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ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1485-1488
Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria


1 Department of Pediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
2 Department of Pediatrics, Obafemi Awolowo University, Ile-Ife, Nigeria

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Date of Web Publication11-Jan-2018
 

   Abstract 


Background and Aim: Diarrheal deaths are largely preventable with the use of oral rehydration salt(ORS) solution. The aim of this study was to investigate the preparation and use of ORS for the treatment of childhood diarrhea in Ilesa, Nigeria. Materials and Methods: The characteristics of the present diarrheal illness as well as biodata, social class, use of ORS solution, and the method of preparation were documented in 250 children with diarrhea at the Wesley Guild Hospital, Ilesa, Nigeria. Data were analyzed using the statistical program for the social sciences(SPSS) version16.0. Results: A total of 151(60.4%) of the children had been given ORS before the presentation. The ORS was correctly prepared in 38(25.2%) of them, whereas hypertonic ORS solution was mostly given to the others. Asignificantly higher proportion(66.7%) of those from high social class had their ORS correctly prepared, compared with 16.1% of those from low social class(P=0.000). The use of ORS was more prevalent among children with longer duration of diarrhea(P=0.004). Asignificantly higher proportion of children who were still breastfeeding were given ORS, compared with those who had stopped breastfeeding(P=0.007). Conclusion:Teachings on the use and correct preparation of ORS should not be limited to diarrhea treatment units, but should rather be included in the routine health talks given to mothers at antenatal and immunization clinics. The provision of a 1 L measure to be used for measuring water for ORS preparation should be seriously considered to combat the problem of hypertonic ORS preparations.

Keywords: Diarrhea, oral rehydration salt, preparation

How to cite this article:
Abolurin OO, Oyelami OA, Oseni SB. Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria. Ann Trop Med Public Health 2017;10:1485-8

How to cite this URL:
Abolurin OO, Oyelami OA, Oseni SB. Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria. Ann Trop Med Public Health [serial online] 2017 [cited 2018 May 23];10:1485-8. Available from: http://www.atmph.org/text.asp?2017/10/6/1485/222654



   Introduction Top


Diarrhea is one of the major causes of under-five mortality in developing countries,[1] including Nigeria. Most diarrheal deaths occur as a result of dehydration, which is frequently accompanied by electrolyte derangements.[1] These deaths are therefore largely preventable with the use of oral rehydration salt(ORS) solution [1],[2] which should be commenced as soon as diarrhea is noticed.

Despite the popularity and availability of ORS, several mothers/caregivers do not give it to their children when they have diarrhea. Furthermore, wrong preparation of ORS is common among the mothers who deem it necessary to give their children ORS during episodes of diarrhea.[3],[4],[5] Home-made salt–sugar solution(SSS) is also effective for the prevention or treatment of dehydration in children with diarrhea, but is no longer popularly used.[1] The decline in the use of SSS is probably due to the fact that it is no longer recommended by the World Health Organization(WHO) since mothers frequently forget the recipe for its preparation, resulting in solutions that are hyperosmolar and unsafe for children.[1]

Breastfeeding also protects against diarrhea-specific morbidity and mortality throughout the first 2years of life [6],[7],[8],[9] because of its protective immunological properties, and its protective value against dehydration, which is an important cause of diarrheal deaths.[1] Continued breastfeeding during diarrheal illnesses is strongly encouraged by the WHO.[1]

The present study was carried out to investigate the preparation and use of ORS for the treatment of childhood diarrhea in Ilesa, Nigeria. The information obtained from the study may help in improving the treatment of diarrhea and ultimately help to reduce diarrhea-related deaths among Nigerian children.


   Materials and Methods Top


The study was carried out at the under-five welfare clinic and the children's emergency ward of the Wesley Guild Hospital, Ilesa, Osun State, Nigeria. The hospital is a unit of the Obafemi Awolowo University Teaching Hospitals Complex(OAUTHC), Ile-Ife. Ethical clearance for the study was obtained from the Ethics and Research Committee of the OAUTHC. Informed consent was obtained from the mothers/caregivers of the children. Two hundred and fifty under-five children with diarrhea were recruited consecutively for the study. This study was restricted to children between the ages of 6months and 5years because most cases as well as complications of diarrhea occur within that age group.

