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 30C 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 1014 days reduced the number of episodes of diarrhoea in
the 23 months after the supplementation regimen. WHO and UNICEF therefore
recommend daily 20 mg zinc supplements for 1014 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 Childrens
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 episodescan rapidly and significantly reduce child mortality
where diarrheal disease is a serious burden.