Richard A. Cash

ORAL MAINTENANCE THERAPY FOR CHOLERA IN ADULTS

Abstract An oral solution containing glucose, sodium chloride, sodium bicarbonate, and potassium chloride or citrate was used as maintenance therapy for acute cholera. In comparison with control patients who received only intravenous replacement of their stool losses, the patients who received the oral solution required 80% less intravenous fluids for cure. This reduction in requirements for intravenous fluids could make therapy for acute cholera in adults more widely available.

Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy

Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases. International efforts are being launched to control their dissemination through global surveillance, a major hindrance to which is the failure of some countries to report outbreaks. Current guidelines and regulations on emerging and re-emerging infectious diseases do not sufficiently take into account the fact that when developing countries report outbreaks they often derive few benefits and suffer disproportionately heavy social and economic consequences. In order to facilitate full participation in global surveillance by developing countries there should be: better and more affordable diagnostic capabilities to allow for timely and accurate information to be delivered in an open and transparent fashion; accurate, less sensationalist news reporting of outbreaks of diseases; adherence by countries to international regulations, including those of the World Trade Organization and the International Health Regulations; financial support for countries that are economically damaged by the diseases in question. The article presents two cases--plague in India and cholera in Peru--that illuminate some of the limitations of current practices. Recommendations are made on measures that could be taken by WHO and the world community to make global surveillance acceptable.

Reducing the health effect of natural hazards in Bangladesh

Bangladesh, with a population of 151 million people, is a country that is particularly prone to natural disasters: 26% of the population are affected by cyclones and 70% live in flood-prone regions. Mortality and morbidity from these events have fallen substantially in the past 50 years, partly because of improvements in disaster management. Thousands of cyclone shelters have been built and government and civil society have mobilised strategies to provide early warning and respond quickly. Increasingly, flood and cyclone interventions have leveraged community resilience, and general activities for poverty reduction have integrated disaster management. Furthermore, overall population health has improved greatly on the basis of successful public health activities, which has helped to mitigate the effect of natural disasters. Challenges to the maintenance and reduction of the effect of cyclones and floods include rapid urbanisation and the growing effect of global warming. Although the effects of earthquakes are unknown, some efforts to prepare for this type of event are underway.

Oral or nasogastric maintenance therapy in pediatric cholera patients.

Balance studies carried out on 12 pediatric cholera patients showed that the patientsabsorbed an oral solution of glucose and electrolytes. The oral solution maintained the patients in positive water and electrolyte balance after correction of shock by initial intravenous therapy. Use of the oral solution reduced the otherwise estimated intravenous fluid requirements by 80 per cent. By this plan, the cost of therapy is reduced. The ingredients of the oral solution are widely available in endemic cholera areas.

Oral or nasogastric maintenance therapy for diarrhoea of unknown aetiology resembling cholera.

Clinical trials under field hospital conditions were undertaken in India and Pakistan to determine the efficacy of oral maintenance solutions in treatment of noncholera diarrheal patients. Those patients with severe dehydration due to diarrhea were 1st rehydrated with a standard intravenous solution until the blood pressure was normal. They were then administered a warmed maintenance solution by mouth or nasogastric tube. Milder cases were given only an oral solution. The oral treatment was found to maintain fluid balance in all cases. Oral electrolyte solutions containing both glucose and glycine produced lower total stool volumes than the solutions made up only of electrolytes and glucose. The addition of glycine to the solution seems to enhance absorption. This oral therapy is recommended because the solution is cheap and the ingredients are widely available. Both solutions eliminated the need for intravenous fluids in 80% of the cases, thus lowering the number of staff man-hours needed per patient. This treatment can, thus, lower total costs and increase availability of diarrhea treatment in developing countries where severe diarrheal diseases are common.

TREATMENT OF DIARRHOEA IN INDONESIAN CHILDREN: WHAT IT COSTS AND WHO PAYS FOR IT

The annual economic burden of diarrhoea in four subdistricts in Indonesia averaged

RAPID CORRECTION OF ACIDOSIS AND DEHYDRATION OF CHOLERA WITH ORAL ELECTROLYTE AND GLUCOSE SOLUTION

2.27 per child aged under 5 years when health centre, hospital, and private expenditures were all considered. The community itself spent

ACETATE IN THE CORRECTION OF ACIDOSIS SECONDARY TO DIARRHŒA

1.03 per child or 46% of the total; 96% of community payments went to the private sector, and 4% were for fees at government health centres and hospitals. The widespread availability of oral rehydration therapy has led to only partial abandonment of ineffective or marginally effective medications; non-rehydration medications amounted to 44% of total treatment expenditures. Most medication costs were for antimicrobial agents, such as tetracycline in the government sector and iodochlorhydroxyquin in the private sector. If the use of tetracycline at health centres could be restricted to 10% of episodes treated instead of the present 88%, their costs could be reduced by 50%.

The private GP and leprosy : a study

Abstract Five patients with severe acidosis and dehydration secondary to diarrhœa were treated with an oral solution containing sodium chloride, potassium chloride, sodium bicarbonate, and glucose. Dehydration and acidosis were corrected within 6 hours. These findings imply that if a patient with cholera or other severe diarrhœa is treated with an oral solution early in the course of his illness, the need for intravenous fluid may be completely obviated.

Oral Therapy for Cholera

Abstract Patients with acute acidosis and dehydration due to diarrhœa were treated with rapid intravenous infusions of electrolyte solutions containing either acetate or bicarbonate, and the rate of correction of arterial pH was monitored. The final pH correction was similar with the two types of solutions, demonstrating that acetate-containing solutions are effective in the treatment of this type of metabolic acidosis.