Oral Rehydration Solution for the treatment of diarrheal dehydration
Global annual deaths associated with diarrhea
Percent (%) Number Maternal NA NA Neonatal 2% 74,000 S llbirth NA NA
Condition: Most common forms of diarrhea Current use in high resource settings: occur when a bacteria or virus proliferates in In general, caregivers encourage exclusive the gut, stimulating secretion of water or breastfeeding so long as the neonate remains inhibiting absorption from the intestine. This vigorous and eating well. If not, intravenous greatly increases the overall volume of rehydration therapy is the standard of care intestinal fluid excreted from the body, outside the home. ORS is prescribed as an carrying essential electrolytes with it. As a over the counter medication for home use. result, patients suffer from dehydration and Application in low resource settings: nutrient deprivation. Diarrheal disease kills Approximately 20% of diarrheal cases are approximately 1.5M children annually and treated with ORS in low resource settings, can be especially dangerous for neonates. saving an estimated 0.5M lives annually. UNICEF currently distributes 1 million Mechanism of Action: Oral rehydration packets every 3.5 days. Large scale solutions (ORS) treat dehydration associated dissemination programs have had great with diarrhea. Several formulations are successes. From 1982-88, a national possible, but the basic ingredients are almost diarrheal control program in Egypt reduced always clean water, sodium, and glucose. infant diarrheal deaths by 82% using ORS. They work because Na+/glucose co-transport In Bangladesh, BRAC trained 13 million proteins on the brush border cells of the mothers to make and administer ORS at intestinal lumen pull sodium and glucose from home. Today, ORS is used in approximately the gut into the cells. As the osmolarity of the 80% of Bangladeshi childhood diarrhea cells increases (due to the influx of sodium cases. and glucose molecules), water is reabsorbed WHO has introduced a revised, low- out of the gut and into the body. osmolarity formulation. Additionally, current Consequently, oral rehydration solutions help WHO/UNICEF guidelines for the to reverse electrolyte imbalances re-hydrating management of acute diarrhea recommend the patient. In most cases of cholera and both ORS and zinc. rotavirus, ORS is the only therapy required.
MakeRepresentative Model Devices Price/L Status Notes Naveh ElectroRice $1.80 Marketed Powdered, several fruit flavors available, Cera Products CeraLyte50 ORS $1.40 Marketed Powdered, travel market focused Abbott Pedialyte $1.25 Marketed Powdered or liquid, pediatric market focus UNICEF Low Osmolarity ORS $0.10 Marketed 1M sachets distributed every 3.5 days * Prices are approximated. Actual pricing can, and will vary by marketplace and market conditions. Characteristics of Representative Product (Unicef ORS)
Technology Operational Parameters Potential opportunities for Characteristics improvement Skills required required Skills Intended end user Family members of Well-executed, large scale training patient programs (of the type used by BRAC) hold great promise as a Training required Minutes complement to ready made packets
Time required per use Minutes Environment / Infrastructure Environment Power required n/a There is a strong move to sachets for making 200 ml, which is a more Waste collection n/a manageable amount and easier to mix and administer. Complementary 1 L clean water; technologies required measurement and mixing vessel
Temperature and Cool, dry storage storage
Maintenance n/a Cost Cost Device Cost (Approx.) <$0.25/packet Aluminum packaging accounts for a substantial portion of cost. Cost/use (Approx.) <$0.25/packet Homemade ORS can be low cost, although implies a training cost and access to clean water. Other Portability < 20g
Regulatory
Efficacy Case studies from around the world show reductions in mortality, in some cases upwards of 80%
Additional devices required for impact: None
Sources: C. King et al. “Managing Acute Gastroenteritis Among Children.” The CDC MMWR. Nov. 21, 2003 / 52(RR16);1-16. S. Hahn et al. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ, Jul 2001; 323: 81 - 85. WHO. Oral Rehydration Salts: Production of the new ORS. 2006 R. Levine et al. Millions Saved: Proven Successes in Global Health. Center for Global Development. 2003.