Knowledge and Use of Oral Rehydration Therapy for Childhood Diarrhoea in India

This paper is a subject study using data from the 1992-93 National Family Health Survey (NFHS-1), carried out by the Indian Ministry of Health and Family Welfare. It uses the data to gauge knowledge and behaviour relating to the use of Oral Rehydration Therapy (ORT) for the treatment of diarrhoea, a major cause of juvenile illness and death in India. The study focuses on women who gave birth during the 4 years before the NFHS-1 survey. The study also attempts to link ORT practices and knowledge to media exposure. While the Indian government has been actively promoting ORT use through an extensive media campaign, this study does not attempt to create direct linkages to that effort but, rather, evaluates the impact of media exposure in the broader sense. Nevertheless, the authors believe that the study reflects on the overall impact and effectiveness of the government's ORT campaign.

The NFHS covered 25 states representing 99% of India’s population. Data were collected from a nationally representative sample of 89,777 ever-married women age 13-49 residing in 88,562 households. This report is based on data for the 38,161 women covered by the NFHS who gave birth during the 4 years before the survey and on data for the 4,558 children born in the period 1-47 months before the NFHS who were ill with diarrhoea during the 2 weeks before the survey. A lengthy explanation details the rational for weighting procedures and the inclusion of all control variables.

The study begins with an assessment of the potential scope of media exposure. Researchers found that 39% of women access radio at least once a week, 27% watch television once a week, and 14% go to the cinema hall or theatre at least once a month. 48% are regularly exposed to at least one form of electronic mass media. 52% are not exposed on a regular basis. Women aged 20-29 are less likely to be unexposed to any media (49%) than those aged 13-19 (52%) or those aged 30-49 (62%). The rural-urban divide is even more pronounced, with 61% or rural women not being exposed to any coverage, as opposed to only 23% of urban women. There were also significant regional differences.

According to the report, 43% of women giving birth 4 years before the survey knew about ORS packages, ranging from 20% knowledge to greater than 70%. The unadjusted figures show that women who are exposed to electronic mass media are significantly more likely to know about ORS packets than those who are not; for example, 56% of exposed women knew about ORS compared to only 32% of unexposed women. The difference of ORS knowledge among rural residents who had been exposed was slightly greater (12% diff.) than among urban residents (9% diff.).

Overall, 30% (adj.) of exposed women had ever used ORS packets, compared to only 23% among those not exposed. This difference was even more evident when the analyses included ORS and recommended homemade solution (RHS) therapies. Of those mothers with children who were ill 2 weeks before the survey, 36% of those with exposed administered either ORS or RHS, compared with only 27% who were not exposed. The difference between exposed and unexposed mothers who ever used of ORS packets within urban areas is relatively limited (33% exposed to 31% unexposed) but in rural areas the variance was more pronounced (29% of those exposed versus 22% of those unexposed).

One noteworthy finding was that media exposure had a far more significant impact on the administration of ORS/RHS to boys than it did to girls. The difference exposed/unexposed when it came to girls was only a 4% increase, while for boys it amounted to a 13% increase. The authors suggest the need for further inquiry and strategies to combat this significant bias. Among children receiving treatment for diarrhoea, public health facilities or providers were more likely to recommend ORS or RHS (45% of the time) than those from private-sector (37% of the time).

In conclusion, the authors suggest that despite the governmental campaign, ORT knowledge and use remains comparatively limited. Only 43% of women who gave birth in the previous 4 years knew about ORS, and a full 69% of children who were ill in the 2 weeks preceding the survey were given neither ORS nor RHS therapy. These findings indicate an overall lack of knowledge amongst both mothers and many health care providers. Nevertheless the analysis, demonstrates that electronic mass media are effective in increasing awareness and usage of ORT. Based on the Abstract of the full report, researchers would agree: "These findings indicate a lack of awareness of proper treatment of diarrhoea not only among mothers but also among health-care providers. There is clearly a need to strengthen education programmes for mothers and to provide supplemental training to health-care providers, emphasizing the importance of increased fluid intake and continued feeding and discouraging the use of drugs. The Oral Rehydration Therapy Programme also needs to address the problem of discrimination against girls in the use of ORS packets. The results of this study indicate that the mass media can help in these efforts."

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