Diarrhoeal disease: current concepts and future challenges. The impact of oral rehydration and other therapies on the management of acute diarrhoea.

The development of oral rehydration therapy (ORT) has resulted in clear and practical methods for replacing fluid and electrolyte losses during diarrhoea. Rehydration salts can be provided in 3 ways; a pre-packed, easy to use, package which requires controlled formulation and distribution, a cereal-based formula from widely available ingredients which require preparation and cooking, or a home-made recipe of sugar with salt, which is relatively easily prepared. Poor retention of knowledge on the correct way to prepare solutions, inadequate availability of ingredients and practical problems of home production are major problems in ORT programmes. Although ORT may be life saving in severe dehydrating diarrhoea, it may not have an impact on milder illness, dysentery or persistent diarrhoea. Breast feeding is a natural and effective method for preventing and reducing diarrhoeal morbidity and its role needs repeated promotion. Early feeding in diarrhoea reduces duration, severity and adverse nutritional sequelae. The benefit of vitamin A and folic acid supplements are as yet unproved; zinc may have a role in aiding recovery of malnourished children. Drug treatment should be limited to parasitic gut infections, cholera or dysenteric disease. Widespread prescribing of drugs for diarrhoea by health workers may be hindering the success of ORT.