ORT III: a dilemma for policy makers, a confusion for parents.

UNICEF announced a new initiative to assist in the effort to reduce high infant and child mortality rates. The program, GOBI-FF, advocates emphasis on 6 components: growth charts to enable early detection of problems; oral rehydration therapy (ORT) for childhood diarrhea; breast feeding for long durations; immunization of children againstg major diseases; food supplements for nutritionally-deprived children; and family spacing. The most dramatic effects have been achieved with the use of ORT. Worldwide, there are 3 types of ORT. ORT I is based on a traditional diarrhea treatment concept involving the use of herbal mixtures or gruels. ORT I was supplanted by early scientific teachings based on an erroneous belief that diarrhea patients should not eat or drink. For years, the only recourse had been immediate hospitalization and use of intravenous saline/glucose. A great breakthrough came in the late 1960s when researchers in Bangladesh discovered that a carefully balanced oral solution of glucose/salt which maximized fluid absorption and replaced lost salts could achieve the same level of rehydration provided by I.V. As the importance of this formula (ORT II) was recognized, developing world governments began promoting its use by widespread distribution of prepackeaged mixes and by training campaigns directed at mothers to teach them to prepare home-made ORS. Indonesia provides a good example of a country with active campaigns on ORT. ORT III is a thick gruel made of about 50 grams of rice powder boiled in a liter of water with a pinch of salt. The ingredients are therefore available readily in every household. ORT promotion has been handicapped by opposition from medical personnel rejecting it as unscientific. A suggestion to overcome this has been to develop a tablet for addition to the rice gruel. However, such a tablet is unnecessary and would only add to the mystique of ORT. Policy makers are thus faced with a dilemma in considering how best to structure antidiarrheal campaigns. Additional information on the 3 types of ORT is provided in the Appendix.