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ORS Solution: A Special Drink for Diarrhoea
Description of tool:
Diarrhoea, which is frequently caused by poor sanitation and hygiene, can have
serious, even deadly results, typically as the result of diarrhoea-related dehydration. It
particularly affects infants, children and old people. Oral rehydration salts (ORS) and
oral rehydration therapy (ORT) have been proven to be successful in the prevention
and management of acute diarrhoea and dehydration, but the effectiveness of these
therapies depends on their becoming routine practice in the home and in health care
facilities. The information in this tool could be used to teach young people about
ORS/ORT, to prepare education materials for families and the community, and to
guide the delivery of health services related to diarrhoea at the school.
The information in this tool was adapted by UNESCO from the following publications:
UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and the World Bank, 2002.
Facts for Life: A Communication Challenge. Third ed. New York: UNICEF; and
WHO/UNICEF, 2004. WHO/UNICEF Joint Statement: Clinical Management of
Acute Diarrhoea at http://www.unicef.org/publications/files/Diarrhoea_FINAL.pdf;
and from the website of the Rehydration Project at http://rehydrate.org/faq/index.html.
Description of document:
Facts for Life provides the essential facts that all families need and have a right to
know to protect children's lives and health. Topics covered include timing births, safe
motherhood, diarrhoea, coughs and colds, hygiene, child development and early
learning, breastfeeding, nutrition and growth, immunization, malaria, HIV/AIDS, injury
prevention and disasters and emergencies.
This information or activity supports Core
Component #4 of the FRESH framework
for effective school health: school health
services. It will have a greater impact if it
is reinforced by activities in the other three
components of the framework.
FRESH Tools for Effective School Health
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ORS Solution: A Special Drink for Diarrhoea1
What is ORS?
ORS (oral rehydration salts) is a special combination of dry salts that, when properly mixed
with safe water, can help rehydrate the body when a lot of fluid has been lost due to
diarrhoea.
Where can ORS be obtained?
In most countries, ORS packets are available from health centres, pharmacies, markets and
shops.
To make the ORS drink:
1. Put the contents of the ORS packet in a clean container. Check the packet for directions
and add the correct amount of clean water. Too little water could make the diarrhoea
worse.
2. Add water only. Do not add ORS to milk, soup, fruit juice or soft drinks. Do not add
sugar.
3. Stir well, and feed it to the child from a clean cup. Do not use a bottle.
How much ORS drink to give?
Encourage the child to drink as much as possible.

A child under the age of two needs at least a quarter to a half of a large cup of the
ORS drink after each watery stool.

