Food based Oral Rehydration Therapy
Prompt restoration of lost fluids and salts is the primary goal of cholera treatment. Oral rehydration therapy (ORT) with high-osmolarity mixture of glucose and salts has been recommended by the World Health Organization (WHO) and proved to be safe and effective in treating and preventing dehydration in cholera patient. The standard WHO-oral rehydration salt (WHO-ORS) prevents millions of deaths each year. Studies of food-based ORS versus WHO-ORS, demonstrated an improved outcome such as reduce purging, short duration of watery diarrhoeas, early recovery and low hospitalization rate. Moreover, food-based ORS provide additional nutrients to supplement WHO-ORS. In the short term, recommending food-based ORS will probably benefit a greater number of cholera patients.
ORS treatment based on standard glucose and salts have been a single formulation recommended by WHO/UNICEF to replace lost fluid and electrolytes for 44 years. Beside the standard ORS, food based ORS such as rice-based ORS can also be use as rehydration therapy for the management of cholera. Rice-based ORS contains cooked long-chain rice carbohydrate powder instead of the glucose or combined cooked rice with WHO-ORS is found is more effective than glucose ORS. ORT III is a combination of a pinch of salt with 50 grams of rice powder boiled in a liter of water. In many developing countries cholera child and patients are fed with rice porridge added with salt. In Bangladesh, “Chira,” flat beaten rice soaked in water, “Luta,” a thick boiled rice-powder fluid and “jao,” a thick fluid preparation of boiled whole rice, is used as rice-salt ORS solution to treat patients with diarrhoea.
Cereals, other than rice can also be added together with ORS because they have better nutrition, in the form of carbohydrate, protein, calcium, and phosphate, as well as vitamins and trace minerals. In many parts of the world, these cereals are available at a low cost. It also meets local cultural preferences and is better than sugar based ORS that are deleterious to dental. Food-based solutions are given to children during acute diarrhoea. These food solutions are based on rice-water, ragi-water, arrowroot-water, tender coconut-water, bicarbonate and citrate-WHO-ORS. When tested on rat model, this food solution either decreased cholera toxin-induced net water secretion (arrowroot-water) or reversed it to net absorption, with ragi-water produced maximum net water absorption, significantly greater than the WHO oral rehydration solutions.
Children receiving ORT based on sorghum showed substantial reductions in stool output. Those receiving maize, millet, potato wheat-based ORS show in lower total stool output compared with ORS based on glucose. In treating dehydration, plantain flour-based solution, maize flour and plantain flour-based ORS proved to be effective and safe.
Journal of Probiotics and Health
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