Intervention 7: Oral Rehydration Therapy (ORT)/Zinc

    

Oral Rehyrdation therapy (ORT) 

A child is said to have diarrhoea if he/she passes three or more watery stools a day. Children become easily dehydrated due to loss of fluids during diarrhoea and, given their lower resistance, are more likely than adults to die from it. The conditions that cause diarrhoea are preventable. Diarrhoea is caused by germs that are swallowed, with underlying causes including poor hygiene, lack of clean drinking water and/or giving infants replacement feeding. In contrast, infants who are exclusively breast-fed seldom get diarrhoea. Death due to diarrhoea is also easily preventable through administering ORT and zinc. ORT refers to the use of ORS together with continued and increased breast-feeding and continued CF as appropriate.

Zinc

Zinc supplementation during a diarrheal episode has been proven to be beneficial, helping to reduce both the duration and the severity of the diarrhoea. WHO recommends 20 mg zinc supplements daily for 10–14 days for children with diarrhoea, and 10 mg per day for infants under 6 months.

7-11 programming promotes correct handwashing among caregivers for diarrhoea prevention and will counsel caregivers to recognise the danger signs of dehydration among children and to seek appropriate care. Access to both ORT and zinc are promoted, as per national guidelines.

Definitions:

  • Health education on hygiene, sanitation, hand washing, cleanliness for diarrhoea prevention
  • Increased BF during diarrhoea episode and continued BG after for <6-month child
  • Early use of orah rehydration solution (ORS)/appropriate household solution during diarrhoea
  • Continued CF and BF during and after diarrhoea episode for a child 6-24 months old
  • 20mg zinc given to child for 10-14 days (10mg for <6-month child)

Target Behaviours/Results:

  • Caregiver practises three-fold ORT approach: ORS, zinc, continued BF and/CF
  • Caregiver knows definition of diarrhoea (three or more liquid stools/day) and recognises signs of dehydration
  • Caregiver recognises signs of severe dehydration and takes the child to health facility for skilled care

Questions:

What is Oral Rehydration Therapy? 

ORT is giving the patient fluid by mouth to prevent and/or correct the dehydration that is a result of diarrhoea. As soon as diarrhoea begins, treatment using home remedies to prevent dehydration must be started.

 If adults or children have not been given extra drinks, or if in spite of this dehydration does occur, they must be treated with a special drink made with oral rehydration salts (ORS).

What is dehydration and why do children get dehydrated? 

Dehydration is the loss of body fluid through diarrhoea or vomiting. When a child has 3 or more loose or watery stools in a day, he or she is said to have diarrhoea. When there is diarrhoea, the bowel does not work normally, and more water and salt pass from the blood into the bowel. Thus, more than the normal amount of water and salts are passed in the stool. The more diarrhoea stools a child passes, the more water and salts he or she loses. This results in dehydration.

Dehydration can also be caused by a lot of vomiting, which often accompanies diarrhoea.  And, dehydration occurs faster in infants and young children, in hot climates, and when there is fever. 

How do you prevent dehydration? 

Dehydration can usually be prevented by drinking more fluids such as gruel, soup, rice-water or coconut water, and also increasing the frequency of breastfeeding, or giving milk feeds prepared with twice the usual amount of water as soon as the diarrhoea starts. If dehydration occurs, the child should be brought to a community health worker or health centre for treatment. The best treatment for dehydration is oral therapy with a solution made with ORS.

What are the symptoms of dehydration? 

As dehydration increases, signs and symptoms develop. These include: thirst, restless or irritable behaviour, decreased skin tightness, dry mucous membranes, sunken eyes, sunken fontanels (in infants), and absence of tears when crying vigorously. Dehydration progresses from mild to moderate to severe. Severe dehydration is very dangerous and will lead to death if not corrected. 

Why do people get diarrhoea and how do you prevent it? 

Dirty drinking water, poor sanitation, and infection can lead to diarrhoea, which is the second leading killer of children around the world.

The following precautions help prevent diarrhoea:

  • Exclusive breastfeeding for babies under 6 months of age
  • Use of clean water for drinking and washing
  • Hand washing
  • Use of latrines
  • Quick and sanitary disposal of babies’ stools
  • Measles immunization 

How do you treat diarrhoea?

Before anything else, treat dehydration quickly if it does occur. The goal is to prevent dehydration from occurring if at all possible. Additionally, give zinc supplements for 10-14 days, depending on the availability of supplies and national policy, and make sure to continue feeding the child. 

What is ORS? Is it safe to give it to a child? 

ORS is a sodium and glucose solution used to treat children with acute diarrhoea. The packets of ORS are widely available in pharmacies, shops, and health centres. A packet of ORS is to be mixed with the recommended amount of clean water. Although these 'salts' are specially made for the treatment of dehydration, they can also be used to prevent dehydration. The packet is used by doctors and health workers to treat dehydrated children. But it can also be used in the home to prevent dehydration.

