (448/584) in the free and convenient group, 64% (340/527) in the convenient only group, 74% (447/648) in the free only group, and 56% (335/597) in the control group. After adjusting for potential confounders, instructing CHWs to provide free and convenient distribution increased ORS coverage by 19 percentage points relative to the control group (95% CI 13–26; P < 0.001), 12 percentage points relative to convenient only (95% CI 6–18; P < 0.001), and 2 percentage points (not significant) relative to free only (95% CI −4 to 8; P = 0.38). Effect sizes were similar, but more pronounced, for the use of both ORS and zinc. Limitations include short follow-up period, self-reported outcomes, and limited generalizability.ConclusionsMost caretakers of children with diarrhea in low-income countries seek care in the private sector where they are required to pay for ORS. However, our results suggest that price is an important barrier to ORS use and that switching to free distribution by CHWs substantially increases ORS coverage. Switching to free distribution is low-cost, easily scalable, and could substantially reduce child mortality. Convenience was not important in this context.Trial registrationTrial registry number AEARCTR-0001288.

Community pharmacists' views of the use of oral rehydration salt in Nigeria.

Background Oral rehydration salt (ORS) is an affordable and effective intervention for the management of acute watery diarrhoea (AWD), especially in children under 5years. A knowledge/practice gap exists among community pharmacists (CPs) in Lagos, Nigeria, and in many low to middle income countries. This gap results in underutilization of ORS for diarrhoea management. Objective The objective was to explore CPs' views of the barriers and facilitators to the use of ORS in practice. Setting Community pharmacy practices, Lagos, Nigeria. Methods Qualitative methods were used to explore pharmacists' views. Recruitment of participants were mainly at zonal meetings. A total of ten CPs participated based on maximum variation and snowballing sampling. Semi-structured interviews conducted covered knowledge, experiences and contextual issues. Interviews were audiorecorded, transcribed and analysed using framework approach to thematic analysis. Main outcome measure Pharmacists' views of barriers and facilitators to the use of ORS. Results Barriers to the use of ORS include caregivers' expectation for an antimicrobial, which was often explicitly and specifically for metronidazole. Also, CPs seemed to doubt applicability of ORS alone, therefore, responded to caregivers' complaints about ORS, by dispensingmetronidazole. These barriers appeared to have normalisedmetronidazole for AWD treatment in this setting. Current facilitators include the caregivers' improved awareness of ORS and access to primary health centers that often resulted in increased demand for ORS in pharmacies. Conclusion CPs' views showed that caregivers' expectations for an antimicrobial may be the main barrier to the use of ORS in their practices.

Disentangling the effects of a multiple behaviour change intervention for diarrhoea control in Zambia: a theory-based process evaluation

BackgroundDiarrhoea is a leading cause of child death in Zambia. As elsewhere, the disease burden could be greatly reduced through caregiver uptake of existing prevention and treatment strategies. We recently reported the results of the Komboni Housewives intervention which tested a novel strategy employing motives including affiliation and disgust to improve caregiver practice of four diarrhoea control behaviours: exclusive breastfeeding; handwashing with soap; and correct preparation and use of oral rehydration salts (ORS) and zinc. The intervention was delivered via community events (women’s forums and road shows), at health clinics (group session) and via radio. A cluster randomised trial revealed that the intervention resulted in a small improvement in exclusive breastfeeding practices, but was only associated with small changes in the other behaviours in areas with greater intervention exposure. This paper reports the findings of the process evaluation that was conducted alongside the trial to investigate how factors associated with intervention delivery and receipt influenced caregiver uptake of the target behaviours.MethodsProcess data were collected from the eight peri-urban and rural intervention areas throughout the six-month implementation period and in all 16 clusters 4–6 weeks afterwards. Intervention implementation (fidelity, reach, dose delivered and recruitment strategies) and receipt (participant engagement and responses, and mediators) were explored through review of intervention activity logs, unannounced observation of intervention events, semi-structured interviews, focus groups with implementers and intervention recipients, and household surveys. Evaluation methods and analyses were guided by the intervention’s theory of change and the evaluation framework of Linnan and Steckler.ResultsIntervention reach was lower than intended: 39% of the surveyed population reported attending one or more face-to-face intervention event, of whom only 11% attended two or more intervention events. The intervention was not equally feasible to deliver in all settings: fewer events took place in remote rural areas, and the intervention did not adequately penetrate communities in several peri-urban sites where the population density was high, the population was slightly higher socio-economic status, recruitment was challenging, and numerous alternative sources of entertainment existed. Adaptations made by the implementers affected the fidelity of implementation of messages for all target behaviours. Incorrect messages were consequently recalled by intervention recipients. Participants were most receptive to the novel disgust and skills-based interactive demonstrations targeting exclusive breastfeeding and ORS preparation respectively. However, initial disgust elicitation was not followed by a change in associated psychological mediators, and social norms were not measurably changed.ConclusionsThe lack of measured behaviour change was likely due to issues with both the intervention’s content and its delivery. Achieving high reach and intensity in community interventions delivered in diverse settings is challenging. Achieving high fidelity is also challenging when multiple behaviours are targeted for change. Further work using improved tools is needed to explore the use of subconscious motives in behaviour change interventions. To better uncover how and why interventions achieve their measured effects, process evaluations of complex interventions should develop and employ frameworks for investigation and interpretation that are structured around the intervention’s theory of change and the local context.Trial registrationThe study was registered as part of the larger trial on 5 March 2014 with ClinicalTrials.gov: NCT02081521.

