An operational study of a 3-tier strategy for implementation of oral rehydration therapy (ORT) was conducted in a block of West Bengal with 216,825 population through the existing health services facilities. All the grassroot level, health workers including their supervisors at various levels were trained regarding the management of patients of diarrhoea with mild to moderate degree of dehydration, by ORT. Another block in the same district with similar demographic features where this intervention was not provided served as control. After 22 months of observation, it was evident that despite adequate training, the performance of Community Health Guides (CHGs) and Anganwadi Workers (AWWs) was not encouraging because of the low utilization of both home available fluids (32.0%) and oral rehydration solution (18.0%) in the study area. Similarly, diarrhoea associated mortality could not be reduced significantly. Lack of motivation and failure to maintain sustained level of skill by the CHGs and AWWs constitute the major bottlenecks for the successful implementation of the programme at the community level.
PIP: Between April 1985-January 1987, researchers conducted a 3 stage operational study of oral rehydration therapy (ORT) implementation in 2 rural blocks of Hooghly district in West Bengal, India. ORT implementation only occurred in 1 block. The stages included training of community health guides (CHGs) and Anganwadi workers (AWWs); monitoring, supervision, and logistic support; and health and practices surveys. Home available fluids (HAF) usage rate increased from 31-53% in the study block, but fell to only 32% by January 1987. In fact, the initial and final HAF usage rates for the study block were comparable to those of the control block (31% vs. 28.4% and 32% vs. 30%, respectively). Moreover the corresponding figures for oral rehydration solution (ORS) use stood at 13% vs. 8% and 18% vs. 18%). Despite several CHG and AWW training sessions on informing mothers to use ORT in adequate amounts as early as possible during a diarrheal episode, only 12.4% of mothers ever educated by a CHG/AWW knew to do so. In fact, none of the mothers administered ORT early or in adequate amounts. Furthermore diarrhea related mortality remained essentially the same in the study area throughout the study (2-2.8) and indeed the lowest rate (1.7) was in the control area in April 1986. Even though mothers in the study block were significantly more likely to know about oral rehydration solution (ORS) and the availability of free treatment for diarrhea in the village (57% vs. 26% and 34% vs. 13% respectively; p.05), no difference in use of HAF and ORS during diarrhea occurred (26.8% vs. 20% and 11% vs. 12% respectively). The researchers concluded that the major obstacles for improvement of HAF and ORS use were lack of motivation and the CHGs and AWWs inability to maintain a sustained skill level.