Experience in running a Diarrhoeal Training cum Treatment Unit (DTTU) in a state teaching hospital in Calcutta.

The Diarrheal Training with Treatment Unit (DTTU) was established in the Department of Pediatrics NRS Medical College and Hospital in Calcutta India in 1990 to promote use of oral rehydration therapy (ORT) in diarrhea in children 0-5 years of age. To evaluate the success of this effort a retrospective review was conducted of the 4349 child diarrhea cases presenting to DTTU in 1991-92. 3919 children (90.1%) were dehydrated at admission; the nondehydrated cases received counseling only and were discharged. 3202 children (73.6%) with diarrhea-related dehydration were successfully treated with ORT; intravenous fluids were administered in 598 (15.3%) of these cases. 717 children (16.5%) required hospital admission; 83.4% of these children received intravenous fluids. The proportion of diarrhea cases requiring antibiotics decreased from 13.5% in 1991 to 6.8% in 1992. Case fatality was 1.8% in 1991 and 1.7% in 1992. The actual cost of treatment was Rs. 150048 in 1991 and Rs. 91178 in 1992. These amounts represent savings of Rs. 600912 and 577867 respectively over what would have been the costs if all cases had been treated on an inpatient basis with intravenous fluids and antibiotics. These findings confirm the effectiveness of DTTUs strategy of ORT management of children with diarrheal dehydration combined with proper training and motivation of both mothers and health workers.