Cereal Based ORT
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Cereal Based ORT
Oral rehydration therapy, if properly practiced, can
cut infant and child mortality rates by at least half and obviate the
need for countless millions of costly visits to hospitals, health
centres, and clinics in all countries. But is this feasible?
Packets of oral rehydration salts (ORS) are not universally available and
the simpler sugar-salt solution can have dangerous effects if it is
improperly mixed or administered. Cereal-based ORT can overcome
both of these disadvantages by providing yet another option for oral
|Name: Cereal-Based ORT
|Theme: Health Workers Knowledge
||Region and Country: Maharashtra, India
This programme will promote cereal-based (food-based) oral rehydration
therapy as an additional method to packaged ORT and home-made ORT for
rehydration of a child. The programme will promote and socially market the
following advantages of cereal-based oral rehydration therapy:
Reduction of Volume, Frequency, and Duration of Diarrhoea, especially in
cholera diarrhoea -- Studies have found that solutions made from rice
flour or any of a number of other cereal reduce the volume, frequency, and
duration of diarrhoea. When rice drinks are used in the management of cholera,
stool volume is reduce by an average of 35%. By contrast, sugar-based
drinks--including ORS do not reduce stool volume. Cereal-based ORT has
been shown to speed up the resumption of solid food intake and to increase the
Effectiveness in non-cholera diarrhoea -- In studies of children with
non-cholera diarrhoea, stool output was 18% lower than with standard ORS.
Subsequent studies have shown that when food was given soon after rehydration,
the reduce of stool output with CB-ORT was only 3.4%, a difference not
considered significant, but regardless, cereal-based ORT was effective in
Building on Local Traditions -- The biggest non-clinical advantages of
cereal-based rehydration are associated with home-prepared CB-ORT. In many
countries, excellent food-based rehydration drinks can be made by building on
local traditions. Health workers can help people understand why it is
important to add cooked rice to the traditional rice water home remedy to make
it somewhat thicker, and how much salt is desirable. Almost any local
grain or starch-rich food can give good results. In short, people can
usually make an effective ORT drink out of their locally-available, low-cost
Nutritional Value -- Cereal-based drinks--because of their low osmotic
pull--can be prepared with up to three times the number of calories as sugar
or glucose drinks, without any risk to the child. This will be
advantageous to children of poor families, and also with a cereal solution,
the faster passage of water out of the gut into the bloodstream could mean
that space for additional food becomes available more quickly.
Safety -- As with the amount of salt, the amount of
sugar (glucose) in the homemade "Sugar, Salt Solution" is close to the upper
limit of safety. If mothers prepare an ORS packet with too little water,
which often happens, the ORS drink itself can contribute to the dehydration.
By contrast, no such danger exists for the cereal drinks unless too much salt
is used. Even if it is made more concentrated than usual, it is still safe
(and nutritionally richer). The drink will be useful as long as it
remains liquid and the child accepts it.
Acceptability to children -- Children are often already used to cereal
gruels as weaning food and accept them more readily than the standard ORS
solution. Also, most mothers (who usually taste anything before giving
it to their child) prefer the taste of a cereal porridge to a solution of
sugar and salt. Many say that ORS tastes bad.
The implementation of this programme will take strong
consideration of the following concerns raised by promoting cereal-based ORT.
Commercial promotion of cereal-based ORT raises concerns, particularly
that promotion of packets may have detrimental effects on acceptance and uses
of standard glucose based ORS packets. The matter of 'competition'
between cereal-based ORT and standard glucose based ORS is of particular
concern to those who are currently involved in national programmes promoting
widespread utilisation of standard glucose based ORS.
The physiological advantages of cereal-based ORT in
clinical studies in hospitalized cases of severe diarrhoea are decreases of
stool volume and duration of diarrhoea, but more needs to be known about the
effects of cereal-based ORT in milder cases of diarrhoea at the 'community
Possible 'competition' between two ORT approaches and new
messages about a different approach to the management of diarrhoea might be
confusing to caretakers, communities, and health workers, particularly where
communication about glucose-based ORS still falls short of the desired
The major issue of concern is that cereal-based ORT might
be considered as food by mothers, and divert them from feeding children during
treatment of diarrhoea, unless the programme emphasized the continued feeding
during diarrhoea, from the beginning of symptoms, is absolutely essential, to
combat diarrhoea and particularly to protect the nutritional status of the
child during diarrhoea. the message must be consistent: children should be
given food during diarrhoea, whatever the form of ORT.
A programme will be designed and implemented to socially
promote CB-ORT and to inform and train health workers, community members, and
mothers about the advantages of cereal-based ORT. The uncertainties and
concerns about the approach will be further researched and conveyed to health
workers, and other relevant audiences. A research and development agenda
will be identified, which will lead to a firm basis for policy formulation.
The development of an action plan based on the research and development will be
encouraged, including advocating close linkages between researchers and
policymakers, to ensure rapid incorporation of the positive characteristics of
Programme Management and Implementation:
This programme will be managed
and implemented by the state of Maharashtra, health workers, necessary training
personnel, and a designated research team.
Programme Monitoring and Evaluation:
The programme will be monitored and evaluated based on the findings of
researchers and policymakers concerning cereal-based ORT. Monitoring will
oversee how the public responds to the social promotion of yet another ORT
method. If the new method introduces issues of confusion or competition of
ORT methods, the programme and promotion of cereal-based ORT will be revised and
accommodated as necessary.
Learning and Dissemination: