Standard WHO-ORS versus reduced-osmolarity ORS in the management of cholera patients.

The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHO-ORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients.

Assessment of the effectiveness of oral rehydration therapy against severe diarrheal dehydration.

A hospital based case-control study for assessing the effectiveness of oral rehydration therapy (ORT) preparation against severe dehydration due to diarrhea was conducted at the Infectious Diseases Hospital, Jakarta, Indonesia. A total of 202 children aged 24 months or less who attending the hospital were suffering from acute watery diarrhea were recruited in the study. Those who were severely dehydrated as assessed by WHO criteria were accounted as cases; those who were non-severely dehydrated were accounted as controls. There were 59 cases and 143 controls. A questionnaire was used to interview all study subjects' mothers about ORT usage and various risk factors. Mothers who used ORT were asked to show how they prepared either oral rehydration solution (ORS) or sugar salt solution (SSS). Effectiveness of ORT against severe diarrheal dehydration was based on the formula for assessment of vaccine efficacy by using the odds ratio (OR). With the use of the logistic regression method, an adjusted OR was obtained after controlling various confounders. The effectiveness of ORT against severe diarrheal dehydration was 72.1% for proper ORT preparation and was decreased to 63.2% when ORT was improperly prepared.

Morbidity and mortality study on diarrhoeal diseases in North Jakarta - an urban area.

Diarrhoea including its interaction with undernutrition is one of the most important health problems and a major cause of death in young children in developing countries including Indonesia. To quantify the problems and to have comparison with results of other diarrhoeal surveys in Indonesia as well as in other developing countries, a survey was done in urban community comprising a population of 5,115 living in a relatively good area which was not a slum, nor wealthy area. The incidence of diarrhoea in this area was 149 per 1000 population a year and mortality rate of 0.2 per 1000 population, and 1.8% of diarrhoeal cases in the community became dehydrated needing hospitalization. The incidence of diarrhoeal disease was lower than in the survey done in semiurban area Ujung Pandang 8 years ago. This may be due to the improvement of environmental health, socio-economic status and better education. 47% of the diarrhoeal cases had occurred in children under age five. The peak incidence was in the 6 to 12 months age group. Young-age combined with low-nutritional status and early weaning may be factors leading to high incidence and death rates of diarrhoeal diseases. Incidence increased in the middle of the rainy season. 30% of the episodes were caused by enteropathogenic bacteria, 15.4% by rotavirus while for 50% of episodes the causative agent could not be determined.