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Published by TemplarKnight56
Oral Rehydration Therapy in cases of diarhea and Vomiting
Oral Rehydration Therapy in cases of diarhea and Vomiting

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Published by: TemplarKnight56 on Feb 26, 2013
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Primary health care means people learning about how totake care of their own health more effectively. Primaryhealth care workers are best chosen from among the com-munity and are then given a short, practical training andbasic health education. Such “multi-purpose” workersknow enough about most aspects of health care to act asagents of change for the better and provide a link betweentheir community and the more formal health services.Primary health workers refer problems beyond their owncompetence to the nearest referral centre where someonewith more knowledge can take over. If the world is to reachthe goal that was set at the WHO/UNICEF Conference atAlma Ata in 1978 of “Health for All by the Year ZOOO”,then millions of multi-purpose primary health workersmust be rapidly chosen and trained.The idea still persists, however, of “uni-purpose”primary health workers trained for a single task. TheBangladesh Rural Advancement Committee (BRAC)programme, described on page two of this issue, trainedORWs (Oral Rehydration Workers) for a single purpose:the promotion of oral rehydration therapy in diarrhoea1disease. There is no doubt that such uni-purpose healthworkers can make substantial impacts on special problems.The danger lies in thinking that their success solves theproblems permanently.The ORW saves the lives of those who would otherwisehave died from dehydration and this is a big step forward.
However, such people can do even more if they are gwen
further training and become multi-purpose health workers.They are then more able to understand the context ofdiarrhoea1 disease, to recognize when different treatmentis required and how to obtain professional help. Forexample, the programme described by Dr Nicholas Cohen,on page two, sees its oral rehydration component as part ofa general package of health measures.Health care has to begin somewhere. Oral rehydration isa very important entry point for communities becausediarrhoea is so common. As Dr Jon Rohde’s article stressedin
Diarrhoea Dialogue 2
“drinking is the message” we haveto get across to every family. But we must always keep inmind the need to prevent diarrhoea1 disease happening andthis is where multi-purpose primary health workers canmake an even greater contribution.This issue of
Diarrhoea Dialogue
takes education as itsmajor theme. Professor Fendall stresses the need forgeneralized health education and the importance of teach-ing people how to teach other people in ways that can bereadily understood and accepted. The pink centre pagesare designed as a pull-out leaflet. The information on thesheets provides a guide for community health workers onthe prevention and treatment of diarrhoea. We hope ourreaders will want to share some of their own ideas andexperiences about ways in which all kinds of health educa-tional messages can be most effectively carried to thepeople who need this knowledge.
K.M.E. and W.A.M.C.Lobon-gur (molasses) being used as a substitute for sugar inmaking oral rebydration solution in Bangladesh. Report onpage two.
Photographs by Dr Nicholas Cohen
In this issue .0
Rex Fendall and Frank Shattock discuss the bestways of teaching the teachers.
0 how do we convey health messages to mothers?
questions and answers
news from Costa Rica, Bangladesh and Mexico.Appropriate Health
Resources &Technologies Action Group LtdDiarrhoea Dialogue
news 888
news 888news 8 8news 888
A simple healthmessage
A national workshop on oral rehydra-tion was held in Bangladesh last year.One of the programmes discussed camefrom the Bangladesh Rural Advance-ment Committee (BRAC) who areworking in a remote rural area ofSylhet. Their programme is based on asimple health message entitled ‘Tenpoints to remember’. These pointsinclude a description of how diarrhoeabegins, the recipe for an oral rehydra-tion mixture ‘lobon-gur’ (with molassesas a local alternative to sugar), thedangers of giving the wrong quantitiesand when a case should be referred to adoctor. The goal of the programme is toteach oral rehydration therapy to onewoman in every household in theproject area.Oral Replacement Workers (ORW),women between 20 to 50 years old whocan read and write Bengali, visit homesto ensure that the lobon-gur mixture isbeing made properly. In Azmiriganj,Sylhet, BRAC has 30 ORWs workingabout 15 days a month. The pro-gramme staff is composed of a projectmanager, two monitors and two teams.Each team assigned to a specific villagehas a coordinator, ten ORWs and aservice staff.Monitors visiting homes two weeksafter the visit of the ORW found that allthe women were mixing the ORTsolution correctly, although only 34 percent could recall all of the ‘Ten pointsto remember’. The ORWs were paidaccording to the number of motherswho were mixing the solution correctlyand could remember some or all of theten points.
BRAC’s oral rehydration programme1980. Glimpse ~012 (1): 1-2.
