The effective case management of childhood diarrhoea with oral rehydration therapy in the kingdom of Lesotho

Document Type

Journal Article

Publication Date



International Journal of Epidemiology








In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children < 5 years of age. At the Queen Elizabeth II Hospital, diarrhoee-related admissions as a proportion of all admissions in children < 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Theraphy Unit (ORTU) to 13% in the first nine months of 1987 (p<0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p<0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% Confidence limits [CL] = 2.0, 11.9), fever ≫38.5°C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9,4), and moderate dehydration (OR= 2.3; CL = 1.2, 4.4) or severe dehydration (OR= 12.1; CL=3.8, 38.5). Breastfed children < 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children < 5 years of age. © 1990 International Epidemiological Association.