Diarrhoea is the third leading cause of childhood mortality in India, accounting for 13% of all deaths among children under five. During episodes of diarrhoea and vomiting, a crucial step is to ensure proper rehydration. With this in mind, the World Health Organization (WHO) recommends a Reduced Osmolarity Oral Rehydration Solution (ORS), which contains the precise concentrations of sodium, potassium, chloride, citrate, and dextrose needed for the human body to rehydrate effectively. However, when people ask for ORS at pharmacies across the country, they are often given ORSL tetra packs, which are frequently mistaken for the WHO-recommended ORS.
This is where Hyderabad-based paediatrician Sivaranjani Santosh comes in. She has been actively campaigning against the sale of ORSL, which is labelled as an electrolyte drink but is not suitable for rehydration during diarrhoea. “During diarrhoea, high-sugar drinks should be avoided because excess sugar can worsen the condition,” explains Dr. Sivaranjani. “When ORSL was introduced, manufacturers met with paediatricians, leading many to believe it was ORS. But in reality, the sugar content in ORSL is as high as in packaged soft/fruit drinks, with only a little extra sodium. We noticed that many children’s diarrhoea worsened. When we investigated we realised ORSL is not the same as ORS.”
Once Dr. Sivaranjani identified the problem, she began raising awareness through workshops, social media platforms such as Facebook and Instagram, and by reaching out to media outlets. In 2023, she took the issue to the Central Drugs Standard Control Organisation (CDSCO), which referred her to the Food Safety and Standards Authority of India (FSSAI). In April 2023, FSSAI issued an order to stop the mislabelling of ORSL. However, in July, the order was revised to allow companies with a valid trademark to retain the name ORS, provided they included a disclaimer.
Some manufacturers began adding disclaimers on ORSL tetra packs stating “Do not use during diarrhoea,” but these disclaimers are often printed in very small fonts, and easy to overlook. “Pharmacists also prefer selling ORSL because they earn a higher margin, as ORSL is twice as expensive as standard ORS solutions,” adds Dr. Sivaranjani.
In 2022, Dr. Sivaranjani filed a Public Interest Litigation (PIL) in the Telangana High Court, demanding that manufacturers remove the letters ‘ORS’ from the name ORSL. In response to the PIL, companies introduced the misleading concept of “silent dehydration,” a term not found in any medical literature, to promote ORSL.
Dr. Sivaranjani hopes the judiciary will take this matter seriously and has called upon paediatricians, and doctors’ associations in India to support the cause.
(siddharth.kumar@thehindu.co.in)
Published - September 13, 2024 12:15 am IST