Dr Nicholas Cohen, currently workingwith the National Institute of Socialand Preventive Medicine in Dacca, hassent us photographs and a report of anoral rehydration programme in Bangla-desh sponsored by the Save the Child-ren Fund (UK) and assisted by theInternational Centre for Diarrhoea1Disease Research (ICDDR,B). Theprogramme, designed to provide oralrehydration therapy where pre-packedoral rehydration salts are unavailableor inappropriate, is aimed at two maingroups. Firstly children, and secondlyvillagers with a special interest in beingtrained as health workers. Two specialfeatures of this programme are themonthly meetings for all those involvedto discuss results and problems, andregular checking of the concentrationof oral rehydration solution made up byvillagers. Ideally, the programme isseen as part of a package of healthmeasures which should be made avail-able cheaply and regularly in everycommunity.
A training programme for national pro-gramme managers was organized byWHO in Bangkok from 27 October to 7November. Forty participants attendedfrom all over the world. The aim of thecourse was to provide information sothat the participants could return homeand set up and manage nationaldiarrhoea1 disease control programmes.This was done by presenting partici-pants with a fictitious country withinwhich, given appropriate data, theyhad to work out the logistics of settingup an oral rehydration supply systemand identify ways of controllingdiarrhoea1 diseases. Discussions withWHO staff running the course and withother participants helped to link thetheory to the particular problems thateach manager would face at home. It ishoped that those who attended thecourse will teach others in future train-ing programmes within the WHOregions. We would be interested tohear from anyone who took part in thetraining programme.
A Spanish edition of
is now available from the PanAmerican Health Organization 525,Twenty-third Street, N.W., Washing-ton D.C., 20037, U.S.A.
OR tablet
PATH, the Programme for Appropri-ate Technology in Health and itsaffiliate, PIACT de Mexico, haverecently developed an effervescenttablet containing enough oral rehydra-tion salts for 2OOcc (a glass or cup ofwater). The new tablet is now under-going final shelf life and packaging testsbefore it becomes available for evalu-ation within oral rehydration therapyprogrammes. A pink colouring hasbeen added to the tablet to take advan-tage of the association (found in manycountries) between pink colour and“stomach medicine”. Further infor-mation on the tablet can be obtainedfrom PATH, 4000 NE 41 Street, Seattle,Washington 98105, USA.2
Diarrhoea Dialogue, issue 3, November 1980. Produced quarterly by AHRTAG at 85 Marylebone High Street, London Wl M 3DE.
n n n
l n n
n n n
Costa Rica
The Ministry of Health and the statewelfare system in Costa Rica are bothusing oral rehydration nationally. Thetreatment was originally developed inhospitals and then auxiliary health per-sonnel were shown how to use it in ruralareas. The Instituto de Investigacionesen Salud (INISA) has developed a packof oral rehydration salts (Sueroral)which is being widely distributed to-gether with instructional materials forhealth workers and mothers. The packcontains the correct amount of salts tobe mixed with 8 ozs of fluid, which isthe size of the average baby feedingbottle.
Costarricense deSeguro Social‘r#*‘rrDo001lb IhVEY A68
Sueroral sachet.
is involved in delivering oralrehydration therapy at communitylevel because Costa Rica already has aninfrastructure for primary health care.Oral rehydration forms part of a broadnational programmeto preventdiarrhoea1 diseases in Costa Rica.Breastfeeding is being promoted andfurther research carried out into thediagnosis and treatment of acutediarrhoea. Education and sanitationprogrammes are under way and theinstallation of water pumps is nowreaching sparsely populated rural areaswith the aim of supplying 95 per cent ofthese areas by 1985.
Leonardo Mata
The challenge to paediatricians ofdiarrhoea and malnutrition was dis-cussed at a symposium held at theInternational Paediatric Congress inBarcelona last September. Speakersfrom all over the world emohasized the
I n
the next issue .
need for better standards of hygieneand nutrition to prevent the millions ofchildhood deaths caused annually bydiarrhoea. A discussion on dehydrationtherapy focused on the recent success-ful introduction of oral rehydrationtherapy in many developing countries.diarrhoea can be successfully treatedwith the WHO/UNICEF oral rehydra-tion solution and that this simpleDr M. Merson from WHO stressedthat all but the most severe cases of
we will focus on water and sanitation
Diarrhoea Dialogue 4
will be availableRichard Feachem will contribute afeature on water and sanitation inat the end of February 1981.diarrhoea1 disease controlour practical advice page will look athand pumpswe will have more questions andanswers, and newsapproach is lowering morbidity anddeath rates. The most important thingnow is to convince paediatricians andother health workers that this simpleapproach to diarrhoea managementworks.
Diarrhoea Dialogue, issue
November 1980. Produced quarterly by AHRTAG at 85 Marylebone High Street, London Wl M 3DE.3

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