Implementation of oral rehydration therapy in villages.
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Biomedical subjects
Publications and source records attributed to B K Sircar.
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A study was carried out in 3 villages near Calcutta, India, having a population of 5464, between August 1992 and December 1994. A cohort of rural children below 4 years of age was prospectively observed to determine the clinico-epidemiological aspects of mucoid diarrhoea and examine propensity to invasiveness. Overall, the incidence of diarrhoea was 1.7 episodes/child/year, and that of mucoid and bloody dysentery was 0.8 and 0.2 episodes/child/year, respectively. Children aged 6-11 months had a higher incidence of mucoid diarrhoea (1.3 episodes/child/year) and the peak season occurred in June and July. Multivariate analysis using logistic regression showed that mucoid diarrhoea and bloody dysentery were closely similar in both clinical and laboratory findings, including raised faecal leucocyte count (> 10/high power microscope field [hpf]). However, abdominal pain occurred more frequently in bloody dysentery than in mucoid diarrhoea. Faecal leucocyte count (> 10/hpf) can therefore be used as an indicator for invasiveness of mucoid diarrhoea at the community level.
A double blind study on determination of ABO blood groups of 210 cholera patients, 44 diarrhoea cases due to Vibrio parahaemolyticus, and 148 diarrhoea cases from whom no vibrios could be isolated (control group), was conducted in Calcutta. A statistically significant difference was found in blood group 'O' when comparison was made between control and cholera groups. No significant association was, however, notices between V. parahaemolyticus-induced diarrhoea and ABO blood groups.
In a cross sectional study of total 14514 tribal Nicobarese people of Car Nicobar Island, an union territory of India, situated in Bay of Bengal, morbidity, mortality and treatment practices of diarrhoeal diseases of under-five children were surveyed. The incidence of diarrhoea (0.2 episode/ch.year), Crude death rate (3.6/1000) and IMR (31/1000 live births) were exceedingly low as compared to SouthEast Asian Countries including mainland of India. ORS utilisation rate was high (41%) as compared to the National figure (12.0%). This is the first study of it's kind carried out in this island and amongst the Nicobarese tribe in India. A preliminary study carried out among the mothers of the hospitalised children indicated that protective behaviours like breast feeding, hand washing, use of chlorinated water and proper disposal of stool were regularly being practiced by the community traditionally. An in-depth study on risk factors of diarrhoea in this island can yield useful clue for describing the same.
This communication is an attempt to review the status and implementation of the Oral Rehydration Therapy in the programme for Control for Diarrhoeal Diseases. The Global and the Indian situations are separately discussed, with more emphasis on the latter. Use of Home Available Fluids (HAF), Salt Sugar Solution (SSS). Commercial packets of ORS and the Government supplied packets of ORS are also assessed.
An extensive outbreak of acute gastroenteritis involving all age group of patients occurred during July-September, 1978 in the Central district of Manipur state. A total of 4469 cases occurred during the period. 45.7% of diarrhoea cases sampled and 47.6% of water samples collected from rivers were found to be positive for V.cholerae biotype EITor. Case fatality rate in this epidemic was exceptionally low (0.8%) which was attributed to the early domiciliary use of oral rehydration salt solution (ORS) in the affected villages. Utility of ORS in drastic reduction of case fatality rate during any epidemic situation was first of its kind in the Indian scene.
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The review of the current status and implementation of Oral Rehydration Therapy at the community level have been presented in this communication with special emphasis on its development, ORS access rate, ORS use rate and home available fluids. The global ORS supply has gone up an increased eleven folds since 1981. Similarly the ORS access rate has also increase from 46% to 68% in 1991. However, the global ORS use rate was low (21%). The major constraints during ORT implementation which have been reported by several scientists are also discussed.
During an operational research study on implementation of oral rehydration therapy in a block of West Bengal, India, amongst a population of 2, 16,805, a total of 171 Community Health Guides and 152 Anganwadi Workers were initially trained for one working day by lectures and slides about diarrhoea case management at the community level. The training was evaluated after two months and found to be inadequate. The workers were then retrained with modern approach using a module (prepared in local language) as suggested by World Health Organisation. The level of retention of the imparted knowledge of Health Workers for different items 2-3 months after training with lectures and slides ranged between 5-25% except preparation of ORS which was 80%. With the use of modules, 47-98% of health workers could retain the same knowledge 3 months after the training. The knowledge thus acquired were sustained even after 12 months of training to a level which was still much better than that retained 2 months after training with slides and lectures. However some of the items like indication of use of Home Available Fluids, dosage of ORS and when to refer a diarrhoea case to health facility were more difficult to recall after one year. This possibly indicates need for in-service training of grassroot level health workers at suiTable interval.