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  1. 1

    Drugs in the management of acute diarrhoea in infants and young children.

    World Health Organization [WHO]. Diarrhoeal Diseases Control Programme

    [Unpublished] 1986. 6 p. (WHO/CDD/CMT/86.1)

    This article presents an overview of current therapeutic practice as recommended by the World Health Organization (WHO) Diarrheal Disease Control Program. The recommendations apply solely to acute diarrheal disease in infants and children. Therapy for such cases is primarily concerned with the prevention or correction of dehydration, the maintenance of nutrition, and the treatment of dysentery. The various approaches to treatment considered are: 1) oral rehydration, which is highly effective for combating dehydration and its serious consequences, but does not diminish the amount or duration of diarrhea; 2) antimotility drugs, none of which are recommended for use in infants and children because the benefits are modest and they may cause serious side effects, such as nausea and vomiting; 3) antisecretory drugs, only a few of which have been properly studied in clinical trials, virtually all of which have important side effects, a low therapeutic index, and/or only modest efficacy. Consequently, none can at present be recommended for the treatment of acute infectious diarrhea in infants and children. 4) aciduric bacteria, on which conclusive evidence is still lacking; 5) adsorbents: kaolin and charcoal have been proposed as antidiarrheal agents in view of their ability to bind and inactivate bacterial toxins, but the results of clinical studies have been disappointing. 6) improved Oral Rehydration Salts (ORS): this may turn out to be the most effective and safest antidiarrheal drug. 7) antibiotics and antiparasitic drugs for a few infectious diarrheas (e.g., cholera). Antibiotics can significantly diminish the severity and duration of diarrhea and shorten the duration of excretion of the pathogen. No antibiotic or chemotherapeutic agent has proven value fort the routine treatment of acute diarrhea; their use is inappropriate and possibly dangerous. It is concluded that oral that oral rehydration is the only cost-effective method of treating diarrhea among infants and children.The Inter-African Committee's (IAC) work against harmful traditional practices is mainly directed against female circumcision. Progress towards this aim is achieved mostly through the efforts of th non governmental organizations (NGO) Working Group on Traditional Practices Affecting the Health of Women and Children and the IAC. In 1984 the NGO Working Group organized a seminar in Dakar on such harmful traditional practices in Africa. The IAC was created to follow up the implementation of the recommendations of the Dakar seminar. The IAC has endeavored to strengthen local activities by creating national committees in Benin, Djibouti, Egypt, Ethiopia, Gambia, Ghana, Kenya, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Somalia, Sudan and Togo. IAC activities in each country are briefly described In addition, the IAC has created an anatomical model, flannelgraphs, and slides to provide adequate educational material for the training of medical staff in teaching hospitals and to make village women aware of the harmful effects of female circumcision. The IAC held 2 African workshops at the Nairobi UN Decade for Women Conference. The African participants recognized the need for international solidarity to fight female circumcision and showed a far more definite and positive difference in their attitude towards the harmful practice than was demonstrated at the Copenhagen Conference/ Forum of 1980. At the United Nations level, female circumcision is receiving serious consideration. A special Working Group has been set up to examine the phenomenon. Finally, this article includes a statement by a sheikh from the Al Azhar University in Cairo about Islam's attitude to female circumcision.
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  2. 2

    Fifth programme report, 1984-1985.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, 1986. 130 p. (WHO/CDD/86.16)

    This 5th report of the Diarrheal Diseases Control Program (CDD) describes the activities undertaken by the program during 1984-1985. Primary objectives of the program are to reduce diarrhea associated mortality, malnutrition, and treatment costs. In so doing the program advocates the use of oral rehydration therapy (ORT) solutions in the treatment of diarrhea and dehydration, and promotes proper feeding during and after diarrheal illness. 3 major strategy areas are: improved nutrition (such as breastfeeding for the 1st 2 years of life), use of safe water, and good personal and domestic hygiene. Program activities involve planning, training (supervisory, management and technical), increasing the availability of ORT (including household solutions, and production and supply of ORS), promoting health education and communication, and the control of cholera in Africa. Summaries of program activities in different regions are included, and collaborations with other WHO programs and other agencies are described. The program supports biomedical research through its global and regional scientific working groups, which includes 62 new projects for 1984 and 67 new projects for 1985. Scientific Working Groups focus on bacterial enteric infections, viral diarrheas, drug development, and clinical management ofdiarrhea.
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  3. 3

    Report of the sixth meeting of the Technical Advisory Group (New Delhi, 11-15 March 1985).

