ORAL REHYDRATION THERAPY (ORT)
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Fellow- Pediatric GI, University of Maryland, USA
Diarrhea is accountable for 25% of deaths in children under five in the world (3 million deaths per year or 8000 per day). Loss of intestinal fluid may lead to severe hypovolemia, shock, and death particularly in young children. Giving fluids to prevent or treat dehydration is called oral rehydration therapy (ORT).
ORT is the most essential and effective way of preventing these deaths. ORT, combined with guidance on appropriate feeding practices, is the main strategy recommended by the WHO Department of Child and Adolescent Health and Development (CAH) to achieve a reduction in diarrhea related mortality and malnutrition in children.
ORT was developed in the late 1960s by researchers in India and International Centre for Diarrheal Disease Research in Bangladesh, for the treatment of cholera. The Indo-Pakistani War of 1971 provoked a public health emergency in the refugee camps set up to house those fleeing the violence. With cholera spreading rapidly and death rates rising, the head of a medical centre in one of the camps instructed his staff to distribute Oral Rehydration Salts (ORS). It was a success, and over the next eight weeks, deaths fell to less than 1%. In 2002, Drs. Norbert Hirschhorn, Dilip Mahalanabis, David R. Nalin, and Nathaniel F. Pierce were awarded the first Pollin Prize for Pediatric Research, in recognition of their work in developing ORT.
In the 1980s nearly five million children under 5 years old died each year from diarrhea. In 2000 this figure had dropped to 1.8 million. Oral rehydration along with improved nutrition and sanitation is central to the package of measures that has helped ensure this fall in mortality1.
Early use of ORT at home in children with diarrhea decreases the number of outpatient visits and hospitalizations, and overall medical costs. Despite relatively high ORT access rates ORT use is inadequate2. These poor results could be a factor of diminished knowledge and inadequate numbers of trained staff. 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 facilities is only 11-12%.
Physiotherapy of diarrhea
Oral rehydration therapy is widely considered to be the best method for combating the dehydration caused by diarrhea and/or vomiting.
In the past, diarrhea was considered to be caused by abnormal gastrointestinal motility. It is now clear, however, that most diarrheal conditions are due primarily to alterations of intestinal fluid and electrolyte transport and less to smooth muscle function. Infectious diarrhea occurs as a result of
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