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ORS Rehydration Recipe

Diarrhea, Oral rehydration therapy (ORT) & Low-osmolarity oral rehydration solution (ORS)

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UNICEF/WHO Report 14 October, 2009 Download pdf 3 Mb Diarrhoea: Why children are still dying and what can be done Diarrhoea is the second leading cause of death among children under five globally. Nearly one in five child deaths – about 1.5 million each year – is due to diarrhoea. It kills more young children than AIDS, malaria and measles combined. Today, only 39 per cent of children with diarrhoea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000. The objective of this WHO/UNICEF report is to focus attention on the prevention and management of diarrhoeal diseases as central to improving child survival. It examines the latest available information on the burden and distribution of childhood diarrhoea. It also analyses how well countries are doing in making available key interventions proven to reduce its toll. Most importantly, it lays out a new strategy for diarrhoea control, one that is based on interventions drawn from different sectors that have demonstrated potential to save children's lives. It sets out a 7-point plan that includes a treatment package to reduce childhood diarrhoea deaths, as well as a prevention package to make a lasting reduction in the diarrhoea burden in the medium to long term. The report highlights the proven diarrhoeal disease prevention and treatment solutions already available today. Many children in the developing world cannot access urgent medical care for severe illnesses, making prevention methods—including improved hygiene, sanitation, safe drinking water, exclusive breastfeeding, and vaccines preventing rotavirus—critical components of diarrhoeal disease control. When diarrhoea occurs, it can be effectively treated with simple solutions, including oral rehydration therapy/oral rehydration solution, zinc and other micronutrients, and continued feeding.  Read more

Clinical management of acute diarrhoea
World Health Organization (WHO), UNICEF
This official joint statement updates previous WHO/UNICEF recommendations on the management of acute diarrhea, taking into consideration new research findings that indicate the success of interventions incorporating reduced-osmolarity ORS and zinc supplementation.
English 241kb • Español 409kb • Français 418kb

Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers
US Agency for International Development (USAID) Micronutrient Program
These guidelines were developed to advise clinic-based health workers on implementing the latest WHO/UNICEF recommendations for ORS and zinc supplementation in the clinical management of diarrhoea.
English 401kb • Español 331kb • Français 171kb • Pусском 583kb

Guidelines for new diarrhea treatment protocols for community-based healthcare workers
USAID Micronutrient Program
These guidelines were developed to advise community health care workers who assist parents with home treatment of children with diarrhea with regard to the latest WHO/UNICEF recommendations.
English 128kb • Español 76kb

Rehydration Project
This website provides up-to-date and comprehensive information and links to resources on diarrhoea, dehydration, oral rehydration, breastfeeding, and related topics.

A simple solution
TIME magazine
This news article provides a comprehensive update on the current use of ORS to treat severe diarrhea, as well as other promising interventions, including rotavirus vaccines.

Implementing the new recommendations on the clinical management of diarrhoea - guidelines for policy makers and programme managers
WHO
This manual advises policy makers and program managers on implementing and/or scaling up use of the new ORS formulation and zinc supplementation for the clinical management of diarrheal disease, as recommended by WHO and UNICEF.
English 377kb • Français 527kb • Pусском 439kb

The treatment of diarrhoea: A manual for physicians and other senior health workers
WHO
Developed for physicians treating infectious diarrhea in young children, this manual has been updated to include guidelines for the use of reduced-osmolarity ORS and zinc supplements.
English 1mb • Français 2.12mb

General information

The evolution of diarrhoeal and acute respiratory disease control at WHO: Achievements 1980–95 in research, development and implementation
WHO (WHO/CHS/CAH/99.12)
This document summarizes the evolution of WHO’s strategy toward researching and implementing interventions for diarrheal disease and acute respiratory disease control in the developing world, including a focus on current integrated strategies for child health.
English 504kb

Expert consultation on oral rehydration salts (ORS) formulation
WHO, UNICEF (WHO/FCH/CAH/01.22)
This meeting report provides background information essential to an expert committee’s consensus toward reducing the osmolarity of previous ORS standards.