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, 1985. 29 p. (WHO/CDD/85.12)

    This paper reports the activities and proposed program budget for 1986-1987 reviewed by the Technical Advisory Group (TAG) at its 6 meeting. The Group also examined 2 reports on the use of oral rehydration therapy (ORT) and the incorporation of cost-effective control interventions other than case management in national CDD programs, and reviewed revised guidelines for the management of the research component of the global Program. With respect to the health services component, the following conclusions and reccomendations were made: the program should maintain a comprehensive approach to diarrheal disease control, while continuing to give major emphasis to and expanding further the case management strategy; continued efforts to promote plan preparation in all developing countries should be maintained; progress is to be regularly monitored; latent plans should be implemented; efforts to improve the global use rate of ORT should be effected; routine antidiarrheal remedies are to be discouraged; training curricula of health personnel must be promoted and improved; preparation of guidelines to facilitate mobilization of developmental support is urged. In the research component, the Group approved the proposed changes in the research management structure, particularly the termination of the Scientific Working Groups and Steering Committees; it endorsed the overall approach of the Program in diarrheal research development; it stressed the need for and suggested ways of achieving a flexible, rapid response to operational research; it welcomed the increase of biomedical projects; it emphasized the need for urgent research to determine which diarrhea cases required ORS treatment. Numerous other recommendations were made.
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  4. 4

    Fourth programme report, 1983-1984.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)

    The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
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  5. 5

    News from WHO's Diarrhoeal Diseases Control Programme.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases. Technical Advisory Group

    Who Chronicle. 1984; 38(5):212-6.

    This article highlights the conclusions and recommendations of the 5th meeting of the Technical Advisory Group of the World Health Organization (WHO) Diarrheal Diseases Control (CDD) Program held in March 1984. On the basis of clinical trials supported by the CDD Program, WHO has endorsed use of oral rehydration salts (ORS) containing trisodium citrate dihydrate in place of sodium bicarbonate. Although the bicarbonate formulation remains highly effective and may continue to be used, the citrate formula results in less stool output and is more stable under tropical climatic conditions. At its meeting, the Technical Advisory Group expressed satisfaction with progress in the health services and research components of the program's activities. By 1983, 72 countries or areas had formulated plans of operation for national CDD programs and 52 had actually implemented programs. Training courses directed at program managers, first-line supervisors, and middle-level health workers are held on a regular basis. 38 developing countries are now producing ORS. Another area of activity has involved development of a management information system to monitor progress toward the target of increased access to and use of oral rehydration therapy for diarrhea in children under 1 year of age. Data from 40 countries indicate that access to ORS was 6-10% in 1982 and usage was 1-4%. There have been reviews of 10 national CDD programs, 7 of which utilized a joint national-external team to collect and analyze information on the management and impact of the CDD program. During 1983, 71 new research projects were funded by the CDD program, bringing the total number of projects supported to 231 (59% in developing countries). Biomedical research has focused on development of more stable and effective ORS; the etiology and epidemiology of acute diarrhea: and development and evaluation of new diagnostic tests, vaccines, and antidiarrheal drugs. In 1982-83, the CDD program received US$1.4 million from WHO and about US$11 million from voluntary contributors. The 1984-85 budget has been set at US$19.7 million.
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  6. 6

    Oral rehydration salts (ORS) formulation containing trisodium citrate.

