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Washington, D.C., National Academy Press, 1981. 22 p. (Contract AID/ta-C-1428)2 essential direct interventions in management of acute diarrheal diseases, oral rehydration and continued feeding, are summarized. Recent estimates of the global problem are that more than 500 million episodes of diarrhea occur yearly in infants and children under 5 years of age in Asia, Africa, and Latin America. 5 million deaths from diarrhea have been reported each year. Dehydration is the major cause of the immediate morbidity and mortality of children with diarrhea. Oral rehydration techniques may assist and reverse progression to severe dehydration and thereby are highly efficient in managing diarrheal disease. Formula selection, preparation of ingredients, distribution of oral rehydration solution, economic considerations, and cost-effectiveness of therapy programs are the primary concerns for those using oral rehydration. Formula selection should take into account the quantity of sodium, potassium, bicarbonate, and glucose in the formula. Preparations should be made so they can be done in the household rather than in national agencies. Centralized national packaging is recommended to standardize the salt/sugar mix. Measuring spoons and containers are also important in the packaging. Distribution should be accomplished by government or private agencies. The home preparation is the most economical. The effectiveness of the program is an important consideration. It is recommended that 2 different formulas be introduced into the community: a simpler lower sodium formula for home preparation and the more complex World Health Organization solution for supervised use in the health center. Continuation of feeding is important during and after diarrheal illness. Anorexia, nausea, vomiting, and abdominal cramps, may accompany acute infection. Cow milk may help produce symptomatic fermentative diarrhea, however breastfeeding should be continued. Fruits, vegetables, and sources of protein should also be fed to patients with diarrhea. Deleterious effects may occur if a patient fails to continue eating. A community system of surveillance and education should be developed to control diarrheal disease.
[Geneva, WHO, 1980]. 45 p.As part of a series of WHO-designed training modules on developing a national program (in a developing nation) for the control of diarrheal diseases, this volume teaches how to determine logistical problems of supply and distribution of therapeutic modules for control of diarrheal disease. In this module, the student is expected to learn how to determine the quantity of oral rehydration salts (ORS) necessary in Fictitia, a wholly made up country, data on which is published in another module in this series called "Fictitia" PIP/802686, to recommend a distribution system for Fictitia, to determine the number of ORS packets the program manager needs to stock for proper inventory in Fictitia, to specify a schedule for reordering ORS packets in Fictitia, to determine the cost of local production of ORS in Fictitia, and to recommend whether Fictitia should produce its own ORS by target date 1986 or import the ORS the country needs.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. , 10,  p. (USAID Contract No. DPE-5969-00-7064-00)A visit was made to Uganda to meet with the oral rehydration solution (ORS) promotion committee to review on ORADEX sales targets, formulate regional sales goals based upon current national sales targets, and discuss product distribution concerns; to draft a document with Medipharm, ARMTRADES, and Media Consultants to review the effectiveness of promotional materials; to meet the PRITECH representative and coordinate the supervision of promotional communications between Medipharm, ARMTRADES, and Media Consultants; to meet with USAID/KAMPALA to determine the status of additional monies and provide an update on current project status; and to meet with UNICEF and review roles for continued interaction on the ORS promotional program between USAID/Kampala, UNICEF, and Medipharm. 90,837 sachets of ORADEX were sold through the end of January, 1992; above the target of 79,000. ARMTRADES, however, sold only 42,741 of its 60,000 target, while Medipharm sold 48,096 sachets; substantially more than its 19,000 target. Medipharm expressed concern over ARMTRADES' weak ability to distribute amd market ORADEX, despite ARMTRADES' claim that its sales efforts are being undermined by freely available UNICEF sachets. In response, PATH worked to improve the operational efficiencies of both Medipharm and ARMTRADES. Medipharm's present transportation facilities and institutional capabilities are insufficient to allow it to handle national distribution independently. For now, it must rely upon ARMTRADES to distribute and market ORADEX. Moreover, Medipharm needs continued supervision to properly manage distributor relations to ensure that distributors receive timely and accurate invoices, monthly statements, and payment due notices. These steps combined with accurate production and inventory planning will eventually provide Medipharm with sufficient experience to distribute and maintain stock on its own. Otherwise, the promotion committee suggested revisions for new materials future support and sales personnel and pharmacist training were discussed; and reports were cited which indicate that ARMTRADES is doing well distributing and marketing condoms through a parallel social marketing program.
Plan of action for the control of diarrheal diseases in the region of the Americas. Interagency Coordinating Committee for the Control of Diarrheal Diseases (ICC/CDD). Plan de accion para el control de las enfermedades diarreicas en la region de las Americas.
