Two tools for child survival: ORS & Growth charts

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Two ubiquitous child-survival tools, oral rehydration solutions (ORS) and growth charts, are less than 50 years old. Both of these tools are simple, intuitive, and logical. In the 1980s, many developing countries celebrated these tools through postage stamps. Let’s take a look at some of them in this blog.

Eureka moments are often gradual

Diarrhoea was always a common occurrence. Cholera , which causes the worst forms of diarrhoea, has been a frequent occurrence in history of mankind. Yet it is surprising that it was only in 1960s that scientists could prove oral rehydration as a simple and effective remedy for diarrhoea. In the 1980s, its use became more widespread, after its endorsement by UNICEF and WHO. Therapy with oral rehydration solution (ORS) has its origins in Bangladesh and India, which have been home to previous cholera pandemics.

Oral therapy for diarrhoea has its origins in 1953. Dr Hemendra Nath Chaterjee, first reported use of a plant juice, which was published as a letter in medical Journal Lancet. In 1960s, some doctors from Cholera Research Laboratory in Dacca, and Tropical Medicine Institute in Calcutta started working on sugar-salt-solutions. These doctors challenged a prevailing view that IV-fluids alone could rehydrate a person with Cholera. In 1968, David R. Nalin and Richard A. Cash, assisted by Rafiqul Islam and Majid Molla, first reported scientific basis and composition of ORS. All of them were young researchers, fresh from medical school. Their painstaking work and a carefully concocted solution, was still a few years away from a global acceptance.

Global acceptance of ORS

Cholera needs large amounts of fluids for a successful dehydration. Till 1970s, IV fluids were a mainstay. ORS was only a supplement. It was used at scale in Bangladesh in 1971 – at the time of its war of independence, and then again in 1976 in more remote dispensaries where IV fluid was scarce. Soon it was evident that oral was better than intravenous. It saved more lives. Use of this solution transcended from Cholera to all diarrheas. WHO first endorsed this formula in 1975, and UNICEF included it as a global strategy in 1980. Subsequently, we have fine-tuned the ORS formula. WHO now advocates a revised 2002 formula, as better than its 1968 parent.

Today ORS is credited with prevention of more than 90% of all diarrheas deaths. We need to use ORS beginning at its first episode, both in children and adults. Dictum is to use it as much as a child can drink. Since 2001, we observe 29th July as a world ORS day. This is also an Indian initiative, that has become global.

Growth monitoring becomes a global movement

Recording weight is simplest of all measures. However, recording birth-weight for all births is a big-deal. So is repeating weight measures, every few months for upto five years of life. First documented growth curve is attributed to French writer and novelist Count Philibert de Montbeillard in early 18th century. He plotted height if his son, every six months for 18 years. But, what can you do with one-curve. We need benchmarks for a society, country, and maybe for entire world. Beginning 1940s UK and then USA constructed first reference charts for adolescents. Later, Tanner in 1965 identified stages of growth, and anthropometry for adolescents.

In 1977 National Center of Health Statistics (NCHS) in US published one of the most extensive growth charts. These charts had centile-lines as a benchmark. Beginning 1980, initially WHO and thereafter UNICEF introduced NCHS growth curves globally. This effort required a simple standardized infant measuring scale in all corners of the globe. Simple bassinet type, spring type and dial type scales were developed and distributed. Mothers, front-line workers and health-care staff all had to learn how to measure, and how to graph.

Four pillars of child survival

In 1983, UNICEF introduced four low-cost, high impact, knowledge mediated measures for child-survival. These measures have an acronym GOBI- Growth monitoring, Oral rehydration, Breast feeding and Immunization. We present GOBI-theme postage stamp series from Zambia and Afghanistan in following panels.

UNICEF added three additional measures. These measures – Family planning, Female education and Food security- have expanded GOBI to GOBI-FFF. Postage stamps from 1980s document these endeavours. Immunization was next huge undertaking, and we will embark on this journey in the next blog.