Improved formula for oral rehydration salts to save children’s lives
WHO, UNICEF
This press release announces WHO and UNICEF adoption of the new, reduced-osmolarity formulation of ORS and provides links to informative resources from both organizations.

Monograph for oral rehydration salts
WHO, The International Pharmacopoeia
This updated monograph on the new, low-osmolarity formula of ORS was revised to provide the quality specifications as adopted by the WHO Expert Committee on Specifications for Pharmaceutical Preparations in October 2005. The monograph was prepared for inclusion in the fourth edition of The International Pharmacopoeia, currently in press.

Oral rehydration salts: Production of the new ORS
WHO, UNICEF (WHO/FCH/CAH/06.1)
Updated in 2006, this manual provides comprehensive information on manufacturing the new formula of low-osmolarity ORS.
English 2.3mb

Treatment guidelines

Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy
US Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 52(RR-16):1-16.
This publication provides guidelines for the use of ORS for clinical management of diarrhea, discusses various formulations of ORS, addresses challenges related to the administration of ORS, and encourages the use of ORS in the home to potentially avoid clinic visits and hospitalizations.
English 450kb

Reducing deaths from diarrhea through oral rehydration therapy
Victora CG, Bryce J, Fontaine O, Monasch R. Bulletin of the World Health Organization. 78(10):1246-1255.
This report evaluates global use of ORS and its impact on reducing diarrheal disease mortality. The authors call for continued and improved data collection regarding the use of ORS and note the benefits such data offer toward informing public health policies and programs.
English 336kb

Treatment of diarrhoeal diseases: Information for pharmacists and other drug sellers
WHO Department of Child and Adolescent Health and Development
This guide aims to improve the practices of pharmacists and drug sellers by providing details on avoiding inappropriate interventions for diarrhea, including underuse of ORS and overuse of antibiotics.

Research

Clinical trials of improved oral rehydration salt formulations: A review
Bhan M, Mahalanabis D, Fontaine O, Pierce N. Bulletin of the World Health Organization. 72(6):945–955.
The authors of this review assess the efficacy and use of different formulations of ORS, as determined in previously published studies.
English 882kb

Falling diarrhoea mortality in Northeastern Brazil: Did ORT play a role?
Victora C, Olinto M, Barros F, Nobre L. Health Policy and Planning. 11(2):132–141.
This study provides data that supports the impact of ORS on dramatic reductions in diarrhea deaths recorded after its introduction in Brazil in the 1980s.
English 707kb

Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico
Gutierrez G, et al. Bulletin of the World Health Organization.74(2):189–197.
This study evaluates the impact of education, ORS introduction, and sanitation improvements on the incidence of diarrheal disease mortality in Mexico between 1978 and 1993.
English/Español 430kb

Multicentre evaluation of reduced-osmolarity oral rehydration salts solution (abstract only)
International Study Group on Reduced-osmolarity ORS Solutions. Lancet. 345(8945):282-285.
The investigators in this study compared the efficacy of reduced-osmolarity and standard ORS in children with acute diarrhea in four developing countries and determined that reduced-osmolarity ORS is the more appropriate intervention for children with non-cholera diarrhea.

Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: Systematic review
Hahn S, Kim Y, Garner P. British Medical Journal; 323:81–85.
Another evaluation of standard versus reduced-osmolarity ORS, this analysis involved data from 15 trials and determined that treatment with reduced-osmolarity solution resulted in decreased stool output and vomiting and reduced the need for intravenous infusions.
English 122kb

Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution (abstract only)
Alam N, et al. Journal of the American Medical Association. 296:567-573.
Authors of this study evaluated the risk of hyponatremia, or reduced sodium levels in the blood, among infants hospitalized with dehydrating diarrhea and treated with reduced-osmolarity ORS. The investigators found no increased risk for hyponatremia when the new ORS formulation was used to treat the infants' dehydration.