IMPROVED FORMULA FOR ORAL REHYDRATION SALTS TO SAVE CHILDREN'S LIVES

The World Health Organization (WHO) and UNICEF announced a new formula for the manufacture of Oral Rehydration Salts (ORS). The new formula will better combat acute diarrhoeal disease and advance the Millennium Development Goal of reducing child mortality by two-thirds before 2015. Diarrhoea is currently the second leading cause of child deaths and kills 1.9 million young children every year, mostly from dehydration.

The latest improved ORS formula contains less glucose and sodium (245 mOsm/1 compared with the previous 311 mOsm/l). The lower concentration of the new formula allows for quicker absorption of fluids, reducing the need for intravenous fluids and making it easier to treat children with acute non-cholera diarrhoea without hospitalization.

ORS use is the simplest, most effective and cheapest way to keep children alive during severe episodes of diarrhoea. The ORS solution is absorbed in the small intestine, thus replacing the water and electrolytes lost. WHO provides the only updated international quality specifications for this formula and UNICEF is a leading supplier of ORS to poor countries. WHO and UNICEF have jointly issued guidance for the production of the new ORS.

WHO and UNICEF recommend that countries manufacture and use the new ORS in place of the previous formula. WHO and UNICEF will help national authorities develop manufacturing guidelines and procedures for the new formula. Establishing the local production of ORS will be a key step to ensure countries can meet their own needs in controlling diarrhoeal disease.

According to UNICEF and WHO, oral rehydration therapy should be combined with guidance on appropriate feeding practices. Provision of zinc supplements (20 mg of zinc per day for 10 to 14 days) and continued breastfeeding during acute episodes of diarrhoea protect against dehydration, reduce protein and calorie consumption, and have the greatest impact on reducing diarrhoea and malnutrition in children.

The revised monograph for the new ORS formula will be published in the fourth edition of The International Pharmacopoeia.

UPDATE ON ONGOING CLINICAL TRIALS ON MALE CIRCUMCISION

The US National Institutes of Health announced that, following an interim review, two ongoing trials in Uganda and Kenya examining the link between male circumcision and the risk of acquisition of HIV infection in men should be continued. The trials are scheduled to end in July 2007 and September 2007 respectively. Data from these studies will be important in validating findings reported in July 2005 from the Orange Farm Intervention Trial in South Africa, funded by the French Agence Nationale de Recherches sur Ie SIDA (ANRS), which showed a reduction of 60% or more in the risk of acquiring HIV infection among circumcised men.

The interim data from the ongoing Uganda and Kenya trials were reviewed in June 2006 by the Data and Safety Monitoring Board (DSMB), which recommended that the studies continue on the grounds that there were not yet enough data to draw firm conclusions. The DSMB further proposed that an additional interim analysis of data from the two studies take place within the next year. “The results of the two ongoing trials will help clarify the relationship between male circumcision and risk of HIV in differing contexts, which is key to determining the reproducibility and application of the Orange Farm findings,” noted Dr Kevin De Cock, Director, WHO HIV/AIDS Department. “While we await these important results, UN partners and others are working to provide coordinated guidance and support to countries to help improve the safety of current male circumcision practices.”

An additional trial assessing the impact of male circumcision on the risk of HIV transmission to female partners, led by researchers at Johns Hopkins University, is currently under way in Uganda with results expected in late 2007. The effect of male circumcision on reducing the risk of HIV transmission among men who have sex with men has been studied but has not been the subject of a trial.