DEHYDRATION DUE TO DIARRHEA;

Background objective: Acute diarrheal diseases leading to dehydration,are among the leading causes of mortality in infants and young children in many developingcountries. The objective of our study was to to assess knowledge, attitude and practice ofmothers about use of oral rehydration salt for management of dehydration due to diarrhea inchildren less than five years of age. Study Design: Hospital based cross-sectional descriptivestudy. Setting: Oral rehydration center of Government Infectious Disease Children HospitalPeshawar. Period: February 16th, 2009 to March, 17th 2009. Patients and Methods: We enrolled115 mothers of infants and children less than five years old by systematic random sampling.We included willing mothers for this study, children less than five years old showing some orno signs of dehydration due to three or more than three episodes of diarrhea within 24 hours.Exclusion criteria included unwilling mothers, severe dehydration due to diarrhea, complaintsof severe vomiting and those having dysentery. Results: We evaluated 115 mothers, withmajority 88 (76%) were 15-25 years age group and 27 (24%) were 26-36 years who visited oralrehydration center respectively. Majority of mothers were uneducated 97 (84%), Housewives103 (90%), 59 (51%) had 4-6 children, 72 (63%) were living in Kacha house and about 84 (73%)had monthly family income less than 5000 rupees. It was found that 72 (63%) mothers knewbenefits of oral rehydration salt in diarrheal dehydration. About 67 (58%) mothers were able totell correct method of ORS preparation. 47 (41%) mothers knew that ORS should be discardedafter one day usage, while 42 (37%) did not know. Doctors, 83 (72%) were found to be the mostcommon source of information regarding ORS usage, followed by mothers-in-law, 21 (18%)and lady health workders (LHWs), 10 (10%) Conclusion: We concludedm young mothers anduneducated motheres of children below five years were of opinion that only medicine is the bestmanagement for diarrheal dehydration.

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.

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.

Scaling up zinc treatment for childhood diarrhoea in the developing country setting: a before‐ and after‐intervention study

AbstractIntroductionZinc sulphate is an important intervention for the treatment of diarrhoea in children in developing countries. We undertook a series of interventions to increase the availability and usage of zinc sulphate at primary healthcare facilities in the Solomon Islands.MethodologyA 12 month before‐and‐after intervention effectiveness trial in 80 randomly selected clinics. Data was collected on whether children &lt;5 years old with diarrhoea had received zinc. Data was also collected on other medications received, the availability of zinc and staff comprehension. A series of interventions was implemented by the National Pharmacy Services Division.ResultsThe mean usage of zinc sulphate increased by 191.2% over baseline; from 106/771 (13.7%) at baseline to 283/710 (39.9%) (p &lt; 0.05, χ2) at follow‐up; the use of oral rehydration salts (ORS) did not decrease. The availability of zinc sulphate increased from 3/77 clinics (3.9%) to 61/69 clinics (88.4%) (p &lt; 0.05).SummaryLow‐cost interventions can improve the usage of zinc sulphate in the Pacific island setting. This paper provides a model for other countries to increase uptake of zinc sulphate and other interventions at the primary healthcare level.

Oral zinc provision in acute diarrhea.

The clinical management of acute diarrhea is based on the use of oral rehydration salts and appropriate nutrition. In addition, the WHO and The United Nations Children's Fund recommend zinc supplementation for diarrhea in children below 5 years. This article aims at reviewing recent literature on the effects of oral zinc for treating acute diarrhea in children. Recent studies confirm that zinc supplementation has a benefit in children below 5 years with acute diarrhea in countries at medium or high risk of zinc deficiency. A few small trials have reported a benefit of zinc in children at low risk of zinc deficiency, with heterogeneity in results. No recent study has explored the effects of zinc in children younger than 6 months, and in this age group previous research refuted any benefit from zinc. Current literature supports the use of oral zinc in treating diarrhea in children older than 6 months, especially if at risk of zinc deficiency, such as children with poor diets exposed to recurrent gastrointestinal infections. More research is needed to confirm findings in children at low risk of zinc deficiency. Currently there is no evidence that zinc benefits children younger than 6 months.

Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death.

We sought to investigate the magnitude, clinical features, treatment, and outcome of children suffering from hypernatremic diarrhea and to identify risk factors for fatal outcome among them. We reviewed 2 data sets of children <15 years admitted to the in-patient ward of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) with diarrhea and hypernatremia (serum sodium ≥150 mmol/L): (a) March 2001 to March 2002 (n = 371) and (b) March 2009 to August 2011 (n = 360). We reviewed their records and collected relevant information for analyses. The prevalence of hypernatremia was 5.1% (371/7212) and 2.4% (360/15 219), case fatality rate was 15% and 19%, respectively. In logistic regression analysis, the risk for death significantly increased in association with serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses and reduced with the sole use of oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated (for all, P < .05). Thus, managing children with hypernatremia using only ORS or ORS following intravenous fluid may help reduce the number of deaths.