A child aged two or older needs at least a half to a whole large cup of the ORS drink
after each watery stool.
Diarrhoea usually stops in three or four days. If it does not stop after one week,
consult a trained health worker.
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Important Supplemental Information about the Use of ORS and other Recommended
Home Fluids (RHFs) for Preventing and Treating Dehydration Related to Diarrhoea†
More than 1.5 million children under five die each year as a result of acute diarrhoea.
Though the number has been reduced considerably since the 1970s, when the estimation
was closer to 5 million, the current toll of diarrhoea-related deaths remains both
unacceptable and unnecessary. Efforts to find feasible, cost-effective prevention and
treatment protocols for the dehydration that results from diarrhoea and causes most
diarrhoea-related deaths have been underway for some time. Research and practice over
many years resulted in recommendations officially endorsed by WHO and UNICEF in 1993,
which, if properly observed, could reduce child deaths related to acute diarrhoea even more
significantly.
The obvious response to dehydration -- giving the child water to drink – doesn’t work
because the liquid rushes through the digestive tract too quickly to be absorbed by the body
tissues. For many years, the only answer seemed to be to bypass the digestive system
altogether and rehydrate the body using an intravenous drip. This is an invasive and
traumatic procedure for a child, and because it must be administered by someone with
medical training, it was (and still is) impractical for most episodes of childhood diarrhoea,
which take place out of range of sophisticated medical facilities.
In 1968, researchers in Bangladesh and India discovered that adding glucose to water and
salt in the right proportions enabled the liquid to be absorbed through the intestinal wall.
Anyone suffering from diarrhoea could replace the lost fluids and salts simply by drinking this
solution. Since the late 1970s, the use of specific formulations of oral rehydration salts
(ORS) and other home-made fluids, has been widely recommended to treat dehydration and
is known as oral rehydration therapy (ORT).
Oral rehydration salts contain a variety of salts (electrolytes)
and sugar. The combination of electrolytes and sugar
stimulates water and electrolyte absorption from the gut. It
therefore prevents or reverses dehydration and replaces lost
salts in conditions such as diarrhoea and vomiting.
Home-made versions of ORS are not difficult to make and a variety of formulations have
been developed around the world using ingredients that are familiar and readily available to
specific populations. The glucose present in molasses or rice water from the cooking pot, for
example, can be substituted for more expensive or hard-to-obtain forms of sugar. Specific
home-made formulations (known as “recommended home fluids”) have been endorsed by
humanitarian organizations and governments around the world to prevent dehydration
before it occurs, to supplement treatment with ORS or for use by populations that cannot
obtain or afford pre-packaged ORS. However, the efficacy of rehydration solutions depends
on the combination of ingredients in specific proportions, and best results, both for
preventing and treating dehydration, are obtained with pre-packed formulations of ORS.
†
The information in this section comes from the UNICEF website at http://www.unicef.org/sowc96/joral.htm and
from: WHO/UNICEF, 2004. WHO/UNICEF Joint Statement: Clinical Management of Acute Diarrhoea, at
http://www.unicef.org/publications/files/Diarrhoea_FINAL.pdf.
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In 1993, following two significant advances in the practice of managing diarrhoeal
diseases―newly formulated oral rehydration salts containing lower concentrations of
glucose and salt and success in using zinc supplementation―the World Health Organization
and UNICEF published guidelines for combining ORT with other actions known to be
effective in the prevention and treatment of diarrhoeal dehydration. The Joint Statement on
the Clinical Management of Acute Diarrhoea calls for the use of ORS and appropriate homemade fluids, breastfeeding, continued feeding, selective use of antibiotics and zinc
supplementation for a period of 10–14 days to reduce the duration and severity of diarrhoeal
episodes and lower their incidence. The specific recommendations, as published in the Joint
Document, are as follows:
RECOMMENDED ACTIONS
The revised recommendations emphasize family and community understanding of managing
diarrhoea. When they become routine practice, caretakers will act quickly at the first sign of
diarrhoea, rather than waiting before treating the child. The aim is that the recommendations
become routine practice both in the home and health-care facility.
 Mothers and other caregivers should:

Prevent dehydration through the early administration of increased amounts of
appropriate fluids available in the home, and ORS solution, if on hand;

Continue feeding (or increase breastfeeding) during, and increase all feeding after,
the episode;

Recognize the signs of dehydration and take the child to a health-care provider for
ORS or intravenous electrolyte solution, as well as familiarize themselves with other
symptoms requiring medical treatment (e.g., bloody diarrhoea);

Provide children with 20 mg per day of zinc supplementation for 10–14 days (10 mg
per day for infants under six months old).
 Health-care workers should:

Counsel mothers to begin administering suitable available home fluids immediately
upon onset of diarrhoea in a child;

Treat dehydration with ORS solution (or with an intravenous electrolyte solution in
cases of severe dehydration);

Emphasize continued feeding or increased breastfeeding during, and increased
feeding after the diarrhoeal episode;

Use antibiotics only when appropriate, i.e. in the presence of bloody diarrhoea or
shigellosis, and abstain from administering anti-diarrhoeal drugs;

Provide children with 20 mg per day of zinc supplementation for 10–14 days (10 mg
per day for infants under six months old);

Advise mothers of the need to increase fluids and continue feeding during future
episodes.
Health-care workers treating children for diarrhoea are encouraged to provide caretakers
with two 1-litre packets of the new ORS, for home-use until the diarrhoea stops. Caretakers
should also be provided with enough zinc supplements to continue home treatment for 10–
14 days. Printed material (including text and illustrations) with advice on preventing
and treating diarrhoea at home should accompany the ORS and zinc supplements.
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 Countries should:

Develop a 3–5 year plan to reduce mortality rates from diarrhoeal diseases;

Assess progress in controlling diarrhoeal diseases by monitoring usage rates of
ORT/ORS, home-based treatment and zinc supplementation;

Using the media and face-to-face communication, promote and refine messages on
diarrhoea prevention, home management of diarrhoea and appropriate care-seeking;

Prioritize improving the availability of the new ORS solution and zinc supplements
through private and public channels;

Craft suitable strategies to educate health-care workers at all levels about using the
new ORS and zinc supplements in treating diarrhoea;

Promote the availability of a zinc formulation that is cost-effective and easily
administered to both infants and children;

