Prompt restoration of lost fluids and salts is the primary goal of cholera treatment. Oral rehydration therapy (ORT) with high-osmolarity mixture of glucose and salts has been recommended by the World Health Organization (WHO) and proved to be safe and effective in treating and preventing dehydration in cholera patient. The standard WHO-oral rehydration salt (WHO-ORS) prevents millions of deaths each year. Studies of food-based ORS versus WHO-ORS, demonstrated an improved outcome such as reduce purging, short duration of watery diarrhoeas, early recovery and low hospitalization rate. Moreover, food-based ORS provide additional nutrients to supplement WHO-ORS. In the short term, recommending food-based ORS will probably benefit a greater number of cholera patients.

ORS  treatment  based  on  standard  glucose  and  salts  have  been  a  single  formulation  recommended  by  WHO/UNICEF  to  replace  lost  fluid  and  electrolytes  for  44  years.  Beside  the  standard  ORS,  food  based  ORS  such  as  rice-based  ORS  can  also  be  use  as  rehydration therapy for the management of cholera. Rice-based  ORS  contains  cooked  long-chain  rice  carbohydrate  powder  instead  of  the  glucose  or  combined  cooked  rice  with  WHO-ORS  is  found is more effective than glucose ORS. ORT III is a combination of a pinch of salt with 50 grams of rice powder boiled in a liter of water. In many developing countries cholera child and patients are fed with rice porridge added with salt. In Bangladesh, “Chira,” flat beaten  rice  soaked  in  water,  “Luta,”  a  thick  boiled  rice-powder  fluid  and “jao,” a thick fluid preparation of boiled whole rice, is used as rice-salt ORS solution to treat patients with diarrhoea.

Cereals,  other  than  rice  can  also  be  added  together  with  ORS   because   they   have   better   nutrition,   in   the   form   of   carbohydrate, protein, calcium, and phosphate, as well as vitamins and trace minerals. In many parts of the world, these cereals are available at a low cost. It also meets local cultural preferences and is better than sugar  based  ORS  that  are  deleterious  to  dental.  Food-based  solutions  are given to children during acute diarrhoea. These food solutions are based  on  rice-water,  ragi-water,  arrowroot-water,  tender  coconut-water, bicarbonate and citrate-WHO-ORS. When tested on rat model, this  food  solution  either  decreased  cholera  toxin-induced  net  water  secretion (arrowroot-water) or reversed it to net absorption, with ragi-water  produced  maximum  net  water  absorption,  significantly  greater  than  the  WHO  oral  rehydration  solutions. 

Children  receiving  ORT  based on sorghum showed substantial reductions in stool output. Those receiving maize, millet, potato wheat-based ORS show in lower total stool output compared with ORS based on glucose. In treating  dehydration,  plantain  flour-based  solution,  maize  flour  and  plantain flour-based ORS proved to be effective and safe.

Joise Angelina
Journal of Probiotics and Health
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