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Effect of ORS, RHF and ORT on Diarrhea Mortality

Reference
Munos, MK, Walker CL, Black RE. The effect of oral rehydration solution and recommended home fluids on diarrhea mortality. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i75-i87.

Background

  • Diarrhoeal disease in children aged < 5 years is the second leading cause of death among 1-59 month old children. (1)
  • Since 2004, WHO has recommended low osmolarity ORS (with total osmolarity of 245 mmol/l and reduced levels of glucose and sodium) for prevention and treatment of diarrhoeal dehydration (2,3)
  • This paper presents evidence from systematic reviews and meta-analyses drawing upon data from community- and facility-based studies to estimate the effectiveness of ORS, and, separately, RHFs on diarrhea morbidity and mortality in children aged < 5 years.


Intervention Effect

Oral Rehydration Solution (ORS) on Diarrhea Mortality

  • 93% relative reduction in diarrhoeal mortality would be expected with 100% coverage, given:
    • 69% (95% CI: 51-80%) relative reduction in diarrhea mortality in communities in which ORS was promoted compared with comparison areas
    • Mean coverage of 74% (52-96%)
  • Quality of evidence was low (non-randomized study designs), but strengthened by consistency of the effect size and direction among the studies, as well as biological plausibility.

Recommended Home Fluids (RHFs) on Diarrhea Mortality

  • Due to low quality of evidence for serious morbidity and lack of well-designed studies assessing the effect of RHFs on mortality, no estimates of effect of RHFs on diarrhea mortality were made.

Oral Rehydration Therapy (ORT) on Diarrhea Mortality

  • The studies were primarily pre/post designs and often did not adjust for confounding; thus, it was not possible to determine whether declines were causally associated with the use of ORS and RHFs, or with other interventions or community changes occurring during the same time.



Background

  • Diarrhoeal disease in children aged < 5 years is the second leading cause of death among 1-59 month old children. (1)
  • Since 2004, WHO has recommended low osmolarity ORS (with total osmolarity of 245 mmol/l and reduced levels of glucose and sodium) for prevention and treatment of diarrhoeal dehydration (2,3)
  • This paper presents evidence from systematic reviews and meta-analyses drawing upon data from community- and facility-based studies to estimate the effectiveness of ORS, and, separately, RHFs on diarrhea morbidity and mortality in children aged < 5 years.


Intervention Effect

Oral Rehydration Solution (ORS) on Diarrhea Mortality

  • 93% relative reduction in diarrhoeal mortality would be expected with 100% coverage, given:
    • 69% (95% CI: 51-80%) relative reduction in diarrhea mortality in communities in which ORS was promoted compared with comparison areas
    • Mean coverage of 74% (52-96%)
  • Quality of evidence was low (non-randomized study designs), but strengthened by consistency of the effect size and direction among the studies, as well as biological plausibility.

Recommended Home Fluids (RHFs) on Diarrhea Mortality

  • Due to low quality of evidence for serious morbidity and lack of well-designed studies assessing the effect of RHFs on mortality, no estimates of effect of RHFs on diarrhea mortality were made.

Oral Rehydration Therapy (ORT) on Diarrhea Mortality

  • The studies were primarily pre/post designs and often did not adjust for confounding; thus, it was not possible to determine whether declines were causally associated with the use of ORS and RHFs, or with other interventions or community changes occurring during the same time.

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