Identify obstacles to the use of ORS, zinc supplements and home-based treatments
in managing acute diarrhoea.
RECOMMENDED FORMULATION
Because of the improved effectiveness of reduced osmolarity ORS solution, especially
for children with acute, non-cholera diarrhoea, WHO and UNICEF are recommending that
countries manufacture and use the following formulation in place of the previously
recommended ORS solution.
COMPOSITION OF REDUCED OSMOLARITY ORS
Reduced osmolarity ORS
grams/litre
Sodium chloride
2.6
Glucose, anhydrous
13.5
Potassium chloride
1.5
Trisodium citrate, dihydrate
2.9
Total weight
20.5
Reduced osmolarity ORS
mmol/litre
Sodium
75
Chloride
65
Glucose, anhydrous
75
Potassium
20
Citrate
10
Total osmolarity
245
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Frequently Asked Questions
about diarrhoea, dehydration, oral rehydration salts and oral rehydration therapy†
 What is diarrhoea?
Diarrhoea is an intestinal disorder characterized by abnormal fluidity and frequency of faecal
evacuations, generally as the result of increased motility in the colon. Diarrhoea may be an
important symptom of such underlying disorders as dysenteric diseases, lactose intolerance,
GI tumours, and inflammatory bowel disease.
Diarrhoea is the passage of watery stools. This means body fluids and salts can be quickly
lost from the body. The person (or child) becomes dry (dehydrated). Among infants and
children, dehydration is especially dangerous and can lead to death.
 Why is diarrhoea dangerous?
When a person gets diarrhoea, the body begins to lose a lot of water and salts - both of
which are necessary for life. If the water and salts are not replaced quickly, the body starts to
"dry up" or get dehydrated. Severe dehydration can cause death.
 What is dehydration?
Dehydration is the loss of water and body salts through diarrhoea.
The human body needs water to maintain enough blood and other fluids to function properly.
If your body loses substantially more fluids than you are drinking, you become dehydrated.
You may lose fluids in a variety of ways:




when urinating
when you vomit or have diarrhoea
when sweating
from the lungs during normal breathing.
Along with the fluids, your body also loses electrolytes, which are salts normally found in
blood, other fluids, and cells.
 How does dehydration occur?
The usual causes of dehydration are a lot of diarrhoea and vomiting. Dehydration can also
occur if you do not eat or drink much during an illness or if you do not drink enough during or
after strenuous exercise. Medications that cause fluid loss to control excess body fluid
(diuretics) are a common long-term cause of dehydration.
Although anyone can become dehydrated, those who become dehydrated the most easily
are:
 babies under 1 year old
 the elderly
 anyone who has a fever
 people in hot climates.
†
The information in this section was adapted from the website of the Rehydration Project at
http://rehydrate.org/faq/index.html.
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 What are the symptoms of dehydration?
Early features are difficult to detect but include dryness of mouth and thirst.
Symptoms of early or mild dehydration include:












flushed face
extreme thirst (more than normal) or inability to drink
dry, warm skin
cannot pass urine or passes reduced amounts of dark or yellow urine
dizziness made worse when you are standing
weakness
cramping in the arms and legs
crying with few or no tears
sleepy or irritable
unwell
headaches
dry mouth, dry tongue, with thick saliva.
Symptoms of moderate to severe dehydration include:












low blood pressure
fainting
severe muscle contractions in the arms, legs, stomach, and back
convulsions
a bloated stomach
heart failure
sunken fontanelle (soft spot on an infant’s head)
sunken dry eyes, with few or no tears
skin loses its firmness and looks wrinkled
lack of elasticity of the skin (when a bit of skin lifted up stays folded and takes a long
time to go back to its normal position)
rapid and deep breathing - faster than normal
fast, weak pulse
 How is dehydration treated?
If you are mildly dehydrated, you need to drink enough liquid to replace the fluids you have
lost. Also, you need to replace the electrolytes (salts) you have lost. Drinking sips of water
slowly, and eating foods that have a high salt content, may suffice to replace the fluids and
salts you have lost.
Alternatively, nonprescription medicines are available that help replenish fluids and
electrolytes, or you can replace both fluids and electrolytes by drinking sports drinks or an
oral rehydration solution (ORS).
Drink the solution (or give it to the dehydrated person if he or she is conscious)
immediately. Do not wait until dehydration becomes severe.
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 What if symptoms of dehydration begin to appear?
The child should be taken quickly to the nearest health post or station where pre-packed
ORS is available. The trained health worker will then show the parents how to mix ORS and
supervise giving it. The health worker should also be able to assess a child who is severely
dehydrated who needs hospital treatment (including IV if necessary).
During the time before the complete ORS can be started the home-prepared solution should
continue to be given. In the unfortunate event that complete formula ORS is unavailable the
home-prepared solution will have to be used instead BUT it is not as effective for the
TREATMENT of dehydration.
Only in a minority of countries, such as some of the more affluent ones and some other
mostly fairly small countries with easy communications, is pre-packed ORS recommended
as the exclusive treatment both for preventive, first-line treatment in the home and for
treatment of dehydration. In most countries, however, home-prepared solutions are the
recommendation for prevention and complete formula ORS for treatment, as described here.
 How long will the effects of dehydration last?
If dehydration is not treated, it can cause death. However, if it is treated in time, recovery is
usually complete.
 What is ORT?
ORT is the giving of 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). The formula for ORS recommended by WHO and UNICEF
contains:




3.5 gm sodium chloride
2.9 gm trisodium citrate dihydrate (or 2.5 gm sodium bicarbonate)
1.5 gm potassium chloride
20 gm glucose (anhydrous)
The above ingredients are dissolved in one litre of clean water. Though in the most recent
recommendation, WHO calls for replacing 2.5 gm of sodium bicarbonate with 2.9 gm of
trisodium citrate dihydrate (the new formula gives the packets a longer shelf life and is at
least as effective in correcting acidosis and reducing stool volume), packets containing
sodium bicarbonate are still safe and effective.
 How does ORT work?
Acute diarrhoea normally lasts only a few days. ORT does not stop the diarrhoea, but it
replaces the lost fluids and essential salts thus preventing or treating dehydration and
reducing the danger. The glucose contained in ORS solution enables the intestine to absorb
the fluid and the salts more efficiently. ORT alone is an effective treatment for 90-95% of
patients suffering from acute watery diarrhoea, regardless of cause. This makes intravenous
drip therapy unnecessary in all but the most severe cases.
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 How do I use an ORS package?
Packets of oral rehydration salts are widely available. To use one of these packets, mix the
contents with 1 litre of drinking water. If drinking water is not available, or if you are not sure
the water is drinkable, boil the water for at least 10 minutes.
 How do I prepare an ORS solution at home?
If ORS packets are not available, mix an oral rehydration solution using one of the following
recipes; depending on ingredients and container availability:
Recipe for making a 1-litre ORS solution using
salt, sugar and water:
1.
2.
3.
4.
I litre of clean water
One level teaspoon of salt
Eight level teaspoons of sugar
Stir the mixture till the sugar dissolves.
The home-made solution is adequate in most causes. However if the diarrhoea is severe,
obtain the special pre-packed Oral Rehydration Salts from a health care worker. Follow the
instructions on the packet carefully.
Drink sips of the ORS (or give the ORS solution to the conscious dehydrated person) every
5 minutes until urination becomes normal. (It's normal to urinate four or five times a day.)
Adults and large children should drink at least 3 litres of ORS a day until they are well.
If you are vomiting, continue to try to drink the ORS. Your body will retain some of the fluids
and salts you need even though you are vomiting.
Remember to take sips of liquids slowly. Chilling the ORS may help.
If you have diarrhoea, continue to drink the ORS. The fluids will not increase the diarrhoea.
Someone with symptoms of severe dehydration (see above) needs to go to an emergency
room or other health care facility to get intravenous fluids (fluids given directly into the veins
through a needle) if possible. If able to drink, he or she should also drink the ORS.
During or after treatment of dehydration, whatever is causing the diarrhoea, vomiting, or
other symptoms should also be treated.
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 Can the solution be made with dirty water?
The benefits of fluid replacement in diarrhoea far outweigh the risks of using contaminated
water to make oral rehydration solution. In situations where it is difficult to boil water,
mothers are advised to use the cleanest water possible.
 Can the ORS solution be stored?
Generally a made-up solution should be covered and not kept for more than 24 hours, due to
the risk of bacteriological contamination. Packets of ORS should be stored carefully and not
kept in temperatures of over 30° C or in conditions of high humidity. Where the ingredients to
make up ORS are being stored in bulk, the glucose/sucrose should be kept apart from the
rest of the dry ingredients. The new citrate formula ORS has a longer shelf life.
 Can ORS be used for everyone?
ORS is safe and can be used to treat anyone suffering from diarrhoea, without having to
make a detailed diagnosis before the solution is given. Adults need rehydration treatment as
much as children, although children must always be treated immediately because they
become dehydrated more quickly.
 What should be done if the child vomits?
Vomiting does not usually prevent the therapy from being successful. Mothers must be
taught to persist in giving ORS solution, even though this requires time and patience. They
should give regular, small sips of fluid. Giving ORT reduces nausea and vomiting and
restores the appetite through correction of acidosis and potassium losses.
 Should feeding continue at the same time as ORT?
Feeding, especially breastfeeding, should be continued once dehydration has been
corrected. Even if the diarrhoea continues or the child is vomiting, some of the nutrients are
being absorbed. Suitable food should not be withheld, as the child may become
malnourished. Once the diarrhoea episode has passed, the child should be given more food
than usual to make up for losses during diarrhoea. Breastfeeding is particularly beneficial
because breastmilk is easily digestible. It also contains protective substances which help to
overcome the infection causing the diarrhoea.
 What sorts of foods are good during diarrhoea?
High energy foods such as fats, yoghurt and cereals are quite well absorbed during
diarrhoea. Small, frequent feeds of energy-rich local foods familiar to the child should be
given. A little vegetable oil can be added to foods such as millet or rice to increase the
energy content.

