A Salty Drink That Saves Lives!
By “Awake!” correspondent in Sierra Leone
It was early evening when two-year-old Jeneba complained that her belly hurt. Her mother, Mariama, wasn’t overly concerned though. Jeneba had suffered the “runs” before. This time it would be the same.
But the diarrhea persisted—frequent, watery, uncontrollable. Then came the vomiting. Jeneba lost strength rapidly. Mariama laid the child across her knees and rubbed her back. It did little to help.
As morning approached, Jeneba lay exhausted on the floor—panting, weak, heart fluttering, her head restlessly turning from side to side, her lovely brown eyes now sunken and half closed, her cheeks hollow, her mouth parched. And Mariama felt utterly helpless.
Wailing greeted the rising sun. Jeneba was dead.
WHAT is the biggest killer of children and infants? Believe it or not, it is dehydration—dehydration caused by ordinary diarrhea.a Five million youngsters under five years of age die every year from it—about one every six seconds. In the developing countries, it snuffs out the life of one out of every 20 children before the age of five. And in economically developed nations, surgery aside, diarrhea ranks second only to respiratory disease as the chief reason why children are hospitalized.
Ironically, though, most of this suffering and death could be eliminated by a simple, salty drink.
How so? First of all, it is not diarrhea that kills. That usually clears up by itself without any treatment. The problem is that a person with diarrhea loses fluids and salts from the body—he dehydrates. If too much fluid is lost and not replaced, death occurs.
An estimated 500 million youngsters in the developing world contract diarrhea annually. In poor areas the average child may have three or four bouts per year. Often, though, the disease is merely a mild inconvenience. But sometimes just a few hours of it, such as with cholera, can bring dehydration and death. Unfortunately, it is difficult to determine in its early stages whether the illness will be life threatening or not. Thus it is essential that parents not only recognize dehydration but also know how to act quickly to prevent and correct it.—See boxes on pages 24 and 25.
Lost Fluids—How Replaced?
If you want to maintain the water level in a leaking bucket, you simply keep adding water. The same is true with a child with diarrhea—fluids in his body must be replaced. This is called rehydration.
Until recent years, this was done by feeding a salty solution directly into the veins (intravenous therapy).[?] Though this was effective and still remains the best treatment for dangerously dehydrated children, it presents problems. It is costly, and it requires skilled personnel and sophisticated equipment, usually available only at health centers or hospitals. These may be far removed from the suffering child. Intravenous therapy is thus out of reach for the majority of those needing it.[?]
Nevertheless, particularly since the 1960’s, there has been another therapy available that is safer, simpler, and cheaper than the intravenous method. It is called Oral Rehydration Therapy, or simply ORT. Like the intravenous treatment, ORT replaces lost fluids and salt. But instead of having the fluid injected into his veins, a child can drink it.
Why wasn’t this thought of before? It was. The problem was that diarrhea not only drains fluids from the body but also restricts liquids from being absorbed through the intestinal wall. So simply drinking fluids was ineffective—most of it passed straight through the body.
But, then, quite by accident an important discovery was made. Medical scientists working with oral rehydration methods added sugar to salt solutions to make them more pleasant to drink. In doing so, they discovered that the body absorbed not only the sugar but also the lifesaving salts and water! The sugar was like a key that unlocked the door to the solution of the problem. When the correct mixture was given, it was found that sugar could increase absorption 25 times!
Significant? Lancet, a leading British medical journal, hailed the discovery as “potentially the most important medical advance this century.” And UNICEF (United Nations Children’s Fund) called it “one of the simplest but most important breakthroughs in the history of science”!
Why? Because now parents can treat their children at home! No special equipment is needed, nor extensive training. It is inexpensive too. Commercially produced packets of oral rehydration salts cost only a few cents and are becoming widely available through various health programs and organizations. All parents need do is mix the salts with water and let the child drink the solution.
But what if prepackaged salts are not available? Parents can make up their own rehydration drink with ingredients found in the home. Though homemade solutions are not as effective as the prepackaged variety, they are a good second choice. And while doctors question their value in correcting advanced dehydration, most agree that homemade solutions play a vital role when taken at the onset of diarrhea.
