Frequently asked questions:What is dehydration?Dehydration is the loss of water and body salts through diarrhoea. Early features are difficult to detect but include dryness of mouth and thirst. The signs of dehydration include: sunken fontanelle (in infants); fast, weak pulse; breathing faster than normal; loss of skin elasticity; sunken, dry eyes and reduced amount of urine. Rehydration is the correction of dehydration.What is ORT?ORT is the giving of fluid by mouth to prevent and/or correct the dehydration that is a result of diarrhoea. As soon as diarrhoea begins, treatment using home remedies to prevent dehydration must be started. If adults or children have not been given extra drinks, or if in spite of this dehydration does occur, they must be treated with a special drink made with oral rehydration salts (ORS). The formula for ORS recommended by WHO and UNICEF contains:

2.6 gms sodium chloride 13.5 gms glucose (anhydrous) 1.5 gms potassium chloride 2.9 gms trisodium citrate, dihydrate

The above ingredients are dissolved in one litre of clean water. This new formula gives the packets a longer shelf life and is at least as effective in correcting acidosis and reducing stool volume. Packets containing sodium bicarbonate are still safe and effective.How does ORT work?Acute diarrhoea normally only lasts a few days. ORT does not stop the diarrhoea, but it replaces the lost fluids and essential salts thus preventing or treating dehydration and reducing the danger. The glucose contained in ORS solution enables the intestine to absorb the fluid and the salts more efficiently. ORT alone is an effective treatment for 90-95 per cent of patients suffering from acute watery diarrhoea, regardless of cause. This makes intravenous drip therapy unnecessary in all but the most severe cases.Can ORS he used for everyone?ORT is safe and can be used to treat anyone suffering from diarrhoea, without having to make a detailed diagnosis before the solution is given. Adults need rehydration treatment as much as children, although children must always be treated immediately because they become dehydrated more quickly.What should be done if the child vomits?Vomiting does not usually prevent the therapy from being successful. Mothers must be taught to persist in giving ORS solution, even though this requires time and patience. They should give regular, small sips of fluid. Giving ORT reduces nausea and vomiting and restores the appetite through correction of acidosis and potassium losses.Should feeding continue at the same time as ORT?Feeding, especially breastfeeding, should be continued once dehydration has been corrected. Even if the diarrhoea continues or the child is vomiting, some of the nutrients are being absorbed. Suitable food should not be withheld, as the child may become malnourished. Once the diarrhoea episode has passed, the child should be given more food than usual to make up for losses during diarrhoea. Breastfeeding is particularly beneficial because breastmilk is easily digestible. It also contains protective substances which help to overcome the infection causing the diarrhoea.What sort of foods are good during diarrhoea?

High energy foods such as fats, yoghurt and cereals are quite well absorbed during diarrhoea. Small, frequent feeds of energy-rich local foods familiar to the child should be given. A little vegetable oil can be added to foods such as millet or rice to increase the energy content.

Foods high in potassium are important to restore the body's essential stores depleted during diarrhoea. Such foods include lentils, bananas, mangoes, pineapples, pawpaw, coconut milk and citrus fruits.

Certain foods should be avoided during diarrhoea, for example those containing a lot of fibre such as coarse fruits and vegetables, wholegrain cereals and spicy foods. 

Is it necessary to use drugs as well as ORT?Drugs should not be used except in the most severe cases. Even then they should be administered with care, preferably after the organism causing the diarrhoea has been identified. Small children with dysentery and fever require an antibiotic. Refer such patients to a health service for advice. ORT on its own is usually enough to rehydrate the child. Unnecessary antibiotic therapy upsets the normal bacteriological balance of the intestine. Many anti-diarrhoeal preparations have proved to be either ineffective or too powerful for very small infants.

Can the solution be made with dirty water?The benefits of fluid replacement in diarrhoea far outweigh the risks of using contaminated water to make up oral rehydration solution. In situations where it is difficult to boil water, mothers are advised to use the cleanest water possible.Can ORS solution be stored?Generally a made-up solution should be covered and not kept for more than 24 hours, due to the risk of bacteriological contamination. Packets of ORS should be stored carefully and not kept in temperatures of over 30°C or in conditions of high humidity. Where the ingredients to make up ORS are being stored in bulk the glucose/sucrose should be kept apart from the rest of the dry ingredients. The new citrate formula ORS has a longer shelf life.

