Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene.
The WHO Global Diarrhoeal Disease Control (CDD) Programme has been implemented in at least 110 member countries. It encourages oral rehydration therapy (ORT) as the chief means to reduce child mortality caused by diarrhea. Despite relatively high ORT access rates ORT (20%->70% in Africa and South East Asia respectively, 1989), oral rehydration solution (ORS) use is inadequate (12.1-26.7% Africa and Eastern Mediterranean respectively, 1988) as well as ORT use (19.2-39.8% Africa and Eastern Mediterranean respectively, 1988). These poor results could be a factor of diminished knowledge and inadequate numbers of trained staff. Yet 58 countries now produce ORS and worldwide production increased from 100-350 million 1 between 1983-1987. In India, however, at least 75% of ORS brands do not meet WHO standards. Further 0.5-1 million <5 year olds succumb annually due to diarrhea (25% of all deaths among <5 year olds). In addition, about 500 million episodes of diarrhea occur each year. ORT is required in 50-100 million of these episodes and hospitalization is needed for 5 million. The Indian CDD program has reduced child mortality from diarrhea by 50% between 1981-1990. It operates under a 3 tier strategy including home management with ORS, and hospital management with ORS and/or IV fluids. This strategy faces several obstacles. For example, mothers in some villages do not know the village health guides who teach mothers how to make ORS. Besides few are motivated at the village level to teach this to mothers. According to government studies, ORT use varies in India from 36-96.3%, but according to operational research by the National Institute of Cholera and Enteric Diseases, ORT use in the best health facilitate is only 11-12%.