    World Health Organization [WHO]. Diarrhoeal Diseases Control Programme; UNICEF

    [Geneva, Switzerland], WHO, [1984]. 2 p. (WHO/CDD/SER/84.7)

    In 1982-1983 the Who Diarrhoeal Diseases Control (CDD) Programme supported laboratory studies to identify a more stable ORS composition, particularly for use in tropical countries, where ORS has to be packed and stored under climatic conditions of high humidity and temperature. The results of these studies demostrate that ORS containing 2.9 grams of trisodium citrate dihydrate in place of 2.5 grams of sodium bicarbonate was the best of the formulations evaluated. 7 clinical trials were undertaken in which the efficacy of ORS-citrate and ORS-bicarbonate was compared. All but 1 of these trials had a double-blind study design. 4 of these studies were undertaken in children below 2 years of age with moderate to severe noncholera diarrhea. The ORS-citrate was received by 128 children and found to be uniformly as effective as ORS-bicarbonate in correcting acidosis. In 3 of the 4 studies from which preliminary data are available, there was a trend towards a reduction (8-14%) of diarrheal stool output in children receiving the ORS-citrate. Countries should have no hesitation in continuning to use ORS-bicarbonate, which is highly effective. However, because of its better stability and apparently greater efficacy, WHO and UNICEF now recommend that countries use and produce ORS-citrate where feasible.
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  7. 7

    Status summary: WHO key research activities in ORT.

    Mahalanabis D

    In: Symposium proceedings: Cereal-Based Oral Rehydration Therapy: Theory and Practice, February 17, 1987 at the National Academy of Sciences, Washington, D.C., edited by Charlene B. Dale and Robert S. Northrup. Columbia, Maryland, International Child Health Foundation, [1987?]. 47-9.

    The WHO Diarrheal Disease Control Program has 2 components to the program, intervention and research. In this article, the WHO-supported research projects are summarized. There are 6 studies ongoing based on a glucose and combination of amino acids and/or dipeptides for oral rehydration solution (ORS). 10 studies are underway of ORS containing maltodextrin in place of glucose. WHO is collaborating with other institutions in studies on cereal-based solutions. WHO is supporting studies on feeding during and following diarrhea with the hope of developing simple guidelines to prepare and provide optimally nutritious diets based on inexpensive, locally available ingredients. WHO is also studying antidiarrheal drugs. The most promising of these are chlorpromazine and cholestyramine. Finally, WHO is supporting research on the microflora in children with persistent diarrhea and effects of treatment with oral antibiotics.
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  8. 8

    Infantile diarrhoea: diagnosis and management.

    Khan MA

    In: Proceedings. Annual Seminar on the Afghan Refugee Health Programme, December 3 and 4, 1986, Rawalpindi, Pakistan, edited by Claude J. Aguillaume, Altaf-ur-Rahman Khan. Islamabad, Pakistan, [Chief Commissionerate for Afghan Refugees, 1986]. 39-54.

    Over 50% of the children in Pakistan have poor nutritional status, making the combination of malnutrition and diarrhea lethal. As diarrhea may be defined as a change in the usual stool pattern, both consistency and the number of stools is important. Usually there is an increase in the number of stools which become more loose than normal. As breastfed infants have less frequent stools normally, this should not be diagnosed as diarrhea. Infantile diarrhea is a common illness because of poor infantile and personal hygiene and unsatisfactory feeding practices. Breastfed babies do not get diarrhea unless they are being given supplementary bottle feeding or other foods in an unhygienic manner. Some of the causative factors contributing to increasing infantile diarrhea are breastfeeding failure, bottle feeding, unhygienic supplementary feeding practices, and malnutrition. Etiological agents which have been isolated from the stool samples of children in developing countries include: viruses; E. coli; V. cholera; Shigellae; Salmonellae; Compylobactor Jejuni; Yersinia Enterocolitica; protozoal infections; and parenteral infections. Infantile diarrhea leads to loss of electrolyte and water from the body. There must be adequate replacement of these or it leads to dehydration and malnutrition. A plan for clinical assessment of acute diarrhea is outlined. Early replacement fluid therapy should begin promptly after diarrhea starts. It is the first and the only effective treatment for dehydration caused by diarrhea. It consists of administering either intravenous or orally a solution in water of salts comprising essential electrolyte. The World Health Organization (WHO) complete formula for oral rehydration is regarded by the majority of people as physiologically the most appropriate single formulation for worldwide use. Guidelines for rehydration therapy are outlined. Children with mild diarrhea may not need rehydration therapy, but dehydration must be prevented. Such children should be given extra fluid -- household food solutions -- which they are used to drinking. The dietary management of diarrhea and the role of drugs in infantile diarrhea are reviewed. Diarrhea can be prevented in the community with environmental sanitation, proper excreta disposal, the control of flies, a clean water supply, personal and domestic cleanliness, and measles immunization.
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  9. 9

