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In: National Council for International Health [NCIH]. New developments in tropical medicine. Washington, D.C., NCIH, 1982 Jan. 63-8.Death from acute diarrhea is most often due to dehydration which results from the excessive loss of water and salts from the extracellular fluid space. Clinical signs of progressive dehydration in children with diarrhea include dry mouth and tongue, absence of tears, sunken eyes or interior fontanelle (in infants), oliguria or anuria, decreased skin elasticity, muscle cramps and abdominal distention and eventually deep and rapid respiration, fast and weak pulse, hypotension, shock, and coma. Replacement of fluids and electrolytes, orally or intravenously, is the only effective treatment for dehydration; if a patient is given an adequate volume of oral glucose-electrolyte solution, diarrheal stool losses can be fully replaced and fluid balance maintained. The World Health Organization's oral rehydration (OR) formula consists of 3.5 g sodium chloride, and 20 g glucose; it has been proven to be safe and effective for all age groups, including neonates. The following steps should be taken in managing diarrheal dehydration: 1) evaluate the patient by rapid physical examination and history, 2) calculate oral fluid requirements, 3) after the intake of fluids, reassess and weigh patient, and 4) breast milk of 1/2-1/4 strength formula milk should be given and OR therapy should be continued as long as the child has diarrhea. The best means of supplying OR solution to most people would be to encourage home use, although problems exist with incorrect mixing of the solution and improper ingredients being used. OR packets can be produced locally. Cost will vary and distribution will require an effective system. Training personnel, village workers, and family workers, however, is the biggest challenge. Presentation of diarrhea requires environmental changes such as food, refrigeration, better personal hygiene, and improved housing, which are all costly. Efforts to promote breast feeding and increase health education about weaning practices and diarrhea prevention need to be increased.
Horizons. 1983 Apr; 2(4):14-20.In Honduras and the Gambia the US Agency for International Development's (AID's) Bureau for Science and Technology and its contractors, working with the Ministry of Health in each country and drawing upon experts in health communications, anthropology, and behavioral psychology, have developed a health education methodology that integrates mass media and health providers. The project uses radio, graphics, and the training of village health workers to teach mothers how to treat and prevent diarrheal dehydration. The World Health Organization (WHO) and the AID assisted International Center for Diarrheal Disease Research in Bangladesh, have demonstrated that lost body fluid and electrolytes can be replaced with an orally administered solution. The treatment is known as ORT, oral rehydration therapy. AID efforts in Honduras and Gambia are showing that semi-literate persons, contacted primarily through the mass media, can be taught to mix and administer ORT. The campaign also includes a number of preventive measures. The Gambian government chose to use ORT packets prepared according to the WHO formula at health centers as a backup to the similar home mix solution. Honduras chose to package their own ORT salts, following the WHO formula, for use both at health centers and in the home. In Gambia the Ministry of Health created a national contest which kicked off with the distribution of 200,000 copies of a flyer carrying mixing instructions to nearly 2000 Gambian villages. Repeated radio announcements in Gambia's 2 major languages told mothers to gather and listen to contest instructions. The radio announcer led listeners through each panel of the color coded flyer which told them how to mix and administer ORT. 11,000 women attended the 72 village contests. Of the 6580 who entered the mixing competition, 1440 won a chance to compete and 1097 won prizes for correct mixing. After 8 months of campaign activities, the number of mothers who reported using a sugar-salt solution to treat their children's diarrhea rose from 3% to 48% (within the sample of some 750 households). The number of women who could recite the formula jumped from 1% to 64%. In Honduras a keynote poster for the campaign that featured a loving mother was distributed simultaneously with the airing of the 1st phase of the radio spots and programs. Within a year 93% of the mothers knew that the radio campaign was promoting Litrosol, the name of the locally packaged ORT salts; 71% could recite the radio jingle stressing the administration of liquid during diarrhea, and 42% knew that Litrosol prevented dehydration. 49% of all mothers in the sample had tried Litrosol at least once during the campaign.