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  • Title: Worldwide impact of oral rehydration therapy.
    Author: Banwell JG.
    Journal: Clin Ther; 1990; 12 Suppl A():29-36; discussion 36-7. PubMed ID: 2187610.
    Abstract:
    Oral rehydration therapy (ORT) has had a dramatic global impact. The worldwide consequences of this therapy are discussed in four categories: (1) adoption of ORT as the primary therapy for acute dehydrating diarrhea; (2) establishment of national ORT programs; (3) scientific knowledge gained from studies into intestinal absorption of oral rehydration solutions; and (4) implications of ORT for the next decade. The Diarrheal Disease Control Program has been assigned a high priority by the World Health Organization. It now includes 99% of the population of the developing world, although it is not uniformly implemented. Because knowledge of how to use ORT parallels implementation, it is hoped that expanded training of community health workers will increase implementation. In addition, specific indications for ORT need further study and refinement so that community health workers may learn to distinguish between diarrheal episodes that require such therapy and those that do not. Better scientific understanding of intestinal absorption of ORT fluids has led to the development of new formulations that enhance absorption of nutrients and repletion of electrolytes. The optimal composition of such revised solutions has yet to be established. In addition to these improvements in utilization, distribution, education, and application of ORT, other measures to reduce the morbidity and mortality from diarrhea can be expected in the areas of better infant feeding practices, improved sanitation, management of persistent diarrhea, targeted therapy for particular groups of infants at high risk, and immunization. The impact of oral rehydration therapy (ORT) on the estimated 5 million deaths of children yearly from acute dehydrating diarrhea is discussed in terms of worldwide adoption of ORT as primary therapy; establishment of national ORT programs; new scientific knowledge of intestinal absorption of ORT solutions; and implications of ORT for the next decade. ORT now encompasses 99% of the developing world, although it is implemented unevenly, as low as 12% in Africa. 75% of ORT formula is now produced locally. By 1988 60% of the world had ORT available, and 25% of affected children received ORT. More community health workers need training in ORT, since knowledge by mothers is key to treating children. Research is needed on the effect of ORT on aspiration pneumonia, the incidence of inadequate rehydration and death after ORT. Causes of death in children with diarrhea, and organisms associated with diarrhea resistant to ORT treatment. Current research focuses on maximal flow of nutrients and solvent drag across the intercellular tight junctions of the intestinal epithelium. Short chain fatty acids, butyrate, propionate and acetate, are also being studied as adjuncts to the carbohydrates and amino acids used in ORT solutions. In the future, ORT will be used with interventions such as breastfeeding, better weaning foods, sanitation, management of persistent diarrhea caused by specific organisms, targeted therapy and immunization.
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