    Cola drinks and rehydration in acute diarrhea [letter]

    Weizman Z

    NEW ENGLAND JOURNAL OF MEDICINE. 1986 Sep 18; 315(12):768.

    Cola drinks are often recommended as rehydration solutions for acute diarrhea. Although several other commercial solutions are available, cola drinks are still very popular worldwide. I have analyzed the electrolyte content and osmolality of Coca-Cola in Israel and have taken the opportunity to review all reported data in this regard in the literature. Like data reported from other countries, my results demonstrated that cola drinks are not suitable for use as rehydration solution, since they have a very low electrolyte content and an extremely high osmolality (Table 1). Thus, adequate electrolyte replacement is not possible, and induction of osmotic diarrhea may worsen the situation. For comparison, the content recommended by the WHO is also presented in the table. Contrary to the general impression, cola drinks should not be recommended as rehydration solutions for acute diarrhea in general or for infantile diarrhea in particular. (full text)
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  10. 10

    How to estimate ORS packet requirements for the first time.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    Geneva, Switzerland, WHO, EPI, 1984 Oct. 12 p. (Logistics and Cold Chain for Primary Health Care 8; EPI/LOG/84/8)

    The objective of this module is to enable the user to estimate the 1st requirement for oral rehydration salts (ORS) packets. This could be for a new health center or an existing center providing ORS packets for the 1st time. With each calculation an empty column has been left entitled "Your area." In this space one can change the assumptions given in the module and put in the figures for his/her own area. This module focuses on how to calculate the requirements for oral rehydration salts. The method used is the same as that described in the module "How to Estimate Requirements for the First Time." This module covers 5 steps: estimate the size of the target population; estimate the incidence of diarrheal diseases; estimate the coverage; decide on the standard treatment; and calculate the number of ORS packets for the 1st month's supply. Exercises are included.
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  11. 11

    Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.

    Cash RA

    Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
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  12. 12

    Dehydration: a new solution.

    Ayres D

    People. 1985; 12(1):31.

    The World Health Organization's (WHO's) improved way to counter the dehydrating effect of diarrhea is a mix of salts and sugars, much the same as oral rehydration salts (ORS) solution already widely used, but is earier and cheaper to package, has a longer shelf life, and will be more effective against the disease itself. In developing countries diarrhea is the biggest killer of children under 5, and most of the deaths are caused by the rapid loss of essential salts and water. Increasing emphasis has been placed on the early prevention of dehydration at home using drinks such as tea and rice water, but the message has not always got through. Many millions of children reach a stage of moderate or severe dehydration when they need treatment with oral rehydration salts. The ORS solution recommended by WHO for over a decade is made up of 20 grams of glucose and 3 salts -- sodium chloride (3.5 g), sodium bicarbonate (2.5 g) and potassium chloride (1.5 g ) -- mixed in 1 liter of water. The children's program UN International Childrens Emergency Fund (UNICEF) supplied some 42 million packets of this ORS worldwide in 1982-83. By the end of 1983, the mixture was being produced in 38 developing countries. Its greatest appeal is that it is simple, inexpensive, and can be used at home. ORS is usable in place of intravenous therapy in 80-90% of clinically dehydrated patients, which has reduced significantly the number of child deaths due to diarrhea in many developing countries. The new improved formula will now make it even more useful. This replaces the sodium bicarbonate of the original formula with trisodium citrate dihydrate, resulting in a more stable product. Clinical trials show that the new formula corrects acidosis at a similar rate to the sodium bicarbonate formula and is considerably more effective in reducing the amount of diarrhea. This is most likely due to the increased intestinal absorption of sodium and water that is facilitated by the citrate. Packets of the new ORS-citrate supplied by UNICEF will look the same as the original bicarbonate. Research continues into other improved ORS formulae.
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  13. 13

    Dehydration: W.H.O. has a new solution.

