From Barriers to Best Practices: Enhancing Oral Rehydration Therapy Utilization for Diarrhea Management in India

Diarrheal diseases are the third leading cause of childhood mortality in India. Oral rehydration therapy (ORT) remains the cornerstone of diarrheal disease management, especially as first-line treatment for acute diarrhea. However, ORT faces significant barriers that compromise its effectiveness in India. Children with diarrheal dehydration frequently fail to receive recommended treatment, primarily due to knowledge gaps among caregivers and preparation inaccuracies. These are further compounded by water safety concerns, poor palatability of home-based preparations, and the practical challenges of handling 1 L volumes. A critical factor determining ORT effectiveness is osmolarity optimization, with current World Health Organization (WHO) [also known as the reduced-osmolarity oral rehydration solution (ORS)]-recommended low-osmolarity ORS demonstrating superior efficacy than the earlier standard-osmolarity formulations that increased risks of hypernatremia and stool output. However, many caregivers deviate from the recommended osmolality in ORS solutions. Creating awareness among caregivers and healthcare providers and training them on proper reconstitution of ORT is essential for optimizing ORT outcomes and reducing preventable dehydration-related morbidity and mortality, especially in resource-constrained settings. Ready-to-drink ORS (RTD-ORS) can be considered as a viable alternative, especially in specific scenarios where convenience and adherence are prioritized. This review aims to examine the challenges and barriers impeding diarrheal disease management in India and address the identified gaps in healthcare delivery and improve treatment outcomes.