[Unpublished] . , 32, , 32 p.The American made remarkable strides in reducing diarrheal mortality and morbidity during the 1980s. All of the nations here had in place a control of diarrheal diseases (CDD) program or CDD activities by early 1989. 1 goal for CDD projects in the region included ORS availability to 80% of all children <5 years old. 17 nations even produced their own oral rehydration solution (ORS). This contributed to the fact that more countries proportionally produced ORS in the Americas than in any other region. Still diarrhea continued to be 1 of the 3 leading causes of death and illness in children <5 years old in most countries in the Americas. Accordingly an Interagency Coordinating Committee (ICC/CDD) Task Force composed of representatives from PAHO, UNICEF, and USAID formed in 1989 to develop a framework for the region and countries to follow in designing plans of action. Each country in the Americas should foster effective cooperation among all organizations involved in CDD activities within that country. If an interagency process, e.g., child survival programs, already exists, the country should include the CDD program into it. National ICC/CDDs should define policies and prepare the plan of action incorporating both technical and financial support from the public and private sectors. They must also coordinate CDD training activities, especially those emphasizing correct case management. Further they should concur on communication projects and coordinate message development and relations with the mass media. These committees must also recognize problems, develop solutions, foster research, and amend national CDD programs as needed. PAHO is the technical secretariat for the regional ICC/CDD which works to foster optimum cooperation among PAHO, UNICEF, and USAID thereby providing maximum assistance to these programs.
In: ICORT II proceedings. Second International Conference on Oral Rehydration Therapy, December 10-13, 1985, Washington, D.C., [edited by] Linda Ladislaus-Sanei and Patricia E. Scully. Washington, D.C., Creative Associates, 1986 Dec. 83-5.At a recent international conference on Oral Rehydration Therapy (ORT) there were discussions on policy issues. Advances in oral rehydration solution (ORS) local production, and the use of private sector and public sector distribution. It was agreed that the roles of ORS packets and home solutions must be carefully thought through and the be the basis of the program. If ORS is going to be available at the household level then the use of the private sector should be considered. The policy to use informal distribution channels and traditional healers has shown to increase public access to ORS. Also, donor support of ORS commodities may not lead to self sufficiency. Governments should plan for self sufficiency in advance and should manage donor support. Advances in local ORS production include factors that promote low cost production such as efficient personnel, economical procurement of materials, appropriate choice of equipment, minimizing duties, and using existing production facilities. The adoption of a citrate ORS formula allows the use of cheaper packaging material. The private sector can and should be used to make ORS available on a wide scale. Product pricing is a highly complex problem and the mothers ability to pay must be balanced against the profit incentives in the distribution system. Subsidies have been necessary to encourage the private sector and mass media campaigns have proven to be a useful subsidy. The key factor in gaining wide coverage is the person who contacts the mother. Competition can be useful in gaining greater effective usage but there are tradeoffs. The high costs of import licenses and hard currency have been stumbling blocks for the private sector production in some countries. It was found that it is inadvisable to set up a separate distribution system for ORS and it should not be given priority over other child survival interventions. Also a policy of cost recovery can make a program more viable in the absence of donor assistance and has increased confidence in the product and therapy.
Geneva, Switzerland, WHO, EPI, 1985 Feb. 9 p. (Logistics and Cold Chain for Primary Health Care 6; EPI/LOG/83/6)The objective of this module is to enable the user to estimate the supply requirements for 5 supply items: chloroquine tablets, oral rehydration salts (ORS) for diarrhea, vaccines for 6 diseases, maternal and child health supplies -- contraceptives and iron tablets, and 34 essential drugs. The method is presented in outline form. A detailed explanation for each of these 5 items is given in 5 other modules. This module thus should be used first and 1 or more of the 5 detailed modules should be read subsequently. These 6 modules describe a method for calculating how much stock should be ordered for the 1st time. The method given in all of these modules can be used for any of the 5 supply items and it can be used in the health center store, the district store, or the regional store. A figure provides an example of the 5 steps for each of the main headings of this course. The 5 steps are: estimate the size of the target population; estimate the disease incidence; estimate the coverage; decide on the standard treatment; and calculate the amount required for each month's supply.