Foods high in potassium are important to restore the body's essential stores depleted
during diarrhoea. Such foods include lentils, bananas, mangoes, pineapples,
pawpaw, coconut milk and citrus fruits.

Certain foods should be avoided during diarrhoea, for example those containing a lot
of fibre such as coarse fruits and vegetables, whole grain cereals and spicy foods.
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It is very important to continue feeding a person with diarrhoea. Give soft, easy-to-digest
foods, like khichri, watery dal, idlis, curd, bananas, etc. You should also give plenty of other
fluids, like nimbu pani, rice kanji, lassi, coconut water, weak tea, etc. If the baby is being
breast-fed, continue to give her mother's milk. Give an extra meal a day, after the diarrhoea
stops, to help the body get strong again.
 Is it necessary to use drugs as well as ORT?
In most cases, no. ORT on its own is usually enough to rehydrate the child (or adult), and
the diarrhoea should get better by itself in a day or two. However, if there is any blood or
mucous in the stools, or any fever or vomiting, the sick person must see a health worker
immediately. You should also seek medical care if the condition gets worse or if there are
any signs of dehydration.
Don't take or give any medicines unless they have been prescribed by the health worker.
Drugs should not be used except in the most severe cases. Even then they should be
administered with care, preferably after the organism causing the diarrhoea has been
identified.
Small children with dysentery and fever require an antibiotic. Refer such patients to a health
service for advice. Unnecessary antibiotic therapy upsets the normal bacteriological balance
of the intestine. Many anti-diarrhoeal preparations have proved to be either ineffective or too
powerful for infants.
It is important to follow any medical advice you receive carefully.
 What can be done to prevent dehydration?
The important thing is to keep replacing the fluid and body salts. At the first sign of
diarrhoea, you must give ORS to the patient. You must give this drink after every loose
bowel movement.
If you have diarrhoea or vomiting, or if you are not drinking very much, force yourself to
begin drinking liquids before you become dehydrated.
If you are caring for someone you think is becoming dehydrated, follow these guidelines
when possible:

Give more liquids than usual.

Remember that a dehydrated person will have less of an appetite. Encourage him or
her to eat and drink small amounts of food and liquids five to seven times a day.

