ORS in rearview
On this World ORS Day, we should celebrate the millions of lives already saved by this simple innovation while remembering that it’s a job not quite done
Oral rehydration therapy (ORT) today is a well-known and widely used therapeutic intervention to treat diarrheal diseases. Its origins date back to the 1960s when American and Bangali scientists were investigating approaches to combating cholera epidemics.
Throughout the mid-twentieth century, untreated cholera had a mortality rate of 30-40%, and the only available therapy at the time—intravenous hydration—was difficult and expensive to implement for large numbers of people during cholera outbreaks.
In 1960, the Southeast Asia Treaty Organisation established the Cholera Research Laboratory (CRL), the forerunner of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), in Dhaka to develop solutions to prevent deaths from cholera. When the seventh and still ongoing cholera pandemic began in 1961, scientists at icddr,b were on hand to help develop a simple but highly effective solution not just for cholera but for diarrheal diseases in general: ORT.
Eventually, it became promoted as Oral Rehydration Solutions (ORS), composed of glucose, sodium chloride, sodium bicarbonate, and potassium chloride dissolved in clean drinking water. ORT works by helping to reverse the electrolyte imbalance caused by diarrhoea. Its development at CRL drew on research through the 1940s and 50s in the US and the UK, investigating salt and sugar absorption in the gut, as well as an earlier unsuccessful attempt at oral rehydration in the Philippines, which had used an excessively concentrated sugar-salt solution.
Keep updated, follow The Business Standard's Google news channel
From the late 1970s, widespread promotion and adoption of ORS have led to dramatic improvements in outcomes from cholera and other diarrheal diseases, saving an estimated 70 million lives to date. Before ORS, diarrheal episodes resulted in at least five million deaths per year in children under five across the world. ORS, along with improvements in hygiene, public health, and antimicrobial therapies, have made such deaths largely preventable.
Despite this progress, diarrheal diseases continue to account for about nine percent of all deaths of children under five across the world (as of 2019), which equates to a non-trivial 4,80,000 deaths every year. In 2016, UNICEF reported that fewer than half of the children under five with diarrhoea in LMICs received ORS, suggesting that there are barriers to ORS use that may be contributing to deaths from diarrheal diseases today.
Consistent with that, a 2020 study found that low ORS coverage tends to coincide with high mortality from diarrheal disease in most subregions across LMICs; coverage was defined as the proportion of children younger than 5 years of age with diarrhoea who received ORS. It is vital now to address barriers to ORS access and use, especially in regions with a high prevalence of diarrheal pathogens. It has been estimated that increasing ORS coverage to 100% may prevent 93% of deaths from diarrhoea.
In 2017, Bangladesh had a mean ORS coverage of 76.2%, and about 82% when also considering the use of recommended homemade fluids. Between 1980 and 2015, ORS helped reduce diarrheal disease mortality in children under five in Bangladesh from 15.1 per 1,000 to 6.0 per 1,000 live births.
While these numbers are highly encouraging, increasing ORS coverage to near 100% will help save thousands of lives each year in a region with a large number of circulating diarrheal pathogens, including rotavirus, Shigella, Salmonella, and Vibrio cholerae.
On this World ORS Day, we should celebrate the millions of lives already saved by this simple innovation while remembering that it's a job not quite done. Governments and international health organisations must continue promoting and expanding the use of ORS to reduce preventable diarrheal deaths in currently underserved regions.
Ornob Alam is a PhD student at New York University, and a Scientific Writer at icddr,b.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