The characteristics of the diarrheal illness as well as biodata and social class were documented for each child. Social class was assessed using the method described by Oyedeji,[10] and further classification into high-and low-social class was done. Use of ORS solution or SSS and the method of preparation were also documented. The children were examined for signs of dehydration, after which the treatment was commenced. Management involved hydrating the patient with ORS solution according to the degree of dehydration. The caregivers were taught how to prepare and administer ORS solution. Infusion of intravenous fluids preceded the use of ORS in patients with severe dehydration. Other specific forms of the treatment were also given when necessary, including antibiotics for dysentery, correction of electrolyte derangements, and hypoglycemia.

Data were analyzed using the statistical program for thesocial sciences(SPSS) version16.0(SPSS Inc., Chicago). Proportions were compared using the Pearson's Chi-square test(χ2), and probability values(P) <0.05 were accepted as statistically significant.


   Results Top


The mean±standard deviation(SD) age of the children was 16.6±9.4months. Two hundred and sixteen(86.4%) of them were aged 24months and below, whereas 34(13.6%) were older than 24months. One hundred and forty-seven(58.8%) were male and 103(41.2%) were female. Two hundred and four(81.6%) were from low social class, whereas 46(18.4%) were from high social class. The mean±SD duration of diarrhea was 3.4±2.5days, with an average of 4.9±2.2 stool episodes/day. The duration of diarrhea was 1–3days in 173(69.2%) of the children, 4–6days in 53(21.2%), and 7–13days in 24(9.6%) of them. One hundred and forty(56.0%) passed 1–3 episodes of watery stool daily, whereas 69(27.6%) and 41(16.4%) passed 5–6 and≥7 episodes, respectively. One hundred and eighty-two(72.8%) and 151(60.4%) of them had a history of fever and vomiting, respectively. Signs of dehydration were observed in 68(27.2%) of the children. Of these 68, 36(%) had mild dehydration, 20(%) had moderate dehydration, and 12 had(%) severe dehydration.

One hundred and fifty-one(60.4%) of the children had been given ORS before the presentation, while none was given home-made SSS. Among those who had used ORS, the ORS was correctly prepared in 38(25.2%) children. Sixty-four(42.4%) of them were given hypertonic ORS solution that was prepared by dissolving a 1 L pack of ORS in one bottle of “small Eva water” or other brands of commercially sold bottled water containing 750 ml of water. Amore hypertonic ORS solution made by dissolving a 1 L pack of ORS in one sachet of “pure water”(~500 ml) was given to 48(31.8%) of the children, whereas one(0.7%) child was given a hypotonic solution prepared with one “big Eva water”(1.5 L). Asignificantly higher proportion(66.7%) of those from high social class had their ORS correctly prepared, compared with 16.1% of those from low social class(P=0.000).

Use of ORS was more prevalent among children aged 24months and below than in those older than 24months(138[63.9%] vs. 13[38.2%]; χ2=8.08, P=0.004). Similarly, use of ORS among children who were still breastfeeding(68.1%) was significantly higher than in those who had stopped breastfeeding(51.3%), and the difference was statistically significant(χ2=7.37, P=0.007). Ninety-three(53.8%) of the children whose diarrhea had lasted 1–3days had commenced ORS, compared with 38(71.7%) and 20(83.3%) of those whose duration of diarrhea was 4–6days and 7–13days, respectively. The difference was statistically significant(χ2=11.30, P=0.004).

There was no statistically significant relationship between the use of ORS and gender(P=0.750), social class(P=0.794), presence of fever(P=0.140), vomiting(P=0.316), or the presence/degree of dehydration(P=0.254 and 0.294, respectively).


   Discussion Top


Less than two-thirds of the children in the present study were given ORS during their diarrheal illness. Recent studies have similarly reported low rates of ORS utilization among Nigerian children with diarrhea. Ajuwon et al.[11] reported the ORS utilization rate of 49.5%, whereas Osonwa et al.[3] reported a rate of 43.5%. Lack of awareness and adequate information on ORS has been identified as some of the factors responsible for this.[3] The low rate of ORS utilization can undermine the benefits of ORS in eliminating diarrheal deaths among Nigerian children. Furthermore, none of the children in the present study was given home-made SSS solution. This suggests that knowledge about the preparation of SSS using salt and sugar is lacking among these caregivers. This is worrisome because such a simple cost-effective therapy can readily be forgotten completely. In developing countries where there are many conflicts and several internally displaced people, such a simple measure will come in handy where there is no ORS.

