Composition, Acceptability and Efficacy of Fermented and Unfermented Cereal-based Oral Rehydration Solution for Home Management of Diarrhoea in Children

Abstract

Objective: The main objective was to evaluate the efficacy of fermented and unfermented cereal-based-Oral Rehydration Solution (CB-ORS) for home management of diarrhoea in children. Materials and Methods: Local varieties of white maize (Zea mays) and rice (Oritz sativa) fermented (48h) and unfermented were processed into fine flours. The proximate composition of the flours was determined using approved methods. CB-ORS were prepared using 50g of cereal flour dissolved in 1000ml of water with salt added. Fifty children (6-60 months) admitted in two hospitals in Onitsha, Anambra State, Nigeria, diagnosed for mild to moderate dehydration were recruited and randomly assigned to one of the five treatment groups: four test CB-ORS and a control (UNICEF-ORS≥310mOsm/L). Sixty millilitres (60ml) of the ORS were given every 30 minutes or after every vomiting/stooling. Body weights, packed cells volume (PCV) were measured before and after oral re-hydration therapy (ORT). Stool frequency and consistency were determined after commencing ORT. Clinical signs of rehydration were evaluated using approved methods. Structured, pre-tested and validated questionnaire was used to assess mothers’ perception of the CB-ORS. Result: More of the UNICEF-ORS was consumed than the CB-ORS. CB-ORS were more nutrient dense. After 6h of ORT, 90% of subjects given UNICEF-ORS were fully rehydrated compared to 80% and 70% of those given unfermented maize and fermented rice ORS, respectively. Within 2 days, 100% and 90% of those given the unfermented and fermented rice-based ORS had formed stools compare to 80% and 60% of those given the unfermented and fermented maize-based ORS, respectively. None of the subjects given the control had formed stools before the 4th day. There were also significant (p=<0.05) changes in PCV values of subjects given the fermented rice and unfermented maize ORS. About 98% of the children accepted the CB-ORS and 95% of the mothers were willing to use them again. Conclusion: UNICEF-ORS (whether old or new) remains the best option for rehydrating the diarrhoea child; however, cereal-based ORS (fermented or unfermented) could be used for both preventing dehydration as well as speeding stool formation. Fermented rice and unfermented maize based-ORS could be used as effective alternatives for home management of diarrhoea in children, especially in resource poor environments.

Key words: composition, acceptability, efficacy, fermented, unfermented, rice, maize, oral rehydration solution, acute diarrhoea.