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Beyond ORT: a new look at diarrheal disease control.


 On the basis of program experience and new scientific advances, attention is directed to changes in understanding of the treatment of diarrhea and innovative program approaches involving the private sector, women's groups, and community organizations. It now is evident that successful treatment of diarrhea calls for more than administration of oral rehydration solution. Good case management -- education, treatment, and follow-up -- also requires continued feeding during and after diarrheal episodes. Referral to medical facilities of those diarrheal cases that cannot be managed at home is also part of good case management. Early administration of fluids, such as rice water or cereal gruel, at the 1st sign of loose stools, can help prevent dehydration. Such home-available fluids provide substantial benefit during dehydration diarrheal episodes when the more desirable, prepackaged oral rehydration solution is unavailable. A control of diarrheal disease program should try to identify the particular fluid in the home which would be most beneficial and advocate it specifically. The fluid should contain some salt and starch and should be safe and effective in preventing dehydration, locally available and affordable, culturally acceptable, easily prepared, and one that mothers are likely to use when needed. In developing countries the concept that feeding and/or breastfeeding should continue during diarrhea is beginning to gain credence. To enhance the effectiveness of educational efforts, program planners need to conduct field studies to investigate which locally-used foods are best for treating diarrhea. Dysentery treatment should include the administration of fluids and feed, as in simple diarrhea, but these therapies are insufficient. Dysentery also should be treated with antibiotics. 1 particularly successful approach is to involve already existing women's organizations in the national control of diarrheal disease programs. Many local private voluntary organizations have extensive networks and credibility at the grassroots level. These organizations, in coordination with national control of diarrheal disease programs, can be very effective in educating village dwellers on oral rehydration therapy and in providing services. Traditional healers also can be mobilized to provide ORT services.
