Perception of diarrhoea and the use of a homemade oral rehydration solution in rural Bangladesh

Abstract

Oral rehydration therapy (ORT) is being widely promoted in developing countries. but the socio-cultural aspects of diarrhoea are often poorly investigated prior to planning the programmes. Since 1980, Bangladesh- Rural Advancement Committee (BRAC), a non-governmental organisation has promoted a home-made OAT solution for use in all diarrhoeal episodes called lobon-gur solution (LGS), which is made from household lobon (salt) and gur (unrefined sugar) using the 'pinch and scoop' method. One mother per household is trained in its preparation and use during a half-hour home visit. By late 1986, over 7 million of Bangladesh's million households had been visited. Initial programme monitoring showed that most mothers could prepare a safe and effective solution, but that its use was less encouraging. A village study undertaken to investigate this low use found that villagers recognize four different types of diarrhoeal illnesses, which are dud haga due to breast-milk in infants; ajTrno due to over-eating or bad food; amasa, a mucoid diarrhoea, with or without blood and of unknown cause and daeria; which is severe watery diarrhoea or cholera. LGS was most frequently used for daeria episodes which, although representing only 5% of all episodes, are those most likely to lead to dehydration and death. Thus, the BRAC message promoting LGS for all types of watery diarrhoea was understood by the people to be of most use for severe watery diarrhoea. The importance of this local classification of diarrhoea has only just received recognition. despite more than 25 years of diarrhoeal disease research in Bangladesh.