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This article is part of the supplement: The Lives Saved Tool in 2013: new capabilities and applications

Open Access Review

Systematic review of strategies to increase use of oral rehydration solution at the household level

Lindsey M Lenters1, Jai K Das2 and Zulfiqar A Bhutta12*

Author Affiliations

1 Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada

2 Division of Woman and Child Health, Aga Khan University, Karachi, Sindh, Pakistan

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BMC Public Health 2013, 13(Suppl 3):S28  doi:10.1186/1471-2458-13-S3-S28

Published: 17 September 2013

Abstract

Background

Diarrhea is one of the major causes of death in children under five years of age, disproportionately affecting children in low- and middle-income countries. Treatment of diarrhea with oral rehydration solution addresses dehydration and reduces diarrhea related deaths. The World Health Organization Programme for the Control of Diarrhoeal Disease began in 1978 and while global ORS access rates have improved substantially over the past forty years, rates of ORS use have stagnated. Investigation is required to understand which interventions are effective in promoting the use of ORS, and where there are gaps in the literature.

Methods

We conducted a systematic search of peer-reviewed and grey literature and included interventions to promote the use of ORS for the treatment of acute diarrhea in children under 6 years. We used a standardized grading format based on the Child Health Epidemiology Research Group guidelines and performed meta-analysis for all categories with more than one data point.

Results

We identified 19 studies for abstraction. For co-promotion of zinc and ORS, mothers in the intervention group were 1.82 (95% CI 1.17, 2.85) times more likely to use ORS to treat their child’s diarrhea episode than mothers in the comparison group. Meta-analysis of ORS social marketing and mass media strategies indicates that mothers exposed to messages were 2.05 (95% CI, 0.78, 5.42) times more likely to use ORS to treat their child’s diarrhea episode than unexposed mothers. However, this is not statistically significant. Both meta-analysis had significant heterogeneity and were graded as moderate/low and low quality, respectively.

Conclusions

We found few studies of interventions to promote the use of ORS; many categories of interventions had only one study. While there are some promising results, this analysis reinforces the need for further investigation into approaches to increasing ORS use.