Author: D.Lakshmi Priya, Bharath Institute of Law

Dehydration, one of the most neglected health problems, poses risks to health globally but especially in developing countries with high temperatures like India leading to loss of fluids for various reasons including sanitation. ORS-L (Oral Rehydration Solution Liquid) is an inexpensive yet ingenious formula that restores the lost electrolytes and liquids in the human body. Focussing on Public Health perspectives such as the science and legal implications of ORS-L, this article brings out the need for its use in children to help reduce mortality levels and bring in health equity. It further touches on policy gaps, issues of public awareness and how law and governance should work together to ensure that life-preserving products are available to all. Based on WHO and UNICEF reports, it is discerned in this paper that ORS-L is not simply a form of liquid to drink or a medicine but a health right which benefits the society and interlaces with healthcare modes in India.

Keywords:ORS-L, Dehydration, Public Health, WHO Guidelines, Health Law, Right to Health

Dehydration occurs when the body loses more water compared to the intake of water, and in this case, the water and salt balance has been disrupted. Dehydration should also be a common public health issue in India due to hot conditions and chronic sanitation issues. According to the estimates, developed by the World Health Organization (WHO), thousands of children under five die due to dehydration caused by diarrhea every year, which can be avoided completely under the condition of using Oral Rehydration Solution (ORS) in this case.

To facilitate this potentially life-saving treatment, ORS-L is an ORS in liquid state that is a ready-to-drink formula. It is an innovative small move with big impact particularly to the rural families, who might not have the privilege of accessing clean water to dissolve the traditional ORS powders.

The dehydration related deaths remain frequent in India even decades after as a well-tested treatment. A little awareness, incorrect usage, and unequal distribution of the same are the primary issues; not the absence of ORS-L. Hence, the question is Why do people lose their lives in developing countries because of dehydration when ORS-L can be easily obtained? is the main study question.

This study aims at achieving the following:

• Understand how the ORS-L works as a channel, as well as a social channel.

• Determine the barriers that block the proper distribution and consumption of the product.

• Highlight the legal and administrative requirements of the state in ensuring the access of common health.

• Suggest and endorse community and policy-level modifications, which would be more effective.

It is projected that should the government and the local health personnel manage to distribute the ORS-L in the right quantity and raise awareness on its use, the incidences of death caused by dehydration will be reduced to a minimum.

This subject is an example of how the law and health policy are inter-related in the case of a law student. In addition to being a commodity, ORS-L serves as a reminder of one of the elements of the duty of the State according to Article 21 of Indian Constitution which recognizes the Right to mint conditional exercise of the Right to Life, the Right to Human Health. As a result, it is not merely an obligation to promote ORS-L as a medicine that is required, but the Constitution stipulates it.

1. Purpose

The main purpose of doing this review is to explore what the researches and health organizations have already put in regard to the use of ORS and ORS-L as a means of reducing the number of deaths that are brought about by dehydration particularly in children.

2. Content

The generic formula of oral rehydration solution (ORDS) which consists of sodium chloride, potassium chloride, glucose, and sodium citrate was developed by the World Health Organization during the 1970s. The power of the frightening strength of Bangladesh and Indian controlled experiments has shown its ability to prevent deaths during diarrheal crises.

In 2002, UNICEF and WHO announced that ORS is among the most significant medical inventions of the 20th century. The former works by Bhatnagar and Singh (2010) and Patel and colleagues (2021) are the first that discovered that the liquid form (ORS-L) is more effective in terms of supply of the product, particularly among children and the aged population who are unable to efficiently mix the powder.

However, the research also indicates a constant lack of knowledge concerning the product. As WHO (2022) says, in the rural area, many households are not aware of using ORS and in addition, they believe that commercial soft drinks are the proper method of hydration and this is a very dangerous trend, and in this case, more programs focused on health education are needed.

Research Design

This research is a qualitative and descriptive study. It is primarily based on the secondary data of the authoritative sources such as WHO, UNICEF, and National Health Mission (NHM) of India.

Participants/Subjects

The paper relies on the state level data of India and in particular, the data on Bihar, Tamil Nadu and Uttar Pradesh where there are a significant number of cases of dehydration but the medical facilities are minimal.

