Caregiver oral rehydration solution fluid monitoring charts versus standard care for the management of some dehydration among Kenyan children: a randomized controlled trial

Abstract

Background: Diarrhoea is a major cause of child mortality. Although oral rehydration solution (ORS) is an efficacious intervention for correcting dehydration, inadequate monitoring may limit its effectiveness in routine settings. We evaluated the effect of using a caregiver-administered chart to monitor oral fluid therapy on hydration status among children with some dehydration.

Methods: An open-label randomized controlled trial was conducted among children 2-59 months of age. ORS fluid monitoring charts were given to caregivers in the intervention arm to record the hourly intake of ORS. ORS was administered without charting in the control arm. The primary outcome was dehydration defined by the presence of clinical signs of some dehydration, severe dehydration or shock assessed 4 h after initiation of treatment. We also assessed the acceptability of the charts among caregivers.

Results: We evaluated 252 patients for the primary endpoint. Among those who received the intervention, 7/122 (5.7%) were still dehydrated following 4 h of ORS administration vs 20/130 (15.4%) in the control group (risk ratio 0.37 [95% confidence interval 0.16-0.85]). Caregivers in the intervention arm reported positive experiences using the fluid charts.

Conclusions: The use of fluid monitoring charts reduced the frequency of dehydration and was well accepted by caregivers, representing a promising innovation for the management of diarrhoea and dehydration in resource-limited settings.

Figure 1.

Table showing World Health Organization classification of dehydration due to diarrhoea and the management at each level.

Figure 2.

ORS caregiver fluid monitoring chart. A simple chart containing columns for recording the amount of ORS to be given, amount of ORS given, amount of ORS remaining and the number of episodes of vomiting and diarrhoea. It also has a section for the clinician to record the clinical signs before and after treatment.

Figure 3.

Flow chart showing participant selection with exclusions on case criteria. Of the 318 patients assessed for eligibility, 50 were excluded because they did not meet the inclusion criteria. These eligibility criteria included children 2–59 months of age with acute diarrhoea and some dehydration as defined in the WHO and Kenya guidelines as well as informed consent from the caregivers. The caregivers were also required to be able to read and write. It also highlights patients lost to follow-up who voluntarily left the study due to time constraints and who opted to continue with ORS administration at home.