ZINC SUPPLEMENTS REDUCE THE SEVERITY AND DURATION OF DIARRHOEA

Twelve studies examined the impact of zinc supplements on the management of acute diarrhoea. Eleven of these showed a reduction in the duration of the diarrhoeal episode; in eight of these, the reduction was statistically significant. Five of the above studies also collected data on stool volume or frequency, and found that zinc supplements reduced stool output or frequency. The data shows that zinc supplementation during and until cessation of diarrhoea (either syrup containing 20 mg of elemental zinc per 5 ml, or tablets of 20 mg zinc such as zinc sulphate, gluconate or acetate) has a significant and beneficial impact on the clinical course of acute diarrhoea, reducing both its duration and severity.

ZINC SUPPLEMENTS PREVENT SUBSEQUENT EPISODES OF DIARRHOEA

Other studies evaluating the effect of zinc supplementation on diarrhoeal diseases found a preventive and long-lasting impact. These studies show that 10 mg to 20 mg of zinc per day for 10–14 days reduced the number of episodes of diarrhoea in the 2–3 months after the supplementation regimen. WHO and UNICEF therefore recommend daily 20 mg zinc supplements for 10–14 days for children with acute diarrhoea, and 10 mg per day for infants under six months old, to curtail the severity of the episode and prevent further occurrences in the ensuing 2-3 months.

Zinc treatment for diarrhea (BACKGROUND )

Zinc is an important micronutrient for the overall health and development of infants and young children. But among children in the poorest countries, zinc deficiency is widespread and can result in higher rates of infectious diseases, including diarrhea.1 During diarrheal episodes, zinc is further depleted. Replacing this critical nutrient is an important way to help children recover from diarrhea and stay healthy. Studies suggest that providing children with a 10- to 14-day course of zinc treatment can reduce the duration and severity of diarrheal episodes and may also prevent future episodes for up to three months.2 Zinc treatment also can reduce the duration of acute diarrhea by 25 percent3 and could prevent one in four diarrhea deaths.4 Preventive zinc supplementation has also been shown to reduce the incidence of diarrhea.

SUPPORT FOR ZINC TO TREAT DIARRHEA

In 2004, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) issued a joint statement regarding the clinical management of acute diarrhea. This statement recommended the use of zinc treatment, as well as oral rehydration solution (ORS), as a two-pronged approach to

treatment of acute diarrhea in children.6 WHO and UNICEF specifically recommend daily 20 mg zinc supplements for 10 days for children with acute diarrhea and 10 mg per day for infants under six months old to curtail the severity of the episode and prevent further occurrences in the ensuing two to three months. Zinc can be administered to young children either as syrup or dispersible tablets, which dissolve easily in a tablespoon of clean water or breast milk. Although its positive impact on diarrhea is well known, zinc is still largely unavailable in most developing countries. Zinc manufacture requires only simple technology and inexpensive ingredients, and it can be produced in both syrup and tablet form, yet supply remains limited. Additional manufacturers are being identified in the developing world to increase production and distribution while keeping costs low to ensure the the children who need zinc treatment the most are able to receive it.

Rotavirus Disease and Vaccines On-line Resources

Worldwide, almost every child will have at least one rotavirus infection before he or she is five years old. The virus is so contagious and resilient that providing clean water and promoting proper hygiene do not significantly reduce incidence, which is nearly the same in industrialized and developing countries. Additionally, because rotavirus usually causes profuse vomiting, ORS/ORT is difficult to administer. Rotaviruses are a genus of viruses belonging to the Reoviridae family. Seven major groups have been identified, three of which (groups A, B, and C) infect humans, with group A being the most common and widespread one.

Rotavirus disease

Rotavirus (pronounced "row-tuh-virus") is the most common cause of severe gastroenteritis in children worldwide.

Rotavirus is responsible for the deaths of an estimated 600,000 children each year, 80 percent of whom live in developing countries.

Rotavirus is found in all countries. Most children have had one or more rotavirus infections by the age of 5.

In young children, rotavirus disease is characterized by diarrhea, vomiting, fever, and severe dehydration. Death is caused by dehydration due to rotavirus infection, not by the virus itself.

Rotavirus disease cannot be treated with antibiotics or other drugs. Regardless of hygiene practices or access to clean water, nearly every child in the world will be infected with rotavirus before age 5. Vaccination is the only viable measure to prevent severe rotavirus illness.

Rotavirus vaccines

Studies of two new rotavirus vaccines recently demonstrated their safety and efficacy among children in middle- and high-income countries.

Clinical trials have been launched, and additional studies are planned, to evaluate the impact of vaccines as a method for the prevention of severe rotavirus disease in developing countries. Results generated from these trials will help national governments make informed decisions about introducing the vaccines into the public sector.

Enhancing diarrheal disease control through a combined prevention and treatment strategy—incorporating rotavirus vaccine; new, low-osmolarity formulations of oral rehydration solution; and zinc supplementation during diarrhea episodes—can rapidly and significantly reduce child mortality where diarrheal disease is a serious burden.