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ELECTRONIC ARTICLE:
Christopher Duggan, Jack Lasche, Martha McCarty, Kathleen Mitchell, Robert Dershewitz, Stephen J. Lerman, Margaret Higham, Annette Radzevich, and Ronald E. Kleinman
Oral Rehydration Solution for Acute Diarrhea Prevents Subsequent Unscheduled Follow-up Visits
Pediatrics 1999; 104: e29 [Abstract] [Full text] [PDF]
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[Read P3R] Are economic constraints really important in the use of ORS?
P S PRABHU   (27 September 1999)

Are economic constraints really important in the use of ORS? 27 September 1999
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P S PRABHU,
Paediatrics Resident
Sheffield Children''s hospital

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Re: Are economic constraints really important in the use of ORS?

drsanjuuk{at}yahoo.co.uk P S PRABHU

It was refreshing to see some new light cast over the use of ORS in a developed country. Having trained in a developing country ,my experience has been that the use of ORS and the apparent benefit is always dependent on the doctor - parent relationship in addition to the factors mentioned in the various studies including this one. This is borne out by the fact that the use of ORS in the united Kingdom where I now work is by far much less than in a developing country like India. I believe that the perception of ORS as a wonder drug is not recognised enough in the developed world both by the general public and the medical and paramedical staff. It is felt that a quickfix solution of using intravenous fluids reassures the parent and the staff caring for the child far quicker than the use of ORS which sometimes may take hours or even days to make a noticeable difference. The fact that oral rehydration is the more physiological mode of replacing fluid should be made clear to all concerned and proper use of ORS encouraged.

In spite of the NHS providing ORS free in the UK, we find the prevalence of its use is lesser than considered desirable. It is however much higher in a developing country mainly because of the stronger belief in the medical profession and the relative judicious use of intravenous fluids in the treatment of gastroenteritis. We have found that distributing leaflets with the ORS explaining the benefits of ORS and the signs to differentiate mild from moderate or severe dehydration is very efective in increasing the use of ORS by parents in a district hospital setting. Another problem I would like to point out is the reconstitution of ORS with fruit juices and sugary drinks which completely alters the composition of the solution and should therefore be strongly discouraged. Articles of this nature especially from the developed world are most welcome and contribute to the care of children with gastroenteritis in a big way.