Watch for signs of more severe dehydration and get medical help as soon as
possible.
 How can I protect myself from getting dehydrated?
1. Know the symptoms of dehydration. Try to drink extra fluids if you know your body
is losing them rapidly.
2. Know the recipe for ORS.
3. If you are travelling in a country that does not have water that is safe for drinking,
carry with you a litre of boiled water and packets of ORS or the ingredients for it.
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Questions about “home-prepared” and packets of ORS
Questions are often asked about "home-prepared" ORS solutions and the relationship
between them and pre-packed complete formula ORS. This is a discussion of our present
knowledge and understanding:
 When is it appropriate to recommend the use of "home-prepared oral rehydration
therapy" and when is pre-packed ORS better?
Home-prepared solutions are recommended for use by parents to give to their child
immediately after an attack of diarrhoea starts and BEFORE any signs of dehydration occur.
Basically, the idea is to PREVENT dehydration and PRESERVE good nutritional status by
maintaining fluid and food intake.
Treat at home
with fluids
Child improves
Diarrhoea
starts
Child gets worse:
dehydration
Health worker treats
with ORS solutions
(or IV if necessary)
 Why is pre-packed ORS referred to as "complete formula" and why is a homeprepared solution not as effective for treatment? Are they not both basically
sugar, salt and water anyway?
No. They are not the same thing at all.
The "complete formula" ORS contains potassium and a base - either bicarbonate or citrate which corrects acidosis which small infants in particular suffer from when they are
dehydrated.
Potassium is important in the treatment of dehydration - most especially for the child who
suffers repeated bouts of diarrhoea.
Potassium is a vital essential element that occurs in the body cells (but very little exists in the
body fluids, almost all of the body's potassium is locked inside the cells). It is not involved in
the so-called "glucose-sodium co-transport mechanism" which is the basis of the way in
which ORS achieves rehydration.
Therefore potassium is only absorbed passively and more slowly. If a child is rehydrated with
a solution containing no potassium, each successive attack of diarrhoea leaves the child
more and more depleted of potassium - this results in fatigue, apathy and muscular
weakness. The typical bloated belly of a malnourished child is largely due to potassium
depletion which causes the muscles of the abdomen to slack. Finally such a child will die.
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 Can potassium be made good by feeding potassium rich foods like bananas?
Fortunately to some extent yes. However, mothers need to be taught and motivated to
modify a child's normal diet to include these foods for several weeks after an attack of
diarrhoea - or more or less permanently, in fact, in order to have much of an effect.
 Does a home-prepared ORS have to be made of sugar, salt and water?
Sugar is in many places very expensive, or even unobtainable. According to WHO and
UNICEF (in the booklet entitled "THE MANAGEMENT OF DIARRHOEA AND USE OF
ORAL REHYDRATION THERAPY - A Joint WHO/UNICEF Statement") there are two basic
types of home-prepared solutions:
(a) Those containing starch rather sugar: throughout the world all people have a basic
starchy foodstuff that is a staple part of their diet - it may be rice; root tubers such as
yams and potatoes; grains including wheat and others, etc.
These starchy foods are nearly always boiled in water to cook them and in the process the
cooking water, especially near the end of cooking, becomes a rich starchy solution, already
boiled and cooled. With the addition of a little salt (so that it tastes no more salty than tears)
such liquids are an excellent home-prepared solution to give to children for the prevention of
dehydration. Unfortunately, they may be less effective for children less then 3 months old.
Only in areas of famine would such solutions not be readily available in the home at no
significant extra cost.
With starches you cannot really give an excess - whereas with sugar an excess in solution
(over 3%) will cause a worsening of diarrhoea due to osmotic effects.
More operational research needs to be done in specific regions and countries to identify and
popularize the use of these starch based home-prepared solutions and uncover any
unforeseen problems e.g. fermenting of the solution after a few hours storage, or that the
liquid is normally fed to animals and may be culturally unacceptable to give to children. In
such cases some simple modification to the procedure may be devised to overcome these
problems.
(b) Sugar and salt solutions have been widely promulgated for years simply because they
are analogous to ORS. Such solutions have certain disadvantages, however. For
instance:

Making such solutions from scratch involves measuring quite accurately two different
weights (or measures) of solids and measuring the volume of water very carefully as
well. Getting the proportions “muddled up” can have disastrous consequences. Thus,
it is more complicated to make properly than ORS, and requires training or a more
competent parent.

Such solutions are more expensive - often much more expensive – and therefore
may be used too sparingly, making them of little or no use.
In spite of this, there are examples where it has been widely used with great success, e.g.
lobon-gur (a rehydration solution made with common salt and sugarcane molasses) in
Bangladesh. The applicability of either method depends very much on local or national
circumstances and policies and should be decided accordingly - there is never a universal
"right" method.
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FRESH Tools for Effective School Health
http://www.unesco.org/education/fresh
First Edition
 Apart from ORT, are there any other important aspects to the management of
diarrhoea?
First, take steps to PREVENT diarrhoea and associated dehydration through the following
measures:






breastfeeding
environmental sanitation
personal hygiene
clean drinking water
clean preparation and storage of food
insect and fly control
Second, reduce the severity and duration of the illness by maintaining or increasing food and
fluid intake DURING and AFTER an attack of diarrhoea. Starving children with diarrhoea to
"dry it up" probably causes millions of deaths a year.
1
UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and the World Bank, 2002. Facts for
Life: A Communication Challenge. Third ed. New York: UNICEF.
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