Data Collection

The health reports of the government, health databases of the world and scholarly articles involving the proper use of ORS and its awareness were used to collect data. The contributions by the implementation of the public health programs and corporate social responsibility activities were also assessed in terms of being useful in promoting ORS-L.

Data Analysis

The researchers analyzed the data due to comparative observation, noting the trends in the awareness level, using ORS-L, and the rate of dehydration in various regions.

Ethical Considerations

This research is founded on the data, which is not confidential and the secondary sources. Personal data or field surveys were not involved, hence, ensuring full compliance with ethical standards of research.

Findings

The consumption of the ORS-L in India grew over 40 percent between 2016 and 2022 due to the awareness campaigns and the availability.

But only half of the rural households possess the right information on proper use of ORS.

The infant mortality rate because of dehydration in the districts where public distribution and health education programmes were intensive reduced significantly.

Sweetened ORS-L preparations were used to win the goodwill of the children and the old people hence the compliance levels increased.

Analysis

The evidence that has been revealed by this study indicates that awareness and access are the key issues that determine the success of ORS-L. The rates of adoption are higher in the regions where health workers (SHA, Anganwadi workers, etc. staff) were also trained. The results are a confirmation of the fact that in case communities are provided with sufficient information and supplies, the death rate due to dehydration reduces significantly.

Interpretation

This hypothesis has been proven true since ORS-L is a pertinent medical intervention but its effectiveness has been limited by the weaknesses in the social and infrastructural system. The rural regions lack proper cold storage, opportune provision and proper communication campaigns. These boundaries underscore the fact that public health is not only about medicine but it must be managed and educated at the same time.

Comparison

Although ORS-L is less effective compared to conventional powdered ORS, it is less dangerous and requires less effort since clean water is not required anymore. In India, the application is very restricted by the logistical system although it has proved to be efficient in the usage of ORS-L in emergency kits within the confines of the home or when traveling. This is what India can follow up on in the future in incorporation of ORS-L in travel and/or home emergency kit.

Implications

The study would propose that ORS-L should be:

• School health kits and hospitals in the countryside.

• Being used and promoted via corporate social responsibility and local awareness campaigns.

• Legally accepted to be a vital and essential public health item as indicated by the national health policies in India to sponsor the public health programs.

To law students; this is just one case of a law like the National Health Mission Act (2005) or consumer protection laws, which can provide the quality and effective delivery of public products to all citizens.

Limitations 

The research relied solely on the sources of secondary data; no field work was done. Most of the evidence on the effectiveness of ORS-L in rural outreach is not available until 2020. The data used by WHO and UNICEF when applied to vast populations might be susceptible to bias in interpretation.

ORS-L is a scientific innovation which is life-saving and combines simplicity with science; it has cut the deaths attributed to dehydration and still has a significant role to play in interventions of public health. However, to prolong its existence, it is important to be aware, have access, and be engaged with the community.

• Introduce ORS-L to schools and rural health hospitals by health departments. 

• Marketing National public education, family awareness of correct and safe usage of ORS-L.

• Encouragement of partnerships between the public and the private would result in improved packaging and storage of ORS-L, as well as education on distribution of ORS-L. 

• ERS-L is expected to be included in emergency relief, and natural disaster response packs.

Future studies can assist in learning about behaviors to administer ORS-L to have knowledge of how cultural beliefs and your education level, and your socio-economic status affects the ORS-L use. This would help the policymakers and health workers in organizing better awareness campaigns.

1. World Health Organization, Oral Rehydration Salts: Production of the New ORS, WHO Technical Report, 2019.

2. UNICEF & WHO, Diarrhoea: Why Children Are Still Dying and What Can Be Done, 2013.

3. S.K. Bhatnagar & R. Singh, Clinical Evaluation of ORS Formulations in India, (2010) 12 Ind. J. Med. Sci. 45.

4. M. Patel et al., Public Health Impact of ORS-L in Rural India, (2021) 7 Indian J. Comm. Health 58.

5. Government of India, National Health Mission Reports, 2022.

6. WHO, Electrolyte Imbalance and Dehydration Management Guidelines, 2022.

7. Ministry of Health and Family Welfare, National Guidelines for the Management of Diarrhea, 2021.