Why the Children Still Die
Though ORT works and works well, there remains the challenge of putting it into the hands of the world community. What progress is being made? In hospitals, ORT is rapidly replacing intravenous therapy as the preferred treatment for most dehydration cases. By late 1983, over 30 developing countries had begun ORT programs, with at least 20 gearing to produce their own oral rehydration salts. And many international health organizations are actively spreading the word about ORT. The results have been positive. In field studies around the world, it has been found that where the therapy has been promoted, dehydration deaths have been cut by 50 to 60 percent! Nevertheless, with half a billion children affected by diarrhea each year, it is a mammoth task to make prepackaged salts available to everybody.b
But could not parents simply prepare homemade solutions? Unfortunately, salt, sugar, and measuring devices are not available everywhere. And even where they are, preparing rehydration drink requires proper training. If, for example, too much sugar is added to the solution, absorption will decrease and the diarrhea may worsen. Too much salt is likewise dangerous. Then there is the size of the dosage. Too much can prolong diarrhea. Too little, and dehydration continues.
There is also the very real problem of changing people’s attitudes. Many are simply unwilling to try ORT. Some mothers still think that the best treatment for diarrhea is to stop giving their children food and drink. Others follow the advice of local medicine men—with tragic results.
It should also be remembered that ORT is only a therapy. It neither stops nor prevents diarrhea. To eradicate diarrheal disease means tackling the global problems of poor water, sanitation, and hygiene.c Malnutrition must also be ended, for in a deadly cycle, malnutrition causes diarrhea, and diarrhea causes malnutrition.
Christians, however, know that the ultimate solution will be God’s Kingdom, which will completely eliminate malnutrition, disease, and even death itself. (Revelation 21:4; Psalm 72:16) In the meantime, oral rehydration therapy remains a simple but highly effective weapon in the battle against this killer of millions of children.
[Footnotes]
a Thus far, 25 different parasites, viruses, and bacteria have been found to cause diarrhea. This, plus other factors, makes it difficult to give diarrhea a precise definition. Broadly speaking, however, we can define it as the passing of liquid, or watery, stools more than three times a day.
b Annual production is now about 80 million sachets.
c Studies have shown that diarrheal infections can be reduced by as much as 50 percent if hands are washed with soap and water after using the latrine and before handling food.
[Box on page 24]
“Potentially the most important medical advance this century.”—Lancet
“One of the simplest but most important breakthroughs in the history of science.”—UNICEF
[Box on page 24]
When Diarrhea Strikes: Guidelines in Treating Children
Do not stop feeding: Fluids should be given. Tea, rice water, barley water, and soups are beneficial. Have drinking water available. Keep giving breast milk to nursing babies. Meals should be given as soon as the child can eat. Small but frequent meals, however, are best. Easily digested, energy-rich foods such as cooked cereals and bananas are good.
Give oral rehydration drink from the outset: This replaces fluid loss and prevents dehydration. Where possible, use prepacked oral rehydration salts. If these are not available, prepare the following solution (Accuracy in mixing is important!):
Table salt: One level teaspoonful
Sugar: Eight level teaspoonfuls
Water: One liter (5 cupfuls at 200 ml each)
How much to give: Amount given should approximate fluid loss. Roughly, one cupful of rehydration drink should be given for each loose stool passed; half that for small children. (Babies can be spoonfed the solution.) LET THE CHILD DRINK AS MUCH AS HE LIKES!
When to stop giving rehydration drink: Usually as soon as diarrhea stops or when thirst for rehydration drink abates.
When to seek medical help:
When dehydration signs are evident.
When the person cannot drink.
When diarrhea continues for four days with no improvement (or after one day in babies with severe diarrhea).
When there is severe vomiting.
[Box on page 25]
Signs of Advanced Dehydration
Little or no urine
Rapid weight loss
Dry mouth
Sunken soft spot in infants
Sunken eyes
Fast, weak pulse
Loss of skin elasticity
Lift the skin with two fingers. If the skin fold fails to fall back to normal, the child is dehydrated
Source: Where There Is No Doctor, by D. Werner, London, 1981, page 159.