    Ayres D

    Dghs Chronicle. 1985 Jan-Mar; 21(1):1, 3.

    The World Health Organization (WHO) has developed an improved formula for oral rehydration solution (ORS) that is based on trisodium citrate dihydrate rather than sodium bicarbonate. The new preparation will be easier and cheaper to package, have a longer shelf-life, and be more effective against diarrhea. Clinical trials have shown that the new formula corrects acidosis at a similar rate to sodium bicarbonate and is far more effective in reducing the amount of diarrhea, especially in diseases such as cholera. Although the citrate solution costs slightly more than the earlier preparation, packaging costs can be reduced by up to 50% through local production, making the end product cheaper. Local production of ORS-citrate does not require new investment or changes in equipment. WHO is recommending that countries with supplies of ORS-bicarbonate should use up these stocks and then decide whether to switch to the new formula. Research is also being carried out on other improved ORS formulas, e.g. glycine-fortified and rice powder-based ORS.
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  14. 14

    Oral therapy for acute diarrhea.

    Gracey M

    Medical Journal of Australia. 1984 Mar 17; 140(6):348-9.

    There are 3 mainand related problems that must be considered in managing acute watery diarrheas -- the treatment of fluid loss and related metabolic disturbances, nutritional management, and drug therapy, but the prime objective in the treamtment of patients with acute diarrhea is to replace lost fluids. The importance of the intact sodium ion glucose absorption system in the toxigenic diarrheas is that it provides a mechanism for hydration via the intestine despite the enterotoxin induced fluid secretion into the gut lumen. This is the basic for oral rehydration therapy (ORT) which is being promoted vigorously by the World Health Organization (WHO) and has been adopted with considerable success in dozens of developing countries. The current question is whether this medical advance can be transferred from the developing to the developed countries. There is good evidence that the time is right for this change. The rehydration solution recommended by WHO has the following composition: sodium, 90 mmol/L; potassium, 20 mmol/L; chloride, 80 mmol/L; bicarbonate, 30 mmol/L; and glucose, 111 mmol/L and can be made by dissolving 3.5 gm of sodium chloride, 2.5 gm of sodium bicarbonate, 1.5 gm of potassium chloride, and 20 gm of glucose (or 40 gm of sucrose) in 1 liter of water. Experience in field trials has shown that most patients with mild to moderate dehydration can be managed effectively by oral therapy based on the above mentioned electrolyte solution. It must be recongnized that more seriously dehydrated patients will require initially more rapid intravenous rehydration followed by oral rehydration to replace continuing fluid losses. It is important also to appreciate that once a person becomes dehydrated replacement therapy should cover both the rehydration pase and the maintenance phase. The aim of ORT is to avoid unnecessary intravenous therapy and its attendant risks. It must supply maintenance fluid requirements and replace fluids lost in watery stools. ORT can work even in patients who are vomiting provided that small volumes of fluid are given frequently, but special care must be taken in children under age 2 and particularly in infants under 6 months of age in whom dehydration tends to be rapid. In general terms, the WHO formulation has proven satisfactory as a basis for ORT in patients with acute diarrheas, and some commercially available products closely resemble this formulation. The WHO formulation, perhaps with a lower sodium content, could be used as a safe guide for oral therapy for patients with acute diarrhea in Australia.
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  15. 15

    Introduction [concerning oral rehydration].

    Barua D

    [Unpublished] 1983. 5 p.

