Finally, one thing that SSS does not do is provide the underlying micro-nutrients that are often lacking and mean that the child cannot fight off the diarrhoea in the first place. Which is where the combined ORS/Zinc Kit recommended by WHO/UNICEF comes in.

There is some interesting recent research in the latest Lancet series (June 06) on this: eg ‘Preventive zinc supplementation in populations at risk of zinc deficiency reduces the risk of morbidity from child hood diarrhoea and acute lower respiratory infections and might increase linear growth and weight gain in infants and young children. A review by Yakoob and colleagues assessed 18 studies from developing countries and showed that preventive zinc supplementation reduced the incidence of diarrhoea by 13% and pneumonia by 19%, with a non-significant 9% reduction in all-cause mortality’. From what we are finding in the field, and what mothers and Health Centre staff tell us, the effect of Zinc supplementation WITH ORS in the same Kit is indeed promising.

So although it is kind of sad to commodify and medicalise SSS the balance of the argument is in favour of ColaLife’s approach.

Tell Rohit to work on a layman’s way of saying ‘adverse risk of hypertonicity on net fluid absorption’.

J

i) Is making SSS really simple?

ii) Are sugar and salt always available in a rural home?

iii) Is it easy to feed homemade SSS to a child? and

iv) Does SSS do the same job?

Perhaps I have misunderstood it, but the implication here does rather seem to be that does seem to be that making SSS might be beyond an illiterate mother/carer’s capacity.

Anyway, glad to hear that your approach is complementing existing ones.

For the record – ColaLife works closely with rural health facilities; most/all have an ORS Corner and they teach how to make SSS. The 4 publications mentioned in the blog post give some very well grounded responses – both for and against ORS/SSS.

The science tells us, however, that Low Osmolarity ORS combined with Zinc is clinically superior to home-made SSS. But mothers should know about all options to rehydrate a sick child – and breast feeding as number one.

First of all, I think it is wrong and a bit patronizing to assume that an illiterate or semi-literate mother can’t be taught to make SSS at home. God knows much of the IYCF messaging which is seen as such an important promotion platform is much more complex.

Secondly, while I don’t doubt that the mixture offered in the kits is clinically more effective than plain sugar and salt solution, I wouldn’t want to see mothers getting into a kind of ‘kit or nothing’ mindset in which, lacking access to the kits, and steered away from SSS by the kit marketing, they ended up not treating the child at all.

Finally, if mothers are saying they don’t have sugar and salt at home, why should we expect that they’d have the kits? I’ll just add that I think ColaLife is a really innovative and interesting project, but I think these questions require more robust and intellectually grounded responses.

T

Very interesting article. The one thing that really comes across is; since “the greatest discovery in the 60’s” the same problems still exist, diarrhoea and child mortality. Yes, it’s right to sell ORS. As long as it gets the treatment out to where it’s needed, faster and in a manner that will be used, it’s right!

To those who challenge whether it is right or wrong, I simply say “after all the years, all the money and all the education, why does the problem still exist?”. Until you [the challengers etc.] come up with answers to that question, it is definitely RIGHT!

B