ORS is safe. It has proven effective in the treatment of dehydration and without apparent adverse effects in worldwide use. It has contributed substantially to the reduction child deaths from diarrhoeal disease. While ORS does not stop the diarrhoea, it does replace the lost fluids and essential salts thus preventing or treating dehydration and reducing the danger.

 

In case ORS is not available, what should be given to a child with Diarrhoea?  

Mothers can use household liquids, preferably those that have been boiled, such as rice water or carrot soup. Ideally these drinks should contain starches and/or sugars as a source of glucose and energy, some sodium and preferably some potassium.

 A simple salt/sugar solution, if these ingredients are available, is also suitable for early oral rehydration therapy. 1/2 teaspoon of salt should be mixed with 6 level teaspoons of sugar in a litre of drinking water. People need to be carefully instructed in how to mix and use the solutions.

 Molasses and other forms of raw sugar can be used instead of white sugar, and these contain more potassium than white sugar. Do not use too much salt. If the solution has too much salt the child may refuse to drink it . Also, too much salt can, in extreme cases, cause convulsions. Too little salt does no harm but is less effective in preventing dehydration. (A rough guide to the amount of salt is that the solution should taste no saltier than tears.) 

How do you manage a child who has diarrhoea? 

 Plan A:The first step is to prevent dehydration by giving more fluid and continuing to feed the child at home. Continue to give extra fluid (as much as the child will take), give zinc supplements and continue feeding the child.

 Plan B: Treat some dehydration with ORS . Give in clinic recommended amount of ORS over 4-hour period. Follow the instructions given by the clinic staff, or written on the packet. If the child wants more ORS than shown, give more. For infants under 6 months who are not breastfed, also give 100-200 ml clean water during this period. Give frequent small sips from a cup. If the child vomits, wait 10 minutes. Then continue, but more slowly. Continue breastfeeding whenever the child wants. Reassess the child after 4 hrs

Plan C: Treat severe dehydration quickly at the health facility.

If the child with diarrhoea is also vomiting, what would you do? 

If child vomits, wait ten minutes and give it ORS again. Usually vomiting will stop. If diarrhoea increases and/or vomiting persists, take child over to a health clinic. 

What is Zinc and how does it help in the treatment of Diarrhoea? 

Zinc is an important micronutrient for a child’s overall health and development. Zinc is lost in greater quantities during diarrhoea. Replacing the lost zinc is important to help the child recover and to keep the child healthy in the coming months.

Giving zinc decreases the duration and severity of diarrhoea and the likelihood of future diarrhoea episodes in the 2-3 months following.

How is Zinc administered? 

Zinc and ORS can be given at the same time while your child has diarrhoea. Zinc is given once a day. Give the zinc at a time of day that is easy for you to remember and repeat every day until all zinc tablets are gone. Dissolve the tablet in a little bit of clean water and give it to the child to drink it. ORS needs to be given throughout the day while your child has loose stools.

Is it safe to take Zinc and ORS while taking other medications such as antibiotics, ARVs, etc.? 

The only side effect of zinc is sometimes vomiting. You should not expect any other side effects. As always, you should see a health centre if your child has any danger signs with or without the zinc supplements. Yes, you can give zinc with other medicines. Only give your child medicines that are prescribed at the clinic or by a community health worker.

 Is it advisable to continue feeding a child with diarrhoea? 

Yes, continue to feed your child and offer an extra meal each day. If your child will eat more than usual, allow him or her to do that. When food is given, sufficient nutrients are usually absorbed to support continued growth and weight gain. In contrast, children whose food is restricted or diluted lose weight and have diarrhoea of longer duration.

For children exclusively breastfeeding, give breastmilk more frequently and for longer at each feed. If not exclusively breastfed, increase fluid. For example, give soup, rice water, yoghurt drinks or clean water. Children with diarrhoea over 6 months of age need to be offered frequent small meals and must be encouraged to eat. 

When should a mother/care giver take a child with Diarrhoea to a health center? 

In any of these cases, a mother or care giver should consider taking the child to the health center: If the child shows signs of dehydration, if the child cannot drink or eat, or is very thirsty. If the child has many watery stools, or is vomiting a lot, if there is blood in the stools, if the child has a fever and bloody diarrhoea, or in the case of convulsions in a child with diarrhoea.

Is it good to give Antibiotics and Antidiarrheal for diarrhoea? 

Many mothers think their baby needs an antibiotic or some sort of ‘drug’ to treat the diarrhoea episode. Antibiotics are only recommended for children with bloody diarrhoea and episodes of cholera.  Giving the mother zinc will likely help with this because zinc decreases the duration of the diarrhoea. Continue to discourage the mother from going to local pharmacies or markets for additional antibiotics or Antidiarrheal.

 

7-11 HEALTH STRATEGY

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