    Those interested in oral rehydration therapy (ORT) can learn much from the history of the evolution of intravenous fluid therapy. In an era when cholera was being treated with strong purgatives, emetics, and forced venesection, the idea of putting fluids into the veins was suggested by a chemist named Herman to his physician colleague Jechrichen in the Institute for Artificial Mineral Waters of Moscow in 1830. In 1882, William O'Shoughnessy, an Irish physician, described fairly accurately the essential chemical pathology of cholera and recommended injection into the veins of warm water containing some oxygenized inocuous salts. By mid May of that year, Dr. Thomas Latta of Scotland put O'Shoughnessy's recommendation into practice. Only 5 of the 15 cases treated survived. He faced severe criticism, but the "Lancet" upheld this outcome as a favorable result as these 5 patients had been saved from an almost certain death. Although cholera pandemics continued to invade Europe and the US during subsequent decades of the 19th century and cholera became the greatest killer of all the bacterial diseases, none of the eminent scientists or physicians of those days gave any further consideration to intravenous fluid. They continued to recommend purgatives, emetics, opium, brandy, tannic acid enema, and so forth. It was only during the last decade of the 19th century that Sir Leonard Rogers, working in Calcutta, succeeded in gaing general acceptance for intravenous therapy for cholera and reduced the mortality rate by about 50%. Dr. Sellard, working in the Philippines, shortly thereafter demonstrated the advantage of adding bicarbonate to intravenous fluids. A rational therapy for cholera began in 1911-12 when Sir Leonard recognized the need to include potassium and accepted the finding of Sellard. Mortality remained high. The history of the use of oral fluid as a folk remedy for dehydration in diarrheal disease is probably as long as the history of this group of diseases itself. The concept of of oral rehydration is not new, but its introduction as a scientific medicine is. In 1964 Captain R.A. Phillips published the initial observation that glucose mediated enteric absorption of sodium and water remain intact even in severe cholera, thus paving the way for establishment of the scientific basis of oral rehydration. The 1st papers on successes with this therapy were published in 1968. In 1972 in a World Health Organization (WHO) seminar the current formula which is most suitable for the management of all diarrheas in all ages was developed. In 1968 WHO stimulated a commercial producer of pharmaceuticals in Geneva to start producing sachets of oral rehydration salts (ORS). The crucial factor in obtaining wide acceptance of oral rehydration as a tool for primary health care was the result of 2 WHO field trails in the Philippines and Turkey in 1975.
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  16. 16


    Heckler MM

    In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.
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  17. 17

    [Diarrhoeal diseases control] Lucha contra las enfermedadas diarreicas.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, World Health Organization [WHO], (1982). 14 p.

    For those countries with high infant mortality rates e.g. 220 deaths per 1000 born, at least 25% are due to diarrheal diseases. The usual cause of death in acute diarrhea is dehydration. The known causes of acute diarrhea are many and often involve an interaction among several factors. The World Health Organization (WHO) in an effort to reduce infant mortality and increase primary health care 9PHC) cites conditions which predispose the individual to acute diarrhea. Included are interactions of certain bacteria, viruses, and parasites with improper treatment, malnutrition, inadequate infant feeding, poor hygiene, lack of safe drinking water, lack of adequate sanitation, and lack of effective epidemic controls. Effective treatment involves oral rehydration salts (ORS) therapy, continued feeding or intravenous therapy, and vaccines and drugs. WHO urges health education to ensure proper and more widespread treatment. To help prevent acute diarrhea, breastfeeding is suggested along with proper domestic hygiene and adequate food. To offset the spread of the disease, careful epidemiological surveillance should be maintained and when an epidemic is detected, treatment should be immediate and intensified. New prevention and control methods are emerging through research in health service and biomedical science. Research is focused on providing different treatment approaches and improved means of delivery, increasing the understanding of the etiology of acute diarrhea, and determining the best methods for community health education. Specific work includes the development of better methods for pathogen diagnosis, a better understanding of virulence factors and associated immune responses, possible vaccines, and intervention of disease transmission. Scientists are looking closely at both bacterial and viral diarrhea with similar objectives. The final hope of these scientists is to provide significant advance in drug development and clinical management.
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