Oral rehydration therapy: a community trial comparing the acceptability of homemade sucrose and cereal-based solutions.

Introduction The Bangladesh Rural Advancement Committee (BRAC) has a programme for promoting the use of table salt (lobon), unrefined brown sugar (gur), and water or lobon-gur solution (LGS) for the treatment of diarrhoea [1]. This programme has already reached over 13 million households where the mothers were taught how to make and use a safe and effective LGS. However, in spite of high levels of knowledge (>90% of mothers), the rates of utilization remain less than 20% throughout Bangladesh. Sugar, either refined or unrefined, is available in a minority of households ( Recent research has shown that a rice-based oral rehydration solution may decrease the fluid loss from diarrhoea as well as provide more calories, while reducing the osmotic load to the intestine [3]. Rice soups are traditionally given during illness and, unlike sugar, rice is universally available in all homes [4]. We therefore decided to test the acceptability and use of a home-made rice-salt rehydration fluid compared with the standard LGS promoted by BRAC. Methods Development of rice-based preparations Based on the proven successful method of teaching mothers about LGS [5], we conducted trials in 995 rural households, during which 5 women and 2 men, all experienced BRAC trainers, developed the most practical and culturally relevant techniques to make rice-salt ORT (RSORT), with a desired concentration of 60 mmol of sodium chloride per litre and 50 g/l rice. Working directly with these rural mothers the trainers investigated the following: the availability, preparation, and cooking of various types of rice; measuring techniques for rice, salt and water; and various approaches to teaching mothers at home so as to give the maximum demonstrated competency in preparation and use of RSORT. The resulting optimum approach was standardized and used by experienced BRAC trainers throughout the study, along with similar proven methods for teaching LGS. Study population Joypurhat, a rural district (population, 619 351) which is not yet covered by the nationwide house-to-house LGS teaching programme of BRAC, was the site of the field trial. Three non-contiguous unions (a) (out of 31), which were similar in geography, population and social patterns, were used to study the extent of utilization of LGS in Dhalahar (pop. 25 622), RSORT in Baratara (pop. 17 322), and both of these in Bhadsha (pop. 25 401) which is located between the former two. Within each union, twenty contiguous villages (about one half of the total) with approximately 2500 households (approximate pop. 13 750) were selected, by convenience, for baseline and subsequent follow-up studies. After preparation of village maps and a precise census, three teams of 15 female interviewers, each with a male supervisor, collected information (using a precoded questionnaire) on the availability of ingredients and equipment for preparing the solution, and on the practices during diarrhoea. Local terms were used to identify the recognized types of loose motions which included dud haga (diarrhoea in breast-feeding children), ajirno (diarrhoea due to indigestion), amasha (mucoid diarrhoea with or without blood), and daeria (severe watery diarrhoea) [2, 6]. The baseline survey was conducted over five weeks in January and February 1987. Randomization of implementation Following completion of the baseline survey, experienced BRAC training teams, one in each union, conducted house-to-house training throughout the entire union. The standard BRAC method of teaching the "seven points to remember" [2], including the actual preparation and testing of fluids, was conducted among small groups of women, up to a maximum of five, in each bari (patrilinearly related cluster of households). …