Geneva, Switzerland, WHO, EPI, 1985 Feb. 21 p. (Logistics and Cold Chain for Primary Health Care 5; EPI/LOG/84/5)This module provides instructions for controlling the quality of the supplies in a store and for distributing or dispensing supplies. The module advises the user on how to decide if a product (a condom, pill, or a vaccine) is still good to use. Simple tests can be performed to determine if a product is still good. These tests are described under the headings of: vaccines; oral rehydration salts (ORS) packets; maternal and child health supplies; essential drugs; and chloroquine. There are 4 ways of controlling the quality of vaccines: by regularly monitoring the storage temperature; by potency testing; by checking if it has been frozen; and by using a cold chain monitor. Vaccines should not be used if they have passed their expiration date; if they have been exposed to high temperatures; if a vial has been partly used in a previous session; if the cap on the vial is leaking or damaged; if the label has come off and the vaccine cannot be identified; if they have been to the field 2 or 3 times without being used; and if DPT, DT, or TT have been frozen. ORS in sealed laminated aluminum foil can be kept for about 3 years. If the content of ORS packets is brown, dark brown, or liquified, it should not be used. Tables provide information on when one's stock of maternal and child health items is still good to use and when to throw away drugs.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
[Unpublished] . 8 p.A study tour was undertaken by the Social Marketing Project in Bangladesh to observe production facilities of oral rehydration salt (ORS) in Bangkok, Manila, and Bombay. This report describes raw materials, plants and equipment, methods and procedures, and quality control for each country. In Thailand the Government Pharmaceutical Organization, under the Ministry of Health, supervises ORS production. ORS has been produced for the last 3 years and presently about 200,000 packets/month (equivalent of 1 litre solution) are being produced, following the World Health Organization (WHO) UNICEF formulations. The Ministry of Health in Manila has been providing ORS based on the WHO formulations for the past 6 years. Currently production is about 2 million packets with proper equipment. Distribution is through district health officials and village health workers. As an adjunct to ORS distribution there is a plan to introduce water purification tablets. The Fairdeal Corporation in India is a commercial pharmaceutical organization which produces 2 ORS solutions: 1) Electral which does not include bicarbonate and accounts for about 80% of total production, and 2) Electral Forte which has sodium bicarbonate and is recommended in severe dehydration cases in adults. Their research has shown that the WHO formulation is inadequate for many countries. Presently sales are about 500,000-600,000 packets/month mainly distributed through medical practitioners. This study also found that: 1) organic lipidity of the product is critical for acceptance; the addition of a flavoring agent is considered important especially for acceptance by small children, and 2) closely controlled humidity conditions (30-35%) and temperature (23 degrees Centigrade) are essential to the formulation and increases the life of the salts to 10-15 days even after opening the packs.
WHO Chronicle. 1979; 33:131-4.The longterm objective of the World Health Organizations (WHO's) diarrheal diseases control program is to eliminate them as a public health problem by improving water supply and sanitation, promoting child care practices and health education, and undertaking other community hygiene measures. The immediate and medium-term objectives are to extend the use of oral rehydration therapy, to combine that therapy with proper feeding practices, and to encourage appropriate child care practices. The goal in 1979, the 1st year of program operation, is to cover about 50 million people, with extension of coverage in subsequent years. WHO recommends that country programs for diarrheal diseases control should take their place as part of national health programs and primary health care activities. Oral rehydration therapy has many advantages. It can be given by health auxiliaries and mothers at an early stage of the illness, thus reducing the risk of severe and frequently fatal dehydration. In both health centers and hospitals, it can essentially replace intravenous therapy and reduce the need for expensive intravenous fluids and for skilled personnel to administer them. When oral rehydration therapy is accompanied by education on proper feeding practices, there is an earlier improvement in appetite and better weight gain. 4 maternal and child care practices can do much to prevent diarrhea--breastfeeding, correct weaning practices, suitable and adequate nutrition for pregnant and nursing mothers, and good personal hygiene in the family. WHO and the United Nations International Childrens Emergency Fund (UNICEF) have reached agreement on an effective mechanism for collaborating at the country level to meet needs for the supply, production, and distribution of oral rehydration salts.
[Unpublished] 1980. 13 p.UNICEF and WHO are jointly sponsoring an education and supply program of oral rehydration therapy for the treatment of diarrheal diseases in developing countries. Studies on the feasibility, acceptability, and effectiveness of (ORS) oral rehydration salts have been conducted in many developing countries and have proven the worth of the therapy. The UNICEF/WHO program seeks to provide wide distribution and educational activities in these areas. General public health education will help the population in medical self help in the area of diarrheal diseases. For countries which have reached the appropriate state of program development, aid in establishing manufacturing facilities for ORS should be the next step. The UNICEF-supported program has plans for operation in at least 51 national programs. Tables present the level of UNICEF support which has already been provided in a great many countries, categorized by region.