Drug Development Global Program

In-depth: Why isn’t oral rehydration solution defeating diarrheal disease?

A hand spoons ORS into the mouth of an infant held by her mother.

Administered spoonful by spoonful, oral rehydration solution is an effective treatment for childhood diarrhea. Photo: PATH/Heng Chivoan.

Oral rehydration solution (ORS), a simple mixture of salt, water, and sugar, was first introduced in the 1970s to reverse dehydration caused by severe diarrhea. Due to its simplicity, low cost, and high effectiveness, it was heralded as one of the most important medical achievements of the last century. Since its introduction, it is estimated to have saved a whopping 50 million lives from diarrhea.

A persistent threat

While the world has witnessed a dramatic decline in preventable child deaths over the past two decades, more than half a million children each year still lose their lives to diarrhea, and it remains the second leading killer disease of children worldwide. For children who survive, a bout of diarrhea can have persistent effects. The World Health Organization (WHO) estimates that 50 percent of malnutrition is associated with repeated diarrhea. In addition, when a child is malnourished or regularly ill during the first few years of life, there are associated negative effects on future cognitive development, education, and productivity.

ORS and water sit on table in front of a row of mothers and children receiving treatment.

Mothers and children in an oral rehydration corner of a hospital in Ghana. Photo: PATH/Doune Porter.

Why isn’t ORS working?

If all caregivers could access and use ORS, diarrhea deaths would drop by a staggering 93 percent, but despite early success, ORS coverage remains low. In areas where it is needed most, only 35 percent of children with diarrhea receive oral rehydration therapy. One explanation for this is that, although ORS is a reliable treatment for reversing dehydration, its benefits are not immediately perceptible to caregivers. Seeing no change in a child’s diarrhea, caregivers may select other treatment, such as antibiotics, which do not rehydrate, have limited effectiveness, and contribute to antibiotic resistance.

Additionally, while coverage for diarrhea treatment remains low in Africa, it’s not alone. Since 2000, data suggest little or no progress in expanding treatment coverage for other major childhood illnesses, including malaria and pneumonia. Although effective solutions to prevent and treat these diseases are available, gaps in case management and a lack of integrated, community-based treatment, have left vulnerable children, particularly the poor and malnourished in remote regions, unprotected.

Combining ORS with an integrated approach to care

With the goal of ending preventable child deaths from pneumonia and diarrhea by 2025, WHO and UNICEF last year launched the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD), which seeks to improve access to proven interventions. Because both diseases are caused by multiple factors that cannot be defeated with a single disease-focused intervention, this new framework more efficiently and effectively fights diarrhea and pneumonia through complementary solutions, like improved nutrition and vaccines, and integrated case management.

Though highly effective and inexpensive, ORS alone cannot defeat diarrheal disease. Taking on this stubborn and persistent threat requires a multipronged approach that combines all available solutions including new and improved drugs, vaccines, proper nutrition, exclusive breastfeeding, improved handwashing and sanitation, availability of safe drinking water, and greater access to effective treatments like ORS and zinc supplements. It will also require training for caregivers and community health workers linked to an effective and responsive health care system as part of GAPPD.

More information

A version of this article previously appeared in our quarterly e-newsletter A Healthy Dose. Sign up to receive the next issue and browse previously published issues.

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