Only 25.2% of the caregivers who gave their children ORS prepared it appropriately, whereas hypertonic ORS solution was mostly given to the others. This is probably due to the fact that the 1 L ORS sachet is the most readily available in the study community, whereas there is no standardized 1 L measure to quantify the volume of water required. Sachet water is usually prepared in 500ml packs, whereas bottled water is prepared in 500ml, 750ml, and 1.5 L packs. To combat this problem, provision of a 1 L measure to be sold at an affordable price along with ORS should be seriously considered in the study community and the nation at large. The observation that mothers from high social class were more likely to prepare their ORS, appropriately, further supports the relevance of social class and maternal education in the management of childhood diarrhea as previously reported by Okoh et al.[12]

It is noteworthy that the use of ORS was more prevalent among children with longer duration of diarrhea in the present study. This suggests that caregivers usually delay commencement of ORS following the onset of diarrhea, which could increase the chances of dehydration occurring in the affected children. The proportions of children that were still breastfeeding and those below the age of 24months who used ORS during diarrhea were also observed to be significantly higher than their counterparts. This may be commendable, considering the fact that the most diarrheal deaths occur in children below 2years of age.[1] However, dehydration is more likely in children who have stopped breastfeeding, when no other form of fluid replacement is given. In children who breastfeed during diarrheal diseases, breast milk may replace fluid losses, and thereby prevent dehydration.[6] Thus, the use of ORS for older children who have stopped breastfeeding should be equally emphasized and promptly commenced.

Teaching mothers how to correctly prepare ORS, as well as SSS as an alternative, will go a long way in reducing the complications of diarrhea in this environment. Such teachings should be incorporated into the routine health talks given to mothers at antenatal and immunization clinics, and possibly over the mass media, rather than being restricted to diarrhea treatment units. Good knowledge of the appropriate treatment of diarrhea before its onset would help in preventing dehydration before the children present at the health facility.


   Conclusion Top


In conclusion, the benefits of ORS administration during childhood diarrhea may be hampered by delayed commencement and wrong preparation. These should therefore be avoided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. The Treatment of Diarrhea: AManual for Physicians and Other Senior Health Workers. WHO/CDD/SER/80.2. 4threvision. Geneva: World Health Organization; 2005.  Back to cited text no. 1
    
2.
World Health Organization. Reduced Osmolarity Oral Rehydration Salt(ORS) Formulation–Report from a Meeting of Experts Jointly Organized by UNICEF and WHO. Department of Child and Adolescent Health and Development. WHO/FCH/CAH/01.22. NewYork: World Health Organization; 2001.  Back to cited text no. 2
    
3.
OsonwaKO, EkoJE, EmaS. Utilization of oral rehydration therapy in the management of diarrhea in children among nursing mothers in Crossriver State, Nigeria. Am J Public Health Res 2016;4:28-37.  Back to cited text no. 3
    
4.
AdimoraGN, IkefunaAN, IlechukwuG. Home management of childhood diarrhoea: Need to intensify campaign. Niger J Clin Pract 2011;14:237-41.  Back to cited text no. 4
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5.
UwaezuokeSN, TagboBN, OkoroBA. Knowledge and utilization of oral rehydration therapy among mothers in Enugu, Nigeria: Ahealth facility survey. Orient J Med 2003;15:45-8.  Back to cited text no. 5
    
6.
HuffmanSL, CombestC. Role of breast-feeding in the prevention and treatment of diarrhoea. JDiarrhoeal Dis Res 1990;8:68-81.  Back to cited text no. 6
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7.
LambertiLM, Fischer WalkerCL, NoimanA, VictoraC, BlackRE. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health 2011;11Suppl3:S15.  Back to cited text no. 7
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8.
MeremikwuMM, AsindiAA, Antia-ObongOE. The influence of breast feeding on the occurrence of dysentery, persistent diarrhoea and malnutrition among Nigerian children with diarrhoea. West Afr J Med 1997;16:20-3.  Back to cited text no. 8
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9.
VictoraCG. Infection and disease: The impact of early weaning. Food Nutr Bull 1996;17:390-6.  Back to cited text no. 9
    
10.
OyedejiGA. Socioeconomic and cultural background of hospitalized children in Ilesa. Niger J Paediatr 1985;13:111-8.  Back to cited text no. 10
    
11.
AjuwonAJ, AgboladeMO, DipeoluIO. Knowledge and use of oral rehydration therapy among mothers of under-five children in Ibadan, Nigeria. Afr J Biomed Res 2015;18:237-48.  Back to cited text no. 11
    
12.
OkohBA, Alex-HartBA. Home management of diarrhea by care-givers presenting at the diarrhea training unit of a tertiary hospital in Southern Nigeria. Br J Med Med Res 2014;4:5524-40.  Back to cited text no. 12
    

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Correspondence Address:
Olufunmilola Olubisi Abolurin
Department of Pediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_370_16

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