Linking research and programs to produce cost-effective solutions: the story of Oral Rehydration Solution

ICDDR,B, the International Centre for Diarrhoeal Disease Research, Bangladesh, popularly known as the Cholera Hospital locally, is an international health research institution located in Dhaka, the capital of Bangladesh. In 1968, it developed the cheapest and most effective treatment for diarrhea, Oral Rehydration Solution, and its research forms the core of the world’s knowledge of diarrhoeal diseases.

ORS, whose value proved itself during the terrible cholera epidemics that occurred during Bangladesh’s 1971 war of independence from Pakistan, has cut total worldwide diarrhea deaths from about 5 million in 1980 to 3 million today. In Bangladesh alone, child mortality fell from 35% to 6% over the following 20 years. No other single medical breakthrough of the 20th century has the potential to prevent so many deaths, over such a short period of time and at so little cost.

The total cost (including staff salaries and other overhead) for treating a child with ORT at a health facility is about US$1. It costs only a few cents for mothers to prepare the solution from ingredients normally available at home, and it could save the lives of 20 million children during the next decade because diarrhea kills more young children around the world than malaria, AIDS and TB combined.

Each year, in the developing countries of Asia, Africa and Latin America, approximately 2.2 million children under five years of age die from acute diarrhea, 80% in the first two years of life. Approximately 70% of diarrhoeal deaths are caused by dehydration - the loss of large quantities of water and salts from the body.

In 1978, CRL became ICDDR,B, now one of the world’s most important and influential health research institutions. Its work is often cited as the authority for important health and population-related decisions taken by multilateral agencies, governments, and development agencies throughout the world. Its list of accomplishments is long indeed. Key accomplishments in addition to its development of ORS include:

  • Demonstration of the limitations of the old injectable cholera vaccine in controlling epidemics and preventing transmission, thus completely changing the health practices of most countries and saving billions of dollars. Recently, field studies showed that orally administered cholera vaccines provide protection that is both effective and long lasting.
  • Demonstration that moderately educated rural female family planning workers, when carefully trained and given a range of contraceptives to offer at the household level, and provided adequate back-up support and supervision, can dramatically increase the use of contraceptives in poor, traditional and conservative, agricultural areas.
  • Years of patient work in Matlab, and more recently in the urban slums of Dhaka, have allowed the Centre to develop unparalleled expertise in community-based health care systems, and offer unrivalled opportunities for health services research.
  • Since 1978 the Centre has trained nearly 15,000 health care professionals now operating in field sites in the five continents. The Centre has done much to train many of the leading experts in public health and enteric diseases, currently holding key positions at leading schools of public health, medicine, and population, throughout the world.
  • Thirty years of demographic studies in Matlab are having a worldwide impact in advancing the appreciation and understanding of the dynamics of populations in impoverished, rural communities, and form the basis for the targeting of health and family planning programs across the globe.

The Centre now addresses issues of reproductive health, HIV/AIDS, dengue, arsenic toxicity, health equity, maternal and child health, health systems, violence, and aging communities among others, evolving in response to the evolving needs of poor countries. Its focus continues to be on coordinating research and programs. “We are not in the business of acquiring knowledge just to publish papers but rather to develop the knowledge that will be useful and practical.”

Asked why an international health research centre is located in Bangladesh rather than Geneva, London or Washington, the answer is simple: “this is where the problems are and this is where the problems can best be understood in all their complexities. This is where science and programmes meet and this is where they are integrated into practical and cost effective solutions”.

This story was prepared from three sources: the ICDDR,B website; an article entitled "A Simple Solution" by Andrea Gerlin published in the October 16, 2006 edition of Time Europe (vol. 168, no. 17); and information on the site of the Rehydration Project, located in Samara, Costa Rica, which focuses on education and provision of information - its site contains many useful resources. The ICDDR,B can be contacted at GPO Box 128, Dhaka 1000, or by email.

 


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