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Cereal Based ORT

Home > Programmes > Cereal Based ORT


Cereal Based ORT


Cereal based ORT

Oral rehydration therapy, if properly practiced, can cut infant and child mortality rates by at least half and obviate the need for countless millions of costly visits to hospitals, health centres, and clinics in all countries.  But is this feasible?

Packets of oral rehydration salts (ORS) are not universally available and the simpler sugar-salt solution can have dangerous effects if it is improperly mixed or administered.  Cereal-based ORT can overcome both of these disadvantages by providing yet another option for oral rehydration therapy.


Name: Cereal-Based ORT
Theme: Health Workers Knowledge Region and Country: Maharashtra, India
Partners: Beneficiaries:
Funding Need: Budget:
Duration: Contact:

Programme Activities:

This programme will promote cereal-based (food-based) oral rehydration therapy as an additional method to packaged ORT and home-made ORT for rehydration of a child.  The programme will promote and socially market the following advantages of cereal-based oral rehydration therapy:

  • Reduction of Volume, Frequency, and Duration of Diarrhoea, especially in cholera diarrhoea -- Studies have found that solutions made from rice flour or any of a number of other cereal reduce the volume, frequency, and duration of diarrhoea. When rice drinks are used in the management of cholera, stool volume is reduce by an average of 35%.  By contrast, sugar-based drinks--including ORS do not reduce stool volume.  Cereal-based ORT has been shown to speed up the resumption of solid food intake and to increase the amount eaten.

  • Effectiveness in non-cholera diarrhoea -- In studies of children with non-cholera diarrhoea, stool output was 18% lower than with standard ORS. Subsequent studies have shown that when food was given soon after rehydration, the reduce of stool output with CB-ORT was only 3.4%, a difference not considered significant, but regardless, cereal-based ORT was effective in rehydration.

  • Building on Local Traditions -- The biggest non-clinical advantages of cereal-based rehydration are associated with home-prepared CB-ORT. In many countries, excellent food-based rehydration drinks can be made by building on local traditions.  Health workers can help people understand why it is important to add cooked rice to the traditional rice water home remedy to make it somewhat thicker, and how much salt is desirable.  Almost any local grain or starch-rich food can give good results.  In short, people can usually make an effective ORT drink out of their locally-available, low-cost food staple.

  • Nutritional Value -- Cereal-based drinks--because of their low osmotic pull--can be prepared with up to three times the number of calories as sugar or glucose drinks, without any risk to the child.  This will be advantageous to children of poor families, and also with a cereal solution, the faster passage of water out of the gut into the bloodstream could mean that space for additional food becomes available more quickly.

  • Safety -- As with the amount of salt, the amount of sugar (glucose) in the homemade "Sugar, Salt Solution" is close to the upper limit of safety.  If mothers prepare an ORS packet with too little water, which often happens, the ORS drink itself can contribute to the dehydration.  By contrast, no such danger exists for the cereal drinks unless too much salt is used. Even if it is made more concentrated than usual, it is still safe (and nutritionally richer).  The drink will be useful as long as it remains liquid and the child accepts it.

  • Acceptability to children -- Children are often already used to cereal gruels as weaning food and accept them more readily than the standard ORS solution.  Also, most mothers (who usually taste anything before giving it to their child) prefer the taste of a cereal porridge to a solution of sugar and salt.  Many say that ORS tastes bad.

The implementation of this programme will take strong consideration of the following concerns raised by promoting cereal-based ORT.

  • Commercial promotion of cereal-based ORT raises concerns, particularly that promotion of packets may have detrimental effects on acceptance and uses of standard glucose based ORS packets.  The matter of 'competition' between cereal-based ORT and standard glucose based ORS is of particular concern to those who are currently involved in national programmes promoting widespread utilisation of standard glucose based ORS.

  • The physiological advantages of cereal-based ORT in clinical studies in hospitalized cases of severe diarrhoea are decreases of stool volume and duration of diarrhoea, but more needs to be known about the effects of cereal-based ORT in milder cases of diarrhoea at the 'community level.'

  • Possible 'competition' between two ORT approaches and new messages about a different approach to the management of diarrhoea might be confusing to caretakers, communities, and health workers, particularly where communication about glucose-based ORS still falls short of the desired coverage.

  • The major issue of concern is that cereal-based ORT might be considered as food by mothers, and divert them from feeding children during treatment of diarrhoea, unless the programme emphasized the continued feeding during diarrhoea, from the beginning of symptoms, is absolutely essential, to combat diarrhoea and particularly to protect the nutritional status of the child during diarrhoea. the message must be consistent: children should be given food during diarrhoea, whatever the form of ORT.

Intended Results:
A programme will be designed and implemented to socially promote CB-ORT and to inform and train health workers, community members, and mothers about the advantages of cereal-based ORT.  The uncertainties and concerns about the approach will be further researched and conveyed to health workers, and other relevant audiences.  A research and development agenda will be identified, which will lead to a firm basis for policy formulation.  The development of an action plan based on the research and development will be encouraged, including advocating close linkages between researchers and policymakers, to ensure rapid incorporation of the positive characteristics of cereal-based ORT.

Programme Management and Implementation:
This programme will be managed and implemented by the state of Maharashtra, health workers, necessary training personnel, and a designated research team.

Programme Monitoring and Evaluation:
The programme will be monitored and evaluated based on the findings of researchers and policymakers concerning cereal-based ORT.  Monitoring will oversee how the public responds to the social promotion of yet another ORT method.  If the new method introduces issues of confusion or competition of ORT methods, the programme and promotion of cereal-based ORT will be revised and accommodated as necessary.

Learning and Dissemination:


Related Resources:




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