An analysis of home-cased oral rehydration therapy in the Kingdom of Lesotho

Mothers in developing countries are being successfully taught to give an oral rehydration solution (ORS) at home. The quantity of oral rehydration fluid that mothers administer to their child remains a critical question. Inadequate quantities render oral rehydration therapy (ORT) ineffective. The primary focus of our investigation was direct measurement of the quantity of fluid unsupervised mothers gave their children at home. This study validates a methodology that provides precise information on ORS administration in the home, information essential for evaluating the effectiveness of home-based therapy and for planning programmes to influence unsupervised mothers to correctly administer ORS to their sick children. This study, conducted in the Kingdom of Lesotho, assessed the impact on home care of the national control of diarrhoeal disease (CDD) programme. Direct observations in the home established each child's status and the quantity of fluid used 24 hr after children left the ORT unit where mothers were instructed to give ORS at home. Data were gathered on natural consequences that might discourage use of ORS, such as vomiting, increased frequency of watery stools and distaste for the solution. The health status of most of the 197 children followed improved. The average volume of ORS administered was 544 ml. A full liter was given by 21% of the mothers. Only 3% of the mothers gave no ORS. The average dose was 65 ml/kg. Younger children got about the same volume as older children; thus, they received a higher ml/kg dose. Mothers gave more ORS to children who had more symptoms of diarrhoeal disease at the time they were brought to the clinic. Mothers who said that their child liked the taste of ORS gave more than those who reported that their children did not like the taste. There was no relationship between loose stool frequency reported by mothers and quantity of ORS given. Interviewers were able to obtain acceptable volume estimates from mothers by identifying the container used to administer ORS in the home and asking how often it was filled. Using this approach, 81% of the mothers accurately recalled how much ORS they had administered. This technique may make it possible to obtain accurate estimates of quantities of supplementary liquids such as juice, tea and soup given in the home.