6401 Evaluating ORT preparation practices among caregivers in the management of diarrhoea at home in children under five in a LMIC: a critical literature review

Objectives Oral rehydration therapy (ORT) is an evidence-based, effective, and cheap treatment for diarrhoea one of the leading causes of death in children under five.1–7 The aim of this critical literature review was to evaluate the ORT preparation practices among caregivers of under-five children for the home-based management of diarrhoea. The ORT types of interest were oral rehydration solution (ORS) and salt and sugar solution (SSS). Methods A search strategy comprising of relevant key words and headings was executed using EBSCO Medline, EBSCO CINAHL, Scopus, PubMed, and Google Scholar. Eligible studies were assessed for quality and data extraction was carried out with an analysis grid table. A narrative synthesis and presentation of the findings was conducted guided by the research questions. Results The search identified 13 primary research papers that were eligible for inclusion in the review. Dates of the studies spanned from 1993 to 2021. The results were presented under the headings recommended practice, caregiver's practice, and recommendations to improve practice. The overarching drawback in caregivers' practice were the irregularities in utilising the water and solute used to prepare ORT. The major gap in practice was the variability in volume of water used to reconstitute ORS and SSS, with the consequent frequent production of hypertonic ORT which worsen diarrhoea morbidity and dehydration and may even lead to death in children under five.1 Conclusion Home-based management of diarrhoea in children with timely and appropriately prepared ORT is a major aspect of diarrhoea care in children. It is necessary to strengthen the skills of caregivers in using this life-saving intervention. More research into the details of care givers interaction with ORT preparation instructions will provide evidence to inform health promotion policies and interventions to improve the utilisation of ORT in countries with high burden of diarrhoeal related under 5 mortality, and low ORT uptake. References Afroz S. Use of improperly mixed oral rehydration salt (ORS) and hypernatremia in children – a burning issue. Paediatric Nephrology Journal of Bangladesh, 2018;3(2):62–65. Binder H. Development and pathophysiology of oral rehydration therapy. Digestive Diseases and Sciences, 2020;65:349–354. Khan AM, Wright JE, Bhutta ZA. A half century of oral rehydration therapy in childhood gastroenteritis: toward increasing uptake and improving coverage. Digestive Diseases and Sciences, 2020;355–360. doi:https://doi.org/10.1007/s10620-019-05921-y. Nalin DR, Cash, RA. 50 years of oral rehydration therapy: the solution is still simple. The Lancet (British edition), (2018, 08 18);392:536–538. doi: 10.1016/S0140-6736(18)31488-0. Okechukwu C, Briggs DC. Symptomatic hypernatraemia secondary to ingestion of poorly constituted oral rehydration solution – a case report. Asian Journal of Pediatric Research, 2020;3(1):1–5. doi:10.9734/AJPR/2020/v3i130117. WHO. Diarhoeal diseases. (2017, May 2). Retrieved from World Health Organisation: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease Wiens KE, Lindstedt PA, Blacker BF, Johnson KB, Baumann MM, Schaeffer LE, Das JK. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17. The Lancet Global Health, 2020;e1038-e1060.