Experience with diarrhea training and treatment unit in Shimla.

India's National Program for Control of Diarrheal Diseases has established Diarrhea Training and Treatment Units (DTUs) to reduce diarrhea-related morbidity and mortality. The cost-effectiveness and impact of oral rehydration therapy (ORT) were evaluated prospectively in all children presenting to the DTU of I.G. Medical College (Shimla, India) in 1993-94. During the 2-year study period, a total of 1240 children 1 month to 12 years of age attended this DTU for treatment. 47.6% were infants and 58% came from rural areas. 87% of patients had acute watery diarrhea, 10.4% had dysentery, and 2.6% had persistent diarrhea. Diarrhea was most prevalent (74.9%) from April to September. 41.9% of presenting children had received ORT before coming to the DTU; as a result, severe dehydration was seen in only 10.7% of cases. Comparison of data on 166 children admitted to the study hospital in 1986-87 (before ORT was introduced) and the 1993-94 cases revealed significant declines in the admission rate due to dehydration and/or associated illnesses (100% vs. 26.8%), use of antimicrobials (66.2% vs. 15.3%), administration of intravenous fluids (71.1% vs. 15.45%), and mortality (9.03% vs. 0.6%). 84.6% of children in 1993-94 were treated with ORT alone. The average cost of ORT per child was Rs. 4.49 compared with Rs. 40.29 for intravenous fluids. Although these findings indicate DTUs are having a favorable impact on the rational management of diarrhea, health education campaigns aimed at promoting even more widespread use of ORT by mothers and health workers are needed.